group and concurrent

Q&A: Group and Concurrent

Question: 

How can we use RESTORE in the delivery of group and concurrent therapy?

Answer:

Great question. To start we have to understand the difference between group and concurrent therapy:

  • Group Therapy - One therapist/asst. providing treatment of 2-6 patients performing similar functional skill activities that are part of their plans of care regardless of payor source.
  • Concurrent Therapy - One therapist/assist. providing treatment to 2 patients simultaneously, who are performing different functional skill activities (per payor guidelines).

Next, let’s look at some of the potential benefits of these deliveries of care approaches:

  • Socialization - helps mitigate the risks of isolation/loneliness and promotes social interaction skills.
  • Patterning of Behavior - promotes the ability to learn from others. Players of similar or different functional ability levels can benefit from observing/demonstrating how to perform an activity that helps to improve their own performance outcomes.
  • Cooperation - the ability to work together towards a common goal can be rewarding and motivating. By working together, players can achieve outcomes they may never have realized individually.
  • Competition - many players are motivated by competition. They may in fact participate longer, move more, and engage more when there is an opportunity for a winning outcome.
  • FUN - the most important benefit is that skill-building with others is more enjoyable than skill-building alone. 

concurrent therapy

 

RESTORE can be used in support of both group and concurrent therapy

Progress can be accelerated by combining socialization, patterning of behavior, and functional skill-building with immersive, interactive content (preferably person-centered based on the expressed interests of each player). Let’s consider the following:

  • 2-6 patients (players) who share a common interest, such as casino gaming, and have therapy plan of care goals to increase activity tolerance (sitting or standing), upper extremity range of motion, coordination, and sustained attention would enjoy participating in a Jackpot, Plinko, or Bingo competition. Players can be in the same room and remain socially distanced while set up with a device with a webcam (laptop, tablet, iPad) and simultaneously address functional skills while performing a friendly competition or just trying to achieve personal bests. Players are able to encourage one another through social interaction, while additionally patterning behavior from other players to help them better achieve their personal desired skill-building outcomes.
  • 2 players who may or may not share a common interest can each be set up with a device and the therapist can facilitate concurrent activities addressing desired functional skill-building with both players. A therapist may also choose to have both players participating on the same screen at the same time while working on different functional skills. For example, one player may be pulling the handle of a slot machine on the right side with his/her upper extremity while sitting and a second player may be pulling the handle on the opposite side of the slot machine with a squat or lower extremity while standing. Although the enjoyment of the same game is appreciated, each player is working on distinctly different functional skills concurrently.

Set up & selection options for the delivery of group and concurrent therapy

  • Group Play
    • Scoring is recorded on a leaderboard. Players can attempt to beat their personal best score and even make their mark on the All-Time Leaderboard
    • 2 Players - Cooperative
      • Best for grouping two players playing at the same time on the same screen requiring similar functional skill-building
      • Concurrent consideration in this mode is to have 2 players on the same screen at the same time requiring different functional skill-building
    • 2 Players - Taking Turns
      • Best for grouping two players, taking turns to encourage each other, pattern behavior, and facilitate competitive motivation
    • More than 2 Players - Taking Turns
      • Best for grouping more than two players, taking turns to encourage each other, pattern behavior, and facilitate competitive motivation 
  • RESTORE Together
    • Players from different devices compete in the same game, same setting competition to see who can achieve the top score.
    • Private Game
      • Best for facilitating a group of 2 or more players in the same location on different devices who desire to experience interactive game play. Players compete with our default settings in a competition where players are able to see their place (who is in first, second, third, etc.) and scoring outcomes in real time
      • A therapist will create a private game on one device and assist players on different devices to access the private game via a unique code that is entered at app.restoreskills.com/together 
  • Single Game
    • Best for group treatment with the therapist providing each player a device and:
        • Addressing the same functional skill-building with different games or individualized settings for the same games
    • Best for concurrent treatment with the therapist providing each player a device and:
        • Addressing different functional skill-building with different games or the same game but working on a different functional skill
  • Tournament Play
    • This is created by the RESTORE team upon request. Play can be enhanced with the creation of a "same game" tournament or multi-game Olympic event-style competition. Events can occur within one location or across multiple locations simultaneously. An event can be created as a single day or multi-day event.

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 when able to experience success, learn from one another, and feel a sense of accomplishment. Therapists are able to appropriately incorporate functional skill-building groups or concurrent treatment using RESTORE for more effective and efficient outcomes.

 

group_together

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! 

We RESTORE-Skills TOGETHER

Q&A: RESTORE-Together

Question: 

Tell me more about RESTORE-Together and it’s benefits? What is the difference between a live game and a private game?

Answer:

We are very excited to be able to introduce RESTORE-Together, which for the first time allows patients/players to play interactively with their loved ones, other patients/residents in their center, and/or with other players across the country - all from the safety of their rooms or in a socially distanced setting. Our primary motivation was to advocate for older adults, vulnerable to the risks of social isolation, by providing access to a virtual community of skill-builders.

Benefits:

  • Helps mitigate the physical, cognitive, and psychosocial risks of isolation by connecting patients/residents with others they know and love
  • Fosters a sense of community to have patients, therapists, and care partners interacting in a similar skill-building fashion with their peers nationwide
  • Increases fun, engagement, and motivation to accelerate outcomes and provide a better patient experience

Live games:

  • The ability to join a desired game with others is always open and does not require a code
  • A player joins, enters a player name/identifier, indicates readiness, and waits a short time (often less than 1 minute) to see other players that join the competition
  • Players will always know the score in head-to-head games or where they rank in tournament-style games

Private games: 

  • Allow a user to send a code to designated participants who can join the action by visiting the website restoreskills.com/together, entering the code, and following the instructions
  • Adds motivation for the player as he/she will be interacting with family members, friends, or peers that they have expressed an interest in joining a fun and competitive RESTORE skill-building session
  • If an audio exchange is desired during the session, we recommend having a phone or video conference call
    • Note - we are working on a simple, emoji-based way to communicate within the game play if audio is not available or desired
    • Note - some video conferencing apps will need to have the camera turned off so that RESTORE has primary access to the camera
  • Players will always know the score in head-to-head games or where they rank in tournament-style games

Instructions for a player joining upon receiving a private game invite:

  • Open Google Chrome and go to: restoreskills.com/together
  • Secure the four (4) character code from the invitee and enter it in the text box
  • Click “Join” to enter the private game
  • If prompted, select “allow” to enable camera access
  • Have a red, green, or blue rounded object available for play (i.e., ball, apple, container lid, cup, etc.)
  • When prompted, use your mouse to select the color of your rounded object 
  • To calibrate, bring your controller to the center of the square, making sure the camera can clearly see the color of the object

 

  • Enter your name or identifier in the text box and click ‘save’

 

  • Click the ‘Ready’ button. When all players are ready, the game will start after a 20 second countdown 

When players (patients) are having fun and engaged they focus less on targeted skills and more on the game. Fostering a sense of community by connecting with others will help mitigate the physical, cognitive, and psychosocial risks of isolation.