Physiotherapy and dementia
Physiotherapy for people with dementia
It’s estimated that almost half a million Australians are living with dementia, so it’s highly likely you know someone with this conditioni. Dementia is also the second leading cause of death in Australia, and the leading cause in femalesii.
Dementia can have a major impact on an individual’s physical and mental health, personality, independence, and ability to participate in their families and communities. Physiotherapy plays a vital role in supporting people with dementia to remain independent and enjoy the best possible quality of life.
What is dementia?
Dementia is a term used to describe a group of conditions that cause a gradual decline in brain function. Because the brain controls so many things, dementia can affect a wide range of physical and neurological functions. Dementia can affect a person’s ability to:
- remember
- communicate
- think
- move
- interact with others
- perform everyday activities
- drive
- work.
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There are various types of dementia, with Alzheimer’s disease being the most commonii. Other types include Lewy Body disease, vascular dementia, frontotemporal dementia and mixed dementia.
There is no cure for dementia yet. However, there are strategies that can help people living with dementia to maintain their physical and mental wellbeing for as long as possible.
What causes dementia?
The cause of dementia isn’t fully understood. However, most types of dementia (except vascular dementia) are related to a build-up of proteins within the brain. This results in a gradual loss of brain function.
Certain things lead to a higher risk of developing dementia, including some things you can’t change:
- Age – the likelihood of developing dementia increases with age, although it is not a normal part of ageing. Younger people – even children – can develop dementia.
- Genetics or family history.
Other risk factors for dementia can be reduced by changing the way you live. The World Health Organizationiii recommends 12 strategies for reducing the risk of cognitive decline and dementia, including:
- Being physically active
- Quitting smoking
- Cognitive (thinking) training
- Managing blood pressure, cholesterol, and diabetes
- Reaching a healthy weight
- Being socially active.
Physical activity therefore has an essential place in dementia prevention and care. In itself, it can lower your risk of dementia. Regular exercise can also help with managing the health conditions linked with dementia – overweight/obesity, diabetes, high cholesterol, and high blood pressure.
Physiotherapy for dementia patients can help by supporting people to be physically active and continue being involved in home and community life.
Physiotherapy can help people with dementia to remain physically active.
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Dementia physiotherapy management: an overview
The Australian Physiotherapy Association (APA) and Dementia Australia note that physiotherapists are key members of healthcare teams looking after people with dementia.
In their 2022 joint position statementiv, they note that dementia frequently affects an individual’s ability to move about and participate in everyday activities. The physical impacts of dementia include:
- muscle weakness
- slower reaction time
- loss of co-ordination
- balance problems and falls
- difficulty doing more than one task at a time – such as walking while carrying a cup of coffee.
Moreover, they point out that the brain changes associated with dementia can indirectly affect physical function.
For example, dementia can lead to:
- visuospatial changes – which can affect a person’s ability to safely move around at home and in the community
- difficulty recognising objects
- problems with processing sensory information, such as sounds
- difficulty communicating needs – such as expressing pain or discomfort.
They note dementia physiotherapy should take a wellness and enablement approach. This involves focusing on maintaining an individual’s strengths, capacities and ‘ability to live well with dementia for as long as possible’.
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Physiotherapy and dementia: What the evidence shows
For people with dementia, physiotherapy is an essential part of an approach that considers a person’s physical, mental, and social wellbeing. Studiesv have shown that physiotherapy can help to improve independence and quality of life for older Australians, including people with dementia.
Physiotherapy does this by:
- improving walking and balance
- lowering the number of falls and fractures
- reducing frailty
- slowing the decline in cognition (thinking)
- improving cognition and mood
- reducing agitation.
Dementia physiotherapy treatment
Dementia can lead to a wide range of consequences, so dementia physiotherapy involves various techniques and strategies. Physiotherapists are experts in movement and function. They prescribe meaningful programs tailored to each person’s needs. Your physiotherapist will help you work towards your goals using recognised, evidence-based therapies.
Examples of physiotherapy dementia treatment include:
Gait (walking) training
Your physiotherapist will assess your mobility, including your walking. Depending on the findings, they might design a program to improve:
- the quality or speed of your gait
- your ability to walk longer distances
- your ability to walk in different environments, including your home and community.
This may involve the use of assistive devices (such as a wheeled walker or walking stick) if needed.
Strength training
Muscle weakness is a common feature of dementia. Physiotherapy for dementia patients often includes exercises designed to build muscle strength. These will be focused on improving your function, such as your ability to:
- stand up from a chair or the toilet
- maintain your balance
- climb stairs
- hang washing on the line
- open heavy doors
- open jars.
Balance training
Balance problems and falls are also common in people with dementia. Physiotherapy exercises for dementia will often include activities designed to help you cope with balance challenges and prevent falls.
For example, you might practise:
- balancing on one leg
- balancing on different surfaces, such as cushions
- maintaining your balance while doing different movements, such as tapping your foot or raising one knee.
Assistive technologies
Physios may be involved in prescribing assistive devices, such as wheelchairs and walking frames.
Dementia physiotherapy treatment might include activities in a social or community setting.
Pain management
Physiotherapists can assess and treat pain using various strategies. Physios are highly trained in pain and understand the signals to look out for in people who can’t communicate with words.
These include facial expressions, flinching, guarding, and sounds such as groaning. Pain management strategies might include exercises and advice about appropriate seating or manual handling techniques.
Social wellbeing and community participation
Physiotherapy might include activities in a social or community setting to encourage participation and social wellbeing.
For example:
- walking or boxing at a local park
- joining a group hydrotherapy or exercise session.
Training support people
Families and support people play a vital role in helping someone living with dementia to reach their goals. Your physiotherapist might train you to support your loved one with:
- moving safely around the home and out in the community
- completing their exercise program
- using assistive devices
- managing pain.
Building the capacity of support people can help someone living with dementia to remain more independent at home and reduce reliance on healthcare professionals.
Physiotherapy for people with dementia
At Active Ability, our NDIS registered physiotherapists have significant experience working with people living with dementia and their loved ones. We focus on strategies to support good health and maximise independence and quality of life.
Our caring team will listen to your priorities and work with you to create a treatment plan tailored to your needs and goals. We also have NDIS registered clinical dietitians and accredited exercise physiologists, so we can provide multidisciplinary support for optimising your wellbeing.
With no waiting list or travel charge, you can get started with treatment right away and make the best use of your funding.
To learn more about how we might be able to help you, contact our friendly team on (02) 8678 7874, hello@activeability.com.au or via our contact form.
REFERENCES:
[i] – Dementia Australia. Key facts and statistics. https://www.dementia.org.au/statistics. Accessed online 12.9.2022.
[ii] – Australian Institute of Health and Welfare. Dementia in Australia. https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/summary. Accessed online 12.9.2022.
[iii] – World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines. https://www.who.int/publications/i/item/9789241550543. Accessed online 12.9.2022.
[iv] – Dementia Australia and the Australian Physiotherapy Association. Physiotherapy and dementia. https://www.dementia.org.au/sites/default/files/2022-06/DEMENTIA-AND-PHYSIO-Joint-Position-Statement-2022.pdf. Accessed online 12.9.2022.
[v] – Chartered Society of Physiotherapy. Physiotherapy works: dementia care. https://www.csp.org.uk/publications/physiotherapy-works-dementia-care. Accessed online 12.9.2022.