Dogs : A Catalyst for Conversation & Joy in Dementia

The Role of an Occupational Therapy Student

Currently Kari Milsom is on an occupational therapy placement in Alzheimer Scotland. This week’s blog is a Q&A about her passion and experience of working with dogs and integrating that into her occupational therapy education and the contribution of dogs for people to live well with dementia

Can you tell us who Kari is?

Hello, I am Kari Milsom, I live in Yorkshire and I’m in my final year studying part-time for an occupational therapy degree at York St John University.  University is a new venture for me as I have been working full-time for 30 something years, mainly in the voluntary sector developing services for people who are facing challenges in life.

Dogs have always been a big part of my life and for the past 9 years I have worked for Hearing Dogs for Deaf People, a UK charity providing assistance dogs to adults and children with a hearing loss. You can find out more about their work here

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When I am not studying part time as an occupational therapy student, I am the National Partnership Manager, responsible for the care and maintenance of the dog and client partnerships for life, there are over 800 Hearing Dog partnerships in the UK with lots in Scotland so it is a big team to manage but I love it!

Can you tell us about why you wanted to come to Alzheimer Scotland for your final year occupational therapy placement?

Studying is not all about theory and books, student Occupational Therapists need to do a minimum of 1000 hours practical placement working in both physical and mental health settings in NHS and social services. My placements had been in Community Adult Rehabilitation, Adult Neuro Rehabilitation, Paediatrics and for my final placement I wanted to gain an insight into what is considered a “non-traditional occupational therapy” setting.

I immediately thought about Alzheimer Scotland. I was drawn to their innovative project, working with Dogs for the Disabled and the Glasgow School of Art, The Dementia Dog project. For me this was my ideal placement. I felt I could learn and contribute to this fantastic project, linking my new and developing knowledge of occupational therapy and in return bring my years of dog expertise into play.

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Can you tell us about your placement in Alzheimer Scotland?

The main focus of my occupational therapy placement is the Dementia Dog project. The Project is made up of quite a few areas; there are the assistance dogs which are out working in the home with people living with dementia in exactly the same way as a Hearing Dog or Guide Dog would work, out and about with their distinctive jackets on.

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You can access more information here

Predominantly I am working on Dementia Dog Days at Alzheimer Scotland Resource Centres, allowing more people with dementia to experience the value a dog can bring in helping with communication, memory, storytelling and mobility.  I am also doing a lot of research to look at the “art and the science” behind why dogs make a difference in these areas.

The wonderful thing is that all this work is so occupational therapy  focussed, how through occupation with the dog, people with dementia are able to engage in a new spectrum of activities or how having a dog involved helps the retention of activities of daily living, independence and being able to stay in your own home for longer.

Poppy, Albert and Alex at our Dementia Dog Day in Kilmarnock.

Poppy, Albert and Alex at our Dementia Dog Day in Kilmarnock.

Where have you been on your placement?

I have been to the Alzheimer Scotland Conference in Glasgow, my arms were aching with carrying all the information I found and my voice was hoarse through chatting to so many people.

I’m linking with the policy team based at the Alzheimer Scotland national office including the two occupational therapy interns Lyndsay and Chris along with the music therapy intern Rebecca.

NHS Education Scotland have adopted ‘Dementia Dog’ as their charity of the year so I’ve been doing some promotional work over there too.

I’m helping set up Dementia Dog sessions with the Alzheimer Scotland Day Care Team at the Dementia Resource Centre in Dundee and a big chunk of my time is spent at the beautiful Dementia Resource Centre in Kilmarnock.

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Everything in there is so dementia friendly and they are setting the trend for how accessible and inviting a space Alzheimer Scotland services can be.

I have had the opportunity to work with the occupational therapists in the local services. I was invited to go along to the Dementia Cafe at Croy Day Hospital in Ayr run by the occupational therapy team there.  I had a good blether with Carol Mitchell and I will be going back in a couple of weeks to the Cognitive Stimulation Therapy Session. To learn more about Carols work read pages 26-27 in Allied Health Professionals Delivering Integrated Care: Living Well with Community Support

What have been your highlights so far?

It has to be the people. The people living with dementia who share so much of their time with me and always seem so happy to answer my questions, it’s a real privilege to spend time with them.  Also the staff and volunteers at Alzheimer Scotland, I have been made so welcome by everyone, the teams work so hard and with such care and attention for their clients, it’s lovely to see.

