Webinar: Physiotherapy and Dementia
Dementia Australia webinars are free videos where subject experts discuss topics relating to dementia for a general audience.
In this webinar, Joanna-lee Tan, Gerontological Physiotherapist and National Chairperson of the Australian Physiotherapy Association Gerontology group, explains the role of physiotherapy in managing physical changes associated with dementia.
You will learn about:
- the physical impacts of dementia on the body
- how physiotherapy can help maintain or improve the physical health and wellbeing of a person living with dementia
- how to find a physiotherapist.
Transcript
[Beginning of recorded material]
[Title card: Dementia Australia]
[Title card: Physiotherapy and Dementia]
Dr Tan: Physiotherapy and dementia. This is a webinar for people living with dementia, and their family, carers, and support persons in Australia. Before we start, I would like to have an acknowledgement of country, and I wish to acknowledge the traditional owners of the land on which this webinar has been created. I would like to pay my respects to the Elders past, present, and emerging, and any Elders who may be here with us today.
My name is Joanna-lee Tan. You can call me Jo. And I'm a titled Gerontology Physio, which means I have a specialisation in working conditions related to ageing. And my role with the Australian Physiotherapy Association is the National Chairperson of the Gerontology Group. Our group has put together this webinar to help people who are living with dementia, and to help people understand what physiotherapy can help people with. This webinar will talk about the physical impacts of dementia on the body, the role of physiotherapy in helping people overcome some of these difficulties, and how to access physiotherapy.
The physical impacts of dementia are not always the most obvious part of the condition. A lot of people focus on memory changes, or difficulty speaking, or other issues like that, but sometimes, the physical aspects are also a part of the condition, and that's where physiotherapy comes in. So, some of the physical aspects are related to changes in the person's brain, and they can impact your physical function because the brain is responsible for controlling the body and how it moves.
One of the things you might notice is that the body is a bit slower to react to changes in surfaces, or if you need to move quickly. The brain is also responsible for controlling our muscles, so the way the brain connects to the body is through the nerves that come from the brain to the muscles, and the brain needs to tell those muscles what to do. So, if there's a difficulty in connecting to the muscles, they're not going to be getting as many information messages, which can make them feel a bit weaker. And this can also be a similar feeling in terms of how muscles and joints coordinate each other to move the body.
There's also some difficulty when you need to move your body but you're also having to do other things. We call that multitasking. A common thing might be if you are walking while carrying something, for example, a cup of tea, or if you are having to reach for something while stepping at the same time, stepping over objects, looking around to see what's coming your way. Those kind of combination movements can be a bit of a problem. And because of all of this, an aspect of both reaction times, strength and coordination, sometimes people living with dementia can have problems with their balance, and they may experience falls like everybody else.
I'll give you an example of how this can impact your physical function in terms of just a simple act of going for a walk. So, how do you think these dementia symptoms might affect your ability just to go for a walk? We all like to go for a walk. It's a very common form of exercise, but when we're out walking, there's things that can challenge us. As you can see here on the slide, there's some people riding their scooters coming along. They might be coming along while you are having a nice walk, and you don't notice them because you're concentrating on the pathway, and that could be a little bit unsettling. Also, when you're going for a walk, the surfaces are not always nice and smooth, so the picture on the right you can see is pretty challenging. There are some long steps going up a hill, so walking's not always a simple activity. However, physios like to work with people to help them overcome some of these challenges. We know that our brain health can be optimised. What that means is that certain activities can help promote our brain working more efficiently. One of them might be improving your cardiovascular fitness. That's exercises where you are getting more oxygen to your brain, like going for a faster bike ride, like an exercise bike, you get your heart rate up, and that actually improves your blood flow to your brain.
These muscles that might be a little bit harder to control can actually be strengthened by doing specific strength exercises. So, when a muscle is contracted, it forms new connections with the brain as the brain tells it what to do. And the more of these contractions, the muscle grows, making it stronger. Balance is also something that we can be improving all the time, because balance is always that combination of messages to the body and the body reacting. And certain balance exercises practised regularly can improve your balance. So having a good, fast working brain is optimised, getting lots of blood muscles that are strong, and balance mechanisms within your body optimised, all of those things can actually contribute to a person maintaining their strength, fitness, and independence.
Physios do quite a bit of research, particularly around falls and balance, but in many other fields. And what physios have been really interested in is doing a lot of research on the aspects of the physical changes related to dementia. And what we have been finding is that people who do regular strength exercises, which include resistance training and balance, will improve their balance, and that can actually reduce falls. We do know that if you have a fall, obviously, there's a chance that you might injure yourself. So, making sure that you do everything you can to reduce these falls is actually going to be a very good option.
