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Turning: Taking the Long Way Around


Did you ever notice that when someone in the early or middle stages of dementia approaches a chair, they sometimes turn “the long way around” before sitting?

Imagine approaching a chair on your left side.  Since your left hip reaches the chair first, it makes sense to most of us to sit down leading with the left side.

I’ve seen this phenomena in about 50% of my Alzheimer’s patients, and 100% of my Parkinson’s patients- instead of continuing with the left hip leading to sit, the person turns back in toward the chair with the opposite side, turning a full 360′ to lead with the opposite hip.

There is something interesting at play here.  What seems automatic to us and our refined movement patterns is not an intuitive movement in a neurodegenerative brain.

So what is the corrective course of action?  Teach the person how to lead with the closest hip?  Or make modifications to the environment to make “long way around” safer?

The answer is yes.  And yes.

I’ve had some success putting tape on the floor in order to provide a visual cue for proper foot placement.  With consistent repetition (for at least 3 weeks), this new strategy can take hold and become the normal way to approach that particular chair.

But strategies like that do not carryover to other chairs… or the bed… or the toilet… or the sofa.  So then modifying the environment with grab bars, super poles, and bed handles become the best strategy for ensuring a safe sit to all surfaces.

Technical terms for this phenomena may include motor apraxia, perceptual-motor deficits, and/or motor planning dysfunction. What it really means, though, is that a more primitive movement pattern- one we learned when we were creeping around while holding onto furniture and always facing the object we were holding on to- is no longer being overridden by more recently learned movement and balance patterns when we could let go and have nothing but wide open spaces in front of us.

What interesting movement patterns have you observed in someone with a neurodegenerative disease?

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  1. Joyce Hornberger

    I was very interested in reading your comments about turning around. I have noticed this in Janice frequently and was getting frustrated with her. I though she was making things more difficult for herself and would try to talk her into doing it the easy way. Now that I know this is common in patients with dementia , I won’t get as frustrated.

    Thank you

    • Joyce, I am so sorry for lengthy delay… I took a few months off to reorganize things around here. Thanks for your comment. Let me know how things are working.

  2. I’m really plaesed that there’s an awareness raising campaign to educate people about the symptoms of dementia and where to go for help. However, I think this campaign overlooks those people with dementia who are in denial about their symptoms which in itself may be a symptom of the illness. Family and friends can’t force someone to visit their GP if they do not believe they are unwell. When you spot signs for concern but can’t do anything about them to help the person with the symptoms it can lead to frustration and helplessness.It sounds like it isn’t actually the person with dementia that goes to get a diagnosis alone but rather due to the intervention of family, friends, GP reception staff etc, so perhaps there should be an emphasis on what these people should do to enable the person you care about to see their GP as it isn’t as simple as discussing or suggesting it in my experience.This also has to be balanced with the fact that if someone is in denial perhaps they aren’t ready for a diagnosis, which could leave them feeling scared for the future and isolated. It’s a really difficult tightrope to walk as you want the person you care for to get help as early as possible but if admitting there’s a problem is going to be detrimental for their own mental wellbeing then perhaps all you can do is monitor the situation, enjoy the present and reassess things further down the line hoping there’s still time to delay the illness and plan for the future.

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