Dorothy Conway, CTRS James L. West Alzheimer’s Center Fort Worth, TX

1. Creating Person-Centered Theraputic Recreation Programs for People with Dementia Dorothy Conway, CTRS James L. West Alzheimer’s Center Fort Worth, TX

2. Objectives for session • Be able to define “meaningful activity.” • To identify the therapeutic value of an activity. • To identify the criteria for creating success in activity participation. • To identify the four qualities or domains of an activity. • List possible appropriate activities for various levels of dementia. • Explain how a variety of staff members can assist in providing activities. • Design a meaningful activity from a simple object and apply to the four domains based on the functional level of the participant.

3. “The purpose of life is a life of purpose.” - Robert Byrne“Purpose serves as principle around which to organize our lives.” - author unknown

4. What is meaningful to a person with dementia? • Get to know the persons background – previous interest, career, hobbies. • Determine the person’s abilities – what are they able to do? • Be prepared to adapt and adjust. • “Meaningful activity” means different things for different people.

5. Groups with Purpose Teachers love to interact with students.

6. Groups with Purpose Gardeners like to garden.

7. Groups with Purpose Woodworkers still like to tinker.

8. Defining point of meaningful activity • Makes the person an active participant, not an attendee.

9. The Four Qualities of an Activity • Cognitive • Physical • Psychosocial • Spiritual

10. Cognitive qualities of an activity: • Enhances memory • Encourages verbalization • Fosters abilities to make choices • Encourages sequencing of thought process

11. Physical qualities of an activity: • Promotes well being • Physical fitness • Improve balance • Promotes normal sleep patterns • An outlet for stress and anxiety

12. Psychosocial qualities of an activity: • Provides a sense of belonging • Provides feelings of accomplishment • Fosters dignity and self-esteem • Provides a way to express feelings • Provides a method to distract/change mood • Provides feelings of security

13. Spiritual qualities of an activity: • Opportunities to have personal faith journey upheld • Opportunities to be part of a faith community • Opportunities for sacredness in daily living

14. Practice in finding the qualities Attending Chapel Cooking Club

15. Exercise Group Valentine’s Party

16. Life is an activity! • Common objects and items found in a typical household can become an opportunity for a therapeutic activity. Example: flag *Hands on practice in finding the qualities of an activity in common objects*

17. Now you know the “Who” and the “What” – How? Understanding who the residents are both past and present, and knowing the qualities of an activity, you can then focus on enabling the resident’s abilities in a successful way.

18. For an activity to be successful, consider the following: • Modification – the more impaired the person, the simpler the activity should be. Attention span shortens as the disease progresses. • Repetitiveness – does not mean boring! Often the routine, familiar tasks learned in the past, can be meaningful and successful. • Multisensory Cueing – using cues that involve several of the senses (visual, auditory, and touch more effective than visual and auditory only). Emphasis sensory abilities that are still intact. • Cultural – is it relevant to the persons past value systems, morals, and life situations? Design activities around the interests of the participants. • Approach and Communication – demonstrate what to do and use appropriate encouragement. Try to group participants with similar functional levels.

19. Determining the Therapeutic Value in an Activity • What is your goal for a particular resident? • Will the outcome be reached in having this participant take part in this certain program? • The therapeutic value of an activity is changeable based on the participants responses, abilities, etc. • Examples of activities and their therapeutic values

20. Providing Activities by Cognitive Levels: • Ideas to promote meaningful and therapeutic activity based on stages of dementia: • Early stage • Middle stage • Late stage

21. Early Stage: GDS Stage 4 & 5 • Games (continues to recognize the concept, may need cues to go to the next step etc.) • Cooking Activities • Puzzles • Assisting duties (delivering mail, stuffing envelopes…) • Setting the table • Sorting and matching • Small group discussions (continues to recognize the group process)

22. …Late Stage 5 and Early 6 • Continue to enjoy and function in the same activity pursuits, but need additional, frequent cuing to be successful. • Changes in vision (depth perception and peripheral vision) may affect participation.

23. Stage 6 • Gross motor games (may hit or kick at a target) • Folding laundry • Music programs (with singing, clapping, swaying) • Cooking • Household chores (dusting, washing tables, stirring) • Simple crafts (sanding, coloring) • Encourage conversation with scrapbooks, life story books, photos

24. Stage 7 • Tactile stimulation (hand massage, feeling differing textures…) • Music • May play catch but will not be able to throw back • Reminiscing and validating the person

25. Dorothy Conway, CTRS James L. West Alzheimer's Center 1111 Summit Ave. Fort Worth, TX 76102 dconway@jameslwest.org