13 M-CARE: Leisure and daily activities

Mobile Training for Home and Health Caregiver For People with Disabilities and

Older People

539913-LLP-1-2013-1-TR-LEONARDO-LMP

Module: Leisure and Daily Activities


Structure

• Unit 1: Leisure and Daily Activities

• Unit 2: Communication

• Unit 3: „Memory Training“

• Unit 4: 10 – Minutes Activation

• Unit 5: Basal Stimulation / Basal Activation

• Unit 6: Motility Exercise for Preparation

• Unit 7: Chair-dancing


Structure

• Unit 8: Fall prevention

• Unit 9: Vision Promoting / Visual Perception

• Unit 10: Current physiotherapy interventions according to the ICF framework

• Unit 11: Auditory Perception

• Unit 12: Taste / Smell

• Unit 13: Event oriented Biography work

• Unit 14: Activities suitable (not only) for people with Dementia


Unit 1

• Leisure and Daily Activities – Activation & Reality-Orientation-Training (ROT)

– Definition

o time-, local-, situational orientation, orientation to her/himself

– Fundamentals

– Objectives

– Indication

– Contraindication

– Spatial Equipment


• Here you can see different ways how to activate a person with disabilities, dementia …, specifically, without overcharging or underchallenging the person – Example: wheelchair users activities consist of adapted sports. You

should be aware of groups near you that offer wheelchair sports/ activities such as basket, rugby, sailing, adapted pools, etc. This improves health, socialization, peer-to-peer action and mental stability of the client.

• You may learn appropriate actions, which you can use specifically for people in care who are no longer able to verbally express themselves


Effects of dementia • Older people affected by dementia increasingly lose touch with

reality, while in different areas disorientation appears: – Time orientation: The client has neither knowledge of the time nor the

current date. Many clients show sleep reversal, they rest during the day and are active at night. They want to go to the supermarket at night or call friends and relatives.

– Local orientation: The client does not identify her/his current place of residence. S/He is walking around in his district and does not find the way back to his apartment. The private room is no longer recognized as a personal living space.

– Situational orientation: The client is no longer able to behave appropriately in a situation. Other people perceive this behaviour as disturbing. Inclusion into social environment is reduced; the client grows rapidly more and more lonely and isolated.

– Orientation to her/himself: The client recipient loses his identity. S/he no longer knows who S/he is and who he was. Basic and central information of her/his biography get lost.


Reality-Orientation-Training ("ROT")

• Serves to slow the decline of these mental skills

• The client is always confronted with information about themselves person, their biography, their living place and the current date

• If the client’s behaviour becomes faulty or inadequate, it will be corrected by you

• The constant contact with that information is intended to delay a decline into typical states of dementia confusion

• ROT only makes sense if all follow this approach in care

• Also family members need to understand the working principle of ROT and they have to apply this concept consistently


• ROT faces clients with their mental limitations because they are corrected for errors

• the dignity of the person may not be violated, s/he may not get the impression that he is being treated like a child

• ROT may well be characterized by a positive expectation but the seniors should not be overwhelmed by a strong focus on performance


Objectives

• Strengthen the client´s connection to reality

• Keep the client temporally and spatially oriented

• Encourage the memory and the retention of the client, so that the s/he gets a positive experience and strengthens her/his self-confidence

• Maintain the everyday competence as long as possible

• Prevent accidents

• Strengthen the client’s identity

• Reduce fear and the feeling of abandonment

• Keep the client’s interest in his environment

• Avoid performance pressure

IMPORTANT: finish ROT at the right time when the dementia disease is advanced so far that the client can no longer be kept in reality


Indications

• At an early stage of Alzheimer's disease

• In stressful situations such as after a prolonged hospital stay

• Disorientation as a side effect of medication or as a result of other underlying diseases


Contra-indication

• If there is a moderate or severe Dementia

• Some clients do not want to be held in reality

• It can easily lead to over- or under-challenging

• The confrontation of the client with his illness may aggravate it

• If you notice that ROT disturbs the relationship between you and the client, then you should terminate the measures


Spatial Equipment • Hang up a big clock in every living room

• Make sure that the watch does not "perish" between other wall decorations

• The client receives a large calendar with a clear week-at-a-glance

• You enlist the planned operations

• Ask family members to note important dates

– these include birthdays, family reunions or scheduled doctor visits

• Hang a mirror –a full length mirror is best

• Attach a large name plate to the front door

• Decorate the living room of the client in seasonal decors

• The door to the bathroom is provided with a clear pictogram


Unit 2

• Communication

– Positive

– Negative

– Other Measures


Communication

• Always introduce yourself with your name.

– “Good day, Mr. Miller. My name is Gerda Smith. I am your PCG.“

• Regularly remind upcoming events and dates.

– “Good day, Mrs. Schulze. This afternoon at 15 clock the hour of tinkering in the community centre will take place.”

• Remind the current place of residence.

– “You now live in your son's house in Nuremberg. In what city did you grow up? “


Communication

• Current day and the current season are discussed regularly. Example:

– “Good morning, Mr. Meier. Today is Monday, July 3, 2012. It is now 10.30 clock. It is outside a friendly and warm summer day.“

• Integrate biographical data in the conversation.

