Monthly Archives: October 2020

skilled nursing isolation

We RESTORE-Skills TOGETHER!

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RESTORE-Together motivates skilled nursing patients to safely collaborate with loved ones and join team activities

Isolation is not for us. As human beings, we are together creatures. We strive for connection from the second we are born; from the minute we look for our mother’s eyes to the language we develop, the relationships we build, and the communities we are so proud to be part of.

Today we are proud to launch RESTORE-Together, enhancing our motivational therapy platform with a multiplayer function.  Patients now have the ability to play therapy-driven skill-building games remotely with their loved ones, connect with other residents in the skilled nursing facility for a group activity, and even participate in live, nationwide gaming tournaments — all from the safety of their rooms!

RESTORE-Together addresses isolation challenge

RESTORE-Together couldn’t have come at a more crucial time. 

Among the biggest emotional challenges, residents are facing during the pandemic is social and emotional isolation. Residents have spent months in their rooms, with day rooms and therapy gyms closed, limitations on visits,  and still no end in sight.  

A new survey of 365 nursing home residents in 36 states, conducted throughout July and August, by the non-profit Altarum Institute, shows that pandemic restrictions have affected nearly every part of residents’ lives, especially their mental health. According to the survey results, “76 percent of respondents reported that they felt lonelier under the restrictions, an unsurprising finding, given that 64 percent of respondents also indicated that they no longer even leave their rooms to socialize with other residents.”

Multiplayer, social gaming opportunities offer residents a chance to safely socialize while making therapy strides.

In our beta testing of RESTORE-Together, the feedback from therapists, patients and their family members has been overwhelmingly positive. We saw firsthand patients’ excitement for the opportunity to connect and share an experience with a loved one or friend. One patient in a Columbus, Ohio-based nursing home tripled his standing tolerance while competing in our slot machine game against his sister in Cleveland. It was a powerful moment for the patient, his sister, and the occupational therapist working with the patient.

We know that today, during the forced COVID-19 isolation, finding the motivation to practice therapy exercises is even more challenging. And residents and therapists alike are tired of the limited therapy exercises they can practice in the patient rooms. 

With RESTORE, we have seen how making therapy more fun, with patient-centered games provides a tremendous boost to motivation. RESTORE turns every patient room into a therapy gym, and now RESTORE-Together turns these same rooms into group therapy gyms.

Group activities that motivate residents with a sense of competition from the safety of their room

Breakthroughs are created when we work together. Even tennis players are not alone in a game, during the game breaks, they communicate with their coaches to get advice and release emotions. When running a marathon seeing your family cheering along the way gives you a burst of energy that will support you in the following miles. 

Just prior to the pandemic, skilled nursing facilities were providing more group and concurrent therapy sessions to comply with PDPM, the new payment system from October 2019. Therapists found that the group dynamic added a social element to therapy, similar to the motivation people receive from a workout buddy or group exercise class. Just as these sessions became more popular, therapy gyms closed.

RESTORE-Together provides nursing home staff with the ability to create a facility-wide activity. Residents now are missing the close friendships and connections that normally occur in these facilities. Thanks to Restore-Together, residents can once again safely join a social activity without leaving their rooms. The smiles on the patients’ faces trying to win a virtual air hockey game while working on transitional movements showed us the power of collaboration.

Studies show that participants are more motivated to complete a physical effort task in which they face competition from another player over one where they are rewarded for winning an overall percentage.

No doubt RESTORE-Together will be an additional source of motivation and smiles for nursing home residents, their families, and the teams working with them across the U.S.  

No special hardware is needed, RESTORE-Together offers all the benefits of RESTORE, now with the additional benefit of collaboration. Thanks to the RESTORE platform, facilities across the country can do the following from their simple laptops:

  • Turn every patient room into a therapy gym with just a laptop and a webcam
  • Employees on every level can become a skill-building superstar. 
  • Connect patients to loved ones and other therapy patients
  • Keep seniors busy, active, and engaged

Everything we do at RESTORE-Skills comes from our passion to help therapists motivate patients. We want to see every patient restore the skills they need to live a more full and independent life. 

Let’s RESTORE-Together,

Eran Arden

Falls Prevention

Q&A: Falls Prevention

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Question: 

How can we utilize RESTORE with our patients in support of falls prevention?

Answer:

Great question. To start we have to consider the physical and cognitive components required for a comprehensive falls prevention approach:

  • Core and lower body strengthening (squats, lunges, etc.) to improve center of gravity control, stability to support sitting and standing
  • Static and dynamic sitting and standing balance (no reaching, single extremity reach, bilateral hands-free isolated and integrated movement patterns)
  • Weight-shifting, lateral mobility, forward/backward mobility
  • Activity tolerance for posture, movement required for completion of self-care, leisure skills, home and community management
  • Sustained attention, concentration, visual scanning, sequencing, safety awareness, decision making, following commands/direction 

RESTORE can be used in support of each component. Progress can be accelerated by combining functional skill-building with immersive, interactive content (preferably person-centered based on the expressed interests of the player). Let’s consider the following:

 

  • Game controllers calibrate to most red, green, blue objects. 

