My Mother died seven days before the world, as we knew it fell apart. Her exit was September 4, 2001, 10:35 p.m. The world as we knew it exploded September 11, between 9 and 10 a.m.
My Mother left this world at an interval when all souls come for accounting, mid-way into the Hebrew month of Elul, two weeks from the first day of our Jewish New Year. Perhaps her task on this earth was complete; she had no more karma to work out. Experiences and relationships had taken her through a full cycle of lessons. To continue on would only have been a repetition.
I like to think this, of course, that her life had an order, purpose, structure, and meaning. My Mother was diagnosed with Alzheimer’s disease in 1995. She lived at home with my father as the main caretaker until January 1999, when she entered the nursing home where she continued to stay, speaking occasionally in a twisted babble, unable to walk, feed or care for herself.
What kind of meaning or purpose could her existence have possibly held at this point? Wasn’t her ‘real life’ over when she entered the caretaking facility and this extra time only an anachronism? Of course, we, her family, were glad to still have her, to be able to visit, but didn’t we usually do so with a great deal of pity and angst? Weren’t we counting the days until she – and we – would be alleviated of this suffering burden? As someone who values movement, action, communication, involvement as hallmarks of a healthy well-balanced life, it would seem that I must have been particularly beleaguered by my Mother’s situation and frustrated in my attempts to make her ‘do something’. It is only when lifting the veil of purpose as measured by attainable goals and communication as marked by shared memories that the real ‘Zeitgeist’ in my Mother’s state of being can be recognized.
I listened to a rabbi during the Yom Kippur remembrance service who spoke about the loss and gain of Alzheimer’s. He wove in a beautiful Talmudic story of a soul before birth who knows the whole Torah but then comes into this world only to lose all memory of that. The rabbi added his own view that perhaps when a person with terminal Alzheimer’s shuts down to the realities of this world that he or she is in the state of reclaiming some of that original pre- incarnation wisdom. (1) I couldn’t agree more. When I came to know my Mother and her illness on these unique terms, a whole new world blossomed, full of purpose, structure and meaning on an even higher level than we are aware of daily. I write this to perhaps prove instructive not just for those with relatives with Alzheimer’s but for all who continually encounter others dwelling in a separate reality, one that touches our existence yet seems thwarted, deprived or imperceptible.
Almost from the time my Mother was diagnosed, she seemed to adopt an attitude of friendliness. I am sure the Zoloft helped some as generally her spirits were good, but it was almost as if she entered this new realm able and willing to receive the caretaking her family had too long neglected of her. We were able to bypass the barrier that stands in the way of adult children touching their parents in nurturing ways usually reserved for our children. Her skin was warm and soft, and we felt her vulnerability as a person not just someone locked in the role of Mother and wife.
We learned to slow down a lot, and as with a child finding glee in first experiencing the world, she, too, was able to revel in the moment. On a walk, at first unaided, then with a cane, a walker and a wheelchair, she, who had been rather shy and self-effacing when in her ‘other’ life, now found no reason not to encounter every person, bird or animal with a direct comment, an odd remark, a wry jest, a smile and a laugh. This was usually received in kind, and what had a moment before been an alienated world of people coming and going in their own spheres now was a community inter-relating.
I don’t know if it’s part of the Alzheimer’s disease process or was just so in my Mother’s case, but she developed visual and auditory acuity. As we rode along, she would hear birds and dogs and talk back to them, while I was only pre-occupied with traffic noise. She loved going to the nearby duck pond and assigning personalities to each feathered friend: “You’re big and fat.” “You look hungry.” “Don’t you want some food?”
When she was still being evaluated as to what was ‘wrong’, a psychiatrist asked her to write a sentence, and she penned: “Sylvan (my husband) is my world.” She was able to focus on what was most essential to her. When we finally placed her in the nursing home, it was more because she just stopped walking one day, making her difficult to move, than from any cognitive or behavioral changes.
Suddenly, there was a group of hands touching her. It took a gulp for us, her family, to (2) allow such continual invasion from strangers. Not every touch seemed as warm or friendly as we felt ours had been. Yet my Mother seemed to bear up under this change in routine and treatment. She checked out people with her wide gaze and often held tightly to the current hand involved in her care. We, in this mundane world, tend to evaluate people through looks, dress or status. My Mother responded only to warmth and gentleness. Hers was a sensual world divided into polarities of hot/cold, gentle/rough, loud/soft, strong/weak.
We, too, learned to appreciate the differing moods and qualities of her caretakers. An aide who delivered a lunch tray with kindness and good humor would sometimes make more of a difference in my Mother’s day than the medical personnel who infrequently examined her.
These brief interactions done in more humane and less mechanical ways formed the basis for my Mother’s life environment and the context for her response.
When we visited, we could often tell how she had been treated that day. The general school of rationalizing thought about Alzheimer’s says: “Well, at least it doesn’t hurt the patient”. No, but it’s damn uncomfortable. Imagine not being able to attend to your own personal needs even to the point of turning over in bed or scratching yourself. You would have no way to express if you were thirsty, if your nose needed blowing, if you were too hot or cold, if the light were shining in your eyes. My Mother was completely dependent on others to meet her needs and probably suffered unimaginable deprivation while the business of the nursing home was transacted all around her. She reached out with her eyes and hands and receptive skin for whatever warmth and kindness was offered her way.
As such, my Mother lived more completely in the moment and in direct contact with love in all its guises than we usually do as we scurry around. What if we all sought and gave to one another the love my Mother without guile opened herself to?
NON-VERBAL DIALOGUE
This synopsis of care giving to my mother in the middle to late stages of Alzheimer’s disease gives hint of the non-verbal skills used in relating to her. We all express and are recipients of non-verbal behaviors. Certainly, this is the level on which we come into life, and for many of us, dementia or not, this is the level on which we leave life. Normal, verbally skilled children use many non-verbal behaviors in their play with peers. It is stated by researchers that (3) for intellectually astute adults at least seventy per cent of their communication is through non- verbal dialogue.
This may seem incredulous when you think of how many years us educated folk have taken to learn our facts and speak impressively. But it may also begin to explain why even with the profuse verbiage of the high tech communications’ revolution, we still have such confusion and conflict in the world so it often seems like we are exchanging information more but really communicating and understanding less.
Everyone wants to be understood, even more necessarily than being wholesale agreed with. Think for a moment of when you had a dialogue with someone and they really ‘got’ what you were saying. You didn’t have to over-explain, sugar coat, understate or worry that the person wasn’t listening.
Most of us, when asked how we are doing, only give a cursory response for we feel that the asker is not really interested. But how long would it take for someone to really hear you if they were open and interested? The meeting of earnest sender and motivated receiver might not need to be measured in terms of time as much as the quality of communication.