– “Mr. Smith, you were born in 1925 in Hamburg. Can you tell me how old are you now?”

• ask for biographical data and link with the present

• speak in simple short sentences


Communication

• Do not overwhelm your client with too much information at once, observe whether he/she has understood what you said

• Differ between the important and the unimportant things

• The incorrect assignment of objects, persons, places, dates and times by the care-recipient are gently corrected without hurting the feelings and individuality of the care recipient


Other Measures

• Design daily routine uniformly

• Daily recurring events, rituals and habits give the care recipient a sense of security

• When planning make sure that you visit the client as much as possible at the same time of day

• Encourage them to take the meals at a fixed time

• Encourage them to follow the news on TV

• The client should wear self-chosen clothing that s/he finds appealing

• The client’s spectacles should conform to a current prescription

• It is important that the glasses are worn consistently

• The same goes for hearing aids


Other Measures

• Examine the use of memos in support of memory

– each memo is bearing only one piece of information

– the font size should be big enough

– the memos should be mounted where the information is needed. i.e.:

• on the TV: “Don’t set TV too loud!“

• in the bathroom: “Stop water after washing hands!”


Unit 3

• „Memory Training“

– Definition

– Objectives

– Organisation

– Exercises

– Games: 1: Journey into the past

2: Extension and Expansion

3: Touch and feel


Definition

• “Memory training” is a collective term for supporting measures with the aim of obtaining a funny way to keep and to promote cognitive skills.

• At the same time “Memory training” can prevent dementing illnesses - especially in the early stages

• “Memory training” is not only helpful for people with dementia but also for elderly or immobile persons for to avoid boredom and to give stimuli for being mentally active


Objectives

• decelerate dementia diseases

• remove existing memory skills and regain lost skills, in particular:

– ability to concentrate, perception, retentiveness, word-finding ability, decision-making ability, associative thinking, thinking in contexts

• evoke pleasant memories

• preservation of vocabulary

• prevent boredom

• help to successful experiences

• increase self-esteem of the client

• integration of new residents in particular in the social life (homes for elderly)


Organisation

• „Memory Training“ requires high concentration and attention

• A good choice is to do it in the morning

• Do it twice per week if possible


Exercises

• Present photos of celebrities of the 50s and 60s, names and professions must be guessed and dialogue can follow

• Hit quiz: play the first ten seconds of a song of the 50s or 60s, whose name must be guessed

• Sing or hum a song whose title has to be guessed

• Guess and complete proverbs

• Search for synonyms. i.e. home, property, construction, building, buildings, home, housing, etc.

• Search double terms, that means words whose first component is equal to the other: highway, highlight, etc.

• Pantomime game: guess an animal, an activity, etc.


Exercises

• Board Games: parchesi ©, 11er-out ©, Memory ©, quartet, Black Peter ©.

• Card game Skat, Sheeps.head, Rummy.

• Read the newspaper and report some articles a summary

• All these games are not “just for fun” but are motivating important parts of a training exercise


Game 1: Journey into the past

• Simple questions of the past such as – “What dishes did you have ... what did you cook?”

– “On what occasions there was something special? What did you cook then?”

• Important is that it is not about to interrogate knowledge, but revive and to awake memories concerning issues and topics


Game 2: Extension and Expansion

Use for this game best-known proverbs, such as:

• The early bird … (catches the worm),

• who digs a pit ...... (falls into it himself),

• The apple falls ….. (not far from the tree),

• No pain ….. (no gain).


Game 3: Touch and feel

• For this game put different objects under a towel

• Let the care recipient touch and describe what he feels

• The important thing is not to guess the object, but to strengthen the sense of touch


Unit 4

• 10 Minutes Activation

– Definition

– Essentials

– Objectives

– Preparation

– Realisation

– Variation


Definition

• "10 Minute Activation" makes it possible to provide to clients with dementia a professional therapeutic care

• The concept takes into account the often time-limited ability for concentration of confused seniors

• Basis of activation is targeted activity with familiar objects, materials or tools from the past of the cared for person

• Those targeted use key stimuli help to activate specifically the long-term memory

• As a "door opener" it makes spilled activity and mobility available again

• Depending on the choice of the exercises various capabilities and resources of the clients are supported such as the fine motor skills, communication skills and self-confidence

(Note: In a “10 Minute Activation” there is no rigid process, because as PCG you have to respond flexibly to the care recipients status and mood)


Essentials

• "10 Minute Activation" makes best sense if it is carried out every day if possible

• It has always to be adapted to the skills and interests of the care recipient

• Almost everyone is suitable for the "10 Minute Activation"

• Very stressful conversation subject such as war, displacement and starvation should be avoided

• “10 Minute Activation” should not take longer than just those ten minutes because people with dementia will be exhausted afterwards


