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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

PAC Champion 3Building Skills to Adapt our Approach!

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Global Deterioration Scale- 1 – No cognitive decline

- 2 – Very mild cognitive decline

- (Age Associated Memory Impairment)

- 3 – Mild cognitive decline

- (Mild Cognitive Impairment)

- 4 – Moderate cognitive decline

- (Mild Dementia)

- 5 – Moderately severe cognitive decline

- (Moderate Dementia)

- 6 – Severe cognitive decline

- (Moderately Severe Dementia)

- 7 – Very severe cognitive decline

- (Severe Dementia)

- So what can they do? The scale doesn’t address that?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

GEM® Dementia Abilities Based on Allen Cognitive Levels

•A Cognitive Disability Theory – OT based

•Creates a common language and approach to providing: Environmental support

Caregiver support and cueing strategies

Expectations for retained ability and lost skill

Promotes graded task modification

•Each Gem state requires a special ‘setting’ and ‘just right’careVisual, verbal, touch communication cues

•Each can shine

•Encourages in the moment assessment of ability and needAccounts for chemistry as well as structure change

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

The GEMS®…

Sapphires

True Blue – Healthy Brain

Diamonds

Clear/Sharp – Routines & Routines Rule – Change is HARD

Emeralds

Green/On the Go with Purpose– Naturally Flawed

Ambers

Caught In a moment of time – Caution Required

Rubies

Deep & Strong – Others stop seeing what is possible

Pearls

Hidden in a Shell – Beautiful Moments to Behold

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

To Start - Look at two videos…

• What do you notice about the helper and the person being helped?

• Why did each of them do what they did?

• How does this relate to what happens in your daily or real life? How does it relate to what you will be doing today?

• What is one thing you want to focus on today, as you move forward?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Introduction: PAC Beliefs

• The relationship comes first…

• People living with dementia are doing the best

they can.

• Every gem, when given the right setting and the

right care, can shine!

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

We are going to be Practicing

- Noticing skills an abilities in someone

we are approaching

- Adapting Positive Physical Approach

-For someone in a diamond state

-For someone in an emerald state

-For someone in an amber state

-For someone in a ruby state

-For someone in a pearl state

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

A Positive Framework…

seeing GEMS

Sapphires – True Blue – Slower BUT Fine

Diamonds – Repeats & Routines, Cutting

Emeralds – Going – Time Travel – Where?

Ambers – In the moment - Sensations

Rubies – Stop & Go – Big Motions or Still

Pearls – Hidden in a Shell - Immobile

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

What changes could we try?GEMS Sapphire Diamond Emerald Amber Ruby Pearl

Visual Cues

Verbal Cues

Touch Cues

Pace

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Receptive Language Changes

Sapphires – high pitched harder, crowded &

loud spaces more challenging

Diamonds – Slower, missing consonants

Emeralds – missing about 1/4 words, needs

pauses – better with rhythm

Ambers – 2/4 words – misses much, catches

some key words out of context

Rubies – social chit-chat, music, rhythm, tone

of voice

Pearls – familiar and friendly, calm or excite

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Expressive Language Changes

Sapphires – word finding a little slower, pauses

Diamonds – varies with affect, word finding

problems, mis-speaking at times of stress

Emeralds – gets stuck in social, repeats

phrases or words, intonation matters

Ambers – repetitive, variable volume, echo

Rubies – less articulated speech, babble, hum

or sing, rhythmic vocalizations

Pearls – sounds to single words, responsive

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Dexterity – Hand Skills

Sapphires – still intact slightly slower

Diamonds – Slower, limited with bilateral skilled

integration

Emeralds – individual actions are there,

sequencing is challenging, more forceful

Ambers – heightened use of hands, skilled tool

use decreased, strong

Rubies – whole hand with limited finger use –

hold and carry, difficulty with release

Pearls – grasp strong, limited opening

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Body Skills

Sapphires – sustained - slower

Diamonds – details not as good, globally Ok

Emeralds – better with dominant side, errors

Ambers – strong more than skilled, limited

safety awareness

Rubies – whole body not segmented, front ok

back not

Pearls – reflexive, great trouble with gravity or

speed or movement

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

People Awareness Skills

Sapphires – sustained – slower to ID

Diamonds – recent ?, older/deeper better

Emeralds – recognize like/not like,

Ambers – can get lost in old-new relationships,

will like or not like in the moment

Rubies – like or not like, familiar versus not

Pearls – voices, faces, touches, smells familiar

or not

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Place Awareness SkillsSapphires – sustained turned around

Diamonds – familiar feels best gets lost in

community & in unfamiliar places

Emeralds – if OK with what is seen is OK, if not

OK seeks the old familiar –task or social

Ambers – OK if “here” feels OK, otherwise will

seek “there”

Rubies – may or may not have a destination

more a movement or stillness pattern

Pearls – is what is experienced comforting

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Time Awareness Skills

Sapphires – lifelong – crunched or expanded

Diamonds – more the past than now

Emeralds – lost in episodes or caught in loops

Ambers – in the moment not the task or

sequence

Rubies – in the experience, not the time

Pearls – time has much less meaning

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Situation Awareness SkillsSapphires – sustained tough to think

Diamonds – old emotions drive new interactions

Emeralds – has moments of time travel

Ambers – more sensory awareness than

intellectual awareness, immediate not big picture

Rubies – only in moments, less body aware

Pearls – more inside than externally aware

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Positron Emission Tomography (PET)

