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Express Yourself

April 20th, 2016 by

What are you doing to make sure you’re aging well? Most people watch their diet, visit their doctors more frequently, and try to exercise more. But is that enough to make your senior years successful?

A documentary, Alive Inside, argues that to truly age well, one needs the arts. The film explores the role music plays in memory, citing cases of patients with dementia and even seniors with typically failing memories suddenly being able to recall vivid scenes from their past with the aid of familiar music. The idea is this: Playing favorite or familiar music for a subject will help trigger vivid recollections, even if the subject’s brain isn’t functioning as it once did. This musical therapy has even inspired the Music and Memory Project, which funds iPods for seniors who can deeply benefit from enjoying music that meant so much to them long ago.

But music isn’t the only thing keeping seniors young at heart. Both the National Endowment for the Arts and the National Institute on Aging have programs that promote all forms of the arts to seniors. Whether painting, composing, dancing, or appreciating, an appetite for the arts seems to help seniors enjoy the aging process. Some seniors write novels or screenplays that a senior acting troop can bring to life. Some seniors paint abstract or classical art to decorate their rooms or local senior centers. The form of expression doesn’t seem to matter as long as something is being expressed creatively.

Some scientists believe that it’s not the art, but the social engagement that is critical to keeping seniors vital. But studies have shown that listening to familiar music, even without engaging with others, can improve memory.

So this weekend, why not plan to include a little art in your life? Catch a concert or go to the symphony with friends. Sign up for a painting class and learn a new technique. Or sit down and write out that story idea that’s buzzing around in your head. Expressing yourself creatively may be the key to keeping yourself happy as you age.

Agitation in Dementia

March 4th, 2016 by

While memory impairment is often what comes to mind when one thinks of Dementia, agitation is what most often causes my phone to ring with a request for an evaluation. Behavioral changes, paranoid delusions, hallucinations and long periods of screaming were described by the psychiatrist Alois Alzheimer, for whom Alzheimer’s Disease is named, in 1907 in his original case description of the disease nearly 100 years ago. ‘Agitation’ is a term that is most often used to describe a wide variety of behavioral symptoms seen in patients with dementia. The medical term used to describe these symptoms is the Behavioral and Psychiatric Symptoms of Dementia, or BPSD for short.

It is estimated that BPSD affects up to 90% of all individuals with dementia over the course of their illness, and is independently associated with poor outcomes, including distress among patients and caregivers, long-term hospitalization, misuse of medication, and increased health care costs.

There are several categories of BPSD, these include:

  • Disturbances of emotional experience such as mood lability, depression, anxiety, irritability/hostility, apathy, and crying spells.
  • Psychotic experiences including delusions, hallucinations, and paranoia.
  • Sleep Disturbances such as sleeping excessively, waking up frequently, sleepwalking and its related conditions.
  • Appetite Disturbance can manifest as low to non-existent appetite and weight loss, excessive appetite/demands for food, and ingestion of non-edible substances.
  • Disinhibited Behaviors include wandering (present in about 25% of patients with Alzheimer’s), yelling (seen is 25% of Nursing Home residents), excessive talking, inappropriate sexual behaviors, and hypermetamorphosis (the need to touch, and sometimes hoard, every object in sight).
  • Personality changes can manifest both as acting in atypical ways as well as experiencing a ‘distillation’ of the personality so that the person behaves as a caricature of themselves.
  • Uncooperative behaviors are most often related to personal care such as bathing, dressing, taking medications, and grooming activities.
  • Certain behaviors can be more commonly associated with different types of Dementia. For example, hallucinations can be a prominent feature of Lewy-Body Dementia, and Complex Sleep Related Behavioral Disorder is often associated with Parkinson’s Dementia, and changes in personality can be the first symptoms of Fronto-Temporal Dementia.

While these behaviors are often manifestations of the underlying brain damage caused by dementia, they are sometimes related to co-occurring medical conditions which should be evaluated as part of an assessment of BPSD. These include things such as urinary tract infections, vitamin deficiencies, thyroid abnormalities, diabetes, kidney and liver function, and pain syndromes.

Assessment of BPSD begins with a thorough evaluation consisting of gathering information from multiple sources to learn not only about the onset and evolution of the BPAD and underlying dementia, but also a detailed assessment of medical conditions, all medications being taken by the individual, as well as an assessment of the possible contributors/triggers of the BPSD from the living environment.

