 A few weeks ago I put together some materials for an in-service training on aphasia. I wanted to share it for those who are looking for an in-service to perform, or for those who would like to learn a little more about it.
Understanding and Working with Aphasia
Presented By: Justin Zarb
Aphasia: Quick Fact Sheet
Who Gets Aphasia and What Causes It?
- By far the most common cause of aphasia is stroke. However, any disease or injury that damages brain tissue can cause aphasia (head injury, aneurysm, brain tumors). It is estimated that about 20% of individuals who suffer a stroke will also incur a serious loss of speech and language.
What is Aphasia?
- Aphasia is a total or partial loss of the ability to communicate whether through listening and understanding, speaking, gesturing, reading, or writing.
When Does Aphasia Onset? When Does Aphasia Get Treated?
- Within hours of recovering from a stroke, aphasia will usually become evident if there has been sufficient brain damage. Sometimes the aphasia will be hard to detect if it is a non-oral form such as reading, writing, or gesturing. A trained speech pathologist should perform an evaluation for the stroke victim.
 This is a great poem written by a man living in a nursing home in Platte, Nebraska. A friend forwarded it to me, and it I thought it was such a great example of how often we overlook the great wealth of experience and history that our residents come into our homes with.
This is also a great resource for staff training, and a great example of a man’s perception of ageism. I would ask everyone that works in a nursing home to take 5 minutes out of their day to read this man’s poem. Apparently, he hid the poem among his personal belongings in his room, and it wasn’t until after his death that nurses found it while cleaning out the room.
Crabby Old Man
What do you see nurses?. . . . What do you see?
What are you thinking . . . . . when you’re looking at me?
A crabby old man,. . . . . not very wise,
Uncertain of habit . . . . . . with faraway eyes?
 If you are lucky enough to become a facility’s activity director you have a lot of responsibility. Like it or not, you are instantly a leader in your department as well as throughout the facility. Your activity staff will look to you, for better or worse, for an example of what to do and as someone to follow.
There are many components to being a great leader, and I don’t intend to cover all of them in this post. However, there was one that hit me yesterday that is crucial for any position you may find yourself in life.
When people in your facility look to you, do they think you follow through what you believe in? This can make all the world to the staff underneath you. If they believe you really follow what you say you believe, they are more likely to get on board with your new ideas. If they can see a discrepancy between your words and your actions, you’ll run into problems. I’ve been slowly implementing a new approach to planning our activity calender that really involves our program’s participants. Yesterday, I was challenged by one of my staff to prove that I was willing to do what I’ve been preaching.
 This year we really worked hard on putting together a lot of patriotic activities for our program. Yesterday we had a group of folk singers come by and sing patriotic songs, and we wrote letters to soldiers last week as well.
We also have a few ladies who really enjoy making crafts, no matter how big or small. We’ve found that one of the crafting activities that seems to work well for a variety of independence levels is crunching up little squares of colored tissue paper and pasting them to an object or a drawing.
To get an activity like this ready all you really need are some sheets of colored tissue paper and scissors, or actually, I prefer using one of those long blades with a grid base (I forget what to call it) so you can cut up one inch squares quicker. We put these flat squares of tissue paper into small cups, like old margarine containers, and put them around the table for our members to choose from. They can then scrunch the paper into whatever shape they’d like and then dip it in some glue to paste it to their shape. Also, for those who have trouble with individually dipping each piece, you can spread glue onto the shape first and then scrunch the paper up and drop them on.
 There are times when we are unsure if one of our residents needs to change their clothes because they had an accident. A few months ago, I had quite the perplexing situation with one of our men, whom I’ll call Dr. Singer.
During our mornings, we hold our Sit and Be Fit exercise activity around 11am, just before lunch. As we began, I noticed a very small puddle underneath Dr. Singer’s wheelchair. I wasn’t quite sure how it got there, was it from him, or did someone spill a little water? I decided to go over and whisper in his ear that I could escort him to the restroom if he needed to use it. He quietly obliged and nodded his head towards the door, not wanting to make a big scene.
I walk him through the door and about twenty feet to the nearest restroom. He can walk short distances, so I locked his chair and helped him stand up. I then held the restroom door open and told him I’d wait outside. He’s always very jovial, and started to sing to himself as he walked inside. As the door closed, I turned around and couldn’t believe what I saw in the hall.
Have you ever asked your residents to bead a necklace at your facility? Do you have bright colored plastic round beads that remind you of 1st grade? I’d like to ask you to consider whether beading a necklace is an activity that most people do on their own when they are grown adults. For most adults, the thought of putting random colored beads on a piece of plastic seems boring and childish. So why do we who work with older adults seem to think it should be great fun for them?
