It is believed that dementia is one of the main causes of disability and dependency among older people around the world. It is a syndrome characterised by a deterioration of cognitive functions, generally chronic and progressive, which can present multiple manifestations. Dementia is usually a progressive loss of the skills and cognitive function, which prevents them from performing normal activities of daily life. In dementia, memory, judgment and ability to control emotions are preferentially affected. The dementia patient may or may not be aware of the situation they are experiencing. The diagnosis of the most important dementias is made by exclusion since no test unequivocally diagnoses the disease. However, it is essential to know whether or not the patient has a potentially treatable form of dementia, so it is important to rule out dementias that have a possible treatment. In these patients, the presence of other frequently associated diseases that can improve with a specific treatment, such as depression, should be evaluated.
There are, however, some proven aids that can bring comfort to someone with dementia. Aside from music and communication, hydrotherapy, physiotherapy also can be of huge benefit. Physiotherapy plays a fundamental role in maintaining the quality of life, and slows down or delays the appearance of various symptoms.
What role does physical therapy play in treating dementia?
Physiotherapy can do plenty in each of the evolutionary phases that different dementias present. The importance of this discipline is that it can preserve the independence and autonomy of the person who suffers with it for as long as possible. The work of the physiotherapist, especially in the advanced phases, is to avoid the progression of the lack of mobility through specific therapies. Some of these are known to slow down muscular rigidity or musculoskeletal disorders. In addition to this, we must not forget the benefits on a mental and emotional level. Whether that is individually or within a group, the benefits are still present. The importance of the physiotherapist should also be emphasised when advising, in multiple aspects of daily activities, the dementia patient, and their relatives or caregivers.
By carrying out the physiotherapy, it is possible to stimulate and maintain the ability to walk independently or with the necessary aids for as long as possible and walk as a form of exercise with beneficial effects on health and fitness. There may be a need for modification of some common exercises. Still, physiotherapy can indeed play a role in any behavioural problems in people with dementia (apathy, anxiety, irritability, hyperactivity, restlessness, wandering). It allows them to focus their mind, for a small amount of time, on physical activity.
All people with dementia who retain the ability to walk independently or with supports can participate, which means there are no restrictions. Those with a level of functional limitation so high that it prevents them from walking even on short distances and with external supports would need a more appropriate physiotherapy program to ensure that they are still able to achieve some benefits.
Frequency and intensity can differ. 20 to 30 minutes four or five times a week, at a pace that is comfortable for the person is best. This can be increased or decreased over time as each patient will have a different and specific set of needs.
Effective physiotherapy techniques against the disease.
Physical and mental “training” is a basic pillar to treat dementias, and the physiotherapist has precise techniques to achieve satisfactory results that translate into a higher quality of life for the person suffering from them. Although this pathology is not directly related to motor function, physiotherapy not only benefits it in a general way by improving movement but also provides great benefits when it comes to stopping mental deterioration, positively influencing both mood and behaviour. Improve situations of apathy, sudden mood swings, negativity, depression, it is possible, also with the help of physiotherapy.
The physiotherapist must carry out an exhaustive assessment of the specific situation of the sick person, taking into account the existence of other possible diseases: diabetes, hypertension, osteoporosis etc. Once the previous evaluation has been made, it will establish the treatment guidelines that can provide the most benefits. Possible therapies can be:
- Massages and therapeutic manipulations that help to relieve joint and muscle pain activating peripheral circulation and reducing stiffness in general.
- Specific physiotherapy techniques whose objective is postural and gait re-education. With active or passive movements, based on kinesitherapy, mobility can be increased to maintain the maximum possible functionality. Working gait, the ability to walk, enhancing stability and balance to avoid potential falls, is especially important in the most advanced stages of the disease. In the same way, achieving a correct posture is essential to avoid developing new pathologies that can affect the joints.
- Group activities. They are especially important because they favour the sociability of the dementia patient, contact with others, communication, language, memory and mental exercise.
Improving general motor capacity and fine motor skills, including, for example, working on the movement of the fingers of the hands, and slowing down the deterioration of cognitive functions are two basic objectives in the treatment of dementia, to which physiotherapy can contribute significantly. Its therapies are effective in any phase of the disease, although experts insist that the idea is to resort to it at the first symptoms. Physiotherapy demonstrates its effectiveness with easily noticeable results.
Physiotherapy can also be, in fact, a practice that offers further comfort to the patient. Dementia patients often feel a sense of confusion in day to day life and the relationship built up between the patient and physiotherapist can offer some form of communication, and joy. They may enjoy and even thrive on these physiotherapy sessions, which can provide them with a lift in mood.
Physiotherapy in more advanced scenarios.
Physical therapy helps Alzheimer’s patients in all phases of the disease. Likewise, when the condition is in a more advanced stage, they highlight the work they do to preserve greater autonomy in the activities of daily living and the independence of the person, trying to delay as much as possible the support of a third party person, family member or caregiver. In the final stage, in addition to avoiding joint stiffness, physiotherapists offer imperative advice to family members and caregivers in the daily care of the patient. This may be done by teaching appropriate postural changes, mobilisations, respiratory physiotherapy and correct patient management and of its surroundings.
Physiotherapy is also widely connected with other physical benefits. Many older patients are prone to other medical issues, such as constipation, kidney stones or high blood pressure. Physiotherapy offers a type of exercise that is not only gentle for the body but also allows it to move just enough to maximise the benefits. Prolonged immobility is very dangerous for anyone, and in older people, this may lead to thrombosis or pneumonia. Therefore, physiotherapy allows the patient to receive still, that vital movement that keeps them from deteriorating any further.
A non-drug therapy that proves beneficial.
We live in a world where medicines are prescribed incredibly quickly. Whilst medications are sometimes the only solution, there are some non-drug therapies such as physiotherapy that do not need to further interfere with the patient’s neurological function.
Physiotherapists study the problems of the elderly, especially in the field of mobility, incontinence, intellectual regression or dementia based on clinical examination and treatment based on the latest research findings and their professional experience. Chronic pain is also taken into account. Within this framework, the patient’s resources constitute the basis on which the treatment is defined. Physiotherapists who work in geriatrics have specialised knowledge in the areas of aging processes, risk factors, problems and consequences arising from multiple conditions. These therapists have in-depth knowledge of palliative care concepts and have specialised skills to grasp the potential and skills of the elderly and therefore define the treatments to establish. The treatment takes place in an office, at home, in the hospital or a residential establishment long-term (retirement homes, nursing homes). There are numerous ways in which this can be achieved, but knowing the patient’s medical history, any specific goals they want is going to assist greatly.
Mobility, state of mind and mood are all tied in together. We already are aware that exercise on any level releases endorphins into the blood which offer benefits to our bodies. This is a similar concept when looking at physiotherapy in dementia patients. It brings a range of benefits that can help with mood-lifting, physical aspects and slowing down the progression of any muscular degeneration. Whether they live within a structured environment, and there is an implementation of routines or whether they are still trying to live independently at home, physiotherapy offers numerous aids to both scenarios. Offering a type of therapy that brings both the physical and mental aspects together is priceless, and thankfully today, there are plenty of options available to make it a reality.
For more information relating on how to help dementia patients, please refer to our website at https://www.homecaring.com.au and contact us today.