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1. The SOT provided Ellie with praise and encouragement for this ability After fifteen minutes however Ellie started to become unresponsive to the verbal and visual instructions She would no longer look up nor attempt to pick up her utensil Ellie said she was tired and her hands were in pain otep 3 The SOT provided her with hand over hand assistance where the SOT instructed her and placed her hand over Ellie s to guide Ellie in picking up her spoon Ellie was still the one holding her spoon The SOT continued to provide hand over hand assistance for the next fifteen minutes However as Ellie s fatigue and hand pain increased she became resistant to the hand over hand assistance provided otep 4 The SOT then progressed to providing Ellie with physical assistance where the v 10 SOT held the physical weight of Ellie s arm and the spoon Ellie was able to continue eating with physical assistance for approximately five minutes As eating progressed Ellie s fatigue increased and she was no longer responding to any type of assistance otep 5 Ellie was provided with a ten minute break After her break Ellie regained some energy and was able to respond to the verbal and visual instructions again Next Steps The SOT recommended to the staff that they provide Ellie with 10 minute breaks every 15 minutes when eating to allow her to re energize The SOT recommended that the staf
2. The SOT observed Ellie and found that she was able to verbally respond to questions and follow one step instructions such as Ellie would you please pick up your spoon Ellie was motivated to eat on her OWn Ellie uses a wheelchair and she is physically able to eat She was able to maintain her stable sitting position for an hour She also had the strength to lift her utensils Ellie s Challenges She required additional support from staff to help stabilize her dishes and to prevent food spillage Ellie was able to focus on eating for five minute periods but would look down place her hands on her lap and close her eyes after this time frame Ellie experienced fatigue and has arthritis in both of her hands that caused a lot of pain when eating Eating Guidelines The SOT used the Eating Guidelines on page 5 to increase Ellie s participation in eating otep 1 The SOT made sure that Ellie s hands were placed on the table ready for eating She was able to establish this hand position without any instruction otep 2 Using Ellie s strength of being able to follow one step verbal instructions the SOT provided her with verbal instruction paired with visual instruction after every spoonful such as Ellie would you please pick up your spoon and pointing to her spoon Ellie was successfully able to eat her soup for approximately fifteen minutes with verbal and visual instructions
3. Montessori A step by Step Guide to Applying Montessori to Increase Eating and Dressing Participation Produced and Written By Elissa McGarvey and Lei Tan MSc Occupational Therapy Candidates 2013 McMaster University elissamcgarvey gmail com leictan gmail com Acknowledgements We would like to acknowledge the assistance of the following individuals for their contributions to this guidebook Judy O Neill for educating us on Montessori and supporting our learning Thank you for all your guidance and enthusiasm It is because of you that we continue to believe in the value of using Montessori to enhance an individual s life Bev Little the staff and residents at Grandview Lodge for being our main resource in developing the information in our guidebook Their support patience and open mindedness to our suggestions have truly been motivating We would like to thank Grandview residents and staff for allowing us to use them as case examples and to take their pictures to enhance the quality of our information Gail Elliot a pioneer of Montessori for individuals with dementia for inspiring us to pursue this endeavor and to continue working towards promoting the independence of older adults Colleen McGrath our placement preceptor for all her guidance and continuous support Katherine Rankin and the Haldimand Abilities Centre staff for their continuous support and for connecting us with the Grandview Lodge and other learning
4. University Ontario Canada Eclectic Whimsy 2012 t s a craft weekend extraordinaire including a canvas wrap giveaway Retrieved from http blog familybringsjoy com its a craft weekend extradonaire including a canvas wrap giveaway Elliot G 2011 Montessori methods for Dementia Focusing on the person and the prepared environment Hamilton ON McMaster University Gilmour H 2011 Cognitive performance of Canadian seniors Retrieved from http www statcan gc ca pub 82 003 x 2011002 article 11473 eng htm Joe Fresh 2012 Joe Fresh Retrieved trom http www joefresh com en Malone M L amp Camp C J 2007 Montessori based Dementia Programming Providing tools for engagement Dementia 6 1 150 157 Mahendra N Hopper T Bayles K A Azuma T Cleary S Kim E 2006 Evidence based practice recommendations for working with individuals with dementia Montessori based interventions Journal of Medical Speech Language Pathology 14 1 XV XXV Ritchie L amp Tuokko H 2010 Mild cognitive impairment Case definitions age and other risk factors International Encyclopedia of Rehabilitation Retrieved from http cirrie buffalo edu encyclopedia en pdf mild_c ognitive impairment case definitions age and o ther risk factors pdf okrajner M J amp Camp C J 2007 Resident assisted Montessori programming RAMP Use of a small group reading activity run by persons wi
