telehealth

NEWS: Ian Oppel Interviewed for “Telehealth Best Practices” Series

Below is an excerpt from the Telehealth Best Practices interview series:

In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful Doctors, Dentists, Psychotherapists, Counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in Telehealth. As a part of this series, I had the pleasure of interviewing Ian Oppel.

Ian Oppel is a healthcare executive with over 25 years of post-acute healthcare leadership experience providing expertise in rehabilitation, fiscal and clinical operations, memory care, senior living, reimbursement, and regulatory compliance. Ian is currently the Co-Founder and Chief Clinical Officer for RestoreSkills, a leading edge therapeutic gamification and telehealth company.

Can you share the most interesting story that happened to you since you began your career?

At one of the very first skilled nursing facilities to implement RESTORE, I was introducing the gaming platform to an 88 year-old patient who was recovering from congestive heart failure. She wasn’t enthusiastic about video games, but was a good sport and willing to try with a goal to increase her standing activity tolerance. 1 minute into the game, her two great-grandchildren ran into the room shouting “Grandma, Grandma we want to play!” She sat down with a huge smile on her face. She handed over the controls to one of the grandsons, while the other sat patiently on her lap before taking his turn. The boys’ mother came over to me and softly asked “what is this and how do I get it for my home?” Before I could answer, she continued with tears in her eyes “my son sitting on her lap is autistic and this is the first time he’s ever entered the room with my grandmother let alone allowed her to embrace him.”

To have played any part of that magical moment was incredible and to this day motivates me to do everything I can to help customers and clients to experience successes both large and small.

...

Can you share a few ways that Telehealth can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?

I was assisting a clinician during a telehealth session with a patient who had suffered a stroke. The patient was part of a large, supportive family who lived near Atlantic City, NJ. He was an avid gambler and the family would make a monthly visit for a weekend of slot machine play. RESTORE-Skills has a game called Jackpot, which is a virtual slot machine with settings that can be adjusted based on a patient’s physical and cognitive ability level to ensure success. The therapist coordinated a virtual session to include the patient’s brother and sister. Initially they observed the session and offered encouragement to their loved one as he played his favorite game. They began to reminisce about the last time they were in the casino together. Then it clicked for the sister as she noticed an improvement in how her brother was moving his arm while pulling the lever of the slot machine (which moved to the opposite side after each pull to challenge his range of motion and coordination). “That’s great exercise and you’re doing something you love at the same time. This makes me so happy” she exclaimed. The therapist was then able to provide the family members with a code that enabled them to all play together on the same screen in a five minute slot tournament. After the session was complete, the therapist noted that it was the longest the patient had stood while performing activity and that it was clear interactivity from his family was key in providing added motivation.

Telehealth evolved out of the need for greater access, flexibility, and demand. Access to quality health providers. Access to reliable transportation. Flexibility for busy schedules/lifestyles. Providers can better meet the increasing demand for patient visits when provided virtually from a single location.

Covid-19 has certainly accelerated the use and scope of telehealth services. At RESTORE-Skills, early on we identified that perhaps an even greater risk than covid for our clients was the challenge of mitigating the risks of social isolation for patients as visitation in senior living came to an abrupt halt. We introduced a new feature, RESTORE-Together, which enabled clinicians working with a patient in their room to invite family members, friends, or even connect with other patients/residents during treatment sessions. They were able to offer visual and verbal encouragement, as well as interactively play on the same screen from the safety of their own homes or rooms.

Check out the full interview with our Chief Clinical Officer, Ian Oppel HERE!

Q&A: Player Dignity

Question: 

We love the RESTORE technology; however, one concern we have is that many of the games appear “child-like” and we worry about this from a dignity standpoint with our senior population. Have you had anyone else with this concern?  Any insight is appreciated. 

 

Answer: 

Thank you for the feedback and important question. 