And last but not least the dogs: Alex 4 Paws, Poppy, Albert and Bo.  All working in their unique ways to add to the quality of life people living with dementia.

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The first 6 weeks of my placement have flown by and I know the final 4 weeks will be on me before I know it, but if you would like to know more about Dementia Dog, do get in touch your can email me on or follow me on Twitter @Kari76npm #dementiadog


Kari Milsom

Occupational Therapy Student


Kari is currently on placement with Alzheimer Scotland and the Dementia Dog team as part of her final degree year via York St John University.  Kari’s substantive post is with Hearing Dogs for Deaf People and upon completion of her degree she will be heading up the Applicant Engagement section as Consultant Occupational Therapist for the charity.  As part of the Dementia Dog team, Kari is creating a Tool Kit for the role out of Dementia Dog Days at Alzheimer Scotland resource centres and creating protocols for dogs to be incorporated into therapeutic activities.

Music Therapy Week 22 – 28 June #MTW2015

Instrumental Role of Music Therapy in Supporting People with Dementia

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This year’s music therapy week has a focus on the instrumental role music therapy has to play in supporting people with dementia and those who care for them. Leading research has shown that music therapy can significantly help to improve and support the mood, alertness and engagement of people with dementia, can reduce the use of medication, as well as helping to manage and reduce agitation, isolation, depression and anxiety, overall supporting a better quality of life (Ridder et al, 2013)

We are celebrating music therapy week with you, with a blog post from Rebecca, our Alzheimer Scotland music therapy intern @mt_rebecca

Catch up with the Alzheimer Scotland Music Therapy Intern

I have now been in post for six months with Alzheimer Scotland and would like to update you on the progress I have been making.  I invite you to listen to my suggested song titles as you read through my blog…

Over the last few months I have been developing my thinking around the practicalities of delivering therapeutic musical activity for people living with dementia. I am in the early stages of developing a document called ‘Music and Me’. This document hopes to do two things:

  1. Promote person centred practice by creating a musical life story for a person living with dementia from childhood through to present day, a profile that can begin at any time for anyone.
  2. Encouraging carers, families, staff, activity organisers and allied health professionals to partnership work and share good practice when engaging people in meaningful musical activity.

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I am about to pilot the idea and work in partnership with a music therapy student from Queen Margaret University in the autumn to see if the theory and aspirations of Music and Me can work in practice.

“I get by with a little help from my friends”, The Beatles

Sharing my learning and my role as a music therapy intern is a large part of my day to day work.  In September 2015, Dr Philippa Derrington  @PLDerrington, Queen Margaret University and I will be presenting at the ‘Music Therapy and Dementia Conference’, Anglia Ruskin University, Cambridge. The title of our paper is ‘Approaching dementia care together’, this will bring focus on the strategic alliance Alzheimer Scotland have formed with Queen Margaret University, and the progress of music therapy within Alzheimer Scotland.  I am looking forward to sharing all the work I have been developing.

“Listen (Dream girls)”, Beyoncé 

Sometimes it’s good to stop, blether and listen! Who knows what we might learn…

Across Scotland AHP’s have been engaging the public in “tea and blether” sessions. The blethers took place throughout dementia awareness week, to help promote the public and professionals to talk about dementia.

I was involved in “blethering” for the week and had many enquiries about the use of music therapy within dementia care. The blether sessions were a great opportunity to spread the word about what music therapist have to offer people living with dementia. On reflection, the blether sessions also provided the AHP’s with the opportunity to listen to the needs of the general public.

“Express yourself”, Labrinth 

Music therapy is all about providing people with the opportunity to express themselves…

Over the last eight weeks I have been running an open music therapy group within Alzheimer Scotland day care services in Dumfries. Music therapy had a role in bringing a group of people together with varying interests, experience and abilities.  The group engaged in creating meaningful music, meaningful conversation and reminiscence therapy. Everyone within the group was able to share the experience with each other and had the opportunity to engage in the music in any way they wished. The music therapy sessions were tailored to peoples individual needs whilst also being part of a group that had a focus on a ‘can do’ attitude.  By doing this I found people were empowered to express themselves within sessions, were creative while also making music.

