Rehabilitation and Dementia: Finding the Right Moment, Not Just the Right Exercise

Rehabilitation for people living with dementia is sometimes misunderstood.There can be an assumption that if cognition is significantly affected, meaningful physical recovery is unlikely — or that rehabilitation simply “won’t work”.

In reality, rehabilitation can work very well in dementia — when it is done in the right way, at the right time, and in the right place.

This is a story about Jo.

Jo’s Story

Jo was a lady living with significant dementia who fractured her hip following a fall. Prior to this, walking had always been a central part of her life. She had been a keen walker and traveller, with a particular love for coastal paths and being outdoors. Before her fall she was walking in the care home.

Following her hip fracture, Jo spent time in hospital. During her admission:

• She required a hoist for transfers

• Engagement with therapy was extremely limited

• Sessions were often short and difficult

• The busy, unfamiliar hospital environment appeared overwhelming

Despite best efforts, Jo was discharged to her care home with very limited mobility and was still being hoisted for transfers.

Starting Rehabilitation in the Care Home

When we began supporting Jo in the care home, it quickly became clear that how and where rehabilitation was delivered would be critical.

An initial session took place in a busy conservatory. There was lots going on — people, noise, movement, distractions. Jo found it difficult to engage, and the session was not productive. Importantly, this was not a failure — it was valuable information.

It told us what didn’t work for Jo.

Changing the Environment — and the Outcome

We adjusted our approach.

Instead of seeing Jo in a communal area, we scheduled sessions:

• In her own room

• After her morning personal care

• At a time when she appeared calmer and more settled

The difference was noticeable.

In this quieter, familiar environment, Jo was more able to focus and tolerate activity. We started gently, initially working on standing. Over time, with regular input and repetition, Jo began to take steps again.

Progress That Mattered

Gradually, Jo progressed from standing to walking with support. With ongoing rehabilitation:

• She moved from hoist transfers to transferring with two carers

• She began walking again using a four-wheeled walker, particularly in the mornings

• Carers were involved in her rehabilitation to ensure consistency and carryover

Although Jo’s dementia did not change, something else clearly did.

When walking, Jo appeared more engaged with her surroundings. She looked around more. Her posture changed. Her face seemed lighter. Although she no longer smiled in a way that was recognisable, what we saw at the end of one session was the closest thing to a smile — and it mattered.

Most importantly, Jo was walking again — an activity that had been a defining part of her life.

What This Teaches Us About Rehabilitation and Dementia

Jo’s story highlights several key principles:

1. Dementia Does Not Mean “No Rehabilitation”

People living with dementia can still regain strength, mobility, and function — even when cognitive impairment is significant.

2. Environment Matters

Busy, noisy spaces can be overwhelming. Familiar, calm settings often allow better engagement and safer movement.

3. Timing Is Crucial

Choosing the right time of day — when someone is most settled — can be the difference between a session that doesn’t work and one that does.

4. Engagement Can Look Different

Progress isn’t always measured in smiles or conversation. Changes in posture, awareness, and connection to movement are meaningful outcomes.

5. Consistency Is Key

Involving carers in rehabilitation allows progress to be reinforced daily, not just during therapy sessions.

Rehabilitation Is About the Person, Not Just the Problem

Jo’s rehabilitation wasn’t about “fixing” her dementia — it was about honouring who she was.

By adapting the approach to suit Jo, rather than expecting Jo to fit a standard therapy model, we were able to:

• Reduce dependence on hoisting

• Improve functional mobility

• Restore an activity that had always brought her purpose

Walking again didn’t change Jo’s diagnosis — but it changed her days.