Webinar: The Montessori Approach to Activities and Dementia
Dementia Australia webinars are free videos where subject experts discuss topics relating to dementia for a general audience.
In this webinar, accredited Montessori for dementia trainer Wendy Henderson explores the connection between Montessori and dementia, and the Montessori approach to activities.
This approach is designed to develop meaningful roles and routines, and enable a person living with dementia to function as independently as possible.
Transcript
[Beginning of recorded material]
[Title card: Dementia Australia]
[Title card: Montessori approach to activities]
Wendy: Hello, I am Wendy Henderson from the Centre for Dementia Learning at Dementia Australia. I am an accredited Montessori for dementia trainer, and have had the privilege of introducing the Montessori philosophy for quality dementia care in many settings. I'd like to begin by acknowledging the traditional owners of the land on which we meet today. I would also like to pay my respects to Elders past and present, and to our shared futures.
You may have heard about Montessori in a school setting, and therefore, a common question asked is, how did the connection between Montessori and dementia occur? Well, it was based on the originated and original work with Dr. Maria Montessori, the first female doctor in Italy and childhood educator in 1907, who developed an interest in the treatment of special needs children through her work at the University of Rome Psychiatric Clinic. Dr. Montessori developed an interest in working with underprivileged children thought to be unteachable, so provided with the opportunity to study the children, was given a room, and took charge of 54 children of the dirty desolate slums of the San Lorenzo outskirts of Rome.
She worked with these children by preparing the most natural and life supporting environments, ensuring the children had an active and meaningful role in the classrooms, transforming the room given to her into an environmentally specific room tailored to the needs of the children, so that the child may fulfil his or her greatest potential, physically, mentally, emotionally, and spiritually. By learning in a non-traditional environment in this way, the children learnt skills needed to survive and provide for their families that they otherwise wouldn't. For her committed efforts on behalf of children and humanitarian work, Montessori was nominated three times for the Nobel Peace Prize in 1949, 1950, and 1951.
Dr Cameron Camp, PhD, is a well-known American psychologist, specialising in applied research in gerontology. He received his doctorate in experimental psychology from the University of Houston in 1979. For 16 years, Cameron worked in academic settings, teaching coursework in adult development and ageing, rising to the position of research professor of psychology. He is a past director of the Meyers Research Institute, and is currently a consultant continuing his research and training throughout USA and internationally. He has worked extensively with Dementia Australia over many years.
Cameron's interest in Montessori commenced when his children started at a Montessori school in the seventies, at about the same time as his work in gerontology. When he went into the Montessori classroom designed to enable kids to succeed, to circumvent any physical or cognitive challenges, and saw the resources being used, he thought it ideal for persons living and working with dementia. Cameron was inspired by the work of Maria Montessori. Her philosophy was that every human being has the right to be treated with respect and dignity, to have meaningful role in a community, to contribute to the best of their abilities, and to live a life that promotes self-esteem while respecting one's self, others, and the environment.
Dr Montessori did not treat children like children. She treated them like persons. She used the same values of respect, dignity, and her equality in her approach to everything. These are the values of the way we all want to live, how we all wish to be treated. And so, using the Montessori message, Dr. Camp commenced use of Montessori based activities as rehabilitative interventions over many years of working with people living with dementia. He has written books and many journal articles, one of those books being Relate, Motivate, Appreciate, an Introduction to Montessori Activities. This book was written in 2013 when we were still Alzheimer's Australia Vic, and is still available on the internet.
For many years now, this is the way we work with persons with dementia and also how we all live our lives. Dr Camp says, "We always say a person with dementia is a normal person who happens to have a memory deficit, and maybe some problems with function, but if you give them a situation and the supports where they don't have to rely on the deficits, you are left with a normal person." This is what Montessori does. It provides supports, strategies, activities, and roles that enable a person living with dementia to function as independently as possible. Maria Montessori had a quote. "Everything you do for me, you take from me." Often, in dementia care, we care too much, and we do too much for the person. We help them too much, often, due to time constraints or we just want to be helpful, but this takes away their opportunity to do some things for themselves, and often, they do not have the opportunity to care for others either. So, Montessori assists and supports the person to be as independent as possible, can be used as a tool for rehabilitation. For example, designing a program of activities and roles that enables a person to build strength and fine motor skills that may assist them to maintain ability to feed themselves. Montessori can be used and adapted for any setting, and can be used for all stages and types of dementia.