Our platform takes into consideration that the majority of skilled nursing residents have a degree of cognitive impairment (in addition to any physical limitations). From my OT and Dementia Capable Care background, we have applied the theory of retrogenesis (back to birth) to our platform. That is not to say treat adults like children, but to appreciate that their developmental ability levels have regressed to the chronological age of 4-16 years old. It is important to keep simplistic themes, actions, and graphics for our population and to be able to grade the games based on the degree of difficulty settings.

 

RESTORE Player Testimonial

The most important key is to ensure an individual is able to experience success. We do not receive concerns related to graphics when the therapists and care partners have ensured the player meets with success and not frustration. Since many have not played these types of games before, the hesitancy is more related to anxiety that they will not perform well and therefore may remark that it is stupid or for kids, but this is typically a defense mechanism.

Video games are the most popular consumed media today and have officially overtaken the sport and movie industries in 2021. We are talking about games like Candy Crush, Mario Kart, Bubble Pop, etc. I'm currently addicted to a Harry Potter Match 3 game (and not even a huge Harry Potter fan lol). If you love games and you love competition, the graphics/animations are secondary to your success and FUN!

 

 

Get Your Game on with Grandma

How video games can strengthen the relationships seniors value most

While the vast majority of video gaming enthusiasts are millennials, a growing crop of older adults are accessing video gaming technology for entertainment, cognitive stimulation, physical activity, and social fulfillment. They’re even making video games a part of their health and well being.

During the pandemic, the increased adoption of video games among seniors is proving to be more important than ever. This is especially true for skilled nursing and senior living residents in need of a lifeline to counter the effects of social isolation and loneliness.

Some senior care centers are even using video games as a means of skill-building, applying newly developed therapy and wellness technologies into their clinical approach. In my work as CCO and occupational therapist at RESTORE-Skills, I regularly see seniors use gaming technology to reach therapy milestones faster and improve physical and cognitive abilities. At the same time, they’re strengthening relationships with loved ones and friends by connecting virtually via fun, therapeutic video games on our platform. This happens all from the safety of their rooms.

All of this comes as no surprise to those studying the impact of video games on seniors. A study of adults ages 60-80 published recently in Behavioural Brain Research indicated that video games may be used to enhance cognitive health in older adults. The findings suggest that both novel experiences and exposure to rich three-dimensional environments may work together to improve cognition.

Based on these findings and my own experience, skilled nursing facilities and senior living communities need to become early adopters of this new technology or be left behind.

Tournament gaming enhances social connections and fosters a sense of community

Users of RESTORE-Skills also benefit socially and emotionally by playing virtual tournaments against friends and family as part of their therapy and wellness regiment. What’s more, they’re sharing a common language with Millennial and Gen Z grandchildren outside of these sessions. 

This is because there can be limits to conversation among seniors and their loved ones, especially for those in skilled nursing homes dealing with language impairments. It doesn’t help that many younger people are accustomed to rarely making phone calls, preferring text and social media apps instead. 

The wider the generation gap, the harder it is today to make small talk.

Unless you’re talking about video games. 

Skilled nursing and senior living residents learn a new language to share with younger relatives

Consider the following example from among skilled nursing patients we have served in therapy. A male patient, and former salesman with a gift for gab, suffered a stroke and had expressive aphasia, limiting his ability to communicate. He also had limited movement of his right upper and lower extremities. When we introduced him to our therapy video game solution, he was eager to give it a try. Although he had never played video games before, he considered it a way to impress and relate to his son and grandson, both avid video game players. 

This patient is one of many.

 

 

A study published in Sage Journals revealed that sharing in video games fosters relationships and connections while producing positive emotions for both grandparents and grandchildren. “As a consequence, game designers should take into consideration ways to enhance these social aspects of gameplay.”

Seniors who play video games now have a shared language to connect with their kids or grandkids. Instead of brief conversations about what’s happening at school, they can instead play a game together and make it part of the patient’s therapy exercises. 

Prior to the pandemic, one 88-year old senior living resident and great-grandmother was introduced to a virtual skill-building therapy session to improve her range of motion, coordination, and ability to perform activities of daily living. She willingly participated but wasn’t overly enthusiastic. 