Objectives

• Capacity for communication is strengthened

• Biographically anchored skills are tracked

• Sense of order, discipline, care, etc. will be resurrected

• Earlier stages of life and recalled, and talking about memories is stimulated

• Knowledge about own biography will be extended

• More joy in life

• Deficits fade into the background

• Social behaviour is encouraged

• Body sensation and mobility power will be enhanced

• compromise of dementia patients is avoided


Preparation

• We put together a collection of materials and store it in labelled cardboard boxes

• Two types of collections:

– Collections related to the care recipient:

o For a housewife and mother, the collection includes, for example, old soap boxes, a washboard or temporally appropriate toys

o The collection of a former car mechanic could include tools or small parts

o It also draws upon of hobbies, such as stamp collections, soccer shoes or drawing materials


Preparation

– Collections related to themes:

o For this we choose items that belong to a time-matching issue

oPossible priorities would be about "school", "shopping", "Christmas in the 50s", "The garden in summer," etc.


Realisation

• All the senses to be touched – audible, visual, gustatory (taste), tactile (touch), vestibular (sense of

balance) and olfactory (smell and taste in combination)

– if the theme "baking" is treated, it should not only be talked about

– the care recipient should have the opportunity to smell the ingredients, to taste and to touch

• Ask care recipient to take things out of the box and touch them

• Ask care recipient for the memories s/he connects with the article, ask especially what sensations are triggered by these memories, and also whether the odour, colour or texture seems familiar


Variation

• instead of cartons also transparent plastic bags or tins can be used:

• a transparent bag offers another sensory stimulus

• metal boxes are familiar to many care recipients from their childhood and they are often associated with pleasant memories (biscuits, chocolate, etc.)

• many care recipients respond positively on handkerchiefs, here you can use different materials - it is also possible to use the handkerchief for mobility exercises


Unit 5 • Basal Stimulation / Basal Activation

– Definition o Vibratory, Vestibular, Somatic, Olfactory, Oral, Auditory, Tactile, Visual

– Objectives – Preparation – Initial Touch – Vibratorial stimuli – Vestibular stimuli – Somatic stimuli – Olfactory stimuli – Oral stimuli – Auditory stimuli – Tactile stimuli – Visual stimuli


Definition • “Basal Activation” enables severely dependent people with

perceptual loss to get in contact/touch with their environment.

• Since these care recipients have lost many of their skills, the remaining possibilities of perception will be targeted for using the “Basal Activation”. In most cases even with severe brain damage, a number of senses remain by which a care recipient can be contacted.

These are:

• Vibratory stimuli, the perception of vibrations. These can be generated by means of a massage device, an electric toothbrush or a razor.

• Vestibular stimuli, perceptions of changes in a position. These include sensations caused by gravity, balance or acceleration. Examples are up and down movements, swing, rotating and rocking motions.


Definition

• Somatic stimuli, which means touch perceptions. For this the largest sensory organ, the skin, will be stimulated. The possibilities range from holding hands up to touch, massage or perform a full body washing.

• Olfactory stimuli, which means perceptions of smell. These stimuli can be addressed by scents such as perfume or fragrance oils.

• Oral stimuli, i.e. perceptions by food, but also by eating substances and treatments for the mouth.


Definition

• Auditory stimuli, i.e. perceptions by noise or voices. Effective are here familiar sounds like favourite music, voices of family members or nature scenes such as a birdsong.

• Tactile stimuli, i.e. perceptions by palpation of objects. Convenient are mostly objects whose shapes are known by the client as s/he has often used this in the past, such as household devices, articles from professional life or personal care items.

• Visual stimuli, that is visual perception. In this case photos may be used, which are in a biographical context of the client. Stimulus can also be induced by the interplay of dark and light during the day-night cycle.


Objectives

• The ability of the client to respond to stimuli will be improved • The client can refer to lost skills and can recover as many of them as

possible • The client has gained a sense of reliability and safety • The curiosity of the client is awakened • The client has lost her/his fears • The client has overcome her/his isolation • The client is back to the state of wakefulness and is able to turn to her/his

environment • The well-being of the client is improved, s/he feels her/his existence as

pleasant • The body is not perceived solely as a source of pain and suffering • Brain damage is compensated by crosslinking under the influence of newly

acquired experiences and impressions, using still intact neurons • Muscle tone is improved


Preparation

• What activities did the client not like?

• Is the client left or right handed?

• What has been her/his attitude of the client to touch?

• Has s/he hugged known people or did s/he prefer to remain aloof?

• What meals and what drinks did the client like?

• Which sounds and what kind of music did s/he like?


