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. Purpose: 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. Implications: 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.

Older adults with dementia experience more frequent and injurious falls than their cognitively-intact peers; however, there are no evidence-based fall-prevention programs (EBFPP) for this population. The Otago Exercise Program (OEP) is an EBFPP for older adults that has not been well-studied in people with dementia. We sought to explore the feasibility of group delivery of OEP in an adult day health center (ADHC) for people with dementia. We collected demographic data, Functional Assessment Staging Tool (FAST), and Mini Mental State Exam (MMSE) scores for seven participants with dementia. Pre- and post-test data included: Timed-Up-and-Go (TUG), 30-Second Chair-Stand (30s-CST), Four-Stage-Balance-Test (4-SBT), and Berg Balance Scale (BBS). We implemented a supervised group OEP, 3x/week × 8 weeks. Most participants required 1:1 supervision for optimal challenge and participation. Five participants completed the program. All had moderately severe to severe dementia based upon FAST; MMSE scores ranged from mild to severe cognitive impairment. Four of five participants crossed the threshold from higher to lower fall risk in at least one outcome (TUG, 30s-CST, 4-SBT, or BBS), and four of five participants improved by >Minimal Detectible Change (MDC₉₀) score in at least one outcome. The group delivery format of OEP required significant staff oversight for optimal participation, making the program unsustainable.

What are the core capabilities physiotherapists need to deliver quality care when working with people with dementia and their families/caregivers? A three-round modified e-Delphi study. Panel members were physiotherapists experienced in working with people with dementia and/or educating and/or researching in the dementia field. A steering group (16 international physiotherapists and a consumer) developed a draft framework including 129 core capabilities across 5 domains for panel members to rate their appropriateness for inclusion as a core capability to provide high quality care to people with dementia and their caregivers/families. The RAND/UCLA method was used to assess consensus. Thirty-five physiotherapists from 11 countries participated in Round 1, 31 (89%) in Round 2 and 28 (80% of Round 1) in Round 3. All core capabilities were rated appropriate for inclusion in each round. Panel members recommended wording refinements across the rounds and suggested 51 core capabilities for consideration. Three rounds were needed to reach consensus, resulting in 137 core capabilities rated appropriate for inclusion across 5 domains: 1) Knowledge and understanding, n = 36; 2) Assessment, n = 39; 3) Management, interventions and prevention n = 40; 4) Communication, therapeutic relationship and person-centred care, n = 17; and 5) Physiotherapists self-management and improvement, n = 5. This e-Delphi study outlines the core capabilities physiotherapists need to provide high quality care to people with dementia and their families/caregivers. These core capabilities can be used by physiotherapists to help identify knowledge/skill gaps, as well as by educators to improve their training of undergraduate and postgraduate students, and clinicians. CONTRIBUTION OF PAPER.

Introduction: Exercise benefits individuals with Parkinson’s disease (PD). Rock climbing includes exercise characteristics from clinical guidelines (e.g., aerobic, resistance, balance training, cued-movements, community-based) and offers unique somatosensory and visuospatial experiences that may aid motor learning. This study examined climbing’s effects on PD physical function.Methods: This quasi-experimental observational pilot study used pre-to-post-test comparisons to assess participants with mild to moderate PD (Hoehn and Yahr 1-3) who walked independently. The intervention included 12 weeks of community-based, twice-weekly top-rope climbing under one-on-one supervision, tailored to skill level. Wall angles, hand/foot holds, and routes varied and became progressively more difficult as skills increased. The primary outcome was the Community Balance & Mobility Scale (CBMS); secondary measures included the Agility T-Test (ATT), 9-Hole Peg Test (9HPT), upper extremity reaction time using BlazePods (UE-React), and grip strength.Results: 28 participants completed the study: 8 women/20 men; mean age = 66.1 (sd = 7.4) years; average disease duration = 4.0 (sd = 3.6) years. Paired t-tests comparing pre- and post-test scores and effect sizes (ES) with 95% confidence intervals (CI) were calculated for significant results using Hedge’s g. Findings were: CBMS (p < 0.001; ES = 0.573, 95% CI = 0.178-0.960), ATT (p < 0.001; ES = 0.462, 95% CI = 0.078-0.838), 9HPT (p < 0.001; ES = 0.480, 95% CI = 0.094-0.858), UE-React (p <0.001; ES = 0.329, 95% CI = −0.045-0.696); GS changes were non-significant.Conclusions: Rock climbing demonstrated medium-size effects on mobility/balance and small-size effects on agility and dexterity that could impact functioning in everyday activities.