ot groups with older adults reference: ross, ch. 6-8 mandel, jackson, zemke, nelson & clark,...

OT GROUPS WITH OT GROUPS WITH OLDER ADULTSOLDER ADULTS

Reference: Ross, Ch. 6-8Reference: Ross, Ch. 6-8Mandel, Jackson, Zemke, Nelson & Mandel, Jackson, Zemke, Nelson &

Clark, Lifestyle RedesignClark, Lifestyle RedesignMacdonald, OT Approaches to Macdonald, OT Approaches to

Treatment of Dementia PatientsTreatment of Dementia Patients

From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Ross Five Stage GroupsRoss Five Stage Groups

►Based on sensory integration theoryBased on sensory integration theory►Organized by degree of sensory inputOrganized by degree of sensory input►Designed for persons with limitations in Designed for persons with limitations in

cognition, sensory processing and social cognition, sensory processing and social skillsskills

►Examples: Allen levels 2 to 3, persons with Examples: Allen levels 2 to 3, persons with moderate to moderately severe dementia, moderate to moderately severe dementia, chronic mental illness, post CVA or TBIchronic mental illness, post CVA or TBI

►Good choice for persons who don’t Good choice for persons who don’t verbalizeverbalize


5 Stages – Brief Review5 Stages – Brief Review

► I. Orientation – Begin with something novel, I. Orientation – Begin with something novel, say names, give everyone a turn (pass on)say names, give everyone a turn (pass on)

► II. Movement is emphasized – Gross motorII. Movement is emphasized – Gross motor► III. Visual Motor Perceptual Activities – More III. Visual Motor Perceptual Activities – More

control added to movement (target)control added to movement (target)► IV. Cognitive Stimulation and Functioning – IV. Cognitive Stimulation and Functioning –

Use alerted state, involve group interactionUse alerted state, involve group interaction►V. Closing the session, familiar, calmingV. Closing the session, familiar, calming


Ross Makes the Following Ross Makes the Following AssumptionsAssumptions

► Stimulation thru activities affect the central Stimulation thru activities affect the central nervous systemnervous system

► Selected vestibular, tactile, or other stimuli Selected vestibular, tactile, or other stimuli promote the brain’s ability to register, promote the brain’s ability to register, organize, and respond adaptivelyorganize, and respond adaptively

► An organized sequence of inputs enhances An organized sequence of inputs enhances the response and response probabilitythe response and response probability

► Response to stimulation by special Response to stimulation by special populations can be motivated by 5-stage populations can be motivated by 5-stage groupsgroups


Assumptions, cont.Assumptions, cont.

►When neurologically impaired adults register When neurologically impaired adults register sights, sounds, textures, etc, and find it sights, sounds, textures, etc, and find it pleasurable, they are motivated to interact pleasurable, they are motivated to interact and habituate the experienceand habituate the experience

► A routine of organized sequences restores the A routine of organized sequences restores the likelihood of an automatic, habitual responselikelihood of an automatic, habitual response

► Adverse stimuli also organize by producing a Adverse stimuli also organize by producing a protective response (beach ball)protective response (beach ball)

► 5-stage group appears to restore 5-stage group appears to restore environmental interaction for impaired environmental interaction for impaired individualsindividuals


Ross GroupsRoss Groups

►Goal is to achieve calm alertnessGoal is to achieve calm alertness► Uses alerting and calming activities in an Uses alerting and calming activities in an

organized sequenceorganized sequence► Involves same seven steps as client centered Involves same seven steps as client centered

groups, but incorporated non-verballygroups, but incorporated non-verbally► Uses more than one activity during each Uses more than one activity during each

sessionsession► Requires knowledge of how to grade an Requires knowledge of how to grade an

activity for more or less stimulationactivity for more or less stimulation


Example of 5 Stage groupExample of 5 Stage group

►McMahon and Sonstroem (Ross, Ch. 11)McMahon and Sonstroem (Ross, Ch. 11)►Group at Goodwill Industries Group at Goodwill Industries

Opportunities for Older Adults (OOA) Opportunities for Older Adults (OOA) programprogram

►Led by 2 COTAsLed by 2 COTAs►OT helps plan and gather materials prior OT helps plan and gather materials prior

to group sessionto group session►Photographs show an increased alertness Photographs show an increased alertness

and awareness of surroundings with each and awareness of surroundings with each stagestage


Stage IStage I

► Signs of unrelatedness before group beginsSigns of unrelatedness before group begins► Expressions change as therapist enters roomExpressions change as therapist enters room► Each member is acknowledged and welcomedEach member is acknowledged and welcomed► Purpose of group is briefly statedPurpose of group is briefly stated► Attention of each member is obtained to extent Attention of each member is obtained to extent

possible (similar to a warm up)possible (similar to a warm up)► Activity: Marionette is passed around and triedActivity: Marionette is passed around and tried► Puppet says: “My name’s Harvey, what’s Puppet says: “My name’s Harvey, what’s

yours?”yours?”


