It’s no fun when our friends with dementia get upset and we aren’t able to help.  No fun for them especially, and no fun for us.

They might get upset because they’ve heard a loud noise, or because their toenails are too long and painful and someone puts on their shoes, or because they all of a sudden can no longer figure out how to use a seatbelt, etc.

An esteemed Occupational Therapy colleague of mine, Dr. Matt Dodson, owner of Braintrust Services (https://braintrustrehab.com)  and I were visiting about the brain and it’s “switch and dial” mechanism.  Matt has extensive experience working to help folks who have suffered from brain injuries and strokes, and a portion of his work is with this “switch and dial” system.

He used this metaphor to describe how when the deep part of the brain gets activated by something sudden, it’s as if a switch gets flipped.

The information from that sudden event gets sent in a split-second to the front part of the brain, which is supposed to act like a dial, to help us make the right response to the sudden event, to the information our brain has just received.  Our brain can help us decide that the sudden event was maybe not the threat we at first thought, so the dial helps us tone down our response.  Our brain might let us know that it was a real threat, and the dial allows us to react quickly to keep ourselves safe.  Or the dial helps us adjust our response, using cognitive skills such as logic and memory, to help calm ourselves down after this upset to our system.

Getting the dial to work quickly and work well is an outcome we hope for when folks are trying to work their way back into relationships and society after a brain injury, for example, and we hope that with therapy and recovery, the dial will work better.

But our friends with dementia…they are losing the cognitive skills that serve as the dial.  They are losing the valuable part of the brain that helps them decide what to do about the loud noise they no longer understand.  Or what to do about toenails that hurt when someone puts on their shoes.  Or what to do when they aren’t able to remember where they put their wallet, etc.  As such, they are left with information that the brain has received and that has upset them, accompanied by increasingly fewer cognitive resources to plan a good response.  

And, sadly, the valuable dial mechanism won’t get better, because dementia is progressive and as of yet, there’s not a cure.  

So that’s where we come in.  When we understand that our friends with dementia are losing the cognitive skills that would allow the dial to work, we use our cognitive skills, in specific dementia-friendly ways, to help them make sense of the sudden events, and make an appropriate response.

It’s the privilege we have of creating an environment where the reality of losing skill becomes a reality that is not filled with fear or unease or uncertainty, even though the sudden events still come.  But we help them respond, and feel safe and comfortable.  

So, then, we become the dial.  It’s good.  For both of us.  

©Jill Couch, MS, OT/L