The feedback from everyone involved was extremely positive.

Some of the comments included:

  • “Music therapy makes me feel happy”
  • “I enjoyed being part of a group”
  • “The music has a big impact on that man, it’s amazing”

The overall feedback suggested that people felt happy and relaxed after the sessions and my colleagues comments reflected this too.

In the next few weeks I will be running music therapy sessions in our sensory day care service in Alzheimer Scotland Dumfries resource centre. The focus of this work will take on a similar format but engage people with advanced dementia. I am confident of the benefits of music therapy for people with advanced dementia, enabling people to engage in a therapy that is inclusive, person centred and has the ability to tap into memories of long ago

“Thank you for the music”, Amanda Seyfried (mamma mia)

Thank you for supporting music therapy and dementia by reading this blog. Please feel to leave reflections, comments and questions below.

June 22nd-28th is music therapy week… why not share your favourite piece of music with a loved one…

Thank you for the music!

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Music Therapist/Music Therapy Intern


I recently graduated from Anglia Ruskin University with a postgraduate Master of Arts degree in Music Therapy. At present I am working with Alzheimer Scotland as a Music Therapist/Music Therapy Intern. I have a key interest in further researching the benefit of music therapy for someone living with dementia. I gained this interest after having a personal experience with a close family friend who had Alzheimer’s disease, I was inspired by her clear motivation when interacting musically with me. This initial experience led me to train as a music therapist.  I hope that throughout my time working with Alzheimer Scotland I can contribute to the growing research around music therapy and dementia care.

Dementia Awareness Week, Scotland


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For a week we talked about dementia. A key feature of Dementia Awareness Week, 2015 was our ‘Tea & Blether’ events all over the country; encouraging members of the public to meet and talk about dementia in a relaxed setting.

During the week we promoted the role and added value of Allied Health Professions, raising awareness about our unique therapeutic and rehabilitation skills. Ultimately helping to improve the public’s understanding of who we are and why they would want to approach us for help.  We had the opportunity to listen, to hear what is important to you, people living with dementia and your families and friends.

We wanted to share with you some of our #mugselfies from our tea & blether’s, so sit back and enjoy looking through our photo gallery.

Your #mugselfies

What were your highlights from Dementia Awareness Week, Scotland 2015? Send us your #mugselfie to and we will add you photos to the gallery.

Thank you for being involved in this year’s Dementia Awareness Week, 2015

Elaine HunterElaine Hunter
Allied Health Professional Consultant, Alzheimer Scotland

My remit in Alzheimer Scotland is to bring the skills of AHPs to the forefront of dementia practice and to share with them the principles and practice of working in a major charity that is dedicated to “making sure nobody faces dementia alone”. I am leading the delivery of commitment 4 of Scotland’s Dementia Strategy. In short, a great job working with great people.

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 5 “Ask a Speech & Language Therapist”

5th June will be by Joy @joysltdem

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Communication and eating, drinking and swallowing are fundamental to our well-being, and it is the speech and language therapist’s role to help with these skills for people with dementia at all stages of the illness. The following questions highlight many common areas of difficulty and I hope that the answers provide people with ideas on how to work around the challenges.

Question 1 – Do speech and language therapists work with people to learn to sign some words when speech is going?


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Answer – This would be very unusual, unless the person had signed previously. It is recognised that it is generally difficult to learn new skills. However, increased use of body language and natural gesture is fully recommended. Most of us have highly developed skills at reading body language that we developed as babies and toddlers before we even started speaking. It is likely that the person with dementia is reading body language (which includes facial expression, tone of voice, posture etc.) long after language comprehension has deteriorated. It is therefore important to be aware of what you are communicating non verbally and to enhance natural gesture to facilitate comprehension. The person with dementia can also be encouraged to increase their use of gesture to aid their expression when words are difficult to find. Playing miming games such as charades may be a way of encouraging this skill.

Question 2 –My wife has difficulty with her speech. She gets very confused and often uses words that make no sense. She then gets angry with me when I don’t understand what she wants and sometimes throws things at me. I am weary and at times quite frightened. I have no idea how to help her tell me what she wants.

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Answer – this is a difficult one. It is obviously important to reduce frustration because more effective communication is always achieved in calmer settings.  Firstly, always ensure that distractors such as television, radios, barking dogs, crying grandchildren etc., etc. are reduced to an absolute minimum. One to one communication is always more likely to be effective.

