How to get a dementia patient to walk again: A compassionate caregiver's guide

According to the National Institute on Aging, dementia often affects a person's physical abilities, including their gait, balance, and coordination. This can make it challenging to keep a loved one mobile and reduce the risk of falls. This guide provides caregivers with compassionate and effective strategies on how to get a dementia patient to walk again or regain mobility safely.

Quick Summary

This guide offers safe and compassionate strategies for helping a person with dementia regain mobility, covering physical and environmental adaptations. It details specific exercises, guidance on choosing appropriate mobility aids, motivational techniques, and managing behavioral challenges. Practical steps for home modifications and the importance of professional involvement are included.

Key Points

• Consult Professionals: Work with doctors, physical therapists, and occupational therapists to create a safe and tailored mobility plan.

• Start Gradually: Begin with small, manageable movements like seated exercises, progressing slowly to assisted walking to rebuild strength and confidence.

• Create a Routine: Establish a consistent schedule for physical activity and tie it to a purposeful activity to reduce confusion and increase motivation.

• Modify the Environment: Remove tripping hazards, improve lighting, and use visual cues to create a safe and navigable home space.

• Use Appropriate Aids: Choose the right mobility device based on a professional assessment and ensure the patient is trained to use it correctly for maximum safety.

• Employ Motivational Techniques: Use familiar music and positive reinforcement to encourage participation and make exercise a more enjoyable experience.

• Handle Resistance Calmly: If a patient resists, use simple, reassuring language and redirection instead of force, as resistance often stems from fear or confusion.

• Monitor for Causes of Discomfort: Be alert for signs of pain, fatigue, or illness, which can contribute to mobility decline and agitation.

Understanding the Causes of Mobility Decline

Mobility issues in dementia patients stem from a combination of physical and cognitive factors. A person may experience muscle weakness, poor balance, or shuffling due to motor control problems associated with the disease itself, a syndrome known as 'parkinsonism'. Additionally, conditions like apraxia can cause uncoordinated movements, while cognitive issues such as spatial disorientation can lead to unsafe walking. It is crucial to consult a doctor to rule out other treatable causes of pain or immobility, such as arthritis or muscle fatigue, before beginning any new program.

Partnering with Professionals

Before implementing a plan, collaborate with healthcare providers to create a safe and effective strategy. A physiotherapist can design an exercise program specifically tailored to the patient's abilities and needs. An occupational therapist can provide expert advice on home modifications and the most suitable mobility aids. Their guidance is essential for ensuring safety and maximizing potential.

Creating a Motivational Routine

Motivation is key when encouraging physical activity. Consistency helps create a sense of familiarity and reduces confusion.

• Incorporate routine: Schedule short, regular walking sessions for the same time each day. Tying the activity to a purpose, like walking to the dining room or to look out a favorite window, can be more effective than simply saying, "Let's go for a walk".
• Start small: Begin with very short distances, even just walking across a room or standing up from a chair. Gradually increase the distance as strength improves.
• Use music: Familiar music can stimulate movement and positively impact mood and engagement. Choose songs your loved one used to enjoy or dance to.
• Embrace positive reinforcement: Praise their effort, no matter how small the accomplishment. Encouragement builds confidence and makes the activity a more positive experience.

Implementing Safe and Effective Exercises

Physical activity programs for dementia patients should focus on improving strength, balance, and endurance. A multi-component approach often yields the best results.

Seated Exercises

For those with limited mobility, seated exercises are a safe and effective starting point:

• Leg extensions: While sitting, straighten one leg at a time, holding it parallel to the floor for a few seconds before lowering.
• Ankle circles: Rotate the ankles to improve flexibility and circulation.
• Arm raises: Raise arms to shoulder height, then overhead to strengthen upper body and core.
• Sit-to-stand: Using a sturdy chair with armrests, practice standing up and sitting down slowly to build leg strength and functional mobility.

Assisted Walking and Balance Training

Once the patient shows improvement, introduce assisted walking and balance exercises:

• Assisted walks: Walk alongside your loved one, offering an arm for support or using a gait belt for stability. Walk at their pace, and gradually encourage them to slow down if they are moving too quickly.
• Walking on varied surfaces: As appropriate, walk on different, but still safe, surfaces like low-pile carpet, pavement, or a gentle, flat garden path to improve balance.
• Balance exercises: With a wall or sturdy furniture for support, practice heel-to-toe walking or standing on one foot for a few seconds at a time.

Choosing the Right Mobility Aids

Selecting the correct mobility aid is critical for safety and support, but it should be based on a professional assessment.

