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Physiotherapy for People Living With Dementia

Physiotherapy for People Living With Dementia

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Physiotherapy For The Elderly

Physiotherapy For The Elderly

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Falls Prevention

Falls Prevention

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Everything You Need to Know About Knee Replacements

Everything You Need to Know About Knee Replacements

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Everything You Need to Know About Hip Replacements

Everything You Need to Know About Hip Replacements

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Femoro Acetabular Impingement (FAI)

Femoro Acetabular Impingement (FAI)

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Physiotherapy for People Living With Dementia Physiotherapy for People Living With Dementia

Physiotherapy for People Living With Dementia

Hello and welcome back again to the ThreeSpires Physiotherapy blog where we take a look at all things physiotherapy related. The UK has an aging population and one of the consequences of this is that there are many more people living with some form of dementia. As community physiotherapists seeing our patients in their homes or quite often their care homes we have a large amount of experience of working with patients with dementia and I wanted in this blog to have a look at how physiotherapy for patients with dementia works and what some of the challenges are.

What is Dementia?

Before looking at the challenges of providing physiotherapy for patients with dementia it is probably necessary to have a look at what dementia is. This definition from the NHS seems a good place to start:

“Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of brain functioning. There are many different causes of dementia, and many different types. “

I think, from this definition we can see that dementia is a reduction and worsening in a person’s ability to think clearly and process things and it also highlights the fact that dementia is an ongoing process which may have started slowly and will in general worsen with time.

Types of Dementia

There are many types of dementia and in this article about physiotherapy and dementia it isn’t necessary to cover them all but it is good to have an understanding of the main types and how they affect patients.

  • Alzheimer's disease: This is the most common form of dementia and accounts for approximately 60% of dementia in the UK. Symptoms can involve memory loss, difficulty recalling recent events, and problems with language. Decision-making, planning, and personality can also be affected as the disease progresses.
  • Vascular dementia: This is the next most common type and it comes from reduced blood flow to areas of the brain (commonly from strokes or mini-strokes). Unlike with dementia from Alzheimer's, symptoms with vascular dementia can occur suddenly following a stroke or come on in a stepwise fashion.
  • Mixed dementia: as the name suggests this is where there is more than one type of dementia. This is most commonly a combination of Alzheimer's disease and vascular dementia (often the patient will have had some TIAs or potentially a stroke).

There are other types of dementia but as a physiotherapist these are the most important types to be aware of.

What Are The Symptoms of Dementia?

As a physiotherapist seeing patients with dementia, in all honesty knowing the type of dementia that they have is not as important as being aware of the general symptoms that a person with dementia can present with. It is also key to know that dementia is a wide spectrum of symptoms and that the symptoms a person has can change on a daily basis. That being said, below are some of the key features that someone living with dementia may display and how this can impact upon physiotherapy:

Memory Problems:

People living with dementia are likely to experience changes to their ability to remember things and may become increasingly forgetful. Short-term memory is often particularly affected with many patients retaining good long-term memories at first.  Patients may find it difficult to remember names or faces and as a physiotherapist seeing patients with dementia. I find it is essential to always introduce myself and state what I am here for no matter how many times I have seen the person before. Poor short term memory and a lack of ability to remember what happened last session is one of the key features that makes physiotherapy with anyone with dementia very challenging, as each session will stand alone for that patient rather than forming a series of sessions that they build upon.

Reduced Cognition & Awareness

Many people living with dementia will also have a general reduction in their cognitive abilities and their awareness of where they are both in place and also in time. It may be the case that they will be confused as to what year it is and where they are. For example if they are living in a care home they may well not understand this very clearly and will often think that this is a temporary residence. Concentration and focus is often affected and this becomes evident as a physiotherapist when trying to get patients to concentrate on doing their exercises as often they are very easily distracted. The ability to problem solve and understand more complex topics is also commonly affected and for many patients they will not be able to understand the purpose of any exercises that they have been asked to do.

Communication Difficulties

Although speech itself is rarely affected the ability to communicate clearly and understand what is being said is very commonly affected and this is usually one of the major barriers to physiotherapy and rehabilitation. Being able to understand what is being said to you makes completing exercises given to you by a physio much easier, often patients with dementia will take a long time to understand the nature of the exercises and will require a large amount of repetition of both the physical exercises and the words before they are able to grasp what needs to be done.

Behavioural Changes

A very sad and unfortunate side effect of dementia is that often a person’s personality and temperament will change and they may become very agitated and even angry about things that in the past would not have bothered them at all. They may lack impulse control and behave in ways that are not normally socially acceptable and they may become very restless and find themselves constantly pacing back and forth. As with all of the other symptoms of dementia this makes physiotherapy more challenging and as physiotherapists we have to be aware of these features and try to work around them as best as we can.