Dementia Progression vs. Normal Brains

G. Small, UCLA School of Medicine.

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Choosing to be Sapphire?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

What changes could we try?GEMS Sapphire Diamond Emerald Amber Ruby Pearl

Visual Cues

Verbal Cues

Touch Cues

Pace

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

In the next breakout- Adapting Positive Physical Approach

-Someone in a Diamond state (your mentor)

Let’s watch the videos – with PAC Skills, and without

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these steps did you see? Which did you NOT see?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these did you hear/see? Which did you NOT?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

With a diamond

• Approach from the front to stay in visual field

• Give visual cues, within my own space, to match my words

• If wanting to keep something in hand or no touch needed,

no hand offered

• Supportive stance at edge of public space

• Notice what is happening and compliment

• Ask for help or opinion

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

In the next breakout- Adapting Positive Physical Approach

-Someone in an Emerald state (your mentor)

Let’s watch the videos – with PAC Skills, and without

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these steps did you see? Which did you NOT see?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these did you hear/see? Which did you NOT?

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

With an emerald

• Approach within binocular field of vision and observe

• Give visual cues, with her name, to shift from task to social

• Hand-shake to Hand-under-Hand® to get into personal

space

• Supportive stance for a conversation, no touch support

needed

• Notice what is happening and compliment

• Reflect and match the message and words to connect

• Strong visual + verbal to initiate the next task

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

In the next breakout- Adapting Positive Physical Approach

-Someone in an Amber state (your mentor)

Let’s watch the videos – with PAC Skills, and without

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these steps did you see? Which did you NOT see?

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these did you hear/see? Which did you NOT?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

With an amber

• Approach with awareness of object confusion

• Engage with visuals, outside of arm’s reach to connect

• Show first, then allow space for a copy of the action (bring

two or more props)

• Fewer words, stay flexible, rarely will you get the exact

action or task completed as expected

• Use rhythm and muscle memory to start, support, or

complete a task

• If it isn’t life or death, let it go…

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

In the next breakout- Adapting Positive Physical Approach

-Someone in a Ruby state (your mentor)

Let’s watch the videos – with PAC Skills, and without

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these steps did you see? Which did you NOT see?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these did you hear/see? Which did you NOT?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

With a ruby

• Approach within monocular visual field

• Use full PPA with Hand-under-Hand® connection to offer

support and direct focus

• Show and say the use of the object with 1-2 words at a

time, focus on rhythm of speech over words

• Pass the task over, if possible, after getting movement

started

• Stay connected at a joint in case support is needed again

• Go slow – allow 3-8 seconds for a response

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

In the next breakout- Adapting Positive Physical Approach

-Someone in a Pearl state (your mentor)

Let’s watch the videos – with PAC Skills, and without

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these steps did you see? Which did you NOT see?

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

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Which of these did you hear/see? Which did you NOT?

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

With a pearl• Approach within monocular visual field

• Possibly adapt Hand-under-Hand® to joint-to-joint support

and connection

• Use rhythm of voice and soothing (firm and slow) touch

• Offer space between the steps of the task to allow for

processing or shift in task

• Try only moving one hand at a time

• Stay connected at a joint, possibly providing stability with

your own body

• Notice the responses through movements over the words

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

The LIVING GEMS®

Progression of the

ConditionTo the tune of This Old Man

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

SAPPHIRE true, you and me

The choice is ours, and we are free

To change our habits, to read, and think

and do

We’re flexible, we think it through!

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

DIAMOND bright, share with me

Right before, where I can be

I need routine and different things to do

Don’t forget, I get to choose!

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

EMERALD – go, I like to do

I make mistakes, but I am through!

Show me only one step at a time

Break it down and I’ll be fine!

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

AMBER – HEY!, I touch and feel

I work my fingers - rarely still

I can do things, if I copy you

What I need is what I do!

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

RUBY – skill – it just won’t go

Changing something must go slow

Use your body to show me what you need

Guide, don’t force me. Don’t use speed!

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Now a PEARL, I’m near the end

But I still feel things through my skin

Keep your handling always firm and slow

Use your voice to calm my soul.

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Top Five Human Needs and

Emotional Indicators of Distress

Five Human Needs

IntakeHydration, nourishment, meds

Energy Flowtired or revved up

directed inward or outward

OutputUrine, feces, sweat, saliva, tears

Comfort4 Fs and 4 Ss

PAIN Free!!!Physical, emotional, spiritual

Five Expressions of

Emotional Distress

Angryirritated – angry – furious

Saddissatisfied – sad – hopeless

Lonelysolitary – lonely –

abandoned/trapped

Scaredanxious – scared – terrified

Lacking Purposedisengaged – bored – useless

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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

INTENT

I'm sorry I was

trying to help

EMOTION

I'm sorry I made

you angry

INTELLECTUAL

CAPACITY

I'm sorry, I had no right to

make you feel that

way

THAT HAPPEN

ED

I'm sorry, it should

NOT have happened

THIS IS HARD

I'm sorry, this is hard, I

hate it for you

© Teepa Snow, Positive Approach, LLC – to be reused only with permission.

Pauses and

Seeking a Time-Out…

- to recover

- to think

- to practice

- to take care of yourself