Improving Social Communication in Persons with Dementia Using Montessori Activities

Transcription

1 Improving Social Communication in Persons with Dementia Using Montessori Activities Megan Malone, M.A. CCC-SLP, Jenny Loehr, M.A. CCC-SLP Cameron Camp, Ph.D.

2 Objectives Upon completion of the session, participants will be able to: 1. Describe 2 strategies discussed to improve social communication in persons with dementia. 2. Provide one functional goal used in therapy using the activities discussed. 3. Describe the basic principles of Montessori- Based Dementia Programming.

3 Acknowledgements Information in this presentation is supported by the following grants from the National Institute of Mental Health, & the Retirement Research Foundation Programming for Dementia: Maximizing Abilities 5R21MH ; C. Camp (P.I.) Montessori-Based Training for Persons with Dementia: Serving as Group Activity Leaders Retirement Research Foundation Grant # RAMP: A Mental Health Intervention for Long-Term Care Residents with Dementia 5R34MH C. Camp (P.I.)

4 Menorah Park Center for Senior Living Beachwood, Ohio 356 Skilled Nursing Beds (All Private Rooms) 320 Independent Living Apartments 116 Assisted Living Units Home Health Agency (Three Sites) Adult Day Center (Over 60 Clients) Extensive Rehab Department Driving Assessment Program Rehabilitation Apartment Aquatic Center Child Care Center

5 About Myers Research Institute An emphasis on developing practical interventions for dementia and other disabling conditions associated with aging Funding provided by both federal and private sources NIA, NIMH, National Alzheimer s Association, Retirement Research Foundation, HCR Manor Care Foundation, etc.

6 Mistaken Beliefs About Dementia Individuals with dementia cannot learn or remember information Best way to care for persons with dementia is to make them comfortable, accept their idiosyncrasies, and be patient with them

7 Research Tells Us Dementia is the loss of mental functions involving thinking, memory, reasoning, and language to such an extent that it interferes with a person s daily living. Dementia is a group of symptoms that can include: Language disturbances (e.g., aphasia, dysphasia, anomia) Problematic behaviors (e.g., repetitive questioning, wandering) Difficulties with activities of daily living (e.g., dressing, personal grooming) Personality disorders (e.g., disengagement, aggressive behaviors)

8 Dementia & Communication Deficits Word-finding difficulties Verbal perseverations Pragmatics (turn taking, topic maintenance) Reading comprehension Diminished vocabulary

9 Strengths of Persons with Dementia Curiosity Sense of Humor Willingness to Help Retention of Memory for Past Events Procedural Memory Ability to Read

10 Montessori-Based Dementia Programming A method of CREATING and PRESENTING activities/interventions based upon the teaching methods of Maria Montessori. CREATING: external cueing, manipulatives, templates, materials adapted to the needs/abilities of participant, etc. PRESENTING: reduced environmental distractions, proper seating arrangement, demonstration of tasks, task breakdown, choice, etc.

11 Montessori-Based Dementia Programming GOAL To create persons who are as independent as possible, able to make choices, and who are treated with respect and dignity

12 Maria Montessori Maria Montessori ( ) was the first woman M.D. in Italy. Montessori worked with underprivileged children who were labeled unteachable. She believed that education would give these children a better quality of life. She created schools called children s houses and innovative educational activities. These activities gave children a more active role in the classroom.

13 Who was Montessori? The Key to a Better Life For Children: Education Active roll in the classroom Proper environment (Children s Houses)

14 PARALLELS: Montessori-Based Activities & Rehabilitation Circumvent deficits Allow independent functioning Engage in meaningful activity Provide feedback and success Enhance self-esteem Let function at highest possible level Provide meaningful social roles

15 Objectives of Current Research Study Objectives of RAMP: A Mental Health Intervention for Long-Term Care Residents with Dementia are as follows: To enable long-term care residents with early-stage dementia to serve as group activity leaders for residents with more advanced dementia through the Resident-Assisted Montessori Programming (RAMP) intervention. To assess the effects produced by the RAMP and comparison group intervention on mental health indices of long-term care residents. To develop a train-the-trainer model enabling long-term care staff to implement RAMP and the comparison group intervention.

