2. REALIZE It Takes TWO to Tango or tangle 3. Learn to Dance
with Your Partner 4. When Something Is Not Working Well What Do We
Tend toDo? 5. Being right doesntnecessarily translate into agood
outcome for both OReither of you 6. Deciding to change yourapproach
and behavior WILL REQUIRE youto stay alert and make choices it is
WORK 7. Its the relationship that isMOST critical NOT the outcome
of one encounter 8. Who Are YOURChallenging People? Who Challenges
YOU? 9. What are the ChallengingBehaviors thatGET TO YOU? 10. What
Are the Most Common IssuesThat Come Up??? Not going to the MD
Eloping or Wandering Losing Important Things No solid sleep time
Getting Lost Getting into things Unsafe task performance
Threatening caregivers Repeated calls & Undressingcontacts
Being rude Refusing Feeling sick Bad mouthing you to Striking out
at othersothers Falls & injuries Making up stories Infections
& pneumonias Resisting care Seeing things & people Swearing
& cursing Not eating or drinking Making 911 calls Contractures
& immobility Mixing day & night Shadowing 11. By managing
your ownbehavior, actions, words &reactions you can change
theoutcome of an interaction. 12. REALLY Ask YourselfIs this
Behavior a Problem BehaviorOR is this a So What Behavior An
Annoying Behavior 13. Is it REALLY a Problem?Is it a RISKY
BEHAVIOR? Risk to that person (physical, emotional,physiological
risk)? Risk to the caregiver? Risk to Others? Is the RISK REAL and
IMMEDIATE? If NOT, it is a SO WHAT behavior 14. If it is a SO WHAT
Behavior Leave it ALONE! Figure out how to let go of it Let it go!
15. If it is RISKY Describe the behavior OBJECTIVELY WHO? WHAT?
WHERE? WHEN? WHAT helps WHAT makes it worse? Frequency &
Intensity? 16. SIX Pieces to the Puzzle Personal history and
preferences Type & current level of cognitive loss Other
conditions & sensory losses Environmental conditions Care
partner approach and behaviors What happened full day & all
players 17. Knowing the Person History Values and beliefs Habits
and routines Personality and stress behaviors Work & family
history Leisure and spiritual history Hot buttons & comforts
18. Level of Cognitive Function What CAN the person do?What can the
person NOT do?What CUES are effective? Ineffective? What are
interests based on level?Consistency of Cognitive Level? 19. The
persons brain is dying 20. NormalBrain AlzheimersBrain 21. Positron
Emission Tomography (PET) Alzheimers Disease Progression vs. Normal
Brains Early Late NormalAlzheimers Alzheimers ChildG. Small, UCLA
School of Medicine. 22. So what is happening? Memory damage
Language damage Cant learn new things Has very concrete Forgets
immediate past understanding of words Does time & space travel
Misses 1 our of 4 words Uses old memories like new may miss Dont
May not ID self or others Word finding problemscorrectly Word salad
problems CONFABULATES COVERS Follows visual cues Follows your cues
Seeks out the familiar Gets very vague & repeats Can get stuck
on an old Uses automatic responsesemotional memory track Mis-speaks
23. So what is happening? Impulse Control Problems Performance
Problems Say whatever they are Thinks they can do better
thinkingthan they can Swear easily Can sometimes DO Use sex words
or racial slurs BETTER under pressure when stressed sometimes worse
Act impulsively Uses old habits Not think thru consequences
Attempts can be dangerous Cant hold back on thoughts or fatal or
actions They will tell you one thing Responds quickly &
strongly and then do another to perceived threats Families may over
or under Flight, fight, fright limit activities 24. How do these
losses relate to some risky behaviors? Persistent going Lost and
Looking inability to terminate cant find places not able to
anything else looking for familiar discomfort Invading space
Eloping - escaping automatic actions following cues following
interests & habits wanting to leave no awareness of
personalspace going somewhere Shadowing Constant talking or looking
for helpvocalizing Comfort Trying to communicate Resisting care
Self-stimulating Self-care Lack of Initiation Movement Wont move or
cooperate 25. Diamonds - Routines & RepeatsACL 5 Word finding
problems Becomes anxious and Logic problemsfrustrated easily Place
& time confusion Has trouble with new Very independent or
routines and locationsseeking constant Tries to maintain control
&reassurance social behavior Resents take-over May try to
escape/leave Self-awareness varies Can use signage & cues
Fearful about what is Gets turned aroundwrong Momentarily
disoriented Typically resists outside Does regular routines
JUSThelpers FINE! 26. Emeralds- Task OrientedACL 4 Has trouble
sequencing Uses visual information tothru tasks & activities
figure out what to do Often skips steps Follows samples & demos
Looking for what to do Cant do an activity if visualand where to be
prompt is not there Believes they can do it Specifics and content
in Dont need your helpspeech can be limited Has a mission in mind
Gets stuck on stuff Goes back in time Needs to be involved Gets
lost in place Looks for stuff to do 27. Ambers- Hunting &
Gathering ACL 3 Uses hands to touch, Imitates actions copies
youfeel, handle, hold Tool use is challenging Explores what is
visible Follows othersand hidden Investigates the environment
Invade others space to May taste or eat what theyexploresee
Difficulty terminating Repeats actions overand over Difficulty
getting focused on care tasks Sees in pieces not whole Becomes
easily distressed Impulsive or indecisivewith unpleasant tasks
Understands few words Asks ?s mechanically 28. Rubies - Stuck on GO
ACL 2 Gross motor only Cant stop or sound Poor finger use asleep
Limited visual processing Copies your mood Very limitedfacial
expressionscommunication skills Cant grade strength Unable to do
more Better with rhythm andcomplex motor actions repetitive
movements Imitates those around Loses weight Problems with chewing
On the move wandersand swallowingforward no safetyawareness 29.
