How to Live Your Best Life With Dementia – Top 10 Tips
Three years ago my husband, Dave, was diagnosed with Frontotemporal dementia (Ftd). At first, I didn’t believe it. How could man in their 50s have this disease? When the doctor told us it was terminal–without a cure or drugs to slow it down-I didn’t hear much more. There must be ways to carry on it. Somehow I would form it out.
Although I didn’t find a booklet on ’10 easy Ways to Live with Dementia’, I have found ways to thrive, despite our challenges. At the 3 year mark, Dave continues to do well and here are 10 reasons why:
1. Attitude: From the occasion the doctor gave us the news, he has never been angry or ashamed of his dementia. He doesn’t waste his vigor on worrying about the future, or resisting what life is giving him. He told me about 3 weeks after his diagnosis…”I may not be able to do much about my brain dying, but I am going to do all things I can to keep my body healthy.” A definite attitude = clearer mind
2. Exercise: Every day Dave takes the dogs for a hike, after he has a run, bike ride or workout in the gym. He says it is one of the few times when he has relief from his headaches. Dr. Amen, an specialist in brain science, says that practice is one of the best ways to keep our brains healthy. It increases blood flow and releases endorphins–improving our mood and calming the chatter in our mind. A modern study showed that exercising will decrease the risk of developing Alzheimer’s by 35%.
3. Diet: Natural, unprocessed foods (fruits/vegetables) are low-glycemic, which maintains a steady blood sugar level–minimizing fatigue, irritability and foggy brain. They also consist of anti-oxidants which neutralize the stresses in the body. Foods high in omega 3 fats (fish, flax seed, and almonds) are foremost for nourishing the brain cells. Since Dave’s taste buds are changing, I am finding creative ways to fit in 5-8 fruit and vegetables a day. I cook sweeter vegetables such as yams, carrots and corn; add fruit and flax seeds to his smoothies; and use plum sauce with fish.
4. Supplements: Dave takes high grade vitamins & minerals (Usana nutritionals) to fill the gaps in his diet and raise the level of anti-oxidants. He also takes gingko biloba, which increases blood flow to the brain; CoQ10, a marvelous anti-oxidant and vigor booster; and a pharmaceutical-graded omega 3 (fish) capsules. Dr. Amen’s book ‘Making a Good Brain Great’ has a more whole list.
5. Purpose in Life: Dave has a good suspect for getting up in the morning. He volunteers at woodworking shows, hunt and recovery fund-raising events, Alzheimer’s Society, and is a Nordic walking leader. He has also chores colse to the house, which change with his abilities. I remember one night I asked him how his day was…”Great”. Why? “Because I got to wash your car.”
6. Socialize: Dave loves being with people, even though he may not identify them, or be able to carry on a fluent conversation. He is activating his memory, problem-solving, speaking and listening areas.
7. Variety: Despite Dave’s routines (watches the weather description at 7:40 and 8:00 am, runs on Monday and Friday at 8:10 am), he likes to do something new every day-walking and biking in separate areas, road trips, or helping me with shopping. Range stimulates the plasticity switch in the brain, which wakes up brain cells. Turning it on is easy as brushing your teeth with your opposite hand, or counting backwards from 100 by 7.
8. Sleep: Dave sleeps 11 hours at night (takes melatonin for a good quality sleep) and has a 1-2 hour nap in the day. Dave is most alert as soon as he wakes up. Dr. Amen recommends 6-8 hours/night. Less than 6 hours causes mood instability and decreased cognitive ability.
9. Hobbies: Duck carving has been Dave’s passion for over 30 years, but hand tremors are making it difficult to carve fine details. He is replacing carving with building jigsaw puzzles. He spends hours scanning the table for pieces, using his fine motor areas to pick them up and fit them in. Sometimes we work on it together, or play trionomos or dice games.
10. Caregiver’s condition & attitude-physical, emotional, mental and spiritual: Just like in an airplane emergency, I have to put my oxygen mask on before I can help Dave. I make time to go out with friends, exercise, and meditate. When I feel sad or overwhelmed, I write in my journal. It helps to publish my tears, and reminds me of what I am gaining from this journey–patience and quality to let go of things I can’t operate (dementia). vigor is contagious…happier and peaceful ‘me’ = easier and healthier care-giving.
