Teepa's GEMS® Brain Change Model

Summary

This script discusses the progression of cognitive diseases, advocating for a shift in perspective from focusing on losses to recognizing the remaining abilities of individuals. It introduces a metaphorical 'gem' scale to describe six cognitive levels, each represented by a unique gemstone, to help caregivers provide appropriate support and care. The speaker emphasizes the importance of understanding each stage's characteristics to enhance the quality of life for those affected, encouraging a compassionate and positive approach to dementia care.

Takeaways

• 🔍 The script emphasizes the importance of focusing on the abilities and strengths of individuals with cognitive impairments, rather than solely on their losses and limitations.
• 💡 It suggests reframing the way we perceive and discuss the progression of cognitive diseases by shifting from a negative to a positive perspective, highlighting what individuals still possess.
• ⚖️ The speaker critiques existing scales that measure cognitive decline, arguing they are too focused on the negative aspects and overlook the remaining capabilities of the person.
• 💎 The concept of 'gems' is introduced as a metaphor for the different stages of cognitive impairment, with each gem representing a unique set of abilities and characteristics.
• 🔵 'Sapphire' is used to represent the care provider's role, emphasizing the need for flexibility, understanding, and support to help the individual 'shine'.
• 💠 'Diamond' signifies a stage where individuals are clear and sharp but inflexible, requiring a careful approach to care that respects their routines and habits.
• 💚 'Emerald' represents a transitional phase where changes are noticeable, and individuals may struggle with clarity and direction, necessitating patience and understanding from care providers.
• 🟠 'Amber' symbolizes a stage where individuals are caught in a moment of time, with a focus on immediate sensations and a lack of safety awareness, requiring vigilant care.
• 🔴 'Ruby' indicates a stage of significant change where fine motor skills are lost, and individuals rely on gross motor movements, requiring care that accommodates their strength and rhythm.
• 🌊 'Pearl' is the final gem, symbolizing the end stage where individuals are deeply affected by the disease but still possess an inner value and beauty that can be revealed with the right care.

Q & A

What is the main message the speaker is trying to convey about progression of diseases like dementia?

The speaker emphasizes that the focus should not solely be on the losses that occur with disease progression, but also on the remaining abilities and opportunities for individuals to shine. They advocate for a shift in perspective from viewing people as numbers or stages to appreciating their uniqueness and preciousness.

Why does the speaker criticize the existing scales used to measure cognitive decline?

The speaker finds existing scales depressing because they overly emphasize future losses and negative aspects of the disease, rather than the current abilities and strengths of the individual.

What alternative approach does the speaker suggest to understand individuals with cognitive decline?

The speaker suggests viewing individuals as 'gems' with unique characteristics and qualities, much like different types of precious stones, each having its own value and beauty.

What are the six 'gems' the speaker uses to represent different cognitive states?

The six 'gems' are Sapphires, Diamonds, Emeralds, Ambers, Rubies, and Pearls, each representing a different cognitive state with unique characteristics and challenges.

How does the speaker describe the Sapphire state?

Sapphires represent a flexible and organized brain that is not experiencing the changes associated with dementia. They are the care providers who need to be adaptable and supportive to help other 'gems' shine.

What challenges are associated with the Diamond state according to the speaker?

In the Diamond state, individuals are clear and sharp but rigid, resistant to change, and may unintentionally hurt others due to their inflexibility. They are good with habits and routines but struggle with new situations.

What does the Emerald state signify and what are its challenges?

The Emerald state signifies a change where individuals are no longer clear and sharp. They may be confused about time and place, make mistakes, and struggle with tasks, often being unaware of their flaws.

How does the Amber state differ from the others, and what are its key features?

Amber represents being caught in a moment of time, focusing on immediate sensations without caution or safety awareness. Individuals in this state may act impulsively and inconsistently, often exhausting care providers.

What are the characteristics of the Ruby state as described in the script?

In the Ruby state, individuals have lost fine motor skills but retain gross motor strength. They may have difficulty with visual tasks, chewing, swallowing, and speech, yet they still have a connection to rhythm and music.

Why did the speaker choose the Pearl as the final gem to represent the end state of cognitive decline?

The Pearl represents the end state where, despite the outward signs of the disease being 'ugly' like an oyster shell, there is still an amazing gem inside. It signifies that even at the end of the disease, the person's essence remains valuable and precious.

What is the speaker's ultimate goal in using the gem analogy?

The speaker's goal is to encourage care providers and society to see the value and uniqueness in individuals with cognitive decline, to provide the right care and support so they can continue to 'shine' despite their challenges.

