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In some senior living communities, the therapy gym is also becoming a therapy arcade. That’s because technologies such as virtual reality have brought “gamification” to rehab.
For example, whereas patients would have lifted weights to build strength and mobility in the past, now they might play a game of virtual volleyball.
“There are definitely clear advantages to gamification of therapy,” Majd Alwan, senior vice president of technology and executive director of the Center for Aging Services Technologies (CAST) at provider association LeadingAge, told Senior Housing News. “Number one is putting the therapy program in an entertaining context. Number two, the [technology systems] that have more sophisticated capabilities in terms of measuring the range of motion give a better assessment to the therapist and a better measure of progress or lack thereof.”
Therapy providers in assisted living, skilled nursing and continuing care retirement community (CCRC) settings echo Alwan’s enthusiasm and are investing in gamification technologies and developing care practices to maximize their value.
Better than a dumbbell
Consonus Healthcare—the therapy arm of Milwaukie, Oregon-based post-acute and assisted living provider Marquis Companies—has widely incorporated virtual reality-based games. The company has 83 contracts to provide therapy, and a virtual reality system is in place across roughly 95% of the business, Regional Vice President-Northwest Jonalyn Brown told Senior Housing News.
That system is OmniVR, provided through Accelerated Care Plus (ACP), a technology, training and clinical programs company. ACP describes OmniVR as the world’s first virtual reality therapy system specifically designed for older adults.
The system involves a camera mounted on a flat-screen TV. On the screen, an avatar appears in a virtual setting—such as a picnic or volleyball court—and mimics the patient’s movements.
“The camera picks up the movements, so there’s no handheld controls, no head equipment,” Brown said.
There are various activities and games that a patient can play using the OmniVR. It’s up to the therapist to select the proper program and dosing based on treatment goals, such as improved standing balance or range of motion, Brown said. The technology collects and spits out data, which the therapist uses to adapt the exercises and coach the patient.
“By and large, the majority of patients love it,” Brown said. “They pick up a dumbbell, they’re not super excited about doing 20 reps. [OmniVR] immerses a patient in the virtual space as an alternative avenue to be engaged. They get competitive.”
Patients can compete against each other—such as in volleyball—or they can compete against themselves, to beat their previous time or to move on to a more complex version of a game.
In addition to better outcomes through increased patient engagement, the technology enables a more data-driven approach. It provides utilization data, so a company such as Consonus can track what activities residents are participating in and see their progress from one day to the next, tailored to discipline, activity and other categories. Its capabilities include showing patient progress on three major assessment tools: the timed up and go (TUG) test; sit to stand test; and functional reach test.
So far, Consonus has not tried to link rehospitalization rates to OmniVR use, but there is some evidence that gamification can lead to improvements in this important metric, Alwan said.
A LeadingAge CAST case study from last year found that The New Jewish Home—a New York-based post-acute and senior living provider—reduced reshospitalization rates among a group of patients who used Jintronix, another system that includes therapeutic games.
Overall, the Jintronix patients had a 5% rehospitalization rate, compared with 11% for similar patients who did not use the system.
The personal connection
Outcomes like this suggest that technologies that “gamify” rehab could be a smart investment—but they’re not cheap, notes Kathy Adkins, rehab clinical consultant/clinical performance specialist with RehabCare, part of Louisville-based post-acute and home health giant Kindred Healthcare (NYSE: KND).
RehabCare also uses OmniVR, but Adkins notes that therapists can use game technology even if their company does not have the capital for a high-end, feature-rich system.
Simpler gaming applications can be downloaded to a smartphone or tablet. They do not collect data or give real-time feedback to the therapist about patients’ performance. Still, they can provide the same sort of patient engagement as more comprehensive, clinically sophisticated systems, Adkins believes.
For instance, she once was working with a dementia patient in assisted living. He was still in the relatively early stages but had lost the ability to speak and was no longer dressing himself, although he was physically capable of doing so.
“It was pure lack of motivation,” Adkins said.
Knowing that he used to be a plumber, Adkins used an app called Flow Free, which involves connecting dots on the screen to make water flow through the pipes.
“I had to put my hand over his to show him how to do it,” she said. “The first time he did it, and the water flowed, he started laughing. He pointed and wanted to do it again.”
Adkins was able to use the game as a reward, incentivizing the patient to dress himself and helping to keep him out of a skilled nursing facility.
The Nintendo Wii is another gaming system with therapeutic potential. Adkins once got a stroke patient to engage in therapy through the Wii’s boxing game (pictured above).
“He’d boxed in the Navy,” she said. “I think it allowed him to get his anger out, too, because he was so angry he could no longer live on his own.”
As these examples demonstrate, games that tap into a patient’s interests can be especially effective. Therapists should not simply set up a person on a game and then rely on the technology to do all the work, Adkins emphasized. They still need to learn about the patient and personalize care.
Consonus’ Brown agrees.
“It’s only one approach to therapy,” she said. “It doesn’t replace the traditional way of providing care.”
Written by Tim Mullaney