5. in the task e e g Would you please pick up your spoon Visual Instruction Provision of pictures signage or hand gestures to direct the individual s attention to the task including body movements and materials involved e e g Placing a picture label of a toilet posted on the washroom door to indicate location of washroom or holding up a red shirt and a green shirt when asking an individual to choose one Physical Touch Provision of touch to cue the individual to initiate a movement e e g At the dinner table tap the individual s right arm to get his her attention to pick up the spoon Hand over hand Placing your hand s over the individual s hand s to guide the individual to complete the task The individual is the one holding the tools e g shirt or spoon and completing the task As the individual s ability to do small parts of the task increases the hand over hand grip can be lessened e e g Placing your hand over the individual s hand as she picks up a fork and spears a piece of fish Physical assistance Assist the individual by bearing physical weight of the limb e e g Lifting individual s arm while holding the shirt open when dressing Dependent Individual is unable to complete the task despite provision of assistance and needs the task to be completed for them Eating Guidelines Directions For each question on the left hand side answer YES or NO to determine the amount of support you would need t
6. individual to Know and understand how much he she can do on his her own Refer to Eating Guidelines on page 5 for a tool to help you know what to observe Keep the same schedule for eating such as breakfast at 8 30 am lunch at 12 noon and supper at 5 pm everyday Help the individual eat in the same order every meal e g first take a sip of juice then bite the piece of toast This will help the individual learn the steps in eating Social roles can be offered to individuals based on their abilities and interests such as helping with the dining table set up or washing the dishes after eating When assigning an individual to set up the table use a template to help the individual know where to place utensils the cups plates and bowls on the table Refer to pages 17 18 for a sample template and for some examples of social roles related to eating Q How can I encourage an individual to make choices during eating e e If the individual is able to make decisions allow him her to choose what to eat Keep choices simple and do not over talk Nd If the individual is not eating consider offering him her a different choice of food Use would you instead of could you as would offers a choice to complete a task e g Would you please pick up your spoon Q How can the environment be set up to increase eating participation Post signage to inform
7. put on your sock Q How can the environment be set up to increase dressing participation Separate clothing into categories e g pants hang on the left and shirts hang on the right Use signage on the closet drawers to indicate the location of the individual s clothes Use realistic pictures of clothes instead of cartoons Using pictures of individual s own clothes is helpful as it can be more recognizable to the individual Ensure the images and labels are large enough for the individual to Nd read Refer to Signage Readability Guidelines on page 20 Remove clutter to decrease distraction If the individual s vision has deteriorated use a background colour that is different from the clothing colour so the clothing stands out This way the clothing will not blend into the background Ensure dressing area is well lit Q How do I begin dressing with the individual Prepare the individual for dressing Begin by getting the individual s attention by calling out his her name and or touching the individual s hand Then orient the individual to the task by asking Would you like to get dressed for the day Ensure that there is an area properly set up for the individual to get dressed Dressing should 13 always occur in the same area This area should have a comfortable place for the individual to sit and any special supports the individual may nee
8. the individual of the mealtime schedule Refer to Signage Readability Guidelines on page 20 Make the dining area easily recognizable for the individual by displaying pictures of food or food related items Displaying family pictures or flower arrangements at the centre of the table also promotes the sense of home and the invitation to eat Foods that are familiar to the individual and match with his her dietary needs should be served Consider playing music that is familiar to the individual before eating to help him her learn that a song indicates it is time to eat Lin et al 2010 If the individual s vision has deteriorated use a placemat colour that is different from the colour of dishes so that the dishes stand out This way the dishes will not blend into the background The same strategy can be used for the food colour against the colour of the dishes e g broccoli on a white plate Remove clutter in the dining area to decrease distraction Ensure dining room is well lit The environment must be rich in motives which lead interest to activity and invite the individual to conduct his own experiences Maria Montessori Q How do I begin eating with the individual Nd Prepare the individual for eating Begin by getting the individual s attention by calling out his her name and or touching the individual s hand Then orient the individual to the task by asking Would yo
