Dementia and Therapy: Can PT/OT/ST help?

I have spoken to many family members over the years regarding physical therapy (PT) for their loved ones that have memory loss. I am often asked if therapy can help someone who does not consistently follow directions. 

Muscles need to be worked

I always say, your thigh muscles don’t care that your brain isn’t working right! Therapists are experts at adapting their exercises to functional movements. I have had many therapy sessions that consisted of activities that were in my patient’s world in that moment. When someone has dementia, you meet them where they are. 

Different approach

I will approach my patient, introduce myself and start a conversation. I then see where they are in that moment. It could be right where I am, or it could be somewhere completely different. Wherever they are, I join in. I have had a patient tell me that she is waiting for her mother. I then suggested we get out of her wheel chair and walk down the hall to see if her mother was there. One time, I took a patient to the nursery area of the memory care unit she was in and we stood and rocked the baby (excellent balance exercise) and then we lifted the baby up and down while counting (arm strengthening). 

I have also had a lot of success using repetitive movements like a reclining bike or NuStep machine. I often will add music and many times this along with the continuous motion will keep them engaged. I can adjust the resistance on the machine throughout their workout and in turn my patient is participating in interval training strengthening both their legs and their heart. 

OT

Occupational therapists (OT) focus on safety with daily activities and adaptive equipment, particularly in the bathroom and with dressing. OTs will often time their therapy appointments during a patients normal morning routine and turn the bathing and dressing that they need to do for the day into a therapy session. They can introduce equipment, teaching with practical use. Sometimes patients are agreeable, sometimes they are not. 

The key in therapy with those that have dementia is to go with the flow. You cannot rationalize like you can with someone without dementia – ie telling someone that the leg exercises we are doing will allow you to stand up from a chair with more ease. But movement is always beneficial. And therapists are able to encourage specific movements that will have the best possible impact on long term positive functional improvements. 

ST

Part of what Speech Therapists (ST) do is cognitive therapy. They are able to assess cognition using a number of standardized tests, and then use these results to assist their patients on tactics to improve their daily function. There does come a point however where a person’s cognition has declined to a point where caregiver education would be the main goal. The data STs can obtain is invaluable to the entire caregiving team. 

Therapy works!

All three therapies have a goal of educating family on how to best support their loved ones. PTs and OTs focus on functional movements, hands on assistance, safety and durable medical equipment among other things. STs can help you understand how to best communicate with your loved one and what can be expected based off their current cognitive processing. There are many areas that therapy can help during this dementia journey. 

All therapies require a doctor’s order so this is often the best place to start. Most physicians love therapy, but occasionally you will hear that therapy cannot help those with dementia. But I can tell you that this is not true. Therapy almost always has a role, even if is care giver education.

Obviously I am bias, but my knowledge as a PT as been invaluable during this time with my mom. I have ordered her equipment, referred her to PT and ST when needed and I have been able to adapt her apartment to reduce her fall risk. So the answer is a resounding YES, therapy can definitely help. We have an important role and my own mother has greatly benefited from therapy services many times over the years.