PAC Champion 3 - teepasnow.com
Transcript of PAC Champion 3 - teepasnow.com
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
PAC Champion 3Building Skills to Adapt our Approach!
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Global Deterioration Scale- 1 – No cognitive decline
- 2 – Very mild cognitive decline
- (Age Associated Memory Impairment)
- 3 – Mild cognitive decline
- (Mild Cognitive Impairment)
- 4 – Moderate cognitive decline
- (Mild Dementia)
- 5 – Moderately severe cognitive decline
- (Moderate Dementia)
- 6 – Severe cognitive decline
- (Moderately Severe Dementia)
- 7 – Very severe cognitive decline
- (Severe Dementia)
- So what can they do? The scale doesn’t address that?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
GEM® Dementia Abilities Based on Allen Cognitive Levels
•A Cognitive Disability Theory – OT based
•Creates a common language and approach to providing: Environmental support
Caregiver support and cueing strategies
Expectations for retained ability and lost skill
Promotes graded task modification
•Each Gem state requires a special ‘setting’ and ‘just right’careVisual, verbal, touch communication cues
•Each can shine
•Encourages in the moment assessment of ability and needAccounts for chemistry as well as structure change
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The GEMS®…
Sapphires
True Blue – Healthy Brain
Diamonds
Clear/Sharp – Routines & Routines Rule – Change is HARD
Emeralds
Green/On the Go with Purpose– Naturally Flawed
Ambers
Caught In a moment of time – Caution Required
Rubies
Deep & Strong – Others stop seeing what is possible
Pearls
Hidden in a Shell – Beautiful Moments to Behold
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To Start - Look at two videos…
• What do you notice about the helper and the person being helped?
• Why did each of them do what they did?
• How does this relate to what happens in your daily or real life? How does it relate to what you will be doing today?
• What is one thing you want to focus on today, as you move forward?
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Introduction: PAC Beliefs
• The relationship comes first…
• People living with dementia are doing the best
they can.
• Every gem, when given the right setting and the
right care, can shine!
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We are going to be Practicing
- Noticing skills an abilities in someone
we are approaching
- Adapting Positive Physical Approach
-For someone in a diamond state
-For someone in an emerald state
-For someone in an amber state
-For someone in a ruby state
-For someone in a pearl state
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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 – Big Motions or Still
Pearls – Hidden in a Shell - Immobile
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What changes could we try?GEMS Sapphire Diamond Emerald Amber Ruby Pearl
Visual Cues
Verbal Cues
Touch Cues
Pace
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Receptive Language Changes
Sapphires – high pitched harder, crowded &
loud spaces more challenging
Diamonds – Slower, missing consonants
Emeralds – missing about 1/4 words, needs
pauses – better with rhythm
Ambers – 2/4 words – misses much, catches
some key words out of context
Rubies – social chit-chat, music, rhythm, tone
of voice
Pearls – familiar and friendly, calm or excite
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Expressive Language Changes
Sapphires – word finding a little slower, pauses
Diamonds – varies with affect, word finding
problems, mis-speaking at times of stress
Emeralds – gets stuck in social, repeats
phrases or words, intonation matters
Ambers – repetitive, variable volume, echo
Rubies – less articulated speech, babble, hum
or sing, rhythmic vocalizations
Pearls – sounds to single words, responsive
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Dexterity – Hand Skills
Sapphires – still intact slightly slower
Diamonds – Slower, limited with bilateral skilled
integration
Emeralds – individual actions are there,
sequencing is challenging, more forceful
Ambers – heightened use of hands, skilled tool
use decreased, strong
Rubies – whole hand with limited finger use –
hold and carry, difficulty with release
Pearls – grasp strong, limited opening
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Body Skills
Sapphires – sustained - slower
Diamonds – details not as good, globally Ok
Emeralds – better with dominant side, errors
Ambers – strong more than skilled, limited
safety awareness
Rubies – whole body not segmented, front ok
back not
Pearls – reflexive, great trouble with gravity or
speed or movement
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People Awareness Skills
Sapphires – sustained – slower to ID
Diamonds – recent ?, older/deeper better
Emeralds – recognize like/not like,
Ambers – can get lost in old-new relationships,
will like or not like in the moment
Rubies – like or not like, familiar versus not
Pearls – voices, faces, touches, smells familiar
or not
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Place Awareness SkillsSapphires – sustained turned around
Diamonds – familiar feels best gets lost in
community & in unfamiliar places
Emeralds – if OK with what is seen is OK, if not
OK seeks the old familiar –task or social
Ambers – OK if “here” feels OK, otherwise will
seek “there”
Rubies – may or may not have a destination
more a movement or stillness pattern
Pearls – is what is experienced comforting
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Time Awareness Skills
Sapphires – lifelong – crunched or expanded
Diamonds – more the past than now
Emeralds – lost in episodes or caught in loops
Ambers – in the moment not the task or
sequence
Rubies – in the experience, not the time
Pearls – time has much less meaning
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Situation Awareness SkillsSapphires – sustained tough to think
Diamonds – old emotions drive new interactions
Emeralds – has moments of time travel
Ambers – more sensory awareness than
intellectual awareness, immediate not big picture
Rubies – only in moments, less body aware
Pearls – more inside than externally aware
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Positron Emission Tomography (PET)
Dementia Progression vs. Normal Brains
G. Small, UCLA School of Medicine.
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Choosing to be Sapphire?
