Friday, October 30, 2009

Salem State College Course for Caregivers

I am scheduled to teach this course at Salem State College.
However, it may be canceled due to low enrollment. Please pass this information to anyone whom you think would benefit.
Course Title:
Alzheimer's: A Caregiver's Journey
Course Number: NCHR 314
Where: Salem State College
When: Saturday, November 14, 2009 from 9:00 a.m. to 1:00 p.m.
Call for information; (978) 542-6000

The focus of this session is to share information and provide support for those who are dealing with this disease. You will learn how to relate to the Alzheimer's victim in meaningful and enjoyable ways. Topics will include: Normal memory loss, chooing an adult day care center, home care services or residential facility, legal considerations, ways to integrate cultural identity into the victim's life and care for the caregiver. Related information and resources are provided in the instructor's book and on her web site at: You will leave this class with a copy of the book: Still Giving Kisses: A guide to Helping and Enjoying the Alzheimer's Victim You Love as well as an understanding of how Alzheimer's disease is diagnosed, its progression and ideas on how to help the person maintain independence and functional skills, as well as many handouts.

Birdwatching with the Alzheimer's Patient

I love this video. It shows how a daughter took a simple and familiar activity that her mother always enjoyed and was able to continue to offer it with some adaptations as they picnicked in the car, watching birds. We all have histories of favorite recreational past times that can be incorporated into activities that are shared and enjoyed with loved ones.

Wednesday, October 28, 2009

Occupational Therapy with Clients with Dementia

This week's Practice magazine from the American Occupational Therapy Association has a good article titled Occupational therapy for Clients with Dementia. Monica Heltemes describes the role of OT's in assisted living facilities- since AL is such a fast growing long- term care option for seniors. Residents with dementia and psychiatric disorders are common in ALFs. My mom moved into an ALF with a memory impairmment side when she was in the early stges of Alzheimer's disease. According to the author, the role of OT's is to:
  • Perform an evaluation including the Allen cognitive Assessment
  • Identify the best ability to function
  • Create a plan to maximize and maintain function and safety
  • Analyze the triggers of behavior issues and implement strategies to minimize them.
  • Provide caregiver education
  • Provide recommendations regarding the client's driving status
OT services for persons with dementia are covered by Medicare and this may include determining the need for and training to use assistive devices. Heltemes recommends use of the Cognitive Performance Test (CPT).
The article goes on to describe treatment interventions and gives case studies. I was lucky that the staff of the ALF where my mom lived was fantastic at addressing all of these needs. However, it was when she moved int a nursing home - when OT input would have been extremely valuable in addressing her emotional, sensory and behavioral needs during the late stages of the disease. The only therapeutic input I observed was when I complained about her positioning in a recliner where her feet and arms were often hanging off the sides and to evaluate dining and food texture needs.

Tuesday, October 27, 2009

Roller Skating is Great for the Brain and Body

I skate Tuesday mornings in an all adult session with people who are are on the older side 60-70 years of age, a few in their 80's and few younger than 50. I am right there in the middle at age 55 and just started dance skating five years ago. I loved skating around the block when I was a little kid with those clumsy metal skates that fit over my shoes and the key that tightened them in place. But skating around the block was about all I did.
Learning a new motor skill such as roller skating really keeps the brain working. I used to fall a lot, like every couple of minutes- its just part of the learning. I wear knee pads and wrist guards since I fall on those body parts the most. Skating is not for everyone but I like how it makes me feel like I am back in the 60's buggying at a rock concert. I hope that wherever I am living when I reach my 80's- they play the Beatles.

Yoga and the Elderly

Paying for a yoga class would be a wonderful holiday gift to give any loved one but especially an older relative. Yoga contributes to healthy bones, balance, mental health and overall strength and flexibility.
There are lots of books available on this topic. I like this one because it has chapters on arthritis, hip replacement surgery, Parkinson's disease, healthy hears and memory impairment.

I also like Peggy Gardiner's book Yoga at the Kitchen Sink. Written from an occupational therapist's perspective. More information at:
Here is a good laught!

Monday, October 26, 2009

Visual Stimulation and Alzheimer's Disease

During the early stages when my mother was becoming less active and less able to hold a conversation- she still enjoyed looking at photographs, watching videos of her favorite musicals such as Fiddler on the Roof and looking at interesting visual objects such as an aquarium.
As the disease progressed-she was unable to enjoy actually looking at objects because she had her eyes closed more and more. Whatever she did look at, I needed to hold in front of her face and encourage her to open her eyes. However, when she was still able to look around her nursing home room, I bought and positioned an artificial aquarium near her bed. She enjoyed that for a while until she stopped attending to nearby objects. This fake aquarium is electric and has moving bubbles and fish. I bought mine at CVS for about 12 dollars.