Pearls Reflexes Rule ACL 1 Bed bound or chair bound Swallowing and
eating Unable to sit up for any problemslength of time Muscles
shorten and Unable to communicatecontractures formsverbally
Pressure areas develop Lots of reflexes because of no movement
Breathing changes& limited intake Moments of being Responds to
touch, voice,presentmovement, smells Can make eye contact &
Startles easilysome automatic Motor agitation
indicatesresponsesneeds 30. Health & Illness Mobility problems?
Pain? Sensory problems? Mental health issues? Other diagnoses of
importance? 31. Comparison of Fat Pads 32. Environmental Factors
& Changes Physical Environment People Programming 33.
Environmental Aids Setting familiar friendly functional forgiving
(safe) 34. Environmental Aids Props visible & invisible timely
available matched to ability matched to interests 35. Care Partner
ApproachKnowledge Skills 36. Three Reasons to Communicate Get
something DONE Have a conversation Help with distress 37.
Communication Getting the person to DO SomethingForm a relationship
FIRST Then Work on Task Attempt 38. Connect 1st Visually 2nd
Verbally 3rd Physically 4th Emotionally 5th Individually -
Spiritually 39. How you help Sight or Visual cues Verbal or
Auditory cues Touch or Tactile cues 40. To Connect Use the
PositivePhysical Approach 41. Your Approach Use a consistent
positive physicalapproach pause at edge of public space approach
within visual range approach slowly offer your hand & make eye
contact call the person by name stand to the side to communicate
respect intimate space wait for a response 42. Hand-Under-Hand
Position 43. Your interaction Communicate with awareness look,
listen, think! give your name make an empathetic observational
statement You look busy... It looks like you are tired It sounds
like you are upset wait for a response 44. Give information Keep it
short and simple Its lunch time Lets go this way Heres your socks
Use familiar words and phrases Use gestures and props to help 45.
Encourage Engagement ask a person to try use props or objects ask a
person to help gestureyou demonstrate give simple positive
guidedirections - 1 step at a distracttime redirect 46. Daily
Routines &Client-Centered Programming Old habits and routines
Patterns during the 24 hrs A time to rest, work, playsocialize Your
needs my time 47. To Cope with ChallengingBehaviors Where will you
start??? An idea Care partner education Care partner skill building
48. Then Observe & document the risky behaviorthoroughly what
is the pattern when does it happen where does it happen who is
involved what is said, done, attempted what makes it better worse
49. Is it really a problem? A RISK If NO - leave it alone If YES -
its time to problem solve call the team together put on the
thinking caps 50. REMEMBER Explore all of the following - Personal
background information Type & Level of cognitive function
Health information Environmental issues Caregiver approach &
assistance Habits, schedules & time of day 51. Re-look at the
problematicchallenging behavior What does the person need? What is
the meaning of the the behavior? Do you understand the risky
behavior better? 52. Make a PLAN! Who will do what When will it be
done How will it work What environmental change is needed What
props are needed - where will theybe 53. Implement your plan! Keep
track of progress Document what is happening Communicate among the
team members Rethink - if it isnt working. CELEBRATE - if it is!
54. How can we help better? It all starts with your approach! 55.
How you help Sight or Visual cues Verbal or Auditory cues Touch or
Tactile cues 56. What Do They Do? Question Refuse Release verbal
Intimidate physical Tension reduction 57. What Should You Do? Be
supportive Offer choices & be directive Set realistic limits
Act Take control Re-connect 58. Believe -People Are doingThe BEST
they can! 59. What shouldnt we do??? Argue Make up stuff that is
NOT true Ignore problem behaviors Try a possible solution only once
Give up Let them do whatever they want to Force them to do it 60.
So WHAT should we do???Rememberwho has the healthy brain!
