Tip of the Month - March 2022- Supports for Dementia
WHY use visual communication supports?
Individuals with dementia benefit from visual support systems in order to help them understand language and events around them, remember information and express themselves. Visual supports such as memory books have a huge wealth of evidence and research behind them.
WHAT are visual communication supports
There are many different types of visual systems which may help. It is important to remember that all learning is difficult for a person with dementia, so any type of visual system we put in place must be functional and useful and must be used every day.
Continuum lines – a scale to indicate how someone is feeling or the complexity of a task. You ask them a question and then they can point to a place on the line to show how they feel about that question. | Shopping List – this could be handwritten or printed pictures. You could laminate a visual shopping list and mark what is needed with a whiteboard marker and wipe the marks off once they have been put into the trolley.  | Identification Cards - to be stored in a pocket, wallet or on a lanyard with personal or emergency information  |
| Small objects as visual reminders – place objects around the home as reminders to complete tasks. | Labels and signs - on doors or objects, e.g., place a label and photo on each door in a residential ward or labels on the linen cupboard shelves to sort towels, sheets, etc. | Whiteboard to write lists or instructions, which can be referred back to while completing a task or activity. |
Daily Planner – this can be on paper or using a calendar or app | Menu boards – you could use Velcro or BluTak to change the date and food options each day | Phone lists or visual phones |
Choosing boards. These can be made for specific situations such as a café | Pain boards | Communication passports – there are many examples of communication passports, see our April 2020 tip of the month here Some other examples can be found Talking Trouble Aotearoa - here CALL Scotland - Here SCOPE - here |
Visual scenes - This is a picture or photograph of a real situation on an iPad or other tablet device – it sets the context for communication. Each scene has hotspots that will ‘speak’ if you press them, e.g. a picture of the person’s kitchen will have hot spots - the fridge may say “I’m hungry”, the pantry may say “we need to go shopping for groceries”, the coffee maker may say “Let’s have a coffee”. Speak Scene is a low-cost option for iDevices.   | Timers - to visually show how much longer is left at an event or activity before finishing and moving to something else. You could use a kitchen timer, egg timer or an app. |
Memory Books
A memory book is one of the most important visual communication supports to create. It is a connection to the present and a bridge to the past. This contains information about the individual’s life, history, hobbies, family, friends, holidays, etc. It can be used to
- refocus the individual during difficult situations,
- to initiate conversations about their life and interests,
- to enhance self-esteem
- as a security tool when they are in an unfamiliar place (such as the hospital).
Communication partners could ask the individual about:
- things they feel proud of in their life
- people who are important to them
- favourite memories
- hobbies
- places they have travelled, etc. If the individual does not respond to these questions, flip through the book and read the annotations and comment on items included in the book to initiate conversation.
A memory book can be created on paper using Microsoft Word or by handwriting next to photos in a scrapbook. It is best to keep the pages simple and uncluttered by having only the photos and some short and simple statements on each page. Here are some templates:
It could be created on the computer or an app. Apps and websites such as Book Creator, Story Creator , My Story book and Pictello are useful for creating memory books, electronic ‘talking’ photo albums and for sharing personal information/stories/memories with others.
WHEN should I use visual communication supports?
It is important to use them throughout the day. You may use a range of different supports (from the above list) during different times of the day. Use them to
- warn the individual of what is going to happen (visual timetable or calendar or diary)
- reduce anxiety about what is going to happen (visual timetable or calendar or diary),
- reduce anxiety about memory difficulties (memory book, communication passport, visual scenes, photo albums)
- to enjoy conversation (memory book, visual scenes, calendar).
WHERE should I keep the visual communication supports?
All of the visuals can be used at home, in residential care, at the shops and in other community locations. It is useful to stick the visual up where you would most commonly talk about that person/event/activity, e.g., have a visual timetable on the fridge (pictured beside), a shopping list on the pantry door, memory book and photo album on the coffee table or bedside table, identification card in their wallet or placed in their pocket each morning, pain board beside the bed or in the bathroom, photos of people by the telephone, etc. If it is available it will get used whereas if you must walk to a different room to find the communication support, you probably won’t use it.
HOW should I use these?
