Using the TTAP

Method at Bergen

Regional Medical Center

with Moderate

Alzheimer’s Patients Fall 2009

Lauren Miller

1.From individual the idea thought to group thought

2.From ideas to music off the page3.From music in the mind to image4.From image into sculpture5.From sculpture into movement6.From movement into

words/poetry/stories7.From words into food for thought8.From thought into theme event9.From event into photography

AD can affect the part of the brain that controls memory, behavior, personality, and some other bodily functions.

Mild•Difficulty learning & remembering new information•Difficulty managing finances, planning meals, taking medication on schedule•Depression symptoms (sadness, decreased interest in usual activities, loss of energy)•Get lost going to familiar places•Still able to do most activities such as driving a car

Moderate•Forgetting old facts• Continually repeats stories and/or

asks the same questions over and over

• Makes up stories to fill gaps•Difficulty performing tasks• Following written notes• Using the shower and toilet

•Agitation, behavioral symptoms common• Restlessness, repetitive movements• Wandering• Paranoia, delusions, hallucinations

•Deficits in intellect and reasoning•Lack of concern for appearance, hygiene, and sleep become more noticeable

Severe•May groan, scream, mumble, or speak gibberish•Behavioral symptoms common• Refuses to eat• Inappropriately cries

out•Failure to recognize family or faces•Difficulty with all essential activities of daily living

Alzheimer’s Disease

Session One: 9/30/09TTAP Method: Step One - Drawing

Music/Meditation: The therapist will play soft music and take the residents through a body relaxation and a guided imagery, which the topic correlates to the activity being done.

Conversation: Therapists discuss guided imagery and meditation with the residents. The therapist asks questions like “What did you see?” “Who were you with?” “How did you feel?”

Drawing: The residents are given large sheets of paper and different colored markers and are asked to draw a picture. They are told it can be anything they want, there are no rules or limits on what they can draw.

<- Virginia

Mary ->

• Virginia from her meditation,had a very vivid memory about her grandmother’s garden from when she was 8 years old.

• She uses a lot of detail and fine motor skills to draw her picture.

• When asked about her meditation memory, Mary began to cry because she thought about her Mom & Dad; she ensured us that it was a happy memory.

• She did not know what to draw, so suggestions were made, and she ended up creating this beautiful rainbow.

Eva

Rosalind

• Rosalind began this activity extremely unfocused, but once she began to focus on her drawing, she ended up drawing her house that she saw in her “minds eye”.

• She made a wonderful piece of art work over a 60 minute period of time, which is unusually long.

• Eva was very adamant in the fact that she didn’t seem to want to participate. Once she began to draw, she drew the house that she had lived in and had seen in her mediation.

Irene • Irene did not seem to want to participate very much in this session.

• In her meditation, Irene told us that she saw her parents. She said she felt like she was floating over them and looking at them from above. • She did not know what to draw. When encouraged, she began to draw the tree in the image.

• At the end of the session, she did not want to take her drawing back to her room with her. She turned to the nurse and give it to her, which made the nurse very pleased.

Session Two: 10/7/09TTAP Method: Step Two – Memory Box

Music/Meditation: The therapist will play soft music and take the residents through a body relaxation and a guided imagery, which the topic correlates to the activity being done.

Conversation: Therapists discuss guided imagery and meditation with the residents. The therapist asks questions open ended questions like “What did you see?” “Who were you with?” “How did you feel?”

Memory Box: The residents are given a small wooden box and paints. They decorate their boxes any way they want and are told that they can put their memories in this box, or anything else they want.

Virginia

Mary

• Both Virginia & Mary used a lot of detail in this project.

• They had very specific ideas as to what colors they choose and wanted to do.

• They used various colors to create their memory box.

• They both used one brush, unless a suggestion was made by one of the students to use a different one.

<- Nick

Marie ->

Nick did not seem to want to participate in this session. He continually asked the same few questions over and over. He did not want to do the activity, and once we got him to start painting, he used one color only.