Outlines

00:00

💭 Shifting Perspectives on Disease Progression

The speaker emphasizes the importance of focusing on the remaining abilities of individuals with progressive diseases rather than solely on their losses. They critique traditional scales that predict negative outcomes and suggest a new approach that views people as 'gems' with unique and precious qualities. The speaker introduces a six-tiered system of gems—sapphires, diamonds, emeralds, ambers, rubies, and pearls—to represent different cognitive states, each with its own characteristics and needs. Sapphires represent a flexible and organized cognitive state, while other gems symbolize various stages of cognitive change, from the clarity of diamonds to the sensory-driven behavior of ambers.

05:02

🔍 Navigating the Gem Spectrum: Care and Understanding

This paragraph delves into the characteristics of each gem, starting with diamonds, which are clear but rigid, representing individuals who are set in their ways and resistant to change. Emeralds signify a shift towards confusion and a loss of clarity, where individuals may be unaware of their flaws. The speaker advises on how to provide care for these individuals, suggesting that understanding their cognitive state can help in offering appropriate support. Ambers are described as being in a moment, with a focus on immediate sensations and a lack of safety awareness, which can lead to challenging behaviors. The speaker highlights the importance of recognizing these stages to provide the right care and setting for individuals to thrive.

10:04

🌊 The Pearl: The Essence of Care in Late Stages

The final paragraph discusses the pearl, representing the late stages of cognitive decline where individuals are dominated by reflexes and systems begin to shut down. Despite the outward signs of deterioration, the speaker比喻 the pearl as a symbol of the person's enduring essence, suggesting that with the right care, the 'shell' of the disease can relax, revealing the inner gem. The speaker challenges the audience to see beyond the physical and cognitive changes and to recognize the intrinsic value of the person, advocating for compassionate and attentive care that allows the individual's spirit to 'shine'.

Keywords

💡Progression

Progression in the context of the video refers to the way a disease, particularly dementia, changes and evolves over time. It is not just about the deterioration but also about recognizing the remaining capabilities and opportunities for the individual. The video emphasizes that focusing solely on the losses can lead to missing opportunities to support the person in a positive way.

💡Care Partner

A Care Partner, as mentioned in the video, is someone who provides support and care to an individual with cognitive changes. The role of a Care Partner is to adapt and provide the right support and care to help the individual continue to live life to the fullest. The video suggests that Care Partners should be flexible and not rigid in their approach, as this allows for better care and understanding of the individual's needs.

💡Gems

The video uses the metaphor of 'gems' to describe the different stages or levels of cognitive abilities in individuals with dementia. Each gem (sapphire, diamond, emerald, amber, ruby, pearl) represents a unique set of characteristics and abilities. This metaphor is used to shift the focus from the negative aspects of the disease to the positive attributes and capabilities that still exist.

💡Sapphire

In the video, 'Sapphire' is used as a metaphor for a state of mind where the individual is flexible, organized, and able to work with others. It represents a stage where the care provider needs to be adaptable and supportive, not struggling alone. The Sapphire stage is about maintaining a positive and flexible approach to care.

💡Diamond

The 'Diamond' stage in the video script refers to a state where the individual is clear and sharp but rigid, not liking change. It is a stage where the person may appear to be functioning well, but they are inflexible and may resist changes or new instructions. The video advises creating the right setting and care to help the individual shine, rather than focusing on the rigidity.

💡Emerald

An 'Emerald' in the video represents a stage where the individual's cognitive abilities are changing, becoming less clear and sharp. It is a stage of noticeable cognitive decline where the person may struggle with direction, time, and tasks. The video suggests that care providers should be aware of these changes and adjust their approach accordingly.

💡Amber

Amber, as used in the video, symbolizes a stage where the individual is caught in a moment of time, focused on sensations and immediate desires without safety awareness. This stage can be challenging for care providers as the person's behavior may become inconsistent and unpredictable. The video emphasizes the importance of understanding and adapting to these changes.

💡Ruby

The 'Ruby' stage in the video indicates a further decline where the individual has lost fine motor skills but retains strength and big movements. This stage is characterized by a loss of fine details in vision, speech, and physical abilities. The video suggests that care providers should focus on the remaining abilities and provide a supportive environment.

💡Pearl

A 'Pearl' in the video represents the final stage of the disease, where the individual is deeply affected by the disease's physical toll. Despite the outward appearance of struggle, the pearl symbolizes the inner beauty and value that still exists within the person. The video encourages care providers to see beyond the challenges and continue to provide care that allows the individual's true essence to shine.

💡Cognitive Disabilities

Cognitive Disabilities are impairments in cognitive functions such as thinking, remembering, and problem-solving. In the video, these disabilities are used as a basis for the gem metaphor, with each gem representing a different level of cognitive ability. The video aims to shift the perspective from disability to the remaining strengths and capabilities of the individual.

