Moments in the MindMoments in the Mind2525thth Annual Alzheimer’s Regional Annual Alzheimer’s Regional

Conference, April 16, 2010Conference, April 16, 2010

TTAP Method ™TTAP Method ™

New Directions in ActivitiesNew Directions in Activities

for Self Expressionfor Self Expression

Linda Levine Madori, PhD, ATR-BC, LCATLinda Levine Madori, PhD, ATR-BC, LCAT

Fulbright Scholar, Author and ResearcherFulbright Scholar, Author and Researcher

Overview of sessionOverview of session

Overview of new information on Overview of new information on Neuroplasticity in the brain Neuroplasticity in the brain

How arts and the creative arts experience How arts and the creative arts experience directly effects brain regions and directly effects brain regions and functions.functions.

Establishing a 9 step theme programEstablishing a 9 step theme program Research on the TTAP Method that has Research on the TTAP Method that has

been done. been done. TTAP Method in Finland and Australia TTAP Method in Finland and Australia

Neuroplasticity-The ability of the Neuroplasticity-The ability of the brain to brain to grow or shrinkgrow or shrink in size and in size and

mass.mass. Environmental Environmental

stimulation, including stimulation, including sight , smell, taste, sight , smell, taste, touch and education touch and education is triggering our cells is triggering our cells in the Hippocampus in the Hippocampus region to multiple region to multiple and thus become and thus become larger and more larger and more dense dense (Diamond, 2001; (Diamond, 2001; Snowdon, 2002; Perry 2008 )Snowdon, 2002; Perry 2008 )

Technology allows us to look deep into the living brain

The top slide is of healthy dendrites with rich dense connections.

The bottom slide shows how the dendrites look when cellular deterioration has occurred.

Current Hypothesis on Hippocampus Current Hypothesis on Hippocampus wellness and cognitive reservewellness and cognitive reserve

Early stage: Plaques and Tangles Early stage: Plaques and Tangles develop in the Enthornal cortex, develop in the Enthornal cortex, essential for making new essential for making new memories and retrieving old ones.memories and retrieving old ones.

Middle stage: Over time abnormal Middle stage: Over time abnormal cells move higher up through the cells move higher up through the Hippocampus, responsible for Hippocampus, responsible for complex memories, events, life complex memories, events, life experiences.experiences.

Last stage: Plaques/tangles move Last stage: Plaques/tangles move up and across the brain to the up and across the brain to the Neocortex, eventually preventing Neocortex, eventually preventing orchestration of behavior, eatring orchestration of behavior, eatring and loss of all ADL’s.and loss of all ADL’s.

TTAP Method structuresRight and Left Brain Functioning

into protocalsRight Side Creative Inspiration Visual Reactive Skills Emotional Artistic Playful

Left Side Logical Arithmetic Reading Sequential Concrete Rational Goal Oriented

How Activities Stimulate How Activities Stimulate LEFT Brain FunctioningLEFT Brain Functioning

Left SideLeft Side Creative Art TherapiesCreative Art Therapies

Logical/Rational-----Logical/Rational-----ReminiscenceReminiscence

Arithmetic-------------Arithmetic-------------PuzzlesPuzzles Reading-------------Reading-------------Story BoardsStory Boards Sequential----------Sequential----------Food, cooking Food, cooking

receiptsreceipts Concrete------------Concrete------------Reality orientation, Reality orientation,

names of objects/people names of objects/people

How Activities Stimulate How Activities Stimulate RIGHT Brain FunctioningRIGHT Brain Functioning

Right SideRight Side Creative Art TherapiesCreative Art Therapies

Inspiration-----------Inspiration----------- Object relations Object relations Visual-----------------Visual----------------- Paints, Color, Form Paints, Color, Form Reactive Skills-------Reactive Skills------- Body, movement Body, movement Emotional------------Emotional------------ Photographs Photographs Creative/Artistic-----Creative/Artistic----- Sculpture, 3-D work Sculpture, 3-D work Playful----------------Playful---------------- Being in the moment Being in the moment

TTAP Method utilizes Whole Brain Thinking

Left Side – logic, math, reading, speaking

Right Side- creativity, inspiration, visual

Peak Performance- Using both regularly

Finding the 6 Strengths' of Finding the 6 Strengths' of individuals with AD individuals with AD

Reminiscence Therapy Utilized Reminiscence Therapy Utilized with Dementia – with Dementia – Strengths' and needs identified Strengths' and needs identified

Woods, B., Spector, A., Jones, C., Orrell, M., Davis, S Woods, B., Spector, A., Jones, C., Orrell, M., Davis, S (2006). Reminiscence therapy for dementia: A Review. (2006). Reminiscence therapy for dementia: A Review. The Cochrane Collaboration, Issue 3. Retrieved: The Cochrane Collaboration, Issue 3. Retrieved: 7/15/2009.http://www.thecochrane7/15/2009.http://www.thecochrane..

