Physiotherapy & Dementia: Working with people living with dementia in my final 4th Year Placement

As a physiotherapy student I have always been aware of the growing number of individuals I may come across with dementia, either as a patient or as a family member of the person I may be treating.

I recently finished my dissertation project which focussed on the impact of group based interventions on patients with dementia and therefore I found this placement extremely insightful.  This placement allowed me to work within the community and experience first-hand the services available.

New learning experiences and thoughts for consideration

Within my first week of placement I became a dementia friend.  This session provided me with a great baseline of knowledge and understanding before experiencing first hand work with individuals with dementia.  I now wear my dementia friend badge proudly and hope it encourages people to approach me to discuss dementia if they ever have any concerns.

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Through my time at Alzheimer’s Scotland I have learned the importance of the environment around the person with dementia and the impact this can have on their ability or willingness to participate in an activity.

Before this placement I was not aware of the concept of dementia friendly environments.  For example, having contrasting furniture, signs to aid independence in tasks/ getting around.  Moreover, I had never considered the impact that patterned carpets or colour of equipment I may use for example, metallic Zimmer frames may have on a person with dementia’s ability to perceive the task I am demonstrating.

The patterned carpets can often impact the persons perception and where I may have previously thought an individual had sensory, balance issues may in fact be due to the confusion from the carpet in the area.

Therefore, if I practice mobility with a person with dementia, I am now cautious of the external environment and the impacts this may have on their performance.

Language used and how to facilitate engagement

Having had the experience on this placement of being able to work with individuals with dementia I have now become aware of the language and instructions I use.

Using clear, functional cues proved beneficial in trying to demonstrate the exercise I wanted the person to engage in.

Initially finding the corrected phrases and instructions proved challenging.  However, I soon realised, that if I gave the task I wanted achieved, a sense of purpose that could be applied to the individual participating in the activity, then the individual found it much easier to follow as it ‘made sense’ to them and they could visualise what I wanted them to achieve.

Moreover, I learned that activities deemed as fun were more beneficial for the person.  The use of music (that was of importance/relevance to the individual) to facilitate engagement was extremely beneficial, as it provided a talking point and helped to shape the sessions, when a structured planned exercise programme had previously been unsuccessful and little engagement was shown.

In one case I had two treatment sessions with an individual, where we tried to implement a chair-based exercise programme.  However, this proved extremely challenging and the individual showed little participation and engagement.  However, on the third session we played music that the person enjoyed and managed to encourage activity through dance.  The individual even started to sing! But on previous visits had seemed quite agitated and frustrated by my presence.

I have learned now that this frustration may have been due to the fact that I was trying to facilitate a structured exercise routine and was giving instructions that may have been too difficult for the individual to follow.  By using music and dance, I was able to achieve the physical activity as part of my treatment process without causing the individual any frustration or distress.

Dementia Cafes and Shared Experiences

One of the most valuable experiences I will take away from this placement is the insight and knowledge I gained from attending the cafes.

The cafes provided a social aspect for carers and people with dementia to meet and share ideas.  Being able to attend these cafes and gain insight into how dementia affects everyone differently has been a great learning experience.

The cafes provided a great opportunity to gain current views from people with dementia and their carers about how they feel exercise and physiotherapy fits in with their life.

While at these cafes I used emotional touch point cards which helped to facilitate these conversations- everyone was asked to choose a word they would associate with physical activity.  A common theme that occurred across all cafes was that people often felt frustrated that they were no longer able to complete activities at the same level that they were previously used to.

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By using the word choice cards it allowed people to express their views without feeling pressure.  I then asked individuals to explain their choice of word.  From this discussion I was then able to structure an informal information session and present on current guidelines and opportunities for activity in their communities.

By holding these information events, it allowed me to help overcome barriers that many people perceived to exercise and allowed me to address pre-conceived ideas as to what ‘exercise’ and ‘physical activity’ incorporated.

For most of these sessions it was important that I emphasised that physical activity wasn’t just about going to a local gym- but was in fact about staying active around the home and community.  For example, short walks, changing position, gardening, hobbies, housework etc…

A large proportion of these sessions was focussed on changing the view and perception of the word ‘exercise’ and how as dementia progresses, the type of exercise and activity that an individual will gain from will also change.

Sign-posting to other local services

To validate my own knowledge and improve my holistic approach to care I also made it a key learning outcome that through-out my time on this placement I would learn about wider services available outwith those of physiotherapy.  So that if the need ever arose or a patient or family I was treating, was ever in difficulty or needing advice, I would be able to sign post them to local services that could provide support.

I composed a mind-map of the local services I found within the community that may be of benefit to my future patients at some point in their care:

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This mindmap demonstrates my ‘Community Toolkit’ that I have been able to develop through-out this placement and aim to continue to develop in my work as a qualified physiotherapist.

I feel this placement experience has made me reconsider my pre-conceived thoughts and views on dementia rehabilitation and the potential for people living with dementia and has encouraged me to develop a greater holistic care approach, in order for people living with dementia to receive the best level of care they can and gain the most from my treatments – I have to be adaptable and realise that people living with dementia will not fit a checklist treatment approach.

caitlin
Contributor
Caitlin Kennedy

4th year physiotherapy student at Glasgow Caledonian University

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