Robotic seal connects with dementia patients

Technology offers new tools for communication

[Editor's note: This is the first of a two-part series that looks at communicating with patients who have difficulty communicating. This month, we look at innovative and proven strategies to communicate with patients who have dementia. Next month, tips and strategies for communicating with pediatric patients, and their families, are offered.]

What do robots and iPads have in common? Both are tools used successfully by hospices to improve communications with patients who have dementia.

The robot used by Passages Hospice in Elgin, IL, is not what you typically envision when you hear the word "robot." The six-pound robot looks, feels, and sounds like a baby harp seal.

"We now have three seals we use for our patients," explains Corey Tague, hospice educator and handler for "Pikatti," the first seal purchased by the hospice. "We've always used music, pet, and massage therapies to connect with patients, but the therapeutic robots have created connections we have not seen before," she explains. The advantage of the robotic seal is that he is hypoallergenic, anti-bacterial, easy to clean, and won't bite, she adds. "He is not threatening, even to people who may have had bad experiences with a dog or cat," she says. "No one has had a bad experience with a baby seal that would make them afraid of Pikatti."

One dementia patient, who had been in a nursing home and had not spoken in more than a year, initially did not pet the seal but tracked him with her eyes, says Tague. On the next visit, the woman began holding and petting the seal, and began to talk to the seal. "She was telling the seal that he reminded her of a little sheep she had when she was growing up on a farm," she says. As the patient continued to speak to the robot about her childhood memories of other farm animals, staff and family members in the room had tears in their eyes, she adds. The experience of finding memories the woman wanted to discuss opened up other ideas for family and staff members to use to start conversations, she says.

"The seal has touch sensors and voice recognition capabilities that enable him to move or make sounds in response to someone holding or talking to him," points out Tague. Soft sounds and gentle wiggles mean that he likes how he's being petted, and a sharp sound and a turn of the head means that doesn't like you touching his whiskers, she explains. "He is programmed to my voice so even if others are talking, he turns to me when I speak, but he will also follow other voices," she adds.

Passages is the only hospice using the seal in the United States, says Tague. "I checked into the robot after our administrator saw a news story about it." Because the distributor is located in the Chicago area, Tague went for a demonstration. "I immediately saw what a valuable tool it would be but the price tag was $6,000," she says. The hospice purchased one seal then quickly added another two seals to the hospice, she adds.

Even though Tague and other educators tell patients that the seal is a robot, patients with dementia often refer to the seal as a little dog or cat, she says. "I never correct the patient, in fact, I often tell staff members and volunteers never to argue with a patient who has dementia. In their world, this seal is just like their favorite pet."

Finding out what was important to the patient prior to dementia is a key to successful communication, says Tague. "If you know who they were before dementia, you can understand their behavior today," she explains. For example, one patient who was in the middle to late stages of Alzheimer's would not go to bed at night. "I found out that she had been a night nurse in a hospital for most of her life," she says. "The nursing home staff made up a pseudo chart for the woman to use and every night she would walk around the floor with the staff nurse, making notes on the chart." At times, she would feel the forehead of a patient to make sure there was no fever. "Each night she finished her rounds, put the chart back in its place on the nursing desk, and went to bed with no problem."

The beauty of the "chart and rounds" solution to the patient's bedtime issue was that it was a "productive activity," says Tague. "We were able to give the patient something to do that meant something to her and it helped her self-esteem and made her feel in control."

Technology in the form of an iPad gives Emily Kennedy, MSW, a social worker at Hospice and Palliative Care Charlotte Region in Charlotte, NC, a chance to immediately pull photos that relate to patients' interests, memories, or previous jobs for conversations. "I saw a photo of the patient and her husband on their honeymoon in Hawaii 50 years ago on a table, and I was able to pull up a live shot of a Hawaiian beach," she says. "We looked at waves hitting the beach for 20 minutes while she talked about her honeymoon."

The immediacy of information on the iPad is an advantage when working with dementia patients, points out Kennedy. "I have the photographs, videos, or music right there at the moment the patient shows interest," she says. "This is important because on my next visit, the patient may not show any interest in the same thing."

Kennedy can access all types of music to share with patients and she even has an application that turns the screen into a piano keyboard. "Sometimes I have to put their hand on the screen and show them how the touch of their fingers works the keys, but it doesn't take long for them to start 'playing the piano' on their own," she says.

A thorough assessment of the patient's likes, hobbies, interests, job experience, travel experience, and family is important to give social workers, volunteers, and clinicians clues about topics that can be used to connect with the patient, suggests Kennedy. "When I learned that a patient had sold Avon products for many years, I began greeting her with 'Avon calling' at each visit," she says. The combination of the greeting that meant something to the patient and a variety of scented lotions Kennedy would bring to the visit resulted in animated conversations that the patient enjoyed.

Bringing lotions to a visit also gives the opportunity to provide a hand massage or other gentle touch to an arm, points out Sharon Moore, LCSW, ACHP-SW, senior director of clinical service at the Charlotte-based hospice. "Touch is important for patients with dementia because they feel alone," she explains. "Placing your hand on the arm or giving a gentle hand massage increases the connection," she adds.

Although Hospice and Palliative Care Charlotte Region offers a program focused upon dementia care, there is no one team of employees that provides all of the dementia patient care. All staff members and volunteers receive training on how to communicate with and care for patients with dementia. "The most important message is not to give up," explains Moore. "Too many people, family members included, believe that if the dementia patient quits communicating there is no reason to continue trying to talk to them," she says.

Getting to know the patient is the first step in communication, then use simple language, be at eye level of the patient when talking, and eliminate distractions such as a television, suggests Moore. "Remember to watch for nonverbal cues that the patient is anxious, interested, or calm," she says.

Also, remember not to try to reason or argue with a patient with dementia, warns Tague. "Dementia patients often layer clothes, putting tee shirts and pants over their pajamas, then adding an extra sweater or jacket," she says. "Family members and nursing home staff will often try to tell them they need to take some of the clothing off, but I always ask 'Whose problem is this?'" While patients may be pleased to have dressed themselves, having someone tell them they dressed incorrectly sends the wrong message, she says. "If the patient gets warm, the jacket will come off," she adds. "If the patient has two socks on one foot and none on the other, what does it matter?" She adds, "If the patients' actions don't put them in harm's way, don't make an issue of it."

Sources/Resources

For more information about communication with patients with dementia, contact:

Corey Tague, Hospice Educator, Passages Hospice, 134 North McLean Blvd., Elgin, IL 60123. Tel: (630) 659-6079; e-mail: ctague@passageshospice.com.

Emily Kennedy, MSW, Social Worker, Hospice & Palliative Care Charlotte Region, 1420 East Seventh St., Charlotte, NC 28204. Tel: (704) 375-0100; fax: (704) 375-8623; e-mail: KennedyE@hpccr.org.

Resources:

Alzheimer's Association: "Communication. Best ways to interact with the person with dementia" free booklet can be downloaded by going to www.alz.org. Select "Living with Alzheimers" and then choose "Caring for Alzheimer's" and "Daily Care" from the left navigational bar. Select "Communication" and scroll to bottom of page and click on the pdf icon for the 12-page communication brochure.

PARO Robots, 1380 Hamilton Parkway, Itasca, Il 60143. Tel: (630) 467-1002 or (866) 980-PARO; fax: (630) 467-1044; e-mail: sales@PAROrobots.com; web site: www.PAROrobots.com.