Lewy Body Dementia and Rehabilitation

Conditions We Treat, Dementias, Neurological Rehabilitation

Lewy Body Dementia

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Lewy Body Dementia is a condition that looks different for each person, but the way the disease works in the brain, known as pathogenesis, follows the same general pattern. Some specialized physical, occupational, and speech therapists are trained in understanding how the disease spreads through the brain and how it impacts different functions over time. These changes are specific to Lewy Body Dementia, making your journey with LBD different from someone with Alzheimer’s, frontotemporal dementia, or Parkinson’s.

If you’ve been diagnosed with LBD, it’s important to start building your long-term management team. While you won’t need therapy or medical appointments all the time, you will benefit from having periods of therapy when changes in your body or function start to appear. Having someone to contact when these changes happen ensures you can get the right support at the right time. Early diagnosis and intervention are key to maintaining as much independence and function as possible throughout the course of the disease.

What is Lewy Body Dementia?

Lewy Body Dementia (LBD) is the second most prevalent progressive neurodegenerative diagnosis causing dementia. It is second to Alzheimer’s disease (AD), but differs in many ways. It is signified by lewy body proteins that appear in various parts of your brain affecting thinking, functional activities, judgement, executive function, functions of the autonomic nervous system, and mobility.

The Lewy Body Association has more information regarding the difference between Alzheimer’s Disease (AD) and Lewy Body Disease (LBD).

Learn more about Lewy Body Dementia

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What do I do if I’ve been diagnosed with Lewy Body Dementia (LBD)?

After receiving an LBD diagnosis, it is important to establish a long-term therapy team including occupational therapy, speech therapy, and physical therapy familiar with the progression of this diagnosis. By establishing a small therapy team that will be able to remain with you throughout the stages of Lewy Body Dementia, you will be able to maximize your physical function, maintain your performance in functional activities, and ensure you remain in control of your symptoms instead of the other way around.

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Symptoms of Lewy Body Dementia

Runny Nose
Visual hallucinations (detailed)
Delusions
Agitation and frustration
Difficulty multi-tasking or remaining on task
Information processing difficulties
Stooped posture (similar to Parkinson’s disease)
Overall movements and mobility slowing down
Balance and coordination decline
Walking turns into a ‘shuffle’
Voice becomes more quiet

For more symptoms of Lewy Body Dementia, head to Alzheimer’s Association.

What are my options after receiving an LBD diagnosis?

Although there are neurocognitive enhancement medications, one of the most important things you can do for yourself is to seek out a team of therapists as early as possible. With the right early intervention strategies you can improve your symptoms and/or control the speed at which you experience decline.

What type of intervention is used by a neuro-centered rehabilitation team?

Neurodevelopmental Techniques
Proprioceptive Neuromuscular Facilitation
Cross Crawl Strategies
Neuromuscular Re-education
Neurocognitive Strategies
Heavy Work
Brain Work
Habituation Techniques
Functional training to ensure you can remain independent in self-care (ADLs) and other activities of independence (IADLs) for as long as possible
Staging
Screening
Education

Learn more about Lewy Body Dementia

Schedule an appointment to establish care

How can outpatient occupational therapy help after a dementia diagnosis?

Once given a dementia diagnosis, we can ‘stage’ your dementia progression through specific screens and assessments so that you always feel in control of your circumstances.
Make recommendations for adaptive equipment, durable medical equipment, and mobility aids throughout each stage
Provide a hybrid approach to rehabilitation and maintenance grounded in neurocentric principles offering you an inclusive rehab program.

Multiple Sclerosis and Rehabilitation

Conditions We Treat, Neurological Rehabilitation, Progressive Neurological Diseases

Multiple Sclerosis and Rehabilitation

Authored by Michelle Eliason, MS, OTR/L, CKTS, C.D.S.