When you’re trying to make sure an activity is age appropriate, its a great idea to look to the real world to see what grown adults are actually used to doing. Ask yourself what materials they are used to working with. For what purpose do they carry out this activity?
In truth, adult beading is almost an oxymoron. However, when you look around, jewelry making is something that some grown women have turned into a hobby. Today, there are kits that let you piece together earrings, necklaces, and bracelets that many adults purchase for their own enjoyment. One of my co-workers made everyone earrings for Christmas this past year! Here are some tips to make this simple activity more comfortable and rewarding for our residents and members:
 Recycle these as an activity! Activities in our facilities fall into three categories, supportive, maintenance, and empowerment. Supportive activities require staff or volunteer support for the member or resident to participate in. Maintenance activities help a resident maintain their physical and cognitive abilities as well as their sense of socializing, spirituality, and emotional health. Empowerment activities help the resident re-develop a sense of purpose in their own life. Often, these involve self-expression, personal responsibility, and/or self-respect.
When working with the dementia population, most of our activities fall into the supportive and maintenance categories. It is for good reason, that particular population has an inevitable decline in most cases, and we’re trying to prolong, or plateau, their lives with therapeutic recreation. Sadly, the person with dementia loses out on empowerment opportunities in our facilities because we’ve been so focused on helping them maintain what abilities they still have. We must never forget, that the person with dementia is still a person who is conscious of themself, and therefore needs opportunities of empowerment that help maintain their sense of dignity and self-respect.
I like to think that planning activities is not simply a task or job, but that it is an art. It is a craft that one can hone. Just like any other craft, it is not easily mastered overnight or by working in the field for a long period of time. In fact, I still consider myself to be at the beginning of my journey to hone my craft of being an activity professional.
I’m sure that every activity director, in every facility, comes across the same problem. Namely, that activities are becoming too routine and mundane for the participants in the facility. Of course, this is just one extra idea to spice things up, but I hope that by sharing my thought process behind this activity, I can help inspire others to innovate on their own.
Initially, our program was lacking variety in our table games. We can only play UNO and Yahtzee so many times before the staff and even those with short-term memory loss grow bored of it. In looking for a new activity, I wanted to start by investigating what sort of games our members used to enjoy. This way, I hoped to find an activity that would be readily relatable and feel comfortable for the members when we began playing. It turns out, somebody mentioned that their family played BUNCO with their neighbors and that it was a riot whenever they got together. At this point I was slightly petrified, I had never even heard of BUNCO.
I believe it was yesterday and I saw an article in the Detroit Free Press that pointed out John DeLorean had predicted General Motors’ demise almost decades earlier. Yes, that DeLorean, whose car was featured in Back To The Future. In a book published in the late seventies, titled On A Clear Day You Can See General Motors, DeLorean shared his frustrations with the corporate beheamoth that GM had become, and amazingly, his main bone of contention was the culture of the company.
Although successful as an employee within the company, being promoted to its flagship brands throughout the years, DeLorean eventually left GM because of the culture he described in his book. Mainly, there was an attitude that GM was too big to need to do improvements, that the GM way was inherently the right way, and the fruitfulness the company enjoyed would never and could never pass away.
We who work in long term care, and especially the nursing home, have been hearing about the need for culture change for almost a decade now! Sure, nursing homes continue to generate income and jobs for those they employ, and with the baby boomers coming into retirement, we should all feel very good about our job security. Or should we?
It seems that every year between Memorial Day and the 4th of July we are always looking for new patriotic activities for our programs. Usually, we end up with some sort of trivia game or a new way to glue an American flag together. This year, we found a really engaging activity that you can do in a large or small group, or even one-to-one.
The activity is writing a letter to soldier who does not receive very much mail, to let them know how much their sacrifice is appreciated. How do we know which soldiers don’t receive much mail? Well, there is a program called Any Soldier where soldiers who do receive a lot of mail volunteer to help pass mail out to those who don’t hear from back home very much.
There is nothing more engaging for some of our folks that we care for than this idea. Many of our men served in the military in their youth and many of our women had husbands or sons serve as well. And, when you tell your residents or members you are writing to a soldier who does not receive any other mail, you can really create a meaningful, dignified activity for them.
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A few weeks ago I put together some materials for an in-service training on aphasia. I wanted to share it for those who are looking for an in-service to perform, or for those who would like to learn a little more about it.
