Q&A: Get to know Clinical Success Director, Jim Marlowe, COTA/L

What do you do at RESTORE-Skills and in what circumstances would I come to you for something?

  • As a therapist, I have always been passionate about providing the best possible experience for my patients. In my time spent in other roles such as business development, admissions, and management, I always had a focus on customer service and problem-solving. I joined the RESTORE-Skills Customer Success team because I know the best way to help serve the elders in our communities is to ensure that our partners have the knowledge and training to maximize our platform. I would have loved to have RESTORE as a therapist and am now in a role where I can make that a reality for others.

Who has influenced you most when it comes to how you approach your work?

  • My father. I grew up in a family auction business so I dealt with the public from a young age. He always taught me to treat the janitor with the same respect as the CEO. How important relationships and connections are in life.

What is your favorite thing to do when not at work? 

  • We love to thrift and run a part-time reselling business. I also love to attend my sons’ games. My youngest (Landon) plays basketball, my middle son (Kameron) plays soccer and Esports, and my oldest (Nathan) is killing it in the Esports circuit. He started the program at his school.

If you could snap your fingers and become an expert in something, what would it be? 

  • Home repairs. I am the classic Youtube repairman. I know just enough to be dangerous.

What’s one thing most people don’t know about you? 

  • I am a state-licensed auctioneer (yes I can talk fast).

What led you to this career path?

  • It's really been a combination of my life experiences. I spent 10+ years in sales prior to going back to school to get my COTA license. I have always loved people and now I get to work on a product that directly benefits those same patients I treated in therapy.

What’s one song artist you are embarrassed to admit you like?

  • I don’t really get embarrassed by artists. My playlist has anything from George Jones to Tupac. 

What’s one totally irrational fear you have?

  • Climbing ladders. I hate it. 

Are you a dog person or a cat person (or neither)? 

  • I have always been a cat person but do like dogs. Our greyhound Chase helped to convert me. 

What’s changed you about the COVID-19 pandemic, and why? 

  • I spent the last year and a half in a nursing facility and got to see how COVID affects residents firsthand. The isolation and uncertainty they experienced really opens your eyes to what's important. Family and good friends make all the difference.
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.  

    patients encourage each other for a better day

    Patients Encourage Each Other for a Better Day!

    Here is another happy moment from my trip to our MA facilities last month. If you haven’t had the chance to read my first blog post about Maria’s great therapy experience, you can find it here. But now, I am thrilled to share a story about Joe encouraging his fellow patients that is sure to bring a smile to your face.

    Getting to Know Joe

    Joe was the very first patient to stop in the gym at River Terrace the morning of our visit. I love meeting patients like Joe, he was open-minded and jumped at the chance to try something new during his therapy session! When finding the right game, Joe mentioned that he had never skied, so we checked that off his bucket list by loading Ski Saga.

    While practicing, Joe used various controllers and played four different games to work on weight-shifting, balance, and stepping up & down. He told us that he couldn’t wait to tell his grandson that he went skiing in therapy! After his session was over, Joe left the gym with a big grin on his face. Lucky for us, that wasn’t the last time we would see him during our visit. 

    The RESTORE Difference

    Just twenty minutes after leaving the therapy gym, Joe was back! At that point, a few other patients had joined our group. “Can I come back and watch you play?” he asked, “this is better than being in my room.” It was fantastic! His positive and upbeat attitude was the key to all of us having a better day.  

    The entire time Joe was there to encourage patients as they worked on their own skills. He watched as they played, cheering them on, and making conversation with everyone in the room! It was incredible to see everyone laugh, play, and learn more about each other.  

    Do you have a patient story like Joe’s? We’d love to hear about the difference RESTORE games make in your daily treatment! 

    Follow  RESTOREskills on Facebook & LinkedIn for updates on our platform, new game announcements, testimonials, tips, and much much more! To schedule an obligation free demonstration of our on-demand therapy platform with our team, please contact us at info@restoreskills.com or call (330) 968-2879. We look forward to supporting your goals!

    We Want YOU On Our Team!

    We believe that skill-building can be done more effectively - don’t you?

    Are you someone who sees the potential in ordinary objects? 🤓 Are you excited innovation & eager to share new technology with your peers? Then we want you on our team! We're a team that believes that therapy and skill-building can be fun, engaging, measurable, and data-driven. We are dedicated to leading the change and modernizing the way rehabilitation in SNFs is delivered today.

    Based on the data our platform collects together with therapist and patients feedback, we develop, games, activities and therapy protocols to empower patients and therapists.

    If you believe that skill-building can be done more effectively - Join us!

    Clinical Partnership Director - Occupational Therapist

    • Full-Time Position
    • Greater NYC Area
    • Fast-paced environment, great flexibility, fun workspace, lots of autonomy!

    Therapy and skill-building can be fun, engaging, measurable, and data-driven, and we're here to prove that. It's why we're dedicated to leading the change and modernizing the way rehabilitation in SNFs is delivered today.

    Clinical Program Consultant - Occupational Therapist Assistant (COTA)

    • Part-Time Position
    • Greater NYC Area
    • Fast-paced environment, great flexibility, fun workspace, lots of autonomy!

    About the Position

    Responsibilities include but are not limited to:

    • Training & leading new and current customers
    • Consulting on platform development and implementation
    • Designing ready-made sessions based on Section GG & ADLs
    • Defining new activities for development
    • Miscellaneous projects as assigned

    You will learn what it takes to succeed in the fast-paced world of startups, as well as the evolving US Healthcare market.  And finally, you will work with a global team of talented professionals united around helping people improve, heal, and learn - all while they have fun too!

    About the Company

    RESTORE is an adult rehabilitation and skill-development platform. RESTORE offers fun, therapy-driven activities that can be practiced almost everywhere at any time, eliminating the barriers of limited time frames in the rehabilitation gym.

    With built-in performance tracking, RESTORE gives therapists meaningful information about adherence and clinical progress both during and between in-person sessions. Founded in Israel in 2010, the parent company, Timocco, established its US headquarters in Akron, OH in 2015, and a second office in NYC in 2017.

    Timocco serves school districts, hospitals, private clinics, and nursing homes across the US, Europe, and Israel.

    To apply: Send resume & cover letter (please include salary requirements) to info@restoreskills.com