Pilot Study Of Executive Functions In Elderly Adults In Care Homes

Abstract

This current study aims to show, through a qualitative and quantitative study, that psychomotor stimulation through body percussion using the BAPNE Method can not only improve the skills and abilities of elderly adults and their emotional abilities and behaviours, but it can also improve their cognitive ability. We have based this investigation on a research protocol involving a total of N=48 subjects divided between an experimental group and a control group of care homes of similar characteristics in Seville belonging to the Vitalia Foundation. The intervention was completed using a neuromotricity programme by means of the BAPNE Method. Proven activities which were adapted to the aim of the investigation were used with the experimental group for 12 weeks, on Mondays and Fridays, with each session lasting a maximum of 60 minutes. However, the control group carried on with its usual activities and routines and did not experience any change to their cognitive development. The evaluation tools used were the FCRST Test to assess verbal memory and the P Test to measure phonological fluency. Following analysis of the results obtained, we can conclude that in the post-test phase of the experimental group there are significant results in terms of the assessed variables in terms of improvement of their executive functions and cognitive abilities.

Keywords: BAPNEbody percussionexecutive functionscare homeelderly adultprevention

Introduction

The subject of cognitive rehabilitation in elderly adults has become the focus of various studies which have looked into types of activities that could improve cognitive function. Many such studies have featured expressive activities, such as music (Gregory, 2002).

Authors involved with the BAPNE Methodology have stated that corporal percussion exercises are used at the base of the physical person, but also to give cognitive and emotional aspects. The execution of repetitive movements, along with the singing, stimulate a variety of brain – related brain – related cognitive functions, such as the plan and/or the Athens (Tripovic, Marchese, Carratelli, & Romero Naranjo, 2004). In addition, there is talk of significant improvements in tasks that require cognitive effort, either in aspects such as memorization and efficiency in the processing of information (Pons-Terrés, Romero-Naranjo, Carretero-Martínez, & Crespo, 2004).

This present study is part of a wider ranging study in which we have used a battery of questionnaires and tests in order to assess the executive functions: planning, working memory, concentration, inhibition, sequencing, impulse control and attention, as well as socioemotional and behavioural aspects amongst elderly adults. The tests used in this investigation were: FCSRT, DÍGITOS, ORIENTATION (taken from the Barcelona test), A TEST, RITMO, PRAXIAS, GNOSIAS, SRT, TMT, P TEST, ANIMALES, FAB, HADS, EUROQUOL, MMSE. In this instance, due to the nature of this conference and the brevity of this article, we will only present findings relating to improvement in verbal memory and phonological fluency which were measured using two tests, both validated in Spain: FCSRT and P TEST.

As our sample for this investigation consisted of just 48 subjects, we set out in this initial article to carry out just a pilot study. In order to obtain more significant results, we will carry out follow-up studies to increase the number of subjects in both control and experimental groups.

Problem Statement

Do elderly adults participating in a method of cognitive stimulation using the BAPNE Method within the care home in which they live improve their executive functions and phonological fluency significantly compared to elderly adults who do not participate?

Research Questions

Having used academic meta-search engines to research the issue (Web of Science, Eric, Rilm, Scopus, Dialnet, JSTOR), we can confirm that the subject of cognitive rehabilitation in elderly adults has been the focus of several studies which have looked into types of activities which can improve cognitive functions in adults at this stage of their life. Use of music as an alternative method of rehabilitation for executive functions has been proven, and contrasts with techniques using pencil/paper and computerised rehabilitation which are habitually used in neuropsychological rehabilitation (François, Grau-Sánchez, Duarte, & Rodriguez-Fornells, 2015; Romero-Naranjo, 2014; Särkämö, Tervaniemi, & Laitinen, 2014). The potential of music has also been demonstrated in terms of improvements brought about in general neuropsychiatric symptoms and cognitive functions in elderly adults with severe cognitive deterioration (Hsu, Flowerdew, Parker, Fachner, & Odell-Miller, 2015).

However, what is needed is a greater number of systematic studies which include music teaching specialists in their research teams and which include quantitative results as to the effects of practising body percussion as a cognitive stimulation tool in elderly adults. For this reason, we have used the BAPNE Method which includes a series of articles and research pieces which are based on neuropsychology and which show experimentally by means of validated tests the possible cognitive stimulation which can be brought about (Romero-Naranjo, 2014).

