2010 Washington #1 State, Seattle, April 2010


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TTAP Method Featured presentation at Washington State Alz Conf, over 1000 participants!

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2010 Washington #1 State, Seattle, April 2010

  1. 1. Moments in the Mind 25 th Annual Alzheimer’s Regional Conference, April 16, 2010 <ul><ul><li>TTAP Method ™ </li></ul></ul><ul><ul><li>New Directions in Activities </li></ul></ul><ul><li>for Self Expression </li></ul><ul><li>Linda Levine Madori, PhD, ATR-BC, LCAT </li></ul><ul><li>Fulbright Scholar, Author and Researcher </li></ul>
  2. 2. Overview of session <ul><li>Overview of new information on Neuroplasticity in the brain </li></ul><ul><li>How arts and the creative arts experience directly effects brain regions and functions. </li></ul><ul><li>Establishing a 9 step theme program </li></ul><ul><li>Research on the TTAP Method that has been done. </li></ul><ul><li>TTAP Method in Finland and Australia </li></ul>
  3. 4. Neuroplasticity-The ability of the brain to grow or shrink in size and mass. <ul><li>Environmental stimulation, including sight , smell, taste, touch and education is triggering our cells in the Hippocampus region to multiple and thus become larger and more dense (Diamond, 2001; Snowdon, 2002; Perry 2008 ) </li></ul>
  4. 5. Technology allows us to look deep into the living brain <ul><li>The top slide is of healthy dendrites with rich dense connections. </li></ul><ul><li>The bottom slide shows how the dendrites look when cellular deterioration has occurred. </li></ul>
  5. 6. Current Hypothesis on Hippocampus wellness and cognitive reserve <ul><li>Early stage: Plaques and Tangles develop in the Enthornal cortex, essential for making new memories and retrieving old ones. </li></ul><ul><li>Middle stage: Over time abnormal cells move higher up through the Hippocampus, responsible for complex memories, events, life experiences. </li></ul><ul><li>Last stage: Plaques/tangles move up and across the brain to the Neocortex, eventually preventing orchestration of behavior, eatring and loss of all ADL’s. </li></ul>
  6. 7. TTAP Method structures Right and Left Brain Functioning into protocals <ul><li>Right Side </li></ul><ul><li>Creative </li></ul><ul><li>Inspiration </li></ul><ul><li>Visual </li></ul><ul><li>Reactive Skills </li></ul><ul><li>Emotional </li></ul><ul><li>Artistic </li></ul><ul><li>Playful </li></ul><ul><li>Left Side </li></ul><ul><li>Logical </li></ul><ul><li>Arithmetic </li></ul><ul><li>Reading </li></ul><ul><li>Sequential </li></ul><ul><li>Concrete </li></ul><ul><li>Rational </li></ul><ul><li>Goal Oriented </li></ul>
  7. 8. How Activities Stimulate LEFT Brain Functioning <ul><li>Left Side Creative Art Therapies </li></ul><ul><li>Logical/Rational-----  Reminiscence </li></ul><ul><li>Arithmetic-------------  Puzzles </li></ul><ul><li>Reading-------------  Story Boards </li></ul><ul><li>Sequential----------  Food, cooking receipts </li></ul><ul><li>Concrete------------  Reality orientation, names of objects/people </li></ul>
  8. 9. How Activities Stimulate RIGHT Brain Functioning <ul><li>Right Side Creative Art Therapies </li></ul><ul><li>Inspiration-----------  Object relations </li></ul><ul><li>Visual-----------------  Paints, Color, Form </li></ul><ul><li>Reactive Skills-------  Body, movement </li></ul><ul><li>Emotional------------  Photographs </li></ul><ul><li>Creative/Artistic-----  Sculpture, 3-D work </li></ul><ul><li>Playful----------------  Being in the moment </li></ul>
  9. 10. TTAP Method utilizes Whole Brain Thinking <ul><li>Left Side – logic, math, reading, speaking </li></ul><ul><li>Right Side- creativity, inspiration, visual </li></ul><ul><li>Peak Performance- Using both regularly </li></ul>
