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Currently, ‘older people occupy two-thirds of National Health Service (NHS) beds, and 60% of those admitted will have or will develop a co-morbid mental disorder during the hospitalisation’ . Dementia is the most commonly occurring psychiatric condition experienced by older people in hospital (31%), followed by depression (29%) and delirium (20%) . With an increasing ageing population, there is a greater demand for health care professionals to possess the appropriate education, abilities and beliefs to appropriately care for this demographic. As part of NHS 2020 Workforce Vision it has been determined that by 2020 there will be 72% more over 65’s with dementia, and by 2033 approximately 24% of people will be over 65 and 12% will be over 75 .
Therapeutic interactions have been identified as those that ‘facilitate emotional comfort through the enhancement of patient personal control’. Personal and professional therapeutic interactions have been identified as promoting psychological and physical well-being. Therefore physiotherapists must be able to apply this ‘duality of healthcare, where elements of professional competence are linked with a caring interpersonal relationship for it to be perceived as therapeutic’ . As communication with those living with dementia can often be affected, it is important to ensure that the physiotherapist is effectively interacting with the patient to promote best possible outcome and patient-centred care.
Often individuals can feel inhibited or intimidated working with those living with dementia if not thoroughly prepared prior. ‘It has also been found that the more training a professional has about managing a particular patient group, the more satisfied they are with their job, and that attitudes and level of stress are improved’.
By definition, it is characterized as a chronic or persistent disorder of the mental illnesses caused by brain disease or injury and is marked by the progressive deterioration of multiple cognitive functions, the most common being memory disorders, personality changes, and impaired reasoning . Currently, the exact mechanism that initiates the disease process remains unclear, however there have been several studies done that have come to a similar consensus on the pathology of the development of dementia .
Physiotherapy in Dementia and Communication[edit | edit source]
The benefits of physical exercise to people with dementia are well known. These include maintaining and improving independence and reducing falls risk through strengthening and balance work; improving self-confidence, mood, self-esteem and reducing social isolation; and improving cognition, memory while potentially slowing down cognitive decline . Physiotherapy intervention is also cost-effective, resulting in reduced hospital stays with quicker supported discharge .
Through effective communication, the therapeutic interaction can be enhanced with a person with dementia, and the benefits of physiotherapy can be delivered. Good communication ensures better and smoother exchange of information, and can also help solve the daily challenges relating to patient-therapist interactions .
This was evident in the findings of a study which examined the results of physiotherapy intervention on improving QoL in patients with dementia to emphasize the importance of communication and collaboration between physiotherapist, patient and carers . Here, with the combination of physical exercise and communication, the physiotherapists attempted to help the improvement of patients’ physical abilities through exercise, and also to attempt to slow down the deterioration of cognitive abilities by making the tasks functional and therefore getting the patient to understand the process on a deeper level that just pure repetition. Similar studies yielded similar results, where participants who engaged in such physiotherapy-led activity, displayed maintenance or improvement in physical ability, as well as improvements in mood and behaviour.
Communication to Enhance Therapeutic Interaction[edit | edit source]
Communication is an essential part of human interaction needed to convey a broad range of information, including needs, wishes and feelings. It is considered one of the most important skills in life . How well one can communicate can have an impact on quality of life (QoL), and the level to which one is able to maintain their sense of identity and independence. The study suggests the need for optimal assessment, better communication among health care professionals for treating patients with dementia with multiple impairments.
It is a concept not solely related to spoken word, but also the manner and style in which it is expressed, involving interaction between verbal and non-verbal factors, with listening being one of the most important parts. Key components in the patient-practitioner encounter include:
- Verbal Behaviours, including greetings, open-ended and encouraging questions
- Non-Verbal Behaviours, for example body language, facial expressions and gestures
- Interaction Styles, which encompass aspects of both verbal and non-verbal communication simultaneously, such as being gentle, giving information, emotional support 
- Active Listening– hearing what the person says and feels, and reflecting that information back to display empathetic understanding through paying gentle, compassionate attention to what is said or implied .
