Restoring Movement and Dignity — The Role of Physiotherapy in Dementia
When we think about dementia the first thing that springs to mind is memory loss. However, there are many other changes that can occur which can affect their quality of life.
As dementia progresses, the brain can struggle to control muscle activation, depth perception and automatic movements such as standing up from a low chair. This causes problems with balance, fear of movement, stiff muscles and increased risk of falling. Physiotherapy can help improve mobility, independence and provide comfort and respect.
Why Do They Lose Mobility?
The areas of the brain responsible for memory work alongside areas of the brain responsible for balance and ‘automatic’ movements. This means that if these areas begin to deteriorate they will suffer from:
Automatic movements – Struggle to do automatic movements such as stepping over a door frame or shifting weight to turn around. They will require high levels of thinking.
Depth perception – Can see dark tiles or shadows on the floor as big holes. This will cause them to become stuck, hesitant or take unsure steps.
Muscle wastage – They won’t be doing as much physical activity so will suffer from contractures, slouched posture and joint pain.
Balance – Their brain won’t react quickly to them losing their balance so they will fall heavily.
Physiotherapy Aims To:
Reduce falls and improve balance - Falls can be one of the biggest risks to seniors with dementia. Physiotherapists will assess their gait, balance and vestibular system. We will use seated and supported standing balance exercises, dual task exercises and weight shifting exercises to improve balance on uneven surfaces.
Maintain ‘motor memory - Whilst they struggle with short term memory, their ‘motor memory’ (automatic movements) can often still be accessed. By encouraging repetitive and rhythmic movements we can help their body to retain functional movements such as sitting to standing, stepping and reaching.
Posture and joint mobility - Slouched posture and forward head posture can cause issues with their lungs. We will use gentle mobilisations, thoracic extension and soft tissue mobilisations to reduce stiffness, reduce long term pain and improve breathing.
Reduce anxiety and sundowning - Many people with dementia suffer from becoming restless, agitated and confused in the late afternoon (commonly known as sundowning). By providing them with purposeful exercises such as rhythmic stepping, gentle coordination games and light resistance exercises we can encourage endorphins, regulate their body clock and improve their sleep at night.
Physiotherapy for Dementia
Physiotherapy sessions should be relaxing, enjoyable and pressure free.
Seated gross motor exercises – Using light balls, foam rollers or therabands to improve anti-gravity muscles.
Rhythmic gait – Using a steady beat or traditional music to help with their foot placement, pace and stride length.
Stepping over high contrast, non-slip floor markers.
Proprioception – Using textured items and gentle resistance to encourage proprioception in their joints and muscles.
How Can Physiotherapy Help Your Family?
Physiotherapy can help your family members too:
Transfer techniques – We will teach you how to safely move your loved one from bed to chair or chair to commode using correct biomechanics to reduce long term back and shoulder pain.
Correct aids – We will advise you on what aid they need and ensure it is the right size. This will reduce the risk of them becoming tripped up.
Home safety – We will advise you on where to place grab rails, bed height and contrast strips around the room to encourage independence and safety.
Frequently Asked Questions
Will an elderly person with moderate to severe dementia be able to take part in physiotherapy?
Yes. The techniques used will be adapted to their level of cognition. Physiotherapis
ts will use visual cues, gentle touch, hand over hand and sensory cues to help them take part with ease and minimal frustration.
How can regular physiotherapy reduce agitation?
Exercise can help reduce stress hormones, give them something positive to do with their restless energy and encourage endorphins. Patients who have regular physical activity show less restlessness, improved mood and better sleep.
