How Dementia Affects Language Skills

so when it's not normal we want to recognize as and not normal I will tell you that lots of cardiac events lots of strokes lots of vascular events lots of breathing difficulty problems lots of chemical imbalances in the brain do this this is very vulnerable to skill loss and it could be temporary it could be permanent we want to pick up on changes in this area because this is vital the ability to manipulate words is essential and vital in how we generally interact with each other because what am I expecting to do with my cueing you'll get it you'll be able to process it we've got to recognize when we have issues here we better figure this out really quick our problem is we don't we keep wanting what we can't have here and we keep thinking they're getting more than they're getting because we're doing this they're getting that and they have this whole set of skills put this hand up which is strong powerful and retained on the right so let me tell you what's over there these are all rhythm related skills with one exception it's special so you have language and you have rhythm so let me help you hold on to it we'll look at it in a second so you see it okay here we go put your hands up heels that your hands are gonna hit your temporal lobes to help you remember this and you're gonna go left right like you're marching left right do it again left right good language on the left rhythm on the right now I want you to look at me while you do it first okay you ready formal and straight up language on the Left rhythm on the right now you need to kick that hit you need to get a little rhythm action going there because I want you to have a full body memory cue of what they keep and what they lose and I want you to hang on to it now this is simplified but it's the basics of what they keep and it's the basics of where things are it's complicated but I want to make it too hard for you so what do we have over here leg which on the left rhythm on the right now you lose on the left retain on the right you lose on the left retain on the right so here you're for rhythm skills should keep plus-one this one's special number one automatic social chitchat they keep the automatic social chit Kevin because it's actually hey sweetheart how are you doing you've been okay good how's the family good to see you oh you look great you take care okay see you later chitchat automatic chitchat and so it makes them seem in a social situation like everything's fine and so everybody says you don't know what you're worried about she sounds great but today spent a day at my house because once we get past this do this that surface chit chat the thing that's missing is the depth I can't do the depth I can do the chit chat it's still there it will be there for a long time even late in the disease you're good looking okay yeah you got a nice now on everybody because it's like how did she say remember I said there was a special skill over here I just showed it to you what it is stick your thumb out the special skill are forbidden words your vocabulary that you're not allowed to use in public is store over on the right hand side now there are four categories swear words sex talk remember the first time is a little kid you said mommy what's a penis and she said Shh sweetheart that's fine but let's not say that at the grocery store so loud well I don't have a penis Bobby has a penis tip up here's the deal I'll tell you in the car why can't we talk about it here because there's rules about penises and we talk about them in private why why why look it's a special word let me put it over here so we have swear words we have sex talk ooh here's a bad one racial slur ugly words for other groups other other categories of people that we don't trust like want to be around Rachel oh yeah and the bad news about race it's visual oops bad news bears because I lost all my good words and what I have Lester the nasties and then the last one ugly words shut up you're an idiot stupid facts so preserved those are preserved in almost all brains who have dementia and the reason we think they are is because how they get used routinely in human beings they are used for a particular reason I'll show you in a second so we have normal chitchat second skill that I have this is really important do this rhythm I've got rid of them I can give it and I can get it I still get the rhythm of speech and I can give the rhythm of speech even when I have no content now that I have them and then again and we're gonna hollow down the head hi Daddy have you gonna get together then then they have that pen together you gotta give it and you gotto get the hand I like it another nice yeah yellow cup you gonna get in to get it down down down a pretty good antenna yeah baby you got nice boobies now imagine I'm a church and I'm a judge's wife our society is so not tuned into this that we do this as soon as we hear that kind of thing you know better than that and what I'm gonna tell you is we need to educate everybody you know what it's not about knowing better than that it's what I have left it's a skill unfortunately it's not just rhythm it's the forbidden words - and I don't have boy you look nice in that outfit it's very nice I actually did some of that but then I wanted to say more and when I want to say more you have nice boobs it might have been you looks really nice in that outfit but that's gone I couldn't put all that out there nice outfit nice boobs got that one check and what I don't realize is where I shouldn't where I shouldn't use these words anymore cuz that's parts gone but I know the words now if you get me upset mm-hmm you ready so I give rhythm but I also get rhythm not necessarily content because that is vocabulary comprehension of speech and speech production early in this people will miss out of four words how before you got do you think early in this people will miss out of four words how before you got do you think look early in this people will miss out of four words how before you got do you think do you speak English early in this disease people will miss one out of four words how long before you got lost do you think early in this people will miss out of four words how before you got do you think all I did was skip every fourth word and it's