Mining the potential of the aging brain using
O&M strategies
Presenter: Dr. Kenalea Johnson, COMS
Renaissance in O&M
I hope the result of this conference will be that it
has brought our profession together to provide a
platform for a renaissance in thinking about our
elder population. And that the renaissance will
spread quickly and become as a significant part of
our mission as a profession as service to all other
types of visually impaired, blind, or deafblind
Americans.
Definition of Renaissance
The Renaissance (from Old French Renaissance, meaning
"rebirth"; Italian: Rinascimento, from latin re- "again" and nasci
"be born"[1]) was a cultural movement that some claim spanned
roughly the 14th through the 17th century, beginning in Italy in
the late Middle Ages and later spreading to the rest of Europe. It
encompassed another revival of learning based on classical
sources, the development of linear perspective in painting, and
educational reform. The Renaissance saw developments in most
intellectual pursuits, but is perhaps best known for its artistic
aspect and the contributions of such polymaths as Leonardo da
Vinci and Michelangelo, who have inspired the term
"Renaissance men“
https://answers.yahoo.com/question/index?qid=2008012305173
5AAwz4kN
Why is a Renaissance possible
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We are recognizing new ways to use old methods
We are developing new methods
We are reviving learning methods that lead to new facts
We have become aware of abilities of our elderly
We are abandoning the old thoughts of what the scope of
O&M really encompasses
We COMS are truly “Lust to Dust”
How important are our Elders
Our Elders are the carriers of our memory and life experiences.
The youth have the energy while the Elders exercise their
wisdom. It is everyone's responsibility to grow into a respected
Elder; one who is sought out for advice and council.
http://www.dancingtoeaglespiritsociety.org/elder_role.php
From ‘The Odessey’ by Tennyson
“Tis not too late to seek a newer world”
Goals for this session
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Understand the latest scientific understanding about the
‘aging brain’
Connect those facts to how to adapt the O&M curriculum
to increase independence in elderly persons with visual
impairments or blindness
Examples and suggestions for goals for individuals on your
caseload
Working with elderly persons with developmental delay
and visual impairments or blindness including those with
multiple impairments and or deafblindness
Learning Objectives
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Understanding the need for independence for persons with
learned dependence
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Understanding how movement through space
independently can increase quality of life
Understand a bit of history of services for persons with VI
and other disabilities
Understand how the current method in our residential
center has changed the outlook of our center toward
residents with VI
Understand specific methods found to be effective
Suggestions for the future and implications of the current
changes O&M is offering to our aging population
Aging with Grace: What the Nun Study Teaches Us about
leading longer, healthier and more meaning ful lives
Aging with Grace – Snowden’s findings
Several characteristics for Nuns who did not have dementia
were: education, autobiography’s complexities, relationships,
social bonds, family with common purposes
But, most important of these were the social relationships, the
social bond with the family with common belief systems and
common purpose
Goals of the nun study
Explore the factors contributing to longevity. Could the sisters’
autobiographies, written when they were healthy young women,
predict how long they would live?
The data suggest that the answer is yes.
Nun study
Enchanting Exerpts
One week before Christmas 2000 and two weeks before her
ninetieth birthday, Sister Genevieve Knukel marveled at her
well-being. “I have two good traits,” she told me. “I am alert
and I am vertical.” (p. 183)
“Why shouldn’t I be up?” . . . “Up and grateful.” . . . “Give your
attitude some altitude!’
Social Experience
At one time there was a division of seating in the Nun’s dining
area. The healthy Nuns were seated in an area where they went
through a cafeteria line while the Nuns from the assisted living
center were seated in a nearby area were they had their food and
medication brought to them.
The Convent Leaders decided to merge the two groups.
The healthy Nuns assisted the other Nuns by filling their plates
and assisting them when help was needed. “The quiet sisters
were drawn into conversation, and the sisters who had some
cognitive problems seemed pulled toward the normal end of the
spectrum (p. 168-169).”
Kosik says ‘Brain is a social organ’
He told about the study of Nuns by David Snowden who
wrote ‘what I know for sure is the nutrition for healthy aging is
not just about eating certain foods and vitamins but also it
depends on whom we eat with and it whether the meal nourishes
our heart mind and soul ‘
Aging Brain Facts
How Can we teach an old dog new tricks
How the Brain Changes itself by Dr Norman Doige
The brain’s way of healing by Dr Morman Doidge
Gives the definition of Neuroplasticity as the property of the
brain that enables it to change its own structure and functioning
in response to activity and mental experience.
