Benevolent Ballet Fall Prevention

On Cultural Sensitivity

2010-10-20T10:00:00.002-04:00

I enjoyed reading the article about Cultural Specific Care on the ALFA Update site. I have a sweet story to share. Minna was a tiny Chinese lady who resided in a memory care unit of a nursing home. The staff had told me not to include her as she didn't speak English. Because I like a challenge I paid special attention to her. After our Benevolent Ballet class, which she thoroughly enjoyed , she hurried back to her room. A few minutes later she handed me a tiny package wrapped in a paper napkin. Inside were two pennies for which I gratefully thanked her! This was repeated after each class. Either because Minna ran out of pennies or because her condition was deteriorating this gift became her dessert cookie, a pudding cup and finally a cup of melted ice cream! The Asian custom of reciprocal gift giving was ingrained in her spirit. I'll always remember dear Minna.

On Empowerment

2010-10-11T18:07:00.003-04:00

The frail residents of nursing homes as well as those with middle to late stage Alzheimer's are more capable then they are usually given credit for. They simply need to be encouraged and empowered. They may not be able to do brain surgery but they can do more then sit staring into space, pacing the floor or acting out. I get very angry when aides tell me "Oh! He or she won't do anything. You don't have to bother with them." The key is to first make sure:

That their physical and emotional needs are met
That they feel safe from the possibility of failing (or falling for that matter)
That they know you are interested in them and want share yourself with them

Then all you have to do is sincerely share your passion with them at their level of sophistication and cognition. You will be rewarded by the class's enthusiaastic participation.

Busy September

2009-08-25T13:10:00.000-04:00

Hello Everyone,
On Sept. 22 I'll be going to England to visit my son's family. Their adorable 2 year old twin girls are growing up so fast I've just got to see them! While in the UK I'd like to meet with someone about the possibility of holding a training seminar there. Any guidance would be appreciated.

September is going to be a busy month. On the twelve we'll be having a party for our Uncle Jerry's 102nd birthday After living with us for nearly six years we moved him into Savannah Court Assisted Living.He gets help with all his activities of daily living. There are lots of activities and the staff is caring.

Motivating the Elderly

2009-08-22T10:44:00.000-04:00

Follow the Benevolent Ballet-Fall Prevention Blog for helpful hints on motivating the elderly and inspiration. http://benevolentballetfallprevention/blogspot.com prevention/blogspot.com

Creativity in Alzheimer's Disease

2009-08-18T19:42:00.000-04:00

I have found that creativity is not affected by deficits in memory or cognition. In my classes I have found that after the participants become aware and focused they can exhibit remarkable creativity. It happens after he or she has participated in the exercise program for around thirty minutes or so. Their attention is drawn to the music and they are instructed to “Listen to the music and let it guide you anyway you like” The exercise is facilitated with a scarf, ribbon or balloon. Take Lee, who I’d say is middle to late stage AD. He is amicable and tries but has very poor cognition. The gentleman next to him keeps chiding him which is not good for Lee’s self esteem. I began by placing my hands over his, holding the large balloon. As we began to move with the music and I saw that he understood I backed away asking him to continue. The transformation was astonishing. With a little encouragement he continued to interpret the music with amazing creativity. At the end I told how wonderfully he had done. It was a compliment he badly needed!

I’d be interested to know what experiences you have had regarding creativity with this population.

On Aggressive Behavior

2009-08-17T09:07:00.000-04:00

The aide told me not to bother with the new resident who. I’ll call Mr. J. “He may get violent.” They said. I believe that most bad behavior is the result of the inability to communicate one's needs, indeed, the basic needs of all personhood or the inability to understand their environment. Put yourself in this position. Wouldn’t you be frustrated nearly to the point of lashing out? Just yesterday I overestimated a day care client's ability to follow verbal direction. He immediately tensed up and made a very belligerent remark. A staff member strongly chastised him. It was my fault. I had asked him to understand something that he simply was unable to do. He was frustrated and angry. I went to him taking his hands in mine while comforting him saying something like,” It’s alright. Come on we'll do it together" Finding a building block or retained strength I said “Good music eh?” Mr. J nodded. He felt safer and willing allowed me to take him through the movement and was smiling by the end. I even was able to back away while he continued the movement on his own.

