The symptom most associated with dementia is forgetfulness (so-called: short-term memory impairment). But as the disease progresses, patients also "forget" motor activities , such as eating, walking, maintaining hygiene, etc. In addition, the motor areas of the brain are also damaged. This leads to physical impairments (limited range of motion, stiffness, weakness, falls due to poor balance and pain) that are manifested in decreased function (eating, bathing, dressing, walking, using the bathroom, etc.) and decreased participation (club, family, etc.). This can be exacerbated if there is a background sensory numbness (decreased hearing and/or vision). Due to the complexity of the disease and the prolonged deterioration in all areas, there are several principles that are very significant in physiotherapy treatment:
- Holistic treatment: Addressing physical components alongside mental components. A person with dementia may be troubled and confused by their condition and even feel agitated, and this should be taken into account. For example, if the patient is agitated or anxious, incorporate calm music, stretching, and deep, slow breathing into the treatment. Also, in a state of anxiety, incorporate elements of cognitive behavioral therapy (CBT) to ask guiding questions, depending on the cognitive level (Why do you feel this way? How does it manifest itself? Can you tell me more about the feeling?) alongside expressions that express empathy and inclusion (I see that it is difficult for you, this is really not an easy situation) and lack of judgment.
- Motor learning: A practice that includes multiple repetitions with simple and short instructions. The practice will be repeated both in the treatment itself and in subsequent treatments, with minor changes.
- Functional practice: If there is difficulty walking, we will practice walking, of course at a level of difficulty adapted to the patient, for example using an assistive device or external support, changing the pace, breaking it down into components: practicing a step before embarking on a "full" walk (raising and lowering a leg with the support of a walker, for example).
- Customized: As mentioned, dementia is a complex and progressive disease, not only physically but also emotionally. Therefore, treatment that was appropriate for the same person yesterday may not necessarily be appropriate tomorrow. Treatment will depend on the person's character, mood, physical and cognitive level, and consideration of the person's general medical background and level of cooperation.
- Multi-team care: Usually, the treatment of a person with dementia involves a psychogeriatrician, a family doctor who coordinates the case, a physiotherapist, an occupational therapist, a nurse, a dietitian, a speech therapist, and a social worker/emotional therapist. It is important that the treating parties stay in touch in order to be updated on any worsening or unusual condition. For example: back pain may be a symptom of a urinary tract infection, or there may be a pressure sore that the person is unaware of. When the physiotherapist discovers this, he informs the doctor who, if necessary, changes medication.
- Patience and inclusion on the part of the therapist: It is possible that the person will ask the same question several times during treatment or throughout a series of treatments. Or, that a patient will forget an exercise during treatment. It is important to respond calmly on the one hand, and to contain the difficulty that it will cause on the other. Therefore, it is worth repeating the same exercise as mentioned a large number of times. Containment is of course also towards the family members who are caring for them who may feel frustrated or exhausted from caring for the person with dementia.
- Collaboration and guidance of family members and the foreign caregiver: Preventing falls, preventing and treating pressure sores, adjusting the wheelchair seat, training in the safe use of mobility aids, demonstrating how to make transitions with an emphasis on the degree of support required from the caregiver (this could be supervision, it could be giving a hand, it could be support at the chest or waist – depending on the degree of cooperation and the person's physical level). It is important to actively involve family members and see how they physically support the person when making a transition or walking.
- Ergonomics training: How to protect the caregivers' bodies. For example, when performing a transition that requires a lot of help, hold the person close and in a straight line, bend at the knees, hold in a safe and supportive manner (like a hug). If the person is heavy or refuses to cooperate, consider using a hoist - training will also be provided for this. Training on how to lift heavy weights, for example how to easily put groceries in the refrigerator. If, God forbid, the person falls, how to help them get up.
- Training on fall prevention: Remove obstacles from the floor, turn on lights at night, install a panic bell and grab handles in the toilet and shower, use a shower chair and rubber mat, walk with closed shoes, dry the floor thoroughly after washing, check the integrity of the assistive device, make sure the soles are not worn and symmetrical, and accompany the person as they walk according to the level of support required.
- Home adaptation tutorial: Widening the hallway/entrances to rooms to enable walking with the support of a walker or wheelchair, as mentioned, adapting the home environment to prevent falls, regarding moving house if necessary.
The article was written by Shirley Popilsky, a certified physiotherapist and Pilates instructor, works at the D.K.L Advanced Physiotherapy Institute Ltd. (in collaboration with Maccabi Health Insurance Fund) and at the Day Center for the Elderly on behalf of the Matav Association
Phone 0549192404
Email shirly.popilates@gmail.com