Physical Therapy Treatment of Patients with Dementia

Page by: Claire Sears

Topic: **Physical Therapy Treatment of Patients with Dementia**

Dementia is a common disease among older adults in the United States and is predicted to rise in the coming years. Alzheimer’s Disease, specifically, affects more than 5.7 million Americans and is the 6th leading cause of death among adults1. This disease affects not only the individual diagnosed with it, but his/her family, friends and caregivers. As physical therapists often work with the older population, it is important we understand dementia and the proper way to care for these individuals to minimize impairments associated with the disease and maximize function.

**Objectives:**

·     Types of Dementia

·     Stages of Alzheimer’s

·     Treatment Strategies for this Population

**Types of Dementia**2**:**

·  Alzheimer’s Disease (most common)

o  Approximately 60-80% of cases of dementia

o  Caused by brain cell death

o  Symptoms listed below

·  Vascular dementia

o  Caused by lack of blood flow to the brain.

o  Often associated with previous stroke or atherosclerotic disease.

o  Early symptoms: confusion, disorientation, gait impairments

·  Lewy Body dementia

o  Caused by protein deposits in nerve cells.

o  Early Symptoms: confusion, visual hallucinations, delusions

·  Frontotemporal dementia

o  Nerve cell damage to the frontal and temporal areas of the brain.

o  Often an earlier onset compared to Alzheimer’s disease (40-60s)

o  Early Symptoms: behavior change, issues with speech

·  Mixed dementia

o  Most commonly a combination of symptoms of Alzheimer’s disease and Vascular dementia

·  Other Causes of Dementia: Multiple Sclerosis, Parkinson’s Disease, Huntington’s Disease, HIV-related

**Stages of Alzheimer’s**3,4**:**

1.    Stage 1 – No Impairment

2.    Stage 2 – Very mild cognitive decline – may notice minor memory problems, memory loss not easily distinguished from normal age-related memory loss

3.    Stage 3 – Mild cognitive decline – difficulties with remembering names, word finding, difficulty retaining new information, trouble organizing and planning, family/friends notice cognitive difficulties

4.    Stage 4 – Moderate cognitive decline – poor short-term memory, difficulty with mental arithmetic, forgetful of own personal history, mood swings

5.    Stage 5 – Moderately severe cognitive decline – begin to need help with day-to-day activities, inability to recall address, phone number, etc., difficulty dressing appropriately, still able to toilet and bathe independently

6.    Stage 6 – Severe cognitive decline – needs assistance with daily activities, including toileting and bathing, inability to remember details of personal history, personality changes, loss of bowel/bladder control, wandering

7.    Stage 7 – Very severe cognitive decline – final stage, all daily activities need assistance, lose ability to respond to environment or communicate, lose ability to swallow, muscles become rigid

(Image found on Alz.org)

**Treatment:**

**General**5,6**:**

· Focus treatments on FUNCTION. For example, work on standing balance while folding laundry. Do gait training outside where they often walk.

· Incorporate music into treatment. Music has been shown to reduce agitation and behavioral issues in this population.

o  Make sure the music is familiar and enjoyable to the patient.

o  Choose music that represents the mood you are trying to evoke. Make sure it is not too loud or overstimulating.

**Communication**7,8**:**

Verbal:

· Speak clear and calm and at a slow pace to allow time for the patient to respond.

· Short, simple sentences.

· When asking the patient questions:

o  Keep the questions short and one at a time.

o  Close-ended questions may be more appropriate.

Non-Verbal Communication:

· VERY IMPORTANT! This may become one of the main forms of communication in the later stages of the disease.

· Maintain open and relaxed body language.

· Sit in front and at eye level with the patient as many of these patients develop issues with their peripheral vision.

· Be aware of your facial expressions and body language. These should match what you are saying.

· Provide physical contact with the patient if they are comfortable with this. Hand-under-hand is a great method to use when guiding the patient through an activity or ambulating with the patient.

**Environment:**

 · Treatment environment should be in a well-lit room with minimal distractions.

**Caregiver Support:**

· Don’t forget about the patient’s family and caregivers!

o  Teach them how to safely help the patient transfer and move.

o  Educate them on keeping the patient’s environment free of clutter and rugs to minimize fall-risk.

o  Look for signs of caregiver burden. Refer to appropriate resources and care if needed. Some helpful resources include:

* Alzheimer’s Association - Alz.org
* Teepa Snow – Teepasnow.com

**Additional resources for the therapist:**

·     Alz.org

·     Teepasnow.com

·     Move Forward PT/APTA Website

·     Physio-pedia.com – Dementia, Alzheimer’s Disease

·     Academy of Geriatric Physical Therapy

**References:**

1.    Alzheimer’s Disease. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/publications/aag/alzheimers.htm. Updated June 25, 2018. Accessed July 9, 2018.

2.    Types of Dementia. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/what-is-dementia/types-of-dementia#vascular. Accessed July 9, 2018.

3.    Stages of Alzheimer’s. Alzheimer’s Association. https://www.alz.org/alzheimers-dementia/stages. Accessed July 9, 2018.

4.    Alzheimer’s Disease. Physiopedia. https://www.physio-pedia.com/Alzheimer%27s\_Disease. Accessed July 9, 2018.

5.    Art and Music. Alzheimer’s Association. https://www.alz.org/help-support/caregiving/daily-care/art-music. Accessed July 9, 2018.

6.    Music. Teepa Snow. http://teepasnow.com/resources/teepa-tips-videos/music/. Accessed July 9, 2018.

7.    Using communication to enhance therapeutic interactions with people living with dementia. Physiopedia. https://www.physio-pedia.com/Using\_communication\_to\_enhance\_therapeutic\_interactions\_with\_people\_living\_with\_dementia. Accessed July 9, 2018.

8.    Physical Therapists Guide to Alzheimer’s Disease. Move Forward PT. https://www.moveforwardpt.com/SymptomsConditionsDetail.aspx?cid=48d29ec1-3159-45d3-bf6e-ea31ab7c978a. Updated October 28, 2015. Accessed July 9, 2018.