Stage IIStage II

►Movement activities offered that either Movement activities offered that either excite or relax, according to need of excite or relax, according to need of groupgroup

►Combined with hands-on guidance from Combined with hands-on guidance from therapisttherapist

►Parachute is introducedParachute is introduced►Members reach toward center when Members reach toward center when

seated in a circle. Each grabs an edgeseated in a circle. Each grabs an edge►Promotes good upper extremity ranging Promotes good upper extremity ranging

as well as increased eye contactas well as increased eye contactFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Stage II, resultsStage II, results

► Automatic visual and kinesthetic cuesAutomatic visual and kinesthetic cues► Unifies movement of group as they raise and Unifies movement of group as they raise and

lower the parachutelower the parachute► Good visual tracking as members bounce a Good visual tracking as members bounce a

beach ball in the center, roll tennis balls around beach ball in the center, roll tennis balls around the edge clock wise, then counterclockwise the edge clock wise, then counterclockwise

► Chasing must be done mostly by therapistsChasing must be done mostly by therapists► Automatic corrections noted when ball nears Automatic corrections noted when ball nears

edgeedge► Playfulness and smiles are frequentPlayfulness and smiles are frequent


Stage IIIStage III

►Less physical exertion, more thoughtful Less physical exertion, more thoughtful actionaction

► Identifying, organizing and interpreting Identifying, organizing and interpreting sensory data (perception)sensory data (perception)

►Making productive and meaningful Making productive and meaningful responsesresponses

►Game of matching picturesGame of matching pictures►Take turns copying shapes on Take turns copying shapes on

chalkboardchalkboardFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Stage III, cont.Stage III, cont.

►Requires social skill of taking turnsRequires social skill of taking turns►Encourages others to help when Encourages others to help when

member gets stuck (while member gets stuck (while drawing/copying shape)drawing/copying shape)

►Therapist may need to restate the Therapist may need to restate the instructions for eachinstructions for each

►Verbal attempts to identify objects Verbal attempts to identify objects being drawn should be encouraged being drawn should be encouraged (triangle= pine tree, oval= egg, etc(triangle= pine tree, oval= egg, etc


Stage III, cont.Stage III, cont.

►Common objects placed on floorCommon objects placed on floor►Members asked to identify each by Members asked to identify each by

namename►Blanket covered objectsBlanket covered objects►Therapist asks group to remember Therapist asks group to remember

items, writes name of item on boarditems, writes name of item on board►When all are recalled, clap hands to When all are recalled, clap hands to

applaudapplaudFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Stage IVStage IV

► Use energy created in previous stagesUse energy created in previous stages► Focus on cognitive taskFocus on cognitive task►Opportunity for organized behaviors to be Opportunity for organized behaviors to be

observedobserved►Group discusses feelings about previous Group discusses feelings about previous

activities (processing)activities (processing)►Group asked to remember the sequence, Group asked to remember the sequence,

therapist uses cues to remindtherapist uses cues to remind►Discuss ability to remember, what problems Discuss ability to remember, what problems

each member has with memory each member has with memory (generalizing, application)(generalizing, application)


Stage V - ClosureStage V - Closure

►Restore inner equilibriumRestore inner equilibrium►Something familiar passed aroundSomething familiar passed around►Pat the bunny, pass it onPat the bunny, pass it on►Shake hands goodbyeShake hands goodbye►Therapist compliments members as Therapist compliments members as

appropriate (feedback, summary)appropriate (feedback, summary)►More spontaneous interaction occurs More spontaneous interaction occurs

during closureduring closureFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Ross, Ch. 8Ross, Ch. 8

