OT GROUPS WITH OLDER ADULTS

1. OT GROUPS WITH OLDER ADULTS Reference: Ross, Ch. 6-8 Mandel, Jackson, Zemke, Nelson & Clark, Lifestyle Redesign Macdonald, OT Approaches to Treatment of Dementia Patients From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

2. Ross Five Stage Groups • Based on sensory integration theory • Organized by degree of sensory input • Designed for persons with limitations in cognition, sensory processing and social skills • Examples: Allen levels 2 to 3, persons with moderate to moderately severe dementia, chronic mental illness, post CVA or TBI • Good choice for persons who don’t verbalize From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

3. 5 Stages – Brief Review • I. Orientation – Begin with something novel, say names, give everyone a turn (pass on) • II. Movement is emphasized – Gross motor • III. Visual Motor Perceptual Activities – More control added to movement (target) • IV. Cognitive Stimulation and Functioning – Use alerted state, involve group interaction • V. Closing the session, familiar, calming From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

4. Ross Makes the Following Assumptions • Stimulation thru activities affect the central nervous system • Selected vestibular, tactile, or other stimuli promote the brain’s ability to register, organize, and respond adaptively • An organized sequence of inputs enhances the response and response probability • Response to stimulation by special populations can be motivated by 5-stage groups From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

5. Assumptions, cont. • When neurologically impaired adults register sights, sounds, textures, etc, and find it pleasurable, they are motivated to interact and habituate the experience • A routine of organized sequences restores the likelihood of an automatic, habitual response • Adverse stimuli also organize by producing a protective response (beach ball) • 5-stage group appears to restore environmental interaction for impaired individuals From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

6. Ross Groups • Goal is to achieve calm alertness • Uses alerting and calming activities in an organized sequence • Involves same seven steps as client centered groups, but incorporated non-verbally • Uses more than one activity during each session • Requires knowledge of how to grade an activity for more or less stimulation From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

7. Example of 5 Stage group • McMahon and Sonstroem (Ross, Ch. 11) • Group at Goodwill Industries Opportunities for Older Adults (OOA) program • Led by 2 COTAs • OT helps plan and gather materials prior to group session • Photographs show an increased alertness and awareness of surroundings with each stage From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

8. Stage I • Signs of unrelatedness before group begins • Expressions change as therapist enters room • Each member is acknowledged and welcomed • Purpose of group is briefly stated • Attention of each member is obtained to extent possible (similar to a warm up) • Activity: Marionette is passed around and tried • Puppet says: “My name’s Harvey, what’s yours?” From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

9. Stage II • Movement activities offered that either excite or relax, according to need of group • Combined with hands-on guidance from therapist • Parachute is introduced • Members reach toward center when seated in a circle. Each grabs an edge • Promotes good upper extremity ranging as well as increased eye contact From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

10. Stage II, results • Automatic visual and kinesthetic cues • Unifies movement of group as they raise and lower the parachute • Good visual tracking as members bounce a beach ball in the center, roll tennis balls around the edge clock wise, then counterclockwise • Chasing must be done mostly by therapists • Automatic corrections noted when ball nears edge • Playfulness and smiles are frequent From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

11. Stage III • Less physical exertion, more thoughtful action • Identifying, organizing and interpreting sensory data (perception) • Making productive and meaningful responses • Game of matching pictures • Take turns copying shapes on chalkboard From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

12. Stage III, cont. • Requires social skill of taking turns • Encourages others to help when member gets stuck (while drawing/copying shape) • Therapist may need to restate the instructions for each • Verbal attempts to identify objects being drawn should be encouraged (triangle= pine tree, oval= egg, etc From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

13. Stage III, cont. • Common objects placed on floor • Members asked to identify each by name • Blanket covered objects • Therapist asks group to remember items, writes name of item on board • When all are recalled, clap hands to applaud From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

14. Stage IV • Use energy created in previous stages • Focus on cognitive task • Opportunity for organized behaviors to be observed • Group discusses feelings about previous activities (processing) • Group asked to remember the sequence, therapist uses cues to remind • Discuss ability to remember, what problems each member has with memory (generalizing, application) From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

15. Stage V - Closure • Restore inner equilibrium • Something familiar passed around • Pat the bunny, pass it on • Shake hands goodbye • Therapist compliments members as appropriate (feedback, summary) • More spontaneous interaction occurs during closure From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