Then I would recommend acknowledging when you do not understand and posing questions such as ‘are you talking about….. (the doctor?  tea? yesterday?)

Alternatively pick up objects, pictures and say ‘is it this?’ Visual materials help to focus the person and helps them to remember what it is they are trying to talk about.

As in the previous answer, encourage the use of gesture to get messages across.

However, if all this increases frustration and inevitably sometimes this might happen, it is vital to acknowledge that frustration and suggest she comes back to it later. Then try to distract her with another activity or topic.

Question 3 – My wife gets very frustrated when she can’t find words. Should I finish her sentences for her?

Answer – Finishing sentences for people depends very much on individual relationships and there isn’t one stock answer. I recommend that you ask the person whether they would like support on completing sentences and how soon you should ‘jump in’. Be aware that you need to be listening very carefully to be sure that the word you offer is actually what the person is trying to say, because selecting the wrong word can increase frustration.

Question 4 – I am finding my friends have stopped visiting because it is so hard to have a conversation. Is there anything you can suggest which might help?

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Answer- It can often be daunting for friends to continue visiting if they feel conversation is becoming more difficult; however there are several ways that good interactions can still be achieved. Generally speaking, it is better to focus conversation on a tangible object such as a newspaper, photograph, keepsake or newly acquired item from the shops, for example. This is because 1) the focus is taken off the person and put on to the item and 2) the person is more able to keep in mind what the topic of conversation is.

Old photographs are particularly good as very often older memories remain for longer. Remember though that it is not necessary to correct erroneously remembered memories because the focus should be on the quality of the shared interaction and not the truth as you remember it.

Sometimes people find conversation flows more easily if you are both involved in an activity together e.g. arranging flowers, tidying out a drawer etc.  Simply commenting on things such as ‘that is a beautiful flower’ or ‘I had a pen like this once’ may well result in an exchange of comments.

It is important to avoid the use of questions, particularly open-ended ones such as ‘What did you do in the war?’  Even questions that just require a Yes/No response often don’t lead to further conversation easily and should be used as little as possible.

It is also important not to talk too much. Often we fear silence and try to compensate for the reduced conversation from the person with dementia by talking incessantly. Occasional comments and companiable silence, particularly when engaging in some activity is absolutely fine.

Question 5 – My husband has been put on a soft diet and really misses his favourites. Is it ok to bend the rules a bit?

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Answer- There are many different reasons why people are put on a soft (puree diet). It would be very important to discuss with the Speech and Language therapist (SLT) why he was put on this dietary texture in the first place before bending the rules. Modified diets are used to reduce risk of choking and/ or aspiration of food and drink that might lead to chest infections, and it is vital that the level of risk for your husband is fully understood.

SLT’s are always mindful of balancing the risks against quality of life. It is often found that people manage their favourite foods better due to increased stimulation and therefore an informed discussion with your therapist could result in a controlled trial of these foods.

We welcome ideas and comments from our readers about this blog.

Joy HarrisJoy Harris
SLT,Clinical Lead for Dementia, Lothian

I work in East and Midlothian Psychiatry of Old Age teams seeing people with communication and/ or swallowing problems from the point of diagnosis of Dementia, and at any stage throughout the patient journey as the need arises.

“A blog a day blether” for #DAW2015

Allied Health Professionals Q&A

Day 4 “Ask a Physiotherapist” by @lynnflannigan1

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Hello & Welcome

Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice (CSP 2015). Physiotherapists are specialists in enablement and rehabilitation who can support people with dementia to remain as active and independent as possible.

Physiotherapy can have a significant positive impact on some of the difficulties that people with dementia can have with their walking, balance and muscle strength. See below for what the new Alzheimer Scotland Allied Health Professionals leaflet has to say about physiotherapy.

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We asked people with dementia and their carers what questions they would like to ask a physiotherapist and this is what they asked;

Question 1

Can you offer any hints and tips about keeping the person with dementia mobile? Carer

There is an old saying most of us will be familiar with – “if you don’t use it you lose it”. We know that people with dementia are less active than those without dementia. Mobility problems in people with dementia may be caused as much by a lack of activity as by the dementia itself, therefore it is important to try to keep as active as possible. It is important that the person with dementia tries to keep doing the things they enjoy, especially if they involve physical activity and exercise. The main thing is not to sit for long periods of time as this can cause the muscles to waste and the joints to get stiff.