Communication is regarded corner stone of the healthcare profession and repeatedly appears in national initiatives, professional standards and national guidelines – as a vital component in therapeutic interaction and the delivery of care. Effective communication plays a pivotal role in achieving the planned outcomes of several national initiatives such as the 2020 Vision for Health and Social Care in Scotland  and in Scotland’s National Dementia Strategy 2013-16 . It is also a core necessity of the professional governing body HCPC as set out in the Standards of Proficiency – Physiotherapists , where it is outlined that to be proficient as a physiotherapist, one must be able to communicate efficiently.
Effective communication also forms the basis of therapeutic interactions  as it is a medium of conveying the information necessary to make the patient feel empowered, secure, involved, and valued. All of these elements are the main drivers in patient engagement, compliance and adherence . It has been said that establishing a quality relationship with the patient is very important when working with those with a progressive disease such as dementia. Considering this, it is no wonder that communication is regarded an essential skill that clinicians need to master in clinical practice to improve the quality and efficiency of care .
All types of dementia affect cognition, and therefore some element of communication. This could be verbal or non-verbal factors, memory related, due to alterations in reasoning or social behaviour, the expression of emotions or even movement . Poor communication and collaboration between the patient, family, and physiotherapist may lead to a situation where the person living with dementia and their caretakers are not sufficiently informed about the available care, self-care in dementia, and about the interventions that slow down the disease progression. People with dementia should not be excluded from any services because of their diagnosis, age or coexisting cognitive impairments. Those with dementia and their caretakers should be treated with respect and equality at all times. To facilitate this, health and social care staff should be able to identify and address the specific needs of people with dementia and their caretakers arising from gender, age, religion, physical or sensory impairments, communication difficulties or cognitive impairments. Effective and appropriate use of all aspects of communication can facilitate interactions with such a population. It is also important to consider that non-verbal factors can be just as important as verbal forms of communication in facilitating a therapeutic interaction.
A recent cross-sectional study , measured verbal communication in therapeutic interactions in the MSK setting, and came to some interesting conclusions. It found that physiotherapists spoke for up to half of the session (50% vs 33%), with less than 1.5% of the conversation focusing on psychological factors. When considering experienced vs less experienced physiotherapists, they found the conversation style differed, with senior physiotherapists using more history/background probes and more advice/suggestion, and less reiteration compared to more junior physiotherapists. Notably, experienced physiotherapists were found to talk concurrently and interrupt patients more often than more junior colleagues . The cognitive ability of participants was not discussed. Under the HCPC Standard  it is said clinicians need to be capable of adapting and modifying their interactions with clients to cater for variations in age, condition and cognition.
Another component to consider is the type of language used. In a non-dementia population, a study set out to explore how a therapeutic relationship is established and enacted by focusing on the use of evaluative language, by both physiotherapists and patients, to inform each other about physical capacity, sensations and emotions . It was found that the physiotherapists’ focus narrowed in on factual components, such as determining history and exploring the present complaint. The patients were found to emphasise the emotional and psychosocial impact of loss of ability and pain, concerns which were often not seen to be followed up by the physiotherapists. Furthermore, the study noted that the phrasing and use of language greatly impacted on the patient’s future ability to self-monitor, self-manage and self-evaluate .
How Dementia Affects Communication[edit | edit source]
To better understand the progressive breakdown in communication, we must first consider what occurs intellectually in normal language expression and comprehension. In research done by Bayles it was found that working memory (WM) is critical in normal communicative functioning because ‘it is the engine of cognition, enabling us to form intentions, hold incoming stimuli in consciousness, reverse received input, activate and access stored knowledge, interpret stimuli, monitor expression and plan action’. While ‘storage of verbal material has been shown to activate Broca’s area and left supplementary and premotor areas, spatial information storage recruits right hemisphere premotor cortex and storage of object information activates the prefrontal cortex’.
