KYDZ INTERNATIONAL: 2011

Thursday 29 December 2011

Montessori-based activities for persons with dementia.

Elizabeth Randall, Orlando Education Examiner

October 25, 2008

An Ohio-based psychologist has developed an approach to treating Alzheimer’s Disease patients based on his reading of Montessori education principles. His research indicates that it works.

Cameron Camp, an experimental psychologist and director of the Myers Research Institute in Beachwood, OH, has published the first of a planned multi-volume series of lesson-plans, Montessori-Based Activities for Persons with Dementia.

Dr. Camp, whose wife is a Montessori teacher, began implementing his program in 1996 based on his reading of Montessori principles.

“The Montessori method of education,” he said, “has much in common, both philosophically and pragmatically, with good dementia care. Among the most important principles, he said, is the belief that new learning can take place in persons with dementia.

According to a review in the Summer 2002 edition of Activities Directors' Quarterly for Alzheimer’s and Other Dementia Patients, “Those familiar with Montessori principles in planning activities for children will recognize that the same principles can be used with dementia patients. Montessori activities are planned in sequences that allow learning to progress as cognitive and motor skills develop, or, in the case of dementia patients, decline. Activities are broken down into different parts and just one part is practices until the resident feels competent at it.”

The treatment program is described as “Montessori,” because of the use of developmentally sequenced activities, and the emphasis on concrete tasks. “Patients,” Camp said, “find this interesting and they’re very motivated.”

He added that the program could be applied to anyone with learning disabilities. “Montessori talks about cueing, task breakdown, how to circumvent deficits with executive function. We’ve found that cognition interfaces with neuroscience,” he said. “Piaget thought along the same lines; to look at developmentally sequenced activities to treat dementia.”

Supporting such research, a 2002 study in Clinical Gerontologist (Volume 26, Numbers 1 and 2) reported that the use of Montessori-based activities by visitors of nursing home residents with dementia led to “significant increases in active forms of residents’ engagement with visitors, and corresponding decreases in passive forms of engagement.”

Similarly positive findings came from a 1996 study at Menorah Park Center for Senior Living, .an on-site geriatric research center, where Camp developed the program for Alzheimer’s patients. Menorah Park is the parent organization of the Myers Research Institute.

Program in Action

An encouraging example of the approach is found at the Circle Center Adult Day-Care service in Richmond, VA. In 2002 it became the first adult day care center in Central Virginia to launch a Montessori program for Alzheimer’s patients.

Adult day-care programs typically provide a facility, staff, and daytime activities that enable caregivers to keep elderly relatives out of nursing homes. In practical terms, caregivers can avoid the expense of long-term care and even keep working while caring for a relative with dementia. Although no formal studies have been done about the cost effectiveness of such programs, the benefits of a patient’s engagement with his activities, which Camp’s program provides, is undeniable.

Lory Osorio, the Circle Center’s executive director, said she first heard about the Montessori-based program at a National Adult Day Care Conference. “Camp presented a session,” she said.” My background is in occupational therapy so it made a lot of sense to me.”

She raised funds to build a room in her facility and dedicated it to the geriatric Montessori program developed by Camp, which she calls “Memory Lane.” “There are things about the environment that we’re mindful of,” said Osorio. She uses only one room for her Montessori-based program and ensures that it is a distraction-free environment. “We made it homey and nostalgic,” she said, “ and of an era that these people can relate to.” Big-band or gospel music plays softly. One wall is exposed brick, another displays a homemade quilt, and the other wall is a row of upper and lower kitchen cabinets, “so it looks a little like you’re sitting in a kitchen.” In addition there are photos of Richmond, Virginia, the way it looked in the 1930’s, a display case of old china, and in a recessed display case, old tins of American products: crackers, oatmeal, borax soap.

When the room was ready, Osorio hired a lead program manager, Janina Bognar, to oversee it. Bognar, who earned her Master’s in Gerontology, is effusive about using Montessori with an Alzheimer’s population. She emphasizes that cognitive enhancement isn’t the only benefit of the Memory Lane program, primarily because the agitation, depression and anger, so common in Alzheimer’s patients seems to be noticeably absent. ” Dementia has an overlay of depression, of feeling incapable of doing things,” she said. “ Anything that lifts that veil of depression is beneficial.”

Osorio agrees. “With an aging population there is no emphasis on academics. Our goal is that our folks feel good about themselves. The program provides a focus for their time and taps automatic memory. To successfully complete a task is very important. Patients learn to recall color, counting, textures, manipulation of objects, shapes. The program takes skills that they’re not using and brings them out.” Findings in the August 2003 issue of the Journal of Clinical and Experimental Neurophysiology , support this view, showing that people who do puzzles, exercise and keep their mind busy may actually possess a “cognitive reserve” that enables them to withstand impairment from Alzheimer’s.

The brain of an elderly person with Alzheimer’s isn’t a silent room, and drumming up brain activity is worth the effort . Camp, who acted as a consultant for the Circle Center, became interested in using the program with adults who had Alzheimer’s “around the same time that my children started Montessori school.”

Similar to the Montessori Early Childhood education approach, all activities are customized to personal aptitudes. For example, rather than use traditional Montessori materials, caregivers and trainers for patients with dementia, “take current supplies from people and staff and make them more,” said Camp.

These can include simple and familiar items like spools, beanbags, buttons and popsicle sticks. Camp describes adapting the activity of one person throwing a bean bag at a bulls eye while everyone else just stands around and watches. In the adapted activity, instead of the bulls eye, a pie chart is used. On the pie chart is a participatory label, such as “stomp feet” or “clap hands.” When the bean bag lands in a wedge, everyone joins in.

Osorio said, “ We use materials that people are familiar with using from another part of their life.” One of the Circle Center activities involves sorting work where patients separate colored popsicle sticks to match five ounce juice cups of the same color. Such activities reinforce motor skills and eye-hand coordination, and may help patients relearn simple tasks such as feeding themselves or picking out clothing.

Because of the popularity of the program, Osorio and Bognar are planning to train additional staff members to use the Montessori activities with the Circle Center patients. Bognaris also planning to go into the community to the homes of relatives with Alzheimer’s patients and to schedule activities.

Osorio suggests that in other communities, Montessori schools could encourage students to volunteer in adult day-care centers and to share some of their Montessori activities with Alzheimer’s patients. The human contact would be as important as the activity itself.

The Circle Center, a non-profit agency, received funding for the Memory Lane program from the Richmond Memorial Foundation, which grants funds primarily for health-oriented priorities. The Circle Center staff uses Camp’s lesson plan manual for 90-95 percent of the activities with their Alzheimer’s patients.

Osorio said the manual “would work with pretty much any disability.” Camp’s web site includes a synopsis of the manual and a link to Amazon.com, where excerpts of the manual can be purchased.

The Myers Research Institute has a grant from HCR Manor Care Foundation to introduce Montessori-based programs to three long-term care facilities in Ohio. “National training,” said Camp, “is also being implemented.”

“There is a Montessori saying that is our motto and guides us,” Camp said, “Help those who are in search of activity and cannot find it.”