Movement with Meaning: A Multisensory Program for Individuals in Early-Stage Alzheimer's Disease
Those of us in the field of dementia care are reexamining our philosophical beliefs and exploring practical, hands-on approaches in our relationships with individuals living with Alzheimer's disease. We are creating innovative programs and developing a new framework for preserving the emotional health, autonomy, and dignity of those who need us to walk hand in hand with them, witnessing the process of their experiences with empathy and respect.
Movement with Meaning is one such program. Designed for persons in the early stage of Alzheimer's disease, Movement with Meaning reinforces the remaining strengths and abilities of people with dementia by using a multisensory approach that stimulates all five senses. Practical and interactive by nature, the curriculum is ideal for physical therapists, recreational instructors, and activity directors in adult day centers and assisted living facilities, as well as health care professionals who are senior trainers, music or dance therapists.
As the mind begins to slowly unravel, the body becomes the refuge - the container - the ground - the point of reference. In a Movement with Meaning class, the multisensory activities are divided into five segments that create a choreography of movements in which short, repetitive exercises increase a sense of well being. The program introduces simple breathing techniques, poetry, music, movement exercises (bilateral integration exercises and yoga postures), and sensory activities. Once the person with Alzheimer's disease experiences a sense of his or her inner landscape, anxiety and confusion begin to subside. Movement with Meaning provides an opportunity for the participants to recognize the abilities and talents lying dormant behind the disease and find a new path to connect and communicate with each other and their families.
What an opportunity we have with the advent of early diagnosis. So why wait? Because the long-term memory is not affected in the early stage of Alzheimer's disease, these memories are preserved. I have found that repetition is an effective method for not only retrieving these memories, but as an essential tool in a Movement with Meaning class.
A study published in the American Journal of Alzheimer's Disease and other Dementias (Jan-Feb, 2004 issue) shed light on the effectiveness of repetitive work on maintaining functional levels in Alzheimer's disease patients. In the Adapted Work Program participants were given jobs that included packaging, shredding, folding laundry, stamping and sending our mailings. The program was closed due to budget cuts in funding. The participants were transferred to a traditional day care program which included activities such as bingo, ceramics, music, and current events. Before moving to the traditional day care setting the participants were assessed with the MMSE (Mini-Mental Status Exam), the Cognitive Performance Test, and the Geriatric Depression Scale. And then reassessed again in 4 months, after being at the traditional day care facility. The MMSE and the Cognitive Performance Test scores were lower than expected. All the spouses of the participants reported declines in Activities of Daily Living. The conclusion of the study stated that activities that involve repetitive, sequencing skills promote better self-care at home than traditional day care environments. As mentioned above Movement with Meaning is divided into five segments, with a thematic thread that reinforces the continuity of the program.
The first segment in a Movement with Meaning class is "Centering through Breathing." When an individual with Alzheimer's disease experiences disorientation, has difficulty remembering names, or finding the right word, this can be unsettling and cause anxiety. The antidote to help diminish anxiety is mindful breathing. Once the mind is calm and relaxed concentration will follow. In his book, "Your Memory: How it Works, and How to Improve it," K. Higbee documents that high anxiety interferes with attention and concentration. Therefore, it is imperative to establish an environment that promotes a peaceful inner state. When participants feel relax and calm the ability retrieve firmly rooted songs, prayer, and poems begin to surface.
The second segment in a Movement with Meaning class is "Learning by Heart." The participants memorize a short poem or song. Poems and songs that were learned early in life are stored in the long-term memory and remain accessible to the person with early-stage Alzheimer's disease. Repetition is the method for learning a new poem or song. The rhythm patterns and cadence in each poem or song creates an atmosphere that is safe and nonthreatening and brings something to the lives of the participants that is representative of what was there before the disease. Included in the second segment is the use of visualization techniques to expand on the imagines evoked by a poem or song. Visualization increases concentration because it creates focus on the more subtle "mental pictures" and "feelings" of a poem or song.
The third segment is a Movement with Meaning class (A Delicate Balance and Nice and Easy Yoga) including both bilateral integration exercises and yoga postures. Problems with balance and coordination begin to occur in early-stage Alzheimer's disease. Muscles love rhythmic movement. By satiating the body with repetitive bilateral exercises or yoga postures, participants are not only integrating both left and right hemisphere of the brain but are also increasing their spatial awareness, balance, and coordination. These exercises and postures are similar to Tai Chi in that they help the participant identify the body's midline - the median plan where the left and right sides of the brain and body cross or overlap.
In a study in the Winter 2003-2004 issue of Generations an article titled: "Balance Intervention to Prevent Falls," addresses the importance of exercises that include flexibility, balance, and sensory awareness. A multidimensional program is important for fall reduction. By aligning the body with the earth, a nonverbal statement is made: "I know where my body is in time and space." By incorporating a physical component in a Movement with Meaning class, the transition from the cadence of a poem or the melody of a song is experienced as part of a continuum, unfolding a choreography of movements with a theme and purpose.
The fourth segment is a Movement with Meaning class, "A Sense of Timing," which introduces music and rhythmic exercises to help the participants integrate and embody a poem or song. The rhythm patterns are synchronized with the cadence and melody of the poem or song. Rhythmic instruments such as chimes, drums, bells, and claves are nonverbal ways of communicating. The repetition of a beat or dance evolves an inner musical sense, and inner timing. Without thinking, the participants begin to tap their feet or sway their bodies from side to side. Studies in Germany reveal that when individuals with Alzheimer's disease participate in music therapy that include rhythm instruments sensory and motor integration are promoted.
The last segment is a Movement with Meaning class, "Reawakening the Senses," devoted to using the senses of smell, taste, and touch, with attention to color, shape, and texture. Exploring the senses allows individuals with Alzheimer's disease to gain access to their own unique internal landscape. We make sense of the world through our senses. The body is the primary receptor and container of experience. Appropriate sensory stimulation is a main avenue to awakening latent memories, as well as supporting existing functional abilities.
When the elements Movement with Meaning are put together in a daily program, attention is refocused back to the body of the person with Alzheimer's disease. For whatever was lost in the cognitive realm can be recalled through the senses. As one participant in a Movement with Meaning stated when asked what she thought about the program, "I have enough to hold on to."
I'll ask the same question again: So why wait? The time is now, in the early stage, to reinforce remaining strengths and abilities. The time is now, while the individual is aware of his or her personal biography, to investigate the sense of the individual's inner landscape is changing. The time is now to create an environment that strives to preserve the identity and dignity of each individual affected by Alzheimer's disease.
Barbara Larsen, M.A., Ed.
Creator & Author, Movement with Meaning
P. O. Box 2636
Nevada City, CA 95959