I am a mental health therapist who sometimes works with married or otherwise together couples. By the time they get to me, communication usually consists of blaming the partner and defending one’s own actions. All hope of here and now, unfettered open sharing is gone. Each partner is trying to shore up his/her own defenses to survive, and there is quite a bit of self-guilt even with the outward hostility.
Yet, it was important to note that somewhere, sometime, each probably felt that this now estranged partner had a way, which boosted their mate into feeling better about him/herself.
How was this possible? Yes, certainly, chemistry and pheromones had much to do with it. But there was also an openness, a felt sense of the other and a ready response. A person used all available communication channels – sight, sound, touch, voice quality, movement — to express and to receive.
Thus, a relationship was born and along with that came many commitments. And with commitments came assumptions about role definitions. But the beating heart and soul of the individual lay underneath. Just because they had made a commitment didn’t mean their feelings and responses to the other weren’t changing. But due to expediency in the rush of everyday life, (4) less was communicated about what really lay inside of a person. Dialogue became reduced to one channel: “Are you saying words that agree with mine? If not, then I’ll likely shut you off.”
So as a therapist, my basic tack with these couples was to have them engage in a deceptively simple exercise: paraphrasing. “Sit and look directly at one another. The listener is to have an impassive face, not giving hints of approval or disapproval to the partner’s utterance. The speaker gets to talk for a whole minute (which probably will seem like the longest minute ever) about any event or anecdote of the day, nothing particularly intense or emotional at this point. After the minute, then the listener is to put into his or her own words what s/he hears the partner say. The partner then gets to agree with or correct what their partner says to be sure the partner heard them correctly.”
Usually after participating in this seemingly benign exercise, couples who beforehand could not agree on the time of day, now let out a sigh of relief and said things like: “Wow, he really heard me!” or “We never talk like that at home” or “It’s the first time she listened and didn’t interrupt.” This is the power of verbal communication which may account for thirty percent or less of what we say to one another.
Now, when we begin to add in all the aforementioned dynamics of non-verbal communication, we increase the number of channels and come to a crossroads. We can either fully embrace all the information now offered us and create a situation of richness like we may have had at the start of the relationship, or we are so preoccupied with our own thoughts and ways of being that much interference plays in the channel, and it becomes clogged with white noise.
COMMUNICATION WITH CAREGIVERS
I have taken this long to draw out a parallel situation to what communication is like between the person with Alzheimer’s Disease, at varying levels of progression, and with their caregivers, whether family who would seemingly know the person better or with institutional staff who may make valiant attempts to be there yet feel befuddled and frustrated much of the time.
Think about it. In the world of teaching, another foray of mine, there has been much research done and emphasis placed on “learning styles.” Each of us, probably through genetics (5) and early rearing and proclivities, has developed our preferred way of filtering presented information. Some do better with information offered visually – pictures, charts, graphs, videos. Others are aural learners responding to lectures, audio tapes, class discussions. Kinesthetic learners respond best to doing–participating in projects, hands on activities, and, literally, moving while assimilating information.
Some of us, of course, combine learning styles, and it is important to know where we, as caregivers and one half of the communication equation, and where our relatives and patients stand. Imagine, if you were someone who apprehended best through the world of sight. You traveled; you did photography; you were sensitive to the changing hues of the seasons; you enjoyed movies and plays. These images were strong as they resonated with a structure in your brain where all this information fit and made sense. You weren’t just seeing outlines and colors and people moving along amorphously. No, whole webs of stories and relationships were revealed through what your eyes enveloped.
But, suppose the antennae inside you that received these in meaningful sequence became dull, dimmed, mired in receptivity. You physically saw all the pictures and actions, however it just didn’t mean what it used to or certainly not what a normed group of peers would agree to.
This is beginning to get inside the head of the Alzheimer’s patient. They are not without receptors. They are not immune to what passes before and around them. But it doesn’t add up to some meaning they can identify or that they have the capacity to respond to in a way which can begin a shared dialogue based on mutually acknowledged reference points. This is the supreme learning disability. There may be receptivity, but cognition and clear expression are lacking.
And yet, we wonder, does what’s presented to the Alzheimer’s patient in their environment mean anything to them? Is it all a blur, or is there some intrinsic meaning they may feel but which we are unable to apprehend? Although people may have preferred receptors for receiving information, no information is delivered on only one channel. Thus, along with the sight of leaves turning in the fall also comes the sound of migrating birds, the waning crescendo of crickets, the cool touch of a breeze, the pungent smell of pumpkin pie baking. And, of course, there is the human element. Are they experiencing this fall scene alone? Are grandchildren nearby? Are old friends present? Is there time taken to fully experience what is coming through the senses, or is the experience hurried and pressured? (6) As for any of us, a message of warmth and acceptance or harshness and rejection is delivered through many modes. The Alzheimer’s patient may not ‘know’ that it is now October and falling leaves signal the portent of winter and that they must shore up their furnace, order oil, check the snow tires and buy a new parka. Yet, based on personal anecdotes, I will now recite and, on the experience you as a caregiver may have if you follow some of these prescribed methods, you can bet your bottom dollar, that the Alzheimer’s patient will react in some ways we can perceive – IF our antennae are sharpened. We may then come away with a felt, believed sense that being with our loved one outside on a Fall day has been experienced as overall positive or negative by them.
We need to be open to the possibility that they can receive through all channels. Yes, of course, along with dementia affecting the thought process, normal aging deficits of failing sight and hearing may also be affecting them so sensory channels may not be picking up on what they once did. But, even so, unless there is total blindness or deafness, something is filtering in to form life’s reality for this person.
Thus, given extreme physical deficits, the Alzheimer’s person is, at some level, capable of receiving outside information. And we know that in the pre-disease state, they each had some preferred method of learning, as well as, of course, a whole slew of images from life experience which made sense and formed the basis on which they engaged the world.
What about ourselves? What do we know about our own preferred learning style and our way of receiving and organizing information? Suppose we are a mostly aural learner. We listen to tapes; we attend lectures; we carefully remember the words others say to us. We get upset when later someone contradicts what they had said to us because we put such value on the veracity of the spoken word.
So how do we then engage in a relationship with an Alzheimer’s person when words will not mean the same to each of us and when we can’t know what sight filled images register in their mind?
We do this by very carefully being in the present moment with no presumptions and then paying attention to all the data from our own channels and what transpires between us. The goal is not to teach or to require recollection, rather it is to engage together, as fully in this moment as possible, and from that a connection is born. This will have its own reality and energy. It can then (7) inspire the opening of further channels with more information received and responses given. The greater our openness and flexibility – not afraid of appearing silly, not knowing – the greater the chance for a real exchange which will have its own level of meaning without needing to fit into pre-ordained categories.