4 Signs Your Aging house Member May Need Dementia Care or Alzheimers Care
Getting older is a scary thing, and many of us live in denial about the effects of aging. This is true not only of ourselves, but of house members as well. The fact is many house members ignore signs of memory loss, because they don’t want to face the reality that their aging loved one may need dementia care or even Alzheimers care.
Though not wanting to deal with a difficult situation like a house member with dementia is understandable, not dealing with it can be downright dangerous. There are numerous cases every year of seniors being hurt badly or even killed because of some kind of incident resulting from serious memory loss. If you have a loved one that may be losing their memory, it may be time to look at hiring an in home caregiver to look after them.
Knowing what to look for is the first step in determining the need for dementia care. Here are 4 inherent signs that your aging loved one may need an in home caregiver:
1. Forgetting lowly Every Day Things
Forgetting things as we age is normal, and not remembering something from the distant past is not normally anyone to get too implicated about. But if your loved one is forgetting stuff like where they put their wallet or when to take medication, then it may be more serious. If you see any memory loss that has the inherent to disrupt their daily lives, it’s time to think about getting them help.
2. Confusion About Time and Place
This is a big one that can be quite dangerous. If your elderly parent has lived in a single area for a long period of time, but is suddenly forgetting where they are when they walk nearby the block, that is absolutely calculate for concern. an additional one tasteless qoute is forgetting what day it is, or what time it is. These are all signs that an in home caregiver might be required for their safety.
3. Decreased qoute Solving Ability
The quality to deal with every day challenges that come up is part of life for a healthy, well-adjusted adult. But when a person who has been able to deal with challenges almost their entire life suddenly can no longer handle simple things like planning a trip or calling a plumber to fix their sink, then you know there might be something wrong. A dementia care or Alzheimer’s care scholar may be needed to help with this.
4. Seclusion From Work or Society
This one sometimes happens gradually-a missed day here or there for example. But before you know it, you comprehend that your loved one no longer goes to work and has no desire to spend time with their friends or have any communal interaction at all. The calculate is quite simple: fear. They are in fear that the habitancy who know them will comprehend that they are losing their memory.
If any of these 4 things are happening, it is best to get in touch with a dementia care or Alzheimer’s care scholar to address these issues. Though they may not be able to cure your house member, they can at least keep them safe and help them deal with their health more effectively.
Alzheimer’s Disease: A Form of Dementia
Alzheimer’s disease is the most tasteless type of dementia. The disease was first observed by a German psychiatrist and neuropathologist Alois Alzheimer in 1906 and is named after him. Alzheimer’s disease is an incorrigible neurodegenerative disorder generally occurring in individuals above 65 years of age but cases with early onset of the disease are not uncommon. A record presented in 2006 specified that about 26.6 million individuals suffer from this neurodegenerative disease. The symptoms of this disorder are although inimitable for every private but there are many symptoms that are common. The first symptoms of the disease are loss of the potential to form new memories and inability to recall current events. Diagnosis of Alzheimer’s disease is based on cognitive tests and brain scan. As the disease advances the private shows the symptoms of confusion, irritability, aggression, mood fluctuations, language problems and finally long-term memory loss. The vivacious functions of body fail to operate and death is the decisive fate. Less than 3% percent live for about fourteen years after the Diagnosis of the disease.
The literal, cause of Alzheimer’s disease is still not understood. Researches carried out all over the world designate that the disease is caused due to the accretion of plaques and tangles in the brain. Although treatment for this disorder is available but the chances of unblemished rescue is less. More than 500 clinical trials have been carried out but rigorous suspect for the occurrence of this disorder is yet not available. Mental stimulation, balanced diet and practice are recommended for the patients of this disorder. As Alzheimer’s disease is degenerative and incurable disease allowable supervision of the inpatient is essential. Family preserve is sturdily required.
Who are at risk?
The prime factor blamable for Alzheimer’s disease is increased age and as the age of the private increases the risk of this disease also increases. According to a record about 10% of the individuals belonging to the age group of 65 and 50% of the individuals of the age group of 85 suffer from Alzheimer’s disease. According to a guesstimate the amount of patients of this disease will growth to 14 million by 2050. Genetic factors are also idea to be responsible for this disease and most of the individuals produce this disorder after the age of 70.