💡Occupational Therapy

Occupational Therapy is a healthcare profession that helps individuals with physical, mental, or cognitive disabilities to develop, recover, or maintain daily living and work skills. The video mentions that the gem metaphor is built off a scale used in occupational therapy, indicating that the approach to care is informed by professional practices aimed at enhancing the quality of life for individuals with cognitive changes.

Highlights

The importance of focusing on what individuals with dementia still have rather than just the losses they experience.

The introduction of a new perspective on dementia progression, viewing individuals as 'gems' with unique qualities.

The concept of 'Sapphire' as a cognitive level, representing a flexible and organized brain, crucial for care providers.

The 'Diamond' cognitive level, characterized by clarity and rigidity, and the challenges it presents in care.

The 'Emerald' stage, where changes in cognition become more noticeable, and the need for understanding and patience.

The 'Amber' stage, associated with being caught in a moment of time, and the importance of sensory experiences.

The 'Ruby' stage, marked by a loss of fine motor skills but retention of strength and rhythm.

The 'Pearl' stage, symbolizing the hidden beauty and value within individuals despite advanced dementia.

The need for care providers to be flexible 'Sapphires' to support individuals at different cognitive levels.

The potential for care providers to become 'Diamonds', causing friction, and the importance of recognizing this to provide better care.

The challenge of recognizing the 'Emerald' stage to avoid misunderstandings and to provide appropriate support.

The 'Amber' stage's inconsistency and the struggle for care providers to adapt to changing behaviors.

The 'Ruby' stage's loss of fine motor skills and the need for care providers to manage safety and provide comfort.

The 'Pearl' stage as a metaphor for the enduring essence of a person's identity despite severe dementia.

The overarching theme of viewing individuals with dementia as precious gems, each with unique characteristics and value.

The call to action for care providers to see the potential for 'shining' in every individual, regardless of their cognitive stage.

