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Gisèle with therapists
Gisèle Behocaray reviews memory exercises with speech language pathologist Mike Tanner (L) and occupational therapist Bindhu Sadasivan. (Photo: UHN)

Gisèle "Gigi" Behocaray's superpower used to be her ability to remember everything. Her memory was so sharp employers used to joke that they'd be lost without her.

So, imagine how it felt when her powers started to slip due to mild cognitive impairment (MCI). She was suddenly forgetting names and at a loss for words.

"I would stop mid-sentence, because I knew what I wanted to say, but couldn't find the words to say it," says Gigi, 88.

But after participating in Toronto Rehab's 10-week, group-based program, "Learning the Ropes for Living With MCI™," which is run through the Geriatric Rehabilitation Service, she's learned tricks and developed tools to exercise her memory, and says she has her superpower back.

"I feel so much better about my ability to remember things now," she says.

"It's a big part of my independence."

Aimed at older adults with MCI but still living independently

"Ropes," as the program is known, focuses on optimizing cognitive health through lifestyle choices, memory training, and psychosocial support.

The name itself stands for Record Organize Practice Elaborate Stop/see/say it – the memory strategies taught each week.

The program is aimed at older adults who are experiencing MCI that is greater than expected for their age but doesn't compromise their ability to live independently in their community.

Memory difficulties may include forgetting important information, such as names, appointments, conversations, or recent events.

"Our goal is to make participants aware of lifestyle factors and memory strategies that can be implemented, to overcome their memory challenges," says co-facilitator Bindhu Sadasivan, an occupational therapist.

Each session, participants and caregivers gather together for the first hour to talk about lifestyle factors, such as nutrition and leisure activities, that support cognition.

During the second hour, the group splits, with caregivers convening for peer support facilitated by a social worker while participants learn memory-training tools.

"On week one, we ask participants to identify just one memory difficulty that improving on would create an impact," explains co-facilitator Mike Tanner, a speech-language pathologist.

"Each week, participants learn new strategies to address that problem, practice at home, and come back ready to report on their progress."

For example, Gigi identified remembering people's names as her memory difficulty.

To overcome this, her favourite tools include associating people's names with celebrities or something they're wearing, such as "Mike wears moccasins," which fall under Elaborate, and writing down and repeating names over spaced intervals of time, which falls under Practice.

Building partnerships with peers

The Geriatric Rehabilitation Service launched Ropes nearly two years ago when an increase in referrals for patients with MCI challenged their model of care.

"We were already offering one-to-one memory strategy sessions, but as numbers continued to grow, we saw a need for a more effective and efficient way to deliver comprehensive support to patients," says Bindhu.

To answer this need, the team decided to adopt an existing, evidence-based program developed by Baycrest Centre.

Strengthening the health sciences ecosystem in Toronto, by building partnerships with peers, is a priority for UHN – and the opportunity to use proven best practices, without reinventing the wheel, supports this priority.

"It's not just about them creating the program and us running it," says Bindhu.

"There really is this shared thought between our organizations that we can work together, collaborate on research, share learnings, and deliver the best care to all our patients."

Measuring impact

On the 10th and final week of the program, participants are asked to rate their performance and satisfaction, as it relates to the memory problem they identified in the first week. 

The team uses an adapted version of the Canadian Occupational Performance Measure, a validated tool, to measure outcomes.

"We use this to assess how well participants are doing, and if the strategies are proving effective," explains Mike.

Out of 59 participants, initial data shows that 88 per cent report perceiving significant improvement in their performance, while 78 per cent report increased satisfaction with their performance.

Each participant's results and learned strategies are shared with their primary care providers to support their continuum of care once the program is finished.

"What we love most is seeing and hearing how the program is improving people's lives," says Bindhu.

"The confidence building, the adoption of strategies, and how they're making an impact."​

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