However, about 2-5% of the individuals produce the symptoms in their early forties and fifties. The children of a person with early onset of the symptoms of Alzheimer’s disease are at 50% risk of developing this disorder. The gene settled on chromosome 19 is believed to be responsible for this disease. However, in majority of cases specific genetic risks have not been identified yet. Other risk factors linked are high blood pressure, coronary artery disease, high blood cholesterol and diabetes. All the patients of Down syndrome produce this disorder in their forties.
Symptoms
The onset of the disease is gradual but the symptoms come to be more penetrating as the disease advances. Problems linked with short-term memory usually arise in the earlier phase of the disease. Mild personality changes also occur in the first phase of the disorder. With the advancement of the disease the inpatient develops symptoms of difficulty in abstract Mental and other intellectual impairments. The inpatient feels difficulty in carrying out the office work also. Behavioral changes also take place. In later cases the person becomes confused and disoriented in relation to month, time, citizen and places. The person is also at the jeopardy of getting infected with pneumonia and the condition come to be worse before the death of the patient.
Ten warning signs of Alzheimer’s disease and mild cognitive impairment
The Alzheimer’s connection has developed a list of warning signs that can help the healing master to ascertain whether a person is suffering from Alzheimer’s disease or not. These signs are memory loss, difficulty if performing duties coupled with family. Problems with language, disorientation in relation to time and place, decreased judgment potential and difficulty in abstract thinking. Misplacing things, mood fluctuations, behavioral changes and loss of potential to take initiative for any task are also common. The advancement of this disorder is precarious and sluggish and the memory status of the inpatient becomes inferior day by day but he or she may not produce dementia as there are convinced criteria that form the baseline of dementia. This syndrome is recognized as Mild Cognitive Impairment (Mci) and can be analyzed only after neurophysiological testing. There are numerous forms of Mci but the most tasteless one is linked with memory impairment. The aptitude to plan a work and the cognitive potential of the private are not affected in this syndrome. Individuals with this type of Mci are known as amnestic Mci and have a high risk of getting affected with Alzheimer’s disease. Individuals with incapability of decision making are at low risk of developing Alzheimer’s disease.
Causes and risk factors
The rigorous cause of the disease is still vague but the amyloid cascade hypothesis is most extensively discussed and agreed in this context. The data that supports this hypothesis legitimately comes from the early onset of Alzheimer’s disease that had a genetic basis. In about half of the patients with early onset of symptoms of Alzheimer’s disease, mutations play a key role. In all these patients mutations consequent in the disproportionate output of a protein fragment known as Abeta in brain. In the present scenario much of the research is focused on looking out the ways to slow down the greatest output of this protein in Alzheimer’s disease. The biggest and the essential essential factor of this disorder is the increased age. The individuals belonging to the age group of 65-85 are at the duplicate risk of developing this disease. Only 1-2% of individuals of 70 years of age produce Alzheimer’s disease however, about 40% individuals of 85 years of age produce this disorder. The individuals that lived in the past for about 95 years were not the sufferers of this disease.
There are many genes that can be considered responsible for the development of this disease but they may not produce the disorder every time. The major risky gene that is generally considered responsible for Ad is apoE that encodes for apolipoprotein E. This gene apoE occurs in three alleles namely apoE2, apoE3 and apoE4. The allele apoE4 is believed to upsurge the risk of the disease and the frequency lies below 30%. The individuals with one copy of apoE4 have two-three times increased risk of developing Alzheimer’s disease and those with two copies of this allele have nine-fold increased risk. generally individuals with two copies may not suffer from the disease all the time but only one copy of E4 is generally found in individuals with late onset of the disorder. We can predict here that genetic basis does not form a strong baseline for Alzheimer’s disease. Genetic tests also do not forecast that the children of the patients of this disease are at the risk of developing this disorder in their lifetime. Majority of the studies carried out have signposted that females are at a superior risk of developing Alzheimer’s disease in comparison to males. It is clear that the lifespan of females is longer than males but this criterion cannot be correlated with the occurrence of Ad. Scientists believe that the estrogen level can be compared with the risk of developing the disease, so much research is now focused on this issue. Even studies have indicated that the individuals who have received traumatic head injuries are at an elevated risk of developing Alzheimer’s disease.
