Best Free Online "Therapy" Games

In this day and age its nice to have a few online therapy tools at your fingertips, so today after work I crawled the web to find the least obnoxious games you could recommend to a patient or client (or even a family member) who would benefit from participating in fine motor, calculations, vocabulary, problem solving games.

In no particular order...

Luminosity
www.luminosity.com
After hearing about this website from a few clients I logged on myself and discovered a fun way to track your progress (and cognitive state) daily.  Be warned: if you want to try it you have to enter in some details about yourself and set some goals (how OT!) as well as respond to an email in your inbox before you are allowed to play (or work).  In the free version you are allotted a few games a day and you can generally only play them once before you are moved along and finished your "training" for the day.  Or you can also pay a subscription fee to be a full member and have access to all the games on their system.


Maze Race
http://www.primarygames.com/puzzles/mazes/mazerace/
This game is significantly harder than most of the maze games I found online so if your client has fine motor difficulties they will find this game impossible.  If you are encouraging your client to use it for problem solving and cognitive flexibility it is a great choice - you are controlling a green ball with your arrow keys and racing the computer (a red ball) to the pin.  Your score depends on how fast you are and by how much you beat the computer - addictive!!!  Make sure to warn your client that they will have to watch a short advertisement before they can play.


Word Winder
http://www.shockwave.com/gamelanding/word-winder.jsp
This word game is one of the more challenging free ones out there - you can find easier ones that will have you "Boggle" your way through a jumble of letters to a timer but this one does that AND is like a crossword puzzle.  It will even give you a hint about the clue and then after that even fill in some of the letters so you can find it crossword style (linking the letters together) in the jumble.  There is a timer for competitive players, and bonus points are added if you finish without needing any hints and without running out of time.  Again, addictive!

Addition Aliens
http://www.addinggame.net/
This is a free online game that can help clients improve their addition and subtraction skills in addition to their fine motor coordination and processing speed.  The game is an arcade style space shooter game where players have to type the answer to the math problem, otherwise the aliens shoot at the buildings and depending on the level of difficulty your game is over.  There are four levels of difficulty for every level of ability.

Hope these games help some of your patients, there are so many out there let me know if you find any better ones!
Good luck!

Home Health Occupational Therapy: Its So Friggin' Functional

Today I went to a client's house for his weekly follow-up Occupational Therapy visit.  Having met a lot of our activity of daily living goals already we had started to focus in on progressing the strength and coordination of his non-dominant hand, which he had injured in a stroke event several months ago.  Luckily he regained full range of motion in his hand but his coordination and ability to do fine motor activities (tying shoelaces, buttoning a shirt...etc) is still lacking.

I had already decided to order him a Neuro Muscular Electrical Stimulation unit for his in-home use but until that arrived I wanted to continue to progress him towards full function by giving him ideas for functional tasks he could practice to improve his coordination and dexterity.  Because he is still the cook in the house I had instructed him last week to try balancing a saucepan full of water in his non dominant hand while walking laps on his deck; he would get feedback on his performance moment to moment from seeing the water move and he could struggle or fail at the task without causing a mess.

He laughed today as he told me that it hadn't gone very well, and that he was ready for any new ideas I had that didn't involve water and getting his shoes drenched.

We happened to be sitting at his dining room table with his laptop open in front of us; he had been checking his Email and Facebook and suddenly an idea hit me.  I asked him to move the  detachable mouse to his non dominant hand and navigate the browser window to search for a maze game we could try.  We found a free maze game at http://www.addictinggames.com/puzzle-games/clickmaze2.jsp and after watching a terrible ad for women's menstrual cycle products he got to try it.  After a few minutes of losing all three of his "lives" in 10 seconds he stopped to read the directions and voila...a new therapy tool was born!

A Therapy Progression

Today a parent (and primary caregiver) of one of my Home Health patients asked me if there was a outline available for how to measure her daughter's physical progress in therapy and how to maximize her overall physical recovery.

I thought for awhile before admitting that I didn't know if there was such a document in existence.  As soon as I said that I started thinking that I should write one!  I worked in Physical Rehab and Skilled Nursing for five years and encountered several clients who started out completely dependent but who eventually made their way back to function.

So, for all you new OT's, caregivers, and parents out there, here are some guidelines for progressing a patient, a family member or a child from dependence to independence in physical tasks:

1) Bed Mobility (moving around in bed and getting in and out of bed)
This is definitely a Physical Therapy area of expertise but drawing from my collaboration with PT's over the years here are some basics:

• Work on rolling, with assistance and with equipment (then with no assistance and no equipment)
• Progress to sitting up, with assistance and with equipment ((then with no assistance and no equipment)
• Your patient is independent (or modified independent, with equipment) when they can roll side to side without assistance, sit up at the edge of their bed without assistance and get back into lying down without assistance.

