Monica Leach, PT, DPT, GCS is a Board-Certified Clinical Specialist in Geriatric Physical Therapy at the Department of Rehabilitation & Sports Therapy at Cleveland Clinic. She shared with us how physical therapy can help people with Alzheimer’s and other dementias.
Read the Q&A with Dr. Leach below.
WAM: Most people think of physical therapy as rehab for a physical injury. You speak of it as being larger—as actual preventive medicine—can you explain?
Dr. Leach: We know from recent evidence that one of the risk factors for developing Alzheimer’s is low physical activity. A pillar of physical therapy practice is to provide education to patients to promote a sense of ongoing physical activity, wellness, independence, and increased self-efficacy throughout their lifespan. This is done typically through their home exercise program that we provide to patients based on their specific needs. We provide patients with the education and importance of ongoing physical activity throughout the lifetime, promote and provide resources for ongoing exercise and wellness through community groups, and therefore we can potentially change the trajectory of a potential cognitive disease process.
WAM: When we talk about Alzheimer’s disease and other dementias, we tend to focus on cognitive changes taking place, but are there physical symptoms of dementia and what are the most common ones?
Dr. Leach: Yes, a slow walking pace, or what we call “variability”, in someone’s walking can be some of the earliest indicators of a possible cognitive dysfunction. Variability in gait means the individual may have differing step lengths, heights, or strides from one step to another as they’re walking compared to a more typical walking pattern that is fluid and symmetrical.
WAM: Is maintaining a sense of balance important not just for physical, but also neurological health?
Dr. Leach: Absolutely – maintaining balance can have a huge impact on physical and neurologic health by reducing risk of injury, falls, and keeping someone as functionally independent as possible.
WAM: How can physical therapy help someone with dementia maintain their independence?
Dr. Leach: Physical therapy can help someone with dementia by specifically targeting and curating interventions that help them practice functional and meaningful tasks, such as having someone practice balance while doing something that is familiar to them like folding towels, sorting, playing cards, etc. We can also assist in helping patients practice doing two things at once (multi-tasking) to challenge both physical and cognitive function. In addition, physical therapy can involve caregivers to help promote function and independence at home, along with teaching caregivers safe techniques for keeping their loved one with dementia safe and reducing risk of falls.
WAM: People with dementia may have trouble expressing when they’re in pain. How can a physical therapist help both patients and caregivers manage this challenge?
Dr. Leach: This can be challenging but luckily, there is a specific scale that therapists can use to help accurately assess pain levels in patients with cognitive impairments. It’s called the Pain Assessment in Advanced Dementia Scale (PAINAD). It assesses breathing, negative vocalization, facial expression, body language, and consolability on a scale of 0-2 for each item, with a higher score indicating more severe pain. I like this tool because it covers behaviors that individuals may show when uncomfortable or in pain, and can provide guidance for what clinicians and caregivers should be on the lookout for when treating someone with dementia who may be experiencing pain. Another resource could be asking the patient’s caregiver if there have been any notable changes in behavior at home to provide further insight if you believe the person may be experiencing pain.
WAM: How might physical therapy help someone emotionally, cognitively, or even socially?
Dr. Leach: Physical therapy can help someone cognitively through performing the correct amount of physical exercise, specifically aerobic exercise, tailored to what is meaningful to the patient to either prevent cognitive decline OR slow down the cognitive decline already in place. Physical therapy can help someone emotionally and socially by providing individuals with a sense of empowerment, self-efficacy, and autonomy in their care by showing them and their caregivers different tools to promote independence, overall wellness, and a full quality of life.