16. Ross, Ch. 8 • Examples of graded order • Simple puzzle (8 to 20 pieces) • Show picture, all members work on putting together to match picture • A Stage III activity • How to modify to make harder or easier? • Example: Remove one piece for each member, keep rest intact From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

17. Ross 5-Stage Groups: Summary • Looks simple but is exceedingly complex • Requires thorough knowledge of sensory integration theory • See Table 7A for comparison of 5-stage group with A. Jean Ayres theory • More on this group intervention technique next year in advanced SI class From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

18. Macdonald: Stage Specific OT Groups for Persons With Dementia • Groups of 4 to 8 members • Based on Reisberg FAST Stages • Goal is to Maintain function through practice • Category 3 to 4 have lost abstract reasoning • Category 5 to 6 have decreased judgment and disorientation • Category 7 has minimal speech, motor skills, and awareness From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

19. Macdonald: Mild Stages • Categories 3 and 4: • Motor exercises, movement to music, board games, sorting tasks, perceptual motor games (horseshoes, ring toss, bowling) • Verbal Activities: Focused discussion of current events, modified trivia/memory games, creative writing, reminiscing, group storytelling • ADL: Discussion, demonstration, use of adaptive devices, practice of routines of self care, labeling and sequencing From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

20. Macdonald: Moderate Stages • Categories 5 and 6 • Gross and fine motor activities graded for lesser degree of decision making and problem solving • Verbal: Focus on reality orientation, use of more extensive visual aids, simple word games, expression of feelings, poetry reading, and structured socialization • Sensory: Stimulation through activities and related discussions From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

21. Macdonald: Severe Stage • Category 7: Emphasis is prevention of total regression • Sensory: • Tactile – Nylon netting, vibrators, lotion, hugs • Visual – Balls, lights, colors, movement • Auditory – Noisemakers, hand clapping, music • Olfactory – Coffee, cloves, potpourri, strong odors • Vestibular/kinesthetic – Slow rocking, passing weighted objects, ankle weights • Also suggests Ross 5-stage groups for all categories From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

22. Well Elderly Study: 9 Modules • Occupation, health, and aging • Transportation and occupation • Finances and occupation • Health through occupation (physical, mental) • Dining as an occupation • Time and occupation • Home and community safety • Relationships and occupation • Outings, exploration, and special events From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

23. Using the Modules • Flexible application, modified according to group & individual needs and interests • Each topic related to occupation, discuss how related (e.g., transportation) • Used Cole’s 7 steps • Record ideas on flip chart • Plan a group activity as a way to implement some of the ideas (bus scavenger hunt) • Discussion encouraging self-reflective analysis From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

24. Group Title: Lifestyle Redesign Goals: • Occupational Self-Analysis • Think about occupations you have found most fulfilling • Evaluate extent to which they are experiencing occupational deprivation or dysfunction • Identify fears or physical limitations that are barriers to engagement in life (the world) • Determine small steps to overcome barriers • Shift in attitude from “I can’t” to “I can” From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

25. Group Process • Completing exercises in the modules • Planning and enacting group activities • Discussing how occupation effects health and happiness and well-being • Perspective of remaining engaged in life as key factor of successful aging • Incorporation of 2 aspects: Selection style and experienced meaning From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

26. Selection Style • Balance • Habits and routines • Flexibility • Orchestration • Time structure From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

27. Experienced Meaning • Meaning in life is basic human need (Maslow, Frankl) • Flow: Positive psychological state that results when engaged in an occupation in which the challenge carefully matches one’s abilities • Past history: Occupations are meaningful when tied to one’s culture and beliefs about their value • Flexibility: May be needed in substituting different occupations for ones no longer possible From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

28. Prevention Programs: Initial Planning • Suggest OT begin with needs assessment of well elderly in your community • Develop topic and themes • Develop criteria for membership • Research community funding • Establish meeting place • Recruit participants From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

29. Implementation • Meetings: Small groups • Outings (experiences, take photos) • Rapport building • Include discussion of occupation and analysis as part of each session • Follow up on individual and group interests • Promote group cohesiveness • Prepare participants for ending (time limited) From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

30. Some ideas • Introduction to occupation • Health and aging: Changes in occupation • Occupations: Time and energy • Active mind: Mental challenges and games • Outing: Library • Transportation and occupation: Exploring resources • Nutrition: Deciphering food labels • Adaptive equipment in the kitchen • Home safety: Body mechanics, energy conservation, fall prevention • Cooking and dining together From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.