Tabourne, C., Jung, L., McClear, E.(2008) Life Tabourne, C., Jung, L., McClear, E.(2008) Life Review Programming (LRP) with Korean individuals Review Programming (LRP) with Korean individuals diagnosed with Alzheimer’s disease. American Journal of diagnosed with Alzheimer’s disease. American Journal of Recreation Therapy. (4):25-35.Recreation Therapy. (4):25-35.

TTAP Method™ naturally enhances the 6 TTAP Method™ naturally enhances the 6 remaining strengths in the disease process-remaining strengths in the disease process-

CCDERS©CCDERS©

Emotions and LearningEmotions and LearningThe Hippocampus The Hippocampus

is located in the is located in the Limbic system, Limbic system, which is called the which is called the seat of our seat of our emotions. Art emotions. Art stimulates stimulates emotions, thus emotions, thus enriching the enriching the mind.mind.

Research in Emotions, Learning Research in Emotions, Learning and Creativity into Practiceand Creativity into Practice

Rich lRich language usage and emotions impactsanguage usage and emotions impacts

Learning and decreases stress.Learning and decreases stress.

Dirkx, J. (2001). The Power of Feelings: Emotion, Imagination, Dirkx, J. (2001). The Power of Feelings: Emotion, Imagination, and the Construction of Meaning in Adult Learning. New and the Construction of Meaning in Adult Learning. New Directions for Adult and Continuing Education, 89: 63-72.Directions for Adult and Continuing Education, 89: 63-72.

Serrano, C., Allegri, R., Martelli, M., Taragano, F., Rinalli, P. Serrano, C., Allegri, R., Martelli, M., Taragano, F., Rinalli, P. (2005). Visual art, creativity and dementia facilitates (2005). Visual art, creativity and dementia facilitates learning. Vertex, 16(64):418-29. Retreived July 10learning. Vertex, 16(64):418-29. Retreived July 10, , 2009 2009 from from http://www.ncbi.nlm.nih.gov/pubmed/16314895-structurehttp://www.ncbi.nlm.nih.gov/pubmed/16314895-structure

Now your TTAP Now your TTAP InteractionInteraction

Through an objectThrough an object (Object relations Theory)(Object relations Theory)

How TTAP Method™ Directly How TTAP Method™ Directly Effects Cognition and Emotions Effects Cognition and Emotions

THE TTAP METHOD : A 9-step THE TTAP METHOD : A 9-step structured therapeutic interventionstructured therapeutic intervention

MULTIMODAL MULTIMODAL APPROACHAPPROACH

Regions stimulatedRegions stimulated

Multimodal approach was Multimodal approach was founded by Lazarus in 1950’s founded by Lazarus in 1950’s and described as any therapy and described as any therapy which implements individually which implements individually tailoredtailored

Treatment programs address Treatment programs address behavior, affect, sensation,behavior, affect, sensation,

imagery, intra and imagery, intra and interpersonal relationshipsinterpersonal relationships

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STEP 1: FROM INDIVIDUAL THOUGHT TO GROUP IDEAS ON THE PAGE (linguistic, visual)

STEP 2: FROM IDEAS TO MUSIC -Meditation (intra/interpersonal, musical, visual)

STEP 3: FROM THE MUSIC IN THE MIND TO THE IMAGE (kinesthetic, spatial, visual)

STEP 4: FROM THE IMAGE INTO SCULPTURE (spatial, visual, kinesthetic)

STEP 5: FROM SCULPTURE INTO MOVEMENT (kinesthetic, visual, musical)

STEP 6: FROM MOVEMENT INTO WORDS/ POETRY & STORIES (linguistic, intra personal)

STEP 7: FROM WORDS INTO FOOD FOR THOUGHT (linguistic, kinesthetic, interpersonal, intra personal)

STEP 8: FROM THOUGHT INTO THEME EVENT TO (inter/interpersonal, spatial, visual, kinesthetic, musical, linguistic, visual ,intra personal)

STEP 9: FROM EVENT INTO PHOTOGRAPHY (linguistic, visual ,intra/interpersonal, kinesthetic, spatial)

7 Protocols' utilized in Bergen 7 Protocols' utilized in Bergen Regional Study,2009Regional Study,2009

1. Meditation-1. Meditation-

self reflectionself reflection 2. Oil paste drawing2. Oil paste drawing 3. Wreath sculpture3. Wreath sculpture 4. Mask Making4. Mask Making 5. Memory Box5. Memory Box 6. Painting 6. Painting 7. Food event 7. Food event

