Appendix A - Type Size Test

Invite the person to read the words listed on the following page starting with the largest type size gradually working your way down.

The type sizes used are: 100 (about one inch high/2.5cm), 72, 48 (about a half-inch high/1cm), 36, 24, 16 and 12 points.
If they cannot read a word, say ‘Did I make the letters too small?
Ok. We’ll only use letters that are the right size.’
Don’t ask the person to keep reading after they first cannot read a word.

Print out the following pages:

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Appendix B - Sorting Pictures Templates

Appendix C - The Evidence.

Montessori Activities for Agitation, Affect and Engagement

Scientific evidence supporting the Montessori methodology

The authors of this book have also done research to show the impact of Montessori activities.
A study with 44 aged care facility residents with dementia and high-frequency agitated behaviour (usually pacing) showed distinct changes in these individuals’ agitation, engagement and affect. However, this was a select group. All participants resided in facilities in Melbourne, Victoria and only around 20% of everyone in facilities was eligible for this study, because of our focus on agitation, which was usually associated with severe dementia.

We observed individuals 30 minutes before, during and after an intervention applying activities with Montessori principles. For every minute we recorded the presence or absence of the behaviour. Hence, the score for every period could range from 0 to 30.

Figure 1- Minutes with Agitation

Figure 1. Minutes with agitation for a group of 44 people with severe agitation and dementia

Before doing the activities, the participants in this group were pacing on average 17 of the 30 minutes (Figure 1). During the activities this was reduced to 8 minutes. After the activities facilitator left, the level went back to the same level as before the activities.

Figure 2 - Minutes with Agitation - english and non english

Figure 2. Minutes with agitation for people with and without English language fluency

The group consisted of people who were still fluent in English (32 individuals) and people who had lost their fluency in English because it was their second language (12 individuals). Figure 2 shows that the group who had lost their fluency in English was pacing more before the activities than the group who could still speak English. The reduction of agitation in the non-English speaking people was greater than the reduction in English speakers.

Active Engagement
We also recorded at one minute intervals what the predominant type of engagement of the participant was. We studied 4 types of engagement: 2 positive kinds (active and passive engagement) and 2 negatives types (non- and self-engagement). Active engagement meant that the individual was actively participating with the environment or the activities, either by talking to people or by handling materials. Passive engagement meant they were still involved with the environment or activity by listening or watching. Self-engagement was a focus on the self, usually associated with agitation as well, and non-engagement was signified by a blank stare.

Figure 3 - Minutes with positive engagement

Figure 3. Minutes with positive engagement for a group of 44 people with severe agitation and dementia

Figure 3 shows that there was limited opportunity for these people to be positively engaged before and after the activities were delivered: on average, 7 of the 30 minutes. However, during the Montessori activities they were able to positively engage with the facilitator and the activity for 22 of the 30 minutes, resulting in positive interactions between facilitator and participant.

The findings presented have been published in scientific journals:

  • Van der Ploeg ES, Eppingstall B, Camp CJ 2013.
    A randomized crossover trial to study the effect of personalized, one-to-one interaction using Montessori-based activities on agitation, affect, and engagement in nursing home residents with Dementia. Int Psychogeriatr. 2013 Apr;25(4):565–75. doi:
  • Orsulic-Jeras S, Judge KS, Camp CJ 2000.
    Montessori-based activities for long-term care residents with advanced dementia: effects on engagement and affect. Gerontologist. 2000 Feb;40(1):107–11.
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