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 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 http://www.brennerpathways.org/montessori-and-alzheimers/ 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.

Check out youtube for videos on Teepa Snow. She's one of the foremost therapists working in the field. As far as I can tell, she's working from experience, rather than scientific research (which I find more alluring than the 'scientific' approach anyway .. but that's my personal bias).

Well I am a trained nurse, and from all I have read and practiced you are doing positive things for your mother, however, each patient is unique and what works for one doesn't for another. Generally speaking though, keep your mother in her long-term memory mode. Those 1920 - 1950 era songs will stimulate the brain. Brain games like Lumosity have not been proven that successful, but if you want to spend money and do them, then do them. This is a terminal illness. No one gets out alive and therefore as the mind gets more foggy expect the muscles tol start deteriorating. The brain starts shutting down muscle coordination, speech, movement, and then muscle atrophy. It is not a pleasant experience to be a caregiver and see this disease rob your loved one of the vibrant person they used to be. Be good to yourself, and know we all are blessed by your taking care of your mother.

I saw one of Teepa Snow's videos about dealing with Lewy Body Dementia, in which she claims that relying on muscle memory and old patterns was more effective than trying to give step-by-step instructions. I thought back to the times I helped my husband stand from a sitting position by telling him to "give me a hug" and holding my arms out. Hugging is something he knew how to do without thinking about it. And when he stood up to hug me, our mission was accomplished!

I don't know how much research has been done on this (and each kind of dementia is different) but I say try it. If it works for you and your loved one, hooray!

LadeeC Thank you So much for recommending the videos . I had never heard of Teepa Snow. This is an amazing amount of helpful info.

Jeanne Gibbs -I LOVE the Give me a hug approach to standing! This is exactly the approach that works with my Mom but we had not found a good cue for Standing and standing is getting VERY problematic. My Mom is Somewhere in the later stages at this point, Step by Step directions are not always helpful . She says OK-but then her body doesn't do it . I really don't think She is refusing . I Think her brain is just Not
sending a coherent message to her arms and legs • Finding ways to use Muscle memory lets us skip the brain and go Straight to the muscle. I KNOW the hug will work for my Dad!

Ferris1 I made my Mom an entire Set of CDs of the songs that I Knew she loved. She was training to sing professionally before She married my Dad and Singing has always been a HUGE part of her life. She doesn't always sing along -but I love the gasp of delight She gives as each Song starts and the wide Smile.

Jeffrey 20832 I also try and do EXACTLY the same thing every time I am with my Mom. I say exactly the Same words. I hand her things exactly the same Way. I use the Same towell every morning on the floor for her Shower. She has a red Washcloth to wash her body-and a white one to wash her face • . I run the Shower before She gets in so it is is warm. Then turn it off while she Steps in and sits down. I cover the showerhead with a towel So she hears the water before it hits her and to be Sure the first Water that touches her is warm. When washing her hair I wrap a towell around her face and ears So no water gets on her face. She has 3 red hand towels She dries with while sitting in the Shower then a white one She dries Underneath with when She gets out, When she walks in the bathroom every morning those towels are Stacked in order on the counter. We have never discussed them. She has never touched them or Commented on them in the 2 years I have helped her with her daily Shower. I just hand them to her as needed. One day last month I accidently had one IN the wrong place in the stack. When she Came in the bathroom she said HUH- pulled it out of The stacK and put it Where it belonged. This from a Woman in late Stages of Alzheimers • We have to hand her the silverware So she eats. Her language is Severely depleted and only reactionary at best °

other things I do
Hand her false teeth to her high straight in front of her mouth So her hand is moving towards her mouth As she takes them.

At night help her hand make a fist with the thumb up and while doing the Same myself. I bring my haul up- hers comes up When her thumb ls in front of her mouth say "Let's get your teeth." Put my thumb in my mouth mimicing the motion of taking out teeth. She takes out her teeth.

The partial for the bottom takes 2 hands but is a Similar process

For the 9 remaining teeth I hand her the tooth brush from the side Straight in front of her mouth So that once again her hand is in position when she taken it.

Bathing- I wash her back then bring the cloth up to her Left Shoulder And pause. She automatically reaches for it with her right hand and continues the washing motion on her front.

when She finishes her front She'll Spread the tag out flat and read for her face. I pull that ray off her hand and lay the one With face cleanser on it during that motion, Her hand is still going towards her face.

