Thursday, January 31, 2013

The article below is from the January 25, 2013 edition of the Globe and Mail (Ottawa / Quebec Edition) and was written by Tralee Pearce. Photographs by Fred Lum. 

A new school of thought 

on dementia

Montessori principles aim to reduce anxiety and provide meaningful activity for adults with cognitive diseases

‘Find the story and see the person’ 

As more Canadian families grapple with the heartache of dementia, a new program offers hope by applying the simple principles of Montessori education to elder care.

A retired cardiologist sits at a table at Toronto’s L’Chaim Retirement Home, sorting through cardiograms. He’s not volunteering his time helping others, however. Unbeknownst to him, he’s working at keeping what memories he has.
Therese Holtzman makes cookies at Dementia Support Dov & Zipora Burstein Senior Centre in Toronto. L’Chaim is using the Montessori Method for Dementia program, a novel approach to combat dementia that has been rolling out in day centres and nursing homes across the country over the last few years. Taking the principles of the Montessori method created for children in the 1970s and applying them to adults suffering from a range of cognitive diseases, the program is seen as a ray of hope in what is often a heartbreaking reality. More than half a million Canadians are currently affected by dementia, and with an aging population, it is poised to become an even greater concern.
The program’s relatively simple approach is part of its appeal. As in the case of the doctor, the Montessori Method gets people to do tasks that feel familiar, along with brain-boosting games, discussion groups and a physical environment that’s designed to both reassure and stimulate. And it seems to help.
At the Dementia Support Dov & Zipora Burstein Senior Centre, the first day centre of its kind in the Greater Toronto Area, Miriam Greenberg is working at rolling out cookie dough. It’s obvious she’s done this many times before. Her manicured hands move the rolling pin very slowly to smooth out each segment to its edge, pressing any cracks that have formed back together.
In other settings, this petite 87-year-old and the three other women at the table would likely have been seen primarily as dementia patients who need constant care. Here, at the new seniors’ day centre Greenberg attends three times a week, she’s seen as a woman who might have enjoyed baking earlier in her life and who might enjoy it today, too. “I used to bake a lot,” she says as she sprinkles a nut mixture over the dough. “Grandma’s cookies,” she adds, her voice trailing off as she quietly lists the first few ingredients.
The Montessori Method for Dementia is the brain child of Gail Elliot, a retired McMaster University gerontologist who now runs a business training caregivers and consulting with public and private institutions. She was inspired by the work of an American psychologist, Cameron Camp, who in the late 1990s seized upon the idea that by finding the person behind the dementia, caregivers can find clues about how to strengthen their brain function – or at least slow the decline. “Find the story and see the person: Who is that person today and how can we bring that person out?” says Elliot. “Memories aren’t all gone. Let’s find out what still exists and capitalize on it and enhance the quality of life.”
While Elliot resists seeing too many parallels between young children and people with dementia so as not to infantilize anyone, she does think the Montessori brand may help the idea click for many.
“It’s so basic,” she says. “When you’re doing something with your child, you’re thinking what are the needs of this child? What does he like to do, what is he able to do? You don’t challenge him to do too much because he’ll be frustrated and gives up. But you make it a little harder than what he can do so he can improve.”
Others who work in the field see Montessori-based methods as having good potential for providing stimulation and engagement.
Habib Chaudhury, a professor and graduate program chair in the department of gerontology at Simon Fraser University, says more research is needed but there is “some evidence that the method reduces anxiety and provides meaningful activity for people with dementia.”
He says another factor he sees as beneficial is that the method relies heavily on the sensory environment, and the five senses, which is “very important in dementia experience.”
At the centre, it’s hard not to notice another major Montessori principle in play, that of the “prepared environment.” Large, legible signs fill the walls. There’s a huge calendar, reminding people what day it is. At the self-serve coffee and tea table everything down to the sugar bowl is labelled. While the exits are cleverly camouflaged by tromp l’oeil paintings of furniture – to avoid the common behaviour of many dementia patients to “exit-seek” – everything else is well labelled, including the bathrooms and the kitchen cupboards.
“Nothing is left to their memory to guess,” says Deborah Rothenberg, the director of operations, as we tour the centre. “It’s a safe place.”
Tables are prepped with adult versions of daycare activities like sorting, puzzles and games. Song books and stories are printed only on the right-hand page, with a “Please turn the page” note on every lower righthand corner. Where children might play with cute animal images, the activities here play to the crowd. There’s a basket of towels to fold and one holding socks to match. If there were men here today, they might be pointed in the direction of a bin filled with Home Depot tubing and plumbing connects – adult Lego if you will.
“Nothing is babyish,” she says. Except, that is, for one of the small rooms flanking the centre’s large open space filled with baby dolls and clothes. Rothenberg is careful to point out that this room is therapeutic for very low-functioning dementia clients, who can find cuddling dolls and dressing them comforting – the seven women here today are considered highfunctioning and would be insulted to be asked to play with dolls.
In addition to helping seniors spend a meaningful, enjoyable day, Elliot says the program can also curb many of the behaviours associated with dementia, such as patients grabbing at staff, repeatedly asking the same questions, wandering and screaming, which can be common in facilities without more resources.
“I’d like to transform the way we care for people with dementia.”
Greenberg’s daughter, Fern Kutnowski, says the difference in her mother, in the past four months she’s been attending the $59-a-day program, has been astounding. She had been on a decline health-wise and spent most of her time sitting in a chair looking out the window. Now, she’s more likely to engage in conversation with her daughter and doesn’t need to be nagged to get active. Although she was resistant to go at first, “She feels good at the end of the day. She’ll come home and say ‘I worked very hard today.’”
And, yes, baking may have played a role. “My mother was an amazing baker. We all used to ask for ‘Safta’s (grandmother’s) cookies.”
Greenberg, who has suffered from dementia for more than seven years, lived in an apartment with home-care help, but now lives in a seniors’ home. Kutnowski says she is functioning well and is engaged in life.