There is always a purpose to the activities and roles. Montessori activities are not just done for the sake of it. There is thought, assessment, and purpose behind them in order to encourage independence. Meaningful roles and routines are based on what we know about the individual's interests and level of ability. The purpose of the activity or role may be to assist with the cognitive skills using activities that promote number recognition, matching items to size and colour, sorting items into like categories. It may be to assist them with their physical and gross motor skills, to encourage independence for activities such as sweeping, exercise, and throwing balls.
Montessori-based activities as rehabilitative interventions place emphasis on an environment that supports memory loss and respects the person. It provides an approach for shaping a purposeful, meaningful community in which a person with dementia can live. It enables individuals to be as independent as possible, to have a meaningful place in their community, to have high self-esteem, and to have the chance to make choices, and meaningful contributions to their community. Montessori can be used as a tool for rehabilitative or restorative interventions. I'd like to make it clear that this is linked to procedural memory. It can be controversial, but that is because people don't necessarily understand that that is the link. Maintaining activities and roles that enables the person to build strength and fine motor skills can be things like assisting with hanging out the washing, squeezing the pegs actually exercises the fingers in the hands, using tongs to serve salad or vegetables, assists to maintain skills to grip a fork or a spoon to feed themselves, gross motor skills to maintain strength in arms and hand, to hold a garden trowel to dig and plant bulbs, or squeezing the nozzle on a hose to water the garden. There is always a purpose to the activities and roles.
What you do to support the person will depend on their strengths, abilities, skills, and interests. Using cognitive ramps and cues, setting up signage and external cues may assist a person to be more involved and independent. We ask questions like where are the cognitive ramps for a person? And how can we modify our homes and communities to better accommodate persons with dementia? Where are the cognitive ramps for a person? Maybe we need signs on doors, or labels on cupboards. Have you got a calendar? The day and date marked? What are some external cues, like clothes on the bed and turning on the shower so they can hear the sound of water? Opening blinds to let natural light in to signal daylight? Being handed a tea towel to dry the dishes, jigsaw puzzles on an uncluttered table to signal a puzzle to be solved, setting up the hose ready to water the garden. Remember, keep it simple. Too many signs will confuse, and too much clutter will confuse.
Now, I will discuss memory to help you understand the why about what we've just spoken about. Our memory is a complex system that has many layers. When considering the impact of dementia on memory, and the capacity a person with dementia has to engage in meaningful activities, it is important to distinguish between declarative memory and procedural memory. Declarative memory, also known as explicit memory, is about personal history, facts, events, knowledge, vocabulary, or way finding. For example, knowing when you were born, knowing what day or month it is, knowing what season it is. When we talk about memory in everyday conversation, we are generally referring to our declarative memory.
Declarative memory is always impaired with dementia, so we need to find ways to provide the missing information in the environment. It's useful to have photo albums clearly labelled with clean, clear, coloured pictures, if possible. Make up some storybook collections about some personal stories now to be able to read back to them in the future, to remind the person of who they are. Procedural memory, also known as implicit memory or muscle memory, is the autonomous habitual or motor skills requiring repetitive muscle movement. Example, riding a bike, driving a car, cleaning your teeth, feeding yourself. It refers to relatively effortless, unconscious, and automatic forms of learning and memory. Muscle memory, or procedural memory, tends to be less damaged in people with dementia.
Our focus is on retained ability. The Montessori approach supports engagement by focusing on what the person can still do, by using procedural memory, and by providing support for damaged areas of declarative memory. Montessori-based activities enable persons with dementia to be engaged with activities of meaning and pleasure using a strength-based approach. It is successful because it is based on the use of muscle memory. As this muscle memory is often maintained throughout the progression of people living with dementia, the activities can be very successfully used as a rehabilitative or restorative measure.
Just to recap, dementia commonly affects declarative memory, language. For example, a person who has English as a second language may revert to their native tongue as their dementia progresses. May lose their insight. Are they hungry? Are they cold? Are they thirsty? Attention, I think we've all experienced people living with dementia whose attention spans may become decreased over time, unless they're actually interested in what they're doing, then we see improvement. And the initiative – what we need to do is be the starter motor for them, to set them up so that, or to begin an activity so that it's ready, and we can just simply demonstrate how to get started, and then they can keep going.
