Teepa's GEMS® Brain Change Model
Summary
TLDRThis 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
💭 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.
🔍 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.
🌊 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'.
Mindmap
Keywords
💡Progression
💡Care Partner
💡Gems
💡Sapphire
💡Diamond
💡Emerald
💡Amber
💡Ruby
💡Pearl
💡Cognitive Disabilities
💡Occupational Therapy
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
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