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?