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© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Welcome“It’s all about You”
Provincial Long Term & Continuing Care Conference
May 14, 2019
Charleen Phelps, R.N.Teepa Snow, Positive
Approach, LLC
Positive Physical Approach
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
..
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Relationship vs Agenda
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Strength, Power & Grip = STRONG
(these 2 fingers are used for opening a jar, using a hammer
or plyers, etc.)
Skill = MANIPULATORS(these 3 fingers
are used for buttoning buttons,
utensils etc.)
Pressure Sensor – allows you to hold onto something just right. Ex: Hold eggs gently,
Pull a rope hard) Rub this area to reduce
stress.
Dementia will rob you of SKILL
before it will rob you of
STRENGTH
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Believe: It Takes TWO to Tango … or Tangle…
•Learn to DANCE with our partner•We must be willing to STOP & BACK OFF
•Being ‘right’ doesn’t necessarily translate into a good outcome
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
“Mrs. Jones…. You willbe having a shower!”
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
GEMS®: A Positive Framework
Sapphires: True Blue - Healthy Brain - Slower but Fine
Diamonds: Clear/Sharp – Routines and Routines Rule – Change is Hard – Cutting
Emeralds: On the Go with Purpose – Naturally Flawed – Time Travel
Ambers: Caught In a Moment of Time – Caution Required – All About Sensations
Rubies: Deep and Strong – Others Stop Seeing What is Possible – Stop and Go – Big Motions or Still
Pearls: Hidden in a Shell – Immobile - Beautiful Moments to Behold
Tab 1
Page 13
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
How we Take in Information
1. What you see
2. What you hear
3. What you feel/ touch
4. What you smell
5. What you taste
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
How We Give Information
Visual – How we look
Verbal – What we say
Touch - What we do
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Normal Brain Brain with Alzheimers
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
When my brain makes mistakes;
I make mistakes!
• Learning, memory, way finding
• Visual regard
• Sensory motor
• Executive Control
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Amygdalae:
Dangerous Need
Risky Want
Dislike Alert/Aware Like
Tab 1
Page 10
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains
G. Small, UCLA School of Medicine.
Primitive
Brain
Primitive
Brain
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Hand-under-Hand®:
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
1. Less Peripheral Awareness
2. Tunnel Vision
3. Binocular Vision
4. Object to Use Confusion
5. Monocular Vision
6. Limited Visual Regard
Changes in Visual RegardWith each new level of vision change, there is a
decrease in safety awareness.
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Dynamic Assessment
Visual regard
Ability to speak and understand
Skill in movement
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
3 Zones of Human Awareness:
•Public Space: more than 6 feet away•Visual awareness and social interactions
•Personal Space: 6 feet to arm’s length away•Friendly and personal conversations
• Intimate Space: within arm’s reach• Intimate touch or connections
Tab 1
Page 17
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
CONSIDER
• Pace• Visual Cues• Verbal Cues• Physical Cues
Tab 1
Page 16
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Visual Cue Options:
- Signs
- Pictures
- Props or Objects
- Gestures
- Facial Expressions
- Demonstrations
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
A Dynamic AssessmentTool for a Shared Relationship
Use the
Positive Physical Approach™
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Positive Physical Approach™* (PPA™)*
• Stop moving at 6 feet out
• Greet: hold your open hand still next to your face, say their
name
• Offer hand in a handshake position
• With their acceptance, slowly come in from the front within
visual range
• Move into supportive stance, turn shoulders
• From the handshake, move into Hand-under-Hand®
• Get low: sit, kneel, or stand at or below their level
• Make a connection: PPC, then wait for their response
• Deliver a message: use V-V-T Cues and a PAS
* = if in public space and you start the interaction
Tab 1
Page 18
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Positive Action Starters (PAS):1. Help: Be sure to compliment their skill in this
area, then ask for help.
2. Try: Hold up or point to the item you would like to use, possibly sharing in the dislike of the item or task, “Well, let’s try this.”
3. Choice: Try using visual cues to offer two possibilities or one choice with something else as the other option.
4. Short and Simple: Give only the first piece of information, “It’s about time to (first task).”
5. Step by Step: Only give a small part of the task at first, “Lean forward.”
Tab 1
Page 21
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Positive Personal Connections (PPC)
1. Greet or Meet: introduce yourself and use their preferred name: “Hi___I am ___” or “I am___ and you are?”
2. Say Something Nice: indicate something about them of value
3. Be Friendly: share about you, then leave a blank
4. Notice Something: point out something in the environment
5. Be Curious: explore a possible unmet like, want, or need
Tab 1
Page 21
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Hand-under-Hand® Assistance:
• Helps assist doing with, not for
• Protects them and us!
• Helps direct gaze – eye-hand coordination
• Pressure in the palm is calming
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Hand-under-Hand®:Protects aging, thin, fragile,
forearm skin
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Try Hand-under-Hand®:
1. To comfort
2. To visually direct - look at
3. To get started - initiate
4. To help with detail - assist
5. To move or change direction
Tab 1
Page 29
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Try Hand-under-Hand®:
1. To get the person to stand
2. To get the person to walk
3. To get the person to eat/drink
4. To get the person to take meds
5. To get the person to sit down
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
THANK YOU!
© Teepa Snow, Positive Approach, LLC – to be reused only with permission.
Handouts are intended for personal use only. Any copyrighted materials or DVD content from Positive Approach, LLC (Teepa Snow) may be used for personal
educational purposes only. This material may not be copied, sold or commercially exploited, and shall be used solely by the requesting individual.
Copyright 2017, All Rights ReservedTeepa Snow and Positive Approach® to Care
Any redistribution or duplication, in whole or in part, is strictly prohibited, without the expressed written consent of Teepa Snow and
Positive Approach, LLC
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