Saturday, October 6, 2018

Coming Full Curcle

Here is an inteeresting article about learning in those with dementia
New York Times

IN a colorfully decorated room on the Upper West Side of Manhattan, a half-dozen bright minds were engaged in a Montessori exercise called category-sorting. The categories were “dessert” and “non-dessert.” Pheona Yaw, who led the exercise, held up yellow cards with words on them.
“Carrots,” she said, reading from the first rectangular card. “Dessert or non-dessert?”
That was an easy one, the group agreed. “Not dessert,” they said. Ms. Yaw placed the card over a rectangular outline on the non-dessert side of the board.
She moved on.
“Strawberry shortcake,” she said, holding up the next card. “Dessert?”
“No, that’s not a dessert at all,” said Holly Kromer-Sharpe, decisively. Others disagreed. Ms. Yaw put the card aside and moved on to pizza, on which there was agreement: pizza was not a dessert. Then she returned to strawberry shortcake.
“Dessert or non-dessert?” she asked.
Holly Kromer-Sharpe again spoke first. “I think that’s a dessert, yeah,” she said, just as firmly, as if the question itself were an affront. “What’re you trying to do, anyway?”
In a typical Montessori classroom, teachers use category-sorting exercises to help young students see patterns and connections. But the participants in this group were mostly in their 80s and on the other side of the cognitive development curve. They are residents at an assisted-living facility for people with dementia called Hearthstone at the Esplanade, which has six other homes in New York State and Massachusetts. Since July the residents have participated in a full-time program of Montessori-based activities designed for people with memory deficiencies.
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The program was created by Cameron J. Camp, an experimental psychologist who has applied childhood education principles to people often considered past the point of teaching. Through the Myers Research Institute in Beachwood, Ohio, where Dr. Camp developed training seminars and materials, dozens of nursing facilities around the country now use his curriculum.
A common misconception about people with dementia, Dr. Camp said, is that they no longer learn. But they do: residents learn to find their dining room table, for example, well after the onset of Alzheimer’s disease. And because they no longer have the higher brain function they had as adults, he reasoned, they are well suited to Montessori.
Developed by Maria Montessori in Rome in the early 20th century, the Montessori method holds that young children learn best when they direct their own learning, with teachers providing tools that engage all their senses. Children learn through their hands and muscle memory, as well as through their eyes and brains. A child might learn the letter C by rubbing her hand over a sandpaper cutout in the letter’s shape while sounding out the letter, using sight, sound and touch together.
Dr. Camp began to consider a similar approach for people with dementia in 1983, while working with the elderly at an adult day center in New Orleans just as his 3-year-old son entered a Montessori school. His wife was a Montessori preschool teacher.
“I started to see all these things that would translate from one to the other,” Dr. Camp said.
At the Montessori school, a boy had trouble focusing on his lessons. At the adult center, a woman with Alzheimer’s who had just regained her vision through cataract surgery became terrified when anyone moved her wheelchair. Dr. Camp saw a parallel. Both were overstimulated by background sensations — the boy because he could not shut out peripheral signals to focus on the task at hand; the woman because her surgery enabled her to see all the boundaries and edges around her, and she thought she was in danger of crashing or falling.
The solutions were similar. The teacher had the boy do the exercise with his eyes closed; the woman held her eyeglasses whenever she was moved. Both improved, and eventually learned to make do without the intermediary step.
As many as 5.2 million people in the United States have Alzheimer’s, including about one in eight people over age 65, according to the Alzheimer’s Association. This number will probably grow as baby boomers pass through their 60s and 70s. No drugs have been proven to do more than slow the disease’s progression. As the Alzheimer’s population grows, nursing homes and geriatricians are working to rethink the possibilities of life with the disease.
The Montessori-based programs for the elderly build on the work of Barry Reisberg, a New York psychiatrist who coined the term “retrogenesis” to 
describe the way the mind’s deterioration reflects its development: the first faculties to develop are the last to go. For instance, children around age 2 begin to understand their image in a mirror as a reflection of themselves, rather than a separate person; people in advanced stages of Alzheimer’s lose that distinction and are often frightened by mirrors, especially in bathrooms, where they think a stranger is watching them. Understanding this helps gerontologists recognize the problem not as random disorientation but as a predictable condition.
“We don’t say they’re crazy, we say this is where they are in the sequence,” Dr. Camp said. “The fix is that you put a window shade on the mirror. But you only come up with the fix if you say, ‘Why is this happening?’ ”
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