As a result of deficits in working memory, individuals with dementia will often exhibit attentional impairments and disproportionate problem solving and visuospatial difficulties, as well as difficulty with open-ended questions which require searching memory for an answer.
As a result of the pathophysiological mechanisms of dementia, impaired communication is a common feature, therefore physiotherapists must take extra care with this population in order to facilitate a positive therapeutic interaction.
The effects of dementia range in severity related to the individual and the disease progression, but can often first appear as forgetfulness. The condition effects memory, language, perception, behaviour and cognitive skills, such as abstract thinking, reasoning and planning . The effects on cognition can accumulate in a slower speed of processing thought or inability to understand complex concepts, which can impact on communication.
As dementia progresses and worsens, symptoms become more obvious, often interfering with the persons level of independence and ability to engage in interactions with others.
Dementia affects communication in a number of ways. A person may have trouble finding the right word, repeat words or phrases, or become ‘stuck’ on certain sounds or phrases. Those with dementia are likely to have other sensory impairments such as hearing or vision, which can make it harder to communicate. Being unable to express themselves properly, may cause loss of confidence, anxiety, depression or withdrawal .
Language related problems can manifest in different ways depending on the individual and the staging of the disease, but they do occur in all forms of dementia as the language control centres of the brain are affected. Signs of language impairment include being unable to find the right word, or the use of related or substitute words. In some cases, the person may not be able to find the word at all. Also, a person may have fluent speech, but with no meaning or may use mixed up words or grammar . As the condition progresses, a person may be unable to express with language, which may be a source of distress to both themselves and their carers. This may mean the person is unable to convey feelings of pain, discomfort or illness. These situations call for the physiotherapist to modify communication, such as facilitating therapeutic interactions through pictures, pointing, or actions .
Understanding and trust are key elements of any relationship and facilitate positive interaction. Considering the above cognitive effects of dementia, it may be hard for one to develop a sense of trust in another . Effective communication can overcome this barrier, and create an environment where the patient with dementia works with the physiotherapist towards achieving desired therapeutic outcomes.
Tips for Using Communication to Overcome Barriers to Therapeutic Interaction[edit | edit source]
Dementia can pose as a barrier to communication, which many may find upsetting or frustrating. These barriers can impact a wide range of issues, including the therapeutic interaction between physiotherapist and patient. There are methods and strategies which help facilitate interaction with people with dementia and those who support them, to communicate in a way that is most effective . These methods may require the physiotherapist to adjust skills, behaviours and the delivery of information such as those discussed regarding the non-dementia patient population. These alterations should meet the needs of the person living with dementia and facilitate and strengthen therapeutic interaction 
The following are some tips from the Alzheimer’s Society for using communication to enhance the therapeutic interaction with people living with dementia:
BEFORE YOU SPEAK:
- Environment – good lighting, minimal background distractions
- Attention – get the person’s full attention before beginning
- Position – where they can see you as clearly as possible, eye level is more preferable to standing over the person
- Proximity – sit close, but do not invade personal space
- Body language – maintain an open and relaxed composure
- Time – have enough to spend with the person, if you feel rushed or stressed, take a breath as this will come across to the other person
- Prepare – think about and plan what you will discuss, use the environment to enhance communication
- Timing – take advantage of the time of day the person is most alert
- Fluctuation – days vary, so make the most of the ‘good’ days and find ways to adapt to the ‘bad’ days
- Other needs – for example pain, hunger, should be met before beginning
HOW TO SPEAK:
- Clear and calm
- Pace – slightly slower, allowing time in between sentences for though processing and response
- Tone – avoid speaking sharply or raising your voice
- Brief and succinct – short, simple sentences
- Flow – speak in a conversational style, as opposed to a series of questions
- Talk to them, not about them – be patient and respectful, do not talk as if they are not there, or as you would a child
- Humour – try to laugh together about mistakes or misunderstandings. It can enhance the therapeutic interaction, and relieve pressure. BUT, be sensitive to the person and do not laugh at them
- Inclusion – involve the person in conversations with others, which may require slight adaptations of terms used. This can help a person with dementia to retain their sense of identity and value, while reducing feelings of isolation and exclusion.