Initial touch

• Address the client by his name

• Touch quietly and clearly individually defined parts of the body, this should be above the breastbone

• The contact is maintained for a moment

• Then the hand slides from this point in the direction of the next body part


Vibratorial stimuli

• Rapping about the chest or extremities with light pulses with the flat hand or fingertips

• Use of vibrating equipment, change of approach point between "soft" muscle areas (e.g. thigh for local vibration) and "hard" skeleton areas (e.g. chest because the vibrations can be transmitted deep into the body)

• Shaving using a electric shaver

• Dental care by an electric toothbrush


Vestibular stimuli

• Bring care recipient to upright position in bed

• Transfer the client into a hammock that is slightly vibrating

• Rock of light weight clients in a sheet

• Rock the client by you sitting down behind them and rocking them gently back and forth

• Riding in a wheelchair using a seat belt, accelerate and decelerate, and drive over uneven surfaces


Somatic stimuli

• Complete or partial washing

• Massages

• Stimulating liniments

• Bath or shower for the care recipient, using a rough washcloth

• Dry with a warm terry towel

• Touches, changing in intensity, length and position

• Cyclic change of position on a base that can be sensed easily

• Choose a mattress as hard as possible, taking into account the pressure ulcer risk

• Begin touches always in the middle of the body and then move to the periphery


Olfactory stimuli • Distribution of different odours, such as floral fragrance and

skin care products

• Make the connection between nursing activities and odours, apply a perfume or aftershave at the end of primary care

• Offer among residents with feeding tubes scents of spices such as anise or thyme

• Carers should always use a specific constant perfume, so they are visible to the clients

• If necessary, use odours that are related to the professional record of the resident, such as a few drops of gasoline

• If necessary, use a duvet cover that was previously used for a few days by the spouse or life partner


Oral stimuli • In any action to lip, oral or dental hygiene care products

should be used which have a pleasant taste of their own

• The gums and tongue can be stimulated with a soft toothbrush

• Careful: Triggering a gag reflex should be avoided

• Wipe buccal cavity (cavity between the jaws and the cheeks) with a cotton swab

• Apply care products to the lips

• Spread suitable food to tongue and lips such as cola, juices, honey, etc.


Auditory Stimuli

• Address the client with his first and last name

• Talk to the client , even if he may not understand

• Play recordings of relatives, friends, etc.

• Care for a change of silence and noise, i.e. by opening and closing the door

• Sing a song, while doing the basic care

• Play familiar music (favourite songs)

• Use instruments such as drums, rattles, xylophones, etc.


Tactile stimuli

• Create an individual touch-board with different items

• Give different materials into the care recipients hand, such as paper, stones, cherry stone pillow, ball of wool, sponges, etc.

• Give the client familiar objects whose shape s/he knows from the past


Visual stimuli • Playing home movies, which were provided by family members

• Transfer of the client in a wheelchair, so that s/he can look out from the balcony or window

• The lighting of the room is based on the day / night cycle, at night, a dim light is turned on

• Selective illumination of the room and illumination of certain items, such as a family photo

• Room furnishings with soft colours and decoration with photos

• When entering the room take into account to enter into the field of view of the client first, so that s/he perceives the visitor

• Use unique gestures and facial expressions


Unit 6

• Motility Exercise for Preparation

– Definition

– Essentials

– Objectives

– Realisation


Definition

• A key objective is to maintain physical mobility, as it is closely related to mental health

• Often due to the physical decay, immediately the loss of mental abilities follows


Essentials

• The exercises are always performed seated or standing, but not when lying down

• Exercises while lying down are usually more exhausting and make the breathing more difficult


Objectives

• Relaxation, minimizing the psychomotor restlessness

• Reduction of aggression

• Minimize risk of falling

• Strengthening of self-confidence and self-esteem

• Preservation of joint mobility

• Promotion of muscles as well as the performance of the tendons and ligaments


Realisation • Warm up (e.g. clapping, walking, shaking, oscillating or vibrating)

• Perform the exercises at the right tempo

• If the exercises cause pain, terminate immediately

• Breathe normally, so do not stop breathing under tension

• Make pauses if the client’s power is not sufficient or the disease requires this

• If a care recipient does not move correctly, never refer directly to the error, it is better to explain the correct execution again

• During stretching exercises the participant never should cushion

• To facilitate learning exercises for dementia affected participants, give catchy names to the exercises such as "wrap yarn " or “inflate the tires"


Unit 7

• Chair dancing

– Definition

– Essentials

– Objectives

– Preparation

– Realisation


Definition

• Dancing is an important Unit of life, and especially for the recreation of ageing people

• Traditional ballroom dancing is demanding, while chair dancing (in group) offers a reasonable alternative

• They may also be performed by seniors with limited physical and mental abilities


Essentials

• Chair dancing is an integral Unit of promoting physical activity among seniors

• The gaming factor overrides therapeutic or musical goals

• Chair dancing will give fun to the participants


Objectives

• Physical and mental degradation is generally slowed down

• The dance evokes the joy of life of the care recipient

• Old memories are reawakened and made available to the care recipient

• Through the harmonious movements the general mobility of the resident will be strengthened

• Body awareness and coordination skills are improved

• Ability to concentrate is strengthened

• The cardiovascular system and the respiratory functions are supported


Preparation

• The caregiver or animator selects the dances and the matching music

• Various criteria are:

– the dances have to be adapted to the physical resources of the participants. These can vary significantly and are defined by age and diseases (stroke, heart attack, etc.)

– particularly suitable are songs that come from the youth of the participants

– the music should have a reference to the region

– the season and Holidays (harvest time, Carnival, Christmas, etc.) should be taken into account


Realisation

• New music will be played once

• If necessary, give song information, i.e. about year, artist, etc.