Ten minutes into the session, her two great-grandsons surprised her with a visit, raced into the room and asked for a turn. She shared her red ball-shaped controller, and the boys took turns sitting on her lap while they waited to play. 

The staff later learned this was the first time one of the boys, who has autism, had ever entered his grandma’s room willingly and engaged physically. Such is the potential healing and connective power of this essential language and activity. 

This kind of interaction makes a difference in any scenario, but especially in a season where grandkids are holding up signs at windows of skilled nursing facilities in lieu of actual visits.

 

Video games create generational connection while providing crucial therapy

Learning the language of video gaming gives both family members and their senior relatives a productive way to spend time together. And, the pandemic has led more seniors to be open to adopting new technology out of pure necessity.

In 2020, the pandemic propelled the video game industry to make more money than movies and North American sports combined. There’s no indication this will slow in 2021.

As more people adopt video gaming technology, the benefits are clear. Research is showing the power of video gaming, especially on cognition of older adults; making it crucial that video games are widely adopted by healthcare. 

Adding therapy to video games and enabling families to connect through the technology is an incredible opportunity for post-acute rehab providers especially. 

 

Making therapy fun with video games leads to better outcomes

Refusals are always a challenge for healthcare professionals to overcome, especially in skilled nursing and rehab facilities. However, making therapy and wellness sessions fun and engaging can lead to more positive outcomes. 

One male patient who had a history of multiple falls and therefore a reluctance to leave his room was refusing physical therapy support. However, he eagerly agreed to try out the RESTORE-Skills video gaming platform as a fun way to achieve his balance goals and reduce his risk of falling. 

He was able to virtually ski in a world cup race, pull a slot machine handle to win a jackpot, and rock climb to the top of an ancient temple – all interests he had never experienced before. As soon as he finished his session, he shared how excited he was to tell his grandson all about his experience. He actually remained in the therapy clinic to watch and encourage others as they participated. 

Making video gaming accessible for seniors

The key to successfully adopting video gaming technology for those in senior care centers is making the video games accessible and user friendly. Any video gaming technology for seniors must have the following features: 

  • Easy to access
  • Easy to learn
  • Easy to use
  • Gradable (adaptable to an individual’s abilities)
  • Relatable
  • Meaningful
  • Have audio and video call compatibility

Access to virtual communities of friends and peers

Besides making therapy fun, video games inspire users to play and achieve more through gamification. Competition, collaboration, achievements, and a sense of community drive people to meet their goals in an enjoyable way. 

Our RESTORE-Together feature allows patients and players to play interactively with loved ones and friends in a facility or across the country from the safety of their rooms. One patient’s siblings were unable to visit during a recent short-term rehabilitation admission. They worried that their phone calls didn’t provide enough meaningful connection. 

The healthcare team coordinated for the patient’s siblings to join his therapy session to encourage him and participate themselves. They watched their brother stand for ten minutes at a “slot machine,” trying to win the jackpot with a weighted controller. It was a huge improvement over his previous best record of only one minute.

The therapist was then able to send a code to the patient’s siblings so they could play a slot machine tournament together, followed by a “Let it Snow Bingo” game that helped with hand-eye coordination, sustained attention, strengthening, and activity tolerance. 

Being able to share this experience with others is a key to healing success. 

 

In-room player

The fact that seniors can use video games to connect to their loved ones is an added bonus to the physical, cognitive, and psychosocial benefits the technology offers. The gamification and fun aspects make programs like RESTORE-Skills appealing enough for seniors to work on skills more effectively. 

Confidence to strengthen the mind, body, and social connections that matter most  

When seniors have access to video game technology for skill-building, they experience greater confidence, as well as an increased desire to regain social skills and connections. Even the staff enjoys training and learning how to use this technology to benefit their patients. 

Video games are most successful when they are easy to access, easy to learn, and easy to use. The game must also be gradable, or adaptable to an individual’s ability. The more relatable and meaningful the games are to the individual, the more the patient is excited to use the program. 