  10. 11. Finding the 6 Strengths' of individuals with AD <ul><li>Reminiscence Therapy Utilized </li></ul><ul><li>with Dementia – Strengths' and needs identified </li></ul><ul><li>Woods, B., Spector, A., Jones, C., Orrell, M., Davis, S (2006). Reminiscence therapy for dementia: A Review. The Cochrane Collaboration, Issue 3. Retrieved: 7/15/2009.http://www.thecochrane . </li></ul><ul><li>Tabourne, C., Jung, L., McClear, E.(2008) Life Review Programming (LRP) with Korean individuals diagnosed with Alzheimer’s disease. American Journal of Recreation Therapy. (4):25-35. </li></ul>
  11. 12. TTAP Method™ naturally enhances the 6 remaining strengths in the disease process- CCDERS©
  12. 13. Emotions and Learning <ul><li>The Hippocampus is located in the Limbic system, which is called the seat of our emotions. Art stimulates emotions, thus enriching the mind. </li></ul>
  13. 14. Research in Emotions, Learning and Creativity into Practice <ul><li>Rich l anguage usage and emotions impacts </li></ul><ul><li>Learning and decreases stress. </li></ul><ul><li>Dirkx, J. (2001). The Power of Feelings: Emotion, Imagination, and the Construction of Meaning in Adult Learning. New Directions for Adult and Continuing Education, 89: 63-72. </li></ul><ul><li>Serrano, C., Allegri, R., Martelli, M., Taragano, F., Rinalli, P. (2005). Visual art, creativity and dementia facilitates learning. Vertex, 16(64):418-29. Retreived July 10 , 2009 from http://www.ncbi.nlm.nih.gov/pubmed/16314895-structure </li></ul>
  14. 15. Now your TTAP Interaction <ul><li>Through an object </li></ul><ul><li>(Object relations Theory) </li></ul>
  15. 16. How TTAP Method™ Directly Effects Cognition and Emotions
  16. 17. THE TTAP METHOD : A 9-step structured therapeutic intervention <ul><li>MULTIMODAL APPROACH </li></ul><ul><li>Regions stimulated </li></ul><ul><li>Multimodal approach was founded by Lazarus in 1950’s and described as any therapy which implements individually tailored </li></ul><ul><li>Treatment programs address behavior, affect, sensation, </li></ul><ul><li>imagery, intra and interpersonal relationships </li></ul>04/18/10
  17. 18. <ul><li>STEP 1 : FROM INDIVIDUAL THOUGHT TO GROUP IDEAS ON THE PAGE </li></ul><ul><li> ( linguistic, visual) </li></ul><ul><li>STEP 2 : FROM IDEAS TO MUSIC -Meditation </li></ul><ul><li>(intra/interpersonal, musical, visual) </li></ul><ul><li>STEP 3 : FROM THE MUSIC IN THE MIND TO THE IMAGE (kinesthetic, spatial, visual) </li></ul><ul><li>STEP 4 : FROM THE IMAGE INTO SCULPTURE (spatial, visual, kinesthetic) </li></ul><ul><li>STEP 5 : FROM SCULPTURE INTO MOVEMENT (kinesthetic, visual, musical) </li></ul><ul><li>STEP 6 : FROM MOVEMENT INTO WORDS/ POETRY & STORIES (linguistic, intra personal) </li></ul><ul><li>STEP 7 : FROM WORDS INTO FOOD FOR THOUGHT (linguistic, kinesthetic, interpersonal, intra personal) </li></ul><ul><li>STEP 8 : FROM THOUGHT INTO THEME EVENT TO (i nter/interpersonal, spatial, visual, kinesthetic, musical, linguistic, visual ,intra personal) </li></ul><ul><li>STEP 9 : FROM EVENT INTO PHOTOGRAPHY </li></ul><ul><li> (linguistic, visual ,intra/interpersonal, kinesthetic, spatial) </li></ul>
  18. 19. 7 Protocols' utilized in Bergen Regional Study,2009 <ul><li>1. Meditation- </li></ul><ul><li>self reflection </li></ul><ul><li>2. Oil paste drawing </li></ul><ul><li>3. Wreath sculpture </li></ul><ul><li>4. Mask Making </li></ul><ul><li>5. Memory Box </li></ul><ul><li>6. Painting </li></ul><ul><li>7. Food event </li></ul>
  19. 20. Conversation, Music and Meditation- Steps 1, 2
  20. 21. Meditation, oil pastel, music and drawing- Steps 1,2,3
  21. 22. Mediation, music, and Wreath sculpture- Steps 1,2,3 & 4
  22. 23. Mask Making- Steps 1,2, 3, 4 & 6
  23. 24. Meditation, Music and Memory Box Steps 1, 2,3, 4 & 6
  24. 25. Meditation, Music and Painting Steps 1, 2, & 3
  25. 26. Music, Phototherapy, and Food Steps -1, 2, 3,4, 6,7 & 9
  26. 27. <ul><li>TTAP Method creates structure to programming through: </li></ul><ul><li>1. Assessment forms-Time and Frequency </li></ul><ul><li>2. Learning styles-indicated </li></ul><ul><li>3. Brain Regions Stimulated </li></ul><ul><li>Aides in documentation of Rehabilitation </li></ul><ul><li>Aides in documentation of Restoring Functions- </li></ul><ul><li>Aides in documentation & assists in reimbursable </li></ul><ul><li>outcomes . </li></ul>