- Use them in natural everyday conversations to add to your verbal communication. You don’t stop talking when you use a visual communication support. The visual added to your verbal communication can increase the individuals understanding and memory recall.
- Be consistent in using the communication supports every day.
- Ensure that everyone communicating with the individual with dementia knows how to use the communication supports so that there is consistency.
Tips for communicating with an individual with Dementia
How you talk to people with dementia is just as important as the visual cues you use. You should train caregivers and communication partners to:
- Ask simple questions
- Give the person extra time to respond – count to 10 after you ask a question or make a comment before saying anything more
- Speak in short, concrete sentences
- Respond immediately to communication attempts
- Maintain eye contact
- Redirect the person from frustrating or embarrassing problems to things such as photo albums, memory books or other activities
- Rephrase the conversation so far, to keep a topic focused when a person is confused
- Try to have a shared visual referent to look at together
- Avoid quizzing for the ‘right answer’
- Encourage and validate the use of any communication techniques
From http://praacticalaac.org/praac.../
Videos to support training
University of Queensland have created some high-quality videos for residential and home care support staff to learn about how to support communication:
https://www.youtube.com/playlist?list=PL71596BDFC6BE368Dtipof the month march 2022 tips for dementia.pdf
https://www.youtube.com/playlist?list=PL8940478A0D6DBE97
Talking Mats
Talking Mats is a resource that supports decision making and sharing opinions during conversations. It uses sets of symbol cards and is interactive. It requires a visual scale and a space on which to display the options. Talking Mats training is available within New Zealand, see our website here to complete the foundation training.
References:
- PrAACticalAAC
- Talking Mats
- University of Queensland
- Oxfordshire Total Communication
- CALL Scotland
- National Health System, England
- SCOPE
- Alzheimer’s Australia
- Dementia Ability
Created by Jessamy Bell (TalkLink Speech Language Therapist) in consultation with Annabel Grant (Massey University Speech Language Therapist and Clinical Educator with Research interest in Communication disorders of Dementia) in July 2016. Updated by Paula Shennan (TalkLink Speech Language Therapist) in November 2021.
To download this tip of the month as a PDF, please click here
WHY use visual communication supports?
Individuals with dementia benefit from visual support systems in order to help them understand language and events around them, remember information and express themselves. Visual supports such as memory books have a huge wealth of evidence and research behind them.
WHAT are visual communication supports
There are many different types of visual systems which may help. It is important to remember that all learning is difficult for a person with dementia, so any type of visual system we put in place must be functional and useful and must be used every day.
| Continuum lines – a scale to indicate how someone is feeling or the complexity of a task. You ask them a question and then they can point to a place on the line to show how they feel about that question. | Shopping List – this could be handwritten or printed pictures. You could laminate a visual shopping list and mark what is needed with a whiteboard marker and wipe the marks off once they have been put into the trolley. | Identification Cards - to be stored in a pocket, wallet or on a lanyard with personal or emergency information |
| Small objects as visual reminders – place objects around the home as reminders to complete tasks. | Labels and signs - on doors or objects, e.g., place a label and photo on each door in a residential ward or labels on the linen cupboard shelves to sort towels, sheets, etc. | Whiteboard to write lists or instructions, which can be referred back to while completing a task or activity. |
| Daily Planner – this can be on paper or using a calendar or app | Menu boards – you could use Velcro or BluTak to change the date and food options each day | Phone lists or visual phones |
| Choosing boards. These can be made for specific situations such as a café | Pain boards | Communication passports – there are many examples of communication passports, see our April 2020 tip of the month here Some other examples can be found Talking Trouble Aotearoa - here CALL Scotland - Here SCOPE - here |
| Visual scenes - This is a picture or photograph of a real situation on an iPad or other tablet device – it sets the context for communication. Each scene has hotspots that will ‘speak’ if you press them, e.g. a picture of the person’s kitchen will have hot spots - the fridge may say “I’m hungry”, the pantry may say “we need to go shopping for groceries”, the coffee maker may say “Let’s have a coffee”. Speak Scene is a low-cost option for iDevices. | Timers - to visually show how much longer is left at an event or activity before finishing and moving to something else. You could use a kitchen timer, egg timer or an app. |
Memory Books
A memory book is one of the most important visual communication supports to create. It is a connection to the present and a bridge to the past. This contains information about the individual’s life, history, hobbies, family, friends, holidays, etc. It can be used to
- refocus the individual during difficult situations,
- to initiate conversations about their life and interests,
- to enhance self-esteem
- as a security tool when they are in an unfamiliar place (such as the hospital).
