Using puzzles in occupational therapy for our patients with dementia is a great way to work on goals, reminisce, and use as a part of a patient's sensory diet.
I will discuss how to incorporate them into working toward your goals for physical limitations, cognitive limitations and recommendations on what to look for in puzzles specifically for patients with dementia.
When to Use Puzzles When Working on the Physical Limitations of Patients With Dementia
- Activity tolerance: grade by keeping track of the time that the patient is participating, increasing time each treatment session
- Dexterity: grade by keeping track of the amount of time participating, increasing time each treatment session
- Visual - spatial skills: grade by matching colors and keeping track of accuracy (pt demonstrates ability to match 3 different colors with 75% accuracy) or timing how long it actually takes to put it together, noting how many pieces it is
- Visual scanning: grade by starting with only a few pieces to look for and then increasing number of pieces to find
- Crossing midline: grade by requiring patient to only put pieces together with one hand, reaching across midline and progressively placing pieces farther away
- Range of motion in both fine motor and gross motor of upper extremities: grade by keeping pieces close and then progressively putting pieces farther away or even using a felt board on a wall with velcro on the back of the puzzle piece, which would increase ROM required
Make sure you are deciding how you are going to grade the activity so you can document where the patient begins with the task and you can continue to document progression.
When to Use Puzzles When Working on the Cognition of Patients that Have Dementia
You can use puzzles with patients that are in the early and middles stages of dementia and depending on their cognitive level, you will have to determine how many piece puzzle is most appropriate.
I typically like to use puzzles that have few pieces (9-15 piece puzzles for middle stage dementia and 16-25 piece puzzles for early stage dementia), is a meaningful activity for the patient and is adult themed (so basically, no cartoons, Disney or teddy bears unless it is an interest to the patient 🙂 ).
The goal with using puzzles is to match their cognition in order to perform the activity and find success, enjoyment and satisfaction in its participation vs increase cognitive ability. They do not necessarily have to understand what the ultimate goal of the puzzle is, but they do have to have a basic understanding of the puzzle steps (even if they need to be cued).
Make sure the puzzle is an activity that the patient has performed in the past or is interested in to make sure it is a meaningful activity. Purposeful occupation can help with reduction in agitation, physical and verbal outbursts and most importantly, promotes quality of life in our patients, especially those with middle and late stage dementia.
Using Puzzles as Part of a Sensory Diet for Patients with Dementia
A sensory diet is a personalized activity plan that provides the sensory input a person needs to function throughout the day without being either overstimulated or understimulated.
Puzzles can easily be a part of this plan as an activity that the patient can participate in if it is 1) matched appropriately to their cognitive level (typically ACL level 4.0 and above) and 2) appropriate external cues are provided if necessary.
* Click Here to Get a Link to a FREE Sensory Diet Guide for Adults per ACL *
Do they need:
- Set up: Can they get all the pieces right side up and laid out appropriately to actually complete the puzzle?
- Prompting: This can be provided by either verbally prompting by saying, "What's next?" or physically prompting, by pointing to help them with the next step or initiating the activity.
- Verbal cuing: Give 1 or 2 step directions to participate in the puzzle. "Pick up the yellow piece. Put it here."
- Hand over hand assistance: Give physical assistance/cues to participate.
After you figure out what puzzle and what external cues they need, you can then easily educate the staff and family members that may be helping the patient with the puzzle.
Finding the Perfect Puzzle for Patients with Dementia
I really like the puzzles designed by Monica Heltemes, an occupational therapist and founder of Mind-Start.com. They are brightly colored, adult themed pictures, have a simple basic design without too much detail and makes the puzzles in 12, 24 or 36 pieces.
I also have used a 9 piece puzzle designed and made by Mike Shehata, an occupational therapist over at Therapeutic Woodworks. What is great about this puzzle is that sometimes it is difficult to find ones specifically for men. I live in an area where many of my male patients previously worked with their hands and enjoyed the outdoors - hunting, fishing, hiking. He designed a wooden puzzle specifically for this group.