 

  • If working on functional reaching, select objects appropriate to maintain grasp/hand control or optimized for patients with only gross motor extremity control 
  • The calibrated controller for mobility should optimally have a center of the body placement (between chest and abdomen) so the player can maintain hands-free (especially if in need of assistive device)
  • Use the controller/camera view box (camera or white box in the lower right portion of the screen which tracks controller connection) to assist with patient positioning based on desired movement patterns

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    • Game settings and webcam settings can be graded based on the current physical and cognitive abilities of your player:

     

    • Backgrounds can be adjusted for greater contrast or to simplify visual display
    • Speeds and difficulty can be ranged from easiest to most difficult
    • Music and effects can be varied for appropriate encouragement and engagement
    • Range of motion capture can be reduced for players with limitations or expanded for those with full range capabilities
      • Best for games challenging a combination of up/down, left/right, and diagonal movement patterns
      • Best for games challenging a combination of up/down and left/right movement patterns
      • Best for game challenging left/right movement patterns in sitting, and left/right, forward/backward movement patterns in standing
    • Webcam setting options
    • Full, medium, small screen capture
    • Large, medium, small circular capture (narrows capture from square to circular configuration) 
    • Large, medium, small semi-circular capture (maintains top screen circular capture, but removes bottom screen circular capture requirement

     

    Demonstrate intended movements and explain why they are critical components to limiting or preventing falls

    • Patients are often fearful of falling. Having the ability to pattern their movements after seeing the therapist in action, can instill greater understanding and confidence 

     

    • Determine which skill areas you plan to target and match the game(s) with your plan. A few to consider with default game duration:

     

    • Ski Saga (default is 3 minutes). Players can control a skier in a race by stepping/shifting left/right and squatting, or up/down, left/right upper extremity movements to avoid obstacles, slalom between flags, and obtain coins and gems. Bonus points awarded after 10+ successful obstacle navigations
    • Ancient Temple (no set time limit). Players use both hands, sitting or standing, in an alternating up/down movement pattern to simulate rock climbing, with various integrated movement patterns included to challenge this treasure hunt adventure 
    • Spooky Spiders (default 3 minutes). Players utilize a dynamic, upper extremity or mobility, range to shoo away spiders of all sizes dropping/climbing vertically while watching out for a chance to knock a witch off her broom flying horizontally across the screen 
    • Bounce It (default 2 minutes). Players align with a silhouette, sitting or standing,  and can use their knees, feet in an upward motion to connect and juggle a soccer ball.

     

    When players (patients) are having fun and engaged they focus less on targeted skills and more on the game. They have less anxiety or frustration overcoming gravity and a fear of falling, when not focused on that fear every second. When a player demonstrates appropriate control, sustained action, adequate activity tolerance, and desired cognitive function that is when it is most beneficial to follow up a RESTORE session with a functional activity as they will now have the confidence to complete successfully.

    RESTORE Self-Feeding Skills

    Q&A: Self-Feeding Goals

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    Question: 

    How can RESTORE help therapists to support self-feeding goals with patients?

    Answer:

    Great question. To start we have to consider the physical and cognitive components required for self-feeding:

    • Ability to bring hand to mouth
    • Ability to apply and sustain proper grasp or prehension to a utensil or finger food item
    • Activity tolerance for posture, movement for anticipated feeding duration
    • Sustained attention, concentration, problem-solving, sequencing

    RESTORE can be used in support of each component. Progress can be accelerated by combining functional skill-building with immersive, interactive content (preferably person-centered based on the expressed interests of the player). Let’s consider the following:

    • Game controllers calibrate to most red, green, blue objects. 
      • If working on up/down movements with hands for finger food, select objects to replicate prehension or grasp
      • You may even consider real food items in the color family such as grapes, tomatoes, apples, candy, etc.
      • If working with utensils, select a spoon that is red, blue, green or can have a colored sticker attachment
    • Game settings and webcam settings can be graded based on the current physical and cognitive abilities of your player:
      • Backgrounds can be adjusted for greater contrast or to simplify visual display
      • Speeds and difficulty can be ranged from easiest to most difficult
      • Music and effects can be varied for appropriate encouragement and engagement
      • Range of motion capture can be reduced for players with limitations or expanded for those with full range capabilities
    • Almost every RESTORE game has upper extremity motor compatibility. A few to consider with default game duration:
      • Take Flight (plays based on lives, duration not limited). Players can control a plane in flight with up and down movement to avoid obstacles and obtain coins and gems.
      • Jackpot (default is 5 minutes). Players can have the slot machine handle alternating sides after each pull or remain on one a single side for more concentrated motion
      • Bullseye (default 2 minutes). Players can control a bow and arrow to hit various targets and bonus items, while avoiding penalty items such as dynamite
      • Ladybugs or Car Cross (rounds of play). Players practice up/down movements to assist ladybugs or cars to cross a bridge, while avoiding allowing pests or undesirables to cross

    When players (patients) are having fun and engaged they focus less on targeted skills and more on the game. They have less anxiety or frustration in trying to bring food to mouth, if only working on this during self-feeding. When a player demonstrates appropriate control, sustained action, adequate activity tolerance, and desired cognitive function that is when it is most beneficial to follow up a RESTORE session with an actual self-feeding session.  

    Practice Self Feeding with RESTORE