Physical Therapy For Alzheimer’s Patients

Increases Mobility And Strength

Alzheimers disease often affects balance and can lead to a high risk for falls. Regular physical therapy helps to keep bones and muscles strong as coordination declines.

You might notice that although your loved one is able to walk that they have an unsteady step. The physical therapist will work with your loved one to build muscle memory to help with preventing falls. The muscles continue to know how to respond even when the brain is not able to register unstable surfaces.

An added bonus of regular physical therapy is improved sleep. One study matched participants with therapists who assisted them to walk for 30 continuous minutes. After 6 months it was found that the participants were sleeping for an extra 36 minutes and waking less at night.

Cognitive And Emotional Benefits

Physical therapy can boost confidence, decrease aggression, slow down disease progression, and improve quality of life, which in turn helps with cognitive and emotional well-being.

Slow down memory loss and cognitive function

Physical therapy especially with aerobic exercise can slow down the loss of cognitive functions. This type of therapy is associated with modest improvements in attention and processing speed, as well as executive function and memory. Researchers dont know exactly what mechanisms are behind this effect, but its likely a mixture of increased blood flow to the brain, better sleep quality, improved cardiovascular and metabolic health, and fewer symptoms associated with depression.

Improve mood and decreases aggression

Anxiety, aggression, and depression are common among patients with dementia. A physical therapist can help your loved one be more active, which reduces anxiety, improves mood, and reduces the need for medication. Studies have found that physical therapy can reduce depression, as well as help the patient control symptoms of restlessness, irritability, and aggression.

Increase quality of life

Many dementia patients feel unmotivated as a result of cognitive dysfunction. Most dont enjoy feeling unproductive. Physical activity can give these patients a sense of purpose to achieve a goal. Having a routine of physical therapy exercises to complete every day can provide dementia patients with more motivation and increase their quality of life.

Findings Of The Review

Themes

The thematic synthesis resulted in 7 themes relating to the research questions. There were 5 themes related to beliefs: the belief that working with people with dementia is complex and challenging the belief that opportunities for education in dementia care are lacking the belief that working with people with dementia is a specialized area of practice the belief that systems are unsupportive for working with people with dementia and the belief that people with dementia deserve rehabilitation but that their potential to improve is less certain. There was 1 theme related to knowledgelack of knowledge in some areas of dementia careand 1 theme relating to confidencelack of confidence working with people with dementia.

One code, desire to provide dementia care, was created from qualitized data from 3 studies,, but did not contribute to any themes. In these studies, physical therapists and physical therapist students reported that they did not have a preference to work with people with dementia.,

Critical Appraisal Results for Included Quantitative Studies Using the Joanna Briggs Institute Critical Appraisal Checklist for Analytical Cross-Sectional Studies

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Physical Effects Of Alzheimers

If you have a loved one who has been diagnosed with Alzheimers , it is very important to know what to expect with their physical abilities. Three main physical obstacles that often arise with Alzheimers patients as their condition declines are as follows:

• . Alzheimers targets brain cells associated with muscle awareness and movement. People with this condition may begin to lose their strength and balance. Alzheimers also affects levels of cognitive self-awareness, which can cause a person to forget they need an assistive walking device such as a walker or cane. This could result in a serious fall or injury.
• Incontinence. Alzheimers impairs the muscles that control bladder function, which can cause incontinence will occur more frequently.
• Thisdisability begins with difficulty handling daily activities such as getting dressed, washing yourself, or brushing your teeth. As the individuals condition declines, they may have trouble chewing and swallowing food

Individuals with Alzheimers disease may also develop other age-related degenerative conditions such as arthritis. Its important to seek help early in diagnosis to make sure you or your loved one is taking necessary precautions to preserve their wellbeing.

How Is It Diagnosed

The exact cause of Alzheimer’s disease remains unknown. It is likely due to many factors that make diagnosis difficult. There is no single test for Alzheimer’s disease. Health care providers who are trained to work with older people may notice the early signs. It may take days or weeks for the medical team to complete a set of tests to make a diagnosis.

Researchers are getting closer to making a diagnosis by using brain imaging. Scans that may help with diagnosis include a CT scan, an MRI, a PET scan, or ultrasound. These tests can show abnormal brain structure or function. Mental-function tests and other tests also may be used.

Physical therapists may recognize early signs or symptoms of the disease. If a physical therapist suspects Alzheimer’s disease, he or she will make a referral to a specialist.

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Risk Of Bias In Individual Studies

We will use the Risk of Bias 2 Tool to assess the risk of bias in all included articles at the study level. At least two review authors will assess risk of bias across the five RoB 2 domains, specifically bias related to randomization, deviation from intervention, missing data, measurement, and result selection . A third review author will resolve any conflicts regarding risk of bias considerations. Finally, review authors will provide a rationale for all choices regarding risk of bias. A stratified analysis will be used to assess and report the levels of bias identified across included studies.

How Can A Physical Therapist Help

Physical therapists are in a great position to help people age well. Research shows that:

• Physical activity can improve brain function and memory. This is true for healthy older adults or for those with mild cognitive problems.
• Regular exercise may delay the onset of Alzheimer’s disease in healthy older adults.
• Regular exercise may delay a decline in the ability to perform tasks in people who have Alzheimer’s disease by improving their strength, balance, and walking ability.