• The dancing moves are initially practiced without music

• In most cases, it is sufficient that the sequences of movement are shown once or twice “dry”

• Plan sufficient breaks

• The requirements are increased slowly


Unit 8

• Fall prevention – Consequences of falling

– Mobility restricting measures

– Important Risk Factors of Downfall

– Suitable measures for prevention

– Tools for downfall prevention

– Evaluation

– Your home under the microscope

– Checklist

– Pay your attention

– Exercises


Consequences of falling

For the patient

• injury • ache • immobility, result:

potentially pneumonia, bedsores

• muscle weakness / contractures

• disability • anxiety • fall-related mortality

For their relatives

• self-reproach

• concern for their relative

• home care or placement in a nursing facility

• scepticism


Mobility restricting measures

• They may act as a trigger for agitated and disoriented people to flee

• Injuries in case of a downfall are mostly more serious

• Negative effects of immobilization are serious

• Immobilization is not a suitable means for the prevention of downfalls. Instead: Ask yourself why the care recipient wants to get up now, or to do this or that?


Important risk factors for falling

• Advanced age

• Incontinence

• Acute disease process

• Diseases such as diabetes, Parkinson, etc.

• Visual impairment

• Impaired cognitive skills

• Falls in the past

• Medication, walk limitations and balance limitations

• Environmental factors such as lighting


Suitable measures for prevention of falling

• Mobilization only if accompanied by a person

• Use of appropriate tools, walker, cane

• Environmental adaptation, accessibility, no swelling, no trip hazards

• Promotion of continence

• Re-evaluation of medication

• Adjustment of diet and fluid intake

• Modification of the visual impairment


Tools for fall-prevention

Sturdy shoes Walker / rollator Stopper socks Suitable clothes, not too

loose or too tight pants Height adjustable bed

(low position) Grab rails Long shoe horn Tongs Hip protectors


Evaluation

IMPORTANT also:

• Provide a balanced diet and a proper hydration

• Pitfalls in the household MUST be eliminated e.g. rickety tables, scattered telephone cable, loose carpet edges

• Let check your glasses strength regularly

• Does the care recipient use tools? Then check its function, i.e. the brakes of the rollators, rubber nubs of walking aids.


Your home under the microscope

• Falls often happen where one feels particularly safe, namely at home. And this mostly during everyday situations such as going to the toilet at night or leaving the shower.

• Many homes do not meet the needs of older people. Often small changes could be enough to make life easier, to improve the independence and to enhance security.

• Because it is especially difficult to perceive the hidden dangers in your own environment, here is a checklist.


Checklist

• Access to the house / outside area:

Is a banister available? (At a non-level access)

• Hallway and stairs / cellar stairs:

Are the stairs coiled or stages are slanted?

Are the stairs entirely surface covered with flooring?

Is there a handrail? Handrails should go beyond the beginning and end of the stairs.

• Technical equipment:

Is there an electric door handle or intercom available? Is the phone well reachable?

Is there sufficient lighting / light available?


• Doors:

Are there thresholds?

Is the door width sufficient for walkers or wheelchairs?

• Kitchen:

Are seats easily accessible with tools?

Can frequently used items in cabinets easily be reached?

• Bathroom:

Is a threshold-accessible shower facilities available?

Is there a shower stool? Pitfalls / Bath Rug?

Is the seat height of the toilet adapted to the person?

Is there adequate handholds in the bath / shower / toilet?

Is the light switch easily accessible

Checklist


• Bedrooms:

Is the light switch easily accessible from the bed?

If necessary, is a sensor switch available?

Is there a storage option at the bed?

Is the bed accessible with aids i.e. a wheelchair?

Is the bed height adjusted?

Is there a night light for orientation?

• Apartment: go through all the rooms you have in mind:

Are the floor coverings secured against slipping?

Are there unsolicited pets?

Are there any pitfalls? (Loose items, rugs, ...)

Checklist


Pay also attention to …

• Please check traces inside the home. i.e. from the kitchen to the living room or from the bedroom to the bathroom, are they attainable also in in poor lighting

• Sometimes there is great time pressure (urinary urgency)

• Organize if possible that all rooms are on one level to overcome as few stairs as possible

• Also check if a home emergency call is necessary


Exercises

• Get up and sit down on a chair: It should be a stiff chair and it may have armrests for support. In this exercise, the leg muscles and the corresponding joints are primarily trained. Redirect the client to come up with the upper body forward at first and then to stand up. When sitting down, make sure that s/he does not simply fall down on the chair, but sits down effectively controlled. This exercise should be initially performed 5 to 8 times.


Sitting on a chair while lifting the lower leg alternately : The care recipient is sitting on the chair and alternately lifts the lower leg as far as to form a straight line with the thighs. The back should remain as straight and tall as possible. This exercise should be performed 6-8 times. This will strengthen especially the thigh muscles. Only the knee joint is moved.