WHAT TO SAY:
- Questions – avoid too many, or a complicated format, as this can cause frustration or withdrawal if the person cannot find the answer
- Closed questions – may be more appropriate as open-ended or choice questions may cause confusion
- Focus – stick to one idea at a time. Giving choice is important, but too many options can cause confusion
- Accessible – if the person is finding it hard to understand, break down your message into component parts so it’s more manageable
- Rephrase rather than repeat – also use non-verbal communication as an aid
- Short and often interactions – if the person fatigues easily
- Facilitate or correct? – as the disease progresses, the person may become confused about what is true or not. If they say something that is not true, try to find ways of steering the conversation around the topic, and look for meaning behind what they are saying, rather than contradict them directly
Listening is one of the most important elements of communication, and is more than the physical process of hearing. Active listening is the highest form of listening and therefore is a special communication skill. It requires listening not only for what is said, but also for the intent and feeling of the speaker. It needs to occur in a non-rushed manner, using appropriate body language, showing interest in the speaker’s words . It is a vital tool for a physiotherapist in communicating with a person with dementia , as is discussed below:
- Listen – carefully and offer encouragement
- If you don’t understand fully – rephrase what you have understood and check if it is right, the speaker’s reaction and body language is a good indicator of this
- Alternative phrasing – if a person has difficulty with word selection or finishing a sentence, ask them to explain it a different way. Observe their body language, facial expression and how they hold themselves as this can give you clear signals about how they are feeling
- Do not rush – allow plenty of time to respond, as information processing and responding may take longer
- Do not interrupt – as this can break the pattern of thought, so wait
- Expression of feelings – whether sad, or happy; let them express what they are feeling. Do not dismiss worries, sometimes it is best to just listen and show you are there
Non-verbal communication can be a pivotal tool especially as dementia progresses. In the later stages of the disease, it may become one of the main methods of communication. Therefore, it is important that the physiotherapist learn to control and use their own body language to get information across to a person with dementia. It is also important to be able to correctly understand the patient’s body language and recognize what they are saying so that they can be confident in supporting them to remain engaged and contribute to QoL . The following are some pointers  that may help with this:
- Your non-verbal communication – another person can read your body language, and a person with dementia is no different. Be aware of this as sudden movements or a tense facial expression may cause upset or distress, making communication difficult. Ensure your body language and facial expression match what you are saying
- Personal space and position – do not stand too close or stand over them, as it can be intimidating. Respect the person’s personal space and position yourself at or below eye level, as it will help the person with dementia to feel more involved and in control of the situation.
- Physical contact – can be used to convey your interest or to provide reassurance. It is important to assess the appropriateness of physical contact not only with each individual but also at each encounter.
To Correct or Not Correct?:[edit | edit source]
Although there is a lack of peer reviewed literature on how to communicate effectively with a dementia patient, and whether or not correcting the patient is appropriate, general opinion states that through continual correction the patient may begin to lose their ‘self concept if they are continually made to feel ashamed or embarrassed’ : p.1. During the early stages of dementia, it may be beneficial to ‘gently and respectfully remind the individual of facts, unless this has a tendency to upset them’ : p.1. Otherwise it is best to distract them, change the conversation and ensure that you do not lecture the patient as this can lead to arguments or negative responses ,.
It is also very important to avoid patronizing talk or elderspeak when communicating with this population as it has been found to increase restiveness, can lower self-esteem and increase dependent behaviour . ‘Resistiveness to care is measured by problem behaviour such as aggression, withdrawal, and vocal outbursts that disrupt care’ 
Tips for if a patient forgets conversation or event:
- ‘Avoid telling the person they have heard the information before.
- Ask yourself whether it really matters if the person remembers a recent conversation or event. Forcing the matter can makes things worse.
- Set up a regular routine. This can make it easier for the person to remember what is going to happen during the day.
