I had a similar problem with my mom a few months ago when they were staying with us. She had had progressive problems with dementia, somewhat accelerated in the past year. She had been independent in gait for short distances but fell in the middle of the night and apparently strained her knee. There was no fracture.
Until the strain healed she required max assist of two to walk any distance at all. Her motor planning was poor at best and throwing a new knee pain on top of it essentially incapacitated her. At least she could communicate to us that her knee hurt, but I had to talk her through every step. Once the pain was gone she resumed her former level of gait. It doesn't sound like her dementia was as far gone as your patient's, however, who may have completely "forgotten" how to move/stand/walk. Repetition seemed to help but the apraxia made even that a very slow process. Best you can do is keep repeating the activity but try not to overdo. Good luck! Connie Severin, PT ----- Original Message ----- From: "Ron Carson" <[EMAIL PROTECTED]> To: <[EMAIL PROTECTED]> Sent: Wednesday, December 17, 2003 4:00 AM Subject: [OTnow] Help with Client > Hello: > > I am working with a client who was diagnosed with Alzheimer's Disease > approximately 7 years ago. She has shown a steady decline in occupational > independence during the years but she has shown a significant decline in the > past month. > > The family is 100% dedicated to keeping their mother at home. > > The family reports, that about three weeks ago, the client was walking > in/out of the home with SBA. While outside, the client fell, apparently when > striking at a caregiver. Since her fall, she has shown tremendous decline in > her ability to walk, stand and transfer. Prior to the fall, the client would > stand in the bathroom while the family cared for hygiene. To day, the client > required max assist (X2) to stand. The possibility of a hip injury/fracture > remains, but all orthopedic x-rays were negative. > > The questions I have are: > > 1. What are the likely causes of the client's recent decline: > > a. Normal progression of the disease > > b. Fear of falling/standing secondary to recent fall > > > 2. Based on the above, or any other plausible explanations, what treatment > approaches will best facilitate this client to be able to increase her > participation in toileting and transfers. > > Thanks, > > Ron > > P.S. I am seeing the client today and Friday and plan to make a decision > about which direction to take our remaining therapy. Should we continue > working on remediation of underlying issues or begin adaptive strategies to > decrease the family's burden and promote the client's safety > > > > > _______________________________________________ > To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com > > The OTnow Mail Archive: > www.mail-archive.com/[EMAIL PROTECTED] > =============================================== _______________________________________________ To unsubscribe, visit: http://otnow.com/mailman/listinfo/otlist_otnow.com The OTnow Mail Archive: www.mail-archive.com/[EMAIL PROTECTED] ===============================================