Physical therapists are movement experts. They design exercise programs for people with a variety of health conditions, including Alzheimer’s disease. They can play a key role in preventing decline.

In the early and middle stages of Alzheimer’s disease, physical therapists help people stay mobile. With this help, people can continue to perform their roles at home and in the community.

In the later stages of the disease, physical therapists can help people keep doing daily activities for as long as possible. This reduces the burden on family members and caregivers. They can instruct caregivers and family on how to improve safety and manage their loved ones needs. Through a home assessment, physical therapists can help make the home safer. Physical therapy can help improve quality of life and may delay the need for facility-based care.

Physical therapists are trained to use a variety of teaching methods, techniques, and unique approaches to treating people with Alzheimers disease, including:

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It Can Help Maintain Independence

In the later stages of Alzheimers disease, daily activities such as eating, bathing, and toileting may become increasingly difficult.

Your physical therapist can help provide opportunities to strengthen your muscles so you can continue performing these tasks independently.

Your physical therapist can also help your support network set up a safe environment in your home.

Understand & Exploit Motor Learning Strengths

Motor learning literature as it relates to ILwD is limited, but provides some important themes. Rehab focus may be on re-learning skills or may be on skills requiring new learning . These strategies can be useful in both contexts.

Prioritize procedural learning

Consider salience of tasks

Saliency is a relevant component of motor learning for all populations, but even more so for ILwD . Functional relevance may need to be more obvious for ILwD, where lower extremity strengthening is disguised as sit to stand activity drills and balance training is clearly framed within a motivating goal . Dutzi et al. demonstrated the capability of rehab participants with mild-moderate dementia to accurately identify functional limitations and set meaningful goals using a structured approach. This reminds PTs not to make assumptions about patients insights into their own needs and represents an important integration of person-centered care.

Intentionally design practice sessions: repetitive, consistent, constant, & blocked

Table 2 Terminology for Motor Learning & Practice Schedules

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It Can Increase Mobility

People suffering from Alzheimers disease are often at a high risk for falls.

And because Alzheimers is most commonly a disease of old age, it can often accompany other diseases common in seniors, such as:

• A history of traumatic brain injury

Each of the above can either leave you more prone to falling, or make a potential fall more risky.

Your physical therapist can help strengthen your muscles in order to prevent injury from falls.

Additionally, regular physical therapy can help build muscle memory, which allows your body to respond to movement even when your brain is struggling.

Exercises For Resistance Training

Resistance training typically involves lifting weights or pulling against resistance bands to improve muscle strength and endurance.

This type of exercise can be very helpful for older adults experiencing cognitive decline. For example, a study found that six months of strength training in patients with mild cognitive impairment improved cognitive performance and protected some areas of the brain against further degeneration and shrinkage. Whats more, the benefits were still visible up to one year later.

See below a few examples of resistance training exercises you can do at home. Its important to note that some of these exercises can be quite strenuous and are not suitable for everyone. If you or your loved one is not physically able to do these exercises, consider modifying them to be less difficult or skipping them completely.

For each exercise that you do, perform 3-5 sets of 3-5 reps twice per week.

Squats

Note: Skip this exercise if you have a knee injury or other major knee issues.

• Stand upright with your feet shoulder-width apart.
• Bend your knees to lower down as much as possible .
• Go back to the standing position.

Lunges

Note: Skip this exercise if you have a knee injury or other major knee issues.

Push-ups

Note: Skip this exercise if you have any major issues with your wrists.

Planks

Bicep Curls

Overhead Press

Chest Press

Calf Raises

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Decreases Aggression And Improves Mood

Aggression and depression can be common traits throughout the progression of Alzheimers. A physical therapist will help your parent or senior loved one to be active. Regular activity has been repeatedly shown to improve mood and reduce aggression.

One study found that an hour of therapy each week for 12 weeks drastically reduced depression. The therapy focused on balance, endurance, flexibility and strength training.

Physical therapy also helps to stabilize aggression through regular exercise. The therapist assists your loved one with active movement and stretches that releases endorphins that soothe the brain. A study found that people with Alzheimers who regularly participated in physical therapy over a 24-month period had fewer hospitalizations related to behavioral problems.

How Does Physical Therapy Help Dementia Patients

Physical therapy has many benefits for patients with Alzheimers disease, Lewy Body dementia, frontotemporal dementia, Parkinsons disease, and other forms of dementia:

• Physical benefits: Not surprisingly, physical therapy benefits physical function and health. Exercise improves cardiovascular health , increases fitness and strength, improves balance, and decreases the risk of falls. Patients carry out their daily activities more easily and enjoy improved quality of life.
• Cognitive benefits: Physical therapy can also slow down loss of cognitive function in dementia patients. This effect is likely due to increased blood flow to the brain, better sleep, improved cardiovascular health, and fewer symptoms associated with depression.
• Emotional benefits: Physical therapy helps with mental health problems, such as anxiety and depression, which are common amongst dementia patients. Engaging in regular exercise improves mood, reduces the need for medication, and helps the patient control emotional symptoms of dementia, such as restlessness, irritability, and aggression.
• Social benefits: In addition to physical, cognitive, and emotional benefits, physical therapy can offer dementia patients important social benefits. It reduces social anxiety, helps build stronger social connections, and supports dementia patients efforts to maintain their independence for longer.

