Dementia
Dementia is a progressive neurocognitive disorder that affects people differently. Memory, language, visual perception, and other mental functions are affected first. Some people may be unable to control their emotions, which may result in personality changes. Later on, balance, gait, strength, and other physical functions decline rapidly.
Since dementia affects each person differently, PTs and PTAs need to be creative. Some may develop fears of falling and refuse to move, while others will not stop. Many don't understand what is happening to them and may be scared, so having some familiarity can help calm them down. PTs and PTAs have found that talking with the patient and family members, finding out what makes them happy and integrating this information into treatment has helped. This may include things such as playing an instrument, looking at pictures, or spending time with pets. Speaking slowly and clearly is another strategy to use, as it takes people with dementia longer to process information than people who don't. Finally, you can't be sure how this patient will react to you, but having a positive attitude and wearing a smile makes you seem less threatening. Integrating these strategies into treatment sessions can lead to better outcomes.
The following article was written by a PT who describes her clinical experience working with patients with dementia. Here is also a link to more information about dementia.
Integrative Cognitive Stimulation Therapy (ICST) is a program available to those that have mild to moderate dementia. Sessions consist of mentally stimulating activities such as singing or playing a game. Members also discuss topics ranging from favorite childhood memories to current events. Here is a video with more information.
Fibromyalgia
Fibromyalgia is a chronic pain disorder that can result from genetics, chronic stress, or secondary to another pathology. It affects people of all ages but is most commonly diagnosed in middle and older women. The main symptom is bilateral pain at different points on the body. Other symptoms include chronic fatigue, sleep trouble, anxiety, and depression. Older adults often have comorbidities, such as high blood pressure or osteoarthritis, which can make symptoms worse.
Physical therapy interventions include both passive and active treatments. Passive treatments include deep tissue massage, heat therapy, hydrotherapy, TENS, and ultrasound. Active treatments include light aerobic exercise and gentle stretching. All of these helps increase blood flow to affected areas. Aerobic exercise, such as Tai Chi and Qi Gong, has been shown to be more effective in reducing symptoms long term. In addition to improved circulation, these also promote strength, flexibility, and help reduce fatigue. Here is a weblink to a basic Qi Gong session.
Video: https://www.youtube.com/watch?v=g-jSBBwr8Ko
As with many chronic conditions, a large part of treatment should involve teaching the patient self-management strategies. Eating the right foods, exercising regularly, stress management techniques, can all help decrease symptoms. It is important for the patient to identify the triggers and find a way to eliminate them.
The symptoms of fibromyalgia may leave a person wanting
to be alone, leading to social isolation and depression. This is a self- perpetuating
cycle, with social isolation feeding depression and vice versa. In the older population,
this can be debilitating, especially since close friends and family may no longer
be alive, and they may feel like they have nobody else to talk to. Encouraging patients to read, paint, or do some
other activity that they enjoy is one way the PTA can help. PTAs can also recommend
seeing a mental health specialist for coping strategies. Most importantly, it's
important for the patient not to feel alone even though they may want to be. My
Fibroteam is one of many online support groups available in which members
can connect with others their age and share stories. This website also has articles
that give tips on managing the condition.