►Examples of graded orderExamples of graded order►Simple puzzle (8 to 20 pieces)Simple puzzle (8 to 20 pieces)►Show picture, all members work on Show picture, all members work on

putting together to match pictureputting together to match picture►A Stage III activityA Stage III activity►How to modify to make harder or easier?How to modify to make harder or easier?►Example: Remove one piece for each Example: Remove one piece for each

member, keep rest intactmember, keep rest intact


Ross 5-Stage Groups: Ross 5-Stage Groups: SummarySummary

►Looks simple but is exceedingly Looks simple but is exceedingly complexcomplex

►Requires thorough knowledge of Requires thorough knowledge of sensory integration theorysensory integration theory

►See Table 7A for comparison of 5-stage See Table 7A for comparison of 5-stage group with A. Jean Ayres theorygroup with A. Jean Ayres theory

►More on this group intervention More on this group intervention technique next year in advanced SI technique next year in advanced SI classclass


Macdonald: Stage Specific OT Macdonald: Stage Specific OT Groups for Persons With Groups for Persons With

DementiaDementia►Groups of 4 to 8 membersGroups of 4 to 8 members►Based on Reisberg FAST StagesBased on Reisberg FAST Stages►Goal is to Maintain function through Goal is to Maintain function through

practicepractice►Category 3 to 4 have lost abstract Category 3 to 4 have lost abstract

reasoningreasoning►Category 5 to 6 have decreased judgment Category 5 to 6 have decreased judgment

and disorientationand disorientation►Category 7 has minimal speech, motor Category 7 has minimal speech, motor

skills, and awarenessskills, and awarenessFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Macdonald: Mild StagesMacdonald: Mild Stages

►Categories 3 and 4:Categories 3 and 4: Motor exercises, movement to music, board Motor exercises, movement to music, board

games, sorting tasks, perceptual motor games, sorting tasks, perceptual motor games (horseshoes, ring toss, bowling)games (horseshoes, ring toss, bowling)

Verbal Activities: Focused discussion of Verbal Activities: Focused discussion of current events, modified trivia/memory current events, modified trivia/memory games, creative writing, reminiscing, group games, creative writing, reminiscing, group storytellingstorytelling

ADL: Discussion, demonstration, use of ADL: Discussion, demonstration, use of adaptive devices, practice of routines of adaptive devices, practice of routines of self care, labeling and sequencingself care, labeling and sequencingFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Macdonald: Moderate StagesMacdonald: Moderate Stages

►Categories 5 and 6Categories 5 and 6 Gross and fine motor activities graded for Gross and fine motor activities graded for

lesser degree of decision making and lesser degree of decision making and problem solvingproblem solving

Verbal: Focus on reality orientation, use of Verbal: Focus on reality orientation, use of more extensive visual aids, simple word more extensive visual aids, simple word games, expression of feelings, poetry games, expression of feelings, poetry reading, and structured socializationreading, and structured socialization

Sensory: Stimulation through activities and Sensory: Stimulation through activities and related discussionsrelated discussionsFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Macdonald: Severe StageMacdonald: Severe Stage

► Category 7: Emphasis is prevention of total Category 7: Emphasis is prevention of total regressionregression

► Sensory: Sensory: Tactile – Nylon netting, vibrators, lotion, hugsTactile – Nylon netting, vibrators, lotion, hugs Visual – Balls, lights, colors, movementVisual – Balls, lights, colors, movement Auditory – Noisemakers, hand clapping, musicAuditory – Noisemakers, hand clapping, music Olfactory – Coffee, cloves, potpourri, strong odorsOlfactory – Coffee, cloves, potpourri, strong odors Vestibular/kinesthetic – Slow rocking, passing Vestibular/kinesthetic – Slow rocking, passing

weighted objects, ankle weightsweighted objects, ankle weights► Also suggests Ross 5-stage groups for all Also suggests Ross 5-stage groups for all

categoriescategoriesFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Well Elderly Study: 9 ModulesWell Elderly Study: 9 Modules

1.1. Occupation, health, and agingOccupation, health, and aging2.2. Transportation and occupationTransportation and occupation3.3. Finances and occupationFinances and occupation4.4. Health through occupation (physical, Health through occupation (physical,

mental)mental)5.5. Dining as an occupationDining as an occupation6.6. Time and occupationTime and occupation7.7. Home and community safetyHome and community safety8.8. Relationships and occupationRelationships and occupation9.9. Outings, exploration, and special eventsOutings, exploration, and special events


Using the ModulesUsing the Modules

► Flexible application, modified according to Flexible application, modified according to group & individual needs and interestsgroup & individual needs and interests

► Each topic related to occupation, discuss how Each topic related to occupation, discuss how related (e.g., transportation)related (e.g., transportation)