Of course she doesn't NEED a shower everyday .We do it everyday So it is always expected,

We do a 100 pc puzzle every day • I sort the pcs putting all the straight edges in front of her. As I Sort Itryto lay Connecting pieces end to end. She still notices those anl puts them together. She is happy when we get the border made. Within the last 2 months it has become increasingly rare for her to spontaneously put a pc IN. But she still nearly always sees the Connections when I lay them next to the places.

Jeffrey 20832
When Mom first become incontinent and Lost Control of her bowells she was still VERY Vocal and aware. She would NOT be told to go to the bathroom. bathroom, toilet etc were trigger Words for major angry episodes. The bathroom is just off the Kitchen on the way to the Living Room. I made it ROUTINE that anytime we travel from Kitchen to Living Room we go in the bathroom.
I'll say "Lets go this way" If she did ask whyI said," I'll show you when we get in there. When she Saw the toilet she automatically turned and pulled down her pants. At this point she is much less aware and the turn to the bathroom from the Kitchen is automatic ' So she goes to the bathroom when she first gets up. About an hour after breakfast when the puzzle is done. After lunch usually mid afternoon Before dinner and Before bed. It is rare that she has an accident the days I am there.

NeverAlone / Thank you for your Comment. The Comment from the doctor is helpful•I think that you will find that as the disease progresses routines you establish now become very important. Also- while your Mom is able to do some self care Study her motions So that yow will Know ways to hand her things Or motions to begin with her. You have to Know how to speak directly to the muscles once you can't go through the brain..

County mouse / I know what you mean about the problem when Someone else is there• I can't be there 24/7 and my Dads' other help is sick So we have to find someone new. The last help did Not do things like I Showed and explained and Mom had some major angry episodes as well as embarrassing degrading Inappropriate bowel movements. Part of me Says to be more insistent this time. Part of me Says that will come off as Controlling and no caregiver will want to work for my Dad because of his bitchy daughter. This is actually why I am looking for actual research riensearch in this. I'd rather Cite some methodology rather than "I think you should give her the toothbrush like this"

Tennie / fantastic ! Thank you So MUCH

naricinfo- I actually as Support staff in Adult Services at Champaign Public Library. My husband calls me a librarianand I tell him NO those people are AMAZING and you have proven my point, I'm afraid That I don't Know how to PM you?
I really would like to read Some of these. I think you found exactly what I needed

kdcmlOll/ I understand your frustration COMPLETELY There are 3 of us caring for my MOM. Always me- the other 2 have changed periodically. But there has always been Someone Who didn't think Mom needed a shower everyday. And their right. She doesn't. But they always had A LOT more angry episodes about Showers. But worse if my day was after their day -I got Shower resistance. When the shower happens everyday -NO resistance and that is SO much easier. The things that go the Smoothest are the things that are done the Same. I have adapted What I do sometimes to match others, also, I do my best to Conversationally Mention things that work when we are together. The other 2 caregivers have always taken GOOD Care of Mom. Just not as Smooth as it could be. As long as it is GOOD Care I tell myself to keep my mouth shut-not try to Control Someone else's behavior (which never goes well) and be Sincerely thankful I am not doing this alone..

MikeB26 I love this Story. Thank you for Sharing.

Kathleen2251932 This Information is very enlightening! A doctor told my Dad That Mom has Alzheimers Which made me dubious because I've always heard a REAL diagnosis can only be made with an autopsy also. And this doctor Was DEFINITE! Mom's Alzheimers has never been anything like my grandmother's though. Mom can definitely still learn a routine. She had quit peeling her own banana in the mornings and I worked with her and she gained that
back. She still needs prompts but she peels it and slices it into her cereal bowl. Also She was in the hospital for a few days then a rehab center for a month and she learned her birthday. When she first went in and they asked She just
turned and looked at my Dad. By day 3 she was Saying March and after a week she rattled it off easily. I love your story of the teacup! Also even though I'd say she Is late stages she certainly Still knows us and will eyen Sometimes call us by name. Knowing about Vascular dementia gives me another Way to explain Using muscle cues to caregivers rather than directions.