Skilled nursing facilities and senior living communities must adapt to offer residents the opportunity to learn the language of video games. By creating virtual communities, tournaments, avatars, and immersive experiences in a world without borders, seniors can work on developing skills in a meaningful, collaborative and entertaining way.

Just don’t be surprised when grandma gets the high score! 

WREG News Live at 9

NEWS: RESTORE-Skills featured on WREG News Live at 9

RESTORE-Skills' CEO, Eran Arden, spoke with Jerrita Patterson on WREG News' Live at 9 about connecting seniors & their loved ones.

Patterson: More and more senior citizens are really lining up to get coronavirus vaccines across the country. But for many in nursing homes, the pandemic continues to keep them isolated from both family and friends. Now, a new platform is changing the way loved ones can interact all while staying safely apart. This morning, we're live with the CEO of RESTORE-Skills, Eran Arden, to learn more about RESTORE-Together.

Patterson: Correct me if I'm wrong, but this is a motivational therapy platform, correct? Explain what this is about.

Arden: Jerrita, thank you very much! Yeah, you are correct. RESTORE-Skills is a gaming enviornment that motivates residents in nursing homes to continue building and matain the skills they need to live independetly. We use a simple computer, so no expensive devices needed, and we have about 200 activities all designed to motivate the patients to stay active. [They can] work on their sit to stand skills, motor skills, range of motion and everything in between all while playing games.

Arden: When the pandemic started, we also realized we also want to help connect family members to their loved ones in the facilities. So, we created an enviornment where residents that are isolated [in their room] can play with their loved ones [who are] at home.

Patterson: What has been the reaction from those in nursing homes? What have you heard? What have you seen so far?

Arden: The reaction is amazing and that's what empowers us to wake up in the morning and develop the [platform] and our games.

Check out the full interview on WREG News' Live at 9 Facebook page HERE!

Spectrum 1 News Ohio

NEWS: RESTORE-Skills featured on Spectrum 1 News Ohio

Below is an excerpt from the story from Spectrum 1 News Ohio:

CLEVELAND — Elizabeth Sims and her caregiver admit that since the start of the coronavirus pandemic, things haven’t been the same at The Heights Rehabilitation and Healthcare Center in Broadview Heights. Pandemic restrictions have cut out communal dining, team exercise and group therapy at facility.

“Before, we used to be able to be down in the therapy gym. So, it would be fun because they're all around people; you could play games and now, you're really stuck in the rooms with the patients,” Sims says.

Things have taken a turn for the better at the facility. Residents started connecting virtually through RESTORE-Skills, a computer based motivational therapy platform with a multiplayer function that now allows patients the ability to play skill-building games with one another.

“At least they can interact and you're using technology and they can still get involved and do some kind of fun…and it helps her cognitive skills.”  Tina Wilson’s caregiver says.

Check out the full interview with our CEO, Eran Arden, and the team from The Heights HERE!

abc7 San Francisco

NEWS: RESTORE-Skills featured on ABC7 San Francisco

Below is an excerpt from the story from ABC7 News San Francisco:

SAN FRANCISCO (KGO) -- Health is an important aspect of Building a Better Bay Area.

As patients at care facilities are dealing with prolonged social isolation with visits from families curtailed or not allowed, caregivers are turning to multi-player skill games to improve patient outcomes.

Bingo has always been a popular way to engage patients in care facilities to use their minds, hands, and arms. COVID-19 has not only stopped that, but also visits from loved ones.
"If we don't have friends and peers to work with, then you know, then we, unfortunately, don't have the motivation to practice and to live longer," said Eran Arden, CEO at Restore Skills. RESTORE-Skills is a cloud-based platform with a library of 50 games that occupational therapists can use for rehabilitation and skills development.
51-year-old Mike Willham has multiple sclerosis. Moving a ball in his hand to play a slot machine game is more than just having fun at winning jackpots. "It allows me to move my left arm from side to side and up and down. And it has built up strength in the left arm," said Willham as he made those moves. An up and down motion with the ball caused the arm on the slot machine to activate."
It's helping with cognition, it helps with fine motor, gross motor coordination, strengthening," said Carrie Blum, an occupational therapy assistant at The Heights Rehabilitation & Healthcare Center. "It's been helping with their endurance and activity tolerance."