Common Symptoms of Multiple Sclerosis

Multiple sclerosis (MS) is a neurodegenerative disease affecting the central nervous system (brain and spinal cord). During the progression of MS, the immune system attacks the myelin covering your nerve fibers. Myelin is the protective covering surrounding your neurons allowing your brain to communicate with the rest of your body. When this covering begins to breakdown, the ability for your brain to communicate with your organs and muscles also begins to breakdown. Over time, this lack of communication affects physical function and skills for independence. After receiving a diagnosis of Multiple Sclerosis (MS), it is crucial to find a trustworthy long-term therapy team consisting of occupational therapy, speech therapy, and physical therapy to ensure you are maximizing function throughout every stage of its progression. Early intervention and oversight of symptoms will greatly benefit you during this journey.

Common symptoms include:

Increased fatigue (most prevalent)
Numbness or tingling in the hands and feet
Muscle weakness
Severe stiffness at times (spasticity)
Walking difficulties
Slurred speech
Cognitive changes
Depression

For additional warning signs of Multiple Sclerosis check out this article. Discover more information regarding the resources for the National Multiple Sclerosis Society through the Multiple Sclerosis.

Meaningful Activities (Occupations) affected by Multiple Sclerosis

Moving and turning (stiffness and decreased flexibility)
Walking (numbness and tingling in feet)
Standing tolerance while cooking a meal, using cooking utensils, and holding a pot/bowl/plate
Taking care of children or parents due to fatigue and muscle weakness
Coordinating large movements
Eating, fastening buttons, putting on makeup, shaving, turning a key, opening a jar, and writing (decreased dexterity, fine motor coordination)
Decreased endurance and stamina for all tasks
Decreased memory, problem-solving skills, executive function, and motor planning affecting all ADLs and IADLs

What does occupational therapy address during outpatient therapy?

Offers you a comprehensive evaluation
Balance and mobility strategies
Upper body and lower body strengthening
Education regarding simple stretching and range of motion programs to maintain flexibility and prevent muscle tightness
Activity Modification and learning compensatory methods when needed
Education regarding energy conservation techniques
Cognitive changes (memory, recall, information processing)
Functional performance during ADLs and IADLs
Recommendations for adaptive equipment, durable medical equipment, and mobility aids.
Home assessment and screening for appropriate home modifications

It is important to understand the body’s response to neurodegenerative illnesses and to always look for a second opinion if you have been diagnosed and told therapy will not be effective. Remember that your brain has a desire to find new pathways and new ways of accomplishing meaningful activities (IADLs or ADLs) after an injury (neural plasticity) and the function of neural plasticity exists until the day you die.

What are some additional problems outpatient occupational therapy can address?

Your ability to move (upper and lower body mobility)
Range of motion including effects of a joint contracture, spasticity, or flaccidity
Your ability to take care of your own personal care (ADLs)
Your ability to complete essential activities for independence (IADLs)
Learning techniques to improve your planning, reasoning, and organization
Getting into and out of your home
Working and returning to work
Wheelchair Assessments and Positioning
Community Mobility
Remaining independent in your home
Addressing personal concerns, worries, and psychosocial barriers that may be preventing rehabilitation progress

References

Multiple sclerosis. (2019, April 19). Retrieved from https://www.mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269

American Journal of Occupational Therapy, April 2016, Vol. 70, 7003395010. https://doi.org/10.5014/ajot.2016.703001

Ghahari, S., & Finlayson, M. (n.d.). A RESOURCE FOR HEALTHCARE PROFESSIONALS .

Godman, H. (2017, August 11). The Role of Occupational Therapy in MS. Retrieved March 12, 2020, from https://health.usnews.com/health-care/patient-advice/articles/2017-08-11/the-role-of-occupational-therapy-in-ms

Helpful Page Definititions

Functional Plateau

What is a functional plateau or functional baseline?

It can be confusing when you are told that you have stopped making progress and no longer qualify for therapy - nobody wants to hear this! A functional plateau label is given when the therapist you are seeing stops seeing progress being made toward the goals he/she set during the evaluation process. It is also considered 'reaching a new functional baseline'. This means they believe you have reached maximum progress or you will not make any measurable gains in the near future. They can no longer justify restorative therapy (therapy to bring back function).

