1. Improving Quality Indicators with NeuroGym®
Eric Heiden MSc.
Marion Godoy RN BScN
NeuroGym FIT
Responsive Health Management Inc.
Abstract
Mid-loss ADLs represent a dimension of mobility loss that has potential for change through targeted physical activity programs. Mid-loss ADL items include transfers and mobility. NeuroGym Technologies produces specialized exercise equipment that allows therapy staff to intensively train mid-loss ADL items safely and intensively across a broad range of residents. Implementation of a mobility training program with NeuroGym equipment, delivered through restorative care and physiotherapy has been used to target mid-loss ADLs over 6 consecutive quarters at the O’Neill Centre Long Term Care Home. Therapy staff maintained a program serving over one third of residents in the facility, who received targeted mobility training using the NeuroGym equipment. The therapy team was coached on a regular basis by a NeuroGym therapist who provided assistance with exercise selection, progression, and evaluation of training programs for individual residents. The percentage of residents worsening in mid-loss ADLs has decreased, while the percentage of residents improving or remaining independent in mid loss ADLs has increased.
Background
Once a resident loses the ability to transfer independently, restorative and therapy programs have few options for effective exercise training. Residents who are transferred by mechanical lift would generally require two or more therapy staff for weight bearing exercise, a situation that is not practical given current staffing resources. Exercise equipment manufactured by NeuroGym Technologies provides a means of safely enabling movement for residents at all levels of mobility, thus allowing therapy staff to bring weight bearing exercise to residents who otherwise would not receive it.
Innovation
The NeuroGym line of mobility enabling equipment is designed to allow residents with significantly impaired function to safely participate in progressive physical exercise. Enabling equipment provides therapy staff with the means to bring the known health benefits of physical activity to residents with functional impairments that would otherwise prevent them from receiving this kind of training. Regular and progressive training with enabling equipment has been shown to allow residents with impaired standing, balancing and stepping ability to practice and improve these abilities and even recover function in LTC settings. Mobility training programs using enabling equipment and targeting a large number of residents have the potential to influence facility level quality measures such as the “Improved ADLs” and “Worsened ADLs”.
Impact
Items in the mid-loss range of ADLs, including the ability to transfer and ambulate, can be effectively targeted by enabling equipment. Worsening mid-loss ADLs are associated with several negative health outcomes including social isolation, incontinence, pressure ulcer risk, and increased care demands. An intervention targeting mid-loss ADLs has the potential to impact several key quality indicators and reduce care demands for a wide range of residents.
Before NGFIT Program
Since NGFIT Program
Implementation
NeuroGym Technologies provided a range of enabling equipment designed to allow functional mobility training for long term care residents across a range of functional levels. The NeuroGym equipment included machines designed to allow residents to train sit to stand ability, balancing, stepping, trunk strength and bed mobility, as well as lower body strength, endurance and range of motion. In addition to the equipment, NeuroGym FIT provided ongoing support in the form of weekly visits from an experienced therapist to coach the therapy staff in optimizing the use of the equipment on hand. Ongoing support from the NeuroGym therapist included advising therapy staff on equipment setup and use, progression of training over time, tracking of short-term performance measures, and targeting training programs toward facility level quality indicators.
Results
Therapy staff maintained a list of more than 50 residents using the NeuroGym enabling equipment over 6 consecutive quarters. Weekly attendance tracking was used to evaluate resident participation, with a target of 3 training sessions per week identified as the necessary intensity for improving function. Short term performance measures were collected on a monthly basis to evaluate progress for individual residents. Attendance and short term performance measures were used to trigger progression in individual resident programs. The percentage of residents with improved mid-loss ADLs has gradually increased over 6 quarters, while the percentage of residents with worsened mid-loss ADLs gradually decreased.
NeuroGym Sit to Stand Trainer
NeuroGym Pendulum Stepper