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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
For the slides from this presentation, visit:
www.teepasnow.com/presentations
Slides will be available for 2 weeks
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Handouts are intended for personal use only. Any copyrighted materials or
DVD content from Positive Approach, LLC (Teepa Snow) may be used for
personal educational purposes only. This material may not be copied, sold or
commercially exploited, and shall be used solely by the requesting individual.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach® to Care
Any redistribution or duplication, in whole or in part, is strictly prohibited,
without the expressed written consent of Teepa Snow and
Positive Approach, LLC
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Intellectual Disabilities
and Dementia: Recognizing
and Understanding
and
Dementia Communication and
Behavior
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Intellectual Disabilities and
Dementia:
- Other than Down Syndrome, dementia
affects about 5-10% of the ID
population - somewhat younger than
general population
- Increases after age 50-65
- Increases if history head of injury
- Increases if family history of dementia
- Increases with other risk factors
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Unique Changes:
- Attention losses are first - not memory!
- Self-care skills are affected early
- Seizures may be noted: ‘staring’
- Reduced speech attempts: more
slurring or repetitive words
- Increased stereotypical behaviors
- Sensory needs and tolerances change
- Behaviors change: ‘plans’ don’t help
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Down Syndrome and Dementia:
- Dementia, specifically Alzheimers, is believed to affect the large majority of people with Down syndrome
- Due to premature aging, onset is earlier
- Ages 35-65, the number with dementia increase dramatically
- Some individuals will experience very rapid onset (1-3 years)
- Most progression lasts 3-10 years
- Frequently have other medical problems
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Alzheimers:
- Two forms: Early/Young Onset and Normal Onset
- New info lost
- Recent memory worse
- Problems finding words
- Mis-speaks
- More impulsive or indecisive
- Gets lost
- Notice changes over 6 months – 1 year
- Lasts 8-12 years
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Vascular Dementia:- Sudden changes: stepwise progression
- Other conditions often present: diabetes, hypertension, heart disease
- Damage is related to blood supply, not primary brain disease, so treatment can plateau
- Can have good days and bad days
- Judgment and behavior ‘not the same’
- Spotty loss (memory, mobility)
- Emotional and energy shifts
- Lots of similarity with Alzheimers
- Watch for and manage depression
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Lewy Body Dementia:- Movement problems, falls
- Visual hallucinations: animals, children, people
- Fine motor problems: hands, swallowing
- Episodes of rigidity and syncopy
- Nightmares or insomnia
- Delusional thinking
- Fluctuations in abilities
- Drug responses can be extreme and strange:
toxicity, paralysis, death, or can have the
opposite of the intended effect
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Fronto-Temporal Dementias:
-Many types
-Frontal types: impulse and behavior control loss (not memory issues)
-Says unexpected, rude, mean, odd things to others
-Disinhibited with food, drink, sex, emotions, actions
-Temporal types: language loss
-Can’t speak or get words out, nonsense words
-Can’t understand what is said
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Believe:
People with dementia and
developmental disabilities
are doing the best they can!
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Review: How Can We Help?
1. Positive Physical Approach™
2. Hand-under-Hand® for connection and
assistance
3. Supportive Communication
4. GEMS® States
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Positive Physical
Approach™- Pause at edge of public space (6 feet)
- Greet with your open hand next to your face, smile
- Call the person by name, if possible
- Move your hand into handshake position
- Approach slowly and within visual range
-Move from a handshake to Hand-under-Hand®
-Shift into a Supportive Stance alongside them
-Get low by standing or kneeling, but don’t lean in
-Make a connection and wait for their response
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
A Positive Approach(To the Tune of Amazing Grace)
Come from the front
Go slow
Get to the side,
Get low
Offer your hand
Call out their name, then wait…
If you will try, then you will see
How different life can be
For those you’re caring for!
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Hand-under-Hand®:Protects aging, thin, fragile, forearm skin
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Supportive Communication:
To Communicate
When They’re Distressed:
First - Connect
Then - Use Supportive Communication
Finally - Move Together to Something New
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Be a Detective, Not a Judge!
