Alzheimer’s Disease and Physical Therapy

Ryan LaCorte Elise Pavlick, Publications

What is Alzheimer’s Disease?

Alzheimer’s disease is the most common form of dementia, affecting one in eight Americans over the age of 65. Dementia is a general term for a variety of conditions that develop as a result of malfunctioning nerve cells in the brain. Research has shown that individuals with Alzheimer’s disease tend to develop abnormal structures in the brain, called plaques and tangles, that block communication between nerve cells in the brain and body. Plaques build up in the spaces in between nerve cells, and consist of a protein called beta-amyloid. Tangles are described as a collection of twisted fibers made from a different protein, called tau, that develop inside nerve cells rather than in between them. Because the nerve cells are unable to work properly, individuals can experience a variety of cognitive, behavioral, and physical symptoms. Alzheimer’s disease is progressive, meaning that is worsens over time, and although there is currently no cure for Alzheimer’s disease, medication and physical activity can be helpful in slowing its progression.

What are the signs and symptoms?

The most common symptom of early-stage Alzheimer’s disease is difficulty remembering newly learned information. As we age, it is common to experience occasional memory loss or slowed thinking; however, serious memory difficulties and confusion are signs that the brain is not working exactly as it should.

As the disease progresses, individuals tend to experience mood and behavior changes, increased confusion about time and place, disorientation, and difficulty responding to the demands in their environment. Physical symptoms accompany cognitive changes, particularly muscle disuse, difficulty walking, negotiating turns and obstacles, and loss of balance.

How can physical therapy help?

The physical symptoms mentioned above ultimately increase an individual’s risk of falling, which can possibly lead to serious injury. Research has shown the importance of physical activity for overall well-being. During a physical therapy evaluation, a licensed physical therapist evaluates various components of the body in order to determine impairments that may be contributing to a patient’s symptoms. From there, an individualized exercise program is created to meet the specific needs of each patient. A supervised exercise program, with the goal of increasing muscle strength and improving balance, will ultimately lead to improved safety awareness and decrease a patient’s fall risk. The following are important aspects that are addressed in each exercise program, as deemed appropriate by a physical therapist:

Strength and Flexibility

As Alzheimer’s disease progresses, individuals tend to become more sedentary, which leads to muscles becoming weak and tight. This is predominantly true for the muscles of the hips and legs. The lower extremity muscles are very important for standing and walking, so as they become weak, it becomes particularly difficult to perform daily tasks and ambulate, or walk around. Physical therapy can help break this cycle by developing a safe strengthening and flexibility program to improve muscle performance. As an individual’s strength starts to improve, exercises may be altered or advanced to further maximize strength gains.

Gait Training

In addition to developing an exercise program, a physical therapist will evaluate and determine the most appropriate assistive device for each patient in order to provide safe ambulation. The most common assistive devices are rolling walkers, single point canes, and quad canes. The physical therapist will educate and train the patient on how to correctly use his/her assistive device during ambulation. If unsafe ambulation is identified during the initial evaluation, subsequent treatment sessions will consist of gait training, in order to maximize safety awareness. As quality of gait improves, the patient will be challenged to negotiate obstacles and ambulate on various surfaces, in order to simulate real life situations. Continued practice will eventually lead to improved safety awareness during community ambulation and while performing daily tasks.

Balance

Along with safe ambulation, balance is by far one of the most important aspects of minimizing an individual’s fall risk. Balance can be divided into two components: static and dynamic. Static balance refers to an individual’s ability to maintain balance while in a still position, whether that be while seated or standing. Dynamic balance refers to maintaining balance while moving. Both static and dynamic balance are addressed during physical therapy by simulating tasks that individual’s experience in their daily lives. These tasks include reaching, stepping onto and off of various pliable surfaces, and negotiating obstacles while walking. This is a great opportunity to not only challenge balance, but also memory, as the patient will need to follow directions and remember multi-step commands. By challenging balance in various ways, the body is better able to adapt and learn how to respond safely and appropriately during real life situations.

What happens after you finish physical therapy?

All of the factors addressed during physical therapy work together to improve overall function and safety. Once an individual has achieved his/her goals and is ready to be discharged, the physical therapist will provide the patient with a home exercise program so that the gains made during physical therapy can be maintained. Physical therapy can provide the tools for success, however it is up to the individual to use the information he/she has learned to continue to maximize safety and functional mobility!

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