  27. 29. TTAP© Structure enables therapist to document and chart regions stimulated, amount of time and frequency
  28. 30. Open ended statements. <ul><li>1.” I felt free during this group” </li></ul><ul><li>2. “ I feel very happy” </li></ul><ul><li>3.“I was able to really create something” </li></ul><ul><li>4. “I was able to do what I wanted” </li></ul><ul><li>5. “Someone saved me a lot of trouble” </li></ul><ul><li>6. “ I would like to be more active but I am not right now” </li></ul><ul><li>7.”I am becoming more active coming to this program” </li></ul><ul><li>8.”I am always active” </li></ul><ul><li>ISNT COGNITION HOW WE THINK ABOUT HOW WE FEEL? </li></ul>
  29. 31. <ul><li>Does the TTAP Method provide opportunities for cognitive stimulation? </li></ul><ul><li>Student responses': </li></ul><ul><li>“ Seeing the patients each week we observed them becoming more active as each week went by. One pt. didn’t want to do anything in the first 3 sessions and then she started wanting to do more and more.” </li></ul><ul><li>“ The patients would tell us they were feeling more alive AND how their minds were more alive.” </li></ul><ul><li>“ The patients were indeed stimulated cognitively in giving them choices, making decisions, and taking action, this stimulates the brain.” </li></ul>
  30. 32. 10 Research Studies on Cognition and the TTAP Method <ul><li>Hebrew Home for the Aged, (Levine Madori, 2005, 2009) – significant outcomes </li></ul><ul><li>Cento de Oro, Spanish Population (Alders, 2009)- significant outcomes </li></ul><ul><li>Helen Hayes Rehabilitation Hospital , (Levine Madori & Andreassi, 2009) – significant not published </li></ul><ul><li>Bergen Regional Medical, moderate/severe (Levine Madori & Mullins,2009)- significant findings </li></ul><ul><li>Cornell University, Mild Alzheimer’s Disease (Levine Madori, Fonsetti & Jordan, 2009)- significant findings </li></ul>
  31. 33. Research Studies on Cognition and the TTAP Method <ul><li>6. Beechtree Rehabilitation Hospital, moderate/severe, (Levine Madori & Coveney, 2009-10) </li></ul><ul><li>7. Edward Hospital Linden Oaks, moderate/severe locked unit </li></ul><ul><li>8. Downstate Medical Center, African American Mild/Moderate- Brooklyn Community Day Center </li></ul><ul><li>9. Cornell Continued- Case Study, (Levine Madori, 2010)- 3 year Study- Appointed Clinical Researcher Memory and Evaluation services. </li></ul><ul><li>10. Hämeenlinna Alzheimer’s Association- 3 year study </li></ul>
  32. 34. Finnish study #1 <ul><li>Eija Pelokangas & Marjanna Rantala, </li></ul><ul><li>Seinajoki University, Masters in Social work and HealthCare Division. </li></ul><ul><li>This study took pace also through the Government program titles Demke-project. The purpose was to develop program to increase quality of life for individuals with AD, and to increase nursing participation in actually facilitating activities on a dementia unit. </li></ul><ul><li>Qualitative study , data collected by pre and post surveys from staff, administration and nursing. Views of the elderly were analyzed. </li></ul><ul><li>Outcomes included the overall significant and positive responses from residents on the unit , verbal interviews with staff after the 15 week program, and post collection of data 8 weeks after the intervention. Post intervention found significant increase in activities by nursing on unit. </li></ul>
