Dementia

Dementia affects memory and thinking, but it also affects movement — walking slows, balance deteriorates and falls become substantially more likely. Reduced activity then accelerates physical decline, which is where physiotherapy has a clear role.

What we focus on

• Falls prevention — balance and strength work, plus home hazard assessment. Falls in dementia carry a high risk of fracture and of a step-change loss of independence
• Maintaining walking — distance, speed and confidence
• Strength and endurance, which decline quickly with inactivity
• Preserving transfers — bed, chair, toilet. These are what determine whether care at home remains possible
• Positioning and contracture prevention in later stages
• Supporting carers with safe handling technique

Adapting how sessions are run

Standard rehabilitation instructions do not work well when new information is hard to retain. So:

• Short, simple, consistent sessions at the same time and place
• Familiar, repeated routines rather than new exercises each week
• Demonstration rather than verbal explanation
• Working with what the person can still do automatically — walking, familiar movement patterns, music and rhythm, all of which are often preserved when explicit memory is not
• Involving carers so the routine continues between sessions

Being realistic

Physiotherapy does not slow the cognitive decline. What it does is maintain physical function, reduce falls and support the quality of daily life — and for many families, help someone stay at home longer.

Home visits are frequently the better option here, since a familiar environment reduces confusion and the exercises are set up around the person's actual home.