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Activation of Familiar Movement Patterns

I had a gentleman the other day who has been declared “dependent” by the assisted living staff for over a year.  He has a diagnosis of late stage Alzheimer’s, although I suspect there is some Parkinson’s disease at play here as well.

We’ll call him Bob.

Bob spends his life in a tilt-in-space wheelchair that is rarely tilted to any gravity-assisted postural benefit.  Subsequently, his trunk is flexed, his head is forward, and is unable to change his position.

It takes two people to lift Bob from the chair to the edge of the bed- where they immediately lie him down.

The other day, we gave Bob two gifts.

The gifts of time and opportunity.

We sat Bob at the edge of the bed where he sat slumped and rounded.  He was completely dependent on us for balance- if we let go, he would quickly fall either to the left or straight back.

The secret to getting someone with Alzheimer’s disease and poor communication skills to follow your instructions is to not phrase them as instructions.

Traditionally, therapists are trained to give commands like “lean forward”, “extend your trunk”, “use your arm for support”.  But with Alzheimer’s disease, such phrases are completely ineffective.

I held up my hand and said “High Five!”… and suddenly Bob activated his trunk, corrected his posture, shifted his weight forward, and was able to balance while reaching forward to give me a High Five.

Bob’s brain remembered a movement pattern and the whole thing kicked into place.  From that point on, he was able to give me High Fives in multiple planes and maintained his sitting balance, unsupported, for more than 5 minutes.

Bob is not “dependent”.  Bob just can’t follow new instructions.  But he CAN find old movement patterns and put them into play.

It just takes is time and opportunity.

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3 comments

  1. Wow, smart thinking. Just goes to show you the power of procedural memory.

    I may have to steal that tidbit for my next co-treat.

    -Brian Smith SLP

  2. Thanks Sue! I was struggling with a young 54 year old patient with Alzheimer’s disease, not having any carry over even within an activity. I worked with her on putting a can of green beans in different cabinets yesterday (functional reaching, ROM, weight shifting, strengthening for UE and LE, etc..) I found doing “an ordinary activity” was much easier for her to do than following my directions on “typical therex”.

    ~ Kim McCullagh, PT

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