Tips from: Physical Therapist | Occupational Therapist | Social Worker

Authored by:
Martha (Marty) R. Hinman, P. T. , Ed.D.
Ruby Decker Professor of Physical Therapy and Fellow, Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX.

Dr. Hinman has treated and conducted clinical research with geriatric clients in nursing homes and hospital-based clinics over the past decade. She has also conducted numerous wellness seminars and health screenings for seniors living in the community with a focus on preventing osteoporosis and falls.

F is for “familiarity.” This applies to the type of treatment, the treatment environment, and the therapist. Find out what the client used to do for work or as hobbies and match these functional movements with the type of exercise you want them to perform. For example, if you want to emphasize weight-bearing activity, familiar music may be used to prompt a client to dance. Also determine any interventions that might trigger an undesired reaction. For example, aquatic therapy may be ideal for someone who loved to swim, but will be a poor choice for someone who was fearful of water or had a near-drowning experience in the past. Whenever possible, try to treat them in a familiar environment (their home or hospital room) as opposed to the physical therapy clinic, and always have the same therapist work with the same client.

U is for “understanding.” Use simple language that is very literal and can be clearly understood by the client (e.g., walking machine vs. treadmill). In addition, the therapist must understand the nature of the disease and be ready to abandon one communication strategy if it isn’t working and try another approach. The therapist must remain calm and constantly reassure the client to keep him or her from acting out in response to frustration or anxiety.

N is for “no distractions.” All physical therapy evaluations and treatments should take place in an environment that has a minimal amount of visual and auditory stimuli that may distract the client’s attention away from the therapist. If treating a client in his or her room, close the door to prevent interruptions.

C is for “cues and contact [eye].” Individuals with dementia require repetitive cueing, both verbal and nonverbal. The therapist should make eye contact each time he or she speaks to the client and reinforce verbal cues with visual ones whenever possible. Small group exercise classes are sometimes useful in reinforcing repetitive exercises because the clients can watch the group leader and other group members perform the activity with them. Brightly colored objects (scarves, balloons, balls, etc.) used in the exercise session may also elicit a better response from this population because they tend to experience spatial and perceptual problems. Likewise, when ambulating on steps the edges should be highlighted with bright paint or tape to accommodate their loss of depth perception. When attempting to minimize wandering and/or prevent falls, the use of familiar signs may be used as visual cues. For example, a stop sign on the door may keep them from entering a certain area.

T is for “touch.” Individuals with dementia often respond better to physical prompts than verbal ones. Holding a client’s hand and gently guiding it through a motion is more likely to elicit the desired response than describing or demonstrating the motion to the client. The therapist should always ask permission before touching the client and may need to experiment with the type of touch used to find out what the client responds most positively to. For example, clients with dementia are more likely to attend to the gentle pressure of an open hand than to light tapping or touching with a fingertip. Touch may also be used to soothe or calm a client who is agitated. Soft furry animals (real or stuffed) such as cats, rabbits, and small dogs are often helpful therapy aids, particularly for nonverbal clients.

I is for “intact abilities.” Teaching a client with dementia a new motor skill is usually an unrealistic goal. Instead, the therapist must focus on developing and maintaining intact physical abilities. For example, in cases of severe dementia, a client with a hip fracture cannot be expected to learn how to use a walker with restricted weight-bearing status. Thus a wheelchair is a more realistic option during the immediate post-op period. Remember, it is always easier to adapt the client’s environment to meet their altered functional status than it is to retrain the client.

O is for “one step at a time.” The therapist must realize that clients with dementia cannot process multi-step directions, and they may not be able to complete a task if steps are skipped. For example, when cueing a client to get up from a chair, the therapist may need to give five separate commands such as: “Sit up straight. Place your feet flat on the floor. Put your hands on the armrests. Lean forward. Push yourself up.” Likewise, it is usually unwise to combine multiple interventions (e.g., an exercise program and gait training) in the same treatment session.

N is for “never rush.” Extra time should be scheduled when evaluating or treating a client with dementia. Cognitive deficits will slow reaction and movement time, so if the client is rushed, motor errors will occur that could compromise the client’s safety. Whenever possible, it is better to see the client for multiple, short treatment sessions as opposed to a single, long session. Clients with dementia tend to fatigue easily and this will further compromise their ability to attend to the task at hand.

A is for “automatic activities.” The best exercises are those that utilize more primitive, automatic responses. Thus, kicking or tossing a ball is a better way to strengthen leg and arm extensor muscles than lifting a weight. However, small cuff weights (1 to 2 lb.) applied to the wrist or ankles during functional activities such as walking or dancing are an excellent way to strengthen muscle and bone.

L is for “limit choices.” When evaluating a client with dementia, avoid using forms or scales that ask the client to rate his/her pain or describe his/her activity level. Questions that require a “yes or no” answer are best. Likewise, clients with dementia have difficulty with open-ended treatment sessions such as “What exercise would you like to do first today?” Thus, the therapist should be very organized and directive; when giving the client a choice, no more than two should be offered. For example, “Would you rather ride the bicycle or take a walk? Would you like to dance to this song or that song?”