► Used Cole’s 7 stepsUsed Cole’s 7 steps► Record ideas on flip chartRecord ideas on flip chart► Plan a group activity as a way to implement Plan a group activity as a way to implement

some of the ideas (bus scavenger hunt)some of the ideas (bus scavenger hunt)► Discussion encouraging self-reflective Discussion encouraging self-reflective

analysisanalysisFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Group Title: Lifestyle Group Title: Lifestyle RedesignRedesign

Goals:Goals:►Occupational Self-AnalysisOccupational Self-Analysis

Think about occupations you have found Think about occupations you have found most fulfillingmost fulfilling

Evaluate extent to which they are Evaluate extent to which they are experiencing occupational deprivation or experiencing occupational deprivation or dysfunctiondysfunction

Identify fears or physical limitations that are Identify fears or physical limitations that are barriers to engagement in life (the world)barriers to engagement in life (the world)

Determine small steps to overcome barriersDetermine small steps to overcome barriers►Shift in attitude from “I can’t” to “I can”Shift in attitude from “I can’t” to “I can”


Group ProcessGroup Process

►Completing exercises in the modulesCompleting exercises in the modules►Planning and enacting group activitiesPlanning and enacting group activities►Discussing how occupation effects Discussing how occupation effects

health and happiness and well-beinghealth and happiness and well-being►Perspective of remaining engaged in Perspective of remaining engaged in

life as key factor of successful aginglife as key factor of successful aging► Incorporation of 2 aspects: Selection Incorporation of 2 aspects: Selection

style and experienced meaningstyle and experienced meaningFrom Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Selection StyleSelection Style

►BalanceBalance►Habits and routinesHabits and routines►FlexibilityFlexibility►OrchestrationOrchestration►Time structureTime structure


Experienced MeaningExperienced Meaning

►Meaning in life is basic human need (Maslow, Meaning in life is basic human need (Maslow, Frankl)Frankl)

► Flow: Positive psychological state that results Flow: Positive psychological state that results when engaged in an occupation in which the when engaged in an occupation in which the challenge carefully matches one’s abilitieschallenge carefully matches one’s abilities

► Past history: Occupations are meaningful when Past history: Occupations are meaningful when tied to one’s culture and beliefs about their tied to one’s culture and beliefs about their value value

► Flexibility: May be needed in substituting Flexibility: May be needed in substituting different occupations for ones no longer possibledifferent occupations for ones no longer possible


Prevention Programs: Initial Prevention Programs: Initial PlanningPlanning

►Suggest OT begin with needs Suggest OT begin with needs assessment of well elderly in your assessment of well elderly in your communitycommunity

►Develop topic and themesDevelop topic and themes►Develop criteria for membershipDevelop criteria for membership►Research community fundingResearch community funding►Establish meeting placeEstablish meeting place►Recruit participantsRecruit participants


ImplementationImplementation

►Meetings: Small groupsMeetings: Small groups►Outings (experiences, take photos)Outings (experiences, take photos)► Rapport buildingRapport building► Include discussion of occupation and Include discussion of occupation and

analysis as part of each sessionanalysis as part of each session► Follow up on individual and group interestsFollow up on individual and group interests► Promote group cohesivenessPromote group cohesiveness► Prepare participants for ending (time Prepare participants for ending (time

limited)limited)From Cole, M. Group dynamics in occupational therapy instructor's manual. Online document, http://www.efacultylounge.com, based on Cole, M. (2004). Group dynamics in occupational therapy, Third edition. Thorofare, NJ: SLACK Incorporated.

Some ideasSome ideas

► Introduction to occupationIntroduction to occupation► Health and aging: Changes in occupationHealth and aging: Changes in occupation► Occupations: Time and energyOccupations: Time and energy► Active mind: Mental challenges and gamesActive mind: Mental challenges and games► Outing: LibraryOuting: Library► Transportation and occupation: Exploring resourcesTransportation and occupation: Exploring resources► Nutrition: Deciphering food labelsNutrition: Deciphering food labels► Adaptive equipment in the kitchenAdaptive equipment in the kitchen► Home safety: Body mechanics, energy Home safety: Body mechanics, energy

conservation, fall preventionconservation, fall prevention► Cooking and dining togetherCooking and dining together


ot groups with older adults reference: ross, ch. 6-8 mandel, jackson, zemke, nelson & clark,...

Documents

group dynamics

group interaction

online document

stage groups

response probability

ot groups

ross groups goal

calming activities