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Physiotherapy in Dementia: Psychophysiotherapy
Physiotherapy in Dementia: Psychophysiotherapy
Physiotherapy in Dementia: Psychophysiotherapy
1 APRIL 2012
Psychophysiotherapy
Physiotherapy In Dementia
Jaswinder Kaur, Shweta Sharma, Jyoti Mittal
Department of Physiotherapy, Dr. RML PGIMER & Hospital, New Delhi - 110001
The word Dementia comes from the Latin de 4. Primary Dementia: That does not result
meaning “without”and mens meaning “mind”. from any other disease e.g. Alzheimer’s
Dementia is a significant loss of intellectual abilities disease, vascular dementia, lewy body
such as memory capacity, severe enough to interfere dementia, HIV associated dementia.
with social or occupational functioning. It affects 5. Secondary Dementia: That occur as a
memory, language, perception, behaviour and result of a physical disease or injury e.g.
cognitive skills such as judgement and abstract progressive supranuclear palsy, Multiple
thinking. Dementia usually first appears as Sclerosis, ALS (Amyotrophic Lateral
forgetfulness. But as the dementia progresses and Sclerosis) Dementia.
becomes worse, symptoms are more obvious and
Diagnostic Criteria
interfere with the ability of individuals to take care
of themselves and ADL’s (Activities of Daily According to DSM-IV, diagnostic criteria for
Living). Depression affects 20–30% of people who Dementia3 is:
have dementia, and about 20% have anxiety1. 1. Memory impairment: impaired ability to
A recent survey done by Harvard University learn new information or to recall old
School of Public Health and the Alzheimer’s Europe information.
consortium revealed that the second leading health 2. One or more of the following:
concern (after cancer) among adults is Dementia2. • aphasia (language disturbance);
Prevalance of dementia increases with age over the • apraxia (impaired ability to carry out
age of 65, its prevelance is 5-10% and at 85 it is motor activities despite intact motor
25-50%. Most types of dementia are non-reversible function);
which means the change in the brain that are causing • agnosia (failure to recognize or identify
the dementia can’t be stopped or turned back. objects despite intact sensory
Alzeheimer’s disease is the most common type of function);
dementia. • disturbance in executive functioning-
impaired ability to plan, organize,
Types of Dementia sequence, abstract
1. Cortical Dementia: Where the brain 3. The cognitive deficits result in functional
damage primarily affects the brain’s cortex impairment (social/occupational).
or outer layer. It tends to cause problems 4. The cognitive deficits do not occur
with memory, language, thinking and social exclusively solely during a delirium.
behaviour. 5. Not due to other medical or psychiatric
2. Sub cortical Dementia: Part of the brain conditions.
below the cortex is affected. It tends to Interventions In Dementia
cause changes in emotions and movement
in addition to problems with memory. This includes following:
3. Progressive Dementia: It gets worse 1. Physiotherapy: It helps in improving
overtime, gradually interfering with more physical function (mobility, balance,
and more cognitive abilities. coordination and strength), in treating
difficulties associated with ageing such as
200 Delhi Psychiatry Journal 2012; 15:(1) © Delhi Psychiatric Society
APRIL 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.1
patient weak elongated extensor muscles instructed heel-toe standing, partial wall
while ranging the shortened tight flexors squats and chair rises, single limb stance
muscles. with side kicks or back kicks and marching
• ROM exercise should be also emphasize in place, all while maintaining light touch
restoring range in the neck and trunk and down support of the hands.
can be performed in combination with 3. Strength Training: It helps in building
rotational exercises to promote relaxation. lean muscle mass, increasing metabolism,
II. PNF (Proprioceptive Neuromuscular controlling blood sugar levels. Ideally 10-15
Facilitation) Pattern: Muscle inhibition techni- repetitions of 8-10 exercises should be performed
ques Hold Relax or Contract Relax. Contract Relax thrice a week. Resistance may be applied with
is the preferred technique because it combines therabands, light weight dumbells etc.
autogenic inhibition from isometric contraction of 4. Gait Training: Gait re-education helps
the tight agonist muscles with active rotation of the in improving mobility and functional ability without
limb. support.
III. Traditional Stretching Techniques : • The major goals are to lengthen stride,
• Gentle stretching of elbow flexors, hip, broaden BOS (Base of Support), improve
knee flexors and ankle plantar flexors. stepping, improve heel–toe gait pattern,
• Stretching can be combined with joint increase contralateral movement and arm
mobilisation techniques to reduce tightness swing and provide a programme of regular
of the joint’s capsule or of ligaments around walking.
a joint. • Weight transfer; standing on single limb.
• Autostretching or Self-stretching. • High stepping to strengthen the flexors.
• Maintain the stretch force atleast 15 – 30 • Side stepping or crossed stepping with or
seconds. Ideally the stretches are repeated without support.
atleast 3-5 times. • PNF activity of braiding, which combines
• Ballistic stretches (high intensity bounding side to side stepping with alternate crossed
stretches) and aggressive stretch should be stepping to improve the lower trunk
avoided. rotation with stepping movement.
2. Balance Training: It is important in • Normal heel-toe progression.
patients with dementia to improve confidence and • To overcome shuffling pattern, draw foot
reduce the risk of falling. As balance is position marks or parallel lines with red or yellow
specific so both standing and sitting balance colours; then ask the patient to walk on it.
exercises are encouraged. Right movement and • The patient should practice stopping,
frequency of exercises are suggested by trained starting, changing direction.
physical therapist. They help the patient in • Auditory cues can be effective in improving
improving general body coordination and provide gait. Turning of 180 degree should be
better sense of surrounding space and environment. practiced first then 360 degree.
• The balance training always begin from 5. Aerobic Exercises: aerobic training helps
lower COG (Centre of Gravity) to higher in improving cardiovascular health, strength the
COG. hormones immune system. As physical activity
• Training should begin with weight shifts decr eased beta-amyloid proteins leading to
in both sitting and standing in order to help decreased amyloid plaque. Neural disruption, hence
the patient develop an appreciation of his improving brain health. Aerobic exercise includes
limits of stability. jogging, cycling, swimming or any physical activity
• By giving the slight push to patient and that rejuvenate the patients pulmonary and cardiac
patient tries to maintain the balance. capacity. For maximum benefits 30 minutes session
• Reaching activities. thrice a week is advised. Patients can start with 10
• Activities on Swiss ball. -20 minutes sessions depending on fitness levels
• Kitchen sink exercises: The patient can be and can progress accordingly. Alternative exercise
202 Delhi Psychiatry Journal 2012; 15:(1) © Delhi Psychiatric Society
APRIL 2012 DELHI PSYCHIATRY JOURNAL Vol. 15 No.1
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Conclusions
How do they compar e with researchers
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