Dementia Care and Treatment: Tips and Reminders

 Providing therapy treatments and care to a patient suffering from dementia can be particularly difficult, as many clinicians know. Weak muscles, broken bones, and unsteady balance all present challenges to a patient’s progress with skilled therapy services, but compounded with confusion and disorientation resulting from dementia can sometimes prove to be an immense barrier. To help your patient succeed in their therapies despite dementia, consider the following items:

Familiarity: Patient’s with dementia respond best to familiar and personal settings, items, people, etc. New activities and ideas are difficult to comprehend and respond to.

Involve family members – Going with the theme of familiarity, involve family members of the patient in treatments if able. Their presence can elicit better participation and response to the therapist simply by association. Also, a familiar face can help calm and center the patient.

Create a treatment routine – Continuing with the familiarity theme, again, establish a regular treatment routine. Consider scheduling treatment at approximately the same time or same days if possible. When planning out the treatment course for the patient, choose a series of exercises and activities and stick with a similar, if not same, series in order with each treatment with only slight, gradual changes and adaptations to promote progress. This repeated routine with help the patient to create an expectation and association with therapy, decreasing anxiety and increasing participation.

Creativity: Patient’s with dementia typically cannot follow along with standard exercise regamines or neuro rehabilitation, so you must be creative and observant to your patient’s response to your treatments. Find things that they want to do that are more engaging or fun instead of things they have to do for typical progressive treatment courses.

Therapeutic use of self – New and novel items, tasks, and ideas are difficult to comprehend and respond to for a patient with dementia, so giving them an exercise or piece of equipment they may have never use if often met with resistance and little success. Consider using yourself as the equipment, resistance, support, etc. Commands of “hold my hand” and “raise your arms like me” are easy to understand and follow, near reflexive, versus “grab this bar” or “hold on to your walker”.

Consider more functional activities – Continuing on the idea of treatment approach and consideration, patient with confusion are more likely to attend to and complete tasks they have done hundreds of times in their life, such as light house keeping, laundry, and ADL tasks. When aiming for gains in performance components like strength, endurance, and standing balance, don’t shy away from functional tasks in lieu of rout exercises.

Pathology: Always consider the disease process and inner working of dementia with patients suffering from its’ effects. There are simply some hallmarks of dementia that cannot be overcome with some treatment techniques, but there are some ways around these barriers.

Plan morning treatments – Just like a muscle, as the day wears on the brain becomes tired and weaker. For those with dementia, this is especially true. Planning treatments prior to midday will help in removing the factor that mental fatigue can present.

Responding to confusion/agitation – All joking aside, sometimes a patient’s confusion and memory lapses can be a blessing. If working with a patient with dementia and they become agitated or combative, it is best to simply step away, even leave the room for a short time to give them an opportunity to calm down and reset. Sometimes just 5-10 minutes later can be a whole new event for the patient. Don’t argue with someone suffering from dementia. You cannot explain to a person who is confused that they are confused…because they are confused.

Therapy: Finally, when considering your overall approach and plan of care make sure you never discount the symptoms of dementia as a barrier or deficit. Plan accordingly.

Biomechanical frame of reference – Since graduation most of use have forgotten our frames of reference, but one in particular is worth dusting off when working with dementia. The biomechanical frame of reference focus purely on the musculoskeletal and other body systems as areas to focus on and removes consideration of the patient’s comprehension and understanding of the purpose of therapy. For dementia patients, this can be very beneficial. Case in point, for a patient with dementia with a history of multiple falls, educating them on safe transfer techniques and proper use of a walker may meet little success. In contrast, taking that same patient through a treatment course that develops trunk and leg strength and stability will decrease the patient’s fall risk percentage despite their safety awareness.

Repetition – Overall, the most effective treatment technique and consideration I have found when working with patients with dementia is repetition, repetition, repetition. Persistent review and completion of exercises, techniques, and treatment tasks with help the patient hurdle the short term memory and comprehension difficulties they have in favor of the long term memory, reflexive muscle memory responses of regular repetition.