Yes, this is new territory we’re walking here. Yes, there are plenty of chances to fall over ourselves and mis-perceive what is actually occurring. But, with this non-judgmental approach, there is opportunity to allow for enriching hybrids of communication to develop.
I am a movement therapist by training. While it is required to have a background in dance, the actual practice of movement therapy involves using all those aspects of non-verbal communication which are involved in the art of dance–rhythm, touch, pacing, breathing, posture, spatial awareness, gesture. These dynamics are also used in our everyday relationship with other human beings.
Some of these affect our verbal interaction, too, like rhythm, pacing and breathing, along with voice tone and pitch. While we as caregivers we may be able to separate which of these dynamics is most present in our interaction with the Alzheimer’s patient, the patient, also, is displaying these dynamics.
This is the dance between us. This is what will make for more satisfying, less frustrating communication with the Alzheimer’s patient. We use everything we are aware of to engage with everything they offer us, and the sum definitely becomes greater than the disparate parts.
Now I will discuss how you might approach the patient, then in full awareness how you can begin to engage with him/her and how you could deal with some potentially problematic situations. I offer a host of ideas for creatively opening up dialogue between you, your loved one or your paid charge.
PREPARING TO APPROACH THE PATIENT
We need to prepare our whole self. Given our day so far and our mental attitude, we may be feeling rushed, hassled, and short tempered. The patient, like a child or a dog, will pick up on these. (This is not to diminish the patient’s humanity, but rather to exalt their level of non-verbal acuity.)
So before trying to engage, take a minute or five or ten to de-stress–stretch, breathe, find (8) your more centered settled self. Then sit and become aware of your surroundings. When the thoughts in your head take over, and they will, come back to breathing, let them go and open all your receptive channels. Notice what you are seeing, hearing, kinesthetically feeling without over analyzing it.
For example, if I am in a room with light blue walls and I hear a siren in the background and the heat is turned up a bit too high, I may feel depressed or suffocated or feel like tragedy is impending. It’s important to note this because your Alzheimer’s patient may be living in similar surroundings. We may intentionally try to cheer him/her up, but as s/he hears the siren and feels warm and suffocated and is under-stimulated by the passive color, then his/her system may spiral downward. Thus, if our communication to cheer them isn’t working, we may now have a clue about how to restructure the environment.
Also, suppose in your sitting attempt to compose yourself, you feel your heart beating wildly even though you have not just exercised. Then you remember that tonight after this encounter with the patient that you must go home and do your taxes or pay your bills. You rightly feel some anxiety. If you visit the Alzheimer’s patient at 4 p.m., s/he may not ‘know’ that dinner is next, but this is ‘sundowning’ that time of the day when the Alzheimer’s patient’s anxiety is raised. The patient may also have a sense that dinner is next, and if feeding is particularly difficult for them, this can cause an anxious reaction. Thus, in your interaction it will help to find a way to address the patient’s anxiety before proceeding further.
So you prepare by calming and centering yourself and paying attention to your external and internal environment by trying to track the source of your feelings so as to get a clue as to how to transform those should you choose.
You want to be very clear with your own feelings so you do not risk doing what is called ‘transference’ with the patient. This would be to transfer or assume that whatever you are feeling the patient must certainly be feeling. This is easy to do with the Alzheimer’s patient as they can seem so passive and malleable. But you would be doing them a disservice. No matter how far into the disease process each person is, he/she is still a separate individual with their own proclivities and responses.
You want to keep outer distractions to a minimum so you can focus on direct interaction. If you are going to be with the patient in your or their home, make sure the TV and radio are off. (9) Find a part of the house that is not so cluttered or busy. If meeting them in the nursing home, even in a crowded day room, take them to a corner that is a bit out of the fray. Arrange as much as you can for the temperature to be right, keeping in mind that elderly people, in general, like things warmer than younger people do.
Note how the person is dressed and how they are sitting. Are the clothes put on properly and fastened, or are they falling off the person? This happens particularly with very thin patients. Is a sweater bunched up so it might be causing pressure on the person’s back? Do they have wool next to their skin, and you notice they may be itching? Is their nose running? Is there food caught between their teeth? Think of how you might feel if your personal needs went unattended, and you could not rectify these on your own.
BEGINNING INTERACTIONS
By focusing on and taking care of personal needs and doing all this in a gentle, unhurried, non-judgmental way you convey to the patient that they are in a caring environment. You describe what you are doing and say you hope this will help them to feel better. Maybe they’ll understand a word or phrase, maybe not. But if you use a consoling tone of voice with humor and a relaxed face and smile, s/he will have a pleasant experience. You may even want to sing about what you are doing. If there is an existing song that fits, good; if not, you might make up a song, but use a familiar tune, one you think the person may have heard before. Alzheimer’s patients may mumble gibberish for hours, but when they hear a song that literally plucks a familiar chord, they are able to sing along. This is akin to striking a gold mine, and as a caregiver, you should always aim for it.
In terms of our non-verbal, using-all-channels model, you would be touching the person with softness and warmth, looking at them and singing–touch, sight, sound–your chances of communicating have just multiplied.
To further engage the patient, as with anyone, it is usually better to start with something they were formerly interested in–music, art, exercise, animals, flowers, etc. For music, obviously you could sing or play CD’s. For art, you might have copies of pictures they have seen, or if they painted, copies of their own pictures. If exercise, you can take their hands and start to move (10) and possibly they might follow. For animals, you might have a live dog or cat, or stuffed animals might be equally good. It’s nice to get ones that make sounds when you press them. Both real and stuffed animals have the added benefit of being tactile and comforting. For flowers, you might bring in live ones or even very realistic artificial ones. Bright colors will be more stimulating; pastel shades more restful. You need to watch that the person does not try to eat them.
What enables this to work and gives the activity a spark is for you to allow your open, flexible, playful self to emerge. Remember the goal is not infallible remembering or perfect participation. The goal is mutual engagement.
Let’s say that my relative had lived on a farm with animals and had also done some gardening. S/he was never particularly artistically expressive and had actually belonged to a rather conservative religious sect that did not put a high value on flamboyant self-expression. So I might begin by bringing in some stuffed animals with sounds included inside, or I could make the sounds myself verbally. I might move or bend the animals to show them eating, running, sleeping, etc. For a higher level Alzheimer’s person, I might use an animal video. There are many good ones of animals in their native habitats. Get one that clearly shows the lives of animals living on a farm without being complicated by some human story.
