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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Welcome“It’s all about You”
Provincial Long Term & Continuing Care Conference
May 14, 2019
Charleen Phelps, R.N. Teepa Snow, Positive
Approach, LLC
Gems®
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Seeing more than loss
The Living Gems®
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..
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What is
Dementia?
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The person’s brain is dying
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Four Truths About Dementia
1. At least 2 parts of the brain are dying
2. It is chronic and can’t be fixed3. It is progressive and will get worse4. It is terminal
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only with permission
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Tab 1
Page 6
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How we Take in Information
1. What you see
2. What you hear
3. What you feel/ touch
4. What you smell
5. What you taste
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How We Give Information
Visual – How we look
Verbal – What we say
Touch - What we do
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Visual Cue Options:
Signs
Pictures
Props or Objects
Gestures
Facial Expressions
Demonstrations
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Normal Brain Brain with Alzheimers
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Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains
G. Small, UCLA School of Medicine.
Primitive
Brain
Primitive
Brain
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Primitive Brain is in Charge of:•Survival:
•Autonomic protective – fright, flight, fight + hide or seek•Pleasure seeking – meeting survival needs and finding joy
•Thriving – Running the Engine:•Maintain vital systems: BP, BS, O2sat, Temp, pain•Breathe, suck, swallow, digest, void, defecate•Circadian rhythm• Infection control
•Learning New and Remembering:• Information •Places: spatial orientation•Passage of Time: Time awareness
Tab 1
Page 10
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HippocampusBIG CHANGE
Learning & Memory Center• Way finding• Learning &
Memory• Time Awarness
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Amygdalae:
Dangerous Need
Risky Want
Dislike Alert/Aware Like
Tab 1
Page 10
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• Impulse Control• Be Logical• Make Choices• Start-Sequence-
Complete-Move On
• Self Awareness• See Others’
Point of View
LeftRight
LeftRight
Executive
Control
Center
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Vision Center – BIG CHANGES
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1. Less Peripheral Awareness
2. Tunnel Vision
3. Binocular Vision
4. Object to Use Confusion
5. Monocular Vision
6. Limited Visual Regard
Changes in Visual RegardWith each new level of vision change, there is a
decrease in safety awareness.
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Understanding Language – BIG CHANGE
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Hearing Sound – Not Changed
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Sensory StripMotor Strip
White Matter Connections
BIG CHANGES
Formal Speech & Language
CenterHUGE CHANGES
Automatic Speech
Rhythm – Music
Expletives
PRESERVED
LeftRight
LeftRight
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Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains
G. Small, UCLA School of Medicine.
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Progression of Dementia
Alzheimer scale: Early - Middle - Late
Global Deterioration Scale 1 - 7
Allen Cognitive Levels 0 - 6
The Gems®
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Seeing more than loss
The Living Gems®
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A Positive Framework…seeing GEMS
Sapphires – True Blue – Slower BUT Fine
Diamonds – Repeats & Routines, Cutting
Emeralds – Going – Time Travel – Where?
Ambers – In the moment - Sensations
Rubies – Stop & Go – No Fine Control
Pearls – Hidden in a Shell - Immobile
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Dynamic Assessment
Visual regard
Ability to speak and understand
Skill in movement
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•True Blue
•Optimal Cognition,
•Healthy Brain
Sapphires
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Sapphire
True Blue
•Optimal Cognition Aging normally
•Slowing down: needs more time to process
•True to self: likes/dislikes are same
•Able to learn: takes practice
•Stress, fatigue or pain can induce Diamond moments
•Time to recharge or heal can restore to Sapphire
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Clear and Sharp
Routines and Rituals Rule
Diamonds
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Diamond
Clear and Sharp
•Routines and Rituals Rule: likes familiar•May resist change or won’t let things go•Rigid under pressure: limited perspective•Becoming protective: may be territorial•Repeats self: hard to integrate new information•Can cover mistakes in social interaction•Symptoms may or may not be dementia related
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Emeralds
Green and
On the Go with a Purpose
Naturally Flawed
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Emerald
•Green and On the Go with a Purpose
•Naturally Flawed
•Desires independence: noticeable ability change
•Vocabulary and comprehension diminishing
•Communication becoming vague
•May neglect personal care routines
•On the go: needs guidance and structure
•Difficulty finding way to and from places
•May be lost in time
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Ambers
•Caught in a Moment of Time
•Caution Required
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Amber
Caught in a Moment of Time
•Caution Required
•Focused on sensation
•Will react to how things: look, sound, feel, smell or taste
•Lives in the moment: not socially aware
•No safety awareness: typically very busy
•Difficulty understanding and expressing needs
•No ability to delay needs or wants
•Needs help with tasks: may resist
•Hard to connect with: may exhaust care partners
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Rubies
Deep and Strong
Others Stop Seeing What
Is Possible
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Rubies •Deep and Strong
•Others stop seeing what is Possible
•Retains rhythm: can sing, hum, pray, sway and dance
•Understands expressions and tone of voice
•Losing ability to understand language
•Limited skill in mouth, eyes, fingers, and feet
•Can mimic big movements: gross motor abilities
•Loss of depth perception; monocular vision
•Falls prevalent: can only move forward
•Care Partners will have to anticipate unmet needs
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Pearls
•Hidden Within a Shell
•Beautiful Moments to Behold
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Pearls
Hidden Within a Shell
•Person is still there
•Moments of connection take time and will be short
•Knows familiar: unmet needs may cause distress
•Unable to move by themselves: fetal position, still and quiet
•Primitive reflexes have taken over: difficulty swallowing
•Brain failure shuts down body: diminishes need too eat or drink
•Care Partners need to give permission to let go
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What to Do!?
Go with the flow
Use Supportive Communication techniques
Avoid reality orientation
Use objects and the environment as cues
Apologize
Use gestures and pointing
Acknowledge and accept their emotions
Use empathy and validation
Use familiar phrases or known interests
Respect values and beliefs
Be where they are in the moment
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The LIVING GEMS®
Progression of the Condition
To the tune of This Old Man
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SAPPHIRE true, you and me
The choice is ours, and we are free
To change our habits, to read, and think and do
We’re flexible, we think it through!
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DIAMOND bright, share with me
Right before, where I can be
I need routine and different things to do
Don’t forget, I get to choose!
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EMERALD – go, I like to do
I make mistakes, but I am through!
Show me only one step at a time
Break it down and I’ll be fine!
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AMBER – HEY!, I touch and feel
I work my fingers - rarely still
I can do things, if I copy you
What I need is what I do!
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RUBY – skill – it just won’t go
Changing something must go slow
Use your body to show me what you need
Guide, don’t force me. Don’t use speed!
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Now a PEARL, I’m near the end
But I still feel things through my skin
Keep your handling always firm and slow
Use your voice to calm my soul.
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“It’s the set of the sail and not the gale that determines our
direction!”
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THANK YOU!
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