The Limbic System's Role in Dementia

okay well what we're gonna do to start the day off is a brief review of the sorts of things we did yesterday the cool thing is no matter how old you are if you don't have fairly significant dementia you can grow new synaptic connections the bad news when you are 25 do this there you go when you are 70 do this keep keep going you're getting there it literally increases free you have to increase intensity and frequency to get new synaptic connections to form and hold as we age chemically it is much harder for your brain to form new synapses with increasing age the chemistry just doesn't support it the more excited and interested you are and the more you rehearse something the quicker the connection will form but if you let it go too quickly it will be gone and when you hear me speak again you go did she say that last time I swear don't remit that oh yeah I remember now because you put it in a storage area but you didn't really access and use it regularly and so the more you use what we talk about that's why yesterday was awareness now I felt like knowledge for many of you but it will run out and it'll be all gone if you're not careful so what we're gonna do is manipulate it a little bit so you'll be able to access it again and again and again that's what this is all about because it doesn't do us any good if you get it in you lose it but here's my ultimate I don't care what you learn if you don't do something different because the reason I'm in this is not because of you as much as I like you I mean I do I like you a lot but I'm not in it for you I'm in it for people who have dementia and because people have dementia and they're doing the best they can I want us to do the best we can and that means we have to be learn move beyond what we know to what we do and we have to make it a new habit so we're not even doing the old thing we don't even think about the old thing anymore we just do it the new way because it absolutely is just what we do but there's a lot of work to get there and that's what people keep forgetting you have to do it over and over and get feet on how you're doing so the first thing we're gonna do is review your brain and what we're looking at is how well your brains burning fuel and put your hand way high in the air burning red equals full-out a hundred percent yellow mid-range down here where we have the light blue burners on but you haven't applied any gas and the dark blue purple zero burn because there are no brain cells in those areas okay now at the top of each picture put your hand right here we're looking at the front of the brain and the person is lying like this so on this side is the left hand side the right hand side and at the bottom is the back of the brain okay so what we're gonna do is talk about first the middle of the brain so I want you to do this center of the brain first part to develop called the limbic system the Thrive to survive so I want you around your table to go around your table and identify some things that are happening when you have thrive to survive what is the basic thrive to survive involve talk around your table for a second what does it involve what helps you survive think about what helps you survive okay I'm gonna come around what's one thing y'all said okay I'm gonna have you be more basic than that get your hand down get your hand out this is what human beings need yeah you gotta breathe you got exchange oxygen you got to get oxygen in carbon dioxide out absolutely respiration and how fast you respirate and how deep and well you respirate okay that's one here's what I'm gonna do I'm gonna give you five basic physical needs five basic physical needs do this when thumbs up and do this hunger and thirst hunger and thirst it's part of that core there is a basic human need if you're gonna survive you got to eat and drink right it's just a rule now second one rum crash do that with your finger crash second one wake rest so wake sleep but it's also high energy low energy you all know circadian rhythm in order to survive you've got it establish a circadian rhythm so that you have that rhythm of wake sleep wake sleep wake sleep because you've got to recharge your batteries before you can use the battery charge if you wear it all the way down and you don't have a way to recharge it late in the disease what do you see after noon when I'm lost and confused I can't settle myself back down ah ah lack of ability to regulate so you got to regulate that that's in that core babies who are chronically unable to do that what happens what happens to their parents yone I just sleep Oh that'll help okay let's go to the third one hold it up all by itself I always pick an ugly one now drop it down and Dingle it around elimination in order in order to survive you've got to eliminate waste product once you form it so what is it going to involve in human beings pooping and peeing you've got to eliminate what you don't need anymore so putting it out when you don't need it anymore it's you've got to do it or you're not gonna survive you got to get rid of it you can't keep the urine in there it's got to come out okay the next one now I do this because I want you to sort of think about this this was the most challenging one close your hand into a fist now take your index finger and notice how without any work at all you can make it totally line up with the rest of your hand you see how you can line it up with the long bones in the in your hand try to do that with your ring finger don't don't do it keep it closed up tight and try to make it go up real straight by itself can you get it no can you push it up there does that feel good it's uncomfortable uncomfortable in order to survive you've got to be comfortable you've got to be comfortable so now of all of them though this is the most individual because each of us is designed in such a way as in order to be comfortable we have to have sort of several things met one is temperature because if it's too hot or too cold you can't survive so you've got to find that place where you're feeling comfortable another one textures things pokey things that don't wool some people can't wear wool some people can't wear things that are that are too slit they don't like then other people like well I don't see what's wrong with it feels fine to me so it's textures against your skin it's movement of air it's move real close to the person now - just move up real close move up real close to him how many are going okay that's way too close so distance how close other people are to you how much space you need to feel comfortable and