- Encourage them to use a diary or journal to record things that have happened. Pictures and words are useful tools. They can be used to remind the person what they have done, as a conversation starter.
- Include cues and prompts, and try to give context, instead of asking vague questions.
- Consider using reminders such as sticky notes or a wall calendar for one-off tasks, and more permanent reminders for tasks the person does more
- Consider assistive technology devices
- Focus on one thing at a time: giving the person too much information may be overwhelming.
- Keep information simple, and repeat it often (if necessary).
- Reduce distractions such as background noise.
- Keep questions simple and specific, eg ‘Do you want tea or coffee?’ rather than, ‘What would you like to drink?’ This helps the person to make a choice by narrowing down options’ .
Assistive Technology – a General Overview[edit | edit source]
The Awareness of AT Devices and Solutions, and Codes of Practice[edit | edit source]
Bonner and Idris (2012)  claim, that the awareness of AT products, devices and solutions is fairly poor and unequal across the UK ‘relating to the quality of AT solutions available to people with dementia due to the varying approaches taken around the country.’ They add , that despite the existing ‘industry-led standards and codes of practice, it must be noted that currently there is no formal central guidance around what constitutes ‘good’ AT, no key indicators, etc.’
The authors also identify the need to address these issues, as ‘there is the risk that solutions will be sought which only partly achieve the required aims – or not at all – and the confidence in AT solutions is undermined’, which can lead to disuse of various types of ATs, despite their ‘very real beneficial features.’ 
Various Purposes of Using AT in Dementia Care[edit | edit source]
According to Alzheimer’s Society , technology can be used in many different ways and for many purposes – it can help carry out activities and everyday tasks, increase a person’s safety, improve their confidence and quality of life; help manage risks at home, etc.; help with memory and recall; enhance their social participation, and monitor their health. It can also support independence and can help people who have problems with:
- hearing and eyesight,
- safe walking,
- finding their way around,
- memory and cognition
- daily living activities
- socialising and leisure.
Some technological aids have been designed specifically for people with dementia, but a lot of technology targeted at general public can also be helpful. AT and assistive devices (ADs) can serve various purposes :
- devices such as: automated prompts and reminders, clocks and calendars, medication aids and locator devices;
- technologies supporting safety (automatic lights; automated shut-off devices; water isolation devices; special plugs; fall sensors; telephone blockers, etc.);
- technologies supporting safer walking – to minimise certain risks such as the person getting lost or leaving the house at night or not appropriately dressed (alarm systems alerting a person’s move outside a set boundary; GPS and radio-frequency tracking devices or location monitoring services);
- telecare – systems or devices that remotely monitor people living in their own home and that can enable them to get support or access response services when necessary. They include community alarms, sensors and movement detectors, video conferencing; devices monitoring daily activity, such as movement sensors that oversee a person’s activity at home during day and night.
While devices listed above are useful in enhancing quality of life for people with dementia, their functionality lies mainly in supporting everyday tasks, enhancing safety and independence, and monitoring health; and does not target issues with communication and social interaction.
Bharucha et al. , quoted in Klimova et al. , observe that the literature on assistive technologies for people with dementia focuses on the devices supporting physical disabilities or on engineering and science domains rather than cognitive or functional disorders, despite the fact that these disorders are the most debilitating in dementia .
Use of Assistive Technology to Enhance Therapeutic Interactions[edit | edit source]
Murphy et al. ) believe that the progressive, gradual deterioration of a person’s ability to remember, understand, reason and communicate is one of the most distressing aspects of the illness, both for the person with dementia and their family, friends and caregivers. This can put pressure and demands on staff in various care settings to improve their communication skills .
As we have already established in our previous chapter ‘Communication to enhance therapeutic interaction’, communication is a vital component of therapeutic interaction –. We have also explored the effects dementia has on the affected person, such as memory loss, reduced cognition, linguistic and sensory impairments, etc. ,. Considering the above factors, we can assume that modifying these variables by the means of certain ATs, can have an effect on communication, and thus, can potentially enhance therapeutic interactions between the patient and the therapist, which the present section will explore.
