Allied Health Professionals Q&A
Day 4 “Ask a Physiotherapist” by @lynnflannigan1
Hello & Welcome
Physiotherapy helps restore movement and function when someone is affected by injury, illness or disability. Physiotherapists help people affected by injury, illness or disability through movement and exercise, manual therapy, education and advice (CSP 2015). Physiotherapists are specialists in enablement and rehabilitation who can support people with dementia to remain as active and independent as possible.
Physiotherapy can have a significant positive impact on some of the difficulties that people with dementia can have with their walking, balance and muscle strength. See below for what the new Alzheimer Scotland Allied Health Professionals leaflet has to say about physiotherapy.
We asked people with dementia and their carers what questions they would like to ask a physiotherapist and this is what they asked;
Can you offer any hints and tips about keeping the person with dementia mobile? Carer
There is an old saying most of us will be familiar with – “if you don’t use it you lose it”. We know that people with dementia are less active than those without dementia. Mobility problems in people with dementia may be caused as much by a lack of activity as by the dementia itself, therefore it is important to try to keep as active as possible. It is important that the person with dementia tries to keep doing the things they enjoy, especially if they involve physical activity and exercise. The main thing is not to sit for long periods of time as this can cause the muscles to waste and the joints to get stiff.
Sometimes a person with dementia will lose their confidence to do activities they used to enjoy. Their health or social care professional should be able to offer advice about this. Alzheimer Scotland also has a guide for carers around Activities – the link can be found at the bottom of the page.
If a person with dementia is having difficulty with their mobility then a physiotherapist can offer them some advice and may provide some exercises to help.
How can you best help someone out of their bad or chair without hurting them? Carer
Unfortunately, it is possible to hurt someone when you are assisting them out of a chair or bed. It is also possible that the carer can be injured when doing this. The main piece of advice would be never to pull someone up by the arms as this can cause serious damage to the shoulder joint. The most common mistake people make is to rush the person with dementia or not to explain what you want them to do well enough. Always explain what you want the person to do, without giving too much information at the one time. It sometimes really helps the person if you show them visually first what you want them to do. Try to encourage the person to do as much for themselves as they can – only provide physical assistance if you have to. Sometimes moving and handling equipment will be recommended if the person with dementia cannot be assisted by another person safely.
If you are unsure about how to best encourage someone to be as independent as possible or to assist them where required, a physiotherapist can offer you advice.
How do I prevent my mum from falling? Katy, carer
Falls aren’t an inevitable part of living with dementia, however, some of the symptoms can make people with dementia more at risk of falls. People with dementia can also have the same health conditions that increase the risk of falls as people who don’t have dementia. There are lots of different factors that can put a person with dementia at risk of falls. Of course we can all have a slip or a trip, however, there are some factors which will increase the risk of having a fall. These include; problems with mobility, reduced strength or balance, medication side effects, continence problems, problems with feet/footwear, poor nutrition/hydration, a history of previous falls, vision problems, hearing problems, dizziness/fainting, how you interact with the environment and confusion/dementia.
It is important that your Mum’s own individual risk factors for falls are identified so that where possible they can be reduced/managed. This is usually done by a health or social care professional such as a physiotherapist using a multifactorial risk assessment, which is a risk assessment which looks at the most common factors which can cause falls . A personalised action plan should then be completed. Physiotherapists are commonly involved with providing exercises which increase strength and balance and therefore reduce the risk of falls.
General advice about how to reduce falls can be found in the NHS Scotland Up and About booklets which can be found at the link in the references section. NHS Inform also have a falls prevention webpage with a section on dementia and falls which can also be found in the references section.
My mum (Mrs T) walks with a stick and is waiting for a replacement knee operation. She’s always been independent and likes to do her own shopping, but recently fell outside her local supermarket when carrying her shopping and is now too frightened of falling to go out. I think my mum is getting very depressed and I was wandering what aids (other than her stick) might be there to help mum keep her balance outside.
As her daughter has seen a fear of falling is a serious consequence of falls which can lead to low mood, a loss of confidence and a resulting restriction in activities. Restricting activities can then lead to a vicious cycle of further loss of confidence and physical deterioration which can further increase risk of falls
As a physiotherapist I would firstly want to assess why Mrs T is falling to see if I can offer any advice, provide an exercise plan or signpost her to other services to reduce her risk of falls. If her stick is no longer providing Mrs T will enough support and Mrs T was unsafe then I would consider providing her with a delta rollator which is a 3 wheeled rollator. As a physiotherapist I would always rather provide rehabilitation to avoid providing walking aids wherever possible, however, the right walking aid can increase mobility and confidence for some people.
Alzheimer Scotland Activities: A Guide for Carers of People with Dementia http://www.alzscot.org/assets/0000/0266/activities.pdf
NHS Inform Falls Prevention Page http://www.nhsinform.co.uk/falls/about/
NHS Scotland: Up and About Taking Positive steps to avoid trips and falls http://www.healthscotland.com/uploads/documents/23464-UpAndAbout.pdf
Up and About in Care Homes Deputy Project Lead
I am a physiotherapist with a special interest in dementia. I am currently seconded to the Scottish Government as part of the Up and About in Care Homes Falls Prevention Project.
Tomorrows Blog with be by Joy and “Ask a Speech and Language Therapist ” Q & A.