Lessons In TR

I’m attending the PATH Intl 2018 Virtual Conference this year and so far it’s quite good. They’re doing a nice job having topics that are applicable to a lot of the different roles in running a program. I really appreciate that they went out of their way to get presenters that are professionals/experts in their own field (not the EAAT field) and also picked topics in response to what members said they wanted to hear about. My favorite presentations today were “Working Successfully With People With Dementia” and “How to Process the Loss of a Therapy Equine” because I got the most applicable information and ideas out of it for me currently being “just an instructor.” So I want to share with you my notes from the Dementia talk. Click here for the whole webinar on PATH Intl’s web store. I don’t want to steal her presentation, just share what I found the most interesting and helpful as an instructor. I’ve rearranged the information from how it was presented so that it’s most helpful to me. I hope it helps you out too!

Notes from “Working Successfully With People With Dementia” by Debi A. Buzanowski-Stowell and Sandra Monahan

About Dementia

• Dementia is a general term, and can represent 75+ different conditions
• Dementia does not just affect memory, but all aspects of the brain: judgement, attention, perception, reasoning, organization, abstract thought, and language
• Therefore dementia affects all aspects of working with horses, not just remembering, but deciding if something is safe, making the body do what the brain wants, and so on
• As brain deterioration affects their perception of whether something is real or not, this can cause a lot of fear
• Short term memory goes first, long term memory goes later

What you may see

• Poor reasoning
• Poor decision making
• Can’t come up with an answer
• May do unsafe things
• Movement doesn’t align with what they’re trying to do – they stroke the horse too fast or approach too quickly
• It’s hard to think outside the current moment
• Language use issues can be frustrating for everyone
• Destroys short term memory
• They forget what you just told them
• They ask you the same things over and over even though you just told them
• They have difficulty understanding the passage of time
• Difficulty following direction
• They may remember X (like living on a farm growing up) and think that time is now (and talk as though they live on the farm now)
• Mood swings, personality changes
• Inappropriate behavior because no filter
• Difficulty finding the right words
• May stop speaking
• May speak in a word jumble
• Loose vision: peripheral, depth, perception
• Sensory changes: hallucinations, diminished senses, altered sense of touch

Adaptations

(Harry Potter anyone?)

• Pay attention all the time! Constant vigilance! Don’t expect them to make good decisions (like not walk behind the horse) (even if they told you they grew up with horses)
• Refocus them – a lot!
• Give a lot of reassurance (to prevent fear)
• Work in the present moment
• Tell them “soon”, “later”, or “in a little while” instead of 5, 10, 15 minutes, etc.
• They need a lot more reminding/cueing
• Just go along with it, when their memories get muddled
• Don’t take mood swings personally
• If they are getting worked up: validate their feelings, give them space, then re-approach in  few minutes
• Fill in words when appropriate (as they forget them) – Graciously fill in the gaps to prevent embarrassment
• When words are forgotten, continue the conversation as if nothing happened
• Speak slower and use less words
• Rely on body language to guide the conversation and gauge how they’re feeling
• Try to say it in 7 words or less, then wait 7 seconds
• As vision deteriorates, always approach from the from and watch out for hazards for them. Be aware that water (puddles) may become scary, and shadows look like holes.
• Treat every interaction as if it’s your first – say your name a lot!
• Break tasks into simple directions, one given at a time
• Cue – often hand over hand or starting an activity for them will help them remember something they know
• Redirect –  get in their face and say their name, place their hand on what you want them to focus on
• If 2 people are needed to work with them, only 1 speaks and gives directions (too many people instructing can be overwhelming and confusing)
• Make eye contacts and get low so they can see your face – which may take them a few seconds to recognize
• Use concrete language, not slang (“cool!”) – as though they’ve regressed to baby language which is only literal
• But don’t speak in baby talk or voice, they are not babies
• Use positive wording – lots of “no’s” or corrections can become discouraging
• Nice ways to say “no”:
  • “I wish I could”
  • “I don’t know, I’ll see what…” (I can do, find out, etc.)
  • “I think it’s too…today” (hot, cold, etc.)
  • “That sure sounds like fun”
  • “What a great idea. Maybe next time.”
• Don’t argue – it’s impossible to win an argument because they’re unreasonable, it only leads to frustration and the person becoming defensive
• Say “I’m sorry” a lot, it makes it your problem
• Music may be good to make simple tasks relaxing, but if they’re trying to do 2 things it may be too much or distracting

Important concepts

• We must step into their world because they cannot come into ours and we cannot control what they think. This means you may have to play along or use “therapeutic fibbing”.
• Therapeutic fibbing
  • pretending in order to keep them feeling safe and from escalating in fear or anger
  • Examples:
    • pretend you’re whoever they keep calling you
    • see their hallucinations
    • when they just brushed the horse for an hour and forgot so they want to do it more, tell them the horse is too tired
    • tell them what they want to hear (want to ride? Sure, I’ll check in on that.)
    • make someone else the bad guy (I’ll check with the barn owner, or, the doctor says…)
    • make a fake phone call (to check with the doctor)
    • pretend the needed area/door is locked
  • Unless they are looking to your for an honest answer, then be honest – you will learn your client and what works best

What have you found to be helpful in working with clients with dementia?

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Note: This is not professional advice, this is a blog. I am not liable for what you do with or how you use this information. The activities explained in this blog may not be fit for every rider, riding instructor, or riding center depending on their current condition and resources. Use your best personal judgement! If you would like to contribute an activity or article, please contact me here, I would love to hear from you!