neuro rehab

Q&A: Neuro-Rehab

May is Better Hearing & Speech Month & we're proud to support our dedicated therapist users. On a recent customer success support call, a speech-language pathologist asked if we could provide a marketing summary of the benefits of RESTORE when working with neuro-rehab patients.

How RESTORE can help clinicians accelerate and optimize outcomes with stroke and brain injury patients:

RESTORE-Skills’ therapeutic gamification platform comprehensively supports clinicians by targeting the functional deficits and underlying neurological impairments most commonly presented by stroke and brain injury patients. Using a laptop or mobile device, therapists can quickly access and customize over 200 games and activities targeting the physical, cognitive, and life-readiness skills necessary to accelerate and optimize clinical outcomes.

Patients move more, stand longer, and refuse treatment less by combining skill-building with fun activities based on their personal interests such as skiing in a world-cup race, pulling a slot machine handle, flying a plane, or practicing their medication management. Every game has settings that can be adjusted to ensure the player can experience success, even if it’s their first time video gaming. A patient’s family members and friends can be invited to remotely join a therapy session via a user-friendly, video-conferencing experience to see their loved one, offer encouragement, and add motivation by playing along all from the safety of their own home.

neuro rehab

 

 

"I feel the games have helped me to improve the movement and coordination in my arm. I'm right-handed so it's important I regain as much as I can to get back to what I used to do. My favorite game is Plinko.  I use my left hand to support my right arm in getting the chips to the top of the board. We had a tournament last week and I actually got the best score on one of the days. It was a lot of fun!"

 

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.  When players (patients) are having fun & engaged they focus less on targeted skills and more on the game. RESTORE-Skills makes rehabilitation more fun, stretching patients’ abilities playfully and diverting their attention away from discomfort, anxiety, or frustration.

 

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!

 

 

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!

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.

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!