Conversation, Music and Conversation, Music and Meditation- Steps 1, 2 Meditation- Steps 1, 2

Meditation, oil pastel, music Meditation, oil pastel, music and drawing- Steps 1,2,3 and drawing- Steps 1,2,3

Mediation, music, and Wreath Mediation, music, and Wreath sculpture- Steps 1,2,3 & 4sculpture- Steps 1,2,3 & 4

Mask Making- Steps 1,2, 3, Mask Making- Steps 1,2, 3, 4 & 64 & 6

Meditation, Music and Meditation, Music and Memory BoxMemory Box

Steps 1, 2,3, 4 & 6Steps 1, 2,3, 4 & 6

Meditation, Music and PaintingMeditation, Music and PaintingSteps 1, 2, & 3Steps 1, 2, & 3

Music, Phototherapy, Music, Phototherapy, and Foodand Food

Steps -1, 2, 3,4, 6,7 & 9Steps -1, 2, 3,4, 6,7 & 9

TTAP Method creates structure to TTAP Method creates structure to programming through:programming through:

1. Assessment forms-Time and Frequency1. Assessment forms-Time and Frequency

2. Learning styles-indicated2. Learning styles-indicated

3. Brain Regions Stimulated3. Brain Regions Stimulated

Aides in documentation of RehabilitationAides in documentation of RehabilitationAides in documentation of Restoring Functions-Aides in documentation of Restoring Functions-

Aides in documentation & assists in reimbursableAides in documentation & assists in reimbursable

outcomes .outcomes .

TTAP© Structure enables therapist to TTAP© Structure enables therapist to document and chart regions stimulated, document and chart regions stimulated,

amount of time and frequencyamount of time and frequency

Open ended statements.Open ended statements. 1.” I felt free during this group”1.” I felt free during this group” 2. “ I feel very happy”2. “ I feel very happy” 3.“I was able to really create something”3.“I was able to really create something” 4. “I was able to do what I wanted”4. “I was able to do what I wanted” 5. “Someone saved me a lot of trouble”5. “Someone saved me a lot of trouble” 6. “ I would like to be more active but I am not 6. “ I would like to be more active but I am not

right now”right now” 7.”I am becoming more active coming to this 7.”I am becoming more active coming to this

program”program” 8.”I am always active”8.”I am always active”

ISNT COGNITION HOW WE THINK ABOUT ISNT COGNITION HOW WE THINK ABOUT HOW WE FEEL?HOW WE FEEL?

Does the TTAP Method provide opportunities Does the TTAP Method provide opportunities for cognitive stimulation?for cognitive stimulation?

Student responses':Student responses':

““Seeing the patients each week we observed them Seeing the patients each week we observed them becoming more active as each week went by. becoming more active as each week went by. One pt. didn’t want to do anything in the first 3 One pt. didn’t want to do anything in the first 3 sessions and then she started wanting to do sessions and then she started wanting to do more and more.”more and more.”

““The patients would tell us they were feeling more The patients would tell us they were feeling more alive AND how their minds were more alive.” alive AND how their minds were more alive.”

““The patients were indeed stimulated cognitively in The patients were indeed stimulated cognitively in giving them choices, making decisions, and giving them choices, making decisions, and taking action, this stimulates the brain.”taking action, this stimulates the brain.”

10 Research Studies on Cognition and the 10 Research Studies on Cognition and the TTAP MethodTTAP Method

Hebrew Home for the Aged, (Levine Madori, Hebrew Home for the Aged, (Levine Madori, 2005, 2009) –2005, 2009) –significant outcomessignificant outcomes

Cento de Oro, Spanish Population (Alders, Cento de Oro, Spanish Population (Alders, 2009)-2009)-significant outcomessignificant outcomes

Helen Hayes Rehabilitation Hospital , (Levine Helen Hayes Rehabilitation Hospital , (Levine Madori & Andreassi, 2009) –Madori & Andreassi, 2009) –significant not publishedsignificant not published

Bergen Regional Medical, moderate/severe Bergen Regional Medical, moderate/severe (Levine Madori & Mullins,2009)-(Levine Madori & Mullins,2009)-significant findingssignificant findings

Cornell University, Mild Alzheimer’s Disease Cornell University, Mild Alzheimer’s Disease (Levine Madori, Fonsetti & Jordan, 2009)-(Levine Madori, Fonsetti & Jordan, 2009)-significant findingssignificant findings