Doidge’s brain facts
Brain cells are constantly communicating electrically with one
another
They form and re-form new connections, moment by moment
This constant forming is a source of an unique kind of healing
Stages of Neuroplastic healing – role of energy
Energy has many forms – important
3 Stages of Neuroplastic learning
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The Pervasiveness of Learned Nonuse-after trauma the
brain goes into crisis stage and the person goes through
about 6 weeks of functioning poorly – and ‘learns’ he can’t
do things
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The Noisy Brain and Brain Dysrhythmias-mind feels
‘noisy’-probably because the neuronal circuits couldn't
generate enough strong, sharp signals to stand out against
the background noise of all the other neuronal signals being
fired in the brain
Rapid Ongoing Formation of Neuronal Assemblies-a
neuron, or group of neurons will be used for different
purposes, at different times –”One day’s mapping would no
longer be valid on the morrow.”
Stage of Healing
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Correction of general cellular functions of the neurons and
glia
Neurostimulation-some kind of energy-based
neurostimulation of the brain cells is required (light, sound,
electricity, vibration, movement, and thought (which turns
on certain networks)
Neuromodulation-Brain restores the balance between
excitation and inhibition to the neural networks
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Neurorelaxation-once fight or flight is turned off, the brain
can accumulate and store the energy that will be needed for
the efforts of recovery
Neurodifferentiation and learning-brain is quiet and rested
and ready to learn because the circuits can regulate
themselves
Value of Movement
Exercise benefits the brain even before it benefits the body. The
brain does not store its own fuel, nor does it produce its own
fuel. The brain relies on the body to get its needed fuel—oxygen
and glucose—to the brain.
http://www.humankinetics.com/excerpts/excerpts/learn-howexercise-benefits-the-brain
Social Insurance
http://dana.org/Cerebrum/2011/Aging_with_Meaning/
Dr. Cohen recommended that each of us create a “social
portfolio” in which we inventory assets including personal
interests, skills, resources, and relationships to build up a kind of
“insurance” against expectable future losses. We can adjust our
activity patterns with age, as in relinquishing skiing for hiking or
nature walks. Dr. Cohen also wrote about satisfaction in
developing new skills. He was excited by his observation that
older individuals often take advantage of newfound personal
freedom and creativity to develop new interests. He emphasized
that ongoing participation in activities that contribute to society
are valuable, as they continue to be a source of affirmation and
meaning. Dr. Cohen exemplified this approach. After retiring
from an eminent career at the National Institutes of Health
(NIH), he continued his research in aging as head of the Center
for Aging and Humanities at George Washington University
until his death. - See more at:
http://dana.org/Cerebrum/2011/Aging_with_Meaning/#sthash.0d
d5KPU0.dpuf
How does the social experience happen
One of the greatest gifts Cohen gave was
http://cahh.gwu.edu/center-aging-health-humanities
Environment changes
Dr. Karen Pape Baby brains DO recover, but habit hides it:
https://www.youtube.com/watch?v=WKVbRDJ-nxs
How do we change a Brain
Novelty
Challenge
Focus
It takes more brain to learn something new than to do a habit
Fresh snow
Perfect practice makes perfect
Habits are hard to break
But the more difficult the task the more of the brain is involved
We need to look for the athlete not the child
Downloadable pdf http://www.karenpapemd.com/wpcontent/uploads/downloads/2015/05/waterexercise.pdf
Some Traditional Theories
Often used
All based on sighted, temporarily abled individuals
Developed to allow bean counters to develop policies without
involvement with individuals
Creates methods for partitioning individuals by characteristics
Leaves unconnected brains, minds and individual self
characteristics
Are all too often used on populations not in the norming groups
for the stats, i.e. persons with disabilities and non-traditional life
situations
So looking at how learning happens
We worked to see the gestalt of each person
Our question was . . .
How do we effectively change lives for the better for these
adults who have lived all their lives in institutions?
How do we change the ‘official stance’ that all persons with
disabilities are better off in the community?
Unable to do make the change, how do we prepare the adults for
the regular community life?
The most glaring fact
These adults have been to McDonalds, shopping, visits with
families, some outings . . . .
BUT they have always come back to the institution and the
caregivers, culture, and schedules they have grown up in . . .