Improvement of BPSD is often achieved through a combination of adjustments in medication, treatment of any underlying medical conditions, and modification of the individual’s environment/caregiver approach. Because there are so many different types of agitation and because each patient’s background, life story, medical issues, and temperament are unique, an individualized approach that takes all of these variables into account is most likely to be successful.

 

Use It or Lose It

February 25th, 2016 by

When we think of retirement, most people picture a life of ease: sipping cocktails by a beach, playing with grand-kids, or finally getting a chance to relax on the couch and catch up on your Netflix time. All of these activities can be great fun, but where’s the challenge?

For years, scientists have seen a link between engaging in enjoyable activities and maintaining a healthy brain. But could merely engaging in enjoyable activities be enough?

In a new study featured in Restorative Neurology and Neuroscience, researchers have found that the brain works best when it’s challenged. The study followed two groups of seniors: One group was assigned to socialize for 15 hours a week, engaging their peers, but learning no new skills. The other group was taught skills on a digital camera for 14 hours a week, taking on progressively more complex assignments. Scientists found that the group who spent their time actively learning new and challenging skills did better on cognitive tests.

Researchers are drawing links between strong neural pathways in the brain and cognitive challenges. This means that while chatting with friends might make you feel young, learning Russian could keep your brain young.

How do you challenge your brain? Scientists are still trying to determine what parts of learning preserve neural pathways, but they believe that increasingly difficult tasks are the best way to keep your brain healthy. Objectives like learning a language, developing a new craft, or memorizing a dance routine are good ways to engage your brain in active learning. Consider perusing the brochures for community college classes near you or check neighborhood bulletin boards to help you find an interest that will allow you to challenge your brain.

Whether you’re hoping to stave off memory loss or just want to spend retirement discovering all the things you didn’t have time for while you worked, the point is this: Learning isn’t always easy, but hard-won lessons impart precious knowledge as well as promote a healthy brain.  

Don’t Get SAD; Get Better

February 11th, 2016 by

Winter can be a bit of a downer.

Snow, ice, unsafe driving conditions, bitter cold—all of these factors can make winter seem depressing. But winter blues are more than just a passing notion; each year some people get SAD, or Seasonal Affective Disorder. SAD is a clinically diagnosable form of depression that can result in overeating, fatigue, difficulty concentrating, and loss of interest in daily activities. Scientists theorize that SAD is brought on not only by the drop in temperature, but the reduced amount of daylight. In essence, our bodies respond to the change in season by slowing us down physically and emotionally.

For seniors, SAD can be especially debilitating. The National Alliance on Mental Illness reports that more than 6.5 million Americans over the age of 55 experience depression. To make sure that seniors are not suffering from SAD, caregivers and loved ones should keep an eye out for crucial signs. If seniors seem to have lost interest in activities they typically enjoy, isolate themselves from friends and family, or spend inordinate amounts of time sleeping, caregivers should consider intervention.

Unlike for many forms of depression, for SAD there is a simple, non-pharmaceutically based treatment: the sun. Exposing SAD sufferers to sunlight can help energize and cheer most patients. If you suspect a senior is suffering from SAD, bright, sunny areas of the home are the best way to elevate their mood without the use of chemicals. Light box therapy is another effective option—filling a room with artificial sunlight to help minimize the effects of SAD. Sunlight therapy lamps, which are inexpensive, might also be an intelligent addition to your home décor. Even those who aren’t suffering from full-blown SAD will get a natural boost from the simulated sunlight.

Whether you’re worried about a senior who seems down or trying to cope with the effects of the season yourself, no one has to be SAD. Stay mindful of the signs, and seek help if any SAD symptoms present to eliminate this highly treatable form of depression.

Sing Along If You Know the Words

January 19th, 2016 by

What’s your favorite song?

Whether it’s a golden oldie or new music, chances are, if it’s your favorite you know the lyrics by heart. You sing them on long car rides, in the shower, or when you’re having a good day. It turns out, these impromptu karaoke sessions are good for more than your vocal training.

Finnish researchers have found that singing may be a way to improve brain function, even in patients with early stage dementia. Singing improved the mood and the cognitive abilities of everyone in the study, especially those with early stage dementia.

Researchers studied the effects of music on the brain for 10 weeks, allowing seniors to sing their favorite tunes, hum music, and listen to tunes. Seniors with mild dementia showed improvement in memory, thinking skills, and their ability to get around. Those without dementia showed improved memory skills as well.

Singing also served as a mood elevator. Seniors who were encouraged to sing reported mood improvement and increases in optimism.

What does this mean for the seniors in your life?