9. the laundry This can include washing drying and folding the clothes It may also include carrying the laundry to the laundry room and or back to the closet to put the clothing away Sorting the laundry or clothing Choosing or helping to choose his her own outfit for the day If the individual is elderly and has young grandchildren the individual can help his her grandchild pick out an outfit and get dressed This can help the individual remember how to get dressed himself herself and reinforce the dressing process If the individual is younger he she can help his her siblings or parents choose their outfit 18 Leisure Activities for Dressing The following activities can be completed with the individual e Looking through catalogues and magazines to pick out an outfit for an occasion This can be an outfit for a family member or a friend or for the individual himself herself It can be for a special occasion like a party a job interview or just for everyday wear When the individual picks out the clothing you can ask him her to cut it out to make a collage or write down the items in a shopping list so the clothing can be tried on at the store To make this activity easier give the individual cards with clothing items on them and ask him her to make an outfit from the choices on the cards Joe Fresh 2012 Taking the individual shopping for new clothes for himself herself or for a family memb
10. d e g Grab bars for balance Instruct dressing one step at a time This can be outlined in a visual schedule of dressing posted in the bedroom or with verbal one step clear instructions eg would you put on your shirt then would you do up the buttons Give praise and encouragement to the individual throughout dressing for trying to dress or being able to do each step of the task e g You did a great job at putting on your sock Q How can adjust the amount of support provide to an individual Use the Dressing Guidelines on page 11 to help determine the abilities of the individual You may need to use trial and error to figure out what amount of support will work best with the individual It is important to note that there is no one correct approach that will always work The key is to be patient with the individual and to be open minded to trying various approaches The individual s abilities may change over time Use the Continuum of Assistance on page 3 to help you know how to adjust the amount of support you need to provide the individual As the individual improves offer less assistance If the individual declines offer more assistance e g If the individual is unable to put on socks with verbal or visual instructions try using hand over hand guiding of limbs If the individual begins to be able to put on socks once again use only verbal or visual instructions Q Ho
11. e her own only using verbal chosen for the signage was instruction to encourage her tailored to Grace e g Grace calls Others were choosing her outfit her sweater a jersey for her and not giving her the option to choose what she would like to wear A student occupational therapist SOT worked with Grace to assess her abilities in dressing and to establish a consistent dressing routine for the staff to follow with Grace Grace s Strengths The SOT observed Grace and found that she was able to verbally respond to questions and follow one step instructions Grace was motivated to dress on her own and choose her outfit for A P PEAN Contrast of white on yellow d The signage follows the Signage Readability Guidelines on page 20 to make it easily readable otep 2 The SOT verbally instructed Grace using one step instructions to the activity by asking Grace would you like to get dressed The SOT provided verbal and visual instructions to direct Grace to the closet to begin her dressing by choosing an outfit Grace was able to read the signage and understand what the signage was telling her to do The SOT provided Grace with praise and encouragement for this ability step 3 Grace was not able to initiate the task using the visual instructions on the signage The SOT paired the visual instruction with verbal instruction Grace was able to follow the paired instructions and
12. er or friend Dressing frames can be a way to incorporate dressing into a leisure activity at home Dressing frames are material stretched over frames that have zippers snaps laces and buttons Dressing frames allow the individual to practice doing up fasteners and other tasks related to dressing Refer to picture below Constructive Play Things 2012 19 otories about helping a child to get dressed or choosing an outfit can be used during a book reading time Make cards of clothing e g shirts and pants then give them to the individual to sort into categories Make cards of an outfit and have the individual indicate the order the clothing should be put on Making up cross words or word searches using clothing words can help the individual be familiar with the names of the clothing 20 signage Readability Guidelines Adapted from the Canadian National Institute for the Blind Clear Print Accessibility Guidelines n d Readability should be the first priority when making your information accessible to everyone The following Signage Readability Guidelines will help you design your information to access a wider audience Contrast Make the text and background colours highly contrasting e g Black Text on a White Background sai i lel Ee Es Dark Blue Backaround is easier KOME versus Green text on a white background is harder to read Text Colour For easier readability make the text c
