Dementia is often associated with changes in memory and thinking, but it can also affect movement, balance, strength and a person’s ability to complete everyday activities.
These physical changes may develop gradually and can increase the risk of falls, reduced mobility and loss of independence. Neurological physiotherapy can help a person living with dementia remain active, safe and involved in the activities that are meaningful to them.
How Can Dementia Affect Movement?
Dementia affects each person differently. Depending on the type and stage of dementia, a person may experience:
- Changes in walking speed or pattern
- Reduced balance and coordination
- Muscle weakness and reduced fitness
- Difficulty standing up, turning or using stairs
- Reduced confidence when walking
- Difficulty planning or sequencing movements
- Changes in posture
- Increased risk of falls
- Reduced participation in exercise and community activities
- Difficulty following instructions or learning unfamiliar movements
Some forms of dementia may cause more pronounced movement changes. For example, dementia with Lewy bodies and Parkinson’s disease dementia may be associated with stiffness, slower movement, shuffling steps and episodes of freezing.
A sudden change in mobility, balance, alertness or behaviour should always be discussed promptly with a GP or other health professional, as it may be caused by illness, injury, medication changes or delirium rather than the usual progression of dementia.
What Is the Role of a Neurological Physiotherapist?
A neurological physiotherapist understands how changes in the brain and nervous system can affect movement and function.
The physiotherapist begins by assessing the person’s current mobility, balance, strength, physical capacity and everyday challenges. They will also consider the person’s health, environment, interests, communication needs and support network.
Based on this assessment, physiotherapy may focus on:
Maintaining Strength and Physical Fitness
An individual exercise program may help maintain muscle strength, endurance and the physical capacity required for everyday activities.
Exercises are selected according to the person’s abilities and may include walking, sit-to-stand practice, strengthening exercises, cycling or other familiar and enjoyable activities.
Improving Balance and Reducing Falls Risk
A physiotherapist can assess factors that may be contributing to falls, such as reduced balance, muscle weakness, changes in walking, difficulty turning or problems moving around the home.
Treatment may include balance training, functional exercises, walking practice and practical strategies to make movement safer.
No intervention can prevent every fall, but identifying risks early may help a person move with greater safety and confidence.
Supporting Walking and Mobility
Neurological physiotherapy may help a person practise walking, transfers, stairs and other movements required at home or in the community.
The physiotherapist can also assess whether a walking aid may be helpful and provide education on its safe use. Because learning to use unfamiliar equipment can be difficult for someone living with dementia, recommendations should be individualised and introduced carefully.
Preserving Everyday Function
Physiotherapy is most useful when treatment relates to activities that matter to the person.
This may include:
- Walking to a local café
- Gardening
- Getting in and out of bed
- Standing from a favourite chair
- Attending a community group
- Playing with grandchildren
- Continuing a familiar recreational activity
Practising meaningful movements in a familiar setting can make exercise easier to understand and more relevant.
Managing Pain and Other Physical Conditions
A person living with dementia may find it difficult to describe pain or identify where it is coming from. Pain may instead appear as reduced movement, facial expressions, withdrawal, agitation or a change in behaviour.
A physiotherapist can assess for possible physical contributors and work with the person’s family, carers and healthcare team to support appropriate management.
Adapting Physiotherapy for a Person with Dementia
Effective physiotherapy should be tailored to the person, not only to their diagnosis.
Helpful approaches may include:
- Using short, clear instructions
- Demonstrating movements rather than relying only on verbal explanations
- Completing one task at a time
- Allowing additional time to respond
- Practising in a quiet and familiar environment
- Establishing a consistent routine
- Using familiar activities, music or personal interests
- Providing visual or physical prompts when appropriate
- Involving family members, carers or support workers
- Focusing on encouragement and successful participation
A person may not remember completing an exercise session, but they may still experience the physical, emotional and social benefits of participating.
Why Is Early Physiotherapy Important?
Seeking physiotherapy early provides an opportunity to identify changes in walking, balance or strength before they have a greater effect on independence.
It also allows the physiotherapist to develop routines while the person is more able to participate in planning and learning. Family members and carers can be shown how to support safe movement and continue suitable activities between appointments.
Physiotherapy can also remain valuable as dementia progresses. Goals and treatment strategies may change over time, moving from improving physical capacity to maintaining mobility, supporting safe transfers, managing discomfort and assisting carers.
Working Together with Families and Healthcare Professionals
Supporting a person living with dementia often requires a team approach. Depending on the person’s needs, this may involve their GP, geriatrician, neurologist, occupational therapist, speech pathologist, dietitian, psychologist, nurses and support workers.
Family members and carers provide valuable information about the person’s usual abilities, routines, interests and recent changes. Their involvement can help make physiotherapy practical, consistent and meaningful.
When Should You Consider a Physiotherapy Assessment?
A physiotherapy assessment may be helpful if a person living with dementia:
- Has fallen or is becoming less steady
- Is walking more slowly or taking shorter steps
- Is having difficulty standing, turning or using stairs
- Has become less active
- Is losing strength or physical confidence
- Is finding it harder to complete everyday activities
- Has recently started using a walking aid
- Is experiencing pain or stiffness
- Needs assistance with transfers or mobility
- Has family members or carers who would benefit from guidance
Supporting Movement, Confidence and Quality of Life
Although physiotherapy cannot cure dementia, it can form an important part of supporting a person’s physical health, safety and quality of life.
At Advanced Neuro Rehab, our neurological physiotherapists provide individualised assessment and rehabilitation for people with conditions affecting the brain and nervous system. We work collaboratively with each person, their family and their wider healthcare team to support meaningful goals and help them remain as active and independent as possible.
To discuss whether neurological physiotherapy may be appropriate for you or someone you support, contact Advanced Neuro Rehab to arrange an appointment.
This information is general in nature and does not replace individual medical or physiotherapy advice. Speak with your GP or healthcare professional about any new or sudden changes in memory, behaviour, movement or function.