Remember that there are other therapists with other perspectives! There are specialty therapists for each individual diagnosis and they may see different therapeutic potential! Always get a second opinion before accepting the idea that you or your loved one has reached all of your maximum potential! You may just need another approach!

Neural Plasticity

What is neural plasticity or brain plasticity?

Neural plasticity or brain plasticity is a concept known by neurological-centered medical professionals. It is your brain's ability to create new pathways to work around injured ones! This is the foundation of rehabilitation (your body's ability to repair itself). Whether you are re-learning to put weight through your joints after surgery or re-learning to open and shut your hand after a stroke -- neural plasticity is involved! If someone has had a stroke, brain injury, diagnosed with Alzheimer's or another form of dementia, multiple sclerosis, etc. ---the body's desire to maintain its ability to function does not disappear it just needs to be guided in a specific way.

Functional Activities

Occupation-based interventions are the most functional-based approach to rehabilitation. When you are invested in the activity and understand why you are doing something, your brain's ability to heal and re-learn motor patterns improves exponentially! Occupational therapists are functional rehabilitation specialists which means we are experts in translating physical strategies into functional activities! We understand that performing a sit-to-stand in the studio is much different than getting up from your favorite recliner chair! Likewise, re-learning how to move your arm or walk in the studio is much different than feeling confident entering your home or moving about the community! Buffalo Occupational Therapy always bridges this gap and includes these real-life elements as part of our outpatient rehabilitation process!

Activity Analysis

Occupational therapists specialize in activity analysis. Activity analysis is breaking down a task into its basic parts and you master each part of the whole activity in order to enable maximum independence.

Instrumental Activities of Daily Living (IADLs)

Instrumental Activities of Daily Living (IADLs) are essential for independence in life roles and required for aging in place. There are 8 activities core activities for independence including cooking, cleaning, communication, taking and managing medication, handling your personal finances, transportation and community mobility, shopping

Cooking - The ability to follow a recipe and having the stamina to prepare a meal for yourself and/or your family

Cleaning - The ability to perform light housekeeping including making your bed, doing your laundry, washing the dishes, taking out the trash, vacuuming, sweeping, cleaning your bathroom, etc.

Communication - The ability to use the telephone, the computer, have conversations with people (familiar and strangers), communicate your needs clearly.

Taking medication - The ability to sort and organize your medication or determine a compensatory method to do so as well as taking the appropriate dosage at the appropriate time.

Personal Finances - The ability to establish an organization method to understand financial responsibilities and pay your bills on time.

Transportation - Whether you are driving, calling for a driving service like a taxi or Uber, or taking public education. You must have a defined action plan for community mobility and transportation.

Shopping - The ability to plan transportation, plan a grocery/clothing list of needs for yourself and your home, have the stamina to collect your items at the store, and be able to get them into your house.

Activities of Daily Living

Occupational therapists are trained in occupations and activity analysis. An occupation is an activity that you believe is important to your life. There are many levels of occupations, but activities of daily living (ADLs) are the most personal activities and are usually the ones people find most important if they were to lose the ability to complete them.

ADLs include:

Bathing and showering
Getting dressed
Going to the bathroom
Walking and getting up and down from a chair or car
Eating and swallowing
Feeding
Sexual activity
Personal hygiene and grooming
Being able to use personal care devices like adaptive equipment and durable medical equipment

Mobility Aid

As occupational therapists, we can assess functional movement and recommend adaptive equipment as well as durable medical equipment that will enhance your community mobility. Before we can make any recommendations, we must assess your ability to move and determine how you are walking and holding your posture, if you are presenting with muscle imbalances, the status of your upper body and lower body range of motion and flexibility deficits and finally, determine the status of your muscle stamina. After we complete this assessment, we can help you decide what mobility aid would be most appropriate for you, if any.