Transcripts

time to talk about progression how does

this disease change over time now

unfortunately typically what people talk

about is loss oh it's worse it's worse

it's worse and it's going to get harder

and things are going to get worse but if

that's all you're thinking about you're

missing opportunities it's not just

about the loss it's always about what do

they have left and so I took the scales

that were out there and looked at them

and frankly they're pretty depressing

they emphasize too much Oh what's going

to happen next and it's not a good thing

so what I decided is let's stop talking

about people as though they weren't less

and let's start looking at people as

though they still have something

my job as a Care Partner is to figure

out how to provide the right support and

the right care so they can shine quit

thinking about them as numbers is this a

stage one two or three or a level one

two three four five six seven and

instead how about if we looked at how

are they precious how are they unique

what do they have that I can still use

to help them live life because life

happens and we're both going to live it

so how's it going to be so I thought how

about gems how about if we thought about

people as precious and unique there's

not a single gem that I know of that

people don't find attractive and

interesting and if I could get you to

think about people as having something

positive something good and I got you to

see them that way and understand them

that way then you may be more interested

in providing the right setting in the

right care so they can shine and so what

I did is I took a scale that's out there

Allen cognitive levels cognitive

disabilities it's something used in

occupational therapy and I took that and

I built off of that and what we have our

gems six of them six levels sapphires

and diamonds and emeralds and Amber's

and rubies and pearls all of those are

amazing gems but they're all different

they're all unique they all have

characteristics now the way I organize

this is sapphire

I notice how it's on the other hand it's

a little special it's a brain that's

true blue it's a brain that's not

experiencing the changes that come with

things like dementia instead this is a

brain that's flexible it's organized

it's able to work with all these other

gems and when you're a care provider

it's really important to be a partner

who is flexible and not really

struggling on your own but the reality

is you're probably going to experience

some moments that aren't Safire like

when that happens take a break because

you do want to be a sapphire to care for

the gems now let's talk about the gems

diamonds emeralds

Amber's rubies and pearls diamonds clear

sharp but rigid have lots of facets to

them but inflexible not liking change

but absolutely able to shine but

diamonds can also cut you they can hurt

you because they still are who they were

but they're different they're clear in

they're sharp

so you may not even believe or think

that this is real that they have a de

metric because they they know what

they're doing that she's just being

stubborn maybe maybe not

sometimes things like zirconia pnes can

trick you they look like the real deal

and they're not but if you see somebody

who's acting like a diamond if you

experienced diamond behavior create the

right setting in the right care things

get better if you don't recognize it you

can get cut so when someone is in a

diamond state what we're talking about

is rigid inflexible I'm very good with

habit and routine the things I've always

done I'm not so good with new stuff I

don't like change and I don't like

people telling me what to do if they

never told me what to do if you were

always an authority figure we're

probably in good shape I may follow you

around more and shadow you but I won't

argue with you but if you've never been

the boss of me this is going to get to

be a real problem

emeralds things are changing and unlike

the diamond it's not clear and sharp

anymore there's a color you've noticed

this is usually about the time most

people get identified as having

than going on this is emerald green go

in a stoplight sequence the green light

is go these people are going but they

aren't always sure where their words are

not always clear and sharp like they

used to be their direction and the

timeframe it's not always where they

think they are and where you thought

they were emeralds are always flawed but

camera'll doesn't know that they think

they're fine everything's fine so if

they have a problem you're it

or if there is a flaw well it doesn't

matter so this is where we start to

notice changes in my ability to do

things I'm making mistakes I'm skipping

steps I'm getting lost in a day I get

lost in my life I think you're a

different person than you are I think

I'm in a different place than I'm in I

start a task and then I go do another

test having not finished that I get

turned around pretty easily I have a

flaw but if you match up and you don't

point out my flaw it goes a lot better

so with emeralds things are changing for

both of you and I'm no longer clear and

sharp I am struggling and I may not know

that guess who will be struggling you if

you're not careful because you want what

we had before and you aren't going to be

able to have that now let's talk about

the next gem ooh oh oh oh Amber's yeah

most of you don't really like Amber's in

real life with dementia but let me

describe amber amber is one of the most

interesting gems because it actually

isn't found in the ground gem it's

something like SAP coming out of a tree

and something getting stuck in it and

then more SAP and then it hardens up a

little bit it's something caught in a

moment of time and that's where these

folks are they're in a moment of time

it's all about sensation it's all about

what does it feel like what does it look

like what can I do with it do I like it

don't I like it I'm in a moment I don't

have caution I don't have safety

awareness I'm all about if I want it I

want it now and if I don't like it I'm

not doing it and so this is off

whereas a care provider you you really

struggle because my behavior is so

inconsistent with who I used to be but

an Amber is an Amber they aren't a

diamond Durr and emerald and they

certainly aren't a sapphire so this is

the point in the disease where you might

see me engaging in ways cuz I'm still

very interested and curious but I don't

know whether it's safe or not so I may

pick up things and do things with them

and it's not okay I invade your space I

take things I I mess with stuff and I

may have a low sensory need or a high

sensory need for any of the five senses

but I don't have safety awareness and I

wear you out because I'm not always good

at when and when not to sleep it's sort

of like if I feel like it I do not all

the time but it's important to notice in

the moment critical to be a sapphire you

struggle to not be a diamond at this

point oh yes we can become diamonds

don't think it's all about dementia it's

about brain change and in a moment you

can have a diamond moment you little

sapphires in other words you get

frustrated with what's going on and you

have a hard time particularly with

Amber's the next gem Ruby now Ruby's

changing yet again we're no longer a

caution light with the stop light and

what stops is all fine motor skill but

what do I keep big movement and strength

I've got some strength but I don't have

skill so what you're going to notice in

those times I've lost fine motor in my

eyes in my fingers in my mouth and in my

feet so I have trouble figuring things

out visually I have trouble chewing and

swallowing sometimes but for sure

together together we go go get up they

head to hem getting speech out but I

still have rhythm and I still have music

that's the gift that's something I can

still do because it feels like to you it

should be skill

but it's actually sort of automatic so

with rubies although I lost the fine

skill I still have the big so my hands

now are more gross

I don't manipulate I hold and because I

keep strength unfortunately I can grab

on to something and if that something is

you I could hurt you I don't mean to I

like pressure I like to hold on this

stuff I don't always know how to let go

hmm

sometimes you're having that problem too

because you're again slipping from here

to here because you're going from a

Sapphire to a diamond if you find those

moments and you will with rubies because

it's so scary I can't settle down I

can't get started it's a struggle you

need to take that step back and time

yourself out take a deep breath get

oxygen to your brain let go of what was

so you can be that Sapphire oh and

that's critically important when we get

to this last gem the pearl

now I selected the pearl for this state

because at that moment think of the

outside of an oyster shell and as you

look at that oyster shell I've got to

tell you that is one of the ugliest

things you'll ever see in this world and

you never think that on the outside of

an oyster shell you're going to find

this amazing thing and at the end of

this disease what this disease does to

the human body is pretty ugly it turns

on reflexes it shuts down systems it's

making it very difficult I lose my gross

motor and what I'm ruled by reflexes I'm

actually stuck untracked ah but with the

right care the shell relaxes just a

little and in there you find this

amazing gem a pearl bill layer upon

layer and a single grain of sand this

amazing gem still in there but often

trapped and sometimes

you're not careful you spend way too

much energy worrying about the shell and

you miss the most important thing that's

not the gym with the right care you get

to see the real gem this amazing person

not who they used to be but I'm still in

there I me but I'm different I'm not a

ruby or an amber or an emerald or a

diamond I'm not the Sapphire I may have

once been but I'm still there and I'm

still me but I'm different the question

for all of us is can we see the precious

and unique can we experience the person

as this amazing gem of great value and

give them the right setting in the right

care so they can shine