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It’s More Important Than Ever for Your Residents with Dementia to Benefit from Therapy

Published On 7.2.20

By Irene Blumenthal, PT, MHA

Director of Senior Living Partnerships

The COVID-19 pandemic has hit the senior living industry like a Mack truck. And the most vulnerable population was affected the most: residents with dementia and those living in specialized dementia neighborhoods.

Why? Residents with dementia are linked to an increase in transmission of the virus and are at higher risk due to a gene variant that puts people at a greater risk of developing Alzheimer’s disease and is also linked to COVID-19. This, along with a multitude of other factors, including the inability to socially distance, forced isolation and immobility, challenges with hand hygiene and disinfection practices, and the disruption of normal routines. Combine these factors with it is no surprise to see residents who have been significantly weakened over this time.

Picture this: Sarah is a resident living in the dementia care neighborhood of an assisted living facility. She is mobile and normally walks the halls all day. Typically, she ventures outside into the garden, sits on the bench, comes back inside, and participates in group recreational activities. What are all the mobility tasks she just practiced? Gait on both even and uneven surfaces, transfers and lower extremity strengthening getting in and out of chairs, upper body strengthening and coordination opening and closing the doors, and fine motor skills and language participating in the social events.

Now the assisted living community must have COVID-19 restrictions in place. Sarah must remain in her room, eat meals in her room, talks to others very little because all community social activities are canceled, and cannot have any visitors take her out to the gardens. Over the next three months, Sarah’s muscles begin to atrophy, her mobility declines, she has trouble walking, she needs more help with ADLs, and her language skills regress.

Sarah needs strengthening now more than ever. But can dementia residents benefit from rehab and show improvement? YES!

The Connection Between Dementia and Muscle Mass

You may know that dementia and associated Alzheimer’s disease is a disease in which the mass of the brain deteriorates, thus causing all the telltale signs you see in your residents every day. But did you know that muscle mass, or strength, also plays a role? It turns out that the loss of brain tissue is correlated with the loss of muscle mass.

“We observed a direct correlation between whole-brain volume — an estimate of brain atrophy — and lean mass, suggesting that brain atrophy and loss of muscle mass may co-occur”

The more muscles are repetitively exercised, or given the proper load and strain, the more the muscle tissue responds and increases. A person with dementia has muscle that responds the same as a person who does not have dementia. Thus both will over time and the proper dosage and resistance to exercise, demonstrate the same physiological response.

So why are so few residents who have dementia receiving rehab services? The thought still persists that if a person can’t remember instructions or follow a home exercise program, they can’t improve their abilities. But this is simply not the case. If given a chance, muscles can strengthen, gait speed and quality can improve, and self-care abilities can be preserved. All it takes is a change in thought and strategy to incorporate meaningful and repetitive functional tasks rather than prescriptive exercises.

This work uses the theory of repetitive task training and errorless skill learning.

How Exactly can Someone with Dementia Improve with Therapy?

The typical therapy interventions we are used to seeing — most notably resistance exercises — are confusing and frustrating for many people with dementia, especially when the disease is in its later stages. That is where repetitive task training (RTT) or errorless skill learning (EL) comes in. The principles of EL are used as a method for individuals with memory impairment. They involve any intervention aimed at reducing the number of errors throughout the various stages of learning. It combines a series of tasks where the task at hand is broken down into small steps, followed by immediate error correction and encouraging residents not to guess. All while the clinician is modeling the task steps with cues.

This is done over multiple sessions per week and for a 90-day plan of care. While that may seem like a long course of therapy, it is necessary to allow a person with dementia the time and repetition needed to learn these tasks (or steps) in order for them to achieve their goals. Standard therapies have typically involved training and letting the person “figure it out as they go.” However, EL has been proven to be more effective than traditional therapies for people with dementia — with gains that are made and can last even once therapy is complete.

How can I help my Residents with Dementia Right now?

The most important point to remember is that therapy gains or potential is possible, and their memory impairment should not be a limiting factor to their access to services. After several months of inactivity and less social stimulation, most residents, with or without memory impairment, will demonstrate significant declines.

Having a skilled physical or occupational therapist assess and prescribe an appropriate series of treatments is the first step. Another important step is reintroducing familiar routines over time, so that life can return to as normal as possible given the circumstances.

Residents with dementia are able to benefit from therapy interventions. They deserve the opportunity to make meaningful gains for both their physical and cognitive well-being.

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