13. f continuously assess Ellie s changing needs and abilities since she may need more assistance as the eating activity progresses due to her fatigue and hand pain The SOT also encouraged the staff to be open minded to modify the amount of assistance that they provide to Ellie based on her changing needs Modifying the amount of assistance may include providing verbal and visual instructions or physical assistance The SOT encouraged the staff to provide Ellie with a lot of praise and encouragement to motivate her with eating The SOT made a recommendation to staff to purchase a Dycem non slip mat to help Ellie stabilize her dishes Dressing Guidelines Directions For each question on the left hand side answer YES or NO to determine the amount of support you need to provide the individual Progress through the steps on the right until the amount of support matches the individual s ability to complete the activity Score the individual s ability to complete the activity based on the amount of assistance you provide for each question The lower the score the more independent the individual is in the activity and vice versa Add up all the scores to determine the Total Assistance Score out of 70 Questions Does the individual identify the need to change clothing Can the individual locate where clothing is stored Can the individual open the drawer closet to retrieve clothing Can the individual choose all a
14. he process of thinking including one s awareness reasoning judgment and ability to respond to information AHDEL 2000 as cited in Gilmour 2011 Cognitive impairment refers to difficulties in thinking that affects an individual s ability to do everyday activities Cognitive impairment may be caused by brain injury or dementia including Alzheimer s disease In 2011 a total of 747 000 Canadians lived with some form of cognitive impairment including dementia This number is expected to double by the year 2031 Alzheimer s Society of Ontario 2012 The frequency of cognitive impairment may increase with advancing age Ritchie amp Tuokko 2010 Why use Montessori with individuals who have a cognitive impairment With the continuous increase in cognitive impairment there is a crucial need for resources to help improve the quality of life of those affected and decrease the decline in their ability to do everyday activities Daly 2012 The Montessori Method originally developed for children by Maria Montessori integrates the principles of rehabilitation into education Camp 2001 The literature of Montessori with older adults with dementia has shown to increase engagement in activity and positive affect mood Malone amp Camp 2007 Mehandra et al 2006 Skrajner amp Camp 2007 With increases in engagement the residents behaviours decrease because they are attending to the activity and not consumed w
15. is easier to read versus Design Simplicity and Cleanliness anarrow space between letters is harderto Keep signage basic with only the read necessary information Do not Columns clutter signage with multiple Text in columns involves less eye pictures and designs that may be movement and less peripheral distracting vision to read Therefore separating your text into columns e g refer to the picture below is highly recommended Paper Finish To minimize glare use a matte or non glossy paper finish Caregivers have the important role as facilitators of an activity J O Neill Personal Communication November 20 2012 As facilitators it is essential to adapt an activity based on individual s level of functioning It is important to encourage the individual to have an active role in his her daily activities Montessori 1914 as cited in Elliot 2011 There is no one approach that will always work with an individual The key is to be patient and to be open minded to try various strategies We encourage you to invest your time and to always keep the purpose of Montessori at the forefront of your care to increase 22 the quality of life of your care recipients The more time you invest in providing care the bigger the contribution you make to the well being of your care recipient J O Neill Personal Communication November 20 2012 Provide the individual with choices and set up the environ
16. istance on page 3 to help you know how to adjust the amount of support you need to provide the individual As the individual improves offer less assistance If the individual declines offer more assistance e g if the individual is unable to pick up a spoon with verbal or visual instructions try using hand over hand guided maneuvering of limbs If the individual begins to have the ability to do this task again use only verbal or visual instructions d M LA UA sia spoon in his her mouth and to chew When you are asking an individual to remember a fact or an event use cues in the environment to help him her remember As an example when an individual needs to remember what time lunch occurs one can direct the individual s attention to the signage displayed on the dining area wall that indicates mealtimes Avoid asking questions that require an individual to use memory for facts such as What is my name since the individual may not remember the answer Pairing verbal instructions with visual instructions and or physical touch may make it easier for the individual to follow the instructions e g Show an individual a clock and verbally read the time out loud Encourage repetition of tasks within eating as more repetition improves learning and ability to do these tasks Q How can I make eating successful for the individual It is important to focus on the Q How can I make eating easier for
