Ries Julie D
Center for Optimal Aging and Physical Therapy, Marymount University, 2807 N Glebe Road, Arlington, VA, 22207, USA.
Arch Physiother. 2022 Apr 1;12(1):9. doi: 10.1186/s40945-022-00134-5.
INTRODUCTION & BACKGROUND: The aging of the population assures increased prevalence of Individuals Living with Dementia (ILwD) and there will be an increased representation of this cohort requiring physical rehabilitation. If physical therapists (PTs) manage these patients as they do their age-matched, cognitively-intact peers, they will likely be unsuccessful. ILwD have unique needs related to interpersonal and pragmatic components of rehabilitation. Therapeutic nihilism (doubting the benefit of therapy) is well-documented in PTs, either because of existing biases about dementia or previous challenges in working with ILwD. Physical rehabilitation eligibility and placement decisions are often made by PTs without special training in dementia, based upon brief exposure to patients in environments not well-designed for their best functioning. This can lead to underestimation of rehabilitation potential and denial of future PT services. PTs who work with ILwD desire more practical knowledge and targeted skills. Those with more education and training have a more positive attitude and outlook related to ILwD.
The purpose of this paper is to introduce a framework for rehabilitation with ILwD equipped with pragmatic ideas to facilitate therapeutic success. The four primary components of the model are: (1) Establish a personal RELATIONSHIP, (2) Use intentional verbal and nonverbal COMMUNICATION, (3) Understand and optimize MOTOR LEARNING capabilities, and (4) Create a safe, purposeful ENVIRONMENT. Specific strategies to help PTs optimize each component are provided with supporting evidence. The model is intended to be dynamic, encouraging PTs to capitalize on the most accessible strategies within their control for a given patient and setting.
This framework provides a practical resource for working with ILwD with immediate implications for facilitating therapeutic success. The model is displayed in a schematic that reminds the reader of ideas at a glance within the context of each of the components. If an appreciation for this content was among core competencies required among PTs working with ILwD, perhaps there would be significantly fewer patients written off as "uncooperative" or "unable to participate" in PT.
人口老龄化确保了痴呆症患者（ILwD）的患病率上升，并且这一群体中需要身体康复的人数将会增加。如果物理治疗师（PTs）像对待年龄匹配、认知功能正常的同龄人那样管理这些患者，他们很可能会失败。ILwD在康复的人际和实际应用方面有独特需求。治疗虚无主义（怀疑治疗的益处）在物理治疗师中已有充分记录，这要么是因为对痴呆症存在现有的偏见，要么是因为之前在与ILwD合作时遇到的挑战。物理康复的资格和安置决定通常由没有接受过痴呆症特殊培训的物理治疗师做出，这是基于在对患者功能发挥不佳的环境中短暂接触患者而做出的。这可能导致对康复潜力的低估以及未来物理治疗服务的拒绝。与ILwD合作的物理治疗师渴望获得更多实用知识和有针对性的技能。那些接受过更多教育和培训的人对ILwD有更积极的态度和看法。
本文的目的是介绍一个针对ILwD的康复框架，该框架具备实用理念以促进治疗成功。该模型的四个主要组成部分是：（1）建立个人关系（RELATIONSHIP），（2）运用有意的言语和非言语沟通（COMMUNICATION），（3）理解并优化运动学习能力（MOTOR LEARNING），以及（4）创造一个安全、有目的的环境（ENVIRONMENT）。提供了帮助物理治疗师优化每个组成部分的具体策略及支持证据。该模型旨在具有动态性，鼓励物理治疗师在给定患者和环境下，利用其可控范围内最易获取的策略。
这个框架为与ILwD合作提供了一个实用资源，对促进治疗成功具有直接意义。该模型以示意图展示，能让读者在每个组成部分的背景下一眼就想起相关理念。如果对这些内容的理解是与ILwD合作的物理治疗师所需的核心能力之一，那么或许被认定为“不合作”或“无法参与”物理治疗的患者会显著减少。
