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Section 24
"Writing," Styrofoam Ball, & Days Diary

Table of Contents | NCCAP/NCTRC CE Booklet

"Writing"

The way you might initiate writing with a resident is to test if your resident is able to make a few marks on a paper.  The following are goals from Volume Five in this series regarding “Making Time for Your Low Functioning Alzheimer's Residents.”  That Volume provides you with over two hundred sample Care Plan Goals.  Here is a sample of a few of the Care Plan Goals related to writing as an activity.

Residents with whom to try “Writing”

Styrofoam Ball Adaptation
As mentioned earlier, many residents can bring their thumbs and index fingers towards each other, but lack the muscular coordination to actually grasp.  If this is the case, to assist them with writing their names, letters, or just marking on paper, slide a pencil through a Styrofoam Ball.  Select a diameter of ball that best compensates for this grasping problem. 

Observe and Assess!
1. Evaluate if the resident is unable to grasp a narrow pencil.  Obviously you would not have a resident use an adaptive device if he or she does not need one.
2. Stabilize the paper by taping one sheet of typing paper to the over-the-bed-table placed in front of the resident.  Masking tape is easier to remove from the Formica table top than Scotch tape.
3. Make sure that the table is positioned at the lowest point, if possible.  However, be sure it is not touching the resident's knees and is accommodating the movement of their elbow and wrist. Volume One in this series has more details regarding work surface height.
4. Demonstrate marking on the paper.  As mentioned earlier, be sure if you are right-handed that you are standing to the resident’s right so that when you stabilize the project, your arm will not be in the resident’s line of vision.
5. Offer the pencil with the ball to the resident to see if she can grasp it independently.
6.  If your resident is not able to grasp the Styrofoam ball independently, cup your hand around his or hers.  Then give a compliment and say something like, "Good, great, good job. You’re really able to hold the pencil well."  However, in fact, perhaps you are actually holding the pencil with your hand cupped around theirs.
7.  If your resident is unable to mark on the paper him or herself, you might have the following Care Plan Goals…

Assess whether or not, for example, your Marie writes or prints her name.  If she is using cursive writing, be sure you have your sample of her name in cursive.  However, if she is printing her name, be sure to print the sample of her name.  Thus, she can use this as a guide. Then, leave in a labeled Activity Project Bag in resident’s room.
Residents with whom to try Styrofoam Ball

Culture Change Implementation: Place Styrofoam Ball in labeled Activity Project Bag left in resident’s room for CNA, volunteer, etc. use.

Days Diary

Usually, residents who are at the mental level to benefit from making marks on paper, might be able to benefit from a Reality Orientation device like a Days Diary.  The Days Diary is exactly what it sounds like.  It is a Diary of what the resident does during the day.  The Days Diary is a pocket folder containing magazine pictures, or a book you have made of magazine pictures depicting events in the resident's day such as meal times and activities.  For a resident who has more capability (and by "more capability" I mean that he or she has an attention span of several minutes and is in the early, rather than late stages, of Alzheimer's), you might assist him or her in making a "Days Diary." Because of its structured format, the creation of a Days Diary is a good activity for a volunteer to conduct with a resident. 

Observe and Assess!
To initiate this activity with your Effie, discuss with her what her daily activities are.  She gets up in the morning, she has breakfast, lunch and dinner, and she may go to some activities during the day. 
To implement the Days Diary, I find it is best if someone takes several sessions to discuss with the resident what they recall about their day.  For example, if breakfast is important to your Effie, you may end up with two or three pages of pictures representing breakfast.  Because of the time involved in making a Days Diary, as mentioned above, this is a good activity for a volunteer.  For example, the volunteer may say to Effie, “Now Effie, in the morning what kind of food do you like to have for breakfast?  Let’s look through this magazine and see what we find.” Or maybe you can have some pictures already torn out by another resident, who has created a picture file for you.  Usually Dietary likes food discussions prior to a meal, because if the discussion is conducted right before lunch it may help to stimulate the resident’s appetite.  You will probably get the best results, if the Days Diary is not made for the resident, but is made with the resident's input.  I find assisting in the construction and discussion of the Days Diary helps the resident in the early stages of Alzheimer's to maintain his or her awareness that there are certain activities that they do differently in the morning than in the afternoon.  You might put the Days Diary in an Activity Project Bag taped to the nightstand next to the resident’s bed.  Label this bag “Effie’s Days Diary.  Feel free to discuss pictures with her to assist her memory.”
 
Here is how a conversation implementing the Days Diary might be structured. 
--You might start off by asking, "Effie, what do you do in the morning?"
--If needed, guide the discussion by saying, "Well, let's see, you wake up in the morning. Let’s look at some pictures that remind you of waking up." 
--Your morning pictures might consist of a picture of orange juice, a picture of a bed, and a picture of a sunrise. 
--Then you ask, "Which one of these pictures do you think that you would like to have to remind you of morning? 

Paste the selected picture(s) to a sheet of construction paper.  You might use a felt marker and write the label Effie wants to put on each picture.  Effie night request you to print the word "breakfast" by the picture of orange juice.  Then you would use Elmer’s glue and glue the picture of the orange juice, for example, to construction paper with the word "breakfast" or "morning" or "wake-up" on it… whatever your Effie decides to label the first part of her day. 

I’ve had some residents who just have one picture to represent a concept like breakfast; other residents have several pictures for the morning and hardly any for any other times of day. For lunchtime, you might have some pictures of food.  For one Days Dairy I made for a resident, there was a plate of spaghetti for lunch to illustrate that meal.   I pasted with Elmer’s glue the picture of the spaghetti on the construction paper, and then wrote the word "Lunch" at the bottom.

Observe and Assess!  Perhaps, if your Effie's attention span is so short her recall from day to day is practically nonexistent, the goal might become not to create a finished Day Diary, but just to have a reality-based discussion about the pictures and her memories. 

Residents with whom to try a Days Diary

Culture Change Implementation: Place Days Diary in labeled Activity Project Bag left in resident’s room for CNA, volunteer, etc. use.