“If she was healthy, she might think this was nonsense. But it’s working. She’s not the same person.”


It's spreading...Montessori with Elders. 
Imagine an Elders' Casa!

Saturday, January 26, 2013

Flower Arranging in an Adult Day Program - Exercises in Decision Making

Flower arranging (click flower arranging to see the work being done in one of my old classrooms) was one of my favorite lessons to present when I was a teacher.  I loved the coupling of flowers and mathematics. Watching a 4 year old hold a stem of flowers up to a vase and estimating just how much they should cut off so that it would fit the height of the vase silenced me as I viewed their deep concentration.

Every few weeks, the local florist donates a large, plastic tub of flowers to the Bridge. It is such a wonderful gift. In the fall, they brought in dozens of miniature sunflowers.  Yellow-mooned blossoms brought a glow to the place.

The last donation was a mixture of roses and carnations. There were dozens of each. One of the seniors enjoys breaking the large quantity of flowers down into smaller groups from which she makes floral arrangements. She makes many decisions as she goes along regarding color and height combinations, as well as how many to put in one vase or another. This senior does have dementia. She may or may not remember she did the work an hour afterwards, but the evidence of her work remains for days.

Her first independent decision was to sort the flowers by color. She slowly pulled them out of the various vases and then piled them on the table into color groups. 

Then she took five or six of one color of carnations and placed those into a vase. Next, she selected a handful of flowers of a different color. She then stood back and took a moment to decide on what to add and where.

In the foreground of the photo below you can see one of her first completed arrangements. But wait, just when I thought she was done with that arrangement, she picked a white rose from another vase and....

...inserted it into the bundle of pink and purple carnations as an accent point. She leaned back for a moment and smiled at her work.

She worked for more than an hour creating one arrangement after another.

Decision making: She divided, that's right; she used mathematical skills, the flowers into groups and then she created enough arrangements for each of the dining tables. Writing this now, I have this new thought on flower arranging, and I have written a lot about the subject over the years.  There are overlapping elements between flower arranging and spooning - they are both activities/work in which quantities are distributed.

Then she placed one vase on each table - again, distribution of quantity.