Research Studies on Cognition Research Studies on Cognition and the TTAP Methodand the TTAP Method

6. Beechtree Rehabilitation Hospital, 6. Beechtree Rehabilitation Hospital, moderate/severe, moderate/severe, (Levine Madori & Coveney, 2009-10) (Levine Madori & Coveney, 2009-10)

7. Edward Hospital Linden Oaks, 7. Edward Hospital Linden Oaks, moderate/severe locked unitmoderate/severe locked unit

8. Downstate Medical Center, African American 8. Downstate Medical Center, African American Mild/Moderate-Mild/Moderate-Brooklyn Community Day CenterBrooklyn Community Day Center

9. Cornell Continued- Case Study, (Levine 9. Cornell Continued- Case Study, (Levine Madori, 2010)- 3 year Study-Madori, 2010)- 3 year Study- Appointed Clinical Appointed Clinical Researcher Memory and Evaluation services.Researcher Memory and Evaluation services.

10. Hämeenlinna Alzheimer’s Association- 3 year 10. Hämeenlinna Alzheimer’s Association- 3 year study study

Finnish study #1Finnish study #1 Eija Pelokangas & Marjanna Rantala,Eija Pelokangas & Marjanna Rantala, Seinajoki University, Masters in Social work and Seinajoki University, Masters in Social work and

HealthCare Division.HealthCare Division. This study took pace also through the Government This study took pace also through the Government

program titles Demke-project. The purpose was to program titles Demke-project. The purpose was to develop program to increase quality of life for individuals develop program to increase quality of life for individuals with AD, and to increase nursing participation in actually with AD, and to increase nursing participation in actually facilitating activities on a dementia unit.facilitating activities on a dementia unit.

Qualitative study , data collected by pre and post Qualitative study , data collected by pre and post surveys from staff, administration and nursing. Views of surveys from staff, administration and nursing. Views of the elderly were analyzed.the elderly were analyzed.

Outcomes included the overall significant and positive Outcomes included the overall significant and positive responses from residents on the unit , verbal interviews responses from residents on the unit , verbal interviews with staff after the 15 week program, and post collection with staff after the 15 week program, and post collection of data 8 weeks after the intervention. Post intervention of data 8 weeks after the intervention. Post intervention found significant increase in activities by nursing on unit. found significant increase in activities by nursing on unit.

Tarja Vanska (September, 2009),Diaconia University of Tarja Vanska (September, 2009),Diaconia University of Applied Sciences, Helsinki Nursing Degree.Applied Sciences, Helsinki Nursing Degree.

Research study designed for large Rehabilitation Hospital Research study designed for large Rehabilitation Hospital for War Veterans. Nursing staff took course in TTAP for War Veterans. Nursing staff took course in TTAP Method and decided to use as research thesis.Method and decided to use as research thesis.

Study had 2 prongs- short-term goal was to investigate if Study had 2 prongs- short-term goal was to investigate if TTAP Method could be used as a therapeutic TTAP Method could be used as a therapeutic intervention successfully with those diagnosed with intervention successfully with those diagnosed with moderate and severe AD.moderate and severe AD.

Secondly, could the TTAP be utilized as part of the nursing Secondly, could the TTAP be utilized as part of the nursing responsibility.- this study used 6 steps (meditation& responsibility.- this study used 6 steps (meditation& Music, painting, phototherapy, baking, dance)Music, painting, phototherapy, baking, dance)

Results of a 8 week study- Peak in physical performance Results of a 8 week study- Peak in physical performance measures, significant increase in socialization . measures, significant increase in socialization . Participants showed high satisfaction. TTAP thus was Participants showed high satisfaction. TTAP thus was found to be both therapeutic and rehabilitative as a found to be both therapeutic and rehabilitative as a methodmethod

Laura Hanski& Kaisu Kohola (December, 2009) Laura Hanski& Kaisu Kohola (December, 2009) Seinajoki University of Applied Sciences, School of Seinajoki University of Applied Sciences, School of Health care and social work.Health care and social work.

Title: We are all artist’s; Study of the TTAP Method in Title: We are all artist’s; Study of the TTAP Method in Retirement HomeRetirement Home

Activities in Finland retirement homes for older adults are Activities in Finland retirement homes for older adults are often missing. The government has established a often missing. The government has established a Program to ensure Quality of Life issues with elders.Program to ensure Quality of Life issues with elders.

Students found a facility with no programs being offered, Students found a facility with no programs being offered, they approached administration and staff about starting they approached administration and staff about starting a TTAP Method Program.a TTAP Method Program.

This qualitative study used interviews, photographs, with This qualitative study used interviews, photographs, with family, staff, and individuals.family, staff, and individuals.