Check out the full interview with our CEO, Eran Arden, and the team from The Heights HERE!

Falls Prevention

Q&A: Falls Prevention

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
  •  

    • 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

    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
    nursing home with physical therapy

    How to deal with therapy refusals

    Know when it’s a clinical indicator or wake up call

    Standard in every skilled nursing therapist’s day is dealing with patients’ refusal of therapy. A typical SNF therapist averages 1-2 refusals of treatment each day. That can be 15-20 percent of a therapist’s day that’s canceled! 

    Of all those therapy refusals, most are legitimate. But among them, there are some SNF patients who could be motivated to get up and exercise. 

    Often, a motivated therapist can cajole a patient to join the scheduled therapy session. But many times, it’s simply easier for a busy therapist to let a tired or distracted patient skip a session. 

    And now with PDPM, where SNFs are no longer reimbursed for therapy minutes, therapists have even less motivation to counter patients’ refusals than they once did under the RUG-IV payment plan with CMS.

    However, therapy is the key reason patients enter a skilled nursing rehab center, and its centrality to patient care is unquestionably essential. Skilled nursing therapy is key to the healing process and to slowing the physical and mental decline of aging patients. 

    PDPM means therapists and SNFs are focused more on quality than quantity, but that still means that a patient who is prescribed any number of weekly therapy sessions absolutely needs to access those sessions in order to achieve the best outcome. 

    The responsibility lies on the therapist to make sure refusals don’t stand in the way of accessing therapy.

    3 underlying reasons skilled nursing patients refuse therapy

    Patients will have a whole host of reasons for refusing therapy, and most of them are absolutely legitimate. It’s up to you as a therapist to consider how the patient is responding and determine the source of the refusal. This way, you can determine if the reason is something you can work around or if it’s a sign of a bigger issue. And sometimes, refusals just might mean that you have work to do to make therapy sessions more worthwhile.

     

    Reason #1: Patient isn’t feeling well 

    Patients may be adjusting to a new medication, still healing from a recent procedure or have any number of clinical challenges that can make therapy more difficult. Speak to interdisciplinary team members to see if they have also received concerns and what subsequent actions have been taken

    Reason #2: Patient has concerns outside of their control 

    Skilled nursing care has to be integrative for therapists to successfully treat patients. This means letting the care team know when a patient doesn’t get enough sleep because of a loud roommate or a patient didn’t eat because the food got too cold. Be an advocate for the patient if action has not been taken to address concerns/complaints. 

    Reason #3: Patient is apathetic

    Sometimes patients will refuse therapy without a specific reason. Statements like “Maybe tomorrow?” or “I don’t want to do it today” can mean that the patient isn’t seeing the value of the therapy sessions.

     

    Reassess your approach to skilled nursing therapy for apathetic patients

    If you are unable to identify the source of why your patient is refusing care, it’s time to ask yourself some hard questions.

    We as therapists are taught the therapeutic use of self approach. This means we use all our faculties to meet our patients where they are, with empathy, and bring them to where we want them to be for the session. We use our creativity, attitude, and effort to make patients feel positive, motivated, encouraged, and successful. This is how we gain their trust and ensure they feel empowered.

    7 questions therapists should ask when facing refusals 

    • Are you offering a care approach that has meaning to the patient?
    • Are you offering a care approach in which the patient believes they have the opportunity to experience success?
    • Can you grade your approach to gain trust and agreement?
    • Are you conveying enthusiasm and excitement in your approach or are you going through the motions and thinking about the end of the day?
    • What is your strategy to motivate? 
    • Can you modify the environment to one that will promote a more successful experience?
    • Can you modify the intended activity based on the fluctuating physical and cognitive ability output of your patient? 
    Health visitor and senior

    Therapists’ methods to deal with refusals

    Once you’ve taken some time to ask yourself the hard questions above, you are poised to better address therapy refusals. The following are some steps you can use.