7 Steps for Involving those with Severe Cognitve Deficits in Exercise Programming

2009-08-07T14:06:00.000-04:00

Yes it is possible for those with severe cognitive deficits to participate in exercise and other activities programming. The process goes like this:

1. Greet warmly putting person at ease and feeling safe ( i.e. unchallenged).

2. Use body language and eye contact to keep person focused

3. Use as few words as possible giving one or two word directions and then just demonstrating

4. Always approach and direct the person from the front keeping eye contact

5. Ask permission to take the person’s hands and then guide him through the exercise gradually letting go and backing off while giving positive reinforcement for even the slightest effort. Ifise necessary repeat this process.

6. With each effort make empowering statements. For instance, “See you can do it!” or “Beautiful!” or “That’s exactly right!”

7. Watch for signs of frustration, pain or fatigue.
Let me know if this works for you and please feel free to add to this list.
Enjoy

Follow Me

2009-07-26T17:18:00.001-04:00

I have updated my blog with stories, tips and pictures. I hope that everyone interested in caring for the elderly will Follow Me. If you have a relevant site I'd be happy to exchange links with you.

The Wanderer,,Funny Story

2009-07-26T16:53:00.000-04:00

Who says that those with late stage AD can't plan or make decisions? Helen was a new client at the adult day center. She was a wanderer pacing aimlessly in and out of the room where we were having class. At one point she paused and looked at me. I thought she was feeling the music. Aha! this was my chance. I said "Come on Helen. Lets dance."I take her hands and begin to dance with her. After reluctantly moving with me she starts to lead and I'm thinking "Oh this is good". Helen then very purposely leads me to the couch and sits me down! Her attitude was "I'll show You!" Well, she showed me alright and put me in my place!

“I feel like I could fly!”

2009-07-17T12:53:00.001-04:00

I didn’t feel much like teaching today. The air conditioner had died and I was drained. But a job is a job and the show must go on. As always I psyched myself and plunged in. It turns out that the class at the adult day care went well with good humor and participation. We always end with improvisation using scarves ribbons or balloons and then the bow or reverence. Among the usual comments of “Oh that was good!” and “Bless you!” (from my African American friends and Islanders) Ms. Ruth claps her hands and says “I just feel like I could fly!” Well I just hugged her and thanked her and told her that she had made my day worthwhile!

On Music

2009-07-10T22:08:00.000-04:00

The magic of classical music and dance are ageless. The young child may be a fairy queen. The teen may imagine herself as Juliet. The elderly are transported back to a time of beauty, grace and romance. It becomes the perfect medium for exercise and self expression. Even neuro-muscular problems can helped when the person focuses on the music instead of the mechanics of movement. It has been found that the part of the brain that processes music isn't usually affected by Alzheimer's or other dementias. Many nursing homes play music all day long. However, unless the residents' attention is drawn to it by the leaders' verbal cues, eye contact and body language, the music will be like white noise in the background and do no good. I have found that classical and semi classical music that have clear rhythms (waltzes, marches, polkas and even adagios) and mood works best for exercise. It doesn't matter if the residents have never listened to classical music. I have used it with residents coming from diverse backgrounds. Through the process of empathic engagement the residents will almost always 'get it'.

Twitter

2009-07-08T11:43:00.000-04:00

I hope to update this blog more often now that I have subscribed to twitterfeed. I am not sure how it works. So we shall see. If you are interested in motivating the elderly to participate in group activities especially exercise please follow. The approach I use has been helpful when transferred to activities of daily living. I'd love to know your theories on motivation.

Ballet at My Age…..Oh My!