amazing how quickly you lose the train and so what they do is called speaking off on a tangent they have tangential speech because they're trying to follow along but they get lost pretty easily even early on because you're missing on average put up four fingers one out of four and if one out the one out of four you're missing is a Content word like a now and you miss comprehended the now you are way off base and so then the person looks at you like what are you talking about it's because we're not actually connecting up we're missing each other because I think I'm getting it I don't know what I don't know and it's not like I'm doing this on purpose I just miss this but I keep this rhythm thing so my brain says you're getting it so let me give you another example of keeping rhythm this is early in certain dimensions and it's called primary progressive aphasia a particular type of dementia and this particular type of dementia affluent variation not nonfluent I'll show you nonfluent in a minute you'll pick up on it but but listen do you know that the articulation of that phenomena that is the one that many people find to be particularly articulated and that's the one I wanted to point out when you find that articulation occurring that is the one that you will want to precipitate and the precipitation will result in the phenomenological event that you are looking to actually have the thing be the one that you want to participate well I absolutely find that to be fascinating do you not find that articulation to be something that we should participate in now his eyes just crossed in his brain went oh I'd hope I did not sign up for something I don't want to do now I want to point out when I did that how hard you found your brains working your brains were keep fit you're kept going okay wait a minute no there was a word oh I recognize that one but they don't seem to go together and your brain is struggling because you hear all these words into your mind it's like you can feel your faces go I have no idea what she's talking about but it feels like it should make sense cuz I had great rhythm and so you found yourself looking at me very closely all of you are watching me really closely thinking okay I'll be able to figure this out she'll get to a point where it all makes sense it's sort of like going to the doctor's office when he says well now what we're gonna do is we're gonna have to adjust your range of motion because what you've had you have a muscle impingement and the muscle and catchment is gonna result in some nerve pain and we want to be careful that we don't really cause that articulated joint to not you're like so what is it I'm supposed to do and so you're looking for a translation the challenge here is I've got this beautiful rhythm I have absolutely no content and about nine out of ten times I won't know that I'm not making sense I think that I'm still sharing content of value and when you act like I'm not making sense and you give me cues back that say I don't understand what you're I get flustered because I don't understand how could you not get this I mean you I'm being as clear as I know how and I mean I'm giving you great content you've got to watch really carefully I want you to look at your person I want one person to say now you know the phenomenological event that we're looking at that's the one that's gonna articulate everything and I want the other person to go what are you talking about and I want you to really look puzzled and I want you to go I want you to give a good strong visual cue I have you are making no sense whatsoever try using words I can understand I want you to actually stand in front get in front of a person and do that kind of reaction now I'm gonna tell you you're gonna see a variety of reactions on my part if I think you're really stupid because I can't figure out I didn't know that I was making mistakes I didn't have awareness what's the most likely reaction I get angry with you how stupid are you what are you an idiot and now this thing kicks in and I start being really mean to you on the other hand let's say I have awareness and I'm anxious and nervous and I'm starting to notice that I'm sorry I'm not and what I do is quit talking so many of these folks will choose to go mute because they do recognize it and I know I'm losing my skill now here's where I'm gonna want to be with my partner from now on I don't want to get separated from my spokesperson because if I don't have a person who can speak for me on mute and so now I get panicky any time this primary is out of my sight I want them to be right where I can see them because they speak for me and if I don't know where they are and you say I'm just gonna run this store no please don't do that because I I'm this is where I'll latch on to folks because understand speech is so critical in our environment in our world that if I don't have a way to connect I literally become so panicked I can't function and I will have panic attacks if you try to step away from me because I'm so scared that no I won't be I won't know how to get and I know that I can't so this is that moment of real distress and it really is horrible I mean it's beyond horrible when my whole life I've been a speaker a talker a lawyer a teacher a secretary I've used words to connect to communicate and now I have none and I know it and I know that when I try I don't make any sense and so many people they have rhythm but they don't have content and what we do is see what they can't do instead of go to the side where they have strength and work from the side that's retained and we make them feel incompetent and because they feel income today stop trying and that third group ooh the strong folks damn damn damn stupid-ass people all of your every single one of you now what's my reputation like every time you approach me I mean I seemed I mean and what I what I do is I have awareness and I'm so scared I do not want to put myself out there so I'm busy I write words down i'ma write notes at what I'm gonna say and then I then I get there and you try to come and I I fall apart and I go to those ugly words because I'm so scared that I'm gonna get caught and so I often say things or I just talk on those are the people who don't have clue until you give them a huh does this make