Using life long habits, routine, and muscle memory to provide her direction rather than instructing her on tasks. Is there any real research about this approach?

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I have NO training as a Caregiver and only a popular works education on Alzheimers and how the brain functions. But it seems to me that habit and muscle memory are the last things affected by Alzheimer and I have made that a core principle of caring for my mother. Using life long habits, routine, and muscle memory to provide her direction rather than instructing her on tasks.IS there any real research about this approach? I'd be interested also in hearing from others Who do this..


I know routine is essential for me in caring for my mom with Alzheimer's Disease. I try to do the same thing every morning and every evening. That has helped me when she doesn't remember how to get dressed or where her clothes are. I routinely hang up her clothes in her bathroom on hangers, so she can wash up and change into her clothes every morning. Same thing at night with pajamas, also hung up in the bathroom, same way, same place. She has caught on and remembers most of the time. Try to wake up and go to sleep same time every night. She gets her coffee in the same mug every morning, her evening cocoa at 7 PM in the same mug every night. I try to use routine to keep things calm as much as possible. It is not enough of course, but it certain does help set her expectations on what the day will be like. What do you do?
I am not aware of any current research on this subject. I am fairly new as my mother's caregiver and would be interested to know if there is info on this as well. But I can tell you that a Dr.from Baylor University advised me that routine and muscle memory seemed to really help patients he had seen and I have been doing this with my mother for several months now. I can't tell you if or how this is going to help in the long run yet, but I do know that when I have to skio her routine and exercises for some reason, it seems to really throw her off for a few days. Seems to me that it is helping her and it is still something we can do together.
I've tried it a bit, using drill ("dress left" "stand at ease" etc.) which God knows should be as deeply embedded as anything could be, with - mnyeh - mixed results. I suppose it depends on the type of dementia: my mother's mixed picture means that she will have lost some feedback from her motor systems, too, which would explain why she seems to have no idea where her feet are sometimes.

I agree that it's an attractive idea - saves an awful lot of arguing and repetition. We have devised little dance routines for things like transferring, and for getting into the car, which kind of work but only as a pas de deux - in other words, I still have to put her hands in the right places, so if she's trying to do things by herself or if anyone else (other than an experienced PT or OT) is helping, it's no go.

Don't know if there's any research. I'll have a look at the University of Bradford and see if they say anything.
quick google search on using muscle memory for dementia patients yielded this and
website: livescience/19765-music-alzheimers-patients-memory.html and lots of other links. certainly something to think about
This is a very interesting question! I searched several literature databases including REHABDATA, Medline, OT Seeker, and the Cochrane Collaboration. Many of the citations I found stressed the need for routine or the effect of changes in routine on behavior (increased stress, confusion, aggression).

In REHABDATA I found the following articles:
Helping persons with mild or moderate Alzheimer's disease recapture basic daily activities through the use of an instruction strategy. Disability and Rehabilitation , Volume 31(3) , Pgs. 211-219. Data showed that the intervention strategy involving verbal instructions for the single activity steps presented automatically through technology was effective in helping all participants on each of the activities.

Much of the Medline results focused on the effects of certain medications on routine and memory.

OT Seeker, a database of evidence based research in occupational therapy, had about 40 citations on dementia and memory, including systematic reviews of cognitive therapies which you may want to review. Google OT Seeker to find the database. At least three Cochrane Reviews of the current literature were included in the OT Seeker search results. Google The Cochrane Library to learn more.

If you'd like to dig deeper into some of these databases, please feel free to PM me, as this forum may not allow pasting of links directly to the databases I mention. (I've had my links disappear in the past.)

See what happens when you ask a librarian? ;)
Certainly makes sense. Daily routines for all of us are important. There are 4 of us giving care to my elderly mom, and all of us consider ourselves the 'chief' not the 'Indian'. Insisting on routines (for 2 years now) has fallen on deaf ears. That said, we each have our own routines when we are with Mom. However, they vary somewhat, which is confusing to Mom. Again, deaf ears when I suggest we talk and come up with one routine and stick to it. Good topic.
I don't have any advice. I do have an anecdote. Many people might know that Glen Campbell had Alzheimer's. My wife and I went to a show in his "farewell tour." He had difficulty talking to the audience and remembering song lyrics. But when his fingers hit those guitar strings it was magic all over again-- there wasn't a dry eye in the house. And that was all deep muscle memory from the songs he had been playing for decades.
I worked in Geriatric Research. There is a difference between Alzheimer's and Vascular Dementia. Physicians will tell you if an older person appears to be have Vascular Dementia that it is a mixed dementia 85% of the time. I dont believe this personal. My mother had vascular dementia for 12 years. One thing i did notice was repetition. My mother was fine as long as she did the samething everyday. They can learn new tasks. I was amazed I taugh her how to make rice out of a box. She was able to repeat it. She got herself up, fed herself, and was able to put herself to bed. The only issues where somethings she didnt do as well. Ie: washing dishes wasn't as good as before. But, her eye sight wasn't as good. She did not remember to put on her glasses. She didn't need to put them on everyday. Towards the end she didn't wash as well. I know with Vascular Dementia there function will slowly decrease. They plateau for a while and then they take a hit in their brain. The very last thing I noticed was my mother would take a mug of tea and put it to the edge of the table. This was very dangerous bucause it was very easy for her to knock the tea in her lap and recieve severe burns. My remedy was to set the table myself with a tea cup and saucer. So she would remember to put the cup back into the saucer. That was a longterm memory function. This was the generation that drank from teacups and saucers. My mother took a fall. I was in the house and needed an ambulance to take her to the hospital. She had open gash right to the bone. I was trying to control the bleeding. She told the doctor she couldn't remember if she hit her head. The doctor ordered a c scan. He did tell me her brain looked like she had vacular dementia. She had taken many hits over the course of 12 years. My mother died three months later at home very peacefully from another complication. She knew her 4 children to the end. I have seen patients with true Alzheimer's. They do not plateau. They cannot relearn tasks. It is a constant slide until death. I dont know how the new medicine works as far as slowing the progression. I know one thing they really don't know until death and they take a look at the brain. They diagnosis by symptoms. But, they will tell you they believe vascular and Alzheimer's they are a mixed dementia 85% of the time. I don't believe this. I saw how different they are. I always knew my mother was vascular dementia and it was proven at the end.
Definately routine for Alzheimer's patients is one of the best things we can do. Same time every day to: get up, get dressed, eat breakfast , medications, walk, lunch, afternnoon activity, time for visitors, dinner, medications, shower, icecream, bed. Thats our routine.... My mother in law knows Fridays haidresser and Sunday church.... you are right these things she has not forgotten. When she asks what day it is I say Sunday... she says oh church! She will say what do I do next ... I say ok shoes come off etc..... Whatever routine work but keep it the same as much as possible.You can not rush a person with Alzheimers. And too much noise or commotion gives them sensory overload.
The talk of routine made me realize that my mother's routine has always been the lack of one. Trying to get her to follow my routine would be like herding cats. We have a Sunday routine, but the other days are pretty helter skelter. I wonder if it is best to let her keep choosing her own routine daily or to try to get her into some type of schedule.

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