How can a person with Alzheimer's disease or dementia benefit from rehabilitation when they don't even recognize their own family or places that should be familiar to them?
This is a very common question. Physical therapy, occupational therapy and speech-language pathology services can be beneficial to the person with dementia as well as their family and caregivers at various stages of Alzheimer's or dementia.
In the early stages, rehabilitation services can help your loved one be as functional as possible for as long as possible. The focus of physical therapy (PT) with dementia care is to improve balance, muscle strength, and mobility and provide pain management. Another goal of PT treatment is preventing falls. People with Alzheimer's or dementia are at greater risk of falls and mobility problems due to muscular weakness, history of falls, gait, balance deficits and cognitive impairment. Safe physical activity, including exercise, will maintain strength, balance, ability to walk and ability to get into or out of a chair or car.
Both the physical and occupational therapist may assist you in changing and enhancing your loved one's environment to improve function and safety. Environmental modifications such as adding signs on bathroom doors and labeling drawers for socks and shirts may allow a person with dementia to function at the highest level possible for as long as possible.
In the mid-stages of Alzheimer's and dementia, challenging behaviors are most often present during bathing, toileting, dressing and eating – all areas of expertise for an occupational therapist. Occupational therapists can provide instruction on how to manage these daily tasks safely and with as minimal stress as possible. Even if you believe your loved one now has a limited ability to learn new things, occupational therapy treatment can be helpful.
Physical therapy can assess one's ability to walk safely, the risk of falls, and other functional tasks. The therapist will develop a treatment program, including exercise, to help maintain your loved one's current abilities, which also has the effect of reducing the burden on the caregiver. A person does not need to remember having engaged in an exercise program to reap the benefits of exercise – they just have to participate.
In the late stages, the role of physical, occupational and speech therapies change yet again. Rehabilitation therapists can recommend and help you obtain a custom wheelchair to maximize comfort and function for seating and positioning. Skilled therapists can also help prevent and manage the shortening of muscles or joints, and train you in overall care for your family member at the end-stages, including proper feeding.
Speech-language pathologists have a primary role in the assessment, diagnosis and treatment of swallowing disorders associated with dementia. These specialists also can assess a person's cognitive and communication abilities and recommend strategies to help manage difficulties.
Rehabilitation services have much to offer at all stages in the disease process to maximize function, manage day-to-day activities, reduce caregiver stress and improve the quality of life for all.
Mimi Jacobs is a physical therapist who founded Fox Rehabilitation and Fox GERI: Geriatric Education and Research Institute.
Read her full biography