sense okay so rhythm of speech but I get rhythm of speech too this is what we miss I get the rhythm of speech so lemon are you ain't hey huh yeah yeah now you ready how you hold on high you know let me do that okay okay and that time yeah because what we're going to do it and what we yell about okay you going that okay - I love it okay what we're gonna do okay now you're on yeah all right yeah yeah yeah y'all go high oh yeah oh yeah no I think there's a way right all right yeah why is hot antenna on your hand you know that okay all right you ready okay all right why those Hey okay her name huh now let me ask you something you thought I was a person with dementia didn't you yeah uh-uh I'm your caregiver and you have moderately severe dementia what did you get all the rhythm of my speech you could tell exactly when I was asking you a question by the rhythm and you knew you're supposed to answer and then I gave you visual cues about the answer I wanted to hear I nodded when I wanted to I gave you a really good visual these are all automatics by the way and so I got you to say what I wanted you to say but what I didn't realize is you never comprehended anything I said now tell me your first name Judd Judd okay so Jed you stay here just a second what I want to point out is that all I did just so you'll know I'm gonna give you the cue and from now on you'll be able to understand me better all I did was lay my tongue down so I didn't articulate nearly as clearly so I robbed you of consonants and left the vowels for you okay hey you ain't hanging out how oh yeah hey hey hey I'm gonna give you a shower okay all right hey yo yo haha okay hello hey all right all right yeah yeah yeah yeah hey are you see how you're starting to understand my language now because once I tell you what's missing your brains are incredible they are so good at comprehension they went and they found the missing pieces and they're putting the puzzle back together again because you're intact and now you're curious yeah okay I got you you're like everything over a hi-hat yeah hi-yaa and Homer that's what I like about you because one day is totally different than the other one okay all right how how are you you know you're right go ahead yeah I'll hang out haha okay yeah okay are you ready now in this scenario let me be very clear as far as comprehension went what was the first sensation that was really clear to him what I was going to do when I touched him and to his mind this was just a social interaction he had no idea this was going beyond social stuff he thought I was chit-chatting with him having a lovely time he didn't comprehend but it seemed to him that we were being very friendly I was being very nice I was going ready yes and he says yes and then so with your person straight across from you turn and face them I want you to make sure you're facing them so that we get a sense of how horrible this is really okay we're gonna stay right here okay now turning face and here's what I want you to do I want you to look at them and smile and then look down at their shirt and realize they have a great big Watteau meal right there oh it's a really nasty wad I mean it's huge and what I want you to do is the classic care Girt okay okay now let's add a grinning smile Adam okay now here's the new piece all right here's the new piece I'm going to give you remember I said vision changes what they lose is the edge peripheral awareness and their visual field gets smaller and smaller and smaller because they keep curiosity which is your center field and they lose the edge which is safety awareness so their visual field gets smaller and smaller so by this point in the Z's at best do this put on binoculars this is how much of the world they can pay attention to at a time and when you're right in front of them like that what part of you have you asked them to pay attention to your face and so they're watching your face so person with dementia put on your binoculars person who's helping grinning smiling hey oh yeah oh yeah oh hey and now make sure you've nodded and shake them up and now reach out to their shirts what do you realize for the very first time they can't see you coming they have no idea you're about to make contact with your shirt because they think you're being social and with the vision loss and the change in comprehension this touch came out of nowhere they were totally not expecting it try this we're gonna really work on these skills this afternoon but I want you to try this you put that on okay yeah oh yeah yeah mm-hmm perfect thank you Thanks try that with your partner and see how that feels now here it's important all of you I'm watching point to yourself first look down at your own point and then look at theirs and point don't reach out and put your hand on it right away you cue where they can see and then you do the motion and then you point to theirs it's a two-step thanks John alright so we have two language skills left to go over here before we take our break and it's almost lunchtime so I'd better hurry up there's lots more to learn we're gonna learn a lot more with skills this afternoon but I want to wrap this up over here what's over here that's starting to be gone but what is it vocabulary comprehension speech production losing the skill what are we keeping the strength over here automatic social chitchat the rhythm of speech this is the gift this is the blessing this is the thing you want to hook into because it's a retained skill for about 98% of humans who develop any form of dementia music poetry prayer rhythm music poetry and print they will be able to sing when they cannot speak they will be able to sing they will be able to do prayer if it's all familiar prayer so in this group I'm betting I have a majority of folks our Father yep how about this one the Lord is my how do you know it wasn't gonna be the Lord is my god the Lord is my why was it the Lord is my shepherd because it's the twenty yep it's what we do and we're in times of emotional need and it's strongly linked in this thing this rhythm this music this poetry this prayer is hooked into the emotional center it's our strength this is the gift that we have and that they have and this is the way we can connect with one another if we learn to use that gift many of you by now