The abilities commonly retained, as I've already said, procedural memory. Engagement through the sensors, the person can often still see, hear, smell, taste. That often stays with them right through the progression of the dementia. Often, the sensors is what we tap into in the later stages. Can they still read and tell the time? Assumptions are often made that a person with dementia can no longer read, when in fact they may not be able to read a 12 font, but they can read something that's 24 font or bigger. Large print books or large print newspapers are a good thing to have. When telling the time, think about what kind of a clock they might have learnt to tell time with when they were younger. A normal round clock and not a digital clock.
Social skills, they can still say hello, still shake hands. They still know or have an understanding of what's required of them. Emotions, remember, at a basic fundamental emotional level, the person living with dementia can still feel what's going on around them. They're still sensitive to how we are when we are working with them, or when we're doing things with them. In knowing the person, we have to gather information regarding their needs and their preferences, and likes and dislikes. Knowing the person as a unique individual helps us to plan the appropriate support strategies to promote engagement. Consider their strengths and abilities to help us plan opportunities that will provide a sense of purpose, enable independence, support success and achievement, and focus less on inability.
As communication is central to our sense of wellbeing, we need to know what the person requires to communicate effectively. Also, check that they've got their glasses on, or their hearing aids in if they use. Knowing what the person requires for a supportive enabling environment, physically, culturally, and spiritually. Activity and purpose are essential for a person living with dementia. Each person has their own preference for how they choose to spend their day. Knowing what is important to them helps us to provide opportunities for them to make choices and decisions. This shows the person that we respect and value them.
It also may be helpful to know past and present interests, things that worry them, things that comfort them, who the people are that are important to them? Three things that make their day, personal achievements, favourite topics for discussion, what their general motivation is, places they may have lived during their lifetime, and their work, their roles, and volunteering. What have they done? Bucket list. If I could, I would. Many people have one of those, but it's also important to know the person's habits, rituals, and routines. For many years, my mother read her newspaper every single morning with a hot cup of tea, and she wasn't happy if she didn't have her newspaper, if it wasn't delivered. A little thing, but it's a big thing.
Classes of Montessori – the person's carer or family may contribute valuable information. Montessori puts activities and roles into five different classes or areas. Once you know the person's strengths, needs, and interests, you can design a Montessori program of activities and roles for them. Now, the activities and roles may overlap into more than one class of category. That is fine. The main thing to consider is that the activity or role matches the individual person, their interests and skills. As examples, activity of daily living: dressing, cleaning your teeth, buying groceries, sorting their clothes cupboards, cooking, setting and cleaning a table, washing up, flower arranging, raking the leaves, sweeping, dusting, ironing, laundry, folding clothes and towels, rolling wool, sanding, cleaning shoes, silverware or leather goods.
Sensorial experiences examples, guess the sound or sing a song. What is the taste? What is the scent or smell? What are you feeling? Using different textured materials, feet in sand, petting an animal or a soft toy, a hand massage, a rummage box with sensory items. An example could be a picnic at the beach can incorporate all of these things, or it can be as simple as sitting having a coffee.
Cognitive stimulation: looking at photo albums and sorting your photos into specific topics, shape, picture sorting and matching, matching pictures or items, the sorting activity. Where does the item go? In the kitchen, or the bathroom, or the shed, or the bedroom? Find an item in a magazine, do a jigsaw puzzle, and pairing socks. Motor activities can include treasure hunts, golf ball scoop, pegs scooping, putting pegs onto a container, hitting the balloon, throwing balls or bean bags, walks, using tongs to separate items, walking the dog, dance classes.
Group activities: reading groups, and the hint here is to use large print books, music sessions. There can be so many variations on music sessions, as I'm sure you will understand. Work stations: there might be something where two or three people have got some items to be repaired, and they work together to do that. Reminiscing groups, always good fun. Now, armchair travel takes a very different way these days with the use of iPads, with the iPads on their own, or iPads connected to the TV, to go through photo albums, or to try the various apps available to look at things that are overseas, for example, particularly when we are not able to travel. Montessori encourages the use of both group and individual activities and roles. You are not limited to the lists that I've just given you. Again, it will depend on the person's interests and abilities.