Types of mobility aids include cane (single point, quad cane, tripod cane), crutches, knee scooter, cane-crutch combination, walkers (4 wheeled walker, 2 wheeled walker, standard walker), walker-cane hybrid, hemi-walker, gait trainer, scooters, wheelchairs and more.

We will help decide what device would be most appropriate, help with positioning, and then train you on best practices to maximize your mobility!

Comprehensive Evaluation

Occupational therapists treat the entire person. Much like your primary care physician, we were required to learn elements of the entire body so that we could treat holistically (a one stop shop). Because of this, your outpatient rehabilitation specialist will perform an evaluation that assesses the following things:

Personal history
- Who are you? What do you do? What makes you tick? Why are you seeking outpatient therapy?
Physical function (upper body and lower body)
- Strength, range of motion, and flexibility
Neuromuscular function (brain to muscle communication)
- Coordination, speed, agility, and reaction time
Cognitive and Mind health
- Short term memory, recall, information processing, and perception of illness
Occupational Inventory (Activity and role inventory)
- Roles you play like a caregiver, spouse, parent, employee, etc.
- Mobility inventory like the places you need to go
- IADL inventory and what activities are required for you to be independent
- Other activities that are important to you

Parkinson’s Disease

Conditions We Treat, Neurological Rehabilitation, Progressive Neurological Diseases, Walking Conditions

Parkinson’s Disease Treatment

Parkinson’s Disease Therapy and Management

Parkinson’s Disease treatment; Parkinson’s Disease therapy; PD; Parkinson’s Physical Therapy

Common Symptoms of Parkinson’s Disease

Parkinson’s disease is the second most common neurodegenerative disease affecting the amount of dopamine your brain produces and stores. After receiving a diagnosis of Parkinson’s disease, it is crucial to find a trustworthy long-term therapy team consisting of occupational therapy, speech therapy, and physical therapy to ensure you are maximizing function throughout every stage of its progression. Early intervention and oversight of symptoms will greatly benefit you during this journey.

Common symptoms include:

Increased stiffness in your upper and lower body (starting with hands)
Small hand tremors
Decreased speed when you are walking or moving
Small handwriting
Decreased coordination in your upper body and lower body movements
Decreased strength in the muscles used by your voice making your speech decrease in volume
You find yourself ‘stooping’ more or standing/walking with rounded shoulders
Difficulty sleeping

For additional warning signs of Parkinson’s disease check out this article. Discover more information regarding the resources for Parkinson’s Disease through the Parkinson’s Foundation.

Meaningful Activities (Occupations) affected by Parkinson's Disease

Moving and turning (stiffness and decreased flexibility)
Taking a first step (decreased movement initiation)
Controlling walking speed and stopping (walking speeds up over time)
Coordinating movements when changing direction or turning
Eating, fastening buttons, putting on makeup, shaving, and writing (decreased dexterity, fine motor coordination)
Decreased endurance and stamina for all tasks
Decreased problem-solving skills, executive function, motor planning, confusion, safety awareness affecting all ADLs and IADLs

What does occupational therapy address during outpatient therapy?

Progressive resistance training (strengthening for upper body and lower body)
Joint mobilization (stretching and range of motion)
Postural stability (posture, strong back and core)
Balance training
Gait and mobility training (walking, stairs, traversing obstacles in your path)
Aerobic fitness
Functional performance during ADLs and IADLs
Recommendations for adaptive equipment, durable medical equipment, and mobility aids.

It is important to understand the body’s response to neurodegenerative illnesses and to always look for a second opinion if you have been diagnosed and were told therapy will not be effective- regardless of age. Remember that your brain has a desire to find new pathways and new ways of meaningful activities (IADLs or ADLs) after an injury (neural plasticity) and the function of neural plasticity exists until the day you die. Research has demonstrated that with consistent, correct therapeutic interventions for 6+ weeks, walking and fluidity of movement can improve.