norestforweary/ Thank you for your Comment and encouragement. Talking and noise definitely Can be problematic . Our shower routine is very exact and a phone call during it Can be devastating. Standing is REAL ordeal. Mom's brain has difficulty telling her legs to push up. She just Keeps Scooting the dining room chair forward. My nearly always taken Mom out for lunch and dinner. Invariably just as her legs are FINALLY pushing up -someone says , "Well Hello SUE.'" Ugh another 5 minutes . Unfortunately, at one restaurant the owner decided to be helpful and get under her shoulder to help her. Now She positively will not Stand there and has to be lifted from the chair every time • Sometimes at other restaurants also. But my Dad has Caught on that lifting is a bad idea because it quickly becomes THE habit. When he is with a group , though, he is self Conscious about how long it takes her to Stand. and lifts her. People also genuinely want to help and think

Oops- Continuing that thought. and think they are. It is awkward to tell them no and make her do it herself when it is obviously difficult for her

JessieBelle -you may not have an overall regular life routine but I bet your mother Still has the little Mini routines that create muscle memory. And you Can use those to maintain her ability to function

A Side point- Yes I am longwinded -I am a daughter and as far as my mother is Concerned she tells ME what to do NOT the other way.People make Comments that when parents get older the children have to be the parent. That will NEVER happen between my mother and I. My father Can Instruct her . NOT me. I finally found that moving with her through an established routine based on her life and habits while always using A tone of voice that was reminding her of Something SHE had decided to do was the wayto peace- and poop- and pee- and showers -and etc. But only in The role of daughter Who Stopped by to visit. Using muscle memory Cues is partly for her- but also a coping strategy for me.

To MrIrHawkin, I know it can be very difficult to get a parent in and out of a car. If you or you daughter had a SUV it would be so much easier on you you just slide them in and out. I think your mother is playing you. If she can stand. She should be able to pivot around into the wheelchair. Not unless her feet neurological disease like Parkinson's disease. I know my mother got deconditioned shortly after being diagnosis with dementia. I would take her to work with me and she had PT 3x/week for 2 months. She didn't like. But, I Knew for sure she would break her hip. After 8 weeks she was wonderful. This was twelve years before she died in 2011. She walked better than I did until 3 month before she died. She was a true Vascular Dementia. All cause by uncontrolled Hypertension and probably moderate no quite high cholesterol. I have Hypertension. I told my Neurologist. I was afraid of getting Dementia like my mother. He told me keep taking you blood pressure medicine and my cholesterol med and baby aspirin and I would be fine. I also learned heart and blood pressure medicine the pill take once a day. Does not cover you for 24 hrs. You need two doses a day. Most people are having strokes and heart attacks happen between 4am to 7am. I worked in a long term facility for 32 years. 15 years in Nursing and 17 years in Geriatric Research. I worked on a Vitamin D study for 10 year. It was proven the elderly who took higher doses of Vitamin D had less fractures. All the bone gurus where taking high doses of Vitamin D. I gave 2000mg to my mother and I took the same dose. My mother had Osteoporosis and 5 of her sisters. I took the Vitamin D to prevent Osteoporosis, so far I am fine. My mother as I have already mentioned fell 3 months before she died. She never walked again because of a bad muscle injury. But, she couldn't remember if she hit her head. So she had a full body scan. The doctor told me I was right about the Vascular Dementia. He could see where she took many hits to her brain. To my big surprise. 90% of her osteoporosis had reversed it self. Vitamin D is water soluble so I didn't worry about the large doses. I just heard they are recommending Vitamin E for memory. I don't know the recommend dose. But, I would only take what they recommend because Vitamin is fat soluble. When it came to showers. My mother refused her 3 daughters. A stranger she would do anything. But, I remember patients who where very tough to get into the shower. Nursing would give them Ativan 0.5mg to 1mg and 1 hour later they would take there shower. When it comes to Vascular Dementia vs Alzheimer's. I was taught it it was more a mixed Dementia 85% of the time. I don't believe it, my mother lived a long time. Before it is actually diagnosed they already had it for 5 years. I know people with Alzheimer's have a hard time with ambulation tend to get more stiff and need more PT. My understanding with Vascular Dementia they plateau and slide plateau and can plateau for along time. Alzheimer's it is a chronic slide and they really can't say Alzheimer's until they long at the brain. There are families involved who loved one has true Alzheimer's looking for the gene the cause Alzheimer's. I don't know if I would want to know that diagnosis. But, we all are or taken care of elder parents. I know with my mother. I had no regrets and would do it again if I had too. Both of my parents are gone and that is a funny feeling too.