Managing rehabilitation challenges of patients with dementia. Tom Holmes, OTR, MA The University of Texas Health Sciences Center April 2008. DSM IV-R Definition. Dementia: memory impairment + (aphasia, apraxia, agnosia or disturbance in executive functioning)
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Tom Holmes, OTR, MA
The University of Texas Health Sciences Center
Dementia: memory impairment + (aphasia, apraxia, agnosia or disturbance in executive functioning)
+ impairment in occupation or social function
+ decline from previous level
2nd most common form of dementia1
Deficits in attention, frontal-subcortical skills, visuospatial ability.
Core features (need 2)
Recurrent visual hallucinations
Spontaneous motor features of parkinsonism.Lewy Body dementia
3 Clinical variants
disordered social conduct
deficits in understanding word meaning.
Nonfluent progressive aphasic
Expressive aphasia deficits.
Stuttering, agraphia, alexia.Frontotemporal dementia3
A patient’s response to: “Make a slice of toast and put some butter and jam on it”
generalized white matter atrophy.
multiple lacunar infarcts in white matter,
pons and basal ganglia.
lateral ventricular enlargement.
Therapy and Dementia
Is the patient distracted by basic urges (hunger, thirst, need to use bathroom)?
Refusing to participate in therapy.
Drifting off task
Not sustaining a behavior (i.e. Does not continue pedaling restorator)
Goal: Stop the current behavior from occurring and re-direct patient to another stream of behavior.
Hypothesize why person is doing what they are doing.
Give the person something new to do.
Engage person in a meaningful activityRe-Direction
Functional-task re-direct patient to another stream of behavior.exercise8
Components: Vertical, horizontal, carrying, lying-sitting-standing transitions
ADLs in a simulated environment.
ADL’s in patient’s environment.Therapeutic Activities (97530)
used with permission of Dr. Linda Teri
ORIF re-direct patient to another stream of behavior.
If cannot follow, mobilize without restrictions5
Limit mobility to transfers only for 1 month
Automated feedback on weight bearing.
Knee immobilizer to prevent standing
Use weight bearing assist device
Hip Precautions- replacements
Spaced Retrieval memory training
Memory notebook or cuesDealing with precautions