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Alzheimer's Disease Physiotherapy

Research estimates that at least 5 percent of people over age 65 and more than 40 percent of people over the age of 85 have Alzheimer's disease. Together with memory loss and other cognitive problems, patients with Alzheimer's disease may have difficulty performing simple tasks of daily living. Physiotherapists partner with families and caregivers to help people with Alzheimer's disease keep moving safely and delay worsening of the condition.

What Is Alzheimer's Disease?

Alzheimer's disease is a progressive condition that damages brain cells and affects

• how we speak
• how we think
• how we interact with other people

It's the most common cause of dementia, and refers to a group of brain disorders that cause a decline in memory and the ability to perform daily activities.

The risk of getting Alzheimer's disease increases with age; it's rare to get it before age 60. Having a relative with Alzheimer's disease raises your risk of getting it, but most people with the disease do not have a family history of it.

One of the major symptoms of Alzheimer's disease is confusion. Of course there are several other potential causes of confusion, some of which may be reversible if discovered early such as infections or head injuries, both of which requires quick and early interventions and can be treated.

Signs and Symptoms

There are 10 important warning signs of possible Alzheimer's disease:

• Memory changes that disrupt daily life
• Difficulty making decisions, especially in planning or solving problems
• Difficulty completing familiar tasks
• Confusion about time and or place
• Trouble understanding visual images or the way things physically fit together (spatial relationships)
• Finding the right words to say when speaking or writing
• Misplacing items and losing the ability to retrace your steps
• Poor or decreased judgment about safety
• Withdrawal from work or social activities
• Changes in mood or personality

People with Alzheimer's disease also may get lost in once-familiar places.

In the later stages of the disease, they might get restless and wander, especially in the late afternoon and evening (this is called "sundowning"). They may withdraw from their family and friends or see or hear things that are not really there.

They may also unfortunately falsely believe that others are lying, cheating, or trying to harm them.

Along with these "cognitive" symptoms, people with Alzheimer's disease may develop difficulty performing simple tasks of daily living in the later stages of the disease. Eventually, they may need assistance with feeding, bathing, toileting, and dressing.

The physical ability to walk is usually retained until the very last stage of the disease; however, due to confusion and safety concerns, people with Alzheimer's disease may need supervision or an assistive device to help them get around safely.

How Is alzheimer's disease Diagnosed?

The exact cause of Alzheimer's disease remains unknown and is most probably due to many factors, which makes diagnosis difficult. Researchers are getting closer to making a diagnosis by using brain imaging studies such as

• computed tomography scan
• magnetic resonance imaging (MRI)
• positron emission tomography (PET) scan or
  
• ultrasound

These tests can show abnormalities in brain structure or function. Mental function tests, cerebral spinal fluid tap, biomarkers, and genetic testing also can be used to help make a diagnosis. But unfortunately a definitive diagnosis can be made only on autopsy.

Our senior physiotherapists may play an integral role in recognizing early signs or symptoms of this disease. If they recognize you or your loved one is exhibiting signs or symptoms consistent with Alzheimer’s, they will make an appropriate referral to the necessary specialist.

How Can our senior physiotherapists help

For patients with Alzheimer's disease, research shows that:

• Physical activity can improve memory
• Regular exercise may delay the onset of dementia and Alzheimer's disease
• Regular exercise may delay the decline in ability to perform activities of daily living in people who have Alzheimer's disease

In the early and middle stages of Alzheimer's disease, our senior physiotherapists will focus on keeping patients mobile and help them continue to perform their roles in the home and in the community.

In the later stages of the disease, they can help people keep doing their daily activities for as long as possible, which reduces the burden on family members and caregivers. They also may instruct caregivers and family in how to improve safety and manage the needs of a loved one with Alzheimer's disease. 

Physical therapy can help improve quality of life and possibly delay the need for institutionalization (ie long term warding in hospitals or step down care or nursing home placement).

People with Alzheimer's disease develop other conditions related to aging, such as

• arthritis and osteoarthritis
  
• falls
• bone fractures such as hip fractures and spine fractures
• etc
  

Our senior physiotherapists are trained to treat these conditions in people who have underlying Alzheimer's disease. Therapists take into account the impact of the disease on other health conditions, on general health, and on the individual's ability to understand important instructions.

The therapist may use various teaching methods, techniques to simplify instructions, and unique approaches, including:

• Visual, verbal, and tactile cueing - We provide "cues such as pointing to objects or gesturing. For instance, lifting up both arms can signal the person to stand up. Cues can also be given verbally with short, simple, or one-step instruction. Tactile clues holding someone's hand to have them walk with you. Sometimes, 2 or 3 cueing techniques are used simultaneously.
• Mirroring - With this technique, we serve as a "mirror," standing directly in front of the person to show them how to move. To help the person raise his or her right arm, the therapist's left arm would be raised.
• Task breakdown - We're trained in how to give step-by-step instruction by breaking down the task into short, simple "pieces" to be completed separately. For instance, if the therapist wants to teach a person how to safely move from lying in bed to sitting in a chair, the therapist might have the person practice rolling to the side, then pushing up to sitting, then moving to a chair in separate steps.
• Chaining- We can provide step-by-step instructions by linking one step to the next step in a more complicated movement pattern. This technique usually is used once task breakdown has been successful and unites the separate steps of moving from lying in bed to sitting in a chair, to make it one fluid movement.
• Hand over hand facilitation - We take the hand or other body part of the person who needs to move or complete a task and moves that body part through the motion.

Although people with Alzheimer's disease usually maintain the ability to walk well into the late stages of the disease, balance and coordination problems often lead to walking difficulties. Our senior physiotherapist will train the muscles to "learn" to respond to changes in the environment, such as uneven or unstable surfaces.

Train Family Members and Caregivers

The family and caregiver may need instruction in how to safely move, lift, or transfer the person with Alzheimer's disease to prevent injury to the caregiver as well as the person with Alzheimer's disease.

In addition to hands-on care, our senior physiotherapists will provide caregiver training to improve safety and to decrease the risk of injury. For instance, we can show caregivers how to use adaptive equipment and assistive devices, such as special seating systems, canes, or long-handled reachers, and how to use good "body mechanics" (the way you physically move to do a task).

For patients with Alzheimer's and dementia, we often recommend for house call/home visit physiotherapy because patients with dementia will benefit/prefer a familiar environment (which also will decrease distraction).