you want to feel comfortable have you ever had a child that you're trying to comfort and you're like trying to get and they're just like yeah because what you're trying to do is it meeting their need and they're not relaxing they're not getting comfortable and they can't survive that you will wear each other out okay here's another one comfortable sound type of sound intensity of sound what it is whether it's familiar unfamiliar keep a sit-down yeah and what you don't realize is that a noise not only you it actually bothers all the other residents except for the one who's getting up he's totally ignoring it because they're getting up for another reason they were not comfortable and the uncomfortableness of what they were feelings was much more intense than the uncomfortableness of the sound they don't even care about today I'm saying they just want to get comfortable okay it's also what you see intensity of lighting comfort with what visual regard is out there is that a thing that looks good and familiar is that a thing that's really sort of scary I mean if you see something that seems scary and you don't recognize it you can't get comfortable if you're not comfortable you're not going snow I can't do I need to get out of here and it's all about visual regard and comfort so comfort comes in many many different things if people are watching you turn and look at the purse just look at him look at the person and then not shake your head and go are you feeling real comfortable you're sort of gone what's wrong with me what do you want you so of all of them and babies will fit children feel this a lot you can watch children because they're more wide open because they don't have the cover on them but when people have dementia I would encourage you to think about look carefully listen carefully pay attention to all the cues they're giving you because they're trying to communicate with you that they're not and if they're not comfortable this is not going to go well and we keep ignoring that and wanting them to be okay with what's not okay for them because it's not a like' or dislike' it's actually a survival skill what they're trying to say is I can't live like this I can't survive like this I am so uncomfortable that I can't do this you guys are making me nuts and what we tell them to do turn to your partner now this is my favorite smile kindly lean in it's really important you do all these things and now take your sweet little hand out and go calm down sweetheart and now if they didn't like that stroke their hair a little bit it's okay pat around their face and hey oh honey it's okay relax calm down I'm right here I'm right here I hope it's all right sweetheart oh yeah it's okay don't get upset don't get upset sweetheart I'm right here sweetheart here oh let's change your shirt you'll feel so much better and if you think I'm making this up go and watch interactions and what we do is we just we sense it but we don't realize what we're doing is it helping no because what did we do touch we touch right away in our effort to help but we picked a touch that's not a comfortable touch for anybody pat on person next to you pat on even dogs don't like to be patted dogs would prefer to be stroked if you're gonna do something but they don't like when you stroke right around their face right away try that with a dog until they know you and it said it's okay they don't like you stroking right around their head gee imagine that and yet look what we do with people with dementia all the time without thinking okay now the last one of all the basic needs this is the one we missed the most and I put it over on the little finger because it's a strong strong factor in the Thrive to survive stick it up all by itself and now take it and go wow wow wow go ahead and do that stick it out go out what is it pain I'm hurting I hurt and when you hurt what do you have to have to survive relief a pain you can't have pain and survive it wears you out it will actually kill you it will give you note I can't do this anymore how many people have heard when you're an infinite pain when you watch people who are at bone pain metastases attic pain because of cans ow emotional pain and it's not all physical pain it's emotional pain is spiritual pain anytime someone feels unremitting pain they can't survive these can so let's go through those again and hopefully understand once again I'm trying to give you an experiential way of finding this information when you need it without having to go to a note so let's see if you can remember all of those five basic things that help you survive give you a thrive to survive so the first one you have to meet the need of hunger and thirst okay the second one wake-sleep the rhythm of resting and then coming up with energy so that rhythm and notice what I'm doing you want to create a wave-like motion not so what person close your eyes and sort of relax in your chair take your turn with your partner everybody should have a partner by now okay so the person with their eyes closed and relaxed relaxed back in the chair yes caregivers you people demented people keep your eyes closed your relaxed caregivers wake up how many of you went you even know who is coming you knew we were gonna do something right we want this so let me show you how you do that tell me first name again cuz I can't remember Sharon six feet out your eyes are closed you're asleep I quit moving at the edge of her public space right here public now if her eyes were open she would see me obviously what the she's not processing data now give her a shot at it because she would like to hear me before she feels a touch Sharon nothing happened hmm okay she still doesn't know I'm here I'm not gonna go share it Sharon because that's the same thing as having an alarm clock that goes I know what you're waking up that way because I know I'm going to over arouse you which is going to result not in your limbic waking up but in your autonomic automatic amygdala going into hyperdrive and I don't want that because that's fright flight fight I know that so what I'm gonna do Sharon Sharon good morning now what I did I got down to the side and if you noticed I'm at six feet you may not put your arm out each arm is about 36 inches long so when I add it together I'm right at the boundary of her personal space which is where she's looking for me to start talking to her so I get down to the side so I'm not threatening she's in a position where I'm not overtop of her I've got some distance from her I take my near arm the arm that is nearest her and I reach out I say her name Sharon and then I lay my