Have you ever seen the movie The Notebook? The storyline follows a couple’s love story from early years through older age when the wife is diagnosed with dementia, presenting with severe memory decline.

By Julie Gala, MA CCC-SLP, PAC Certified Trainer, Senior Director of Clinical Success at RESTORE Skills

The husband visits her every day at the long-term care community where she resides and reads their love story to her in the hopes she’ll remember who he is by night time, only to repeat the process the next day. He must have taken a note out of Teepa’s book by providing patience, visual imagery, repetition, and emotional connection when interacting with his wife.

Positive Physical Approach

Original article by Teepa Snow, MS, ORT/L, FAOTA, with minor updates by Julie Gala, MA CCC-SLP, PAC Certified Trainer, Senior Director of Clinical Success at RESTORE Skills

For loved ones or care partners who have not been introduced to the Positive Physical Approach™ (PPA) or Hand under Hand® (HuH) techniques, how could this situation have played out differently?

Try to imagine the following scenario: the husband may walk into his wife’s room at her long-term care community to visit her in the morning, asks her how she is but she cannot remember his name or their relationship. He then becomes upset when she doesn’t remember his name or who he is. When he repeats his name over and over expecting a different result, eventually getting louder with frustration that she can’t remember, he may say things like I’m your husband, We’ve been married for 50 years? Why don’t you remember me? Eventually both the husband and his wife living with dementia are in the middle of an argument and the wife becomes tearful, requiring the staff to intervene, and the husband is told he is not able to visit his wife without supervision in the future.

You might be thinking, Yeah, I could understand. Who wants to visit someone that doesn’t remember them each day and just argues with them? The second scenario happens more often than the first because the general population doesn’t have a solid foundation of positive dementia training. For example, how to support patients living with dementia or their care partners. Loved ones and caregivers can obtain the knowledge they need to avoid painful situations for both the person living with dementia and their loved one by becoming aware through the Positive Approach to Care (PAC) training series.

Three Workshops

The three workshops in the PAC series (Workshop A: Normal vs. Not Normal Aging; Workshop B: PAC Skills; Workshop C: GEMS States), build on each other to provide comprehensive and caring support for a loved one with dementia. Learners will start with identifying the difference between what is normal and what is not normal in the aging brain. Perhaps the wife in the second scenario may have presented with occasional forgetfulness, had difficulty recalling new information, or became confused with tasks that used to be routine. The wife’s memory impairments may not first be noticeable by her loved ones because people living with dementia in the early stages can mask their cognitive deficits with communication.

Four Truths of Dementia

The Four Truths of Dementia guide your support of a loved one with dementia by identifying that at least two parts of the brain are dying, it is chronic, it is progressive, and it is terminal. This helps to establish expected outcomes and minimize unrealistic expectations. Such as the husband in the second scenario expecting his wife to remember his name and relationship after repeatedly telling her.

Once the foundation has been laid for understanding the changing brain, you have the opportunity to build the skills needed to provide positive care. For example, instead of telling his wife over and over who he is, the husband should approach her as if she is meeting him for the first time and request permission to advance into her personal space, using a Positive Physical Approach™ (PPA). Taking the time to reminisce or utilizing Positive Action Starters may generate prior memories and emotions without forcing a request.


Lastly, you have the opportunity to identify where in the dementia process your loved one may be. As mentioned, dementia is progressive and often follows a typical decline from one state to another. Even though people may progress similarly through each state, the experience for each person will be different. Best practice for care partners and loved ones of persons living with dementia is to tap into their interests and hobbies to support person-centered care. Once you’re able to establish rapport and trust, you may enhance participation in cognitive or motor assessments.

If you’re interested in learning more about the differences between normal and not normal aging. Further more positive skill building, approaches, and communication to use with persons living with dementia. And how to provide appropriate assessment and staging you can reach out to the PAC community to locate a trainer who can lay the foundation for a positive approach to dementia education. After all, who doesn’t prefer the happy ending of a Hollywood love story over the heartbreak of a scared and agitated couple. Reach out to the PAC Community to locate a trainer who can lay the foundation for a positive approach to dementia education.


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