When a woman experiencing cognitive decline showed up for her first physical therapy appointment with Christy Ross, PT, DPT, GCS, at Cleveland Clinic Lou Ruvo Center for Brain Health, this geriatric specialist knew she could help not only with the physical complaints of increased falls and chronic back pain, but also with the patient’s difficulty completing daily activities due to memory deficits. In fact, the resulting gain in cognitive function was remarkable enough that the case study and its results were published in 2021 in GeriNotes, a journal of the American Physical Therapy Association.
Here’s a synopsis.
Have goal, will try
Ms. Bach, 79, was repeating questions, misplacing items and having difficulty managing complex tasks as reported by her daughter. With a score of 16 out of 30 on the MoCA (a standard cognitive screening) and a hippocampal volume at the 27th percentile compared with her age peers (based on images acquired via MRI), Ms. Bach was diagnosed with mild dementia — specifically, cognitive impairment due to cerebrovascular disease.
Yet, she remained goal oriented. A retired nurse who lived alone in an active adult senior community with daily support and visits from her daughter, Ms. Bach wanted to return to participating in the social clubs and community exercise programs that she had enjoyed prior to a stroke and to decrease her back pain and increase her endurance. Improved balance was another goal. Compared to individuals without cognitive impairment, those with cognitive impairment experience two to three times more falls.
Dr. Ross prescribed a home exercise program with simple written instructions and accompanying pictures for exercises Ms. Bach could do by herself, as well as supervised aerobic walking and stationary biking with “dual tasking” (performing a cognitive task while exercising) to be aided by her daughter or personal care assistant. The plan encompassed a total 30 minutes of moderate-intensity exercise five days a week, supplemented by twice-weekly, one-on-one PT sessions at the Lou Ruvo Center for Brain Health.
The result? Based on a battery of standardized metrics such as timed sit-to-stands, a six-minute walk test and Berg balance assessment, Ms. Bach showed physical improvement. Perhaps more surprisingly to her daughter, at Ms. Bach’s six-month neurology appointment, her MoCA score had improved 37 percent, from that baseline of 16 to 22 of 30.
“Families often ask if it’s worth the time and effort to bring someone with dementia to physical therapy,” says Dr. Ross. “However, with modification of the communication process and utilization of best-practice, evidence-based interventions, specialized clinicians can effectively serve this rapidly growing population of individuals with cognitive impairment.”
Physical therapy at the Lou Ruvo Center for Brain Health is available upon referral from our neurology providers. To make an appointment with a neurologist, call 702.483.6000.
Photo: Christy Ross, PT, DPT, GCS with patient; courtesy of Cleveland Clinic Lou Ruvo Center for Brain Health.