I'd like to talk about the 12 principles of engagement. They're designed to support interaction and engagement when supporting a person living with dementia. When we apply the principles, we are focusing on the person's capabilities, and capturing their interest, and showing respect. People with dementia are often confronted with what they can no longer do, or with the mistakes they make. The principles are designed to focus on what they still can do, and need to be error-free. The principles are structured in the order that you might use them when interacting with a person. A note, these are not just applied to recreational activities and roles, but also to activities of daily living.
Principle number one, give an activity a sense of purpose and capture the person's interest. Number two, invite the person to participate. I often combine the two of these. An example might be, "It's a beautiful day today, I thought we'd go out for coffee, would you like to have a shower and get dressed now so we can go?" There is also including choice in that in number three. Number four, talk less, demonstrate more. We often use the term, watch me, and start to demonstrate something. And then we say to the person, "You try." Use as little vocalisation as possible when demonstrating the activity, to allow your person the opportunity to focus exclusively on the activity or the task.
Physical skills, number five, focus on what the person can do. Number six, match your speed with the person you are caring for, so slow down. Often, we all are used to working and walking way too fast. Number seven, use visual hints, cues, or templates. Popping the towel over your arm to indicate that it's time to get into the shower, as a cue. Give the person something to hold. Go from simple tasks to more complex ones. The activity is structured to be presented at the person's level of skill and ability to promote success, and enhance self-esteem. Number 10, break a task down into steps, make it easier to follow. Number 11, to end, ask, "Did you enjoy doing this?" And, "Would you like to do this again another time?" Number 12, the most important one, there is no right or wrong. Think engagement. I often have people say to me, "I don't know if I'm doing this the right way or not." My response to them is always, "Did your person look happy? Were they responding?" If the answer is yes, then there is no right or wrong. It's about being engaged.
When applying the 12 principles of engagement, remember to invite the person, minimise your talking, and demonstrate instead. Focus on the experience rather than right or wrong, and use the feedback questions to finalise the activity. Something for you to consider – does the physical environment in your home support meaningful engagement? Is it too noisy? Have we turned off the background noise of the TV or the radio? Is there plenty of light? Are the curtains wide open? Is there plenty of light in the room so the person can see what they're doing? Do we have uncluttered space? An example there is to ensure that the dining room table is cleared off so that you haven't got other clutter on the table interfering if you are going to say, do a jigsaw puzzle. Can they find their way? Can they find the bathroom, for example? If your doors are all the same colour as your wall, how do they know which room is the bathroom? What do you have on your door to indicate where the bathroom is? And colour contrast. If the doors and the walls are all the same colour, they may not even know that there is a door there. Same in white bathrooms. They may not know, be able to define where the toilet is apart from the basin.
What changes could you make to support your person's engagement in meaningful activities? As a conclusion, a Montessori approach provides a vehicle for shaping a purposeful, meaningful community in which people with dementia can live. It aims to circumvent disability, create a community where people are enabled, supported to be independent. This begins and ends with choice. Our mantra at Dementia Australia is, “give it a try”. Quality of life is everything.
For further information or resources, go to the Dementia Australia website, on the website on the screen in front of you. There are also this Relate, Motivate, Appreciate, which is available as a pdf. There is a set of videos called “Purposeful Activities for Dementia”. It is a Montessori-based professional development and education resource. Everybody can use these videos, there's some great ideas on them. They're available on the same website. We also have the Centre for Dementia Learning Education programs at dementialearning.org.au. After that, the National Dementia Help line on 1800 100 500. Thank you for attending this webinar.
[Title card: Together we can reshape the impact of dementia]
[Title card: Dementia Australia. 1800 100 500. Dementia.org.au]
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More on Montessori, activities and dementia
- Activities for people with dementia
Stimulating activities help people living with dementia stay engaged and motivated. Here are some tips and ideas to make activities more enjoyable for everyone.
https://www.dementia.org.au/living-dementia/staying-connected/activities-people-dementia - Activities at Home
This session helps people looking after someone at home to plan engaging activities.
https://www.dementia.org.au/get-involved/events/activities-home - Staying connected
How to stay social and mobile: relationships, communicating, staying in touch and going places.
https://www.dementia.org.au/living-dementia/staying-connected
The National Dementia Helpline
Free and confidential, the National Dementia Helpline, 1800 100 500, provides expert information, advice and support, 24 hours a day, seven days a week, 365 days a year. No issue too big, no question too small.