You could talk about a typical day on a farm and add sound effects as useful–dinner bell, tractor, geese honking overhead, ducks in a pond quacking, etc. Be aware of what your patient is responding to and what not. It’s a fine line, but even though you may be flexible and full of humor, you are not really there to entertain because then it becomes a one-man-show. You are there to engage. So you want to pick up on whatever your patient is offering. They may mimic your sounds or suddenly become wide-eyed at seeing one particular animal. You then want to re- emphasize these things by putting more of your energy behind them. Talk in an animated fashion or sing or introduce a rhythmic element–wooden blocks clopping like animal hoofbeats, a slide whistle that sounds like quacking, maybe one for each of you to play.
For gardening, bring in pots of real flowers, again watching how the person handles them. For artificial flowers, you might spray them with a scent, providing the person is not allergic. Or you can buy large oversize plastic flowers from the dollar store that rotate around. (11)
Thus, you’ve added smell and movement to the sight and touch.
You might bring in a pan with some soil and a bulb, rather than a too small seed. Some patients are squeamish about this, while others approach it with relish. You might encourage the person to dig a hole either with their hand or a small spade and then to plant the bulb. This is literally getting in touch with the earth and can have a primal, satisfying effect.
For a former musician, you can bring in the actual instrument and let the person hold and finger it and maybe put it up to their mouth. You will play CD’s of music they used to play. For music with pronounced rhythmic quality, you can start tapping their hands with your hands; this can then be extended to arms, shoulders, legs and feet. Then you might give the person a drum to beat out the rhythm. It is best to use a hand drum without the complicating or dangerous factor of a stick. Also, you get the tactile sense of skin of the hand on skin of the drum. Many people who never held a drum before can take to this. Again, it’s primal, and we all feel better when we’re in synch with the rhythm of our lives. I’ve also known a former clarinet player well versed in classical music to whom I gave a small baton, and he then conducted the music being played on the CD while the rest of us moved to it. He was having a great joy!
DAILY ACTIVITIES
How does using these techniques transfer to everyday situations with patients when you are trying to attend to activities of daily living and where other persons may also be involved?
Remember to keep the calm atmosphere, as already discussed, regarding foreground and background noise and tone of voice you use with the patient.
To maintain consistency is also important. In addition to keeping things in their place in the person’s home or room, you might add a consistent behavior into your interaction. This then becomes almost a ritual and is a bonding and identifying element. Suppose every time you saw the patient you greeted him/her with a special hand clasp or a certain funny face or a theme song. For one woman I knew it was “You Are My Sunshine.” This decreases anxiety and provides security.
Any repetition is usually a good thing. Alzheimer’s patients will not complain they are bored and that they already knew what you just said. As with young children who many times like to have a favorite story read over and over, with these patients when you latch onto an (12) activity that is pleasing, then it bears repetition. You can then vary it or try to expand it in some way, but the repetition will have created a block of meaning.
Using memory aids of cues representing the different senses is also helpful. As stated, having surrounding pictures of familiar scenes and sounds of music the person has known and liked can be very consoling while a nurse is trying to do a procedure on a patient.
Simplify tasks. If you ask a person to do an activity of daily living–say to help feed or dress them-self, be sure you are with them to demonstrate this every step of the way. Reinforce and praise each step they take. Also, better to say: “Let’s do this together” rather than “Let me help you.” When they become less able, you can do the task for them, but talk your way through it so they at least hear you describe what you are showing. This keeps some connection, even if not direct participation.
Show pleasure and excitement with whatever part of the task they can do. If you need to actually feed them lunch, but they can still hold a fork or spoon, then celebrate that effort. Go on the premise that everyone wants to feel useful and involved. Do not argue, but try to find something acceptable in whatever they do. Even if they want to wander and leave the area, walk next to them and remark how strong and determined they are and how walking is such a healthy thing, but right now we’re going to walk around this area because this is where the music, food, people are.
Encourage recognition rather than recall. Do not ask the patient twenty questions or anything that would stump or frustrate them. But try to provide as many cues for recognition as possible. Again, use sight, sound, movement. Once I worked on a closed ward for Alzheimer’s patients. I only went in once a month for a group. One day I came, and as usual, no one remembered my name or the name of the group. But one little woman got out of her chair and sashayed up to me slinging her hips from side to side. We had done the Hula in there a month before! Something about my presence and music box and maybe the sense that my body was ready for action had triggered a clue that this was now time for movement. Whatever it was, this woman came alive. For people not as astute as her, you might trigger the cue yourself by doing a familiar movement from the last time you met. Grasping hands, touching a shoulder, brushing cheeks can become your mutual anthem. (13)
Once I had people in a more mobile Alzheimer’s assisted living group standing up and waving around two foot long dowels onto which I had glued pennant shaped flags. A participant said this reminded him of sending semaphore signals in the military. I loved his quick response when I asked what these signals meant, and he said: “They’re secret. I can’t tell you.” If I knew the background of even a non-verbal patient, I might have brought in these pennants and would have had a chance of stimulating a response.
Make the environment safe. We have spoken about this in terms of decreasing agitating colors, clutter and noise. Certainly, there are many specific directives for the Alzheimer’s patient at the beginning to moderate stage who is still home either completely by self or with some help. But even with those institutionalized, ostensibly being supervised, dangers lurk. My mother, for the entire two and a half years she was in a local nursing home, could not walk, speak, eat on her own or even turn over or wipe her nose. Nevertheless, some non-astute nurses’ aides left an alarm buzzer lying in her open and very flaccid hand with the misconceived thought that my mother might summon help if needed. This contrivance was hard metal; my mother could have banged her head on it, and she might have tried to put it into her mouth and choked.
Any toy, doll or stuffed animal given to the patient to hold when no one may be looking needs to be checked and rechecked for sharp or loose parts. Beds not long enough may have feet hanging over that are uncovered and will give the patient a cold. Window shades put up in early morning to allow sun in often stay up until evening. But in mid day the strong sun comes in and blinds the eyes of the immobile patient.
Actual room temperature and the patient’s comfort need to be checked during the day and night. Most of us do not want to wear the exact same amount of covering for 24 hours. There are many variables. We need to anticipate and respond to the patient’s needs.
Be aware of signs of allergies or reactions to clothing, particularly if something like wool or latex is next to the skin. Patients cannot tell you if they itch, nor can many of them scratch, but, if you pay attention, you may be able to sense the discomfort even before it erupts into a rash. The skin can still cringe or flinch when something is uncomfortable.
Treat the person as an adult. I’m not sure which directive can be as important as this one. It is one thing to cognitively ‘seem’ like someone is at the one or two year old level. It is quite another for the totality of life experience and deepest feelings to only be at this level. Even when (14) someone appears regressed, we should never assume the person understands nothing and does not mind being treated as a child. People maintain their sexuality and desire for affection and affiliation long into the disease.
