Environment & Communication Assessment Toolkit (ECAT) for Dementia Care Manual

By Jennifer Brush, M.A., CCC-SLP, Margaret Calkins, PhD, CAPS, EDAC, Carrie Bruce, MA, CCC-SLP, ATP, and Jon Sanford, M.Arch

ISBN 978-1-932529-80-7
8.5 x 11
full color
104 pages
© 2012


The starting point for using the Environment and Communication Assessment Toolkit is the ECAT Manual—a user’s guide, technical manual, and educational resource all in one easy-to-use-book!

The Manual details how limitations associated with dementia can impact communication, describes step-by-step how to complete the assessments, and includes appropriate interventions and modifications in handy tables cross-referenced to the assessments.

These interventions and modifications offer specific strategies for implementing environmental changes that tackle the communication difficulties the ECAT Toolkit allows you to pinpoint.

The Manual has other bonuses, too—such as the final section with everything you need to know about lighting (methods, types, fixtures, bulbs, suppliers, and more).

Sold separately and also included as part of the Environment and Communication Assessment Toolkit (ECAT).

Introduction: What Is the ECAT and Who Should Use It?

Resource Guide
Assessment Instruments
Intervention Resources
ECAT Development

Section 1: Resource Guide

A. Introduction

  • What Is Communication?
  • Impact of Communication Disorders
  • Impact of Environment on Communication
  • Environment, Ability and Performance

    • Competence Press
    • International Classification of Functioning, Disability and Health (ICF)

B. From Body Structure to Environmental Interventions

  • Body Structure and Function

    • Normal Aging

      • Changes in Cognition, Memory, and Language
      • Changes in Vision
      • Changes in Hearing
    • Dementia

      • Changes in Cognition and Memory
      • Changes in Expressive and Receptive Language
      • Changes in Vision
      • Changes in Hearing
  • Design Strategies

    • Optimize Cognitive Aspects
    • Maximize Cues
    • Personalize Spaces and Materials
    • Optimize Visual Aspects
    • Enhance Lighting
    • Enhance Visual Organization
    • Maximize Sightlines
    • Maximize Contrast
    • Minimize Glare
    • Optimize Auditory Aspects
    • Minimize Background Noise
    • Minimize Reverberation
  • Environmental Interventions

    • Toileting, Bathing, and Grooming
    • Dressing
    • Orienting to Time / Location
    • Controlling Ambient Conditions
    • Engaging in Leisure and Social Activities
    • Navigating Throughout the Care Community
    • Dining

C. Environmental Interventions as Part of Treatment Planning Process

  • Implementing Modifications in the Care Community

    • Examples of Significant Environmental Modifications

Section 2: Assessment Tools

Assessment Structure

  • Assessment Forms
  • Gray Scale to Assess Contrast
  • Reading Test to Determine Readable Font Size
  • Sound Level Meter to Assess Sound Intensity
  • Light Meter to Assess Light Intensity

Section 3: Intervention Resources

Interventions Based on Environmental Assessment Results
Developing Visual Cues and Reading Material

Section 4: Resources

Where to Purchase Supplies for Environmental Modifications
Useful Sequencing Cues
Useful Signs

Jennifer BrushJennifer Brush, MA, CCC-SLP, is the Director of Brush Development, USA and the Program Director, Montessori Education for Dementia, St. Nicholas Montessori College, Dun Laoghaire, Ireland. Jennifer serves on the Association Montessori Internationale (AMI) Advisory Board for Montessori for Aging and Dementia, and she is the only AMI Certified Trainer of Trainers for Montessori for Aging and Dementia in the US. Jennifer is the co-author of several nationally recognized books on dementia.

Understanding the particular needs of healthcare organizations and families engaged in dementia care she brings more than 20 years of experience as both a leading researcher and direct-care coach in this complex field. She is a nationally recognized speech-language pathologist known for her work in the areas of memory and environmental interventions for people with dementia. She has served as the principal investigator on applied research grants that examined issues pertaining to HIV/AIDS dementia, hearing impairment, dining, swallowing disorders, and the long-term care environment. Ms. Brush has served as Chair of the Professional Development Committee of the American Speech-Language Hearing Association Gerontology Special Interest Division and on the Editorial Review Board of SpeechPathology.com.

Learn more at www.brushdevelopment.com.

Margaret Calkins, PhD, CAPS, EDAC, is widely recognized as an expert in the creation and evaluation of long-term care settings, particularly for people with dementia. She is President of I.D.E.A.S., Inc. (Innovative Designs in Environments for an Aging Society), and Chair of the Board of the I.D.E.A.S. Institute, both of which seek to improve environments for frail and impaired older adults through the conduct of rigorous, applied research, dissemination of evidence-based information and resources, and individual partnering with designers and care providers. She is also a Founding Member of SAGE (Society for the Advancement of Gerontological Environments), and currently serves on the Board of American Society on Aging and the Pioneer Network. She is a sought after speaker, giving more than 20 presentations a year, in the US and abroad. She is also widely published in both academic and trade journals. She is author of the first design guide on environments for people with dementia, Design for Dementia: Planning Environments for the Elderly and the Confused (National Health Publication, 1998). In addition to having a PhD in Architecture, Dr. Calkins is a Certified Aging-in-Place Specialist and is one of the first professionals to receive the Evidence-based Design Accreditation and Certification.

Carrie Bruce, MA, CCC-SLP, ATP, is a licensed speech-language pathologist and assistive technology practitioner who has been working in the field of rehabilitation for more than 15 years. Ms. Bruce is also a Research Scientist at the Center for Assistive Technology and Environmental Access (CATEA) at Georgia Tech, working as an investigator on multiple grant projects. She is distinguished for her work in examining environmental design issues related to accessibility and investigating assessment methodologies that measure the environment’s impact on activity and participation. Her recent work has focused on evaluation and design of spaces, products, and interfaces to support communication in a variety of settings including aquariums, museums, nursing homes, and workplaces.

Jon Sanford, M.Arch, is an Associate Professor in the College of Architecture at Georgia Tech and the Director of the Center for Assistive Technology and Environmental Access (CATEA). He is also a Research Architect at the Rehabilitation Research and Development Center at the Atlanta Veterans Affairs Medical Center. Mr. Sanford is one of the few architecturally trained researchers engaged in environmental issues related to rehabilitation. He has been well-recognized for almost 25 years for his expertise in universal design, accessible design, and assistive technologies across a range of environments from housing to residential care to public buildings and community spaces. He is one of the authors of the Principles of Universal Design and his research spans the microenvironment from the design of toilet and bathing facilities and home modifications for older adults, to the macroenvironment including design of long-term care settings. He has developed a number of assessment protocols, including remote assessments using televideo technology and CASPAR, the Comprehensive Assessment and Solutions Process for Aging Residents. He is currently working on several projects to evaluate the efficacy of interactive teleconferencing to provide remote, therapeutic services to older adults and their caregivers, including a multisite, randomized controlled trial funded by the VA Rehab R&D Service. He has contributed more than 100 articles and chapters to the professional literature and has more than 150 professional presentations.

I.D.E.A.S., Inc. (Innovative Designs in Environments for an Aging Society, Kirtland, Ohio) is a nationally recognized source of expertise on environments for people with dementia that engages in research, education, and consultation on the therapeutic potential of the environment for frail and impaired older adults. Jennifer Brush is Senior Project Director for and Margaret Calkins is President of I.D.E.A.S., Inc.


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