Physios also work together on other aspects of keeping people away from being injured when they have fall. So, if you are concentrating on your environment, and you are learning about moving in your environment, that will actually help reduce your chance of falling as well. What we've found is by doing the regular exercise, you can also slow the decline in cognitive function. So, by keeping all these connections going and making the brain work harder, it actually keeps the brain working, and reduces some of the changes that might occur over time. All of these interventions can actually help people generally feel better, and maybe they're thinking about other aspects in their life like being able to remember things can improve as well.
Physiotherapy like to be involved in the full healthcare assessment of someone who has a diagnosis of dementia, so it doesn't always happen, but we're promoting that as part of this collaboration with Dementia Australia. We are part of your health team, so your health team you might think is your GP, maybe your specialist, a trusted nurse that you see, but we'd like you to think about including physiotherapy in your health team. We do work with other allied health professionals, so traditionally, you might think about a speech pathologist is an allied health, or an occupational therapist, podiatrist, we're all part of those additional health professionals that can really help to optimise someone's health and wellbeing.
We do an assessment as part of our normal process whenever we see anyone for any condition, and we'd like to think of our assessments as being holistic, taking the time to address physical issues, discuss any emotional or thinking issues, and when we are working about a program, we are going to work together with you. We are very famous for helping people with their pain. So, everyone has aches and pains, but obviously, physiotherapy is a profession specialised in pain management. Apart from thinking about issues related to strength and balance, we are there to help people who have pain. And also, sometimes, some pains we are not sure what they're all about, and that helps us to talk to you about different types of issues that you might be having, and that might help you organise your day so that we can actually work out what times a day you're getting pains or other issues, and try and build a program around that.
As I've said, physio can help. We've got exercise and mobility programs, specialised balance classes. You might find these in the community, in your local council, physios might be running classes there, they might be running them in your local community health program. Sometimes, in residential aged care, we run exercise and balance classes. So we're not just seeing people one-to-one, we also see people in groups. We like to help people be out and about safely, so we are pretty good people to talk to about using walking sticks or specialised walking frames just to help people who might have difficulty with their balance and they need a little bit of extra help.
When people have various conditions or if you've been in hospital, if you've had joint surgery, or you've had another problem that's led to needing some rehabilitation, physios are also part of that team, and you may encounter some physios if that happens. If you happen to feel like you need some rehabilitation because you've had some time off from being sick, for example, like a lot of people had Covid, and that actually resulted in them feeling a bit weaker, or breathing problems, physiotherapists have been really active in helping people recover from Covid, and the associated ailments related to that.
We talked about pain, but one of the main issues that people have that can cause pain is arthritis, and we like to help people manage arthritis by giving them special exercises and advice. We also sometimes provide massage or other therapeutic techniques to relieve pain related to arthritis. Also, making sure you're addressing any physical issues relating to your body can help improve your mood and you feel happier if you're not worried about aches and pains, or worried about falling over. And also, it might help you sleep better. So, we know that if you exercise regularly, you do actually usually sleep better.
I talked about walking aids. In this picture here, you can see this is one of my clients, he's using a larger style walking frame, and these kind of walking frames are really good for outside if you are in the yard, or if you are going out walking in the community. But there's other kinds of aids that are smaller, more compact. We have some smaller ones that are good for carrying things if you feel like you're a bit struggling with your balance while you're carrying something in the house, there's some types of frames to help with that. Some frames have chairs on them so if you get tired you can have a rest, and the most important thing with walking frames is to get them properly fitted, because if the handles are at the wrong height, it can really interfere with the way you use it, but it might give you some shoulder pain.
Now, the other thing, physios, you can see them in a clinic, you can see them in a hospital, but they can also come to you. So, if you are feeling like it's difficult to get out of the house, or you haven't got transport, physiotherapists can do home visits. And when we come to someone's home, it's really nice because we get to feel what's important to a person in their home. We can look at their environment, we can make suggestions about navigating around your house safely. We can work with occupational therapists to talk about if any specialised equipment or rails might need to be put in, just to improve the safety in your home.
Balance and falls, we talked about that. And this lady here is doing some specialised balance exercises, and it's never too early to start practising your balance. Some people might have previously done something like yoga or Tai chi, and those activities do improve your balance because part of the exercises usually include balance activities, and working on your balance can help reduce falls.
