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Life of a PTA

The Challenge of Dementia

Published March 21, 2014 9:11 AM by Allison Young

In the skilled nursing setting, many of the patients on my schedule have a dementia diagnosis. Whether displaying mild signs such as repeating a story or severe moaning and perseverating over mundane details, I try to keep the treatment focused on their functional goals. When it comes to touching dementia patients, whether during a transfer or giving tactile cues, I enter their personal space with caution.

After years of lifting, scooting and facilitating patients and their movements, I don't hesitate to touch my patients when teaching or in greeting. The patient's with memory impairments, however, can be impulsive and particular. Recently, I had one patient (with mild dementia) snap, "Don't touch me!" after I tried to lightly stoke her back to soothe low-back pain she was experiencing. Later on that day, as I was leaning forward to offer a moderate assist for a sit-to-stand in the parallel bars, the patient asked if he could kiss me. This is the same patient who tried to take a swing at a CNA and me when we tried to get him out of bed that morning.

Whether a confused patient becomes combative or "too friendly," my therapeutic tactic is to re-direct. At times redirection can only happen in a quiet, calm environment. And even then, redirection and focusing on the task can be futile. Although frustrating at times, I remind myself that this patient's therapy is just as important as the next patient's knee-replacement rehab as we are working on maintaining strength, function and safety during transfers.

It's also important to keep in perspective that these people have lived full lives, including marriage, raising children, having careers and surviving wars. I happen to be one of the last people they'll meet in their lives who is there to help ease their pain. Although aspects of their brain are now dying, they deserve the same respect as any other patient. It just can be a more delicate therapy session.

Do you have patients (with dementia or not) who are "more challenging" than others and if so, do you have any strategies that can assist other therapists (like myself) in helping these patients progress?

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Webinar: Communication Approaches for People with Dementia

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Allison, I love the point that you made that these patients with dementia are people that have lived full lives, including marriage, raising children, having careers and surviving wars.  I also try to keep this in mind every time I work with one of these patients.  I must explain that I am a student at ECU and about to graduate in May of this year, but have spent a lot of my clinical education time in SNF, which is the setting in which I want to work. I think that adding humor has helped me most in working with this patient population.  I have had patients with dementia go from not motivated or not willing to work with me at all to a full session of therapeutic activity by way of a single joke or humorous topic.  For instance, I had one lady who had refused several PTA's and OT's during my last 10 week clinical, and I was the last person to go in and "give it a try" to work with her.  Upon several refusals for PT and consistent efforts to do something active, I sat quietly as the patient did and we both stared at one another.  Her latest reason as to why she couldn't come to the therapy gym was due to all of the pollen (inside?).  Therefore, I simply asked her if she wanted to hear a joke.  I proceeded to ask her, "How do you make a tissue dance?" to which I told her "you put a little boogie in it."  She cracked a smile and was willing to work with me after that.  I'm sure that this would not work for everyone, but when all else fails, I try to incorporate a "boogie" joke to help boost a treatment session.

Colt, Sudent PT March 28, 2014 1:30 PM
Greenville NC

Adrienne, that's a great idea- I'm going to give it a try. I often find that patients will recall their childhood (parents/ siblings/state they grew up in) vs their husband/children/adult memories. Thanks for feedback!

Allison March 23, 2014 12:39 PM

Patience is my key when working with patients who demonstrate dementia. I learned to use redirection by asking about their "first". First car, first time on a roller coaster, first job that sort of thing often engages them with me enough that I can move forward with treatment. Though this approach can back fire if the patient continues to re-tell a lengthy story.

Adrienne , SNF - PTA March 22, 2014 5:26 PM
Asheville NC

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