16 Methodology Three-year, two phase study (NIMH-R34) Phase One: researchers train residents Phase Two: researchers train site staff to train residents (train the trainer model). Four sites per phase (eight total sites) Participants Leaders: 32 persons (4 at each site) with early to moderate dementia who reside in participating LTC facilities (MMSE: 15-20). Participants: 160 persons (20 at each site) persons with more advanced dementia who reside in participating LTC facilities (MMSE: 10-20). Key Outcome Measures: Menorah Park Engagement Scale Leader Assessment Forms MDS Data Alzheimer s Disease Related Quality of Life (ADRQL)

17 RAMP Activities: Memories Squared A group leader holds up a card with an incomplete statement on it for everyone to see, such as "Let Me Call You " The participants have a game board, similar to ones used in BINGO, with different words on it. After the participants complete the statement, they look on their game boards to see if they have the word (SWEETHEART). If someone has the word SWEETHEART, they cover up the word on the game board. After all of their words are covered up, the game is won. It s Raining Cats and

18 RAMP Activities: Memories Squared Modified to match abilities of older adults Clues tap into long-term memory Capitalizes on a common remaining skill: the ability to read Large-print Modified board

19 RAMP Activities: Memories Squared Memories Squared Procedure Leader holds up a cue card and asks a participant to read it aloud to group. If participants have the word on their board that completes the phrase or clue, they cover it with a black square Discussion questions are printed on back of cue card. Leader reads questions to group and promotes discussion throughout activity. When a person s board is filled, he/she has BINGO Game is played till everyone s boards are filled.

20 A Preview of Resident-Assisted Montessori Programming: Video Clip from Pilot Project

21 RAMP Leader Training Protocol Demonstration of activities Research staff lead large-groups at the facilities twice a week for approximately one month demonstrating the activities implementation and procedure As participants become more familiar with researchers and the activities, researchers pull back and allow residents to assist in the leading of the game Based on their performance and interest, a short list of possible leaders for RAMP activities is developed

22 RAMP Leader Materials

23 RAMP Leader Materials

24 RAMP Leader Materials

25 RAMP Leader Materials

26 Preview of Resident-Assisted Montessori Programming: Video Clip from Current Project

27 Case Studies Arden Courts of Austin Cedar Ridge Alzheimer s Specialty Care Center Population and caseload

28 Case Study #1 Mr. H, a 64-year-old male with a diagnosis of Dementia and progressive aphasia Moderate to severe expressive language deficits Moderate receptive language deficits Mild to Moderate cognitive deficits Extremely frustrated with communication deficits Tendency toward social isolation

29 Case Study #2 Ms. P, a 62-year-old female with a diagnosis of Dementia with an aphasia component Moderate expressive and receptive language deficits Moderate cognitive deficits Poor awareness of deficits and self-correction

30 Case Study #3 Group Activity 8 participants ranging in age from participants share moderate cognitive deficits 3 with diagnosis of aphasia and receiving speech therapy

31 Speech Therapy Goals Increased functional verbal communication Increased socialization Increased initiation of communication Improved turn taking skills Increased sequencing skills Increased auditory comprehension skills

32 Group Treatment When dialogue is focused on a specific topic, it is amazing how even a patient who is severely impaired mentally & who rarely makes sense in independent conversation is able to organize thoughts coherently and make appropriate comment addressing an individual directly with a question is best for eliciting maximum participation Shoham & Neuschatz (1985) from Bourgeois (1991)

33 We take note of all the details of a disease and yet make no account of the marvels of health. --Maria Montessori Thank You! For More Information, visit our website

34 References Bourgeois, M. (1991). Communication treatment for adults with dementia. Journal of Speech and Hearing Research, 34, Shoham, H., & Neuschatz, S. (1985). Group therapy with senile patients. Social Work, 30, Skrajner, M., Malone, M., Camp, C., McGowan, A., & Gorzelle, G. (2007). Research in practice I: Montessori-based dementia programming. Alzheimer s Care Quarterly, 8(1): Malone, M. & Camp, C. (2007). Montessori-Based Dementia Programming : Providing tools for engagement. Dementia, 6: Skrajner, M. J., & Camp, C. J. (2007). Resident-assisted Montessori programming (RAMP ): Use of a small group reading activity run by persons with dementia in adult day health care and long-term care settings. The American Journal of Alzheimer s Disease & Other Dementias, 22(1),