Exercises


Standing behind the chair, the lower leg is bent up and down backwards: The client stands behind the chair and holds on to the back. Then s/he shall alternately, sometimes left sometimes right bend and stretch again each lower leg. This strengthens particularly the calf muscles. Complete this exercise 5 to 8 times, then slowly increase.

Exercises


Standing behind the chair, stand on the toes and then back on the heels: The client holds firmly to the back of the chair again and stands on his toes and back on his heels. In this exercise, particularly the balance is practiced. But the muscles of the ankle joint is severely stressed. Since this exercise can overburden some seniors, it is also possible to do it while seated. It should be performed 6-8 times.

Exercises


Sitting or standing - pull up the shoulders: This exercise can be performed while sitting or standing. The client should pull up the shoulders as far as possible and then let loose again. Up to 10 times in a row.

Exercises


Arm circles while sitting or standing: The client is sitting on the chair or stands before the chair, and is circling with the arms. First, only a small circle is described and then larger and larger. Once the largest is made, the circles become smaller again. They should be carried out relatively slowly (a circular movement should take about 8 to 10 seconds). The larger the circles are, the more the arms go away from the body. This exercises especially the mobility of the shoulders. If possible, this exercise should be performed 2 times.

Exercises


Put feet quite close together, release the hand from the chair, and stay as long as possible: This is a very classic balance exercise where the aim is to increase the time of the free standing.

Exercises


Stand with your feet quite close one before the other and release the hand from the chair: A second exercise in balance, the goal is to keep the balance as long as possible.

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Exercises


Additional walk training:

Encourage the client regularly to walk daily small distances. So all the paths in your own home, the way from room to room, the hallway up and down, etc.

Reward client and create incentives for training to walk. Offer your accompaniment to the care recipient when he feels very insecure and needs help.

Clients who are in good health should be asked to walk half an hour at least or more.

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Exercises


Exercises for care-recipients in wheelchairs: For wheelchair users, there is the possibility of "walking wheelchair". This means that the leg supports are removed and the care recipient uses his legs for locomotion. The leg muscles are trained and the person is mobilized.

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Exercises


Unit 9

• Vision / Promoting visual perception

– Setting up a photo wall

– More eye catchers

– Slide shows, private films, use of multimedia

– The sense of touch fulfils many rolls

– Recommendations

– Different kinds of Touchboards

– Bowl of various materials

– Massages


Setting up a Photo Wall • Set up a well-designed photo corner on the wall, very visible to

the client

• It is useful to look at old photo albums in collaboration with the relatives and to the extent possible with the client to select the best images

• Divide the wall in subjects such as people, parties, holidays, marriage, grandchildren, etc.

• It is also nice to change photos from time to time, so as to give new impressions

• It is also possible to enlarge very small photos, so the care recipient can look at them without much trouble

• The photo-corner does not need not be too large either, it should be captured well by the person at a glance


More Eye-catchers

• Dolls, stuffed animals, wooden or cardboard figures, depending on the interests and aptitudes

• Clothesline over the bed with laminated photos, fastened with paper clips for easy replacement

• Wall stickers: these are available in all colours, shapes and patterns; such as flowers, animals, skylines, etc.

– the wall stickers can be conveniently attached to the ceiling and later be removed without residues


Slide shows, private films, use of multimedia

Perhaps the client or the family still have old slide collections or private movies with biographical reference.

Be aware: It can be very difficult and expensive to obtain appropriate projectors or transfers.


The sense of touch fulfills many roles

• Pain perception

• Temperature perception

• Perception of surfaces

• Deep sensibility, the self-perception of the body (position in space, tension of muscles and tendons, detecting motion and motion direction)


Recommendations

Touch board:

• They can be produced relatively easily

• A handy wooden board is simply covered with different materials, preferably with a hot glue gun

• Suitable to this end are fabric remnants (velvet, silk), carpet remnants, cork, wood beads, furs, etc.

• The preparation of these boards can also be done by the care-recipient


Different kinds of Touch Boards

• A bedridden client may, depending on her/his capabilities, just sense the touch-board, or it can be used as a guessing game while being blindfolded: the materials have to be identified

• The touch board can be covered with materials that have a challenging character and invite to work with the materials, i.e. with velcro, zipper, buttonhole, hair or wool that yarns for weaving

• A sound board, which can be equipped with e.g. a bicycle bell, with bells attached to ribbons, with a clicker, mini-organ, etc. - in this variant, the sense of hearing is included


Bowl of various materials Take a bowl and fill it with a variety of materials: From nature:

• autumn leaves

• chestnuts

• grass

• snow

• sand

Be sure not to use any pointed or sharp objects. Let the care-recipient handle the materials, feel and possibly guess again.

Another variant for care recipients who are mentally not very limited:

• fill a bowl with sand or other material, in the bowl things can be hidden, which must be sought out

Other materials: • styrofoam peanuts (packaging

material) • table tennis balls • tennis balls • golf balls • crumpled newspaper


Feel bags

• Feel bags can also be produced relatively easily, you can sew fabric scraps or take a jewelry bag with cords

The advantage of cotton bags:

they can be refilled again and again.

• To fill up you can use dried peas or corn, cherry stones, marbles, wooden beads, small stones, etc.

