This article was written by NCCA member, Susan Swanson, M.A., ATR
Written in Memory of Florence and Hy
I am an expressive arts therapist and have been working with clients diagnosed with dementia for 30 years. I bring programs to assisted living facilities, nursing homes, day care centers and residential facilities. Most of my clients are elderly but some have been diagnosed with dementia at a younger age. What Is Dementia? Dementia is a non-specific illness in which areas of cognition are affected, it may be memory, attention, language, and problem solving. It is normally required to be present for at least 6 months to be diagnosed; cognitive dysfunction that has been seen less than weeks, must be termed delirium. In all types of general cognitive dysfunction, higher mental functions are affected first in the process. In the later stages of the condition, individuals may be disoriented in time, not knowing what day of the week, day of the month, or even what year it is, not knowing where they are, not knowing who they are or recognize others around them.

What must that feel like to the individuals who are dealing with dementia? My clients have talked of feeling confused, lost, lonely, isolated and scared. They feel they have lost themselves, their families and things that are familiar to them. Many have lost the ability to form a sentence or an idea, they feel depressed, indecisive and hopeless.
I can not imagine living with dementia and waking up in a state of confusion every day. I am constantly trying to think of something else I can bring to give them a memory, a smile, or a pleasant thought. Every year I find more items and projects to bring to work. I am now carrying about 70 pounds of materials to make sure my groups are motivated, engaged, and hopeful. Instead of feeling confused, frustrated, anxious, and isolated I want to bring creative activities and materials that accentuate the present moment and I want that present moment to be full of energy, memories, joy and feelings of hope.
As an expressive arts therapist I bring art, movement, dance, music and psychodrama skills and activities to the facilities where I work. I have seen the benefits of these therapies and find those who are touched by these modalities are more in touch with reality, less anxious, more trusting, communicative, and less confused. Non verbal expression as well as verbal expression is encouraged and often welcomed when cognitive abilities have been diminished. Non verbal communication includes eye contact, touch, motion, facial expression, offering of smells and various tactile experiences.
With art an individual’s memory can be stimulated by the making of a flower, a heart, or a Christmas bulb. They end up with something tangible they can feel, touch and that may help them think of the past, communicate feelings and thoughts, it provides something real to show to others and something others can respond to with them.
With dance therapy they enjoy a broader range of movement, music from around the world, rhythm, and expression. With wonderful music they dance as a spontaneous reaction, which provides exercise, deep breathing, relaxation, body alignment, and balance and body awareness. Exercise can improve your mood and give you a general feeling of well being. What is overlooked many times as a benefit of exercise is the body’s production of endorphins during exercise. Endorphins are endogenous opioid polypeptide compounds that are produced by the pituitary gland and the hypothalamus in individuals during exercise. They resemble the opiates in their ability to produce analgesia and a feeling of well-being. Endorphins work as natural pain relievers. It is this relationship between exercise and the release of endorphins that may be responsible for the so-called “runners high” that many fitness enthusiast experience. You don’t have to run to get the benefits of endorphins but moderate exercise will also produce endorphins. Many of my clients say that the pain that they came to the group with is gone by the time the group is over. The physicians tell me that they do not have to medicate these individuals as much as in the past.
During movement and music therapy I bring musical instruments, hats, scarves, canes, and sunglasses. Who doesn’t remember God Bless America? And who has not seen a patriotic hat of red white and blue. While singing a familiar song and wearing a familiar hat it is impossible not to feel part of the here and now as well as part of the group. When singing the theme from Rawhide you may remember the show and by wearing a cowboy hat, and bandana while moving like you are roping a cow, you have to feel that you are in the show.
While listening to swing or big band music clients often remember songs and how they used to dance when they were young. They try it again and are surprised they still remember. Most love wearing the hats and acting out parts they remember from songs, movies or Broadway plays. They are the stars of the show, spontaneous, and care free for the moment. The smiles on their faces shows that for that moment they are not confused, scared, disoriented. They are in the present and feel joy.
I often play various sounds for the group to get them to visualize being in a different place. As they are getting sensory information from the sound of the waves crashing upon the shore, I give them a shell to remind them what they might find there.

When working with the elderly who’s affect is often dull and cognitive abilities have been diminished, it is a joy to see their faces light up when I take their hands to dance, give them something familiar to hold, put a paintbrush in their hand, write a poem from the words they remember, give them the picture I took while they were wearing those silly hats.
So that is what’s up with all those crazy hats and the 70 pounds of materials I carry to work everyday? I will carry, bring, and put on anything to see my groups engaged and reminisce with a smile.
-- Susan Swanson, M.A., ATR
Expressive Arts Therapist
Creativity Consultant
Find out more about Susan Swanson's work HERE