Manual Care and Dementia - Again

[Barrett Dorko]

Today I listened to the latest episode of Studio 360 ( http://www.studio360.org/episodes/2007/06/08) and heard for the first time about the art of William Utermohlen ( http://www.alz.org/preventionconference/pc2007/downloads/utermohlenpdf_052907.pdf).

I never get through the day teaching without being asked about what might be done for the patient with dementia who complains of pain. I know that many of our colleagues face this every day and I feel for them, but must admit I spent no real time in this situation myself when I practiced.

I’ve written of it though, and in Peg’s Piano ( http://www.barrettdorko.com/articles/pegspiano.htm) and Alzheimer’s Gift ( http://www.barrettdorko.com/articles/alzheimer.htm) you’ll find some ideas about creativity in the early stages and I thought I’d try again to engage our community in a discussion about this. Maybe somebody who has asked me about what to do at a course will have discovered something and will contribute a thought.

Have any thoughts?

[Tracy]

Dancing....I had a hispanic woman with chronic neck pain and headaches a while back. I used SC with her and taught her how to do the ideomotion on her own. Although she did not have dementia, she found that if she turned on some lively hispanic music that she enjoyed, she had an easier time with the ideomotion.

I have worked with patients in a semi-vegetative state who could not respond or follow directions, but when a family member sang to them, the patient could sing along. I experienced this with patients with dementia as well, and suspect that if you can find some music that dementia patients can connect with, this may be a good way to get movement and ideomotion incorporated into treatments.

Tracy

[Barrett Dorko]

Tracy,

Thank you for this. My father would put earphones on my mother, playing music he knew she'd enjoy, and it seemed to calm her.

Surely we have a few more readers here who work with these patients regularly and can contribute a thought. Is what you do with them secret (http://www.somasimple.com/forums/showthread.php?t=3869)?

[konradej]

Barrett,

Jason, here I took your work shop in Tulsa, "the shoe comment guy". I work part time in a nursing home, and I find just being present without time constraint, without schedule, without distraction and with gentle hands on with purposeful touch gives them a rare opportunity to express some of their discomfort. Often they will talk of their fears, their life's hardships, to be honest many times I don't even know what they say, but it gives them a non judgemental moment and opportunity for their being to self correct or change a bit of their discomfort. I think too often this population gets labeled as being not responsive, or untreatable, but this only applies if you buy into that.

[Barrett Dorko]

Jason,

Thank you for this insight. I remember you - primarily because of your unusually calm demeanor.

I always ask therapists in your position to report their sense of the patient's response to non-judgmental handling (Simple Contact) when they have only their non-verbal powers still present, or, if verbal, not always understood.

You've actually answered this question, and, in my experience, this doesn't happen very often.

[nari]

Jason,

I am familiar with what you are saying; at the acute neuroscience unit where I worked we all encouraged the stroke patients to sing. Most could; although the speech pathologists weren't too keen on the idea as they tended to sing during speech sessions. In the Aged Care Unit, there were singsongs every day, but the problem there was, the pianist and PT dictated what songs were to be sung. Not a great idea, and some patients just went to sleep because the songs were not familiar, or just plain boring.

What you are doing sounds great. Keep going!

Nari

[Line M]

This totally supports the idea of experience based approach they use for people in early stages of dementia in a nursing home where I come. It's idea is not to confuse and stress out is what the caregivers explained to me and it works satisfaction for both parties.

[Tracy]

No secrets here, Barrett.

Don't have a lot of time to expand. But my grandmother had dementia, and as far as getting her involved or moving, aside from music, she really responded well to children and animals. Her face would light up when children or animals were present. I didn't get to see her much as I lived a state away from her (she has since passed), but when I did see her, I always took my daughter (4 y.o) with me. It may be non-conventional, but incorporating animals and children into therapy with those with dementia, when practical and safe for the animal/child, seems like a wonderful way to treat! Tracy

[Barrett Dorko]

Tracy,

Thank you for this. It would follow that a therapist should take their cue from animals and children - something I've advocated for years.

[Diane]

Speaking of animals, this just in: A Possible Mechanistic Link Between Stress and the Development of Alzheimer Tangles (http://www.newswise.com/articles/view/530861/?sc=dwhn).

Mice when subjected to the stress of bodily confinement develop the sorts of changes seen in Alzheimer's.
Previous studies had shown that extreme physiological stress, such as plunging mice into ice water or starving them for three days, can induce tau phosphorylation. “But what we wanted to know was whether exposure to milder stress, of the kind we experience in our daily lives, can induce tau phosphorylation,” explains senior research associate and first author Robert A. Rissman, Ph.D.

Restraining mice for half an hour, a situation that replicates the body’s reaction to low-level anxiety, fear or social stress, resulted only in a transient phosphorylation of tau. However, when Rissman simulated chronic stress by repeating the procedure every day for two weeks, the modification lasted long enough to let tau molecules tumble off the cytoskeleton and pile up in insoluble heaps of protein.

Go ideomotor movement go!

[Barrett Dorko]

Given this, perhaps we can see the creative activity early in the disease as a survival strategy. If I'm right about the way the culture increasingly pushes back against physical authenticity (poker, postural training, plastic surgery et al) then it's contributing to the Alzheimer's epidemic.

I know that's a tremendous leap, but looking for a way to help these patients will require that we ourselves become creative.

[nari]

Creativity and Alzhiemer's is an interesting topic. I watched a program a few days ago where the rapidly increasing number of ageing widows (65 years on) was described as a social problem in itself.

They interviewed about ten women about their attitudes to ageing and loneliness; all of them were more interested in creativity and getting some fun out of life than mourning the loss of anything.
One 70 yo woman had just found a 26 yo bloke and they were as happy as pigs in mud. The striking aspect, in short, was that they did not care what others thought about their behaviour. Not one exhibited any sign of dementia.

Not worrying about what others think (ie cultural inhibitions) is perhaps the key. I wonder if someone will do some studies on the older folk who are obeying the rules and those who are authentic?

Nari