Sometimes a person with dementia will lose their confidence to do activities they used to enjoy. Their health or social care professional should be able to offer advice about this. Alzheimer Scotland also has a guide for carers around Activities – the link can be found at the bottom of the page.

If a person with dementia is having difficulty with their mobility then a physiotherapist can offer them some advice and may provide some exercises to help.

Question 2

How can you best help someone out of their bad or chair without hurting them? Carer

Unfortunately, it is possible to hurt someone when you are assisting them out of a chair or bed. It is also possible that the carer can be injured when doing this. The main piece of advice would be never to pull someone up by the arms as this can cause serious damage to the shoulder joint. The most common mistake people make is to rush the person with dementia or not to explain what you want them to do well enough. Always explain what you want the person to do, without giving too much information at the one time. It sometimes really helps the person if you show them visually first what you want them to do. Try to encourage the person to do as much for themselves as they can – only provide physical assistance if you have to. Sometimes moving and handling equipment will be recommended if the person with dementia cannot be assisted by another person safely.

If you are unsure about how to best encourage someone to be as independent as possible or to assist them where required, a physiotherapist can offer you advice.

Question 3

How do I prevent my mum from falling? Katy, carer

Falls aren’t an inevitable part of living with dementia, however, some of the symptoms can make people with dementia more at risk of falls. People with dementia can also have the same health conditions that increase the risk of falls as people who don’t have dementia. There are lots of different factors that can put a person with dementia at risk of falls. Of course we can all have a slip or a trip, however, there are some factors which will increase the risk of having a fall. These include; problems with mobility, reduced strength or balance, medication side effects, continence problems, problems with feet/footwear, poor nutrition/hydration, a history of previous falls, vision problems, hearing problems, dizziness/fainting, how you interact with the environment and confusion/dementia.

It is important that your Mum’s own individual risk factors for falls are identified so that where possible they can be reduced/managed. This is usually done by a health or social care  professional such as a physiotherapist using a multifactorial risk assessment, which is a risk assessment which looks at the most common factors which can cause falls . A personalised action plan should then be completed. Physiotherapists are commonly involved with providing exercises which increase strength and balance and therefore reduce the risk of falls.

General advice about how to reduce falls can be found in the NHS Scotland Up and About booklets which can be found at the link in the references section. NHS Inform also have a falls prevention webpage with a section on dementia and falls which can also be found in the references section.

Question 4

My mum (Mrs T) walks with a stick and is waiting for a replacement knee operation.  She’s always been independent and likes to do her own shopping, but recently fell outside her local supermarket when carrying her shopping and is now too frightened of falling to go out.  I think my mum is getting very depressed and I was wandering what aids (other than her stick) might be there to help mum keep her balance outside.

As her daughter has seen a fear of falling is a serious consequence of falls which can lead to low mood, a loss of confidence and a resulting restriction in activities. Restricting activities can then lead to a vicious cycle of further loss of confidence and physical deterioration which can further increase risk of falls

As a physiotherapist I would firstly want to assess why Mrs T is falling to see if I can offer any advice, provide an exercise plan or signpost her to other services to reduce her risk of falls. If her stick is no longer providing Mrs T will enough support and Mrs T was unsafe then I would consider providing her with a delta rollator which is a 3 wheeled rollator. As a physiotherapist I would always rather provide rehabilitation to avoid providing walking aids wherever possible, however, the right walking aid can increase mobility and confidence for some people.


Alzheimer Scotland Activities: A Guide for Carers of People with Dementia

CSP (2015)

NHS Inform Falls Prevention Page

NHS Scotland: Up and About Taking Positive steps to avoid trips and falls


Lynn Flannigan

Lynn Flannigan
Up and About in Care Homes Deputy Project Lead

I am a physiotherapist with a special interest in dementia. I am currently seconded to the Scottish Government as part of the Up and About in Care Homes Falls Prevention Project.


Tomorrows Blog with be by Joy and “Ask a Speech and Language Therapist ” Q & A.

5th June will be by Joy @joysltdem

5th June will be by Joy @joysltdem