We need to treat them as full spectrum beings, meaning that if a man, we can address him as “sir”, “Mr.”, tell him how handsome he looks, remind him of sports he played and joke that women have their eye on him! For a woman, we want to find out how she likes to dress and then fix her up to look pretty. Some patients like to wear a lot of jewelry, which is fine as long it won’t get tangled or put into their mouths.
Again, it’s a fine line, but even with regressed people who we assuage with baby dolls or stuffed animals, we still want to regard their whole personhood. We wish them “Happy Mother’s Day”, bring in pictures of grandchildren, prepare “occupational boxes” of things from a former work life. For example, for a regressed, wheelchair bound woman who was a chemist, we have a box with test tubes (plastic, of course), rubber hosing, tubing, etc. Construction men might like wooden replicas of buildings, a plastic or rubber hammer and saw, maybe even some puzzle pieces to ‘build’ a structure.
DANCE THERAPY AND THE PERSON WITH ALZHEIMER’S
There are many other standard and worthwhile methods developed by occupational and recreational therapists to help enhance the world of an Alzheimer’s patient. Most have validity and have advanced the field dramatically in the past fifteen years from ignoring or subduing patients with medication to now actually finding many easily taught, skill based ways to help them.
I’d like to discuss the field with which I am most familiar–dance therapy. A host of movement based, creative methods were developed over the years by dance therapists, and I took them to the next level by offering them in dance therapy groups for Alzheimer’s and dementia patients. I suggest that these be looked at as creative tools that can work with people in general and to then adapt them at whatever level you are working with relatives or residents. Today, as we know, there are at least two schools of thought in many caretaking facilities. One sets up a separate unit for dementia patients with specially trained staff. The other believes in combining patients of all levels on the same ward, sort of like mainstreaming special education students. (15)
Personally, I lean with the first school, as I have experienced the confusion to patients and staff in having many levels together. With this mixture, everyone gets the short end of the stick–those who need more help have to share what’s available with others. Those who need some help may receive it only after aides are running to assist those in crisis. Obviously, sicker patients can be very scary for those with their wits still about them. Be this as it may, it is all the more reason why it is important to be flexible and able to adapt these creative methods to different levels of ability and interest.
Always the first rule of working with any population for any purpose is to ascertain their needs, desires and interests. The caretaking facility must keep the person safe and reasonably occupied. Relatives who placed the person in the facility want him/her to feel cared for and not made any more distressed than they were before coming in. It is the goal of the dance therapist to creatively appeal to the person’s basic energy and to enliven and extend that in the most healthful way.
But who knows the goal of the patient? They may or may not have engaged in creative expression before, but they certainly have never been in this position as an Alzheimer’s patient in a care facility. Imagine your own feelings if in such a situation. You would certainly feel confused, probably anxious and overwhelmed, perhaps a bit embarrassed, angry at whomever or whatever got you here, strange, alone, certain that nobody could possibly begin to care about your real needs or feelings. This is hardly cause for celebration. But here comes the dance therapist who wants you to perk up, step lively, and by gum, even dance?! Now which person is demented??
As we learned in the prior section, you want to prepare yourself through breathing, stretching, centering and opening your awareness antennae. You come into this as an open field of possibilities with knowledge and preparation of yourself and the person’s situation.
As with any new relationship, you begin by saying hello, introducing yourself and finding out about the other person. You come into the room smiling and making eye contact with everyone. You then go around person to person trying to bridge the gap. It’s important to get to their level by crouching or kneeling down. Make eye contact, smile, say your name. Always ask their name, no matter how out of it they may seem. They just might tell you. Or you can look at their name on their ID bracelet or ask an aide. Aides many times call the person “Mr.” of “Mrs.” (16) and only know the last name. I prefer the first name and usually try to find it out. It’s more personal and offers a better chance of someone responding.
Say hello using their name. Try to make some comment: “I’ll remember that because it was also my mother’s name”; or “Sounds Italian or Greek?”; or “Bonnie–‘My Bonnie lies over the ocean.’”; or “Louise–‘Every little breeze seems to whisper Louise’”. If not the name, then comment: “You have lovely green eyes”; or “I like your blue dress matching your blue eyes”; or for a man, “Cliff – I can feel your strong handshake. You’ve got muscles hiding in there.”
Make them feel warm, accepted, at home, engaged. Now you are forming the parameters of your working group. There are many ways to say a full “Good morning.” “Oh, What a Beautiful Morning” is familiar to many and good for a normal, upbeat greeting. “Morning Has Broken” adds more of a spiritual, pay attention flavor. To focus attention, you may go around with a ‘singing bowl’ (a brass bowl with a wooden stick that makes a high pitch resonant sound which intrigues people who have not seen this before, which is most of us). Wind chimes can spark a discussion with people who used to have these hanging on their porch. A small set of chimes with a wooden mallet is a wake-up call for people who strike it.
For groups that would benefit by the addition of sound and color, try the Audubon series of stuffed birds with sounds inside to press. The calls are authentic to each different bird and can also begin talk about those birds familiar to patients.
After you’ve been with the group a few times, good morning hugs, whether frontal or to the side, are something people look forward to, again on a non-verbal, touch level. I can’t say how many times I’ve gone around asking people if they wanted a neck rub and them literally falling into my hands or telling me about their aching back while sitting in the wheelchair all day. You’re doing this under the aegis of a good morning waking up the circulation, rather than telling people you want to touch them to assuage their loneliness, but that’s essentially what it is.
Ask people if you can “tickle your fancy” and take an ostrich or peacock feather to touch their chin or cheek. Most will tell you how good this feels. Palm to palm tapping to set up a rhythm is another way of touching. Follow the rhythm of the music, a rhyme or even the person’s name. From here you can then move to tapping of shoulders, cheeks, knees, calves and feet.
You do not want to tap anywhere on the person’s core torso; this is too personal. You can also ask them to tap your hands and forearm. Sometimes if people are seated in proximity, and you (17) help them reach out, they can hold hands in a circle. A connecting piece of jersey material, a stretch band, is helpful here. Sometimes two people can face each other with a scarf between them, and then eventually, they can hold hands and sway.
At times when the whole group is exercising to music, I will kneel down and go around chair to chair and help people move their feet, especially for those whose feet seem immobile due to swelling, diabetic neuropathy or just plain lack of feeling which leaves them unmotivated to move. I use small rubber hoops (originally bought to strengthen my biceps!) and ask each patient first if I may move their feet. I then put a hoop around a foot and holding the hoop, I lift it up and down to the music. Sometimes it takes two hands with one hoop to lift one heavy foot. Some people only want one foot moved. Listen to their preferences and feel their physical reactions.