Diagnosis and importance of clinical evaluation
No specific blood test and imaging technique can predict that whether a person is suffering from Alzheimer’s disease. For the Diagnosis of this disorder a person must fulfill the criteria that form the baseline for dementia. A amount of factors can be considered responsible for the development of dementia. Neurological disorders namely Parkinson’s disease, brain tumors, blood clots, cerebrovascular disease and strokes can be sometimes linked with dementia. Chronic syphilis, Chronic Hiv can also sometimes produce the symptoms of dementia. Many medications namely those used for the operate of bladder crisis and incontinence can also cause cognitive impairment. Psychiatric and neurological medications are also responsible for cognitive impairment. If the healing master finds these medication problems in the inpatient he sturdily recommends halting the usage of these drugs. In older individuals that usually suffer from depression also produce the problems linked with memory and attentiveness loss and such a condition can be specified as pseudodementia. Excessive use of alcohol and illegal drugs can be sometimes responsible for the symptoms of dementia. Thyroid dysfunction, thiamine insufficiency and steroid disorders can also lead to cognitive impairment. Blood clots covering the brain region can also cause symptoms of dementia. Carbon monoxide poisoning leads to encephalopathy that develops symptoms of dementia. Sometimes heavy metal poisoning is also considered responsible for dementia.
Since a amount of disorders are often confused with Alzheimer’s disease a allembracing clinical estimation is very leading for the literal, Diagnosis of the disease. Three procedures are generally followed while diagnosing the disorder and these are a unblemished healing workup, neurological test and psychiatric evaluation. These evaluations usually continue for at least an hour. In the United States healthcare ideas a combined help of neurologists, psychiatrics and geriatrics is taken. Even a singular physician can also achieve the estimation well. The American Academy of Neurology has given some guidelines that consist of brain imaging while working with the patients of dementia. These imaging techniques consist of non-contrast Ct scan or Mri scan. Spect, fMri, Pet can also be of help but are not used. In areas covering the United States brain imaging is considered an leading part while diagnosing Alzheimer’s disease. The search for an effective blood test for the excellent Diagnosis of Alzheimer’s disease is still going on.
Prognosis
Alzheimer’s disease is customarily a progressive disorder that reaches its peak within the interval of 8-15 years. The patients generally do not die with the disorder alone but they also suffer from a amount of others problems also like they feel difficulty in swallowing, walking and are at an elevated risk of getting infected with pneumonia. In the later courses of the disease strongly Family aid is required. A inpatient of Alzheimer’s disease is any way unable to solve numerical problems but can feel interest in reading a magazine. Playing of piano may be too difficult for the inpatient as he commits many mistakes but the potential of singing and listening to music remains unaffected. Playing chess may be too difficult for the inpatient but he or she may feel satisfaction while playing tennis.
Treatment
The treatment of Alzheimer’s disease can be settled under medication based and non-medication based categories. Fda has classified two groups of pharmaceuticals for the treatment of this disease and these are cholinesterase inhibitors and partial glutamate antagonists. But none of the drugs can perfectly slowdown the rate of progression of Alzheimer’s disease. In patients suffering from this disorder the process of formation of the brain neurotransmitter especially the acetylcholine stops and research has indicated that this chemical plays a crucial role in memory formation. The cholinesterase inhibitors (ChEis) participate in blocking the breakdown of this neurotransmitter and therefore, help in memory formation. Fda has popular ,favorite four cholinesterase inhibitors namely donepezil hydrochloride, rivastigmine, galantamine and tacrine for the treatment of Alzheimer’s disease but only first three are used by the healing experts as the fourth one is risky and causes severe side effects. Studies have clearly indicated that these drugs slowdown the rate of disease progression only for about 6-12 months and then the disease starts advancing again.
Fda has popular ,favorite the use of rivastigmine and galantamine for the treatment of mild and moderate symptoms of Alzheimer’s disease but donepezil can be used for the treatment of mild, moderate and severe symptoms. The exact suspect why these two drugs are not used against the severe symptoms of the disease is not clear. The major side effects of ChIes are linked with the gastrointestinal ideas and they consist of nausea, cramping, diarrhea and vomiting. These symptoms can be controlled by changing the timing of medication as well as intake of small amount of food and about 75-90% of the patients bear the possible of tolerating the therapeutic doses of cholinesterase inhibitors. Glutamate is the chief excitatory neurotransmitter of brain. One hypothesis suggests that Excessive secretion of glutamate is harmful for brain as it damages nerve cells. Memantine is a drug that slows down the rate of activation of nerve cells by glutamate and is therefore, reducing the progression of this disorder. This drug can be used for treating both mild and severe disease. The inpatient recovers faster if a dose of cholinesterase inhibitors and memantine are given together.
