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.

            Posted in Games, RESTORE, Seniors, Session Tips, Tech and tagged , , , , , .

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