2) Transfers  (getting from one surface to another, ie. from wheelchair to the toilet, from bed to walker)
Generally PT's and OT's work together on transfers, however its usually the OT who covers the instruction and practice of toilet transfers and shower transfers.

• Start practicing transfers using a mechanical lift or a standing lift, a slide board and potentially two caregivers if your patient can't bear their weight through their legs
• Once your patient can bear weight through their legs with assistance, start using a bed rail (if your patient is unsteady in sitting), a pivot disc (if your patient can't step/move their feet), then a walker (if your patient is strong enough to bear weight through their arms and can step their feet) or hemi walker (if your patient can only use one arm for support), and eventually a cane (if your patient's balance is unsteady) or quad cane (again if your patient can only use one arm for support).
• Once you are able to stand by and observe your patient doing the entire sequence of movements safely with their equipment or completely independently to various surfaces safely, your patient has mastered transfers.
  
  
  
  

  

                             

3) ADL (Activities of Daily Living, ie: dressing, medication management, self-feeding, grooming, bathing, toilet hygiene, meal preparation)
This is the "bread and butter" of OT's.  We instruct family members, caregivers and of course patients on how to do their daily activities after their injury or illness.

• Start with your patient in their most supportive position, the head of their hospital bed inclined or in a supportive wheelchair/chair.  
• With assistance and equipment, (a bedrail, trapeze, sock aide, long handled reacher, shoe horn, utensil holder, or a curved utensil) instruct your patient do as much of the activity as they can.  
• If your patient is not safe in sitting work on getting dressed, groomed, bathing and even doing toilet hygiene in bed, again with assistance and with equipment as needed.
• When your patient has started to master ADL in bed, then in supported sitting, move on to doing them in unsupported sitting, and then eventually without equipment or assistance.  
• As your patient can do ADL in unsupported sitting have your patient try the same task without equipment to challenge their strength, range of motion and coordination.  
• Your patient may not complete the activity without equipment the first time but its important to continue to challenge your patient to regain as much of their prior level of function as possible.
• As your patient is able to sit unsupported for their ADL with or without their equipment, continue working on standing.  
• At first they might need a standing frame to help maintain their balance, but with practice and time you can progress your patient to standing with a walker and assistance, to eventually standing independently at the sink for ADL. 
• If your patient can get fully dressed, brush their teeth, feed themselves, go to the bathroom and wipe themselves, pull up their pants and take a shower with their equipment or without, they have mastered ADL.

4) Mobility
This is one of the main roles of Physical Therapy in Physical Rehabilitation and there is so much to this area of physical rehab I would defer to their expertise and extensive knowledge base.  But just like Bed Mobility, there are some basic guidelines:

• Start out with the patient in the most supportive position and get them standing on their feet,  (with assistance and equipment).
• As the patient progresses remove assistance and upgrade or remove equipment until the patient can stand on their own.  
• At the same time you will also help the patient take steps (with assistance and equipment).
• Try to remove assistance and again upgrade or remove equipment to continue to progress the patient's abilities.  
• Start to add on turns, backing up, inclines, declines and various types of ground (rough, smooth, uneven...etc) until the patient is independent, safe and can move freely in their environment.
  
  
    

Unfortunately, no matter how hard you try, some patients won't completely recover from their injury or illness.  This could be because the damage to their brain or body was so significant that no amount of therapy could undo it.  I would like to offer that it could also be because they don't have the motivation or inner will to continue to fight.  At some point your patient may say to you, "Why are you pushing me so hard when I am happy with the way things are and can do things on my own, my way?"  That should be a cue to you, as their family member, therapist or caregiver, to stop and consider, then accept their new reality.

The Paralympics and You!

I caught an interview on NPR the other day with the director of an advertisement for the Paralympics that is making the rounds online.  His name is Tom Tagholm, he works for the UK's Channel 4 TV station and he is an advertising genius.  I am so hopeful that the coverage of this year's Paralympic Games brings more attention and national pride over the accomplishments of these athletes.  

As Rehabilitation professionals I think we should band together and spread the word about this event; maybe when others get a glimpse of the hard working, ambitious, competitive qualities of the Paralympians they will stop feeling uncomfortable about the athlete's disabilities and start celebrating with them!