How Does Having Dementia Make A Difference To Physiotherapy?

Having had a look at some of the key symptoms of dementia, its is probably a good idea to now look in more detail at some of the key ways that physiotherapy for someone with dementia is different to physiotherapy for someone without dementia. In the cases below we can imagine that our patient is elderly (over 80yrs) and has come out of hospital recently after having had an infection and they are struggling to walk.

  1. Slower Start: when released from hospital and sent home, most people are a bit fatigued and disorientated, however this is amplified by dementia and it is often best to wait several days before beginning physiotherapy. Many times relatives of a person with dementia are understandably keen for physiotherapy to begin immediately upon discharge as they are worried about the person losing mobility. However, almost always it is better as a physio to give the person a few extra days to settle in their environment before beginning rehab.
  2. More Physio Sessions Needed: as the person with dementia is highly unlikely to be able to complete or remember to complete any exercises independently they will need more sessions per week than someone with full capacity who can follow an exercise program in between sessions.
  3. More Repetition: as most people with dementia will have memory and processing difficulties, it is important as a physio working with anyone with dementia to give them a great amount of repetition of the same exercises and the same movements. This allows them over time to gradually accept and be aware of what they need to do. This both strengthens their muscles and also gives their brains time to understand and process what need to be done.
  4. Key Role for Relatives: mostly as physiotherapists we work alone with patients but in the case of anyone living with dementia it is really helpful if a relative is present. This generally helps to settle them, relax them and make the person much more cooperative as they know who the relative is and will in general wish to do what they say.
  5. Not All Sessions Are Good: the effects of dementia are highly variable and a person’s cognitive level, awareness and behaviour can fluctuate on a daily basis. It is generally the case that when working with someone with dementia as a physio you need to accept that sometimes the person will either not be able or not willing to complete any rehab. This is often very frustrating and disheartening for relatives but a key part of rehab for anyone with dementia is accepting that the journey will almost certainly have many ups and downs.

I think for us as physios working with people with dementia the main difference between helping a person in their 80s with dementia as opposed to someone in their 80s with full capacity is that rehab will be much slower and involve a lot more setbacks. Often several sessions will appear fruitless and the patient will have done very little or been willing to do little but it is vital that the person is given enough time and patience so that they can make as good a recovery as they are capable of.

How Can ThreeSpires Physiotherapy Help My Relative with Dementia?

Here at ThreeSpires Physiotherapy our physiotherapists help a large number of patients who are living with dementia and who need physiotherapy. This can be for a number of reasons including a recent illness, stay in hospital or potentially a joint replacement. Our physiotherapists will be able to visit the person with dementia either at their home or care home and will be able to conduct an assessment there. Below I have tried to detail this process:

  1. Assessment: this is a vital part of recovery for anyone with dementia and is probably the most important aspect of what we can do as physiotherapists to help. The sooner the patient has an assessment with one of our physios the sooner everyone (such as their relatives) will understand what can be done to help. Arranging an assessment is a simple process and can be done by either sending us an email: enquiries@threespiresphysiotherapy.co.uk or giving us a call on 07884281623. Each assessment takes approximately 1hr and relatives or friends of the person living with dementia are welcome to attend (in fact as explained earlier it is better if someone the person knows is there).
  2. Management Plan: once an initial assessment of the person with dementia has taken place, our physiotherapist will discuss a clear and comprehensive plan to begin managing their recovery. If you (as the person making the booking) are unable to attend then we can give you a call to talk through things. The physio will explain what is happening, what is appropriate to do and how often the person with dementia would need seeing.
  3. Exercises & Follow Up Visits: the physiotherapist will be able to design a rehab and exercise plan for the person with dementia. If the person is living in a care home, this rehab plan can be shared with staff and also given to any relatives so that they can do exercises and encourage the patient. The physiotherapist will then conduct any follow up visits that are agreed and will work on the rehab of the person with dementia.

Okay, I hope that you have found this article about physiotherapy for people living with dementia helpful. Dementia is a complex topic and in this short article I have tried to give an overview of the condition, symptoms and how having dementia impacts upon physiotherapy. In summary, I think it would be fair to say that having dementia adds a layer of complexity to any rehabilitation and makes physiotherapy for a person with dementia more challenging and uncertain than for a person with full capacity.

Should anyone you know have dementia and need help with physiotherapy please get in touch and one of our physios would be happy to help. Just to remind you we are a home visit physiotherapy service and our physios are mobile and will come out to the person’s home or care home.

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