17. ith a behaviour Malone amp Camp 2007 However the research is limited as Montessori strategies applied to older adults with dementia is a relatively new intervention Camp 2001 There is a need for more research in this area as Montessori is beginning to become a more popular intervention Who can use Montessori This guidebook is intended for care providers of individuals with a cognitive impairment who play an important role in enhancing the quality of life of the individuals they care for It was created as a resource tool to help care providers apply Montessori principles during the daily activities of eating and dressing to increase the individual s participation within these activities As you apply the Montessori principles into your provided care you may find that certain approaches can be time consuming We encourage you to invest your time and to always keep the purpose of Montessori at the forefront of your care to increase the quality of life of your care recipients The more time you invest in providing care the bigger the contribution you make to the well being of your care recipient The individual s independence is fostered through the use of consistent roles and routines Promoting the freedom of choice to increase the individual s self esteem and independence The environment is matched with the individual s needs The materials used are easily identifiable important to the individual and visib
18. le The environment is clutter free The activities and the materials used are in good condition meaningful and familiar to the individual The materials used are not broken or worn out The activities are shown one step at a time to help the individual to understand and to repeat the step The activities and the environment progress from simple steps to more complex steps to allow easier learning The presentation of the activity and the environmental set up are matched with the individual s needs interests and abilities Use the individual s procedural memory which is the memory you use when you are doing something automatically without thinking about it As an example when you walk the same way to work everyday you do not have to stop and think about the way you are going When you are asking an individual to remember a fact or an event use cues in the environment to help him her remember As an example when asking an individual what food he she would like to eat present choices of food through a picture or actual food on a plate The activities should always promote success The individual can discover an error he she made on his her own Do not correct an individual s error but praise him her for trying to do the task Continuum of Assistance To help determine the amount of support to provide an individual it is important to understand the individual s current needs and abilities Directio
19. ment to increase his her success in the activity The more you do an activity the better you get at it Montessori 1914 as cited in Elliot 2011 Consistency in approach and practice are essential for easier learning There are no errors Just different ways of doing tasks Montessori 1914 as cited in Elliot 2011 23 References Alzheimer s Society of Ontario 2012 Facts about Dementia Retrieved from http www alzheimer ca en on About dementia Dementias What is dementia Facts about dementia Camp C J 2001 From efficacy to effectiveness to diffusion Making the transitions in dementia intervention research Neuropsychological Rehabilitation 11 495 517 Canadian National Institute for the Blind n d Clear Print Accessibility Guidelines Retrieved from http www cnib ca en services resources Cle arprint Documents CNIB 20Clear 20Print 20Guide pdf Centers for Medicare and Medicaid Services 2013 Long term care facility resident assessment instrument user s manual version 3 0 Baltimore MD Department of Health amp Human Services Constructive Play Things 2012 Set of all 4 dressing frames Retrieved from http www constructiveplaythings com cgibin s sh 2 0 product htm parent id 2Manipulatives amp dept id Lacing amp pf_id JC 55 Daly L 2012 EBP 747 Evidence based practice Montessori based activities and dementia Class handout Department of Occupational Therapy McMaster
20. ns Use the continuum below to adapt a task for an individual When adapting a task it is important to start from simple to complex depending on the individual s needs and abilities As the individual improves offer less assistance If the individual declines offer more assistance Minimal Assistance gt The individual is independent with the task The individual is able to complete the task with the environment set up for him her gt The individual is able to complete the task with supervision and or encouragement to remain focused gt The individual is able to complete the task with step by step verbal and or visual instructions and or physical touch to stay focused gt The individual is able to complete the task with hand over hand guided maneuvering of the limbs gt The individual is able to complete the task with physical assistance in maneuvering of the limbs gt The individual is dependent on caregiver to complete the task for him her Maximal Assistance What does this mean Independent The individual is able to complete the task on his her own with no assistance oet up the environment Setting up the environment to increase the individual s success in the activity e e g clearing the table and setting up the place for a meal with only dishes that are needed Grace would you please open the drawer Verbal Instruction Provision of words to describe the body movement and materials involved
