Ideas Generated
We haven’t met yet and I already hear the ping! ping! ping! of ideas and connections being made.
Barbara—our class veterinarian—is visiting. We were describing this class to her husband and she, a horse-whisperer, says that shifting to a peripheral gaze calms the horse. Research says this is probably a combination of the horse actually tracking the eyes and also of registering the subtle postural and breathing changes the human undergoes as they shift to a peripheral gaze. It is all connected! The human’s peripheral-gaze-body says ‘safe’: eyes, breath, tension in the neck…
I see this as similar to Teepa Snow’s protocol that you usually avoid a chest-to-chest frontal posture when connecting with a person living w dementia—or with any person who is not at ease,— but rather sit to the side or slightly rotate in standing. I suspect that when one goes into a peripheral mood and gaze, the feet just naturally do that. I need to go back and look at Zoe’s wonderful video! (I think that when clowns are frontal—in that first contact where they need to be solidly in the field of vision—they also fold at the sternum in order to project softness and friendliness. And because it is soft and friendly!)
The other connection with Feldenkrais was Barbara’s idea of entrainment. Literally ‘entrainment’ means that your movement, cadence and organization matches the other person’s. You can entrain yourself—and we’ll do this—by matching, say, your hand to your foot and having the more proficient body part guide the less capable one. You ‘couple’ your gait with your breath or your eye movement with your suckling. But humans are also constantly entraining one another—matching breath, matching gait, matching brainwaves.
The wetware that gives us entrainment is very, very ancient. It isn’t in the brain. And it isn’t fragile. So when verbal arguments don’t work—as is usually the case with her clients,— Barbara just looks (with a soft gaze) in the direction she wants the horse to go. She entrains them with her eyes.
Another strategy to get someone to go South when they think they want to go North is to distract them. Reframing from ‘distract from North’ to ‘couple with me as I prepare to go South’ might have a softer feel to it. The practitioner or care partner offers their own attentional state as something worth coupling to, giving the person living with dementia something coherent to entrain to. I think I have seen Teepa do this over and over in her videos.
In these cases, the caregiver's internal state—their peripheral state—becomes the intervention.
Two ideas: calming someone with your own peripheralness and using entrainment within yourself and with others. Next I’ll try to write up the ideas about why we give up our peripheral richness, and it may not be a problem with the actual visual hardware nor a breakdown—exactly—in the gray matter. It might be overwhelm.
Reports of Peripheral Loss
Perhaps the most striking teaching in Teepa Snow’s class was a video interview of a person whose form of dementia led to rapid peripheral vision loss but slow verbal loss, so she was able to very clearly explain how the visual loss progressed for her. As you know, peripheral vision loss isn’t necessarily in the eye and optic nerve; it is in the visual processors as well. But there’s another idea, that people living with dementia actually just give up on the ‘too much of a muchness’ of peripheral information. It is, in a sense, a ‘choice’ to downplay peripheral information—a prioritization in the deluge of inputs.
Patty Schwab passed me some notes from similar interviews with people in different stages/types of dementia. Here are some highlights. (Thank you Patty!)
Related to the Snow video described above: peripheral inputs are less pleasing when they come as a shock. I went into this thinking ‘more peripheral vision is better.’ But from the video I referenced above and Patty’s information, I am thinking a better frame is ‘consistent peripheral vision is best, but if it is spotty, it can actually be a detriment, and at that point the person may consciously or unconsciously choose to shut it down.’ One adaption—less is better—was to wear a baseball cap to limit the input. Another adaptation—more is better—was to wear driving glasses even though the person was not driving any more, because improving the driving-distance vision meant they got fewer surprises.
Different types of dementia, different trajectories but also different external contexts (lighting, car motion, distractions good and bad) and internal contexts (fatigue, stress, interest). This means that adaptations have to be… adaptable.
For some people, mirroring is better than verbal or written instructions (which relates to the next paragraph with the coupling….)
For others, moving objects appear blurry so if the teacher did demonstrate (usually a no-no in Feldenkrais) that might not work for them
Visuo Spatial decline makes walking downhill and stepping off step stools more challenging (often misplace foot or miss last step on step stool). One person found it helpful to wear bright colored shoes so they can better see where their feet are in peripheral vision.Some people find it helpful to walk behind the care partner with hand on their shoulder when they walk downhill so they can feel the depth of decline proprioceptively rather than relying on vision to figure out how far to step down. It also lets them model their movements after care partner's to know where it's best to step. Carie note: coupling of gate has been found to be a good way to improve gait, and I have used this coupling not just side-by-side but from behind, but it hadn’t occured to be to do it from in front! Huh.
Balance is difficult with the eyes closed. Carie speculation: This is true for all of us to some degree—we want to register the horizon. But if that gets worse with dementia, what this says is that when you take vision out of the equation, something else isn’t working as well. Is that because of vestibular challenges or proprioception awry? The whole premise of this exploration is that proprioception is potentially more durable and a good way to build cognitive resilience…
The question I would like to have asked is the mood question. You can go into a peripheral state of mind with your eyes closed, blind. Does that change with dementia? Did I even frame that question properly?