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Raising the Bar in Rehab

Dementia, Part Two

Published February 24, 2009 11:58 AM by Lisa Catenacci
After asking many of my coworkers, my CI, and other colleagues in the PT field, I've learned a lot this week about working with patients with dementia. Before I started looking into this subject, I wasn't frustrated with dementia patients, or anything like that. Most of my patients are pleasant and cooperative with PT. I just want to be as effective as I can be for them.  There is a big difference between A x O x 4 and A x O x zero. 

I had one patient with dementia who asked, "How do you get a police officer around here?  Is every room assigned a policeman, or do you call one when you need one?"  Rather than explain to this patient how irrelevant her question was, I simply responded, "We just call an officer when we need one."  I try to assure the patient, so they won't be as worried or concerned during our therapy sessions, or at all. 

Overall, the tips I learned were: To be very repetitive in therapy sessions.  This will give your patients more opportunities to remember what you are telling them.  Likewise, use short commands, such as "Sit Down" rather than, "Please reach for the armrest, then slowly lower yourself into the chair."

Falls and gait abnormalities are common in patients with dementia, so assessing these risks is another important factor in treating patients. 

If you have any other suggestions for working with patients with dementia, send them my way.  I anticipate I will have many other patients with this diagnosis!


Motor-movement memory might work better than the cognitive memory of orientation, so repetition is a good strategy.  However, understand accessing the "file" in a different setting is very problematic.  Minimize verbage, but seek eye contact.  Hand-holding/gentle rubbing with  friendly, simple and calm conversation can work wonders.  They usually respond more to tone of voice than actual directions-depending on level of impairment. Seek automatic motor responses-especially for initiation(like standing up).  Have a plan to use distraction w/ signs of frustration, agitation. Tie in to familiar functional activities whenever you can.  I successfully used a rolling pin for rehabing a shoulder fx.  when she would not cooperate with usual ex. program. Enjoy the moment(s) and meet them in their world.  

Beth, Geriatric Home Health - PT, multiple March 1, 2009 5:58 PM

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