Dementia & Physical Therapy
RehabVisions and our therapists are no strangers to the topic of dementia. Cognitive testing is a great way for disciplines to work together using their expertise in order to provide the highest level of quality care. We asked Regional Clinical Manager Jolene Denn, SLP to share how her team approaches dementia and her PT’s role. Jolene is an expert on dementia and has presented a CEU course on the subject to RehabVisions therapists.
Know the Stage
Using the Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, there are seven different stages of dementia. Stages 1-3 are the pre-dementia stages. Stages 4-7 are the dementia stages. At stage 5, individuals can no longer survive without assistance. It’s critical to know the stage of dementia in order to effectively create and execute a treatment plan.
In the early stages of dementia, individuals are able to focus on specific tasks better and often display higher-level functioning than is typical for them in their functional environment. Try balance assessments that are dynamic and functional. For example, have your patient complete a paper confetti broom task. Take paper confetti and throw it on the floor. Give the patient a broom and ask them to sweep up the floor. Their attention will be focused on sweeping, and the balance deficit will be evident.
I often see physical therapists post signs in a resident’s room to help assist with decreasing falls. For instance, “Falling hurts–use your call light.” Signage can be powerful and a great tool when working with dementia. However, keep in mind the location of your sign. Patients in the mid-stages of dementia have a visual gaze of only about 32-33” from floor. Place a sign any higher and it is not functional. Additionally, patients generally are able to retain reading skills until the end of stage six. After that, a sign will be ineffective.
As an individual progresses through the stages of dementia, their vision will change, and a loss of peripheral vision is common. Often times when we are assisting a resident with standing or non-weight bearing, where do we stand? Usually, off to the side…thus, we are invisible! So remember to always approach your dementia patients from the front. Then verbally communicate your actions so the resident is able to track you and your movements at all times, even if they aren’t able to fully see you.
Working with individuals with dementia can be one of the most challenging but rewarding experiences you’ll ever has as a therapist. The best piece of advice I can give is simply to TRY. There is no cookie cutter approach that works with all individuals with dementia. Additionally, often times proven methods of rehabilitation will not be effective with this population. As a therapist, it is our duty to get creative with treatment planning. Don’t be afraid to TRY new things. If your trial doesn’t work, be sure to document your skill required to complete the intervention as well as the patient’s response to treatment. Then, try something new next time.
For common caregiver questions and answers relating to dementia and the role of physical therapy, visit the APTA Move Forward website.