Feasibility of evidence-based hand exercises in a home-based program for patients with Alzheimer's disease and depression

Abstract

Ever-growing attention is being focused on the preservation of cognitive ability and on slowing the decline in people with Alzheimer's dementia (AD) utilizing an integrative treatment model (combination of medications and non-pharmacological interventions). The interventions related to increasing regional cerebral blood flow (CBF) for people with AD are in the earliest stages of development. An increased regional CRF in healthy individuals, during hand movements, has been described (Roland, P.E., 1982, Kawashima, R., 1996). To facilitate the CBF in demented, depressed seniors we have developed a set of hand - tennis ball exercises ™ for home-based programs (Bragin V., 2007). In this presentation it will be a description of the latest set of hand exercises (2010–2012) for patients with dementia and physical disabilities, applicable to office and home-based interventions. The set of hand exercises consists of hand and finger movements performed with one or both hands. After completion of the initial assessment of hand movements, all patients receive in-office training and a workbook for home-based programs plus a DVD that demonstrates the exercises. The patients are asked to pay close attention and memorize the series of hand and finger movements. Later on the dual-task portion of the program is introduced, which incorporates breathing or counting during hand exercises. We use video recording and simple computer registration of motor speed and reaction time to monitor the progress of training and finger mobility. The patients tolerate these exercises very well and over time they memorize the movements using their procedural memory capacities. These exercises help the patients regain hand and finger mobility, coordinate hand movements, and increase attention, procedural memory, and brain speed. These movements also have immediate positive effect on emotions. Patients and their caregivers report an absence of intrusive thoughts during exercises and lessened feelings of depression and anxiety. Hand exercises as a component of a home-based integrative program could positively improve hand movements for seniors living with AD. This program appears feasible for outpatient memory clinics, rehabilitation facilities, and nursing homes. The effectiveness of this model in various settings requires and deserves further research.