Physical Therapy and Rehabilitation for Alzheimer's and Dementia


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.

Melanie Sponholz is a Physical Therapist with a Board Certification in Geriatrics (GCS). Melanie is the Director of Quality Assurance and Professional Development at Fox Rehabilitation. She is an alumnus of Columbia University where she received a Master of Science Degree in Physical Therapy.

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Thank you for this article. My Dad has dementia and was put in the health care center at a retirement community. He is just stuck in there, it's not even a place to actually live. The care is minimal. (already has bedsore), They have refused to offer him PT, he has been there 6 months and his muscles have completely atrophied, he was walking when he went in there, now he is crippled and in a wheelchair. My sister and I have not been allowed to intervene as my Dad's "friend" POA Agent has blocked us from all information about our father and for advocating for him. We have an attorney now, but it's slow going and I don't know if he will be able to regain his strength now that he is in a wheelchair. We had a report recently that his doctor at the facility said that "he is not a candidate for PT." I think she is insane. I have no idea how this could even be possible unless they want him to just deteriorate and die as soon as possible.

The main question I have, and I am hoping to get some kind of answer, if we are able to get him moved to a better facility, is PT normally offered, or does it cost extra, and how much does it cost approximately? He is in Phoenix. Cost isn't an issue, I just need to know how to get him the proper care, as at this juncture, it will be hard to get him to even do it as he is so weak and just wants to lay in bed and sleep a lot. So having someone who can really connect with him and work with him is crucial. Also, he can't really go out to any PT place for treatment, again, he is so weak, so it would have to be at the facility where he is. Thanks!
Hello Riley. I am so sorry to hear about your situation. Every time someone says someone is too debilitated for therapy (especially when there is a dementia diagnosis), I get frustrated. Every situation is different, but too often dementia patients are either overlooked or written off without a proper assessment. Please watch the following YouTube video. This patient was considered nonresponsive and totally atrophied.

The facility that this took place at was in Sun City (just outside of Phoenix).
This will help a lot since my dad is getting out of the hospital today to go to a rehab facility. He had a UTI, which really plays with the mind. He has lost most of his tone and needs it back so he can return home.