Non-medication based treatments consist of orientation of the inpatient towards group activities like singing, dancing, walking etc. Cognitive rehabilitation may be helpful in this regard. The chief psychiatric symptoms linked with Alzheimer’s disease are irritation, depression, hallucinations, anxiety and sleep disorders. Suitable psychiatric drugs are although used for the treatment of these symptoms but none of the drugs have been popular ,favorite by the Fda. These symptoms come to be as intense as disease advances that treatment with medication becomes necessary. Agitation becomes very much severe in the later stages of the disease. Agitation is controlled by a amount of agents for example, beta-blockers, anxiolytics, antipsychotics and mood stabilizing anticonvulsants. Newer antipsychotic drugs have taken the place of the older drugs and are giving fruitful results for example, risperidone, clozapine and olanzapine.
Depression is an additional one very tasteless indication of illness of Alzheimer’s disease and the patients can be treated with antidepressants namely sertraline and citalopram. Anxiety in this disorder can be treated with benzodiazepines for example, diazepam. Non-benzodiazepines anxiolytics like buspirone are generally beloved for the treatment. Insomnia is an additional one indication of illness that can crop up in patients of Alzheimer’s disease at any part of their life. Trazodone is a promising drug used for overcoming this symptom. A amount of clinical research trials have been carried with increasing or decreasing the amount of Aβ1-42 but no prosperous consequent has been achieved.
Caring for the caregiver is an essential aspect while dealing with the inpatient of Alzheimer’s disease. Caregiving is a distressing feel and allowable instruction of the caregiver is essential. The 3Rs namely repeat, reassure and redirect can help a caregiver in reducing the troublesome behavior as well as limiting the use of medication in the patients. The short-term training programs can help a caregiver to growth his or her trust while dealing with the patients. Alzheimer’s disease is a curse and it makes the condition of a person worse and death is the greatest fate in later stages. Love, care and preserve can however, help the inpatient to enjoy life.
Behavioral Manifestations of Alzheimer’s Dementia
Alzheimer’s Dementia has a mixture of cognitive and behavioral manifestations. Cognitive impairment is the core problem which includes memory deficits and at least one of the following: aphasia or language problem, agnosia or problems with recognition, apraxia or motor performance problem, and impairment in menagerial functioning (e.g. Planning, abstract reasoning, and organizing).
As the disease advances, the cognitive decline becomes connected with behavioral manifestations. What are these behavioral manifestations of dementia?
Behavioral syndromes in Alzheimer’s can be grouped into two categories: psychological and behavioral. Major psychological syndromes consist of depression, anxiety, delusions, and hallucinations.
Depression in dementia is very common. Up to about 87% of patients organize some form of depression. It is characterized by tearfulness or crying episodes, feelings of sadness, and neurovegetative signs and symptoms such as inability to sleep, lack of appetite, poor energy, and thoughts of death. Irritability is also common. Depression can occur even in the early or mild phase of the illness.
About 50% of demented patients show delusions or false fixed beliefs. Such delusions include beliefs that a relative is stealing, that a spouse is just an impostor or is having an affair with a neighbor, or that friends and relatives are conspiring to cause trouble.
Moreover, many patients with dementia may feel hallucinations. Most of these hallucinations are optic – finding strangers in the house, an animal or insects in the living room, citizen in the bedroom or on top of the Tv set. Occasionally, auditory hallucinations may be experienced – hearing footsteps or knocking on the door or even citizen singing church hymns.
Regarding major behavioral syndromes connected with dementia, these problems include agitation, verbal outbursts, repetitive behavior, wandering, and aggression or even violence. Agitation can be manifested by pacing back and forth, restlessness, and inability to sit still.
Verbal outbursts consist of day-long screaming or occasional yelling at someone. Repetitive behavior is manifested by end and opening a closet or a purse or a drawer. Asking questions repetitively for instance about a relative’s visit is very common.
Wandering can happen especially at the late stages of the illness. If doors are left unlock, some patients perambulate away from the house. Hence, security level becomes an issue.