Low-tech Tools and Devices Enhancing Communication and Interaction in Dementia[edit | edit source]
AT has traditionally been used to help people with dementia remain safe and continue with everyday activities, but it is increasingly being used in supporting communication and social life, and to provide opportunities for activities and enjoyment, which is important in improving quality of life for people with dementia . Technology can help express patients’ opinions and communicate their views and preferences ,) which is essential for the development of person-centred care, the underlying element of successful ‘therapeutic communication’ ,.
Many AT devices are electronic, but the term is not exclusive to high-tech devices . Even the simplest AAC devices , using only pictures or symbols can be used to communicate desired words. Talking Mats ,, is a widely accessible type of low-tech AAC tool (a digital, ‘high-tech’ touch screen version has recently been developed) which uses a simple system of picture symbols and a textured mat that allow people to point out their feelings about various choices within a topic by placing relevant images below a visual scale. It was found that conversations using Talking Mats were more effective for people with dementia than both unstructured (ordinary) or structured conversations. Improvements were clearly visible in the participants’ understanding, engagement, and ability to keep on track and make their views understood.
In their study ,, Murphy et al. interviewed 31 people at various stages of dementia about their well-being in order to compare the effectiveness of communication between usual communication methods and Talking Mats ,. The study found that:
- Talking Mats enhanced the reliability of information provided by people with dementia and extended conversation time.
- The amount of time spent ‘on-task’ – e.g. making eye contact and engaging actively in conversation – increased when using Talking Mats, and subjects were less distracted.
- Talking Mats reduced instances of repetitive behaviour, such as repeating words, phrases, ideas or actions.
Murphy et al. , concluded that Talking Mats can be used at all stages of dementia and that it is an effective tool that improves communication and the quality of care by helping people with dementia to engage with family and caregivers and to communicate their needs and preferences.
High-tech Tools and Devices Enhancing Communication and Interaction in Dementia[edit | edit source]
The nature of assistive technologies is changing . The interest in the implementation of high-tech ATs, e.g. touchscreen technology, to improve quality of life for older people, particularly those living with dementia, is growing ,. In contrast to a common belief that age is a negative factor in using technology, research shows that older generations of people are more digitally aware than 10 years ago .
Technologies and apps for smartphones and tablets are now more accessible thanks to the widespread access to the Internet, and devices and apps that have been developed for the general public are progressively being used by people with dementia .
There are also apps that are developed primarily for people with dementia ,  and a guide is being developed by the University of Sheffield’s Centre for Assistive Technology and Connected Healthcare (CATCH) that aims at identifying apps suitable for people living with dementia .
Touchscreen devices are both interactive and easy to use which can help incorporate ‘restorative memory’ and creative therapy interventions ,. Along with the touch screen version of Talking Mats mentioned in the previous section ,,, one of the most popular apps used in dementia is MindMate , – a self-management app designed to provide an assistance platform for people with dementia, carers and family members. The aim of the app is to engage the patient and help keep their mind active, facilitating the retention of their memories and, by connecting the family, it enables the sharing of information with the carer. It is used by over 45,000 people at home and in various care settings .
It is believed that technology can help people with dementia express themselves and enhance interaction with others (131), and touchscreen devices such as Apple’s iPad (and other manufacturers’ products, also called tablets), have proved popular and have an enormous range of ‘apps’ .
Despite the beliefs and positive observations ,, the University of Worcester’s Association for Dementia Studies (2015) , identifies that there is a lack of ‘systematic approaches to introducing and using touchscreen technology in care settings, as well as a lack of evidence based analysis of the benefits’ ,, and more research is still needed.
The biggest study to date, conducted by the University of Worcester in collaboration with Anchor ,, England’s largest housing and care provider for older people, found that iPads have significant potential to enhance the quality of life of older people in care settings, especially patients with dementia. The study evaluated apps used to reassure, calm, interest and engage residents.
