Physiotherapy in Demential Care – A message from Jeromy Tse, Physiotherapist
This is the 2nd of a series of Articles and Research undertaken at Belvedere Aged Care. On deciding to discuss this topic for this issue of Belvedere Aged Care’s publication, I did some research on articles that supported my view in this area. The following is adapted from information out of ‘Physio-pedia’ which I deem to be accurate and informative.
Noticing Initial Signs
Here are several ‘Dementia Danger Signs’ that we should be aware of listed below. As dementia progresses, the affected person may start behaving differently, being less physically active or begin struggling to communicate:
-Walking more slowly- smaller, shuffling steps
-Afraid to use the stairs
-Unsteady on their feet
-Stutter with feet when starting to move
-Tense body language
-Becoming rigid when moving
-Clenching of Teeth
-Eyes wide open/tightly shut
Most dementias will at some point in their course affect areas of the brain that are responsible for movement and balance. By exercising more and keeping active, individuals with dementia keep their joints, muscles and heart in good shape. They also show signs of engaging more with their surroundings when completing fun activities which they enjoy. As the disease progresses problems with mobility will increase. As the caregiver for an individual with dementia there are some things you can do to encourage activity safely.
Before you consider helping someone walk, make sure they have comfortable footwear, the correct glasses and hearing aids, and that their clothing is secure.
Every person with dementia will be different in terms of how much ability they have, however it is important to involve them in decision making and make activities specific to what they enjoy.
Know their strengths and use them to your advantage.
If they require a walking aid, ensure it is within their reach before walking and if giving assistance, do so at their side so you are both facing in the same direction and move together.
Give the walk a purpose- for example, to eat a meal, watch TV, see a visitor, go to the toilet, or do some exercise.
Reassure the person about their surroundings – for example, if moving from hard to soft floor coverings.
Make walking an enjoyable experience by talking to the person and paying them plenty of attention.
If they begin to shuffle their feet when walking, encourage marching so to lift their feet.
How can a physiotherapist help?
The physio can provide assistance and support by tailoring a unique programme for a person with dementia which includes:
Active range of movement exercises to keep muscles strong and flexible and make functional activities easier
Balance training to improve confidence and reduce risk of falling
Gait re-education with or without support to maximise mobility
Practicing functional tasks to enhance independence
Advise on mobility aids or equipment for the home to ensure safety and promote mobility and function
In the Home
Individuals with dementia are up to 4 times more likely to fall compared to those with no cognitive impairment. Many of these falls can result in hospital admissions. The home can be full of potential tripping hazards for a person with dementia. To prevent falls, try to ensure the home environment is obstacle fee. Some methods to help with this are;
Assess each part of the house for trip hazards;
– Removing objects which may act as an obstacle or provide distraction
– Removing loose carpets or rugs
– Ensuring cables or wiring are not lying across the floor
– Using signs on doors to provide information; bathroom, shower
– Ensure there is adequate lighting throughout
– Placement of handrails / grab-rails on stairs, entrances and toilet
Try to ensure the patient wears suitable clothing and footwear that he/she is unlikely to trip over.
Encourage the patient to keep physically active as this will help strengthen balance and maintain confidence
Here’s how the physiotherapist can help
Provide balance training to improve confidence and reduce the risk of falls.
Carry out a home assessment and advise on devices which will increase safety and promote functional abilities.
Increase patient motivation to decrease fear and anxiety.
Help with exercises for simple everyday things like walking, rising from a chair etc.
Among older adults with dementia who are in long-term care, the number of people suffering from pain or possible painful conditions is high. Yet pain is underdiagnosed and undertreated in these individuals.
Some dementia patients have trouble telling their carer or family member that they are in pain because of problems with the working of the brain, problems communicating, and they may also be confused. In some of these severe cases of dementia, this can leave pain levels being undertreated as many believe that pain is a normal and expected part of getting old, or that people with dementia can’t feel pain.
However, these are both untrue and pain can be treated with dementia patients through a good working relationship between both the carer/family and the physiotherapist/GP. Physiotherapists work as part of a team making sure high quality, effective care is delivered.
What a physiotherapist can do:
Physiotherapists are trained to recognise if any persons with dementia are in pain during activity or exercise. It is important to know that pain can affect an individuals motivation to do any exercise or activities. If pain becomes a problem with your loved one, your physiotherapist can provide information to help recognise pain and put in place strategies to help lessen pain levels and improve the quality of life of the patient.
Jeromy is a passionate Physiotherapist who understands the importance of quality care for the elderly. Having practiced as a therapist for 10 years with experience in both the private and community sectors, he has spent the last 5 years dedicated to Aged Care. On top of being a Physiotherapist, he is also a proud father of two young children, Trinity, who is 3 and Dominic, 10 months old.