She returned to her work table and I watched as she began working silently on one last arrangement of flowers.

When it was finished, she cleaned up her table/work area, returned to her usual seat and began looking at one of her magazines. I left the floor, turned the corner and there it was. A lovely gift placed on my desk next to my computer. She had placed the vase of flowers there for me.

 Her quiet work reminded me of a quote by 
Anne Morrow Lindbergh:

Arranging a bowl of flowers
in the morning can give a sense
of quiet in a crowded day - 
like writing a poem 
or saying a prayer


Never underestimate the creative intelligence of an individual with dementia.

Tuesday, January 8, 2013

Constructive Triangles in an Adult Day Program. Well, kind of...

Sometimes you just have to take a leap of confidence in the Montessori method and the lessons one is so familiar with. I am very limited in regards to the Montessori materials that I have to work with at The Bridge. I would love a gently used binomial and trinomial cube or the small or large hexagon box, but I don't have them...yet. Montessorians around the world have been doing for decades, I modified another material in order to present a work that I felt would be stimulating for and serve the needs of one of the seniors at The Bridge who does not have dementia. Instead, he has other medical issues that require that he be supervised and that he be in a setting that would also provide him social interactions.

I had bought a Chinese Puzzle at a church rummage sale to give as a gift for a fellow Montessori teacher thinking she might like to use it as an extension for constructive triangles. I never had the opportunity to give it to her, so it has been sitting on a shelf in my apartment for a year and a half.

I recently had a wonderful conversation with the head of a Montessori school in British Columbia. We talked at length about how paralyzed a teacher can become if what is in her album is not on her shelf. Maybe a material is broken or has been promised to be order under the next year's budget.  Should the teacher move ahead with the lessons skipping over say the multiplication board and presenting the division board, if there is no multiplication board? Multiplication can be presented with the bead box and other materials besides the board. At a refresher course years ago in Florida, the keynote speaker stated clearly, "Follow the child, not your albums."

The person I wanted to present the constructive triangles to isn't a child. They are an adult. The lessons are already modified to fit the needs of an adult. So...I had this beautiful Chinese Puzzle that kept whispering to me, "Susan, use me at The Bridge in place of the constructive triangles. I am such a beautiful material. I am small and delicate and I invite curiosity." Finally, I decided that it would be perfect for this particular senior.

It was mid-morning when he arrived. I waited for him to get settled. I then approached him and invited him to work with me. He immediately agreed to. I directed him to a table in the back. I picked the puzzle up off my desk and joined him.

Before I revealed what I was holding in my lap, I told him that I had something very beautiful and delicate that I wanted to share with him. I paused for a deliberate minute and then placed it on the table in front of him. I asked him to carefully open it. He did so with precise movements. He pulled the enclosed material out from the decorative cover and placed it on the table.

I then leaned towards him and said, "There are triangles and squares inside and we can make things with them." He smiled and then carefully opened the package. He studied the yellow, wooden material for a minute.

I asked him to take one piece out at a time. He did and immediately he started piecing the shapes together to create something.

After he  made one thing, he made another and then another. He was very pleased with his third construction calling it a rabbit.

The hand loves to engage and this action engages the mind. Maria Montessori wrote, “The hands are the instruments of man’s intelligence.” She also wrote, “We found individual activity is the one factor that stimulates and produces development.” The child's mind is not the only mind that needs stimulation for development. The need for mental development spans a lifetime.

Monday, January 7, 2013

Exciting AMI International Congress News!!

i am delighted to share my recent news! Glenn Goodfellow, AMI International Congress 2013 Administrator/ Montessori Institute NW has named me as the volunteer press / media agent for the Congress. This is the first time the AMI International Congress is being held in the United States. It is going to be held in Portland, Oregon, July 31 - August 3, 2013. It is open to the entire community - teachers, social workers, homeschoolers, educators and philosophers, writers and researchers, artists and more. Please email me if you have any questions about the Congress or have story ideas. I will post here later this week my Congress email, until then feel free to contact me via I have much writing to do! I am enormously excited to be a part of the Congress and to be working with Glenn and so many others.