Memory Aids
The use of memory aids for the management of Alzheimer's communication breakdowns and memory loss has been shown to be an effective way to supplement the communication strategies mentioned previously. Like the use of "memory books" to remind the patient of relevant people, places, and events in their immediate environment, the use of a "communication wallet" can assist the patient with Alzheimer's or other dementia with the structural aspects of communication as well as appropriate content to use in a conversational exchange between the caregiver and patient. Information about some different memory aids as well as information on how to create your own is included below. As you'll see, memory books and communication wallets do not have to be time-consuming, difficult, or expensive to create. They can be as simple or as complex as you like.
Memory Books
Memory book are well-organized collections of photos, captions, notes, and keepsakes about the things that are important in your loved one's life. They help reconnect the Alzheimer's patient with the outside world by providing crucial information and have been shown to have a positive impact on functioning. They may also help stimulate interaction with people less familiar with the patient's life and current condition by facilitating connections with the whole person, not just the person as a patient with dementia. Here's a great step-by-step guide on how to make your own memory book, created and shared by a very generous woman in the UK. If you find yourself overwhelmed, you could start by asking each family member or friend to create a page with memories specific to them and your loved one, and then compiling them into one book. Visit her website or download her basic guide to making a memory book below. http://creativesarah.weebly.com/sarahs-making-memory-books-yourself-guide.html
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Communication Wallet
A communication wallet is like a memory book but specific to language and communication. It can be an effective tool to help keep your loved on on-topic and making relevant contributions to the conversation. In a study done by Michelle Bourgeois in 1990, the husbands of three Alzheimer's patients created communication wallets for their wives, and successfully instructed them on their use. Bourgeois found that after a period of training on the use of the wallet, all three of the women showed a dramatic improvement in their ability to stay on topic, doubling and sometimes even tripling their on-topic contributions. Even more impressive is that they did not just stick to the sentences printed on the cards, but were able to use these as cues to generate their own independent, relevant statements. This effect was maintained for all but one of the participants, who experienced a slight but temporary drop toward baseline in one topic.
This idea of a communication wallet is a great one, and can easily be made at home by following the experimenter's process. I've taken what I feel are the basic points, and arranged them so you can make and use a communication wallet with your loved one, too.
What you'll need: Paper and pen (or computer with printer), index cards, family photos, other pictures as needed, laminating paper and laminator or contact paper (optional but recommended), plastic wallet or small portfolio, plastic dividers with colored tabs.
Choosing your topics:
Here's an example of the type of text that is in a communication wallet:
NOTE: This example only includes three of the simple sentences to save space. A complete wallet will have ten sentences for each topic.
EXAMPLE: Topic 1: My Day
Topic Prompt: "Tell me about your day."
1. I get up and get dressed around 9:00a.m.
2. Then I eat breakfast.
3. After meals I wash and dry the dishes.
Assembling the wallet:
Teaching your partner how to use the wallet:
Effective use:
This idea of a communication wallet is a great one, and can easily be made at home by following the experimenter's process. I've taken what I feel are the basic points, and arranged them so you can make and use a communication wallet with your loved one, too.
What you'll need: Paper and pen (or computer with printer), index cards, family photos, other pictures as needed, laminating paper and laminator or contact paper (optional but recommended), plastic wallet or small portfolio, plastic dividers with colored tabs.
Choosing your topics:
- First identify the top 3 topics of conversation where your loved one is experiencing significant memory difficulties.
- Create a master list of facts of personal relevance specific to each of these 3 areas.
- Choose the top 10 relevant facts for each topic of difficulty and create 10 simple, declarative sentences to represent these facts.
- Choose photos from family photo albums to pair with each of the 10 simple sentences. For topics that are difficult to represent with a family photo (like breakfast or doctor, for instance), drawings or clipart pictures can be used instead.
Here's an example of the type of text that is in a communication wallet:
NOTE: This example only includes three of the simple sentences to save space. A complete wallet will have ten sentences for each topic.
EXAMPLE: Topic 1: My Day
Topic Prompt: "Tell me about your day."
1. I get up and get dressed around 9:00a.m.
2. Then I eat breakfast.
3. After meals I wash and dry the dishes.
Assembling the wallet:
- Print or handwrite each sentence clearly for easy reading.
- Cut out or print the photographs you chose, pairing a relevant photo to each of your simple sentences.
- Arrange your sentences and pictures onto index cards (large or small depending upon preference.) Make each card as organized and visually clear as possible.
- Laminate cards or cover with contact paper (optional but recommended).
- Insert into a plastic wallet or small portfolio.
- Use plastic dividers with color-coded tabs to separate each of the three topics. In the case of someone who can't manage a tab system, each topic can have its own separate and distinct wallet.
Teaching your partner how to use the wallet:
- Get your loved one familiarized with the communication wallet much as possible. The more they become comfortable with it, the sooner they will be able to benefit from it.
- Start by saying: "Now we are going to practice having a conversation. This wallet has pictures and sentences that you can look at to help you remember what you want to say. Open it to the first page. Let's talk about your day. Tell me about your day." (The underlined phrase can be substituted with one of the topics you have chosen for your wallet.)
- Praise your partner for accurately reading the phrases and for making accurate elaborations about the stimulus sentences and expand on them if possible.
- If the communication breaks down after this, prompt them to read the next related sentence to continue to topic of conversation (say "Wait, read this.")
- If they are still unable to contribute to the conversation, read the next sentence aloud to them, encouraging them to participate and read along.
- Continue to practice this until your loved one is comfortable using the wallet to read all 10 sentences for each of the 3 topics in response to a request for conversation.
Effective use:
- Encourage your loved one to use the communication wallet often, with as many conversational partners as possible.
- Be sure to consider the other communication techniques you've learned to support your communication even when using the wallet for extra support and structure.
- If you like the idea and it's working for you, there's no need to stop at 3 topics. Feel free to make more and enlist family and friends to help out.
Bourgeois, M. S. (1990). Enhancing conversation skills in patients with Alzheimer's disease using a prosthetic memory aid. Journal of Applied Behavior Analysis, 23(1), 29-42. doi:10.1901/jaba.1990.23-29
Copyright © 2013, 2014 Lee Ann Faria. All rights reserved.