Improving Social Communication in Persons with Dementia Using Montessori Activities

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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.

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Objectives

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

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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
  5R21MH063395 C. Camp (P.I.)
• Montessori-Based Training for Persons with
  Dementia Serving as Group Activity Leaders
  Retirement Research Foundation Grant 2001-397
• RAMP A Mental Health Intervention for Long-Term
  Care Residents with Dementia 5R34MH075799-02 C.
  Camp (P.I.)

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Menorah Park Center for Senior LivingBeachwood,
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

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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 Alzheimers Association,
  Retirement Research Foundation, HCR Manor Care
  Foundation, etc.

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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

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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 persons 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)

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Dementia Communication Deficits

• Word-finding difficulties
• Verbal perseverations
• Pragmatics (turn taking, topic maintenance)
• Reading comprehension
• Diminished vocabulary

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Strengths of Persons with Dementia

• Curiosity
• Sense of Humor
• Willingness to Help
• Retention of Memory for Past Events
• Procedural Memory
• Ability to Read

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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.

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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
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Maria Montessori

• Maria Montessori (1870-1952) 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 childrens houses and
  innovative educational activities.
• These activities gave children a more active role
  in the classroom.

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Who was Montessori?

• The Key to a Better Life For Children
• Education
• Active roll in the classroom
• Proper environment (Childrens Houses)

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PARALLELSMontessori-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

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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.

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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
• Alzheimers Disease Related Quality of Life
  (ADRQL)

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RAMP ActivitiesMemories 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.
Its Raining Cats and
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RAMP ActivitiesMemories 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

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RAMP ActivitiesMemories 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 persons board is filled, he/she has BINGO
• Game is played till everyones boards are filled.

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A Preview of Resident-Assisted Montessori
ProgrammingVideo Clip from Pilot Project
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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

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RAMP Leader Materials
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RAMP Leader Materials
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RAMP Leader Materials
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RAMP Leader Materials
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Preview of Resident-Assisted Montessori
ProgrammingVideo Clip from Current Project
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Case Studies

• Arden Courts of Austin
• Cedar Ridge Alzheimers Specialty Care Center
• Population and caseload

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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

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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

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Case Study 3

• Group Activity
• 8 participants ranging in age from 64
  78
• 8 participants share moderate cognitive deficits
• 3 with diagnosis of aphasia and receiving speech
  therapy

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Speech Therapy Goals

• Increased functional verbal communication
• Increased socialization
• Increased initiation of communication
• Improved turn taking skills
• Increased sequencing skills
• Increased auditory comprehension skills

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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
  commentaddressing an individual directly with a
  question is best for eliciting maximum
  participation
• Shoham Neuschatz (1985) from Bourgeois (1991)

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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
• www.myersresearch.org

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References

• Bourgeois, M. (1991). Communication treatment for
  adults with dementia. Journal of Speech and
  Hearing Research, 34, 831-844.
• Shoham, H., Neuschatz, S. (1985). Group therapy
  with senile patients. Social Work, 30, 69-72.
• Skrajner, M., Malone, M., Camp, C., McGowan, A.,
  Gorzelle, G. (2007). Research in practice I
  Montessori-based dementia programming.
  Alzheimers Care Quarterly, 8(1) 53-64.
• Malone, M. Camp, C. (2007). Montessori-Based
  Dementia Programming Providing tools for
  engagement. Dementia, 6 150-157.
• 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 Alzheimers Disease Other Dementias, 22(1),
  27-36.