Between now and New Years I am going to focus on objects, services and activities that one might purchase or provide as a holiday gift for a person with memory impairment. If you have one that you find particularly useful-please describe it on my blog.
FYI, I just saw the movie Julie and Julia, loved it and just like the character Julia-would love to know if anyone in the blogosphere is reading this.

Saturday, October 24, 2009

Another Country: Navigating the Emotional Terrain of Our Elders

I am reading Another Country; Navigating the Emotional Terrain of our Elders by Mary Pipher. I had heard of her before when she wrote the book about daughters. But since I only have a son did not give her books much thought. Another Country was mentioned in an occupational therapy article and was published in 1999, so as usual I am behind the times. I thought that it would be really depressing, but she is such a good writer that I am able read a little bit each day and think about her ideas.

Mary Pipher points out how each generation differs in values and ways of thinking and that baby boomers became all me me me whereas the World War II generation was forced to accept poverty, be willing to compromise and create their own fun rather than depend on the television. Actually I like the change that came with educational and career options for women and the fact that I didn't have the full time job of caring for my mother when she had alzheimer's disease for 8 years.
But I do wish I had the support of a large family instead of being the only one in my mother's life who loved her. My sister lived far away and like so many adult children couldn't cope with the dementia and avoided interacting with her.
Right now I am reading about how the generations view "dependency " differently. These days people are ashamed to be "dependent". In the past it was a way of life for family to care for a dependent. I'll keep you posted as I learn more about that other "country" which is what Pipher calls being old old, the state of being ill and dependent- which even healthy people in their 60's and 70's can imagine but not truly understand.

Wednesday, October 21, 2009

Allen Cognitive Levels

Occupational therapists evaluate patients with memory loss to determine what cognitive level they are functioning at. This helps in planning the patient's level of support and what settings his needs can best be met. The Allen Cognitive Levels Screen is commonly used to do this. The screen consists of learning three visual-motor tasks (leather-lacing stitches) with increasingly complex activity demands. Completion of the three tasks requires that the person attend to, understand, and use sensory and motor cues from the material objects (leather, lace, and needles), the administrator’s verbal and demonstrated instructions and cues, and feedback from motor actions while making the stitches.

The occupational therapy students in the following video will give you an idea of how the screening is performed.

Monday, October 19, 2009

Creative Alternatives

Here is an article in Advance for Occupational Therapists that I think has some very clever, inexpensive and creative ideas of interest to home health occupationa therapists:
Creative Alternatives, Part 2

Sunday, October 18, 2009

Saturday, October 17, 2009

Low Vision Occupational Therapy

Occupational therapists are trained to work with patients who have low vision. These patients are usually elderly and commonly diagnosed with macular degeneration and glaucoma, although patients with other diagnosis such as diabetic retinopathy also benefit from low vision occupational therapy.
People with low vision have limitations that cannot be corrected with standard eye glasses or contact lenses. In the United States low vision is commonly considered 20/70 or worse in the better eye with best correction or have a decreased visual field that impacts function.

I work for the agency Visions of Independence (in Massachusetts and surrounding areas) providing home care to low vision patients. The goal is to help patients be as independent as possible and just a few of my job duties are to provide:

  • A home safety assessment to make the environment safer
  • Adaptations with touch and visual cues such as tactile bumps to feel settings on an oven or bold lined paper to make writing easier.
  • Assistance in using low vision glasses, magnifiers and techniques to make reading and writing easier
  • Ways to adapt the environment to decrease glare and increase color contrast
Services are paid for by Medicare after a doctor's referral. For more information, please visit the Visions of Independence web site or contact the owner Eliot Feldman at (781) 784-3320 or email :
As an occupational therapist doing low vision work I found the following text book to be most helpful. Also, please check out the information and many resources on my web site at:

Thursday, October 15, 2009

One of the most helpful books I read when first learning about Alzheimer's disease was "Your Name is Hughes Hannibal Shanks by Lela Shanks. I really learned a lot about not only what it is like to be the spouse of a person with memory impairment but how optimistic, creative and clever a caregiver can be when rising to the occasion. I particularly appreciated the author's adaptations to her husband's clothing and the environment to make life easier for both of them, how she handled behavioral issues and the video she made to help her husband remember his past.