The years they have been in the residential situation has
provided concept development
Based on their experiences (the changing institutional
outlook over the past 100 years)
Not the same concepts outsiders looking into the
‘residences’ have developed as they grew up in the
‘real world’
So, from the O&M perspective
We have the traditional curriculum
We have the infant and preschool curriculum
We have the curriculum that reflects the expanded core
curriculum
We have the Cortical Visual Impairment methods
We have the Deafblind curriculum
But we do not have babies, traditionally blinded individuals, we
have adult brains with multiple handicapping conditions that
have developed concepts based on their experiences in
institutions
Our first attempts were to
Use the same techniques as one would with the traditional
curriculum
But . . .
Although we had success with the ambulatory and higher skilled
persons
Workshop Activities
Work Period
Gardening
Activities
Independent Exploration
Active Learning
Snack Time
Learning to independently set snacks up
Returning tray to the sink and washing items
Outside the normal routine
Distributing water to persons on campus
Using cane to explore the building with COMS
Tasks
Getting equipment for task
Putting equipment away
Core Competencies
Hand under Hand technique
Hand under Hand technique
Human guide technique
Intervener and DeafBlind
Wonderful Benefits of having a Plastic aging brain
Connecting these facts to O&M
Important to brain development
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Culture
Exposure to stimuli
Activities that really work with the aging brain
Mental challenges
Using new challenges to build more synapse networks
Routines with specific beginning, middle, and end
Regular schedules of activities that will provide frequent
practice
Physical group and individual activities
Meaningful activities
Cooking
Cane Travel allows independent travel with instructor
Learning Human guide (Narrow passageway)
Sequencing: Beginning, middle and end
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Regular schedule: Bathroom, wash hands, get first task and
sit down at work table.
Regularity of schedule of activities for each day of the week
Sequencing of workshop activity
Instructing is hand under hand and assistance when needed
Snack routine: sequenced (making smoothies, pudding,
cupcake decoration, etc.)
Routines in crafts
Routine for leaving the facility at the end of the session
Then we had a different need and changed training
Sequence of Development of Spatial-Relationship Concepts
Early Focus,Working with Young Children who are Blind or
Visually Impaired and Their Families, Pogrund & Fazzi, 2002
Mapping of the immediate body.
Mapping of proximal space (within reach of the body).
Mapping of distant space (understands sound cues in the
environment; recognizes landmarks, moves with goal-oriented
intention).
Mapping of near-range object-to-object relationships (container
and lid).
Mapping of body-to-objects relationships (negotiation of
barriers, use of push toys or cane, travel on routes to put away or
retrieve familiar items, trailing).
Mapping of size and shape relationships.
Mapping of part-to-whole relationships (puzzles, recognition of
objects or landmarks through partial touch).
Caine and Caine [1991] came up with twelve brain learning
principles
The brain is capable of performing several activities like
perception and creation or seeing and hearing, at one time.
The search for meaning is inborn.
The search for meaning comes through patterning.
Emotions are critical to patterning.
The brain processes wholes and parts simultaneously.
Learning involves both conscious and unconscious processes.
Each brain is unique.
The process of learning is enhanced by challenge and inhibited
by discouragement.
We have at least two types of organizing memory: spatial and
rote.
We understand best when facts are embedded in natural, spatial
memory.
Learning involves both focused attention and peripheral
attention.
Learning engages the whole physiology.
http://www.brainhealthandpuzzles.com/brain_based_learning.ht
ml
Using these Theories
We changed schedule
We changed routines
We began having regular O&M times with resident and
caregivers
We began having regular times in the Active Learning area
We developed individualized activities that led to higher levels
of independence
We initiated a standardized communication system as there were
non-verbal and those with word systems seemed to have
developed only sentences that were repetitive and didn’t have
relevance to the time or situation
Brain Trivia
The slowest speed at which information travels between neurons
is 416 km/h or 260 mph, that's as "slow" as todays supercar's top
speed (the Bugatti EB 16.4 Veyron clocked at 253 mph).
The cerebellum contains half of all the neurons in the brain but
comprises only 10% of the brain.
The cerebral cortex is about 85% of the brain.
There are about 100 billion neurons in the human brain, the
same number of stars in our galaxy.
The left hemisphere of the brain has 186 million more neurons
than the right hemisphere.
750-1000ml of blood flow through the brain every minute or
about 3 full soda cans.
In that minute the brain will consume 46cm3 (1/5 cups) of
oxygen from that blood.
Of that oxygen consumed, 6% will be used by the brain's white
matter and 94% by the grey matter.
http://www.brainhealthandpuzzles.com/brain_based_learning.ht
ml
Trivia continued
Your brain is about 2% of your total body weight but uses 20%
of your body's energy.
The energy used by the brain is enough to light a 25 watt bulb.
More electrical impulses are generated in one day by a single
human brain than by all the telephones in the world.