Researchers identified a range of positive outcomes for residents with dementia including increased interaction, greater inclusion and improved communication with relatives. The iPads ‘allowed greater interaction between residents with 56% of staff able to involve ten or more residents in activities at one time. Interaction with relatives was also cited as a key benefit with 46% of staff involving family members through the use of iPads. ,
- Supporting reminiscence: recording people’s life histories using apps such as Life Journal triggered positive emotions;
- Aiding recall: the technology was highly valued as an aid to help with ADLs;
- Increasing interpersonal reactions: the use of iPad ‘increased communication with other residents, staff members and family. iPad use enhanced interactions both directly – through activities involving the iPad – and indirectly – by talking about the iPad.’;
- Intergenerational communication: sharing the experience of using the technology acted as a link between younger and older generations;
- Staff-resident relationships: working with the technology helped to get to know the residents better and increased rapport;
- Improving quality of life: via increased interactions and learning opportunity provided by the technology;
- Ease of use: the iPad was perceived to be easier to use than an ordinary.
- Access to WiFi networks is easily provided;
- The staff should be trained and should have the confidence and skills to support their patients;
- The users get one-to-one scaffolded support when needed; and
- The ergonomics of the device, etc., are addressed.
It seems that the touch screen technologies can enhance therapeutic interaction for people with dementia by positively affecting factors such as memory retention, reminiscence, direct and indirect interaction with peers, family and staff; communication and ways of expressing themselves which helps the therapists better understand their needs.
The researchers , recommend that touchscreen technology such as iPad should be successfully implemented on a wider scale in care settings, as it has been found to enhance reminiscence and recall, improve staff-resident rapport and increase interpersonal reactions, etc.
They also recommend , that further prospective evaluation is needed ‘in order to establish the evidence base, particularly in regard to a rehabilitative role for touchscreen technology in the care of older adults with dementia in residential and nursing care home settings.’
The Future of AT in Dementia[edit | edit source]
As we have already mentioned in the previous sections, more research and evidence base is required to fully evaluate the positive impact of AT on people with dementia ,. Evans et al. (2015)  suggest that future development of ATs needs to implement user centred design and user testing. AT designers should use the available literature ‘in order to inform the design of AT for people with dementia. Using interviews with individuals with dementia but also with their caregivers, enables designers to discover what the individuals with Dementia really want and need, as well as what their care givers want and would benefit from so as to increase acceptance. It is not sufficient to simply understand the theoretical causes and implications of cognitive impairment, technologists need to understand what the user and their caregiver really wants from technology’ 
Dementia gradually affects cognition and communication, which in turn can have a negative effect on therapeutic interactions. ATs are increasingly being used to help people with dementia overcome every-day problems in communication and cognition, and AT devices such as hearing aids and ‘low-tech’ AAC and/or ‘high-tech’ touch screen devices have been found to help memory retention, reminiscence, direct and indirect interaction with peers, family and staff; communication and ways of expressing themselves, etc., all of which can have positive effects on therapeutic interactions. Research in this field is still limited and further research is recommended to establish good evidence base.
As the ageing population progressively increases, physiotherapists will be faced with increasing numbers of those living with dementia. As health care professionals, we must engage and promote therapeutic interactions with this population in order to provide optimal patient outcomes. Due to the deteriorations in communication and cognition that can occur with this population, it is important to utilise techniques such as: managing ones attitudes and beliefs, promoting the optimal patient environment, various exercise interventions and assistive technological devices to ensure optimal emotional comfort and patient personal control. Through ensuring psychological and physical well being of a patient, behaviour that can be deemed “problematic” can potentially become better controlled and patient QOL can be enhanced.
If you wish to further develop your knowledge of therapeutic interaction with persons living with dementia, check out these links, documentaries, etc.
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- Pinto, R.Z., Ferreira, M.L., Oliveria, V.C., Franco, M.r., Afams, R., Maher, C.G. & Ferreira, P.H. Patient-centred communication is associated with positive therapeutic alliance: a systematic review. Journal of Physiotherapy. 2012; 58(2);77-87
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