At the request of her family, an 85-year-old female was evaluated for short-term memory loss by a neurologist. She recently had been found wandering in her neighborhood, looking for her way home. Her daughter described that her mother has had difficulty with cognitive function since the death of her husband 2 years earlier and that the family attributed the difficulty to grieving and depression. Her daughter also reported that her mother had fallen a number of times in the last 3 months and appeared more fatigued with activities. On cognitive examination, the patient was not oriented to date or month, but she could identify the day of the week and the season. She was able to name the state, county, and city, but not the clinic where she was being evaluated. She could recall three words immediately after they were spoken to her, but could not recall any after 5 minutes of distraction. She correctly spelled the first three letters of “world” backward. She could name a watch, a pen, and a sweater, but could not name a button, sleeve, or cuff. She correctly drew a clock, but could not set the hands to 9:15. The general neurologic examination was unrevealing, except for diminished light touch and vibration in the distal lower extremities and mildly unsteady gait. The patient was referred for physical therapy evaluation and treatment.
What are possible complications interfering with physical therapy?
What are the most appropriate outcome measures for cognitive dysfunction?
What is her rehabilitation prognosis?
What are the examination priorities?
Based on her health condition, what do you anticipate will be the contributors to activity limitations?
- ANOMIA: Inability to name objects
- APRAXIA: Inability to execute or carry out learned purposeful movements, despite having the physical ability to perform the movements
- CIRCUMLOCUTION: Roundabout or indirect way of speaking; the use of more words than necessary to express an idea
- DEMENTIA: Decline in intellectual function severe enough to interfere with a person's relationships and ability to carry out daily activities
- SUNDOWNING: State of confusion at the end of the day and into the night
Describe Alzheimer's disease.
Identify key stages and changes in function with progression of Alzheimer's disease.
Identify reliable and valid outcome tools to measure cognitive decline.
Discuss appropriate components of the physical therapy examination for the individual with Alzheimer's disease.
PT considerations during management of the individual with dementia, history of falls, general motor and balance difficulties, and decreased endurance due to Alzheimer's disease:
- General physical therapy plan of care/goals: Assess cognition as well as noncognitive function including changes in affect, personality, and behavior; increase (or at least minimize declines in) strength, range of motion, and balance; promote functional movement; decrease fall risk
- Physical therapy interventions:...