How much does human brain think? 70,000 is the number of
thoughts that it is estimated the human brain produces on an
average day.
http://www.brainhealthandpuzzles.com/brain_based_learning.ht
ml
Expressive Communication
Questions for Self Reflection:
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Have you ever felt people weren’t paying attention to you?
Are there times in your professional practice you find you
aren’t paying attention to clients or colleagues?
How have you been able to be more attentive or intentional
in your listening?
From Aging with Grace
(P. 195)
Dr. Deborah Danner, a colleague of Dr. Snowden, was
interviewing the wife of a man who had been bedridden for
several years and rarely uttered a word. The wife had told her
outright, “You can come, honey, but he doesn’t know enough to
feel.”
When Danner was alone with the patient, she recalled the
celebration the couple had had for their fortieth wedding
anniversary. She saw the man smile. Reassured, she went on,
scanning his face for nonverbal signs of comprehension.
Imagine the wife’s surprise when she suddenly heard her
husband’s voice from the other room. One of the things he said
to Danner: “I don’t talk because no one listens anymore.”
When a horse is sold in the marketplace
When a horse is sold in the marketplace
No one asks the horse‐soul if it will allow a strange hand to open
the horse’s mouth, to touch his limbs.
They set my shamed flesh before the dragon of science without
asking my soul.
Ten heads of the lofty dragon observed my misery without
asking my soul.
https://cahh.gwu.edu/sites/cahh.gwu.edu/files/downloads/WAGE
CC_PersonCentered_Care_Toolkit_When_A_Horse_Is_Sold.pdf
We added “communication time to our plan”
We added structured instruction in O&M
Instruction for both the direct service provider that accompanied
the resident each day
Instruction for the resident
Skills:
Doorways
Trailing
Route development
Body concepts
Self familiarization
And other skills as were seen to need retraining
Our plan was to train . . .
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Until we saw complete utilization of our core principles
and interaction with the residents was generalized.
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Our definition of generalization was to have actions
spontaneously happening without prompting in three
different environments.
Biggest hurdles
Other hurdles
Funding
Jumping through hurdles of different regulations that apply to
the daily lives of residents
Trying to change the culture of caregivers who are the major
part of the lives of the residents
Barriers
Resource and Bibliography List for Presentation by Dr. Kenalea
Johnson, COMS and further reading and research items
References
Braverman, E. R. (2011). Younger Brain, Sharper Mind: A 6-Step Plan for Preserving and Improving
Memory and Attention at Any Age from America Brain Doctor. New York, NY: Rodale.
Calvin, W. H. & Ojemann, G. A. (1994). Conversations with Neil’s Brain: The Neural Nature of Thought
and Language. New York, NY: Addison Press.
Cohen, G. D. (2000). The Creative Age: Awakening Human Potential in the Second Half of Life. New York,
NY: Avon Books.
Cohen, G. D. (2005). The Mature Mind: the Positive Power of the Aging Brain. New York, NY: Basic Books.
Conlan, R., Ed. (1999). States of Mind: New Discoveries about How Our Brains Make Us Who We Are.
New York: John Wiley and Sons.
Doidge, N. (2015). The Brain’s Way of Healing: Remarkable Discoveries and Recoveries from the
Frontiers of Neuroplasticity. New York, NY: Viking.
Goldberg, E. (2006). The Wisdom Paradox: How your Mind Can Grow Stronger As Your Brain Grows
Older. New York, NY: Gotham Books.
Kleege, G. (1998). Sight Unseen. New Haven & London: Yale University Press.
Marmor, M. F. & Ravin, J. G. (n.d.). The Artist’s Eyes: Vision and the History of Art. New York, NY:
Abrams.
Neer, F. L., Ed. (1998). Perceiving the Elephant: Living Creatively with Loss of Vision. Berkley, CA; Creative
Arts Book Co.
Nielsen, L. (1990). Are You Blind? Promotion of the development of children who are especially
developmentally threatened. Copenhagen, Denmark: Sikon.
Nielsen, L. (1994). The Comprehending Hand. Copenhagen, Denmark: Sikon.
Nielsen, L. (1993). Early Learning Step by Step: Children with impairments and multiple disabilities.
Copenhagen, Denmark: Sikon.
Ratey, J. J. (2002). A User’s Guide to the Brain: Perception, Attention, and the Four Theaters of the Brain.
New York, NY: Vintage.
Snowden, D. (2001). Aging with Grace: What the Nun Study Teaches Us About Leading Longer, Healthier,
and More Meaningful Lives. New York, NY: Bantam.
