Physical Therapy for Gait, Balance, and Cognition in Individuals with Cognitive Impairment: A Retrospective Analysis

Abstract

Objectives. The purpose of this study was to determine if a pragmatic physical therapy (PT) program was associated with improved cognition, gait, and balance in individuals with cognitive impairment. This study investigated these associations for individuals with Alzheimer disease (AD), vascular dementia (VaD), dementia with Lewy bodies (DLB), and mild cognitive impairment (MCI) in order to better characterize outcomes to PT for each diagnostic group. Methods. Data before and after one month of physical therapy were extracted from patient records (67 with AD, 34 with VaD, 35 with DLB, and 37 with MCI). The mean number of PT sessions over a month was 3.4 (±1.8). Outcomes covered the domains of gait, balance, and cognition with multiple outcomes used to measure different constructs within the balance and gait domains. Results. All groups showed improvements in balance and at least one gait outcome measure. Those with MCI improved in every measure of gait and balance performance. Lastly, cognition as measured by Montreal Cognitive Assessment improved in individuals in the AD, VaD, and MCI groups. Conclusion. While this retrospective analysis is not appropriate for causal inference, results of one month of physical therapy were associated with decreases in gait, balance, and cognitive impairment in individuals with AD, VaD, DLB<, and MCI. Clinical Implications. While physical therapy is not typically a primary treatment strategy for individuals with cognitive impairment, the results of this study are consistent with the literature that demonstrates improvement from physical therapy for other neurodegenerative diseases. Further clinical and research exploration for physical therapy as a primary treatment strategy in these populations is warranted.

Non-Pharmacological Treatments in Lewy Body Disease: A Systematic Review

“…Primary outcomes mainly used to evaluate the efficacy of physical therapies were balance, gait, and cognitive performance (Table 2). Significant improvements in all motor measures were found in a recent retrospective study in which 35 DLB participants underwent a 4-week structured PT programme in a clinical setting [17]. In a randomized controlled trial [18], involving a large cohort of persons with dementia, the following measures relative to 4 PDD participants were reported separately: after 12 weeks of intensive strengthening and balance exercises, 2 PDD assigned to the exercise group improved sit-to-stand, balance, and speed measures compared to the 2 PDD assigned to the control group.…”

“…This systematic search identified five studies with LBD patients that underwent exercise training. The rehabilitation programme was generally an intensive aerobic exercise training of the duration of several weeks (from 4 to 12 weeks) with the specific aim of improving gait and balance [17][18][19] or executive functions [20]. Four of these studies reported positive effects of exercises as regards balance, gait measures [17][18][19], and executive functions measured through the Montreal Cognitive Assessment test [20].…”

“…The rehabilitation programme was generally an intensive aerobic exercise training of the duration of several weeks (from 4 to 12 weeks) with the specific aim of improving gait and balance [17][18][19] or executive functions [20]. Four of these studies reported positive effects of exercises as regards balance, gait measures [17][18][19], and executive functions measured through the Montreal Cognitive Assessment test [20]. Instead, Kegelmeyer and colleagues [21] administered a single session of treadmill walking in LBD patients without showing specific gait improvements, probably due to the short duration of the treatment.…”

Rehabilitation Strategies for Wernicke-Korsakoff Syndrome: Physiotherapy Interventions and Management Approaches

“…WKS is treated with cognitive rehabilitation and thiamine replacement therapy, which has no set dosage and can vary depending on patients' symptoms. Physiotherapy can be used as a primary goal for managing primary treatment strategy in subjects with vascular dementia and dementia with Lewy bodies is needed to demonstrate the efficacy among these populations with the help of gait, balance, and cognitive therapy [ 19 ]. Combining dual-task and function-oriented challenges while controlling balance stimulates the sensory and neuromuscular control mechanisms.…”