Unfortunately for those of us living in the US, the Paralympics won't be shown on any network channels.  NBC is sadly only allowing video content to be shown on the U.S. Paralympics YouTube channel and will air five and a half hours of pre-recorded coverage several days after the events have taken place.  I am so disappointed that I will have to scrounge around online to catch glimpses of these amazing events, so please let's change the US networks minds!  I signed a petition to help change some minds and you can too if you click over here:  10000-to-cover-the-usa-paralympics

Click here to watch Channel 4's Trailer for "Meet the Superhumans"

The Olympics and Disability

During the Olympics I happened to catch one of Oscar Pistorius' races on replay.   I was watching the heavily produced NBC prime-time coverage with family and friends and it brought up a healthy debate.  For those under a rock, four years ago the decision that was made to allow an athlete, South African Spriter Oscar Pistorius, who runs on metal blades, to compete in the Olympics (as well as in the Paralympics).

I could be a little biased in my opinion on this issue because I spend most of my working days as an Occupational Therapist.  My goal as an OT is to help people be more functional in their everyday lives, and what is more functional that being an Olympic athlete!

I happened upon this article from the Huffington Post and I think it encourages all of us in the Rehabilitation field to work harder to help our patients work and live at their maximum potential.
http://www.huffingtonpost.com/steven-stanhope/oscar-pistorius_b_1758065.html

Un-Glamorous OT Moments

Having worked at an insurance company, been a housekeeper in the Emergency Room of a Northern Alberta Hospital and landscaped the grounds of various Assisted Living Facilities one summer when I was 20 I thought I knew unglamorous!

Little did I know that as an Occupational Therapist I would be...

-wiping dried bowel movement off of a patient's groin and buttocks while the PT holds him up

-accidentally kneeling in a bed full of urine while holding a patient in a sitting position


-cleaning the toilet of an old man (pubic hairs and all) before installing his new raised toilet seat because no one else would do it


-inspecting a hoarder house (including their disgusting bathroom) while trying not to touch anything


-trying not to laugh or fall asleep while watching a patient struggle with a cognitive task for 30 minutes in a sweaty, stale room


-teaching a 29 year old man how to wipe his butt after a back injury

-holding a Parkinson's patient, who also happened to be going to the bathroom, in a standing position at a grab bar in the shower while his super hot son hoses him down

-jumping in to hold up a 300 lb patient during a transfer after my student started crying and couldn't do it anymore

-lowering a patient to ground to protect her back after she loses her balance playing Wii bowling

and...

-translating what one hard of hearing patient is yelling at their hard of hearing spouse, including "this is bullshit!"

Mobility Devices for Dummies...

Working with the elderly for the last six years has made me realize that despite our best intentions there are still many patients in nursing homes, private homes and adult foster homes who are using the wrong mobility equipment.  As you read this please consider if there isn't a patient or loved one of yours that could use some help with their mobility...

1) if your patient is walking around with their hands on the walls, furniture or you (we call this furniture crawling)...they need a mobility device (a single point or quad cane, hemi-walker, Front Wheel Walker, Four Wheel Walker or wheelchair)!

2) if your patient is bent forward like the woman below while walking, she is no longer able to control the speed of her four wheeled walker and needs a front wheeled walker like the gentleman beside her.


                          

3) if your patient is only able to walk a few feet, no matter the environment, he will need a wheelchair.  I would like to challenge all healthcare professionals that it is NOT good enough to have your patient sit in a standard wheelchair with standard foam cushion for up to 8 hours a day without taking the time to see if it actually fits them.  

Please get your patient the the right mobility device the first time!  If you fail to recognize when your patient, or even your loved one needs a mobility device you are putting them at risk for falls, pain, pressure sores, respiratory complications, joint problems, over-use injuries and spinal deformities/poor posture.

More than 4 million people use a cane and more than 1.5 million use walkers in the United States alone (http://www.usuhs.mil/med/geriatrics/AssistiveDevicesforBalanceandMobility.pdf), so if you don't know enough to get the right one there is a ton of information out there.  


It is estimated that 1.6 million Americans residing outside of institutions use wheelchairs, according to data from the National Health Interview Survey on Disability (NHIS-D). Most use manual wheelchairs, with only 155,000 people using electric wheelchairs (http://dsc.ucsf.edu/publication.php).  

As Occupational Therapists and Healthcare professionals it is up to us (and the rest of our team) to be responsible for the well-being and safety of our patients.   I would encourage you to take an interest in this aspect of our field of practice because I can guarantee you that you will be working on Seating and Positioning in your career!

Nothing feels better when you finally get your patient the device they needed all along and they feel confident, proud and safe in their mobility!