2009-06-05T19:00:00.000-04:00

The magic of classical music and dance is ageless and become the perfect medium for an exercise program for the elderly.

The bright cheery day room of the nursing home was full of residents who had been brought there to spend their afternoon. Some were sleeping. Many were just staring blankly. A few were pacing. Music was playing but no one was listening.

The group’s leader comes into the room and turns off the music. She greets the group warmly first as a whole and then individually smiling and making eye contact with each member of the ‘class’. The ‘teacher’ then announces that some great music is in store for them. The music begins. “Listen! Can everyone hear it?” she asks. “Isn’t it beautiful? It makes you want to dance!” she says or indicates by her movements and body language. “Ready? Reach those arms up high and then down. Stretch them up, up ,up! Oh that feels so good! Doesn’t it?” And so the Benevolent Ballet-Fall Prevention for the Elderly class has begun. Most of the group is participating. Those who were just watching join in with a bit of hand to hand, eye to eye and heart to heart encouragement. After a few more slow stretching exercises the music changes to an up beat tempo. Again the ‘students’’ attention is directed towards the music. “Listen!….Here’s some good toe tapping music” And we have rhythmic toe and heel drops, marching, knee slaps and claps right up to the end of the tract. They rest happy and worn out. Sometimes there is a round of applause. “Is everyone breathing?” One resident comments “I certainly hope so!” After some deep breathing the class continues at a slower pace for thirty minutes more. At this point brightly colored scarves are passed out. With the music as their guide the class is asked to paint the sky with their colors filling the room with color. They can make any design the music inspires them to. At this point magic happens. Faces are transformed as the residents (men and women alike) perform exquisite, perfectly timed movements. Then it is time to say good bye but not without ballet dancer’s ritual reverence (bow). At the end of every class the group mimes “From my heart to yours.Thank you!”

It is the connecting, sharing and caring that makes a program work. The leader’s enthusiasm, passion and joy become contagious. As long as the potential participants feel safe from failure or harm they will join in and enjoy. The energy goes back and forth inspiring both the leader and the class. This empathic engagement can contribute to the success of most programming as well as residents Activities of Daily Living.

Sheila Lehner is the founder of the Benevolent Ballet-Fall Prevention for the Elderly program. Healthcare professions in 11 states have been trained to implement this unique exercise protocol in their facilities. When used regularly up to an 80% reduction in falls has been reported.

On Appropriate Activities in Long term Care.

2009-05-14T10:10:00.000-04:00

Answer to LinkedIn comment:

Theoretically I agree that activity staff often treat their residents like kindergarteners and don't offer enriching experiences. It is important to understand that a huge portion of nursing home and assisted living residents suffer from some sort of dementia reducing their ability to appreciate very sophisticated programming. Having said this, caregivers and staff must be trained to look for and connect with their charges at each individual's level of sophistication, cognition and physical ability. It helps if activity groups are set up homogeneously according to level of functioning. I believe the methodology behind the Benevolent Ballet-Fall Prevention for the Elderly program has been so successful because each person is taken as an individual and treated accordingly. For high functioning well off seniors we talk about composers, time signitures, ballets, muscle groups etc. For Alzheimer's groups we discuss the music in terms of feelings, memories and rhythm. Muscle use is discussed by encourageing observation of where the movement is felt. Much of these discussions take the form of body language and expression. I also believe that if the resident trusts that you know where they are coming from, they will be more apt to follow participate and enjoy.

Flexibility is Not Just for Ballet Dancers

2009-04-03T18:09:00.001-04:00

Sheila Lehner, Benevolent Ballet-Fall Prevention for the Elderly www.benevolentballet.com

It is not just the gymnast or the ballet dancer who should be concerned with flexibility or ranged of motion. As we age our joints, tendons and muscles stiffen as a result of inactivity, arthritis or other medical conditions. It is important to realize that just about all ADLs (activities of daily living) are dependent not only on strength, coordination and stamina, but also on flexibility.