have started to notice that when I speak I speak with a lot of rhythm I use rhythm and pauses in my speech combined with incredible amounts of visual cueing to emphasize the message so that I have a chance at getting through yeah now it doesn't mean you'll get louder it means you get richer and smoother and fuller and deeper with your cueing but this is the gift the problem is we forget it's a gift and we're all worried about what they lose not what they keep and here's the really cool part when you do this often it lights this up because there is wiring from side to side and when I use what they can do the wiring lights up and suddenly for a short period of time many people can speak more clearly can understand what you're saying to them and this is the way you get there you use what they still have and the last little one on the end another strength is I move with rhythm so I can dance better than I can walk I'm walking barely moving with the Walker you put on I've got really is up and also and you're like seriously I can also do this one watch what happens in here why didn't you repeat me because I saw what happens you have to finish off the rhythm did you have to finish it off so what if I go one two yeah that can help you stand up better I can help you sit down better because what I'm doing is giving you that rhythm anticipatory what's the next thing now you have to be prepared for I didn't get it and you might have to do it a couple times then you may have to break it down a little bit more but learning how to use what I've got remember I got this one too what makes me do this one is when you get my limbic system all stirred up that's the thing you've got to understand you make me angry you scare me you do anything that startles me because we get these words in the first you can learn them somewhere when you're 2 to 7 years old you're somewhere and you hear a word everybody in this room somewhere between 2 & 7 you learned your first one you came home when you said hey mom and your mom like what you went yet it mama said where did you hear that who told you that Johnny well we don't use words like that I never want to hear and go wash your mouth out with something I'm gonna tell you something if I ever hear you use that word again you are gonna be in so much trouble young lady do you understand me yeah now you're looking real sad your brain is going oh look I found the word special word this is kind of cold this was a special word why not get a reaction but what it said is better not leave this in regular vocabulary never want to do this in front of mom again this was a problem I don't want to lose the word it was a special word we're gonna put it where can i hook it where can I store it where I could have it if I want it needed at some point I know I'll put it in the rhythm section and say start your storage unit you have swear word sex words racial slur are ugly words all stored over there now what they found out they do research on this this is important you're in a parking lot all by yourself no one's around you accidentally slam their fingers in a car door 9 9 out of 10 of you will do the following you ready slam you do the little dance there's a dance there's a little dance and there's the flinging of the hand that goes with it and you say the word and you say it with emphasis now what happens when you do that quickly in your brain your brain drops cortisol level and releases endorphins stress relief pain reduction yeah that's where they come in handy you've got to save them for special occasions so they have that gift that hard so here's my anticipation with the next generation here's what they're going to say please please thank you thank you so much because it's clear that fu is going to sort of not be there anymore and neither is any of that other stuff because it's so prevalent everywhere else that they're going to use it special but now here's the tricky part with every grown person when they did the same thing and they put you in the same situation and you slender finger of the car doors and there was a three-year-old standing next to your car here's what would happen with nine out of ten of you one of you didn't give a but the rest slam what don't you get no stress reduction no pain relief but your frontal lobe kicked in and you weren't the one that caught that little kid that word that was really important to you to hold those suckers back so what does that mean well when you get dementia things change get ready those kids are gonna learn soon to learn those words anyway let's not separate them from our elders and let's not make this a disease of isolation simply because of what I have left what you want to do is learn to use what we do have that has value that's what I'm gonna do this afternoon what I wanted to do this morning is separate out myth from reality about what is this thing called dementia and why are we so scared of it well because it looks sort of like normal aging but it's not and then when we do see it sometimes we don't recognize that for what it is and what we keep recognizing is what they're losing but we miss some of that and we for sure miss what they still have so this afternoon is gonna be all about building your skill set when we look more deeply into the brain and understand everything that's gone and everything that's cast you

Channel: Teepa Snow's Positive Approach to Care

Views: 237,699

Rating: 4.8598833 out of 5

Keywords: dementia, alzheimers, lewybody, brain change, caregiving, caregiver, Dementia, FTD, Frontotemporal, care, health, healthcare, support, Lewy Body, LBD, vascular, education, training, PLwD

Id: 0BlZF_4EKp4

Length: 30min 12sec (1812 seconds)

Published: Thu Dec 21 2017

Reddit Comments

[u/SushiSquidKid]

This woman is a GODSEND. She’s really helped me understand what’s happening in my grandfathers brain and why he acts the way he does.

[u/isabel_77]

Wow. This is great.

[u/LV2107]

That was super interesting! Thank you for sharing it!

My dad checks off every single one of those situations she talked about, this is going to be very helpful. I am going to watch the entire series.

[u/FancyAttitude]

This was incredibly interesting. Thank you for sharing.

[u/champerdamper2]

This is amazing! Thank you!!!

[u/travelwaves]

Thanks for sharing