hand flat open fingers no tips flat lay it over the joint of the knee the joint which is proprioceptive I apply a little pressure my face is ready for the greet what I've done with my arm is create a boundary a barrier that says I'm not coming in it's yours I'm at that distance and when her eyes open my other hand is ready Hey and now she connects check she's awake because what we want to slow arousal not over doing it and guess what we tend to do because we're trying to get her done we get in there we want to wake them up unfortunately overdo it and then we pay a price and so today because they're over aroused and they can't settle back down okay somebody had a question yes ah really important so with Kelly I know for instance Kelly doesn't hear me I wanna Morin now if her she was asleep will she have any awareness of me until I make contact no so here's what I want you to do do this if you almost have to be standing up to do it cuz when you're lying down stand up and take your fingers down as far as they'll go what don't your fingertips touch your knees what does that mean it's beyond what's it beyond your intimate space its beyond the intimate space so what I'm picking is a place that is not within your intimate zone and that means you're less distressed when I touch you there then you would be if I touch you within this space because within this space your brain if it's asleep and somebody touches you there goes boom they're close enough to kill me and if you're in a situation where you don't feel comfortable to start with when you went to sleep and you wake up and you don't realize who that person is do you think you're gonna stop and think about what you do what haven't we just activated with that touch in the intimate space the autonomic automatic reflex which is flight fight fright well then the next room down I'm here to help you wait so they didn't work out well for the last one okay so if somebody is hard of hearing this one is basically knocked out so what do we have to be incredibly careful about where we touch because they don't have a lot of warning systems heading in now somebody has glaucoma or Matt actually worse macular degeneration they're robbed of their center field and they have dementia and they're hard of hearing the only system we have to make the initial connection is touch but you must touch beyond the intimate space if you want to reduce at autonomic and you have to do deep proprioceptive touch now people will people tend to not do that reach out to the person next to you when their eyes closed and what I want you to do is I want you to lightly touch I want you to do moving touch on them just do moving touch and just lightly move your fingers on them like do a little quick rub or that little thing people like to do morning good morning how are you how many of you are getting a reaction is like would you oh my god what are you doing now take that same thing you were doing and instead flat open hand pressure morning and if you're going to do anything it's a deep rub it's a deep pressure not a light use the palm of your hand not the light if you're going to stroke take one hand and stabilize it the shoulder so they know where you are and then take the other hand and rub back and forth not the fingers it's always an open flat palm it's it's an open flat now after I've done that if they're starting to rouse now take the flats of your fingers but do your fingers and do quick small circles but make sure you have that hand on the shoulder when you're doing it so you know where you are but what you're going to find is those quick small circles and they're still heavy they are not like they are heavier they will bring somebody up but not in that hyped up way that we do good morning good morning that helped tone-of-voice is incredibly important yesterday we talked about a little bit about older adults and hearing loss they lose high-pitched but they keep deep one of the things that happens when we get anxious we tend to go up in the upper register because our vocal folds get a little tight we give them Oh nervous and then when we bend over we make it worse so one of the rules is you always stay upright and you go down by sitting or kneeling you don't lean in because when you lean in you stretch the vocal folds and that puts you in a higher register it also reminds you of talking to children and you tend to get up in that upper thinning and you pause and you make it sell it sandy how are we and the person with dementia is not stupid and they'll go I am NOT a child I wish you'd quit talking to me like that because they pick up on that tone of voice that we get that comes automatically out of our mouth when we when we are bending over like you're talking to a child which is very different than if you sit down good morning pause deeper voice calmer slower give them a chance well hey good morning how are we today you doing okay it's so good to see you seeing you look good have you been out here let me get your shirt for you rush rush rush rush rush rush rush okay so what's our third one our third thrive to survive elimination Wow the baby's coming oh I got the baby's kind of my water just broke the number of times I've heard people tape at how old are you does it really matter y'all act like if I find out I'm 85 I will realize I'm not having a child well what I'm doing is is identifying the sensation I'm feeling and the emotional memory that I have of that kind of sensation is childbirth what I don't realize is I just peed and I need to go to the bathroom and have a bowel movement that's what I don't realize what I am I'm real it's really uncomfortable and it's hurting and I don't like it and I want this to quit and I'm trying to tell you the intensity of my what I have moved beyond uncomfortable now I'm in pain and because I don't like pain I'm gonna hold that stuff up in which means I have a high risk of becoming impact it particularly if I'm not moving and drinking yeah yeah and you've given me drugs for pay which stop me from moving the whole thing becomes a cycle and then when I'm out Wow she needs it something for anxiety and so the cycle progresses okay so what's our fourth one comfortable and this is the hardest one to figure out for another human being what makes it a little easier knowing what they liked before and what they did not like before so I want you to identify go to your five senses for yourself honest lip of paper these five senses what are they what you see what you hear what you feel and do feeling do combo what you smell and what you taste I want you to have love hate love these hate