You can continue to warm-up the group by doing some exercise for each part. Usually, stretching and breathing works very well. I like Yoga because it combines breath with movement (inhaling on the movement, exhaling on the relaxation), provides a full stretch and is sensitive to connections throughout the body. There’s also a spiritual element to it, whether stated or not, that puts people more on a receptive, balanced level.
Some basic seated Yoga positions that Alzheimer’s patients in the middle stages of the disease may follow are: (include descriptions with diagrams)
Working on as many levels as possible with the music, breath and movement, you can also include imagery. Each stretch conveys an image–“Feel the wind coming through you”; “Reach to the stars, for what you want”; “Pick the apple off the tree”; “Feel your back as a willow tree bending in the wind then coming up straight again.”
T’ai Chi is another exercise form that has been used with more mobile seniors to improve their balance. I’ve used this in assisted living groups having people stand up with their walkers in front of them, then learning how to plant their feet and ground themselves, then being willing to take one or both hands off the walker and follow the T’ai Chi movements. With those sitting or even wheelchair bound, the principles of flow and balance that are T’ai Chi can still be taught. Now you are getting people’s bodies warmed up and primed to the point so they will more naturally want to move. They are coming up and out of themselves into an expressive mode. (18)
CREATIVE THEMES FOR RELATING
There are literally hundreds of themes that can be used for individual and group dance therapy/creative movement sessions. Much depends on the size of the group, people’s comfort level, the variance of similarity in level of ability and interest, the time of the calendar year, the educational and cultural background of participants, props and other resources available.
Let’s start with literature. There is great beauty and meaning in bringing the written word to movement life. There are many familiar writings that have formed the values and ethical basis of people’s lives. These words almost live in their bones, so why not let their bones finally move to these? “All my limbs shall praise Thee”, it says in Scripture. Aesop’s Fables might be a good start. With “The Hare and the Tortoise”, you can start to tell part of the story, then see what others might fill in. It may strike a chord with at least one or a few.
The story lends itself to movement. Do the plodding arm reaching out movement of the tortoise and the quick up and down jumping movements of the hare. For the lower functioning patients, you can bring in stuffed animals and focus on the movement and visual. For the higher functioning, you can have them help you tell the story, then ask them the moral. Or you can cue it–“Slow and steady…” Someone may then complete it. Discuss what this means and offer them some hooks of situations so they can tell you how this has applied in their lives. “Do you remember a time when you were speeding around and forgot something?” Or another time when you thought you’d never get all done but then you felt very satisfied when you finished?”
You can take this in whatever direction people are able to go. Other Aesop’s Fables and their morals are: “The Frog and the Ox”–be true to yourself; “The Peacock’s Complaint”–be happy with your own gifts rather than envious of others; “The Wind and the Sun”–persistence is better than force; “The Lion and the Mouse”–one good turn deserves another; “The Ant and the Grasshopper”–do not be idle. Each of these has movement, drama and discussion possibilities.
Just presenting the idea that morals mean something in today’s world, that there is still a right from wrong, is tremendously validating to a senior population who feels the world they lived in is slipping away.
Chicken Soup for the Soul also has stories that literally warm the heart and can remind people of examples from their own lives. A few I’ve used many times are from the series book–The Third Serving. These stories are: “The Most Caring Child”, about a precocious and (19) loving four year old; “Two Nickels and Five Pennies”, about generousness at a young age, and “An Afternoon in the Park”, about an interpersonal relationship with much beauty.
These stories will remind people of their children, grandchildren and themselves. Again, you can dramatize the stories as you tell them with movements, facial expressions, body posture and animated language. Even participants who don’t get the overall meaning may relate to the idea of a story being told. There’s something consoling about this, and they will appreciate your investment in trying to engage them.
Another story comes from a book with beautiful pictures that can be shown around, The Creation Story, by James Weldon Johnson. You can find this in the children’s section of the library, yet the story is for all ages, for it is, after all, the story of creation. It is told from an African-American point of view with images of a southern landscape. God expresses a full range of emotions, and new life is introduced on each page. I have done a half hour telling of this story using rhythm instruments–drum, bells, triangle, singing bowl, simple wooden flute–and puppets, stuffed animals, masks, colored cloth as the image of the rising sun, foil covered crescent as the moon. You can have the residents do as much of this as possible. They can hold the cloth as we wave it to bring up the sun. They can move the puppets and stuffed animals to ‘come alive’ on their day of creation. You toss the yellow ball as the sun, and they toss it back to you or others. You have them repeat the refrain: “And it was good”; and “God saw that it was good.” It works and can be amazing that when you tell a story or create an imaginary situation, people often feel freer to express themselves.
Poetry is its own world of drama, metaphor, succinct meaning and a place to project one’s own self. Again, the exact poems used will depend on who’s in your group. Emily Dickinson has written poems about loss and loneliness. Robert Frost writes about the life cycle, particularly aging. His poem, “Birches”, is an amazing treatise on a boy becoming a man who remembers his days as a boy when he swung on a birch tree that he is now using to make his final climb to Heaven. This then opens the door to talking about trees as a metaphor for ourselves: our traditions and ancestors–our roots, how we have grown–our trunk, our families and friends–our branches, our creative productions–our leaves and fruit.
Quite a discussion can be had by asking people what kind of tree they see themselves as, (20) or a particular tree they remember from their life and why they liked it so. You can use Yoga postures to emulate our bodies like trees.
Other useful poems have been: Carl Sandburg, “November Nocturne”, “The Last Star”, “Moon Dance”; Edna St. Vincent Millay–“God’s World”, “When the Year Grows Old”; and Haikus by Jack Kerouac. Judith Viorst has written humorous poems about aging, When I Am Seventy.
Many types of dance can be used–ballroom, ballet, folk, square, modern. Ballroom dance had a heyday in the 1940’s when many seniors were growing up. Ask about their favorite dances, where and when they did them, who they danced with, who the bandleaders were, etc. You will help re-stimulate relationships and good times. For those who can stand, you can hold onto each other and, at least, keep up the beat and maybe do a few steps. For those sitting, stay with the beat and arm movements.
Bring in props, like feather boas for extra glamour, a red matador scarf for the tango, maracas for the cha cha. For ballet, you can talk about Tchaikovsky or whomever wrote the music and set the scene of the ballet story. Residents, yes, even men, will respond to the dignity and sustained grace of ballet. It elevates everyone. A Greek line dance can be done with a long rope tied of colorful rags. They each hold on while you change the movements, push and pull, rolling, up and down, side to side.