21. o provide the individual Progress through the steps in the right until the amount of support matches the individual s ability to complete the activity Score the individual s ability to complete the activity based on the amount of assistance you provide for each question The lower the score the more independent the individual is in the activity and vice versa Add up all the scores to determine the Total Assistance Score out of 75 Eating Ready Position Seated comfortably Questions and straight with the back against the chair 1 Does the individual remember the time and feet flat on the floor and arms placed on the place for meals dining table 2 Can the individual establish a ready position for eating Please refer to right side of the page for the definition of a ready position Answer and Scoring 3 Can the individual identify the food items on his her plate YES 5 0 Provide praise and encouragement 4 Can the individual reach grasp the dishes on to the individual to continue doing this task the table E NO gt bD Can the individual grasp the utensils 6 Can the individual cut food items into 1 Set up the environment to manageable pieces increase the individual s success TEC O Can the grasp finger foods with in the activity his her hands 2 If the individual cannot do the task 8 Can the individual scoop spear food items with the environment set up with utensils verbally and or vis
22. olour black and white Coloured text should be limited to titles headlines or highlighted information Text Size The bigger the text the better Make your text large between 12 and 18 point text However take note that size changes between different types of fonts When choosing a text size always keep in mind who your readers are e g bigger text is easier to read Versus smaller text is harder to read Line Spacing The line spacing should be a minimum of 25 30 of the text size to allow readers to navigate more easily to the next text line Heavier types of text will need more line spacing e g A 12 point size text will ae a line spacing of at least 3 6 points as above versus these lines which are too close together Text Font Do not use decorative texts Use standard texts with easy to read upper and lower case characters Arial and Verdana are highly recommended e g this font is easier to read Versus his fout is harder to read Text Thickness Choose moderately thick text types Do not use thin text types Use bold or heavy font when stressing a word instead of using italics or upper case letters e g this text thickness is easier to read versus this text thickness is harder to read 21 Letter Spacing To minimize distractions ensure Ensure that there is a wide space you do not use complicated between the letters backgrounds e g a wide space between letters
23. opportunities Janis Giftopolous for providing us with information to make our resources more accessible Copyright 2013 All rights reserved This book is protected by copyright No part of it may be reproduced in any form or by any means including electronic mechanical photocopy microfilm recording or otherwise without written permission from the authors Table of Contents IIFOGUCHON arr Dr 1 Montessori Principles sssssssssssssssssssssssen n II enses nnns 2 Cont ri rmof ASSISIAfICO racine ec ence eu tertie benc A E to due ence uh T uenrUs 3 i i rom eV esa EO TEE DP 5 Montessori Principles Applied to Eating c cc cece eee eee e eee eeeeneneaaaaees 6 Case Example Applying Montessori to Increase Eating Participation 9 Dressing GuldellfieS orcn ime cite a en lie demos eu became eieneeeticaamaia see eae ede 11 Montessori Principles Applied to DreSSINg ccc cece cece eee e cece eee e eee eeeennees 12 Case Example Applying Montessori to Increase Dressing Participation 15 social Roles and Leisure Activities for Eating and Dressing 17 Signage Readability GuidelineS ccc cece cece eee e eect cess eee eeeaeeeeateeaeeenaes 20 Montessori Take Home Points cccceccceeeeeceeeeeeeeeeseeeeeseeensegneenegens 22 PROTECT CIC cO aerate ors is ree TT TEE 23 Cognition and Cognitive Impairment Cognition is t
24. ot correct an individual s error but praise him her for trying to do the task Allow the individual to discover an error he she made on his her own by providing guidance e g Is that how you would like your buttons done up If the object meets the inner needs of the individual and is something that will satisfy him her it rouses the individual to prolonged activity He masters it and uses it over and over again Maria Montessori 15 Case Example Applying Montessori to Increase Dressing Participation Let s Meet Grace the day She has the physical ability to dress and is able to read Grace s Challenges Grace s difficulty in sustaining her attention and staying focused are major barriers to getting dressed Dressing Guidelines The SOT used the Dressing Guidelines on page 11 to increase Grace s participation in Grace lives in a dementia care dressing unit at a long term care home 4 Step 1 The environment was set she cannot get dressed on her up to increase Grace s success in own and the staff at the home the activity Using Grace s believe she could increase her strength of her ability to read participation in this activity signage with one step The staff were using various instructions and real life pictures approaches to help Grace get were placed in her closet and dressed Some were allowing her drawers as seen in the pictures to choose her outfit and dress on below Note the languag
