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Positive Personal Connector step in PPA

Key points

  • The Positive Personal Connector is the first step of PPA: approach from the front, get to eye level, smile, and pause to read the person's cues before any task.
  • Never approach from behind or the side—this can trigger a startle response and lead to resistance or aggression.
  • Use an open-handed, palm-up gesture to signal safety and invite connection, not a grab or point.
  • Watch for positive cues (eye contact, smile, relaxed body) or negative cues (turning away, stiffening, frowning) and adjust your approach accordingly.
  • The connector step is a data-gathering moment: you assess the person's emotional state, cognitive ability, and physical comfort before proceeding.
  • For tasks near the face, start with a low-intensity touch on the cheeks or forehead before moving to the mouth area, as Teepa Snow demonstrates.

General caregiving information, not medical advice. Check medications and major care changes with your clinician.

Step-by-step

  1. Approach slowly from the front, about 6 feet away, and pause. Make sure the person can see you coming—never approach from behind or the side, which can startle them.

  2. Get to their eye level by kneeling, sitting, or lowering your body. This reduces the power imbalance and makes you less intimidating.

  3. Offer a warm, genuine smile and an open-handed gesture (palms up, fingers relaxed). Avoid crossed arms, pointing, or holding objects that might look like a threat.

  4. Say the person's name in a calm, cheerful tone. Use their preferred name (e.g., 'Hi, Margaret' not 'Mrs. Smith' unless that is their custom).

  5. Wait and watch their face, eyes, and body for at least 3–5 seconds. Look for a return smile, eye contact, relaxed shoulders, or a slight nod—these are positive cues. If they turn away, stiffen, or frown, do not proceed; instead, back up and try again more slowly.

  6. If they respond positively, gently extend your hand (palm up) toward their hand or arm, but do not grab. Let them see your hand coming and invite them to touch you first if possible.

  7. Use a low, slow, rhythmic voice to say something simple and reassuring, like 'I'm here to help you with your teeth' or 'Let's take a little walk together.' Avoid questions that require complex answers (e.g., 'Do you want to brush your teeth now?'—instead say 'Time to brush your teeth').

  8. Before any physical touch, do a 'test touch' on a low-intensity area like the back of the hand or the forearm. Watch their reaction: if they pull away, stop and try a different spot or wait longer. If they relax, you can proceed to the task area (e.g., the face for mouth care).

  9. If the person is coughing or has secretions, as Teepa Snow notes, you might first stimulate the cheeks and forehead with your hand before moving to the mouth area. This lower-intensity touch helps you assess tolerance and gather data on whether the cough is real or a dry throat.

  10. Throughout the connector step, keep your own breathing slow and even. Your calmness will help regulate their nervous system. If you feel rushed, pause and take a breath yourself before continuing.

What not to do

  • Do not approach from behind or the side. This can trigger a startle response and make the person feel attacked. Instead, always approach from the front, within their line of sight.

  • Do not rush into the task without connecting first. Jumping straight into mouth care or dressing without the connector step often leads to resistance, shouting, or physical aggression. Instead, spend 30–60 seconds on the connector step.

  • Do not use a loud or high-pitched voice. This can be perceived as alarming. Instead, use a low, calm, rhythmic tone that matches a relaxed pace.

  • Do not grab or touch without warning. Even a gentle touch on the arm can feel invasive if the person is not ready. Instead, offer your hand palm-up and let them initiate contact if possible.

  • Do not ask complex questions like 'Do you want to brush your teeth now?' This can overwhelm or confuse. Instead, use a simple statement: 'Time to brush your teeth.'

  • Do not ignore negative cues like turning away, stiffening, or frowning. Pushing through will escalate distress. Instead, back up, wait, and try again with a slower, softer approach.

Practical tools

  • The 'Pause and Scan' Checklist

    Before you even speak, scan the person's environment and body: Are they sitting or standing? Are they engaged in an activity? Is the room quiet or noisy? Use this data to decide if you need to adjust lighting, turn off the TV, or wait until they finish a task. This is part of the connector step—gathering data to set up success.

  • The 'Open Hand' Gesture

    Hold your hand out, palm up, fingers relaxed, at about chest height. This is a universal signal of 'I come in peace.' It invites the person to reach out if they want, and it gives you a chance to see if they can imitate the gesture (a sign of cognitive ability). Do not point or clench your fist.

  • The 'Name + Pause' Script

    Use this exact phrase: '[Name], it's [your name].' Then pause for 5 seconds. For example: 'Margaret, it's Sarah.' Then wait. This gives the person time to process and respond. If they do not respond, repeat once more slowly. If still no response, move to a gentle touch on the back of the hand.

  • The 'Test Touch' Technique

    Before any care task, place your hand gently on a neutral area like the back of the hand or forearm for 3 seconds. Watch for a flinch, pull-away, or relaxation. If they relax, you can move to the task area (e.g., face for mouth care). If they tense, stop and try a different spot or wait longer.

  • The 'Low-Intensity Stimulation' Sequence

    For tasks near the face (like mouth care or feeding), start by gently stroking the cheeks and forehead with your hand before moving to the mouth. This lower-intensity touch, as Teepa Snow demonstrates, helps you assess if the person finds it positive or negative. If they tolerate it, proceed; if not, back off.

  • The 'Breath Sync' Practice

    Before you approach, take three slow, deep breaths. As you connect, match your breathing rate to theirs if possible. If they are breathing fast, slow your own breath and they may unconsciously follow. This is a non-verbal way to calm the nervous system.

Discuss with your clinician

If the person consistently reacts with aggression or fear during the connector step, discuss with a doctor or occupational therapist whether there is an underlying medical issue (e.g., pain, infection, medication side effect).

If the person has a known history of falls, ask the clinician for guidance on safe positioning during the connector step (e.g., whether to kneel or sit to maintain your own balance).

If the person is on medications that affect alertness (e.g., antipsychotics, sedatives), ask the clinician how these might impact their response time during the connector step and whether you need to adjust your pace.

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