Trevor-Roper, P. (1971). The World Through Blunted Sight. London: Thames and Hudson.
Digital Resources
https://www.youtube.com/watch?v=ifYcE4-eI_s
Quick Neuroplasticity Explanation
https://www.youtube.com/watch?v=ELpfYCZa87g
Disability Museum
http://www.disabilitymuseum.org/dhm/index.html
Norm and Emma
http://www.broadreachtraining.com/nkevbio.htm
1. Kunc, Norman. (1992) The Need to Belong: Rediscovering Maslow’s Hierarchy
of Needs.
Originally published in: Villa, R., Thousand, J., Stainback, W. & Stainback,
S. Restructuring for Caring & Effective Education. Baltimore: Paul Brookes.
2. Giangreco, Michael. (1996) "The Stairs Don't Go Anywhere!" A self-advocates
reflections on specialized services and their impact on people with
disabilities. Physical Disabilities: Education and Related Service, 14(2), 1 - 12
3. Van der Klift, Emma, & Kunc, Norman.(1994) Hell-Bent on Helping:
Benevolence, Friendship, and the Politics of Help
Originally published in: Thousand, J., Villa, R., Nevin, A. Creativity and
Collaborative Learning: A Practical Guide to Empowering Students and
Teachers. Baltimore: Paul Brookes.
http://www.broadreachtraining.com/videos/moon-come-up.htm
Dame Evelyn Glennie
http://issuu.com/evelynglennie/docs/hearing_essay__revised_2015_/1
Dame Evelyn Glennie’s Hearing Essay
https://www.ted.com/talks/evelyn_glennie_shows_how_to_listen?language=en
How to Truly Listen – TED
https://www.youtube.com/watch?v=d1L_v_S5DTc
Sea Lion doing exercises
https://www.youtube.com/watch?v=fyZQf0p73QM
Man in nursing home responds to music – Oliver Sachs
http://psych.ucalgary.ca/PACE/VA-Lab/AVDE-Website/rembrandt.html
Rembrandt and Van Gogh
http://www.visionandartproject.org/contact
Georgia O’Keefe and Edgar Degas
https://www.apa.org/pubs/journals/releases/psp805804.pdf
PDF results of Nun study 1
http://gerontologist.oxfordjournals.org/content/37/2/150.full.pdf
PDF results of Nun study 2
http://www.usccb.org/about/national-religious-retirement-office/upload/Engaging-Aging-NewsletterFall-2012.pdf
Nun study
http://content.time.com/time/photogallery/0,29307,2042630,00.html
Time Magazine - Nun Study – look for it at this site
http://www.mprnews.org/story/2009/03/24/nuns_alzheimers_study
MPR news
http://www.med.harvard.edu/AANLIB/home.html
Whole Brain
https://www.youtube.com/watch?v=338GgSbZUYU
Margaret Livingston
https://www.youtube.com/watch?v=UyPrL0cmJRs
Dr. Merzenich
https://www.youtube.com/watch?v=y5i3jBhxI4Q
Published on Apr 12, 2012
(Visit: http://www.uctv.tv/) Joel Kramer, UCSF Professor of Neuropsychology and the Director of the
Memory and Aging Center Neuropsychology program. He explores the underlying biological mechanisms
of cognitive aging, and interventions that may optimize cognitive functioning as we age. Series: "UCSF
Osher Mini Medical School for the Public" [4/2012] [Health and Medicine] [Show ID: 23205]
http://gepaconline.gwnursing.org/
The Geriatric Palliative Care Curriculum provides advanced interdisciplinary healthcare practitioners with
foundational knowledge and skills to provide a unique approach to the palliative care of older adults,
including:
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Disease management with compassionate caring,
Maintaining optimum functional abilities in the presence of protracted illness,
Promoting quality of life, and
Anticipating and preparing for peaceful death in the midst of chronic disease.
http://cahh.gwu.edu/washington-dc-area-geriatric-education-center-consortium-wagecc
Washington DC Area Geriatric Education Center Consortium (WAGECC)
http://cahh.gwu.edu/person-centered-care-toolkit
Care Toolkit (PCCT) is a resource for healthcare professionals to teach
concepts for a person-centered approach to care for older adults across healthcare settings.
Tools and techniques are included in a three fold approach of the toolkit: as teaching tools for
interprofessional healthcare providers, as activities to enable older persons to express
themselves and their creative potential, and as self care techniques for healthcare professionals
to reenergizes and maintain their ability to provide a person-centered approach to care.
The Person-Centered