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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

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..

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Relationship vs Agenda

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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

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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

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“Mrs. Jones…. You willbe having a shower!”

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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

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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

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How We Give Information

Visual – How we look

Verbal – What we say

Touch - What we do

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Normal Brain Brain with Alzheimers

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When my brain makes mistakes;

I make mistakes!

• Learning, memory, way finding

• Visual regard

• Sensory motor

• Executive Control

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Amygdalae:

Dangerous Need

Risky Want

Dislike Alert/Aware Like

Tab 1

Page 10

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Positron Emission Tomography (PET) Alzheimers Disease Progression vs. Normal Brains

G. Small, UCLA School of Medicine.

Primitive

Brain

Primitive

Brain

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Hand-under-Hand®:

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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.

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Dynamic Assessment

Visual regard

Ability to speak and understand

Skill in movement

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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

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CONSIDER

• Pace• Visual Cues• Verbal Cues• Physical Cues

Tab 1

Page 16

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Visual Cue Options:

- Signs

- Pictures

- Props or Objects

- Gestures

- Facial Expressions

- Demonstrations

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A Dynamic AssessmentTool for a Shared Relationship

Use the

Positive Physical Approach™

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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

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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

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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

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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

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Hand-under-Hand®:Protects aging, thin, fragile,

forearm skin

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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

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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

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THANK YOU!

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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