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What changes could we try?GEMS Sapphire Diamond Emerald Amber Ruby Pearl
Visual Cues
Verbal Cues
Touch Cues
Pace
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In the next breakout- Adapting Positive Physical Approach
-Someone in a Diamond state (your mentor)
Let’s watch the videos – with PAC Skills, and without
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Which of these steps did you see? Which did you NOT see?
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Which of these did you hear/see? Which did you NOT?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
With a diamond
• Approach from the front to stay in visual field
• Give visual cues, within my own space, to match my words
• If wanting to keep something in hand or no touch needed,
no hand offered
• Supportive stance at edge of public space
• Notice what is happening and compliment
• Ask for help or opinion
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
In the next breakout- Adapting Positive Physical Approach
-Someone in an Emerald state (your mentor)
Let’s watch the videos – with PAC Skills, and without
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Which of these steps did you see? Which did you NOT see?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Which of these did you hear/see? Which did you NOT?
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
With an emerald
• Approach within binocular field of vision and observe
• Give visual cues, with her name, to shift from task to social
• Hand-shake to Hand-under-Hand® to get into personal
space
• Supportive stance for a conversation, no touch support
needed
• Notice what is happening and compliment
• Reflect and match the message and words to connect
• Strong visual + verbal to initiate the next task
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
In the next breakout- Adapting Positive Physical Approach
-Someone in an Amber state (your mentor)
Let’s watch the videos – with PAC Skills, and without
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Which of these steps did you see? Which did you NOT see?
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Which of these did you hear/see? Which did you NOT?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
With an amber
• Approach with awareness of object confusion
• Engage with visuals, outside of arm’s reach to connect
• Show first, then allow space for a copy of the action (bring
two or more props)
• Fewer words, stay flexible, rarely will you get the exact
action or task completed as expected
• Use rhythm and muscle memory to start, support, or
complete a task
• If it isn’t life or death, let it go…
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
In the next breakout- Adapting Positive Physical Approach
-Someone in a Ruby state (your mentor)
Let’s watch the videos – with PAC Skills, and without
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Which of these steps did you see? Which did you NOT see?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Which of these did you hear/see? Which did you NOT?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
With a ruby
• Approach within monocular visual field
• Use full PPA with Hand-under-Hand® connection to offer
support and direct focus
• Show and say the use of the object with 1-2 words at a
time, focus on rhythm of speech over words
• Pass the task over, if possible, after getting movement
started
• Stay connected at a joint in case support is needed again
• Go slow – allow 3-8 seconds for a response
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
In the next breakout- Adapting Positive Physical Approach
-Someone in a Pearl state (your mentor)
Let’s watch the videos – with PAC Skills, and without
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Which of these steps did you see? Which did you NOT see?
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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Which of these did you hear/see? Which did you NOT?
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
With a pearl• Approach within monocular visual field
• Possibly adapt Hand-under-Hand® to joint-to-joint support
and connection
• Use rhythm of voice and soothing (firm and slow) touch
• Offer space between the steps of the task to allow for
processing or shift in task
• Try only moving one hand at a time
• Stay connected at a joint, possibly providing stability with
your own body
• Notice the responses through movements over the words
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The LIVING GEMS®
Progression of the
ConditionTo 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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Top Five Human Needs and
Emotional Indicators of Distress
Five Human Needs
IntakeHydration, nourishment, meds
Energy Flowtired or revved up
directed inward or outward
OutputUrine, feces, sweat, saliva, tears
Comfort4 Fs and 4 Ss
PAIN Free!!!Physical, emotional, spiritual
Five Expressions of
Emotional Distress
Angryirritated – angry – furious
Saddissatisfied – sad – hopeless
Lonelysolitary – lonely –
abandoned/trapped
Scaredanxious – scared – terrified
Lacking Purposedisengaged – bored – useless
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INTENT
I'm sorry I was
trying to help
EMOTION
I'm sorry I made
you angry
INTELLECTUAL
CAPACITY
I'm sorry, I had no right to
make you feel that
way
THAT HAPPEN
ED
I'm sorry, it should
NOT have happened
THIS IS HARD
I'm sorry, this is hard, I
hate it for you
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Pauses and
Seeking a Time-Out…
- to recover
- to think
- to practice
- to take care of yourself