Square dancing is fun. Push four chairs into a square, partners facing each other. You may have four or five such squares in the room. Give each set of partners a blue or gold scarf. Give the other set of partners in the same square the other color. This is so you can say – “Now all blues wave a scarf; all golds bring it overhead…” Any Appalachian or Smoky mountain music is good, lively, upbeat. Begin by bowing head to partner, then to corner. Pick up scarf and shake your hands. Now all four hold edge of scarf to make a circle. Move to left or right. Wave scarf over your own head. Improvise.
The Hula is a great dance for all levels. Buy plastic leis from the dollar store. Have each person pick their favorite color to wear around the neck. Introduce the Hula as a dance that uses our hands to tell a story. Ask or tell them where the Hula takes place–on an island in warm weather. Ask how the ocean would move and make waves with hands. What would people do in the ocean? Do swimming motions varying types of strokes, dive for fish, row a boat, etc. What (21) do people do when they get hungry? Climb a palm tree, use hands to claw your way to the top. Pick a coconut and throw it down to the ground to smash it. Slurp up the milk. Where do they live? In a hut; make outline with your hands. Keep asking what they would add to the story. Do this once as a rehearsal. Then repeat “Hula Hands” and do it all the way through. They’ll like the idea of telling a whole story. It’s fun and gives a sense of accomplishment.
Literally, any dance can be adapted to any level of ability. The Salsa is done with maracas and shoulders moving forward and back, up and down. A Middle Eastern sounding Israeli folk dance, “Zemer Atik”, is done with elbows folded and legs kicking, then touching feet to side, front and back, then hands on hips and stomping with feet. Find the intrinsic beat and basic mood of the dance, then interpret this in the simplest way first, adding complexity as you gauge people’s interest and aptitude.
The Charleston is a lot of fun. People remember this even if they were only five at the time. As leader, you can stand and demonstrate. Certainly, feather boas are good here (actually, they’re some synthetic version these days). I’ve gotten mine at $15 from vintage shops and cheaper ones from the dollar store.
Wrap each person in one around their neck and show how they look in a mirror. Glamorous, no? In doing the dance while sitting, they can hold onto one another creating a chain. They do the dance by moving hands up and side to side tapping with feet out and back. Black Bottom is a similar dance.
Reggae music, which may be unfamiliar to most residents, is very good for loosening up body parts, and people then tend to like its easy beat. Dance music can be used from any of the cultures of the residents: Poland and Germany–polka, Austria–waltz, Italy–Tarantella, Mexico– Mexican Hat Dance, etc.
HOLIDAY CELEBRATIONS
Holiday themes are tried and true ways to relate to residents. Most people have some recollection of Christmas, Thanksgiving, Easter, July Fourth. In Jewish settings, we use the New Year and Passover. Obviously, holidays offer a range of meanings, and loss can be a central theme. So the celebration may wind up being bittersweet. With recreating the highlights of the tradition, you want to allow time to vent the losses. This is not a pity session, but can be (22) therapeutic because it winds up validating where the person is at, rather than having to put on a sincere happy face.
For example, for Thanksgiving with an assisted living Alzheimer’s group, we did “Head, Shoulders, Knees and Toes” to develop a four count beat. This was familiar to people. Then they tapped their own hand, then neighbor’s hand, saying “1–2–3–4, what do we have to be thankful for? Then we took the four counts into wider, slower stretching and deep breathing, stretching up and out, using all body parts. Then we used slower music with the rag rope, still saying: “1–2–3–4, what do we have to be thankful for?” Each person was asked what she was thankful for and then created images: “I am thankful for my health”–take a big breath and stretch arms upward; “I am thankful for my husband”–make shoulders straight and tall as husband would stand or clasp hands over heart; “I am thankful for my children”–rock arms like rocking baby, etc. Then we used melody of “Kumbaya” to do a dance with these images. “We are thankful for our health” and stretch arms upward; “We are thankful for our children”, etc.
Another possibility would be remembering past Thanksgivings and what people made to eat, specific recipes, then enacting those through movement – i.e. cutting up vegetables and bread cubes, mixing them together, stuffing the turkey, sewing the turkey, putting turkey into oven, carving turkey, making wish, breaking wishbone. This combination of moving and talking and invoking smells and flavors has more of a chance of inspiring reminiscence.
Christmas is the time to hand out jingle bells and listen to recorded songs that have a familiar ring to them and thus may inspire some singing. It is comforting to hear and say repeated words whether or not one is really sure of their actual meaning. A soft white ball can be bought or a white scarf tied around an existing ball, and voila – a snowball is born for tossing and getting to say the name of whomever receives the ball. Snowflakes cut from regular typing paper can have holes punched and yarn tied in that is then tied around one’s wrist, and by moving hands, the snowflakes get to dance.
A technique used for Christmas, Easter or birthdays is to pantomime gift giving. The leader can create a gift with her hands. Do stereotypical movements like clasping elbows and rocking, then giving the next person your ‘gift’, a baby. Another idea is to flap one’s arms and to give a bird. Or putting hands over your heart, then giving that away. People will get the message, and they may continue to imitate you rather than create their own gifts, but that is (23) alright. They still get to feel special and remembered when someone gives them a gift.
For Easter, you can focus on the uplift of pastel spring colors by getting six or eight long pieces of ribbon, about 10 or 12 feet across. Sew elastic wrists at each end. Give people seated across from one another in circle either end of the ribbon. Now the colors should all be criss crossed. You can ask them to “have the colors dance” while you play music like Handel’s “Easter Oratorio.” Also, it is the time to hand out colored plastic Easter eggs, each holding several dry beans inside, for a maraca effect when shaken to music.
Memorial Day is the time to hand out small flags and to discuss people’s involvement in WWII or beyond. Almost everyone had some relative involved in the war, and/or they may have been involved in the war effort on the home front. You may also show photos of their loved ones. This is a good time to hug people and tell them how much their relative still loves them or how hard they worked during the war and how much it is appreciated. This does not need to be morose as much as poignant and sympathetic.
If you are at a loss for relating to your loved one/resident, you can always just grab a small rubber or jersey or lycra stretch band and sit facing the person and either play some recorded music or create a rhythm with your vocal sound and then pull this band back and forth between you. It will create movement, a rhythm and interaction. You can vary the speed, pull it up, down, around or sideways. All the activity will get their attention, and then you can begin to relate in some of these mentioned ways.
SENSORY TOGETHERNESS
Just sitting and holding someone’s hand can be a world unto itself. You can stroke the hand with your fingertips or a feather. You can push together palm to palm. You can roll a ‘squoosh’ ball or clay (non-toxic) between you. You can talk about the work these hands did in their life. It is a personal contact without crossing an intimate boundary.
