SPECIAL POPULATIONS

Dementia

Identifying patient's strengths and abilities, rather than deficits and limitations (using familiar and functional activities that rely on procedural and long-term memory as exercises instead of new and unfamiliar fitness equipment). Dawson and her coauthors documented improvements in lower extremity strength, balance, and gait speed in study participants by employing strength-based techniques.

"Always making a good first impression," meanwhile, is key to staying on the good side of this patient population's emotional memory, McCarthy says.

"People who have Dementia often can remember, even when the disease is in its more advanced stages, how they feel about a person-even if they can't remember that person's name or perhaps their own name. For that reason," McCarthy continues, "it's important for PTs and PTAs to have a dementia-friendly attitude and make a good impression every time they encounter that individual-using not just words, but also body language and facial expressions, to gently and calmly communicate who they are and what they want the individual to do."

When it comes to facial expressions, McCarthy adds, nothing beats a smile.

"Smiling uses all the facial muscles and is an expression that's very easy for people to recognize," she notes. "So, when you're communicating with someone with dementia, when it's appropriate to do so and it isn't fake, smile."

Another important concept for PTs and PTAs to keep in mind, says the PTs interviewed for this article, is that while a cognitively intact person might benefit from making mistakes during the therapy process and gleaning lessons from them, the best approach for people with dementia conversely may be what's called "errorless learning."

Specific Interventions for a patient with Dementia:

The Early Stages

In the early stages of dementia, families may not observe physical complications in the newly-diagnosed dementia patient; however, as the individual transitions from one stage of the illness to another, these complications will become more prevalent.

In the early stages, physical therapy is a rehabilitative service that places an emphasis on improving balance, increasing the strength of the muscles, optimizing the patient's range of mobility, and helping in areas related to the successful management of pain. Dementia patients are at a high risk for falls, balance deficits, and weakness in the muscles -even as a newly-diagnosed patient.

Families commonly turn to neurologists and similar medical professionals, but more education has to be provided concerning physical therapy as this is what will truly matter as the dementia patient progresses in their disease.

Environmental Assistance

The next reason that families should be encouraged to sign their loved one up with physical therapy services in the earliest stage of their disease is because PTs can be of great assistance in terms of environmental assistance; that is, helping families change and enhance the patient's living area so that they are able to remain as functional and independent for as long as possible.

Additionally, these services aid in ensuring the overall safety of the dementia patient. Environmental assistance modifications that may be done by physical therapists include adding signage to the living area, moving obstacles, lowering beds and other furniture, and adding cushioning to sharp edges, doors, counters, and other regions in the home that may become a danger to the patient.

Later Stages

As a dementia patient transitions into the later stages of their illness, it will become increasingly important for them to have strength, balance, and effective coordination. Lack of any of these elements may result in the patient becoming unable to walk, unable to move comfortably, unable to feed themselves, and an extreme decline in general comfort level.

As a physical therapist, it is your job to encourage families to sign their loved one up for your services once they have been diagnosed with dementia. Not only can your services and assistance keep the individual safer for longer, it can help prolong their life and optimize the quality of their life.

Parkinson's Disease

PHYSICAL THERAPY FOR PARKINSON'S DISEASE

People with chronic conditions like early onset Parkinson's disease often find physical therapy can improve strength and flexibility, and decrease pain and stiffness. It's part of an array of Parkinson's Disease treatments.

Amplitude Training

A specific form of physical therapy for Parkinson's disease is called LSVT BIG training. (LSVT is Lee Silverman Voice Treatment. LSVT LOUD is therapy to amplify the voice.) "It's meant to help patients with Parkinson's increase what we call 'amplitude of movement,'" says Padilla-Davidson. In LSVT BIG, you make overexaggerated physical movements, like high steps and arm swings. It's a way to retrain the muscles and slow down the progression of hypokinesia, the increasingly smaller, more shuffling movements that happen with Parkinson's. 

Reciprocal Patterns

Reciprocal movements are side-to-side and left-to-right patterns, such as swinging your arms while taking steps as you walk. Parkinson's disease may affect these patterns. Your therapist may help you reinforce reciprocal patterns by the use of a recumbent bicycle (a stationary bike in which you sit in a reclined position) or elliptical machine (in which you use your arms and legs). On your own, says Padilla-Davidson, "Practice walking, keeping in mind the swinging of your arms. It may help to chant or sing to keep the rhythm." Dance classes and tai chi are also useful.

Balance Work

Normal balance, explains Padilla-Davidson, is an interplay among what you see (visual feedback), your inner ear (which helps you orient yourself) and how your feet sense the ground beneath them. Parkinson's disease can affect this balance system, making your gait (how you walk) unstable, which in turn may make you fearful to be in public or crowded spaces. Gait training (practice walking) can help. Exercises that aim to improve balance should be guided by a physical therapist, who can work with you to understand any issues with balance and teach you ways to compensate.

Stretching and Flexibility

It's common for patients with Parkinson's disease to develop tight hip flexor, hamstring and calf muscles. To counteract that stiffness, it's best to stretch at frequent intervals throughout the day, rather than just once, says Padilla-Davidson. Ask a qualified trainer or therapist who specializes in Parkinson's to show you how.

Strength Training

Muscles naturally weaken with age, so strength training is important for everyone. But research suggests that muscle weakness is a bigger problem for patients with Parkinson's disease, says Padilla-Davidson. Depending on what stage of the disease you are in, a therapist might have you do resistance exercises with light dumbbells or a resistance band (a kind of thick rubber band). Pool-based classes, using the water's resistance to strengthen muscles, can also be a good fit, she says. 

AGING & DISABILITY RESOURCE CENTER

Your local aging and disability resource center (ADRC) is the first place to go to get accurate, unbiased information on all aspects of life related to aging or living with a disability.

ADRCs are friendly, welcoming places where you can go for information about aging or living with a disability, whether you are looking for yourself, or you are a concerned family member or friend, or a professional working with issues related to aging or disabilities.

The ADRC provides information on a broad range of programs and services, helps people understand the various long-term care options available to them, helps people apply for programs and benefits, and serves as the access point for publicly funded long-term care.

These services can be provided at the ADRC, by telephone, or through a home visit, whichever is more convenient to you.