25. rticles of clothing appropriate for the day including undergarments shirt pants socks and shoes Can the individual obtain clothing from their drawer closet and take the clothing to the dressing area Can the individual remove dirty clothes Can the individual identify the order of putting on clothing items Can the individual identify the front and back of clothing Can the individual identify appropriate placement of their arm leg into clothing 10 Can the individual put on undergarments a shirt or pants 11 Can the individual button zip and or snap clothing 12 Can the individual put on a belt and or suspenders 13 Can the individual put on socks stockings 14 Can the individual put on and fasten shoes Total Assistance Score 70 Answer and Scoring YES gt 0 Provide praise and encouragement to the individual to continue doing this task NO 1 Set up the environment to increase the individual s success in the activity 2 If the individual cannot do the task with the environment set up verbally and or visually instruct and or physically touch the individual 3 If the individual cannot do the task with verbal and or visual instructions provide hand over hand guided maneuvering of limbs to complete the task 4 If the individual cannot do the task with hand over hand guided maneuvering of limbs provide physical a
26. shes back in the drawers and or cupboards after washing Assisting with meal preparation This can include cutting or mixing ingredients Leisure Activities for Eating The following activities can be completed with the individual Making a grocery list before grocery shopping The individual can look inside the refrigerator and be provided with some assistance using questions to help him her determine items that need to be purchased such as Do you need more eggs Baking a simple dessert or a favorite recipe for a special occasion This can include mixing ingredients cutting dough or decorating Going grocery shopping The individual can look for the grocery items on a list or place the grocery items on the checkout counter or place the grocery items in the bags Putting groceries away The individual can remove the grocery items from the bags or place the items in their appropriate storage areas Making up cross words or word searches using food or eating related words can help the individual be more familiar with various foods and eating related items Making a food poster that can be displayed on the dining area wall The individual can cut food related pictures from magazines and paste them on a large piece of paper Eclectic Whimsy 2012 Social Roles for Dressing Give the individual the choice if he she would like to be in charge of the following roles Doing or helping with
27. ssistance in maneuvering of limbs to complete the task 5 If the individual cannot do the task with physical assistance in maneuvering of limbs complete the task for the individual CMS 2013 12 Q How can l increase the individual s independence in dressing First observe the individual to know and understand how much he she can do on his her own Refer to Dressing Guidelines on page 11 for a tool to help you know what to observe Keep the same schedule for dressing everyday e g individual gets dressed every morning at 7am Help the individual dress in the same order everyday e g first put on underwear second put on pants This will help the individual learn the steps in getting dressed social roles can be offered to individuals based on their abilities and interests such as helping fold the clothes from the laundry or putting the laundry away Refer to page 17 for some examples of social roles related to dressing Q How can I encourage an individual to make choices during dressing e If the individual can make a decision encourage the individual to make the choice of what he she would like to wear Keep choices simple do not over talk If the individual does not want to get dressed consider offering them a different outfit Use would you instead of could you as would offers a choice to complete a task e g Would you please
28. th dementia in adult day health care and long term care settings American Journal of Alzheimer s Disease and Other Dementias 22 1 27 36 Lin L Huang Y Su S Watson R Tsai B amp Wu S 2010 Using spaced retrieval and Montessori based activities in improving eating ability for residents with dementia International Journal of Geriatric Psychiatry 25 953 959 White D 2009 Dreams and Doppleganger Retrieved from http dusanotes hubpages com hub Dreams and Doppleganger
29. the individual When assisting an individual with eating focus on procedural memory which is the memory you use when you are doing something automatically without thinking about it As an example a common procedure of eating is to pick up a spoon and to place it on one s mouth Helping the individual to pick up the spoon and placing it on the tip of his her mouth improves his her automatic memory to put the process of eating as opposed to the right or wrong ways of eating Do not correct an individual s error but praise him her for trying to do the task Allow the individual to discover an error he she made on his her own by providing guidance e g Is this where you want to put your serviette Would it be easier for you to reach if we placed the serviette on your lap instead Case Example Applying Montessori to Increase Eating Participation Let s Meet Ellie Ellie lives in a dementia care unit at a long term care home She cannot eat on her own and the staff at the home believe that she has the potential to increase her participation in this activity The staff were using varied approaches to help Ellie eat oome encouraged her to feed herself while others provided total assistance to feed her A student occupational therapist SOT worked with Ellie to assess her abilities in eating and to establish a consistent eating routine for the staff to follow with Ellie Ellie s Strengths