Aggression likewise may occur. Hitting the caregiver or throwing things are some complaints. Destroying things although rare can also ensue. A gentleman for example hit the wall with a cane and broke the window by smashing a chair.
Although difficult to deal with, most of these behavioral consequences of dementia can be treated especially if recognized and addressed early.
What’s The divergence in the middle of Alzheimer’s and Dementia?
“What’s the disagreement in the middle of dementia and Alzheimer’s?” It’s a common question, and doctors are some of the best at confusing us. Physicians seem to prefer the word “dementia,” possibly because Alzheimer’s has come to be such a loaded word. “Dementia” somehow sounds less frightening to many people, and now even the experts have started using the words interchangeably.
They aren’t interchangeable. Alzheimer’s Disease and dementia are two very different things.
Dementia is a symptom. Pain is a symptom, and many different injuries and illnesses can cause pain. When you go to the physician because you hurt, you won’t be satisfied if the physician diagnoses “pain” and sends you home. You want to know what is causing the pain, and how to treat it.
“Dementia” plainly means the indication of illness of a deterioration of intellectual abilities resulting from an unspecified disease or disorder of the brain.
Alzheimer’s Disease is one disease/disorder that causes dementia. Many other illnesses or “syndromes” can also cause dementia. Parkinson’s Disease can cause dementia. A stroke can cause dementia. Even dehydration can cause dementia.
Many of the things that can cause dementia are treatable, even potentially curable.
If you have taken your elder to the physician and received a analysis of “dementia” you haven’t received a analysis at all. Unless you know what is causing the dementia you can’t begin to treat it’s root cause.
If your physician has diagnosed “dementia” it’s time for a second opinion. You are probably dealing whether with a physician who is not comfortable with the truth, or one who doesn’t know how (or doesn’t want to bother) to differentiate in the middle of all the inherent causes of dementia. whether way, a skilled geriatrician or a neurologist who is comfortable with seniors would be a good place to start.
Neurofeedback Therapy in the treatment of Dementia and Alzheimer’s Disease
If you have been dealing with the deteriorating health of a lifelong companion, you would no doubt welcome any news about advances in medical science that offer hope of slowing the memory loss and reasoning decline of your loved one. Neurofeedback therapy is one of those promising achievements.
Our understanding of the human brain and nervous system, compared to even a decade ago, has dramatically changed the way we view the aging process. We now know that it is inherent to alter the structure of the brain deep into the “Golden” years and much further, perhaps.
In recent months a study seeing at using neurofeedback to treat those suffering with the symptoms of dementia (such as memory loss) complete that neurofeedback may very well slow memory loss, and, in some cases, may even enhance memory. Although study in this area is very minute at this time, future studies are sure to follow.
Professor John Gruzelier, from Imperial College London at Charing Cross hospital has commented “Neurofeedback has been proven to be productive in altering brain activity, but the extent to which such alterations can sway behavior are still unknown.” consideration that he did not place a cap on what is possible, he is naturally saying, in so many words “this much we know, and we need to see what else there is to know”.
People have a tendency to assume the worst inherent outcome about things that they do not fully understand. This lack of understanding translates into a lack of perceived control, and, when we feel like we have minute to no control, we give up, rather than fight. This is the situation of many families who are coping with Alzheimer’s. They have watched a house member continue drift additional away mentally, until suddenly, it seems all that is left is a shell that bears resemblance of a once vibrant human being.
How does neurofeedback help with Alzheimer’s disease? The neurofeedback recipe used to treat Alzheimer’s patients is the same as for anyone other neurological condition. clear reinforcement is used to gently turn the way the patient’s brain is functioning, but it is difficult to specify exactly what happens to bring about these changes.
The suspect is quite simple; Alzheimer’s disease is not fully understood in terms of how it manifests and what causes it to progress. There is still a great deal more to observe about this malady before we can talk definitively about the processes involved in enhancing brain function in Alzheimer’s patients.
What we can say, at this point, is that many case studies exist that demonstrate the inherent of neurofeedback therapy to open clear changes in habitancy with Alzheimer’s. Some of them are very powerful changes; others are far less impressive, but clear changes nonetheless. As we begin to observe more about what is happening within the brain of those who suffer with Alzheimer’s, we will be able to more accurately determine how to best use neurofeedback to intervene.