“Help me, help me, help me,” came the staccato plea from room 14.
“No, shoot me,” growled a personal care assistant who approached the door and went right on going, quick-stepping past the permanently blinking assistance light. It was a small skilled nursing home, 30 rooms or so. There was nowhere to stand, eat, sleep, or a place to work where you could avoid hearing the laboured painful moans of the woman in room 14. There was no beginning to her cry and no end. It was on a loop, a perpetual loop, interrupted only by sleep and medications. Even the staff had started avoiding her.
I remember being horrified by the anger and the apathy of the staff during my first week on site. I routinely stopped in to see her, to assuage her fears and anxieties, to be a BETTER person than those around me (yes, I am ashamed to admit such motivations).
Then one day, I realised that – to enter the room, to attempt to render assistance every hour, was actually adding to the depths of despair in room 14. My visits were experienced as a reset button and produced a fresh sense of abandonment each time I departed. I, too, began to pray. And to duck my head and run.
It was dementia in its finest hour. And it brought shame and fear to everyone in its shadow.
Exercise and Cognition
For generations, physiotherapists have discharged patients with dementia. Discharged them with reluctance, to be sure, but discharged them all the same. Why? It was universally believed that physiotherapy services would be a waste of the almighty dollar. But is that true?
Researchers are starting to poke holes into that premise. They are asking questions such as:
- Can exercise improve the cognition, activities of daily living (ADLs), depression, neuropsychiatric symptoms and even lifespan of patients with dementia?
- Can exercise programming for patients with dementia have an indirect impact on caregivers’ burden, quality of life, and mortality?
- Can exercise programming for patients with dementia reduce the use of the healthcare system for such services as emergency department visits?
Recent studies have shown that there are dozens of ways that physiotherapy can improve the lives of patients with cognitive impairments. Here are five novel ways that physical therapy has made headlines in the world of dementia recently.
1 – Intensive Robotic Rehab
Intensive aerobic exercise, performed on a Lokomat device (robot-assisted walking therapy), can be coupled with cognitive rehabilitation for significant results. A case study of a 72 year old man with vascular dementia treated with robotic rehab showed great improvement in both motor and cognitive arenas post-therapy.
2 – Pool-based Therapy
Where is the last place in the world that you would expect patients to use a therapy pool? Surely a skilled nursing facility runs right up near the top of the list. But research has shown that these patients benefitted tremendously from aquatics as measured by attendance, enjoyment, participation and recruitment of others. The researchers explored the idea that the best pool programs for patients with dementia should include both cognitive and physical challenges. In other words, it’s not enough to exercise. The exercise should include task-simulation of activities of daily living and there should be a cognitive overlay, requiring dual task processing.
3 – Adult Day Care
Group exercise classes, held twice a week at adult day care facilities for three months, have been shown to improve balance and mobility in adults with dementia. The exercises performed were purposefully kept constant, with no novelty, and consisted of functional activities likely to mimic activities of daily living. The groups were run by PT providers, who ensured that participants remained on their feet for the majority of the session. Classes had a ratio of no greater than 3 seniors for every therapist.
4 – Prompting Systems
Physiotherapists are being recruited to assist designers of technology-based prompting systems for patients with cognitive deficits. These therapists are helping manufacturers in deconstructing daily tasks at home and creating verbal or written (on a touchscreen) prompts to aid patients with dementia in being more independent at home. One of the areas of greatest exploration is determining how to phrase prompts so that they are clear and unambiguous to patients with dementia.
5 – Virtual Reality Dancing
Therapy will never be the same again! A group of patients with Parkinson’s disease who were treated with 30 minutes of supplemental dance exercise five times a week for six weeks did better on their functional tests than another group which received 45 minutes of more conventional therapy. The patients were trained using the K-Pop Dance Festival game on the Wii system. The therapists used songs chosen by the patients and told them to attempt to mimic the movements of the characters on the screen. Patients received both audio and tactile (buzzing) feedback.
Andrea Salzman, MS, PT graduated from the University of Alabama at Birmingham with a Master’s degree in physical therapy in 1992. Over the last two decades, she has held numerous prominent leadership roles in the physical therapy field, with a heavy emphasis on academic writing and administrative functions. Between 1995 and 1998, Salzman served as the Editor-in-Chief of an American Physical Therapy Association (APTA) journal. In 2010, Salzman received one of the highest honors given to a physical therapist from the American Physical Therapy Association, the Judy Cirullo Leadership Award. Between 2012 and the present, Salzman has written 12 physical therapy courses for Care2Learn, Relias Learning and reviewed over 100 other course offerings. Currently, Salzman continues in her writing, leadership and administrative roles at Aquatic Therapy University and 10K Health.