Get new tx ideas using puzzles in #OT with your patients that have dementia - what kind are best, how to use them + ways to use them in a sensory diet | #geriatricOT #occupationaltherapy

How to Use Puzzles in OT with Patients That Have Dementia

Mandy Chamberlain MOTR/L Education & Tips for Independent Living 17 Comments

Using puzzles in occupational therapy for our patients with dementia is a great way to work on goals, reminisce, and use as a part of a patient's sensory diet.

I will discuss how to incorporate them into working toward your goals for physical limitations, cognitive limitations and recommendations on what to look for in puzzles specifically for patients with dementia.

When to Use Puzzles When Working on the Physical Limitations of Patients With DementiaGet new tx ideas using puzzles in #OT with your patients that have dementia - what kind are best, how to use them + ways to use them in a sensory diet | #geriatricOT #occupationaltherapy

  1. Activity tolerance: grade by keeping track of the time that the patient is participating, increasing time each treatment session
  2. Dexterity: grade by keeping track of the amount of time participating, increasing time each treatment session
  3. Visual - spatial skills: grade by matching colors and keeping track of accuracy (pt demonstrates ability to match 3 different colors with 75% accuracy) or timing how long it actually takes to put it together, noting how many pieces it is
  4. Visual scanning: grade by starting with only a few pieces to look for and then increasing number of pieces to find
  5. Crossing midline: grade by requiring patient to only put pieces together with one hand, reaching across midline and progressively placing pieces farther away
  6. Range of motion in both fine motor and gross motor of upper extremities: grade by keeping pieces close and then progressively putting pieces farther away or even using a felt board on a wall with velcro on the back of the puzzle piece, which would increase ROM required

Make sure you are deciding how you are going to grade the activity so you can document where the patient begins with the task and you can continue to document progression.

When to Use Puzzles When Working on the Cognition of Patients that Have Dementia

You can use puzzles with patients that are in the early and middles stages of dementia and depending on their cognitive level, you will have to determine how many piece puzzle is most appropriate.

I typically like to use puzzles that have few pieces (9-15 piece puzzles for middle stage dementia and 16-25 piece puzzles for early stage dementia), is a meaningful activity for the patient and is adult themed (so basically, no cartoons, Disney or teddy bears unless it is an interest to the patient 🙂 ).

The goal with using puzzles is to match their cognition in order to perform the activity and find success, enjoyment and satisfaction in its participation vs increase cognitive ability. They do not necessarily have to understand what the ultimate goal of the puzzle is, but they do have to have a basic understanding of the puzzle steps (even if they need to be cued).

Make sure the puzzle is an activity that the patient has performed in the past or is interested in to make sure it is a meaningful activity. Purposeful occupation can help with reduction in agitation, physical and verbal outbursts and most importantly, promotes quality of life in our patients, especially those with middle and late stage dementia.

[cp_modal id="cp_id_2a02f"]*Click Here to Get a Link to a FREE ACL Sensory Diet Guide for Adults[/cp_modal]

Get new tx ideas using puzzles in #OT with your patients that have dementia - what kind are best, how to use them + ways to use them in a sensory diet | #geriatricOT #occupationaltherapyUsing Puzzles as Part of a Sensory Diet for Patients with Dementia

A sensory diet is a personalized activity plan that provides the sensory input a person needs to function throughout the day without being either overstimulated or understimulated. 

Puzzles can easily be a part of this plan as an activity that the patient can participate in if it is 1) matched appropriately to their cognitive level (typically ACL level 4.0 and above) and 2) appropriate external cues are provided if necessary.

Do they need:

  • Set up: Can they get all the pieces right side up and laid out appropriately to actually complete the puzzle?
  • Prompting: This can be provided by either verbally prompting by saying, "What's next?" or physically prompting, by pointing to help them with the next step or initiating the activity.
  • Verbal cuing: Give 1 or 2 step directions to participate in the puzzle. "Pick up the yellow piece. Put it here."
  • Hand over hand assistance: Give physical assistance/cues to participate.

After you figure out what puzzle and what external cues they need, you can then easily educate the staff and family members that may be helping the patient with the puzzle.

[cp_modal id="cp_id_2a02f"]*Click Here to Get a Link to a FREE ACL Sensory Diet Guide for Adults[/cp_modal]

Finding the Perfect Puzzle for Patients with Dementia

I really like the puzzles designed by Monica Heltemes, an occupational therapist and founder of They are brightly colored, adult themed pictures, have a simple basic design without too much detail and makes the puzzles in 12, 24 or 36 pieces. puzzles for people with dementia

I also have used a 9 piece puzzle designed and made by Mike Shehata, an occupational therapist over at Therapeutic Woodworks. What is great about this puzzle is that sometimes it is difficult to find ones specifically for men. I live in an area where many of my male patients previously worked with their hands and enjoyed the outdoors - hunting, fishing, hiking. He designed a wooden puzzle specifically for this group.

How do you like to use puzzles with your patients that have dementia?
Leave a comment and share ideas!



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Comments 17

  1. At least this shows purpose vs. the puzzles that are left sitting out in the nursing home for residents to do because nothing else is offered all day.

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      I am actually not sure if he does! You can connect with him via Facebook or Instagram. He has rebranded and is now called “Therapeutic Builds,” but does the same things!

  2. Thanks for the share about MindStart and all the great ideas for intervention that puzzles can offer. Sometimes a smaller puzzle can be nice just for a task that can be finished within an entire treatment session, while working on fine motor coordination, standing tolerance, visual spatial skills, or the other areas you mentioned. Nice article to help overworked, busy OT’s quickly integrate something different into treatment!

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    Yes! Great idea and I love that we can use puzzles in so many ways – plus economical (and fun to make 🙂 Thanks Erika!

  4. I sometimes use puzzles for reaching, standing balance, organizing an activity, initiation & termination of tasks. I also use the Memory game the same way.

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      I love that we can get creative and work on fundamental components in a FUN way. It DOES NOT have to be peg boards and rainbow arches 🙂

  5. Thank you, Mandy, for all the useful tips you give us. I enjoyed reading all of them and take notes of what I can use with my patients. I would like to share an idea: since I love art, I may do an art piece with the patient of a topic of interest to him/her. I will have the patient color it or paint it; then -depending on the level of dementia – I will cut the art in puzzle like pieces and glue them onto a hard cardboard for easy handling when patient is required to solve it on a future visit. Patient may also be involved in the process taking safety into consideration.

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