• By sensing the sacs small games can be carried out, intellectually active residents can be blindfolded

• They should then feel and name the content


Massages

• Massages are very beneficial, when executed properly

• With a bit of care the client can be massaged also by you

• Massages are possible with hands and a good oil (e.g. Arnica) or with tools like a hedgehog ball

• There are several types of massages – Get started on the extremities and work your way in a light circular

motion to the body trunk in front and then back again

– Try just a foot massage, head massage or brush massage

– For the brush massage you need a body brush with natural bristles and massage products such as loofah or something with sisal

– Starting on the lower legs a dry brush is fed back to the trunk, using a circular motion


Unit 10

• Current physiotherapy interventions according to the ICF framework

E.g. Bobath-concept - (Neuro-developmental treatment)

– Positioning


Positioning

• By positioning, sensing information can be given in order to improve the perception of the body of the bedridden person

• Often care recipients with a disturbance of body perception show great turmoil and severe spasticity

• The goal of improved body awareness is achieved best by positioning with a higher contact pressure (against the pressure ulcer prevention with the demand for a super soft storage)

• Parts of the body that do not lie on the mattress, can be given additional sensing information by other "harder" positioning aids


Positioning

Other measures to improve the perception of the body:

• Not only wet hair can be blow-dried, but sometimes even the body itself

• Retraction of the skin with different materials:

– rough hand towel

– silk cloth

– tennis ball

– fur

– warm cherry stone pillow

– warm stones


Unit 11

• Auditive Perception

– Objectives

– Important

– Prerequisites

– Recommendations for activities

– Guessing Songs

– Guess Sounds


Objectives

• Interruption of the monotonous daily routine, distractions and focus on the music and sound perception

• Listening to music awakes positive feelings and memories for the client

• It can help the promotion of memory, orientation and concentration


Important • The use of music should be determined by the biographical

work, what kind of music the care recipient prefers

• The wrong choice may well have negative effects, such as increased agitation or aggression

• The music should be played in a targeted manner and not run constantly as a background noise

• The same applies for TV


Prerequisites

• If a hearing aid is required, you should be able to choose the correct settings, and use it correctly

• See if the eartip fits and even perform the cleaning


Recommendations for activities

Read out:

• short stories, poems, newspaper and magazine articles or fairy tales – be sure to match the contents of the respective interests and

inclinations, as well as on the cognitive skills of the client

– some older women love gossip about stars and starlets, others are more politically interested and pleased with items from magazines


Guessing Songs

• Sing familiar songs (folk songs, pop, old popular songs) and let the client guess

• If you do not want to sing yourself, you can also insert an appropriate music CD


Guess Sounds

You can record following sounds using your smartphone:

– crumple newsprint

– rattle with a keychain

– let a kitchen clock ring

– stir a drink with a teaspoon

– ring with a bicycle bell

– etc.


Unit 12

• Taste / Smell

– Definition

– Objectives

– Essentials

– Clients with a feeding tube

– Use of various odours

– Recommendation for use

– Important


Definition

• The sense of smell and taste are related very closely

• For the taste sensation of food, it is decisively influenced by the sense of smell

• The tongue can only distinguish four categories (bitter, salty, sweet and sour)

• Be aware that the taste and sense of smell can be impaired by a cold: “the food was suddenly very bland”


Objectives

• With different odours and taste, positive feelings and memories will be awakened in the client

• Promotion of memory, orientation and concentration


Essentials

• Elderly people often lose the sense of taste or smell, so the food should be provided vigorously flavoured with spices and herbs (beware of salt!)

• If the client is losing weight, or is expected to do so, this can be compensated for by increasing the calorific content of food, for example by adding cream, butter and non-saturated oils.


Essentials

• With care recipients with impaired chewing and swallowing ability, it is particularly important to ensure that the food portion consists of the same level of consistency – Example:

• a soup with added dumplings, meat or egg custard is not suitable for this target group, because the liquid is easy to swallow, but the solid constituents must be chewed

• this coordination is too difficult for the person concerned and therefore leads to frequent choking

• therefore, for ease of swallowing, the different food components, such as meat, vegetables and potatoes have to have the same consistency


Clients with a feeding tube Clients fed with a feeding tube, do not have to completely give up

treats

They can still swallow yoghurt or porridge according to their ability

Put honey, chocolate spread on the lips with a cotton swab – clean the lips beforehand

Dive a cotton swab in various beverages (cacao, coffee, tea, soda, cola, wine, beer, malt beer) and spread it on the tongue

Freeze drinks in an ice cube tray and give it to the care-recipient wrapped in gauze in his mouth, so the care recipient can suck it

The method with the small gauze sachets also works with fruit, chocolate, a piece of salami, etc.


Care recipients with a feeding tube

• The approaches described are a good prophylactic remedy for thrush and parotitis (inflammation of one or both parotid glands), encourage salivation and keep the mouth moist.


Use of various odours

• Certain scents and odours can quickly evoke memories and emotions, due to the fact that the sensory input is passed directly into the amygdala (part of brain that performs a primary role in the processing of memory). It also supports the emotional evaluation (fear, sadness, disgust, anger and joy) of impressions.