Neck rubs and foot rubs also qualify as ways to nurture without becoming invasive. Always ask the person first, or, if they don’t understand, then begin to lightly touch the area and be aware of their response–a flinch, a laugh, a grimace, a relaxed sigh. Then proceed a little further. I have rarely had anyone refuse a massage like this. Most people are so touch deprived, that medical procedures are the only way they get touched at all. (24)
Smells also provoke a reaction. While I have not used aromatherapy per se with vials of exotic oils, I have brought in cloves, cinnamon, floral scents, and people have responded with interest and pleasure. It is said that smell is the sense that most quickly revives the memory. (And I quickly found out that loss of sense of smell is often associated with Alzheimer’s disease.) Having patients smell fresh flowers is a good idea if you are right there with them. As with any sensory object, in this case color and smell, some patients may attempt to put them into their mouth. Also, for patients to put their hands in soil to plant a bulb is good. I’ve had success in filling a bin with brightly colored sand, then burying shells and other surprise objects and having people dip in their hands for discovery. The color and texture can be inviting. Some may recall finding shells on the beach. This can be combined with a water theme that will later be described.
Books with large, colorful pictures, yes, children’s books sometimes, are another spark to recognition. Sometimes the color and shape can inspire movement.
Please remember to get and stay on the patient’s level. Imagine someone standing over while you while you are ensconced in a wheelchair and how intimidated you might feel. Better for you to sit facing them, or often, I get on my knees to be at eye level. And remember your voice. Speak clearly and directly but not too loudly. Never yell, and don’t be shrill. Relax your voice so it sounds warm and inviting.
DANCING ON THE TREE OF LIFE
Some days a particular theme or exercise may not be quite right. But there is a specific quality you would like to introduce into the interaction. The quality may be more lightness or conversely, more of a sense of grounding. It may be more openness and expansion or more of a sense of pulling in and organizing. It may be to add quick energy or to slow down scattered energy. It may be to add a flow to the interaction or to tighten things up a bit.
This is where the Four Elements of Earth, Air, Fire, Water are very useful. Each element is necessary for any life, and each element works best in balance, neither too much nor too little of it. Earth works best when we stay rooted and grounded. Too much Earth element and a person is heavy and stodgy. Too little and they seem to float around with no attachment. To (25) bring Earth into balance, we can begin with a strong beat. Tap a person’s hands or forearms. Use a drum. Say their name counting out the beats. Stomp feet. Help find their own rhythm, how they connect to the earth.
Fire is our life energy. It can be quick and changing, dull and extinguished, or it can burn us up with its intensity. Many Alzheimer’s patients move slowly; others in the middle stage of the disease may be feisty, even combative. It helps to focus their life energy in a satisfying way. For fire, use music with a staccato beat. Movements are flipping wrists, jerking elbows and shoulders. Use maracas and shakers. You can alternate quick movement with a pause and no movement, or you can gradually increase, the decrease the shaking. This brings a sense of self-control and the reality that the person might do something to help manage their own energy.
Water concerns our internal flow, when we feel like we are ‘together’, like everything is working and flowing in our body. Imagine waves undulating, never stopping. Now picture the typical Alzheimer’s patient sitting in a chair most of the day, made more rigid by lack of mobility and sometimes by medications. Think of a snake propelling its body in S-shaped slinking. For Water, use ocean music or a waltz, and a sheer light blue cloth to wave.
Air involves the ability to interact in space with others. An “airhead” is scattered; conversely, someone devoid of air element is self-absorbed. We want to draw the person up and out into relating. Things that help stimulate the senses and connect are good, such as a multi- colored pinwheel to use one’s breath to blow around or the small stretch band as previously described to lift the patient’s arms up and out. Breathe in on the movement, and exhale in the pause. Wave pennants, flags or streamers. Making definite sounds is also good to get the person out of him/herself. Recite all vowels from high to low on scale, encouraging residents to make echoing sounds.
Our spine, extending from tailbone to base of skull was created to move in at least five directions: extending tall, rolling over and compressing, bending laterally side to side, twisting toward the back on either side and bending backwards. The more we can do even hints of these movements everyday, the stronger is our spine health. With some massage through their clothing and by use of various stretch bands and other props, even rigid, wheel chair bound patients can increase their flexibility. (26)
Remember to combine these movements with breathing, and you then begin to create a sense of undulation in the torso. The body parts that get the least exercise in a wheelchair are the hips and buttocks. You can begin to enliven this area by having patients place their hands over their belly. Ask them to breathe into that and imagine inflating a balloon. You may first inflate, then show them a balloon as they do this. Or tell them to make their stomach large like after they have eaten a big meal. Then have them blow the air out of their stomach balloon, or ask them to try to get their stomach flat enough to touch their back. After beginning to stimulate the life energy here, you can then ask them to push their stomach forward from the chair, then to bring it back touching the chair. Now have them rotate their torso in a large circle in either direction. You want to be aware of people with catheters or elimination bags and carefully work around those. And, if you’re able to get an accurate history of the person, find out if there have been any sexual abuse issues and be wary if a patient feels tense or frightened. For those who are able to do these water exercises, it can bring a great sense of freedom and increase positive feeling.
Remember that most of us, even those walking around well, normally have one or more of these elements that could use some rebalancing. Through addressing one or more of these Four Elements, you can begin an active relationship with a patient that may then evolve into an even more personal format.
The suggestions herein should help you get started. Remember the basic outline: Center your own mind and body. Be aware of your body space and level, voice tone and eye contact. Know something of the patient’s likes and dislikes before the onset of illness. Understand any true physical limitations of the patient. Bring along basic props – small stretch band, soft ball, pinwheel, shaker and some music with varying rhythms.
Do not force your agenda. See where the patient’s energy and rhythm is at the moment and begin to work there. Extend it using as much sensory apparatus as possible–voice, eye contact, posture, music, touch, bright colors, pleasing smells, etc. to engage fully. Your moment to moment relationship is much more important than worrying about whether you used the exact right techniques. Patients will pick up if you are tense or bored. Find your own investment in the process and approach it in a playful way.
Again, above all, remember that you are working with a person who happens to have Alzheimer’s disease, not with a disease that happens to belong to a person.
Created and written by: Joyce Wolpert R-DMT, LCPC
Joyce Wolpert is a Licensed Counselor and Expressive Arts Therapist.
Joyce Wolpert, LCPC, R-DMT
Licensed Counselor, Expressive Arts Therapist
410 358-0977 – JBDance8@yahoo.com
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Joyce, what a thoughtful and comprehensive piece. I wish I knew you during the years my dad suffered with dementia.