these got it for each of those sensations what are some things you love visually what do you love visually maybe your favorite color maybe where you like what you like to see maybe who you like to see maybe how close you like stuff maybe what do you like to see visually what is they ah yeah visually that draws you it will always draw you you know it glass wine a cup of coffee I mean course lie what's what is gonna draw you what will make you go yeah people things stuff in the environment places whatever visual amount of light the second one things you hear favorite sounds favorite favorite music favorite favorite things and things you absolutely despise you hate it it dry it when you hear it it will absolutely drive you crazy you can't stand it it will make you want to either tell that that's enough tell them to shut up or you'll want to leave or you'll go to sleep because you just can't take it and then I want you to think of things that you like to feel it you love to feel it or do it so it's you doing it not somebody doing it to you what are things you love to do what do you like to feel and what do you hate having to touch what just and for me raw oysters would be on that list I don't want any of that crap in my mouth I do not want I cannot picture anything worse than a raw oyster getting in my mouth I just mmm the texture of it it is not the taste it is simply the texture and I wouldn't do a dog raw egg either I think that's nasty I don't know how y'all do it makes me want a gag right just here thinking about it and I don't like things too tight on me if they're too tight they're coming off which later in the disease might be in the main lobby at 3:00 in the afternoon okay now the next one smells that you really like smells that you love that just oh yeah that is you're going to move toward it if you smell it at all and then think of smells that just and for most of us let me just tell you vomit fits into that category not give you an example oh if you say the word remember those are strong and primitive yeah they're there yeah old God no no not that one mm-hm and then the finally taste what do you love what do you hate taste wise now understand be careful because taste is only sweet sour salty bitter so you want to describe probably things that have that primary quality what quality don't you like very much and which do you really like a lot okay okay did you get you get that damn okay now tear that piece of paper off and what I want you to do is pass it to people over in the in the circle okay you can take a few more seconds to do your homework there I know some of you're like well I mean I was just thinking I didn't write cuz I didn't know I still have to share it cuz you didn't believe your oh so excuse me let me say that again oh so you didn't actually write it down you were just thinking because you figured it was just something you knew you needed to know mm-hm I hope you figure this out before you get your dementia because this is not gonna work if you're the only one who knows that and nobody else knows that about you and you get dimension you can't talk anymore uh-huh all of a sudden this gets a lot more important when you realize it's going to impact your care down the road how many times do you think on your advance directives you write down what you really like and what you don't and yet what did I tell you all these things were part of your thrive to survive and we miss important pieces of data because nobody tells us how important they are okay so take a look at the persons that you got versus your own and notice you may see some similarities but you're probably going to see some significant differences now imagine that I'm your caregiver and I know nothing about you and because I am aware of what makes me comfortable and uncomfortable what is my basic guide I would use myself that's what I use I use myself to try to figure out you unfortunately we tend to make assumptions we don't assess whether we're in the right ballpark or not we just assume that if I like something and it makes me feel good then right off I would assume it would probably be okay for you until you tell me now you know really that's I don't care for that at all now if you lose words and you lose the ability to communicate effectively with words what do you think are your options well let's go and review that section just so you remember put your hands to your temples which is where you process you hear and I want you to do left right do left right do it again good now language on the left rhythm of the right okay so let's try it again left right left right now language on the left rhythm on the right and you lose on the left retain on the right and because on the left what do you do with language manipulate it that's what that skill is all about it's skill that allows you to manipulate language what are the three skills over there nope what language skills now hang on let me give them to you because now you're working too hard this is a word so this is vocabulary comprehension of speech and speech production the actual sensory motor ability to produce speech in the format and way we mean to produce it so the ability to articulate and say words to get one word after the other word so it says what I mean it to say so the that the in in the it's the it's the it's it's the one that that you you you you peck peck peck peck peck no not heck it not peck it and you can actually watch people struggle to they know they know it and they can't find the articulation pattern that will allow them to get the word out that they're look they know it but they can't make the articulation happen because that is a connection between the words in this section put your hand up here with the skill up here in this section sensory motor and they're losing sensory motor fine motor skill set related to the wiring and so they know what they know it but they can't find it but if I say you're looking something something to eat or drink drink something to drink okay yeah we can do that hot or cold not cold not cold you don't want cold you want hot yeah come on let's go find you something okay she can comprehend words when I give her the visual verbal combo a lot better than if I just say words and she has to figure out the word comprehend the word figure out what it means and then give me an answer that's actually really pretty complicated when you think about it right you

Channel: Teepa Snow's Positive Approach to Care

Views: 214,830

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

Id: dsYjMKBsYCk

Length: 35min 12sec (2112 seconds)

Published: Fri Dec 22 2017