  33. 35. <ul><li>Tarja Vanska (September, 2009),Diaconia University of Applied Sciences, Helsinki Nursing Degree. </li></ul><ul><li>Research study designed for large Rehabilitation Hospital for War Veterans. Nursing staff took course in TTAP Method and decided to use as research thesis. </li></ul><ul><li>Study had 2 prongs- short-term goal was to investigate if TTAP Method could be used as a therapeutic intervention successfully with those diagnosed with moderate and severe AD. </li></ul><ul><li>Secondly, could the TTAP be utilized as part of the nursing responsibility.- this study used 6 steps (meditation& Music, painting, phototherapy, baking, dance) </li></ul><ul><li>Results of a 8 week study- Peak in physical performance measures, significant increase in socialization . Participants showed high satisfaction. TTAP thus was found to be both therapeutic and rehabilitative as a method </li></ul>
  34. 36. <ul><li>Laura Hanski& Kaisu Kohola (December, 2009) Seinajoki University of Applied Sciences, School of Health care and social work. </li></ul><ul><li>Title: We are all artist’s; Study of the TTAP Method in Retirement Home </li></ul><ul><li>Activities in Finland retirement homes for older adults are often missing. The government has established a Program to ensure Quality of Life issues with elders. </li></ul><ul><li>Students found a facility with no programs being offered, they approached administration and staff about starting a TTAP Method Program. </li></ul><ul><li>This qualitative study used interviews, photographs, with family, staff, and individuals. </li></ul><ul><li>Conclusion, TTAP Method was efficient to stimulate creativity on all 5 domains. TTAP stimulated nursing to become involved in activities with therapist’s. </li></ul>
  35. 37. Finnish Study #4 <ul><li>Karina Ketola- (Feb. 2010), From Person to Person: The effect of empowering guience on Elderly </li></ul><ul><li>Steering educational group was formed to educate staff working in Dementia Unit in Long Term Care on how to utilize TTAP Method © . </li></ul><ul><li>Collection of Data took place over 20 week period. </li></ul><ul><li>Conclusion, TTAP Method through qualitative data collection from staff and residents, themes that arose from survey, observation and actual notes from sessions proved to enhance both the staff leading the group and the residents with moderate dementia living on the unit. </li></ul>
  36. 38. Finnish Alzheimer’s Association awarded 600,000 euro's to study TTAP Method for 3 years. University of HAMK training students to facilitate programming in home and community. 04/18/10
  37. 39. Research Studies Enhancing Cognitive Performance utilizing the TTAP Method™ Linda Levine Madori, Ph.D., ATR-BC,LCAT, CTRS
  38. 40. TTAP Method utilized with 8 individuals’ diagnosed with Mild Alzheimer’s Disease; Cornell University Memory Evaluation Services
  39. 41. Early findings demonstrate significant increase in mood and self perceived increase in cognition
  40. 42. Using Photographs to stimulate the mind
  41. 43. CLOCK DRAWING TEST: Results could be suggestive of organic causes of cognitive impairment.  Advantages: simple,  non-threatening Sensitivities of up to 86% and specificity of up to 96%. (Samton, 2005) http://neuro.psychiatryonline.org <ul><li>SCORE 4 </li></ul><ul><li>SCORE 0 </li></ul>
  42. 44. Changes in cognition “seen” in Clock Drawing ( Cornell study, 2009) <ul><li>Pre-TTAP Method© Intervention SCORE 10 </li></ul><ul><li>Post -14 week </li></ul><ul><li>TTAP Method© SCORE 13 </li></ul>
  43. 45. Cultural Change in Healthcare; Medical Model to Social Model <ul><li>. There were four early pioneering individuals who began to apply social model concepts to nursing home settings that must be recognized to truly understand the evolution of Culture Change history. The early work that these individuals brought to the movement have become known as the following Culture Change philosophies: -- The Eden Alternative -- The Regenerative Community -- Restraint Free / Individualized Care -- Now the TTAP Method™ </li></ul>
  44. 46. Certification Course on TTAP Method™, New York, New Jersey, Chicago, Illinois.
  45. 47. <ul><li>For more information on the TTAP Method go to… </li></ul><ul><li>www.ttapmethod.com </li></ul><ul><li>http://ttapmethod.blogspot.com </li></ul><ul><li>Levinemadoriphd Channel@ You Tube </li></ul><ul><li>or </li></ul><ul><li>[email_address] </li></ul>