Mobility Aid	Best For	Considerations for Dementia Patients
Cane	Mild walking difficulties or balance issues.	Offers the least support. Ensure the patient understands and remembers how to use it safely.
Walker	More stability than a cane; greater weakness or unsteadiness.	Non-wheeled walkers can be cumbersome. Wheeled walkers (rollators) are easier to maneuver but require braking awareness.
Rollator	Patients who can walk but may tire and need a seat.	Offers a seat and brakes, but a patient may forget to use the brakes, posing a fall risk.
Wheelchair	Significant mobility issues; unable to walk safely.	Ensures safety for longer distances. Can be manual or powered depending on strength and capability.

Modifying the Home for Safety and Function

Making the home environment safe is essential to prevent falls and encourage movement.

• Clear pathways: Remove clutter, loose rugs, and electrical cords from walking paths.
• Improve lighting: Ensure all areas, especially hallways, bathrooms, and stairs, are well-lit to prevent visual misperceptions.
• Add handrails: Install sturdy handrails on both sides of staircases and in bathrooms to provide support.
• Use contrasting colors: Mark the edges of steps with brightly colored tape to make them more visible.
• Modify surfaces: Avoid highly shiny or patterned flooring, which can cause confusion.
• Consider door adjustments: Use pressure-sensitive alarm mats at exits or camouflage doors to manage wandering behavior.

Managing Resistance and Behavioral Challenges

Resistance to walking is common in people with dementia and often stems from fear, anxiety, or confusion.

• Maintain a calm approach: Speak in a soft, reassuring tone. Avoid sudden movements that might startle the patient.
• Use simple, clear instructions: Break down the process into one or two simple steps at a time.
• Redirect, don't confront: If they resist, gently change the subject or activity rather than forcing the issue. You can try again later.
• Check for underlying causes: Pain, an uncomfortable environment, or a side effect of medication can cause agitation and resistance. Consult with a doctor to investigate potential medical reasons.

Conclusion

Supporting a dementia patient to walk again requires a patient and compassionate approach that addresses both their physical needs and cognitive challenges. By creating a supportive environment, developing a tailored exercise routine, and using appropriate mobility aids, caregivers can significantly improve a loved one's mobility and quality of life. Consistent communication with healthcare professionals and a commitment to safety and encouragement will pave the way for successful rehabilitation and greater independence.

Source

• Healthline: Exercise for Alzheimer’s: How to Stay Active in All Stages
• Dementia Australia: Walking safely
• SonderCare: How Do I Get My Elderly Parent To Walk Again?

Frequently Asked Questions

What is the best way to start a walking routine with a dementia patient?

The best way to start is by keeping it short and consistent. Incorporate walking into a daily routine at the same time every day, such as before a meal. Begin with just a few steps or a walk across a room, and use simple, positive language like, "Let's walk to the window." Familiar music can also be a powerful motivator.

How can I motivate a reluctant dementia patient to move?

Use familiar activities and positive reinforcement. If the patient enjoys gardening, encourage them to water plants. If they like dancing, play their favorite music. Avoid confrontational language and instead, use redirection and celebrate small achievements to boost their confidence.

What safety precautions should I take before a dementia patient starts walking?

Clear all pathways of clutter, secure loose rugs with double-sided tape, and ensure rooms are well-lit to prevent falls. Install handrails in hallways and bathrooms. Ensure they wear sturdy, non-slip footwear and consider a gait belt for support during assisted walking.

How do I choose the right mobility aid for a dementia patient?

Consult a physical therapist to assess their needs. They can determine if a cane, walker, or rollator is most appropriate. The right aid provides the necessary support without causing over-reliance, which could slow progress. Ensure the patient is trained on how to use the device correctly and safely.

How can I manage a dementia patient who resists assistance with walking?

Approach them calmly and use reassuring, simple language. Their resistance may stem from fear or confusion. Instead of forcing it, try redirecting their attention to a different activity and try again later. It's also important to rule out any underlying causes of pain or discomfort.

Are seated exercises beneficial for dementia patients with limited mobility?

Yes, seated exercises are very beneficial, especially for those with advanced dementia or limited mobility. Exercises like leg extensions, ankle circles, and arm raises can improve muscle strength, flexibility, and circulation, even when standing is difficult.

What role does physical therapy play in helping a dementia patient walk again?

A physical therapist is crucial for developing a structured exercise program tailored to the patient's specific needs. They can provide exercises to improve strength, balance, coordination, and functional mobility. Consistent therapy can help slow the progression of physical decline and reduce fall risks.