Bruno Bettelheim spent most of his professional life studying child development. Not all of his work has stood the test of time, but one thing I think he got right is the importance of play. He said once, “The child knows only that he engages in play because it is enjoyable. He isn’t aware of his need to play….”
The need to play or otherwise be active applies to adults as well, including people affected with dementia. The activity, the stimulation, a sense of accomplishment are all beneficial and therapeutic. It’s not inappropriate to give toys to people with Alzheimer’s. They might not be aware of the benefit they are getting from the play, but if you watch them I think you will see it.
Toys have never been just for kids
When we select toys for children, the stage of the child’s development is the biggest factor in making a choice. We don’t bring home a rocking horse for an infant. A 100 piece puzzle is inappropriate for a toddler. And a rattle is not the thing to get for your primary school student.
As Alzheimer’s disease progresses, the person effected goes through very similar stages as a growing child, but in reverse. (Use this analogy to visualize the progression of the stages, not as a physiological account of the disease’s progression.) Cognitive, as well as social abilities, are slowly lost as the plaques and tangles that cause the disease spread through the brain. We like to think about it in this way: as the disease progresses, the person with Alzheimer’s regains those childlike (not childish) qualities that make children see their world as a magical place; everything is new for children since they do not have much of a past. In the same way, the world of the person with Alzheimer’s can be full of novelty since he is losing his past to the disease. Without the past of his memories, without the future of his expectations, he is alive in the present.
Toys for People with Alzheimer’s Disease and Dementia
Toys and games are colorful; they’re interesting; they’re fun. Choose toys that are age- and stage-appropriate; these will do a better job of holding the interest of the person with Alzheimer’s. The right toys will be cognitively stimulating and improve quality of life. (Read more about age- and stage-appropriateness in our Activities for Alzheimer’s post.)
What to consider in a toy
Almost any toy that the person with Alzheimer’s is interested in will be beneficial. Most toys will be effective for more than one purpose. The Tangle featured on this page, invented for a broader audience, is a perfect toy for people with Alzheimer’s. It is manipulative. Twisting and turning the jointed sections provides exercise for the hands and arms at the same time that it is relaxing, almost meditative. The bright colors and varied textures of each segment provide sensory stimulation.
Demeaning or Dignifying?
Probably more than with any other recommendation for Alzheimer’s care, the concern will be raised here about the appropriateness of using toys in treatment, or perhaps of particular toys. This concern is understandable. It is difficult to watch a loved one regress into a childlike state. Unfortunately, that is what is happening. That person’s interests and abilities are changing.
The arguments in favor of toys as therapy center around the patient. It is our firm conviction that stage-appropriate activities, including toys, enhance the quality of life of persons with dementia.The only really valid criterion for rejecting a toy or activity is if the person in your care objects to that particular toy.
Alison Mahoney at the Macquarie University, in Sydney, Australia reported that stage-appropriate activities are significantly more effective in bringing about positive outcomes than are age-appropriate activities. You can read more about her study on our Activity post; in essence it means that a toy that was designed for a child might be a better activity than an activity that was meant for a high-functioning adult.
The first time Bernice ever saw a Tangle Toy® was at the dentist’s office. Holly had taken Bernice for a routine examination and gave it to her to occupy her in the waiting room.
Just holding it, Bernice said that it would be “relaxing to move it around in your hand.” And while she moved it around, her creativity came out. She told this story:
“Some man probably invented this because his wife kept hiding everything. This would relax him when he couldn’t find things that she had hidden.”
As she manipulated the toy, Bernice was particularly intrigued with the textures and colors, exploring each section of the Tangle and commenting on or describing them. Holly was particularly intrigued by the flow of creativity manipulating the Tangle inspired in Bernice.
Bernice, like so many people with Alzheimer’s disease, hid things. Hiding things is, in fact, symptomatic of the disease. Also, like so many people with AD, she often forgot where she had hidden them. It is very likely that tendency of hers had something to do with her story.
The great thing about toys is that the pull us into the moment. Once we get involved with a toy, our full attention is taken up with play and exploration. Anything that does that can’t help but be beneficial. The Explorer Ring was, obviously, designed and created for children, yet is one of our best selling “toys”; and whereas it may not be a stage-appropriate activity for most of us, it is certainly appropriate for anyone who gets enjoyment from it. Enjoyment translates immediately to quality of life.
Jean Piaget developed perhaps the best known theory of human cognitive development. According to his theory, the human child develops through four stages, culminating in abstract reasoning. According to Piaget, play is an important part of the process of progression through these stages.
Many have theorized that a person with Alzheimer’s moves backward through Piaget’s stages: Simply stated, the person with Alzheimer’s looses cognitive ability as the disease progresses. Observing someone with AD makes this idea very plausible, though always remember that he is still an adult, with adult experiences and adult sensibilities.
J.Thornbury suggests that not only does this model provide a means for prescribing treatment, but can be helpful in understanding the behaviors of people with Alzheimer’s and dementia, behaviors that can often be disturbing to caregivers and loved ones.
There is an ever-increasing amount of anecdotal evidence reported in the news services and medical publications that dolls and stuffed animals provide comfort and often a sense of purpose to AD patients. Improved behavior, less agitation, better sleep, are all results that have been reported in programs that use these methods.