30. to successfully pick out her outfit The verbal instructions are shown in the following pictures In a second session Grace did not require as much verbal instruction from the SOT and had increased her dressing participation 16 Next Steps Continuous Assessment of Grace s changing needs She may need less verbal assistance as she learns to use the signage Provide praise and encouragement throughout dressing Grace would you please open the drawer Grace would you please choose underwear Grace would you please take the underwear out gt of the drawer 17 oocial Roles and Leisure Activities for Eating and Dressing It is important to include roles and leisure activities into the individual s life that supports the goal of increased participation in eating and dressing The following is a list of ideas for roles and leisure activities related to eating and dressing to help motivate the individual to participate and be interested in self eating and self dressing Social Roles for Eating Give the individual the choice if he she would like to be in charge of the following roles oetting up the dining table A template of the table set up as seen in the picture below may guide the individual to determine where to place specific utensils and dishes Camp 2012 Putting the dishes in the sink for washing after every meal Washing or drying the dishes Placing the di
31. u like to start eating Ensure the individual is close to the table sitting appropriately with his her back against the chair feet planted on the floor or wheelchair foot rests and food placed in front of the individual within reach Encourage the individual to be in the ready position for eating through the use of one step verbal or visual instructions such as placing the hand on the table to prepare oneself to pick up a spoon Instruct eating through the use of clear one step verbal instructions to allow easier learning e g please put the fork in your mouth upon completion one can then say please take a bite or please take the fork out of your mouth and then please chew your food slowly Give praise and encouragement to the individual throughout eating for trying to eat or being able to do each step of the task e g You did a great job of picking up your spoon Q How can adjust the amount of support provide to an individual Use the Eating Guidelines on page 5 to help determine the abilities of the individual You may need to use trial and error to figure out the amount of support that will work best with the individual It is important to note that there is no one correct approach with an individual that will always work The key is to be patient and to be open minded to try various approaches The individual s abilities may change over time Use the Continuum of Ass
32. ually instruct 9 Can the individual put food to his her mouth and or physically touch the ___ 10 Can the individual reach grasp dishes on the individual table If answers listed on the right side do 3 If the individual cannot do the task not work try moving the dishes closer to the with verbal and or visual individual and or using built up utensils instruction provide hand over 11 Can the individual chew and or swallow hand guided maneuvering of limbs thoroughly at the appropriate time and pace to complete the task If answers on the right side do not work try 4 If the individual cannot do the task counting to pace the individual to chew and or with hand over hand guided swallow appropriately such as 1 2 3 maneuvering of limbs provide und a rp the task through the use physical assistance in of a Straw tor fluids maneuvering of limbs to complete 12 Can the individual return dishes to the table the task 13 Can the individual pick up a serviette and use 5 If the individual cannot do the task it to wipe his her mouth with physical assistance in 14 Can the individual stay focused when eating maneuvering of limbs complete 15 Does the individual finish his her meal within a the task for the individual reasonable time ROMAN SIUS POI NES 7h Centers for Medicare and Medicaid Services CMS 2013 Q How can increase the individual s independence in eating Nd First observe the
33. w can I make dressing easier for the individual When assisting an individual with dressing focus on using procedural memory which is memory you use when you are doing something automatically without thinking about it For example ask the individual to button up his her shirt and instruct the individual to the buttons Once the individual begins buttoning the individual should be able to finish as he she is using his her unconscious memory When you are asking an individual to remember a fact or an event use cues in the environment to help him her to remember e g When an individual needs to remember where clothes are kept you can verbally instruct the individual s attention to signage on the closet 14 to indicate where clothes are kept Avoid asking questions that require an individual to use his her memory for facts such as What is my name since the individual may not remember the answer Pairing verbal instructions with visual instructions and or physical touch may make it easier for the individual to follow the instructions e g show an individual a clock and verbally read the time out loud Encourage repetition of tasks within dressing as more repetition improves learning and ability to do these tasks Q How can I make dressing successful for the individual It is important to focus on the process of dressing as opposed to the right or wrong ways of dressing Do n

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