Purpose of the Study

This pilot study aims to show that via a programme of cognitive and psychomotor stimulation through practice of body percussion using the BAPNE Method, not only can elderly adults improve their emotional and behavioural aspects, but also their cognitive ability. This is a crucial factor in carrying out effective prevention and rehabilitation in elderly adults within care homes.

Research Methods

This study was conducted in the province of Seville (Spain). The experimental group was from the San Sebastián care home in Los Palacios y Villafranca (Seville); the control group was from the Kansas City care home, also located in the province of Seville. Both homes are part of the Vitalia Foundation.

Findings

So as to analyse the data, the t-Student test was used to compare mean averages for independent samples, and a level of statistical significance of 0.05 was used. The statistical software used was IBM SPSS v.24 for Mac. The graphs and tables have been made using Microsoft Excel for Mac for greater visual impact.

FCSRT TEST:

The results obtained when calculating the difference in mean averages between the two independent groups (experimental group and control group) show that in the pre-test phase, there is no statistically significant evidence of difference between the two groups. However, in the post-test phase, there are statistically significant differences in the variables of total free recall (RLT, p=0.002) where the difference between the mean averages was 5.958; total facilitated recall (RFT, p=0.045); total recall (RT, p=0.006); total deferred recall (RDT, p=0.005) and in the variable of total free deferred recall (RDLT, p=0.001) which showed a difference in mean averages of 3.5.

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P TEST:

In this test of phonological fluency, statistically significant differences were obtained in the number of total words (POST PT, p<0.001) between the experimental and the control group. Statistically significant differences were also found in the difference between the post-test and the pre-test in the total number of words when comparing the mean average of this difference between the two groups (p=0.01), which was 3.125.

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Conclusion

Through this study, having considered the results collected, we can confirm that the information obtained in the FCSRT test and the P test in relation to development of verbal memory and phonological fluency is satisfactory. Moreover, it has been posible to confirm that the implementation of the neuromotor programme using the BAPNE® Method for the stimulation of the executive functions is viable in the group studied.

Verbal memory requires attention and codification of information. These are processes which we work on to a great extent when performing practical activities with the BAPNE Method. Phonological fluency, however, requires less common strategies (Perret, 1974) as searching for words by their initial letter is not a common task and involves a greater degree of effort. Furthermore, phonological fluency demands the inhibition of the incorrect response, and thus involves greater cognitive effort.

Following the neuromotor programme carried out using the BAPNE Method with healthy adults suffering from mild cognitive impairment, the aspects related to memory and verbal fluency were analysed. Statistically significant improvements were obtained, thus confirming our initial hypothesis. After analysing the data obtained, we have been able to confirm that there are differences between the experimental and control groups across the pre- and the post-test in all the variables; there was no homogeneity between the groups. Although all the students saw some improvement, the experimental group improved more significantly.

It is important to emphasise that over the course of future investigations it will be crucial to look for similiar control and experimental groups so that the pre-test sample can be homogeneous, thereby avoiding extraneous variables. This programme ran for 12 weeks. It would be beneficial to plan for 12 months in future studies. This would produce more significant and reliable data.

To conclude, this pilot study, which included a sample of 48 participants (24 in the experimental group and 24 in the control group) can serve as a basis for future studies including the BAPNE Method as a rehabilitation tool and to improve executive functions related to memory and phonological fluency. This would prove the potential benefits of BAPNE® Method in elderly adults with regard to the development of the executive functions.

References

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2. Gregory, D. (2002). Music listening for maintaining attention of older adults with cognitive impairments. J Music Ther, 39(4), 244–264. https://doi.org/10.1093/ jmt/39.4.244
3. Hsu, M.H., Flowerdew, R., Parker, M., Fachner, J., & Odell-Miller, H. (2015). Individual music therapy for managing neuropsychiatric symptoms for people with dementia and their carers: a cluster randomised controlled feasibility study. BMC Geriatr, 15, 84-93.
4. Perret, E. (1974). The left frontal lobe of man and the suppression of habitual responses in verbal categorical behaviour. Neuropsychologia, 12(3), 323-330.
5. Pons-Terrés, J.M., Romero-Naranjo, FJ., Carretero-Martínez, A., & Crespo, N. (2014). Perceptions towards Wellness and Life Quality through Body Percussion –BAPNE Method and Cognitive Stimulation in Elderly People. Procedia – Social and Behavioral Sciences, 152(7), 1108 -1113.
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