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• Exercises in the swimming pool

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Low Resource Health Settings

More than half of all people with dementia are from low and middle-income countries. Alzheimers disease, other dementias, and non-communicable diseases are expected to continue to be a burden on health systems throughout sub-Saharan Africa, as country populations age and communicable disease mortality and morbidity go down . The number of people with Alzheimer’s disease and dementia in general is estimated to increase far more rapidly in the upper middle, lower middle and low-income countries than in the high-income countries . There is a general lack of awareness of the disease among the population, therefore patients don’t seek for medical care and do not get the treatment they need. Hence, it is under-recognized, underdisclosed, undertreated, and undermanaged, particularly in LMICs. The living environment also often poses little cognitive challenge because families may not understand their relatives behavior . Many of the cognitive and functional assessment tools used in LMICs were originally developed and validated in High Income Countries. There is a need to adapt it to be used more effectively in LMICs .

Physical Therapy Helps Alzheimers Disease

The month of November is dedicated to a cause that affects many lives: National Alzheimers Awareness month. As of 2014, in the United States there is an estimate of 5.2 million Alzheimers patients. Americans are encouraged to participate in Alzheimers Association activities to help fight for a cure.

Alzheimers disease has 10 progressive stages with symptoms. The cognitive symptoms of the disease are the disrupting of memory, language, thinking and reasoning. There are behavioral psychiatric symptoms that are a group of additional symptoms that may occur to some degree depending upon the patient.

The use of physical therapy is important for treating Alzheimer patients. With different stages of the disease, a physical therapist can recognize the challenges associated with it. As an adjunct to traditional medical treatment, a physical therapist will design a treatment program that is specifically tailored to the disease.

Balance Therapy, Therapeutic Exercise, and Massage Therapy are all important methods of therapy for Alzheimer patients. There are specific exercises used in balance therapy that improves balance. Standing with both feet close together or standing on one foot are effective and basic exercises that physical therapists will recommend. To improve safety, assistive devices may be provided. The dependence on assistive devices will be gradually reduced as therapy continues. Supervised balance therapy enables the patient to improve their balance gradually.

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Physical Exercise And Multimodal Interventions For The Treatment And Prevention Of Ad

Dementia is by no means an inevitable consequence of reaching retirement age. There are lifestyle factors that may decrease, or increase, an individual’s risk of developing dementia.22 Around 35% of dementia is attributable to a combination of 9 risk factors: low education level, midlife hypertension, midlife obesity, hearing loss, later-life depression, diabetes, smoking, social isolation, and, of course, low physical activity.41

A meta-analysis that included 16 studies with more than 160,000 participants found a 45% reduction in the risk of developing AD due to the regular practice of physical activity .42 In a sample of 716 older subjects followed for 3.5 years, similar results were found when assessing the risk of suffering AD. Those individuals with low daily physical activity levels were 53% more likely to suffer AD than those who reported more active lives .43

Few studies have been published on the effects of resistance training in people with MCI or AD.44,66, 67, 68 Prominent among them is the randomized, double-blind trial that included 100 people between 55 and 86 years of age with MCI.69 In this study it was shown that 6 months of resistance exercise induced improvements in memory, attention, and executive functions. Moreover, those benefits persisted 12 months after the end of the intervention period.

Diagnostic Tests/lab Tests/lab Values

Currently, the diagnosis of Alzheimers relies primarily on signs and symptoms of mental decline. Primary care physicians and physical therapists can screen for dementia presentations, the next section describes tools for recognizing dementia or Alzheimers presentations in patients. Below are current research developments utilized to exclude other possible diagnoses, while confirming the progression of Alzheimers disease. The Onset of the disease occurs between 40 and 90 years old and most often after 65 years old.

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Data Extraction And Quality Assessment

The quantitative studies that were retrieved were assessed by 2 reviewers for methodological quality using the 8-item Joanna Briggs Institute Critical Appraisal Checklist for Cross-Sectional Studies. The qualitative studies were also assessed by 2 reviewers , using the 10-item Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research for qualitative studies. Items not applicable were not taken into consideration on the overall grading of each study. Any disagreements between reviewers, including items deemed unclear or not applicable, were resolved through discussion. Where a study recorded a yes for the majority of applicable questions, it was deemed to be of high quality. All studies underwent data extraction regardless of the results of their methodological quality.

Quantitative and qualitative data were extracted from studies included in the review independently by 2 reviewers using the Joanna Briggs Institute Mixed Methods Data Extraction Form. Information pertaining to the population , study design , phenomena of interest measurement tool , and context were summarized. For quantitative studies, data extracted included descriptive data or inferential statistics. For intervention studies, only pre-intervention data were extracted. For qualitative studies, information included results of the studies verbatim, including themes and subthemes with corresponding quotations from participants.