My 101 year old uncle was sitting hunched and totally out of alignment in his wheel chair. Attempting to fasten a belly bag around him because reaching down into his pocket had become difficult for him, I asked him to lean forward. "Lean forward", I repeated "I am", he replied barely moving. When I pointed out that he only moved his head and shoulders a little he said, "I can't because you are pushing me back!" He had so little flexibility or range of movement in his hip flexors that he was unable to perform the simple act of bending forward. His physical therapy had been focused on strengthening his arms and legs and had not gotten to dealing with hip flexibility. The ability to stand up from a seated position depends not only on strength in the quadriceps but also in flexibility in the ankles and hips.

Flexibility is also necessary when it comes to balance. Picture yourself getting out of the car while parked on a steep hill. You would not be able to adjust your balance without adequate flexibility in the ankles. There are hundreds of examples of the importance of maintaining freedom of movement in all movable joints.

Freedom of movement can be maintained or regained through regular exercise and simple stretching exercises. When performing stretching exercises it is important that you always start gently, increasing the amount of pressure or pull gradually. You should feel the muscles pull but not to the point of hurting.

Teaching the Elderly

2009-03-07T15:51:00.000-05:00

Think of your most inspiring teacher. What personality qualities did he or she have? I ask this questions at training seminars for health care professionals who work with the elderly. Of the many traits that are named, understanding the students needs, empowerment and passion stand out. I remember a particular teacher I had once who I felt really understood where I was coming from. I trusted her. Her encouragement was empowering and her passion for the material contagious. What does this have to do with working with the elderly? Everything!
Once the student (the elderly in our case) feels understood he or she will trust, bond with and try to understand the leader. The trust will allow the student to feel at ease in following the leaders directions. The belief the teacher has in the student will be accepted and so the student becomes empowered. The teachers passion and joy of the subject (activity) is mirrored by
the class. This whole process is called empathic engagement. Empathic engagement is the basis of the teaching approach for the Benevolent Ballet program.

Music Sets the Mood

2009-02-24T16:05:00.000-05:00

It has been a while since I have posted anything. I have been busy with family matters. However I do want to share today's experience during my class at the adult day care center. Gospel music was playing when I arrived. It was uplifting and had a clear rhythm. So we did our class to it and really got into it. The same exercises take on different meaning with the mood of the music. Several ladies got up and danced while the rest of us kept the beat clapping and tapping. The mood was held throughout the class. Then at the end when we always say and mime "From my heart to your heart...Thank You!" Everyone spontaneously chimed in "Amen!"

More on Engaging the Elderly

2008-11-22T15:29:00.000-05:00

The residents of the assisted living facility had been gathered for a official meeting. It was my turn to try and involve the group in my exercise program. Knowing that recent studies show as many as three quarters of the residents of assisted living have some form of dementia or Alzheimer’s I understood that the group might be resistant to a new activity and a new face. Immediately a few began to leave. Coaxing them back with the promise of music and relieving the fear that they might be challenged with something new by telling them that they can just watch. I promised them that would like the music so much that they might want to join in and move with it. As they music played, I called their attention to it by saying, “Listen!.....Good music, isn’t it?” Making eye contact with each individual (especially the ones I suspect have dementia of some sort), I move with the music expressing the joy of it. Soon, with a bit more coaxing and for the lowest level of functioning, some warm one on one, hand to hand and heart to heart, the group is fully engaged!

Your comments are welcome.

2008-11-18T14:49:00.000-05:00

BENEVOLENT BALLET NEWS

I have just returned from a two week visit to the UK where I spoke to the School of Health Sciences at the University of Northampton . There were mostly OTs, PTs and nurses in attendance and I was happy to see that they all “got it”. They understood how the arts (music and dance) combined with the exercises and teaching approach of the Benevolent Ballet program would absolutely work. They are now looking for some sort of funding or partnership to bring me back.

