It took weeks of practice, but she finally got it. Emma Schrader's 83-year-old fingers somehow remembered what might have been a favorite pastime. They grasped a fat embroidery needle and slowly but surely created a small, perky flower on a piece of cloth - complete with four pink petals and a bright yellow center.
"She picked up right on it," said Ruth Colson, activities coordinator for West End Place in Westminster. "It made us feel so good."
A small victory perhaps, but an encouraging one for Schrader and the West End Place adult day care center, where therapists use a Montessori-based approach to help people with dementia rediscover what they once knew and loved to do.
Schrader did not remember being skilled at embroidery, but her little flower unlocked the talents that had been lost in her mind. The flower will be entered in the 4-H Club fair this summer.
"Every now and then you get somebody that we learn something about," Colson said of Schrader. "Had we not offered this, we would have never known. To talk to her, she would have never remembered what she did."
West End Place, where Schrader and other seniors spend some of their mornings and afternoons, is the only facility of its kind in Maryland to use the Montessori-based program for dementia.
The treatment is relatively simple - based on the principles used in Montessori schools for children nationwide. It guides adults with dementia as they perform relatively simple, but meaningful, tasks broken into a few small steps that they're not likely to forget or fumble.
Through positive reinforcement and repetition - and by using as many of their five senses as possible - they may eventually remember how to perform tasks they once knew how to do on their own.
Although it's not always as successful as it was with Schrader, the Montessori method's supporters say that at the very least, it delays the progression of dementia and often keeps those with the condition happier and more productive.
"It focuses on being able to engage the individual to be able to perform meaningful actions and social roles," said Cameron Camp, director of the Myers Research Institute in Beachwood, Ohio, whose researchers were among the first to employ the Montessori method for dementia.
A person with dementia - which can be caused by Alzheimer's or various other diseases - slowly loses short- and long-term memory, eventually even forgetting to perform daily functions such as swallowing.
Researchers at the Myers institute modified the Montessori approach, designed for schoolchildren, to suit the elderly.
A client deemed competent enough might start off with activities like the ones at West End - matching plastic fruits that they can hold and see to pictures of the fruits on a place mat, or snapping different kinds of belts, buttons and hooks on a colorful contraption that is easier to see and handle than ones on clothing.
If they show progress, clients move on to more complex tasks depending on their skill level. Ideally, a caregiver will find activities that a person enjoys or used to perform in a former job and break them down into small steps.
An example, Camp said, is letting a former plumber help with repairing a washer. Or letting a cook help in the kitchen.
"Instead of saying, 'Make a salad,' you may say, 'Please shred this lettuce, please slice this cucumber' if you break it down into simple steps," he said. "What can we do next? That is the question that is always asked."
A client who likes Chinese food might remember how to use chopsticks if he first practices with cotton balls, then shredded wheat, then noodles. "Persons get better with practice," Camp said. "It's really true, you either use it or lose it."
It's a philosophy that leaves room for innovation on the part of caregivers. Once they're certified in the Montessori method, they can develop whatever activities they think will best suit a client, Camp said.
Colson said she's slowly added contraptions to her collection of activities. Sometimes volunteers make objects such as wooden boxes with several kinds of locks. Sometimes she'll visit her local Wal-Mart and pick out materials for the day.
The Montessori activities usually take about 20 minutes in the morning. In groups of four, seniors who would benefit from the treatment sit at a small table and practice with some of the objects.
Another popular activity at West End is the bell choir, which director Nancy Ensor says has similar goals to the Montessori programming, though it is unrelated. Twice a week, about 20 seniors gather, each holding one or two colored bells. When Colson holds up a colored card, a senior with a matching bell plays along to a taped musical background.
Colson said the activity helps the seniors stay alert and it makes them happy when they visit other nursing homes to play for an audience. "The main purpose is to give them a purpose in life," Ensor said.
Gina MacLeod, the program assistant for elder services who runs the Montessori class, said, "This is really working - you have to put a lot of time and patience [into it]. I am very proud of my ladies."
The approach is slowly catching on. About 100 adult day care or assisted-living facilities nationwide employ the methods for their clients.
Though the ideal is to restore a person's previous functions, it doesn't always happen. But often, merely trying is enough.
"It might not work today for you, but it might work for you," Ensor said. "They all have their little niche inside."
Colson isn't used to the kind of victories she's had with Schrader, but that doesn't mean she's always disappointed. For those at West End Place, the Montessori method is another way to keep the seniors doing the things they like.
"A person with dementia is a person first," Camp said. "Any person who does not have things to look forward to when they wake up in the morning doesn't look forward to the day, doesn't want to get out of bed."
Depression is a major problem that often goes undiagnosed among the elderly, Ensor said, and unhappiness is one of the main challenges the approach hopes to combat, simply by keeping seniors active.
"A person with dementia lives in the moment; it's our job to give as many good moments as we can," Camp said. "They may not remember those moments, and that simply doesn't matter. That feeling they have remains. They associate that feeling with the place they have it."