Marie did not know how she wanted to paint her box, she kept saying she liked it the way it was. We encouraged her to paint the box and individualize it. She started to do so once she saw everyone else was doing it too.

Session Three: 10/14/09TTAP Method: Step Three - Collage

Music/Meditation: The therapist will play soft music and take the residents through a body relaxation and a guided imagery, which the topic correlates to the activity being done.

Conversation: Therapists discuss guided imagery and meditation with the residents. The therapist asks questions like “What did you see?” “Who were you with?” “How did you feel?”

Collage: Residents are given a large sheet of paper and small colored shapes. They make a collage out of the shapes by gluing them onto the paper in whatever pattern they want.

<- Virginia

Mary ->

Virginia used her right brain to decide which pieces to use and how she wanted to place them on the paper. She was very careful where she placed each shape.

Mary is very conscious of where she places each shape. She always asks if what she’s doing is okay and if it looks good. Every time she was ensured she was doing a great job, she would reply with “You’re the best! You know that?”

Marie ->

<- Jeanette

Marie is very sporadic in her placement of the shapes. She uses anything put in front of her, no matter how much of it there is. She will just put it on the paper and expect it to stay, sometimes even before gluing it.

Jeanette was also pretty careful in her placement of the shapes. She had some suggestions made to her, but a lot of her work was from her own imagination and her own ideas.

Session Four: 10/21/09TTAP Method: Step Four - Sculpture

Music/Meditation: The therapist will play soft music and take the residents through a body relaxation and a guided imagery, which the topic correlates to the activity being done.

Conversation: Therapists discuss guided imagery and meditation with the residents. The therapist asks questions like “What did you see?” “Who were you with?” “How did you feel?”

Mask Making: A mask is given to each resident, and they use paint to decorate it to their liking. Afterwards, they are asked to make up a story about their mask.

• Mary had a difficult time starting out with her project, but when suggestions were made to her about what colors to use, or what to paint, she worked very well.

• She said her masks name is Virginia. When asked where Virginia lives, she replied that she lives in Arizona. Virginia is 16 years old. And when asked what Virginia likes to do for fun, Mary responded that Virginia is a Hula Dancer.(Art stimulates abstract thinking processes, Stern, 2009)

Mary

Virginia• Virginia had a very detailed memory of a friend from when she was young. She remembered her friend the first time they met, and this is who she made the mask represent.

• She named her mask Alice after her friend. Alice lived in New York. She loved to play hopscotch and bouncing a ball.

Marie• Maria enjoys the images from the meditation.

• She goes through her project and continually asks for help and what she should do next. Her mask comes out very unique.

• Marie named her mask Chuck. Chuck is 12 years old and lives with Marie. When they go out together, they like to dance!

Halfway Statistics5

4.28

4.46

4.91

4.75

4.91

3.58

3.6

4

4.11

4.1

4.53

4.75

4.7

1. Importance of the activity:A. Level of importance

5 5 5B. Positive mood change 4.3 4.25 4.3

2. Personal perceived pleasure: A. How alive you felt

4.6 4.5 4.3B. Enjoyment 4.75 5 5

C. Comfort level 4.5 4.75 53. Level of interest in the activity:

A. Interesting4.75 5 5

B. Excitement 3 3.75 44. Intensity of response:

A. Challenging2.5 3.5 5

B. Level of responsibility 3.75 3.25 55. Is the activity personal to them:

A. Sensory stimulation3.3 4.75 4.3

B. Personal 3.3 5 46. Meaningful experience:

A. Meaningful3.6 5 5

B. Proud 4.5 4.75 5C. Positive memories 4.6 4.5 5

Week 1 Week 2 Week 3

HalfwayAverage

• So far, all of the residents who are participating in this group seem to be enjoying it.

• They remember us and the group each week, but don’t necessarily remember all of our names , which is very common in moderate stages of AD.

• Residents keep their past projects in their room, which helps them remember us as well as what they did during that session.

•We repeat and review what was done in the last session which has been very helpful.

Group 2 Averages