Now I am back at work with residents and seminars. The economic crisis makes this a hard time for all. However the population is not getting any younger and the elderly are still at great risk for falls. Also the fact that Medicare/Medicaid is not wanting to pay for preventable injuries in hospitals and long-term care is reason enough to look to proven interventions such as the Benevolent Ballet-Fall Prevention for the Elderly program.

To book your seminars for the New Year, please call me at 407-889-7770 or email lehners1@yahoo.com. Bookings can be made through your corporations, QIOs, or other organizations dedicated to improving the quality of life for the residents of long term care facilities.

Best Wishes for a happy Thanksgiving
Sheila

Training Seminars in Indiana and Kentucky

2008-04-04T20:13:00.000-04:00

I am very excited to let you know that I will be conducting four training seminars in Indiana and one in Kentucky April 29th through May 5th 2008. These will be sponsored by Health Care Excel, the federally designated Quality Improvement Organization (QIO) for Indiana and Health Care Excel of Kentucky, Inc., the medicare QIO for the Commonwealth of Kentucky. Both QIOs are participating in a federal initiative to help nursing homes improve the quality of care for residents. Contracted with the Centers for Medicare Services (CMS), the Indiana and Kentucky QIOs provide nursing homes with educational materials and technical support for reaching quality improvement goals.
Improving the quality of life for the residents of longterm care facilities is challenging. Not only do we want to maintain ADLs but we also must consider the residents emotional and spiritual health. Every effort must be made to inspire, motivate and enrich the lives of those in our care.
Programs like Benevolent Ballet which utilizes a 'person centered care' approach along with 'empathic engagement' to motivate residents to participate in the prescribed exercises seem to go a long ways towards these goals.
I am looking forward to working Health Care Excel and then other QIOs to meet with and train their client longterm care facilities in this unique program.

2007-11-05T08:53:00.000-05:00

Tales of Music and the Brain
I have just read Oliver Sacks new book, Musicophilia, Tales of Music and the Brain, and highly recommend it. It validates everything I teach in my Benevolent Ballet-Fall Prevention for the Elderly training seminars. I started dog earring pages I wanted to return to or to cite. Now practically ever page from chapter nineteen on is dog earred. My poor book!

The book drives home the fact that there are actual physiological changes in brain activity when one listens to music, even when one imagines music! It is possible that problem areas in the brain may be by-passed enabling a person to perform certain cognitive and physical activities otherwise impossible.

I have students in a secure Alzheimer’s unit who will sit in a row of chairs and stay engaged and animated for 40 minutes! Of course this takes a lot of energy on the leader’s part. It has to do with empathy going from the teacher to the class and vice-versa. The energy is necessary for this empathic engagement to work.

I have had residents with aphasia able to speak simple and appropriate sentences after a thirty minute session. I've often seen residents with severe neural musclar conditions find their rhythm and control while listening to music. I don't know how long these affects last but I imagine, with enough reenforcement, quality of life will be improved.

The music is all important but the class’ attention must be drawn to it. The leader must respond to it by commenting, singing or moving. When this is done with sincere enthusiasm the class will feel this and respond. Many facilities have music playing all the time. Often it is music the staff enjoys (usually country or rock) and it just goes over the residents’ heads like white noise. When I come in I turn this off for a minute or two, remark on the peace and quiet and proceed to greet each resident individually. Then I introduce my light classical music, tell the class to listen, show how it makes me feel and begin the process of drawing the group in.

How do you use music in your programming?
Thank you Dr. Sacks for an inspiring book!
Sheila

On Engaging the Elderly in Exercise Programming

2007-11-03T10:41:00.000-04:00

We all know the importance of exercise to improve health, prevent falls and improve the overall quality of life for the elderly. The challenge is in motivating this population to participate and do so to the best of their ability. The goals of an exercise regiment cannot be achieved without the participants’ full engagement..

