Paratonia In Flemish Nursing Homes: State Of The Art | 79008
Journal of Alzheimers Disease & Parkinsonism
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Besides well-known cognitive challenges, motor abilities are affected in dementia due to several underlying movement disorders. A major underlying motor problem is paratonia, a form of hypertonia characterized by a variable, involuntary resistance against passive movement. Paratonia is often associated with contractures, decubitus and difficulties in comfortable positioning and daily care procedures. The body of knowledge with regard to paratonia is scarce and thereby evidence-based management is lacking. In an online survey, physiotherapists working in nursing homes in Flanders (Belgium) were inquired for the eventual presence of any implemented (standardized) paratonia policy or protocol and for their clinical appreciation of currently used ‘therapeutic’ strategies and positioning methods/aids. Though paratonia was estimated to be present in 40% of the nursing home residents suffering from dementia, only a minority (17%) of nursing homes seems to have a standardized paratonia policy. With respect to the most applied and appraised therapeutic interventions, positioning and soft passive mobilization could be withheld. For a lying or seated position, respectively C-shaped positioning cushions and a multiposition wheelchair were the most commonly applied and positively appraised positioning aids. According to the respondents, active movement should be encouraged as long as possible, and several relaxation techniques may be of use. Crucial for the success of any therapeutic intervention for paratonia, a multidisciplinary involvement is highlighted as prerequisite, comprising a good communication and cooperation between all staff members. The need for fundamental and clinical research and demand for practical guidelines was highly endorsed by this survey.
Bieke Van Deun has a Master of Science degree in Motor Rehabilitation and Physiotherapy. She has been working as a physiotherapist in a hospital and a nursing home for 10 years. At present, she is a PhD student at the Department of Rehabilitation Sciences and Physiotherapy of the Ghent University. Her research topic is paratonia in dementia.
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