• Examples: – Perfume of deceased partner

– Smell of fresh air

– Smell of certain flowers

– …


Recommendation for use

• Show different scents and smells and ask the client what memories s/he connects with it – i.e. floor wax, cinnamon, onion, colognes, fresh leather, freshly mown

grass, old books, shoe polish, fresh fruit, wine, beer, etc.

• You can also use potpourris, or a fragrance lamp as desired – Remember to limit the use, the client very quickly gets used to the

smell and then the perception disappears

– Use high quality essential oils, enter one or two drops into the bowl of water

• Check with the client or his relatives on preferences


Recommendation for use • Scented candles

• Flowers in the room - with flowers be sure that the scent is not too intrusive and that the care recipient is not allergic

• Ask, if possible, a relative if the client has used such things in the past or not

• Fragrance sacs or pads, i.e. lavender

• Fragrance stones of terracotta can also be placed unobtrusively and drizzled with a drop or two of essential oil


Important

• Take care when using fragrances and essential oils

– some people feel the scents as pushy and even get a headache

– in asthmatics and epileptics seizures can be triggered by strong smells

– and of course, existing allergies must be known and excluded before the application


Unit 13

• Event oriented biography work

– Definition

– Stimulate all five Senses

oAuditory perception

oPerception by touch

oPerception by smell

oVisual perception

oPerception by taste

– Other examples


Definition

• Biography work is work on memory

• People are immersed in their memories and tell their lived experiences in discussions, exercises and personal materials

– they express it, for example, with photos, poetry albums and likewise


Stimulate all five Senses

• Find access to every person via the five senses

• With these senses a person gathers experience on which s/he can come back at any time

• Via sensations these experiences become tangible again and are remembered


Stimulate all five Senses

Activation and stimulation via:

• Auditory perception (Hearing)

– old folk songs

– compete rhymes and proverbs

– music from the teenage years


Stimulate all five senses

Perception by touch:

• knead a dough

• feel sand

• touch animals

• form a snowball

Perception by smell:

• fresh coffee( grind and brew)

• baking cake

• fragrance sacs, flowers, herbs


Stimulate all five senses

Visual perception:

• old pictures

• door signs

• endorsement from the maibox

• old pictures from home

Perception by taste:

• preparing a cake „old recipe“ and snacking on dough


Other examples

• Families – memory

• Pictures - puzzle, images from own experience

• Music quiz

• Fashion show (hire costumes, museum)

• Evening of glory hole


Unit 14

• Activities suitable (not only) for people with dementia

– Selection criteria for suitable activities

– General guidelines

– Opportunities for activities

– Motility

– Sing well-known songs

– Activities close to everyday life / daily living

– Care about retrospectives


Activities suitable (not only) for people with dementia


Selection criteria for suitable activities • Easily to be done • Promising • Familiar activity, biography oriented • Seasonal oriented • “Product" should be useful (e.g. gift wrapping paper,

decorations, greeting cards, ...) • Offers should not be childish, to respect for being an adult

person • No memory training within the meaning of practising • Material selection: beware of small parts, handy, non-toxic • No fear of repetition, … • Private sensation to an activity • "Only those who are motivated, can motivate others."


General guidelines

• Address the person from the front, keep eye contact • Friendliness, conscious use of body language (gestures,

facial expressions, posture, voice) • Speak slowly and clearly, repeat words if necessary, do not

talk too loud • Subdivide short sentences, only one request, divide

workflows into steps • Give the client time


Opportunities for activities

• Sensory experiences, touch • Story reading, storytelling, deal with language, scripture,

tradition • Artistic and creative activities, arts • Etc.


Motility

• Regular walks • Seat gymnastics with background music: rhythms accompany

seat gymnastics with different materials (e.g. balls, balloons, koosh balls (toy ball made of rubber filaments (strings) attached to a soft rubber core), tennis rings, chiffon scarves, plastic hoop)

• Movement games, such as Skittles, Ring Toss • Dancing: chair dances, ballroom dances


Sing well-known songs

Maybe accompanied by guitar, piano … • song books with large print (also known as single activity) • religious songs ("Great God"), religious background? • listen to familiar music • animating songs


Activities close to everyday life / daily living

• Housekeeping activities such as cooking (fruit salad, vegetable

soup, dessert), baking, cleaning, washing dishes, ironing, folding laundry, etc.

• Working with wool, wrapping wool • Office activities: e.g. punching paper and let organize manual

works, e.g. working with wood (wood saw, sand, fretwork ...) • Using tools, sorting nails and screws


Care about retrospectives

• Storytelling with the help of objects from earlier times and remember, i.e. old coffee grinder, books with old fashioned letters …

• Photo albums • Create a life book (reminder album) • Focus on what the care-recipient currently still remembers

(no chronology) • Help for biography oriented care • Help to bring part of the memory and personal history back • Create a memory box

13 M-CARE: Leisure and daily activities

Education

Transcript of 13 M-CARE: Leisure and daily activities