The development of an exercise program inspired by classical music and movement created a means by which the elderly (even those afflicted with Alzheimer’s or other dementias) would be lured into active participation. Along with the exercises an inviting non-threatening approach had to be developed. After all, there are a multitude of reasons why the elderly especially the frail elderly are reluctant to participate.

Based on the concept of Empathic Engagement this approach looks at the causes of apathy and non-participation. With an understanding of the aging process and the conditions which often accompany aging we may know how the prospective participant might feel about taking part in activities especially something new. For the memory impaired any activity may seem like having to learn something new! It is much easier to just say “No” then to risk failure, frustration, pain or simply the unknown. Empathic Engagement is a concept in which the teacher or leader feels or knows what another is feeling and reacts appropriately to produce the desired result. In the case of the elderly person who might be apprehensive all effort must be made to make him or her feel safe, non-threatened and loved. Interestingly this empathy goes both ways. That is to say, the participant often will absorb the leader’s attitude and reflect it back. For example when the leader emits a warm, friendly or joyful feeling the group will often “catch” these feelings and mirror them. It is true that a smile is contagious.

The program is called Benevolent Ballet-Fall Prevention for the Elderly. With a teaching approach that fully integrates beautiful music, exercise and empathic engagement, the class has a mind/body experience and is magically transformed. Flat demeanors are enlivened and dull eyes brighten. With increased alertness the participants work to fulfill their maximum potential.

2007-11-02T13:24:00.000-04:00

Here are some concepts and observations from the Benevolent Ballet teaching approach.

On Motivation
Yesterday I was speaking with an activities director about ways to motive and truly engage her nursing home residents. We agreed that it took more then just a polite "Hello. How are you? Now lift your arms and lower them." Based on the theory of empathic engagement, energy will beget energy. Enthusiasm will beget enthusiasm. Residents have often said to me, "My! You have a lot of energy." I laugh and tell them I want to share some of it with them. They usually get it. The energy I speak of must be in the voice as well as the body language. Warm feelings and commends must be sincerely projected. And Yes it is exhausting! But your reward will be more alert and engaged residents.

Caregivers Need to Relieve Stress
I have just given a class to family member caregivers. I gave them an actual Benevolent ballet class with some tips on how they might try some of the exercises with their loved ones. It was a great success! The program had the same effect on them as it does on my elderly students. They were swept away swept up in the emotion and movement and left wanting more. Caregivers also need this type of activity to relieve stress.

Magic

2007-11-02T13:22:00.000-04:00

The magic of classical music and movement is ageless. In the enchantment of the ballet the young child becomes the fairy queen or king. The young adult is Juliet or Romeo. And the elderly is taken back to a time of beauty, romance and grace. I often hear comments like, "Oh, that brings back memories!" or "I feel like I could fly!" When asked why they wanted to dance didn't the dancers in the musical 'A Chorus Line' say, "It is because everybody is beautiful in the ballet!"I continue to marvel at how the elderly can be inspired by the simple concepts of this program. Once a connection is made with the individuals in the class many things are possible. The class will reflect the leaders enthusiasm and joy. Once their attention is drawn to the music their natural appreciation of it qualities of rhythm, melody and mood kick in and shows in their response. At this point the can be successfully encouraged to participate to the best of their ability and will achieve to their fullest potential.For example: Stella, a 90 something, very frail and in the late stages of Alzheimer's disease sat crumbled over the side of her wheel chair. I stroked her arm and spoke softly to her drawing her attention to the lovely waltz that was playing. She opened her eyes and allowed me to take her hand in mine. As I smiled looking into her eyes and began to gently move her arms with the music she become much more alert and smiled back with twinkling eyes. I call this technique "Eye to Eye, Hand to Hand, and Heart to Heart" After a few minutes of exercises she was sitting up straighter and was even able to respond to a few simple questions!Thats All for now. Please let me know what you think. I really do enjoy sharing my experience and knowledge.You may comment by clicking on the "comments" link at the bottum of this message. Or Email me at lehners1@yahoo.com
Sheila