One of the things when we talk about exercise and fitness is to think about what things you like to do. A lot of times, people have particular sports or activities they've played throughout their life, and it's really those activities that we like people to think about continuing to do, because that's important for your quality of life. So, if you find that some of the symptoms relating to dementia are affecting your ability to interact with regular sports or activities, it could be that you might want to adapt some of those activities to make them still a part of your life. An example might be if you've liked playing golf, and you find walking around the golf course a little bit tiring because you're concentrating while you're playing, having someone or yourself use a buggy might be a way of making that round of golf a little bit easier, and you'll still get the enjoyment of the activity, but it might not be taking as much out of you.
Another example might be if you've played karate, done karate in your lifetime, but it's a little bit fast-paced for you, so stepping to something like Tai Chi, which might be a similar activity but a little bit slower pace, helps to keep your balance and strength, but it's probably a little bit slower, and a little bit easier to participate in. So, what we're talking about is modifying the way you do things, still doing them, but modifying them. And that can be a way of maintaining your connections with the activities you enjoy, especially if you are able to negotiate with those people that you're doing these activities with to help them understand how they can help you as well.
The other thing is getting involved with family and friends, so participating together when we do activities can actually help you feel a bit more confident when you're doing them, and you can enjoy them because you're having fun with your friends and family. I love this picture. Here's a couple that, it looks like they were washing up, and the music might have come on, and they said, “Let's have a dance.” And that's one way of just still being physically active, but you're not actually doing a specific activity. It's just popped into your day spontaneously. But certainly, music and dance are something most of us enjoy, and it can be an easy way to get your body moving. And when you're moving, you are releasing a lot of positive chemicals in your brain, and that can make you feel happier, and also has some aspects of an exercise, it gets your blood flowing, it gets your joints moving, you can feel more free, might even be working on your balance. So, just a simple thing like having a dance in your house is a way of getting moving and exercising.
Getting access to physiotherapy can be a little bit challenging, sometimes. So, we've put some website information on the Dementia Australia homepage there, but I'd like to explain a few ways you can get access to physio. In terms of people who see a specialist and they might be having some tests related to being diagnosed with dementia, some of these clinics exist where there's a multidisciplinary team, and a physio might be part of that team, and they might do some assessment of physical function, balance, coordination, strength, and then work with that team to come up with, perhaps, what we call a rehabilitation plan.
There are private physiotherapists. There's probably one on most street corners these days but private physiotherapists can be accessed without a GP referral. Now, if you have private health insurance, that can cover some of the costs towards going to see the private physio, and that can actually be a way of getting to see someone for a number of visits or ongoing care. Medicare is something that has an aspect for physiotherapy, but you need to speak to your doctor, and they do a plan so you can see a physio that way. Hospitals also have some option to see a physiotherapy through their outpatient, or there's some community systems through My Aged Care that allow access to physiotherapy. NDIS for younger people is another option, if you have a package that can include physiotherapy care, and also in a residential facility there's usually a physio there.
So, it's important to ask for physio for yourself and your carer. Everyone can have different reasons to see a physio, but sometimes, they don't get referred. If you're not sure, you can speak to your doctor, or if you're in hospital for something, you can ask the people in the hospital, you're in the residential care or you have an aged care package. The people who look after you can help you access physio. I love this photo, I reckon it's somewhere very mountainous, but they've put in lots of different roads to get through this pass in the valley. And I think that's a good reflection on what this process of navigating our way through life is like. There are many different paths you can take, but what we'd like to say as physios is we're here to help you navigate some of these paths, so I'd like to thank you for listening today, and I hope I've given you some ideas about what physiotherapy can do for people who are diagnosed with dementia. And if you'd like to access a physiotherapist, our Australian Physiotherapy Association has a website with some resources there at choosephysiotherapy.com. And if you want any more information, you can have a look on the Dementia Australia information page relating to this webinar. Thank you very much.
[Title card: Together we can reshape the impact of dementia]
[Title card: Dementia Australia. 1800 100 500. Dementia.org.au]
[END of recorded material]
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- Australian Physiotherapy Association: Choose physio for ageing well
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- Australian Physiotherapy Association: People living with dementia deserve timely access to physiotherapy
- Australia Physiotherapy Association: Dementia, cognitive impairment and exercise podcast
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The National Dementia Helpline
Free and confidential, the National Dementia Helpline, 1800 100 500, provides expert information, advice and support, 24 hours a day, seven days a week, 365 days a year. No issue too big, no question too small.