Conclusion, TTAP Method was efficient to stimulate Conclusion, TTAP Method was efficient to stimulate creativity on all 5 domains. TTAP stimulated nursing to creativity on all 5 domains. TTAP stimulated nursing to become involved in activities with therapist’s.become involved in activities with therapist’s.

Finnish Study #4Finnish Study #4

Karina Ketola- (Feb. 2010), From Person to Person: The Karina Ketola- (Feb. 2010), From Person to Person: The effect of empowering guience on Elderlyeffect of empowering guience on Elderly

Steering educational group was formed to educate staff Steering educational group was formed to educate staff working in Dementia Unit in Long Term Care on how to working in Dementia Unit in Long Term Care on how to utilize TTAP Method © .utilize TTAP Method © .

Collection of Data took place over 20 week period.Collection of Data took place over 20 week period. Conclusion, TTAP Method through qualitative data Conclusion, TTAP Method through qualitative data

collection from staff and residents, themes that arose collection from staff and residents, themes that arose from survey, observation and actual notes from sessions from survey, observation and actual notes from sessions proved to enhance both the staff leading the group and proved to enhance both the staff leading the group and the residents with moderate dementia living on the unit.the residents with moderate dementia living on the unit.

Finnish Alzheimer’s Association Finnish Alzheimer’s Association awarded 600,000 euro's to study awarded 600,000 euro's to study

TTAP Method for 3 years. TTAP Method for 3 years. University of HAMK training University of HAMK training

students to facilitate programming in students to facilitate programming in home and community. home and community.

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Research Studies Enhancing Research Studies Enhancing Cognitive Performance utilizing the Cognitive Performance utilizing the

TTAP Method™ TTAP Method™ Linda Levine Madori, Ph.D., ATR-BC,LCAT, CTRSLinda Levine Madori, Ph.D., ATR-BC,LCAT, CTRS

TTAP Method utilized with 8 TTAP Method utilized with 8 individuals’ diagnosed with Mild individuals’ diagnosed with Mild

Alzheimer’s Disease; Cornell Alzheimer’s Disease; Cornell University Memory Evaluation University Memory Evaluation

Services Services

Early findings demonstrate Early findings demonstrate significant increase in mood and significant increase in mood and

self perceived increase in self perceived increase in cognitioncognition

Using Photographs to stimulate Using Photographs to stimulate the mindthe mind

CLOCK DRAWING TEST: CLOCK DRAWING TEST:

Results could be suggestive of organic causes of Results could be suggestive of organic causes of cognitive impairment. cognitive impairment.

Advantages: simple, non-threateningAdvantages: simple, non-threateningSensitivities of up to 86% and specificity of up to 96%.Sensitivities of up to 86% and specificity of up to 96%.

(Samton, 2005)(Samton, 2005)http://neuro.psychiatryonline.orghttp://neuro.psychiatryonline.org

SCORE 4SCORE 4 SCORE 0SCORE 0

Changes in cognition “seen” in Changes in cognition “seen” in Clock Drawing (Clock Drawing (Cornell study, 2009)Cornell study, 2009)

Pre-TTAP Method© Pre-TTAP Method© Intervention Intervention SCORE 10SCORE 10

Post -14 week Post -14 week TTAP Method© TTAP Method© SCORE 13SCORE 13

Cultural Change in Healthcare;Cultural Change in Healthcare;Medical Model to Social Model Medical Model to Social Model

. There were four early pioneering individuals who . There were four early pioneering individuals who began to apply social model concepts to nursing began to apply social model concepts to nursing home settings that must be recognized to truly home settings that must be recognized to truly understand the evolution of Culture Change understand the evolution of Culture Change history. The early work that these individuals history. The early work that these individuals brought to the movement have become known as brought to the movement have become known as the following Culture Change philosophies:the following Culture Change philosophies:-- The Eden Alternative-- The Eden Alternative-- The Regenerative Community-- The Regenerative Community-- Restraint Free / Individualized Care-- Restraint Free / Individualized Care-- Now the TTAP Method™-- Now the TTAP Method™

Certification Course on Certification Course on TTAP Method™, New York, TTAP Method™, New York,

New Jersey, Chicago, Illinois.New Jersey, Chicago, Illinois.

For more information on the TTAP Method For more information on the TTAP Method go to…go to…

www.ttapmethod.comwww.ttapmethod.comhttp://ttapmethod.blogspot.comhttp://ttapmethod.blogspot.com

Levinemadoriphd Channel@ Levinemadoriphd Channel@ You TubeYou Tube

oror

Linda@Levinemadoriphd.comLinda@Levinemadoriphd.com