Communication partners could ask the individual about:
- things they feel proud of in their life
- people who are important to them
- favourite memories
- hobbies
- places they have travelled, etc. If the individual does not respond to these questions, flip through the book and read the annotations and comment on items included in the book to initiate conversation.
A memory book can be created on paper using Microsoft Word or by handwriting next to photos in a scrapbook. It is best to keep the pages simple and uncluttered by having only the photos and some short and simple statements on each page. Here are some templates:
It could be created on the computer or an app. Apps and websites such as Book Creator, Story Creator , My Story book and Pictello are useful for creating memory books, electronic ‘talking’ photo albums and for sharing personal information/stories/memories with others.
WHEN should I use visual communication supports?
It is important to use them throughout the day. You may use a range of different supports (from the above list) during different times of the day. Use them to
- warn the individual of what is going to happen (visual timetable or calendar or diary)
- reduce anxiety about what is going to happen (visual timetable or calendar or diary),
- reduce anxiety about memory difficulties (memory book, communication passport, visual scenes, photo albums)
- to enjoy conversation (memory book, visual scenes, calendar).
WHERE should I keep the visual communication supports?
All of the visuals can be used at home, in residential care, at the shops and in other community locations. It is useful to stick the visual up where you would most commonly talk about that person/event/activity, e.g., have a visual timetable on the fridge (pictured beside), a shopping list on the pantry door, memory book and photo album on the coffee table or bedside table, identification card in their wallet or placed in their pocket each morning, pain board beside the bed or in the bathroom, photos of people by the telephone, etc. If it is available it will get used whereas if you must walk to a different room to find the communication support, you probably won’t use it.
HOW should I use these?
- Use them in natural everyday conversations to add to your verbal communication. You don’t stop talking when you use a visual communication support. The visual added to your verbal communication can increase the individuals understanding and memory recall.
- Be consistent in using the communication supports every day.
- Ensure that everyone communicating with the individual with dementia knows how to use the communication supports so that there is consistency.
Tips for communicating with an individual with Dementia
How you talk to people with dementia is just as important as the visual cues you use. You should train caregivers and communication partners to:
- Ask simple questions
- Give the person extra time to respond – count to 10 after you ask a question or make a comment before saying anything more
- Speak in short, concrete sentences
- Respond immediately to communication attempts
- Maintain eye contact
- Redirect the person from frustrating or embarrassing problems to things such as photo albums, memory books or other activities
- Rephrase the conversation so far, to keep a topic focused when a person is confused
- Try to have a shared visual referent to look at together
- Avoid quizzing for the ‘right answer’
- Encourage and validate the use of any communication techniques
From http://praacticalaac.org/praac.../
Videos to support training
University of Queensland have created some high-quality videos for residential and home care support staff to learn about how to support communication:
https://www.youtube.com/playlist?list=PL71596BDFC6BE368Dtipof the month march 2022 tips for dementia.pdf
https://www.youtube.com/playlist?list=PL8940478A0D6DBE97
Talking Mats
Talking Mats is a resource that supports decision making and sharing opinions during conversations. It uses sets of symbol cards and is interactive. It requires a visual scale and a space on which to display the options. Talking Mats training is available within New Zealand, see our website here to complete the foundation training.
References:
- PrAACticalAAC
- Talking Mats
- University of Queensland
- Oxfordshire Total Communication
- CALL Scotland
- National Health System, England
- SCOPE
- Alzheimer’s Australia
- Dementia Ability
Created by Jessamy Bell (TalkLink Speech Language Therapist) in consultation with Annabel Grant (Massey University Speech Language Therapist and Clinical Educator with Research interest in Communication disorders of Dementia) in July 2016. Updated by Paula Shennan (TalkLink Speech Language Therapist) in November 2021.
To download this tip of the month as a PDF, please click here