    Step 1: Show empathy to patients’ needs

    Your first reaction to therapy refusals should always be empathy. Most patients have legitimate hesitations to therapy, such as overall weakness, pain or emotional struggles. Of course, therapy can improve the physical and mental state of patients, but it’s a long process, and the journey can be hard. 

    Listen well to your patients’ concerns and repeat what you hear them saying to you to validate their concerns. If the patient is refusing to exercise because he is in pain or needs an improvement to his care, you may need to advocate for him to the interdisciplinary team.

     

    Step 2: Use a person-centered approach for therapy

    One obvious solution to refusals, of course, is to have a more person-centered approach. Provide therapy on the patients’ schedule, when he is at his best. This is obviously harder to coordinate, but if it reduces refusals to offer a late sleeper a later therapy time slot, then you will have more luck cajoling him to exercise. 

    It also helps to offer the patient something engaging she wants to do. Get to know her interests and goals and relate the therapy back to those goals. Your patient wants to walk her granddaughter down the aisle? Remind her that it starts with working on standing for two minutes.

    Don’t be afraid to get family members involved in what a patient enjoys. Therapy is a great time to jump on a Zoom call with a patient’s loved ones. This makes the family feel connected, increases transparency, motivates the patient and helps you get to know more about the patient. This is why we included a video-conferencing tool right within our RESTORE Skills therapy gaming platform.

     

    Step 3: Make therapy fun and engaging

    Armed with the latest technology that makes therapy interactive, engaging and even fun, therapists can significantly reduce refusals. As the Chief Clinical Officer of RESTORE Skills, where we’ve created just this kind of therapy gaming platform, I see examples every day of patients actually requesting to play our therapy games. They are motivated by the fun they are having skiing, golfing or playing the slot machines, as well as the results they see as they improve their game scores.

    To add to the joy, we are known for an “I hit the jackpot with RESTORE” t-shirt for those patients who hit “Wild, Wild, Wild” on our slot machine game. We are constantly hearing about patients relentlessly playing this therapy game until they win. Meanwhile, they are actually winning at therapy, as they push themselves to reach and stretch farther.

    The right attitude, approach, and activity can make therapy easier and reduce refusals, but sometimes you need added help

     

    Refusals can feel personal. Most therapists have developed conscious and subconscious defense mechanisms related to these remarks. However, simply shielding yourself from the impact is not necessarily best for your patient or your professional growth and development.

    Even the most passionate and creative therapists will still face regular refusals on the job. This is where innovative technology can fill the gap. Having access to a variety of interactive treatment content and the ability to connect loved ones for added encouragement and participation is the perfect compliment to an empathetic, positive and motivating therapist’s approach. Hope these strategies help you realize better outcomes with less refusals.  

    WBOC Good Day Delmarva

    NEWS: RESTORE-Skills featured on WBOC’s Good Day Delmarva

    Below is an excerpt from the story from Good Day Delmarva

    For today's Wellness Wednesday, Sydney speaks with Joe Asseline with the Westgate Hills Rehabilitation & Healthcare Center to learn about the steps they're taking to provide contact-less care during the ongoing pandemic. 

    Today with the help of Westgate Hills Rehabilitation & Healthcare Center in Baltimore, Maryland we discover ways in which they're reaching goals with a contactless approach.

    Joe: I've been working at Westgate Hills Rehab for the past year and a half. My goal is to help patient's restore their function & independence through actiticties of daily living and self-care tasks. 

    Sydney: How are have you noticing that certain facilities or even yours are turning to technology to help folks get the therapy and attention that they need? 

    Joe: In my sesssion, I find it's very important to use video chat...we've also been able to use this really cool RESTORE virtual reality game system. RESTORE is a syetm that we are able to bring therapeutic activties and excercises into the rooms of patients. Not only that, there's a new feature that they've just rolled out that we're able to video chat in with the families so they can add words of encouragement. It's really cool! I find that they're always asking to use it because they think the games are really fun, 

    Check it out the full interview with Joe Asselin, OTR/L HERE!