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Re-creative Resources - Programs for the Cognitively Impaired
re-creative resources - products and services for therapeutic recreation in long term care facilities re-creative resources - products and services for therapeutic recreation in long term care facilities re-creative resources - products and services for therapeutic recreation in long term care facilities


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There are hundreds of reasons why an individual may be experiences cognitive impairment.  The following are just a few: Alzheimer’s disease and other dementias, alcohol/drug abuse, Psychiatric reasons such as Depression or Bipolar, Traumatic brain Injury, Stroke, Cerebral Palsy, Creutzfeldt-Jakob Disease, LYME Disease, Arachnoid Cysts, Binswanger's Disease, brain cancer, and much more. Characteristics of an individual with cognitive impairment may include: decreased cognitive skills such as memory loss, inability to recognize family members, decreased attention span, decreased ability to learn new material, disorientation, inappropriate social behaviors such as screaming, hitting, cursing, inability to focus, word finding difficulty, agnosia, apraxia, aphasia, etc.

Environmental Considerations

  • Places to roam, rest, explore, rummage, etc.
  • Reminiscence environments
  • Home-like environments
  • Snoezelen or multi-sensory environments
  • Use of signs and symbols i.e. bathroom. activity rooms, dining room
  • Familiar photos/memory boxes to identify resident rooms
  • RO Boards
  • Stop signs, do not enter, etc. to minimize enteringinto inappropriate areas
  • Appropriate stimulation i.e. Tact-Tiles on walls, murals, fish tanks, aviaries, etc.

Facilitation Techniques and AdaptationsRaymond

  • Task Segmentation, Task Sequencing, Backward Chaining
  • Hand-over Hand assistance
  • Verbal and/or physical cueing
  • Smaller groups or 1x1
  • Shorter programs (approximately 15-30 minutes)
  • Task-oriented activities based on former interests, lifestyle, occupations such as sorting, counting, folding clothes, sweeping, making beds, shoe shining, maintenance repairs, accountant, etc.
  • Use of adapted equipment i.e. less numbers on a bingo card, large piece puzzles, large dominoes, etc.
  • Use of manipulatives and diversionary items such as pat mats, dolls, busy beads, activity aprons, discovery boxes, etc.
  • Use of Validation Therapy techniques
  • Provide Sensory Stimulation and/or multi-sensory program
    1. Success-Oriented Sensory Stimulation
    2. Sensory Kits and Themes
    3. Multi-Sensory Environments in Long-Term Care
  • Other programs should include: music, exercise, physical games, adapted crafts, gardening, cooking/baking, pet visits, intergenerational programs, reminiscence, spiritual, outdoor/nature, etc.  Programs need to be simplified.
  • Fall Prevention Programs
  • Programs in late afternoon for individuals with Sundown Syndrome
  • Other techniques: Use simple phrases and language, allow time for response, and utilize props and pictures to elicit responses.
  • Create a Personalized Activity Book (by Barbara Smith)



  • Alzheimer's Association 2011 Alzheimer's Facts and Figures Report                             
    You can download this very informative report on the Alzheimer's Association Website. Linking Disclaimer: The Alzheimers™ Association is not responsible for information or advice provided by others, including information on Web sites that link to Association sites and on third party sites to which the Association links. Please direct any questions to
  • Developing a Person-Centered Therapeutic Recreation Program                                     
    This is an incredible program developed by Aimee  Wilson, CTRS and the Village Care of NY team. You can download the entire program right off the internet or contact Aimee for a CD This is an invaluable free resource!

You can get a free copy of Coach Broyles' Playbook for Alzheimer's Caregivers-A Practical Tips Guide. Just call 800-272-3900. You can also download the Alzheimer's Playbook for free on their website.

The Alzheimer's Association is the leading voluntary health organization in Alzheimer care, support and research. They have a great library of resources at

Developed by Naomi Feil, Validation Therapy is a method of communicating with and helping disoriented very old people. It is a practical way of helping the disoriented person deal with stress, enhance dignity,  and increase happiness.

This is an incredible video representing Validation Therapy's Four Phases of Resolution. It is acted out by Naomi Feil herself!

The stages of dementia portrayed through pictures of the elderly and the struggles of the disease.

Alzheimer's: Signs, Symptoms, and Stages is a video that demonstrates that
Alzheimer's disease is a progressive fatal illness.

ADEAR has a great selection of publications regarding dementia and aging. Most of them are free. You can download many from their website and even order some printed versions for free.

  • Barbara                                             
    Barbara A. Smith, M.S., OTR/L writes about her experiences helping her mother who had Alzheimer's disease for eight years. As an occupational therapist Barbara's focus is on adapting the environment and activities for individuals at all functional levels and helping caregivers enjoy time spent with patients and/or loved ones. 


  • The Alzheimer’s Association-Greater Illinois Chapter is pleased to offer a free online resource, Encouraging Comfort Care: A Guide for Families of People with Dementia Living in Care Facilities. This 21-page booklet provides useful information to families and staff of long-term care facilities about Alzheimer’s disease and other dementias, particularly care issues related to the late and final stages.

    For families, this guide will enable them to make informed choices about a variety of medical decisions they may face on behalf of loved ones with dementia living in nursing homes, assisted living facilities, and other types of care facilities. It will also equip families to ask good questions aimed at obtaining the best care for their loved ones, including a handy checklist of comfort care measures to be discussed with staff members of care facilities.

    For staff members of long-term care facilities, the guide will serve as an important tool for those who wish to educate families and assist them in care planning. Individuals and organizations are encouraged to disseminate this booklet in electronic and print formats.

    To view and download the free guide, go to:

  • Meet Me-The MoMa Alzheimer Project                                                                           
    The Museum of Modern Art (MoMA) is one of the first museums in the country to offer programs to make its collection and special exhibitions accessible to people with Alzheimer's disease and their caregivers. These offerings give those living with the degenerative disease an expressive outlet and forum for dialogue. Specially trained Museum educators engage participants in the early and middle stages of the disease in lively discussions by focusing in depth on iconic art from MoMA's collection and special exhibitions. Learn more at
  • The Alzheimer's Project Videos
    As part of THE ALZHEIMER'S PROJECT, 15 supplemental films provide an in-depth look into the scientific advances being made in research and medical understanding of the disease. Learn more and view these videos at

  • Dr. Levine Madori-research update and TV appearance
    Dear Friends and Colleagues,   The third TTAP Method ® Certificate Training Program and the 11th research study is currently being conducted at Edward Hospital in Chicago, Illinois. This past month, the Administrator Ms.Trish Bendel announced a 6 month preliminary findings on pre-post variables being researched on a Gero- Psychiatric Unit after the entire staff had received training.   The study was conducted on a 40 bed unit, and the  variables studied included; patient falls, agitation, aggressive behaviors, and the need for one to one staff interventions on the 40 bed unit. The two most significant findings over the first 6 months were decrease in patient falls and significant behavior changes on the unit. Patient falls were decreased by approx, 50 %, and the need fro one to one nursing supervisions due to agitation, physical and behavioral issues decreased by approximately 90 %. This latter single finding has been estimated by the hospital administration to reduce the direct patient care costs in one year alone to $78,000.00.   Last Wednesday, I was asked to appear on Fox Business News, Varney & Company, to discuss the impact of President Obama’s health care plan initiative on non- pharmaceutical approaches to Alzheimer’s and Dementia treatment. Please view the interview on the link below.

  • The Sensory Connection
    Great free sensory programming ideas.

  • Linda Messbauer
    Multi-sensory environments

  • Alzheimer's Society
    Great resources in the UK

  • I Remember Better When I Paint


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