부산대학교 도서관

The predicted 'epidemic of dementia', present lack of a cure, attitudinal changes towards institutionalisation and association of immobility with admission to long term care together highlight the need to research clinical claims that physiotherapy treatment improves mobility. Participants in this investigation were resident in hospital long term care (psychiatric). Mobility was measured by the Two Minute Walking Test and the assessment tool developed as part of this investigation. Biomechanical studies provided construct validity for the task analysis format which assessed ability from immobile (score 0) to walking four steps (score 18). Kappa coefficients for inter rater reliability ranged from 0.1, p< 0.001 to 0.92, p< 0.0001 with only three items being below 0.5. Thirty five people participated in a descriptive longitudinal study. Trends found suggested that natural improvements may be unlikely and that mobility was lower in the 17 participants who died during the year than those resident at the end of the study. In addition mobility may also be lower in the presence of abnormalities of muscle tone, posture and sitting balance but no differences were found in these neuromuscular features between those who died and those who survived. The response to physiotherapy treatment (functional mobility training, music and movement and body awareness) was examined by two studies. First sixteen people completed a randomised crossover study. In comparison with change of scores during the control phase the treatment phase showed a significant improvement (p= 0.043). Secondly seven people completed all phases of an ABAB single case study. Six of these significantly improved mobility score when physiotherapy was introduced for the first time but maintenance of improvements was equivocal. Results suggest that poor sitting balance on initial assessment may be associated with deteriorating health (9 participants withdrew). The findings of this initial investigation suggest that physiotherapy treatment may improve mobility of elderly people with severe dementia. Therapeutic optimism is encouraged. Hypotheses for testing by controlled clinical trials have been generated.