I know a lot of my CST activity pages are quiz orientated and whilst there are images, songs and practical activities to enjoy, there are usually questions to be answered.
People might think this is contrary to cognitive stimulation therapy non-competitive principles, but I don't think so. We all like to feel a sense of achievement and it is the skill of the CST facilitator to help members to achieve. So if there is a picture based question people are struggling with then clues and prompts can be given.
Here's an example ...
Name the 1959 movie? And name the actors.
Here's a movie trailer - https://www.youtube.com/watch?v=rI_lUHOCcbc
Here's song from the movie - https://www.youtube.com/watch?v=WQIvhotZSUw
Okay, so here's how the facilitator can help members to guess correctly ...
"It's an American movie. The two on the left are male actors dressed up to escape the mob."
"The famous song from the movie is 'I Want To Be Loved By You'. We'll listen to that in a moment."
"The first word of the movie is 'Some'."
"The actors first names are Tony, Jack and Marilyn."
"Marilyn's nickname was 'The Blonde Bombshell'."
The question, having been answered is then made more enjoyable, engaging and inclusive with the video clip. Most members will have seen the movie and elements of it will be held in their long-term memory, especially the music. (Don't you find musical memory is a powerful asset which CST facilitators could exploit more fully?)
The question can then lead to discussion about other movies Marilyn Monroe starred in, who she married, when she died etc. Also other images can be added to extend the discussion. For example ...
'Seven Year Itch', 1955
Or another famous video clip ..
https://www.youtube.com/watch?v=iH3oOVKt0WI - "Happy Birthday Mr President"
Going off at tangents to extend the discussion and facilitate story-telling is absolutely to be encouraged.
When we run our 'Cariad Dementia Cafe' CST groups, we keep a loose score on correctly guessed answers. But we also mark good but wrong guesses and near misses. Importantly, we also give points for singalongs, dances, good stories and practical activities well done. For anything in fact. This means that whilst there might be a stand out winner, everyone feels a sense of participation, completion and achievement.
We also try to be flexible and adaptive, so maybe if a member can no longer write, we'll do a 'shout the answers out' quiz. Or if a member who is more cognitively intact is answering all the questions, we'll try and go around the room, but without putting any pressure on individuals to answer.
For quieter or less cognitively able clients, we'll comment on the brightest smile or the prettiest dress, or we add in a fact we know about them to the conversation or play a song by their favourite artist, which hopefully makes them feel we really know, respect and value them and gives them a sense of pride in that especial lifetime commitment or achievement.
We made an early decision not to exclude members when their cognitive impairment worsens. We tend to have a very inclusive and tolerant group. We have found members to be very understanding of different ability levels, and I really think exclusion is contrary to person centred principles of care. Having said that, sometimes people choose to leave the group because their enjoyment and inclusion level has reduced. When this happens we'll try and arrange alternative activities for them, e.g. Tai Chi, cycling, table tennis etc.
We find it has helped to theme our sessions and over the years have developed an 'off the shelf' library of CST activities pages that we can use on an annual rotation (hence the Blog). Each time we run the session we tweak it and hopefully improve it to make it more engaging and enjoyable. (We always try and include elements of humour in our materials.) Themed sessions also help avoid repetition and make every session different and unique. We have found that using materials themed to seasons or special occasions also helps with orientation.
As for prizes, there is nothing better than a box of 'Heroes' or 'Celebrations' chocolates, which can be shared amongst the group. Phrases like "Didn't we all do well!" and "We're all winners in this group!" help to consolidate feelings of achievement. Often there will also be products created in the session - arts and crafts, baked goods etc, that members can display, take home or eat with their tea or coffee to make that sense of participation even stronger.
As I think have said before, one of the questions I sometimes still get asked (sadly!) is, you put in (all of the facilitators) so much effort to making and running these sessions, but you know some members will not be able to retain a memory of what they have been doing for the afternoon. "Is it worth it?" My answer is always 'Oh God Yes!" If we can help members have an enjoyable afternoon (when we were running face to face groups they were with us for 3-4 hours) then their feelings of participation, engagement, inclusion and achievement will all benefit their well being.
Members might not be able to fully remember or describe what they have been up to when they get home, but they will often tell their care partner that they have had a lovely time and be in a good mood for the rest of the day. And the fact that the next week they want to return and are full of smiles and 'hellos' means that something very positive has stuck.
A useful analogy I feel is to ask doubters if they can remember their last argument with their partner. Most will say they do. When I ask "What was it about?" often they will have forgotten or their memory of it will lack detail. But when I ask "How did it make you feel?" some of that feeling may still be there, or at least the feeling will be remembered.
I often quote Maya Angelou ...
“I've learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”