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xviii Preface
W
e all interact with the environment through our daily activities
working, reading, talking, running, shopping, making coffee,
doing laundry, preparing meals, or taking a shower. These
activities have meaning for us. They either provide opportunities for
enjoyment and creative expression or serve a specific purpose. We all
have a basic need to feel productive and engaged. The same is true
for those with cognitive impairment, although they may need help in
organizing and structuring activities. The activities that people with
dementia are encouraged to pursue should continue to have meaning to
them and not just provide busy work.
The Connections Activity Program helps anyone, from family and
friends to professional care providers, to engage people with cognitive
impairment in meaningful activities. For consistency, the term cognitive
impairment is used throughout this guidebook to refer to individuals
living with Alzheimers disease or other dementias, officially diagnosed
or not. The Connections program is an evidence-informed activity inter-
vention for people with cognitive impairment. Field-testing has shown
that using the approach can promote higher levels of communicative
1
2 The Connections Activity Program for People with Dementia
Therapeutic Recreation
Recreation therapy, also known as therapeutic recreation, is a systematic
process that incorporates activity-based interventions to address the
assessed needs of individuals with illness and/or disabilities (American
Therapeutic Recreational Association, 1987). The purpose of the pro-
cess is to improve or maintain physical, cognitive, social, emotional,
and spiritual functioning to facilitate full participation in life (National
Council for Therapeutic Recreation Certification, 2016). Recreational
therapists can be found as part of the healthcare team working with
people diagnosed with disabilities in a variety of settings, including
nursing homes, hospitals, adult day centers, and psychiatric hospitals.
Most therapeutic recreation assessments begin by gathering infor-
mation about the person, such as past leisure interests and hobbies,
education, career, and family and spousal history. The idea is to match
a persons past interests with current level of functioning. For example,
an expert Bridge player no longer able to process the complexity of the
card game may enjoy a simplified game of cards, such as Go Fish or War.
Or a person with severe physical limitations interested in bicycle riding
might enjoy an adapted bicycle. Research on therapeutic recreation in
nursing homes shows great benefits, including reduced falls and inju-
ries related to falls; reduced challenging behaviors among those with
dementia, which in turn reduces the use of psychotropic medications
Introduction 3
Cognitive Intervention
Cognitive intervention involves assessment and treatment approaches
that improve and/or maintain an individuals functional cognitive and
communicative abilities in everyday environments. In dementia care,
cognitive intervention approaches often capitalize on the persons cog-
nitive strengths and are guided by care providers trained in providing
verbal cues as well as modifying the environment (American Speech-
Language-Hearing Association, 2005; Bayles & Tomoeda, 1997). Envi-
ronmental modifications can include visual aids to assist people with
attention, orientation, memory, and problem solving. In some cases,
4 The Connections Activity Program for People with Dementia
Connections Field-Testing
The Connections program was field-tested using community engagement
or service-learning projects. Results of two service-learning projects are
reported in the American Journal of Recreation Therapy (Braddock
& Phipps, 2010, 2011). The first project was designed as a feasibility
study to examine activity engagement in people with cognitive impair-
ment through partnered volunteering, which involved matching them
with undergraduate students. The goal of partnered volunteering was
to provide opportunities for those with cognitive impairment living in
the community to re-engage in activities with the assistance of student
visitors. Using the Connections Activity Intervention Guides for spe-
cific activities (e.g., gardening, painting; described later in this book),
the students engaged their partners in carefully selected and adapted
activities over an 8-week period. Cognitive and engagement observa-
tions were completed before and after programming.
Results indicated that 11 of 12 individuals successfully engaged in
an activity that once held meaning in their lives. Those with mild cogni-
tive impairment self-initiated activities when these were set up for them
and easily accessible; those with more severe cognitive impairment were
more likely to self-initiate activity following prompting by the students.
Moreover, caregivers reported significantly reduced burden and were
also more confident in implementing activities themselves following the
student-delivered program.
Given these positive outcomes, the Alzheimers Disease Research
Award Fund at the Virginia Center on Aging at Virginia Commonwealth
University provided funding to examine activity selection and set up
for a larger group of people with cognitive impairment. To more fully
understand the level of support needed for successful partnered vol-
unteering, 16 individuals in the intervention group were matched with
those in the comparison group. Individuals and caregivers in the inter-
vention group received regularly scheduled weekly student visits for
8 weeks, whereas the comparison group received activity selection
and setup in the home in one visit. Results indicated that customized
activity selection and setup promoted high levels of physical and ver-
bal engagement in both groups. Compared with caregivers who did
not receive student visits, caregivers with student support in the in-
tervention group reported significant reduction in burden. This finding
Introduction 5
Conclusion
The Connections approach assists care professionals, family members,
and so forth in modifying an environment for people with cognitive
impairment to best support communicative behaviors and engagement
in life. The Connections program is a field-tested activity interven-
tion based on the theoretical underpinnings of therapeutic recreation,
Montessori-Based Dementia Programming, and cognitive intervention,
which generally rely on an individuals strengths, abilities, and interests
in creating supportive environments. Chapter 1 details the steps of the
Connections Activity Program.