Lela Shanks was kind enough to write the foreword to my book: Still Giving Kisses: A Guide to Helping and Enjoying the Alzheimer's Victim You Love. She is an inspiration.

Tuesday, October 13, 2009

Health Care Reform

Older people have a lot at stake with health care reform and the AARP is working hard to improve access, dispel myths and make health care affordable. Here is their list of Myths Vs Facts.
In the November/December AARP magazine , president Jennie Chin Hansen explains that a House bill provision would allow Medicare to pay doctors for voluntary counseling sessions. This counseling would include getting information about living wills, named a friend or relative you trust as your health care proxy and learning about he benefits offered by hospice care.
I wish someone had told me about hospice when mom was in the nursing home. I only found out because I happened to see a Rabbi walking around (an unusual event) and I asked him what he was doing there. He was there providing counseling and some of his patients had Alzheimer's disease. Once I joined the program the Rabbi visited, held her hand, sang to her. A specially trained and loving aide dressed, fed and did activities with mom for 2 hours a day. A special nurse recommended no more blood drawn to test the Depacote toxicity levels (which could be judged based on her behavior). Mom hated those needles that made her agitated.
Now here is an interesting story about the Death Panels myth.
Catchy phrase isn't it.......

Animal-Assisted Therapies

Animal assisted therapies may involve many different types of animals including- dogs, cats, bunnies, horses, llamas and even elephants. It is well documented that nursing home residents perk up and alzheimer's patients receive wonderful sensory stimulation from small, specially trained animals. These animals typically receive many months of training. Some prisons have instituted rehabilitation programs that involve prisoners caring for and training the animals. Read more about animal assisted therapies at this link:
If your are in the Massachusetts area check out Animal Assisted Interventions, a resource for consultation, education and therapy services.

Isn't this tooooo cute!

Monday, October 12, 2009

Adorable Photographs of Our Baby

As individuals with memory loss gradually lose the ability to read, looking at familiar and easy to interpret photographs becomes an increasingful enjoyable and important recreational activity. The simple pictures on the following page can be printed, inserted inside page protectors and used to make a book with a 3 ring binder. Some individuals will be able to read the simple large print captions; whereas, other may benefit more from a 2-3 word title written below each picture to identify what it is.
Home Made Picture book
Susan Berg's boook Adorable Photographs of Our Baby makes looking at simple photographs fun and easy. Berg is an occupational therapist and activities director in a nursing home and used her expertise to create a book that can be used by staff and family members to stimulate the patient with memory impairment. Her book includes:
  • Tips on how to relate to someone with memory impairment
  • Suggestions on how to use the photographs as part of games, to stimulate conversation and calm a person down
  • Ways to use the photographs in an activity group
Learn more about this book and Susan Berg's work at: Alzheimer's Ideas

Sunday, October 11, 2009

Music and Movement for Dementia Patients

I found that my mother responded to music and could sing long after losing the ability to speak or understand questions. The songs from the World War II era that she grew up seemed to be retained in her long term memory the best. I compiled a list of large print song into a book, fitting them into page protectors inside a 3 ring binder. You can print out 28 songs from my web site at:
During the early stages of the disease my mom was able to read these lyrics and sing independently. Later on I prompted her by singing most of the songs and letting her complete familiar phrases such as "Let me call you (Sweetheart)."
Eventually, I did all the singing but she shook a tambourine or I helped her to shake it and I set up her CD player to repeat her favorite songs. Here is another site with songs to print:

Saturday, October 10, 2009

Still Alice

I recently learned of and read the book Still Alice although it has been a best seller for several months. I can see why the book rose so quickly in popularity. It is very eloquently written, offering a realistic (quite the challenge, I think) look into the interior world of a 50 year old brilliant Harvard professor who has early onset Alzheimer's disease.
Please check out my Amazon review
I was so moved by this book- I joined the Still Alive forum.

I will be adding lots more links to this blog over time. Please share any thoughts if you have read Still Alice. As an occupational therapist, I feel that the character could have greatly benefited from OT services that could have included a great deal of environmental adaptations and patient education. But as the book stood, the reader develops an increasing urgency and awareness of Alice's suffering precisely because not only was the loss of cognitive ability devastating but no professional was there to guide, support and educate.