Try to figure out what is being communicated:
•Words
•Thoughts
•Actions
•Needs
•Beliefs
Don’t assume or presume
Don’t discount the message because of how
it is delivered
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
To Connect When They’re
Distressed:
- Send visual signal of connection:
- Look concerned
- Send a verbal signal of connection:
-Use the right tone of voice
- Send a physical signal of connection:
-Give a light squeeze or sandwich the hand
-Offer an open palm on shoulder or back
-Offer a hug if the person is seeking more contact
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What is Supportive
Communication?• Repeat a few of their words with a
question at the end
• Avoid confrontational questions
• Use just a few words
• Go slow
• Use examples
• Fill in the blanks
• Listen, then offer empathy:
“Sounds like…” or “Seems like…” or “Looks like…”
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
More Supportive
Communication:• Validate their emotions
• Early Stage: “It’s really (label emotion) to have this
happen” or “I’m so sorry this is happening to
you!”
• Mid Stage: Repeat their words with emotion:
- Listen for added information, ideas, thoughts
-Explore the new info by watching and listening
- Late Stage: Check out the whole body:
- Face, posture, movement, gestures, touching,
looking
- Look for the need under the words or actions
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Once You’re Connected and
Communicating:
Move Forward:
•Add new words
•Move to a new
place or location
•Add a new activity
Early Stage: Redirection
•Same subject,
different focus
Later Stage: Distraction
•Different subject,
unrelated but enjoyed
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For All Communication:
If what you are trying is not working:
- Stop!
- Back off
- Think it through, then:
- Re-approach
- Try something slightly different
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Ask yourself: Is this
‘behavior’ truly a problem?
- If no, let it go!
- If yes, it’s time to problem solve, so put
on your thinking cap!
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
The GEMS® Progression of
Dementia:
Sapphires: True Blue – Slower but Fine
Diamonds: Repeats and Routines, Cutting
Emeralds: Going – Time Travel – Where?
Ambers: In the Moment – Sensations
Rubies: Stop and Go – Big Movements
Pearls: Hidden in a Shell - Immobile
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Sapphires
- Us on a good day
- Clear and true to ourselves
- May feel ‘blue’ over changes
- Can typically choose our behavior
- May have other health issues that affect behaviors
- Recognize life experiences, achievements and values
- Can follow written info and hold onto it
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Diamonds
-Sharp, hard, rigid, inflexible, can cut
-Many facets, still often clear, can really shine
-Are usually either Joiners or Loners
-Can complete personal care in familiar place
-Usually can follow simple prompted schedules
-Misplaces things and can’t find them
-Resents takeover or bossiness
-Notices other people’s misbehavior and mistakes
-Vary in lack of self-awareness
-Use old routines and habits
-Control important roles and territories, use refusals
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Emeralds
-Changing color
-Not as clear or sharp, more vague
-On the go, need to ‘do’
-Flaws may be hidden
-Time traveling is common
-Are usually Doers or Supervisors
-Do what is seen, but miss what is not seen
-Must be in control, but not able to do it correctly
-Do tasks over and over, or not at all
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Ambers-Amber Alert- Caution!
-Caught in a moment
-All about sensation and sensory tolerance,
easily over or under stimulated
-May be private and quiet or public and noisy
-No safety awareness
-Ego-centric
-Lots of touching, handling, tasting, mouthing,
manipulating
-Explorers, get into things, invade space
-Do what they like and avoid what they do not
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Rubies:-Hidden depths
-Major loss of fine motor finger and mouth skills, but can do gross motor skills like walking, rolling, rocking
-Comprehension and speech halted
-Wake-sleep patterns very disturbed
-Balance, coordination, and movement losses
-Eating and drinking patterns may change
-Tends toward movement unless asleep
-Follows gross demonstration and big gestures for actions
-Limited visual awareness
-Major sensory changes
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Pearls:-Hidden in a shell: still, quiet, easily lost
-Beautiful and layered
-Spends much time asleep or unaware
-Unable to move, bed or chair bound, frequently fall
forward or to side
-May cry out or mumble often, increases
vocalizations with distress
-Can be difficult to calm, hard to connect
-Knows familiar from unfamiliar
-Primitive reflexes
-The end of the journey is near, multiple systems are
failing
-Connections between the physical and sensory
world are less strong but we may be the
bridge
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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
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format, sold, or used in any way other than what is outlined within this under any circumstances without express permission from
Positive Approach to Care.
Copyright 2017, All Rights Reserved
Teepa Snow and Positive Approach to Care
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