Friday, September 14, 2012

TimeSlips – Creative Storytelling for Alzheimer’s Patients

Nearly 16 million Americans will be diagnosed with Alzheimer's disease or another type of dementia by 2050, according to the Alzheimer's Association. Symptoms include mood and behavior changes, disorientation, memory loss and difficulty walking and speaking. The effects of anti-dementia drugs on patients' emotions and behaviors are inconsistent. Now, University of Missouri researchers have found that participation in TimeSlips, a drug-free, creative storytelling intervention, improves communication skills and positive affect in persons with dementia.

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TimeSlips is a nationally recognized storytelling program for people with dementia that encourages participants to use their imaginations to create short stories as a group.

It is an improvisational storytelling method that replaces the pressure to remember with the freedom to imagine. Rather than relying on factual recall, participants respond verbally to humorous images presented by facilitators who record the responses and read narratives to further develop or end the stories.

The TimeSlips Project aims to:
  • Inspire people with dementia to hone and share the gifts of their imaginations.
  • Inspire others to see beyond loss to recognize the strengths of people with dementia.
  • Improve the quality of life of people with dementia and those who care for them.

TimeSlips works best with people in the mid to late stages of memory loss. They are the most open to language experimentation. People in early stages tend to be more eager to capture factual memories.

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"TimeSlips provides rich, engaging opportunities for persons with dementia to interact with others while exercising their individual strengths," said Lorraine Phillips, assistant professor in the Sinclair School of Nursing. "It encourages participants to be actively involved and to experience moments of recognition, creation and celebration. Meaningful activities, such as TimeSlips, promote positive social environments that are central to person-centered care." The storytelling program is an easy and affordable activity for long-term care facilities to implement and allows caregivers to interact with multiple residents at a time, Phillips said.

"TimeSlips offers a stimulating alternative to typical activities in long-term care facilities," Phillips said. "It is an effective and simple option for care providers, especially those who lack resources or skills required for art, music or other creative interventions." In the study, Phillips and her colleagues delivered the TimeSlips intervention in one-hour sessions, held twice weekly for six consecutive weeks. The results included increased expressions of pleasure and initiation of social communication. Improvements in participants' affect lasted several weeks following the final session. The intervention is acceptable for people with mild to moderate dementia, Phillips said.


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This is a typical boy of another era. You can tell by his clothes. His name is Tommy. Looks like he is eating something. He eats cookies from a nice container. You can tell from his face that he thinks he is going to get caught soon. He can already hear footsteps.

He has already been caught by his faithful dog. The dog’s name is Rex. The dog is sitting on a rug. Tommy got caught by the dog while eating cookies. Rex is looking at Tommy and thinks: “Am I going to get some?” He wants something: either cookies or to go outside.

Some man or woman will find him soon and give him a good beating. You can’t do it for a long time.

Tommy is having fun. There is no one around. He knows he is doing something wrong and that makes it many times better. He is licking his thumb.

When he is older he falls in love with a girl who knows how to bake cookies. It may be Regina! (the girl from our other story) They will get married. They’ll have a little boy who likes to help himself from a cookie container. Like father like son.

Key program elements

A volunteer or staff member leads weekly group sessions with 6 to 12 persons with Alzheimer's disease and related dementia. The meeting follows a very structured format, because such individuals still have their procedural memory intact. Participants, who are referred to as "storytellers," sit in a circle. Each meeting progresses as follows:
  • Introduction and setting the rules: At the beginning of each group session, one or more facilitators provides storytellers with name tags and sets the ground rules, explaining that the group is a safe place for storytellers to express themselves and that all responses will be woven into the story. Facilitators try to accommodate any specific needs of the participants. For example, if a storyteller is hard of hearing, the facilitator will move close to the person so that he or she can hear. Facilitators retell the story that was created the week before to reinforce the fact that participants still have the capacity to be creative and to combat those who say they do not. Retelling the story also reminds the storytellers of the structure of the group.
  • Storytelling: The facilitators share a staged photograph or illustration and ask the storytellers questions about what is happening in the picture. Facilitators are purposeful in the way they encourage participants to become storytellers, building on participant responses and using specially designed types of questions to further stimulate imagination, such as:
    • Open-ended: Facilitators strive to make all questions open-ended to encourage responses from the storytellers. They might use questions such as "what should we call the person in the picture?" or "why is that person doing that?"
    • Sensory: Facilitators further encourage responses to the picture by asking storytellers about the sensory aspects of what is happening, such as "what sounds are in the picture?" or "how does the person in the picture feel?"
  • Capturing the story: Facilitators record all storytellers’ answers (including seemingly nonsensical ones) on a large sheet of newsprint in an attempt to capture the emotion of what was said. If a storyteller contributes a response that does not seem to make sense, the facilitator repeats the response to the storyteller to make sure that they have captured it properly. Responses are recorded and crafted into a story in one of two ways—either chronologically or grouped by clusters (e.g., all responses about what sounds are in the picture are grouped together).
  • Reengaging participants: Periodically, the facilitator rereads the story that the group has already created; the goal of this exercise is to keep participants engaged and to help them expand the story. When the group completes the story, the facilitator reads it back to them, using the same emotion and enthusiasm that the storytellers themselves used. Once the story is completed, facilitators and storytellers celebrate what they have created by clapping, and the facilitators thank the storytellers for participating.
  • Sharing stories: After the group session ends, the facilitator types up the story and prints it on the back of a copy of the image. This paper is passed out to storytellers at the next session. Facilitators also strive to share stories more broadly with each storyteller’s community. For example, the facilitator might assemble a collection of stories into a book that can be shared with family and friends at a party, or might invite local artists (e.g., from the community or a nearby high school) to create an exhibit that illustrates a story.


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What are they called? Penguins. There’s only two the same, don’t know what their names are but they are doing alright holding hands. They are in Antarctica. The one on the left’s name is Peter, 'Peter the penguin' and the one on the right is Alice. They would swim to an iceberg and they would be feeling cold. Where is it, down in Victoria? Ones thinner than the other one, that’s what I think because probably one eats everything he sees. They look a little bit like penguins, they may be related. Peter, that’s a good strong name. They would eat whatever suits them. Fish, not these ones (points to the gold fish tank in the corner).

One is fatter than the other. After dinner they would go to bed or go swimming. They look well anyway. Oh dear oh dear they would find an iceberg and settle down. They are both enjoying whatever they are doing. Both good, nice and fine. I’d invite them all together so they can meet one another, it might be the seating accommodations they would have to think about, they’d have to have a friend or they wouldn’t go. They would have problems with their wings if they were invited all together in the lounge room, their wings would stick into each other. I don’t think I would worry about having penguins at home. They look like they are holding hands. One is fatter than the other. One wants to go one way and the other wants to go the other way. What about transport? They’d go on the ice. One is fatter than the other. There’s not much difference between them. Be a bit awkward for the fellas to get in the lounge room, a bit awkward. You couldn’t. If you had a pool you could let them swim there. It would be a bit of a noise when they are talking, it might be a bit much for today. They would find a nice iceberg and settle down.

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