It means it’s time to get musical.

If your loved one is having trouble with memory or mood, consider signing them up for a music class or a senior singing group. An activity with a musical theme is also an excellent idea for seniors with no memory problems, as it will help keep them sharp. If you can’t find a music-based activity, singing along may be the key to victory. Get your senior’s favorite music and arrange for an interactive concert. Afraid of sounding off-key? The study shows that even those who listen to music can reap the mental benefits.

Whether you’re hoping to keep your mind honed or simply interested in a sing along, music may be the key to keeping healthy in 2016.

The Diaphragm: An often neglected Superstar for core and spinal stability for seniors

December 21st, 2015 by

In spite of the Diaphragm being one of the most important muscles in our body, it is often neglected and at times added to our exercise program as an afterthought.

diaphragm viewdiaphragm side view

Diaphragm is a large dome shaped muscle that completely separates the thoracic cavity (heart and lungs) from the abdominal cavity. It is attached to the sternum, the lower 6 ribs, and the top 2 to 3 lumbar vertebra.


 

The Diaphragm is one of the 4 deep stabilizers of the spine along with the pelvic floor, Transversus Abdominis (deep abdominal muscle) (TA), and the multifidus (back extensors). The contraction of the diaphragm causes pressure changes in both the cavities. When the diaphragm contracts, it moves down into the abdominal cavity. This creates an increased intra-abdominal pressure (IAP) which is countered by the resistance of the pelvic floor on the bottom, the TA in the front and the multifidus in the back- thus stabilizing the spine. “Without proper diaphragm contraction the increased IAP will not reach all the way down to the lower lumbar spine, where the loading is most prominent” (Hans Lindgren, 2011).

Our trunk can be compared to a soda can to understand how the diaphragm contributes to spinal stability. A soda can by itself is not strong, what makes it strong is the simple physics of pressure. It is not possible to smash a soda can when it is full and unopened because of the positive pressure from inside being exerted on the atmospheric pressure and gravity.  However, once you pop the can open, it is easy to crush the can. “The skeletal support of the trunk is not inherently strong. The trunk of the body uses a concept similar to the soda can to prevent being “smashed” by external forces”. The 4 deep core muscles, diaphragm, pelvic floor, TA and back extensors (multifidus) help to increase and provide positive intra-abdominal pressure to stabilize the spine and counter the compressive forces of gravity, (Massery 2012).

Conclusion

  • Core stabilization starts with the proper function and activation of the diaphragm.
  • It is necessary to strengthen all the 4 deep core muscles – Diaphragm, TA, pelvic floor and multifidus to allow the diaphragm to support the simultaneous needs of respiration and trunk stabilization.
  • Without the regular pressure changes within the thorax and abdomen provided by the diaphragm- hypotension, constipation, ineffective bladder drainage, and poor respiratory function can result (Massery 2012)
  • Proper functioning diaphragm is necessary for better posture, better balance, decreased low back pain, spinal mobility, and overall improved function and performance.
  • The effects of aging, shallow breathing and disease may negatively impact your ability to use your diaphragm and cause dysfunctional breathing patterns.
  • Dysfunctional breathing patterns are a common contributing factor for stiffness and pain in the neck, low-back and it is often a strong predictor of back pain (Smith et al 2006).

Refer to this link for an example of a Diaphragmatic breathing exercise.

To learn more or to work on your diaphragm, contact Mobility & More Inc. to have an in-home customized fitness program or physical therapy session.

Bordoni B, Zanier E (2013) Anatomic connections of the diaphragm: Influence of respiration on the body system. Journal of Multidisciplinary Healthcare. 6;281-291
Courtney Rosalba (2009) the Function of Breathing and It’s Dysfunction and their Relationship to Breathing Therapy. International Journal of Osteopathic Medicine. 12; 78-85
Massery M (2012 Multisystem clinical implications of impaired breathing mechanics and postural control. In: Frownfelter D, Dean E, eds. Cardiovascular and Pulmonary Physical therapy: Evidence to Practice. 5ed. St, Louis, MO: Elsevier-Mosby
Smith MD, Russell A, Hodges PW. Disorders of breathing and continence have a stronger association with back pain than obesity and physical activity.  Aust J Physiotherapy 2006; 52;11-16

A special contribution from:

Priti Prabhu, MSPT
Mobility & More Inc.
202 386 1595
Mobility & More Inc. provides customized individual and group senior fitness and physical therapy sessions to clients in the comfort of their homes and communities to improve quality of life and maintain or improve functional independence.