A Positive Approach to Brain Change

September 4, 2014

Based on the laughter of 152 people in the audience, you'd never guess the topic was dementia. But as Alzheimer's expert Teepa Snow delivered a one-hour presentation at Lenbrook recently, she had the room roaring with laughter.

Photo: Teepa Snow of Postitive Approach (left) and Kasey Partus, Wellness Manager at Lenbrook (right)

This no-holds-barred woman dressed in khakis, a royal blue blouse, and running shoes with a beautiful silver ponytail didn't use the podium while she spoke. Instead, she captivated the audience with her spot-on advice and humorous impressions of people dealing with "brain change."

Early on she stated very matter-of-factly, "Aging is a way of life. It's happening to all of us, so you might as well get over it and keep moving ahead."

Just when the topic might hit too close to home, Teepa would add an accent, a shuffle, a poignant phrase or interact with an audience member to bring on the laughter. Somehow, she made learning about dementia a little less scary and a lot more human.

Here are the highlights of Teepa's advice to family, friends and care partners for anyone dealing with brain change.

Brain Change is a Certainty

An occupational therapist with 30 years experience in gerontology, care giving and now clinical appointments with Duke University and the University of North Carolina/Chapel Hill's medical schools, Teepa spoke without a drop of sugarcoating.

Her opening statement cut to the chase: A little over 10 percent of people age 65 or older have some type of dementia. And by age 85, nearly 50 percent will have some form of dementia.

"Dementia has a way of surprising you. It acts differently at different times because our brain chemistry can shift quickly," Teepa explains. "We need to educate ourselves on the stages of change and adjust our expectations and responses accordingly."

A New Normal and a Different Approach

She shared her observation from working with hundreds of families and patients, "Dementia eventually has a way of changing everything."  She encouraged family, friends and care givers to change their approaches as their loved one changes in order to be more effective and help reduce stress.

"Your experience of what's normal is now different. So it's going to take a different approach to work it through," she advised.

For the family members most affected by their loved one's brain change, she offered this point of view of acceptance, "I can't have what I once had with you, but I can be with you where you are now."

Start With a Positive Physical Approach

Teepa demonstrated her top nine ways to positively approach someone dealing with brain change, focusing on the way you physically approach the person to help keep them at ease and feel appreciated:

  1. Pause at 6 feet (gives time for visual adjustment)
  2. Greet & smile
  3. Move slowly -- hand offered in handshake position
  4. Move from the front to the side (less imposing or threatening)
  5. Greet with a handshake and your name (so they don't have to recall your name)
  6. Slide into hand under hand hold (very reassuring)
  7. Get to the person's level (meet them at eye level, don't look down at someone)
  8. Be nice -- offer a kind comment and smile
  9. Give your message -- simple, short and friendly (person hears only 3 out of every 4 words you say)

Show Me and Talk Shorter

While showing images of healthy brains compared to brains with various stages of dementia, Teepa explained the left side of the brain tends to be affected first, hence why the loss of language and the ability to recall specific words often happens first.

Nouns are usually the first words to go. When this happens, Teepa recommends:  Ask "Can you tell me more about that? " Urge them to describe more about the word they are trying to recall. Adjectives often come to mind more easily.

She also recommends the question: "Can you show me what you mean?" Perhaps the person wants to brush their hair or their teeth. Often they can show you the motion even when they can't recall and say the words "hair brush" or "tooth brush."

And, if someone tries to brush their teeth with a hair brush, you gently guide their hands and show them where to use the hair brush rather than giving a verbal command.

She taught a quick mnemonic dance to drive the message home about the left and right sides of the brain. Pointing to her left first and slapping her right hip second, she repeated: "Language is on the left, rhythm is on the right." She went on to say this often explains why someone can still dance fairly well when they can't walk as well. And why some can still sing the words to songs when they might not otherwise speak much at all.

In the early to mid stages of brain change, Teepa explained how the person will be able to process three out of every four words you say. So if you know they are going to miss 25 percent of what you say, help avoid miscommunication by simply talking shorter.

Respond, Not React. Substitute, Not Subtract.

Acknowledging how difficult and trying times can and will get as a loved one progresses in their brain change, she closed with a few more practical suggestions:

  1. Respond, don't react. Take a breath and think about your response first.
  2. Substitute rather than subtract. Going back to the hair brush and tooth brush example, if someone is trying to brush their hair with a tooth brush, hand them a hair brush before you say anything and before you take the tooth brush away.
  3. Stop saying, "It's okay." Instead say: "I hate this for you." Your loved one knows something is amiss and that awareness needs to be recognized. Empathize with them rather than glossing over it.

Kasey Partus, Wellness Manager at Lenbrook, knew Teepa would be a big hit at Lenbrook and beamed at the turnout of 152. "I knew I wanted Teepa to come to Lenbrook the minute I attended one of her training seminars last year. But she had a two-year waiting list," Kasey explained. "I kept trying and by chance an opening came up and we got her!"

Teepa also conducted a training session with Lenbrook staff on the importance and challenge of good nutrition for people with dementia.

Lenbrook resident Dr. Scott James, chairman of Lenbrook's Health & Wellness Committee, attended this session too. "Teepa helped us experience some of the frustrations a dementia patient feels from having conditions such as limited peripheral vision," he explained. "She had us cup our hands around our eyes and then had someone try to feed us from a spoon. They had to get right in front of us for us to see the spoon. We also learned how difficult it is for the care receiver to chew and swallow, and the importance of maintaining good hydration and nutrition even when the care receiver may not realize they are hungry or thirsty," Scott said.

For more information and educational materials on dealing with brain change, feel free contact Teepa Snow at teepasnow.com.