Effects of an Art Program on Language Expression in Dementia

By Megan Haduch |
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Art therapy is a method of cognitive stimulation that has been found to produce positive health outcomes for individuals with dementia. The process of creating art capitalizes on brain areas that are often spared until late in the disease; moreover, the  nature of free-form art creation additionally encourages independence, self-control, and self-worth – i.e., cognitive self-efficacy, which has been shown to critically predict functional outcomes. Despite the solid rationale for including arts programs in standard dementia care, few evidence-based guidelines exist.

We have designed a structured, communications-based arts program, Positive Activity, intentional expressions (PAINT), based on the Memories in the Making protocol from the Alzheimer’s Association and pilot data from our lab. As part of a larger study, our project involves observing the impact of program participation on language and communication for participants (three individuals with mild to moderate dementia). Language samples will be collected from program participants at three baseline sessions, during each PAINT session (x 8 weeks), and at two follow-up points.

Our research group has been observing and collecting data using an observation tool while residents are painting.  During painting sessions, researchers and volunteers engage with the participants based off preset guidelines of do’s and do not’s. These guidelines include things such as: do know the participant’s interests and hobbies, do cue participants back on task, do allow adequate response time, do communicate assurance and do display interest throughout the session. On the other hand, don’t add to the participants painting, don’t over-cue, don’t give ideas for painting, and don’t bombard the participants with too many choices. Below is one of our participant’s painting titled “Horrible Scene”.

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All of our sessions are both video- and audio-recorded for off-line analysis. Offline data is recorded on an observational tool designed to examine indicators of communication, cognition, and affect including positive/negative words used, attention, interest, self-esteem, and reminiscence. The data collected during these PAINT sessions is my responsibility to transcribe and analyze using Systematic Analysis of Language Transcripts (SALT) to examine if and how language (e.g., number of ideas produced) improves with regular program participation.  SALT will aid in the analyses of the mean length of utterance, number of different words, speaking rate, verbal fluencies, omissions, and errors. It will show the targeted speakers strengths and weaknesses.  The software will allow us to hone in on areas of concern, which will allow better interpretation of how participant language use has, if at all, changed throughout this process (Salt Software, 2016).  Below is an example of an abbreviated language sample using the SALT software.

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While analyzing these language samples we are looking at various components. These components include but are not limited to: anomia, perseveration, circumlocution, abandoning of thought, inappropriate syntax, inappropriate conversational skills, inappropriate topic maintenance, and less talkative.  Anomia can be known as word-finding difficulty.  Perseveration is repeating oneself or excessively increasing the duration of a sound, word, or thought. Circumlocution is describing the function and/or characteristics of the word that is being thought of.  Abandoning of thought is when an utterance is incomplete or concludes with a filler like “I don’t know”. Inappropriate syntax may be considered when a phrase is paragrammatic (some grammar, but still has errors) or agrammatic (no grammar). Inappropriate conversational skills involve turn-taking difficulties. Inappropriate topic maintenance is when the participant misses the point of messages and fails to stick to it in his/her own messages as well; the individual may go on inappropriate tangents. Less talkative is going to be analyzed based off of how much a participant speaks in a given minute. The image below is a screen shot of some of the data reported back from the SALT software. This image will look a little different based off of each participant’s language sample. Haduch 4



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