As many Occupational Therapy clinicians and students are resesarching the need, use, and functional outcomes of the Nintendo Wii in practice, this may serve as a good resource lead. 

Article source from: http://www.eurekalert.org/pub_releases/2008-04/mcog-otu040408.php

Contact: Paula Hinely
phinely@mcg.edu
706-721-3646
Medical College of Georgia 

Occupational therapists use Wii for Parkinson's study

Ingrid Bell, left, uses the Nintendo Wii with guidance from her occupational therapist, Jessica Westmeier-Shuh. The Wii is part of an MCG study examining the efficacy of occupational therapy in... Click here for more information.

It’s Ingrid Bell’s turn at bat. She steps up to the plate, awaiting the pitch. A 70-mph fastball soars toward her. She swings and connects with the ball.

Foul ball! Everyone cheers for her anyway.

This baseball game’s not taking place on a field, and there’s no real bat or ball to be seen. Mrs. Bell is playing the Nintendo Wii as part of her occupational therapy. She is among 30 Parkinson’s disease patients participating in a Medical College of Georgia study to determine if occupational therapy enhances the treatment of the disease.

Parkinson’s disease affects daily tasks that people take for granted. Brushing teeth, getting out of bed and walking become a problem for these patients because of dopamine depletion, which results in stiffness or slowing of movement and fine motor dysfunction.

“Occupational therapy looks at how the illness affects the patient’s whole life, from the psychological, cognitive and sensory motor standpoints,” says Dr. Ben Herz, assistant professor of occupational therapy in the School of Allied Health Sciences and a study principal investigator along with Dr. John Morgan, neurologist. “Our therapists are responsible for helping someone maintain or gain their independence with functional activities.”

While occupational therapy is frequently used in the comprehensive care of Parkinson’s patients, evidence is needed to support its short- or long-term effectiveness, says Dr. Herz.

“We’re hoping to show a slowing of the progression of the disease and a decrease in medication while increasing function. If we can teach patients to exercise and do functional activities, maybe we can have them take less medications,” he says.

Study participants are divided into an experimental group receiving therapy or a control group that does not. Each participant meets individually with an occupational therapist for one hour a week for eight weeks. Participants in both groups are given functional and standardized tests and evaluated on a quality-of-life scale before and after therapy begins, then four months later. The control group has the option to receive therapy after the second evaluation.

“None of the participants have had occupational therapy before because we wanted no preconceived notions of what therapists would do or how they would do it,” Dr. Herz says. “A few participants were probably taken aback when they heard they’d be playing video games.”

But the Wii has been popular with both participants and therapists.

“Because the Wii is interactive and you have to do certain functional movements to be successful, it’s an effective modality for working with Parkinson’s patients,” says Dr. Herz. “One of the therapists uses the Wii for timing and loosening up, and the other uses it for coordination and balance issues.”

Participants also perform functional activities, such as dressing and rolling over in bed; fine motor skills, like circling in word searches and carefully moving blocks in the game Jenga; and stretching.

“These therapists are thinking way out of the box. They’re doing activities that will make a difference in these participants’ lives based on what we know about Parkinson’s,” Dr. Herz says.

Early results show at least short-term gains. Therapists set goals for each participant prior to treatment. These goals range from independence with daily living activities, such as cooking, dressing or bathing, to functional activities such as sports and leisure without any adaptation. About 98 percent of those goals have been met or surpassed, Dr. Herz says.

When Mrs. Bell started therapy in January, she was dependent on her husband to walk, dress and get out of bed. She could climb only one step on her own.

“Now she’s doing 24 steps without any difficulty,” says Dr. Herz.

“I may need help putting my shirt and shoes on, but I’m trying as hard as I can to do it myself,” Mrs. Bell says.

The study, funded by a $30,000 grant from the National Parkinson’s Foundation, is a collaboration between the Department of Occupational Therapy and MCG’s Movement Disorders Program.

Below is a list of some of the upcoming Occupational Therapy Association conferences for each state in the United States.  Attending your respective annual conference is a great opportunity to earn continuing education credits and to network!

Alabama OT Association September 5-7 Orange Beach, AL (www.alota.org) 

Alaska OT Association September 5-7 Anchorage, AK (www.akota.org)

New Mexico OT Association September 12-13 Albuquerque, NM (www.nmota.org)

New York OT Association September 18-20 Syracuse, NY (www.nysota.org)

Maine OT Association September 19 Portland, ME (www.meota.org)

Arizona OT Association September 19-20 Phoenix, AZ (www.arizota.org)

Kentucky OT Association September 19-20 Paducah, KY (www.kotaweb.org)

Nebraska OT Association September 19-20 Omaha, NE (www.notaonline.org)

Nevada OT Association: September 19-20 Las Vegas, NV (www.nvota.org)

North Carolina OT Association September 19-21 Concord, NC (www.ncota.org)

New Jersey OT Association September 21 Eatontown, NJ (www.njota.org)

Massachusetts OT Association September 26 Westford, MA (www.maot.org)

Wyoming OT Association September 26-27 Cheyenne, WY (www.wyota.org)

Virginia OT Association September 26-28 Portsmouth, VA (www.vaota.org)

South Dakota OT Association September 27-28 Vermillion, SD (www.sdota.org)

Colorado OT Association October 3-4 Denver, CO (www.otacco.org)

Minnesota OT Association October 3-4 St. Cloud, MN (www.motafunctionalistfirst.org)

Oklahoma OT Association October 3-4 Oklahoma City, OK (www.okota.org)

Pennsylvania OT Association October 3-4 King of Prussia, PA (www.paota.org)

Washington OT Association October 3-4 Seattle, WA (www.wota.org)

South Carolina OT Association October 4 Columbia, SC (www.scota.net)

New Hampshire OT Association October 10 Concord, NH (www.nhota.org)

Ohio OT Association October 10-11 Perrysburg, OH (www.oota.org)

California OT Association October 10-12 Ontario, CA (www.otaconline.org)

Iowa OT Association October 11 Des Moines, IA (www.iowaot.org)

Idaho OT Association October 17-18 Boise, ID (id-ota.com)

West Virginia OT Association October 17-18 Morgantown, WV (www.wvota.org)

Michigan OT Association October 20-21 Mackinac Island, MI (www.mi-ota.com)

Tennessee OT Association October 24 Dickson, TN (www.tnota.org)

Georgia OT Association October 24-25 Atlanta, GA (www.gaota.com)

Missouri OT Association October 24-25 Maryville University (www.motamo.net)

Oregon OT Association October 24-26 Salem, OR (www.otao.com)

Hawaii OT Association October 25 Honolulu, HI (www.otah-hawaii.com)

Maryland OT Association November 7-8 Timonium, MD (www.mdota.org)

Illinois OT Association: November 13-15 Springfield, IL (www.ilota.org)

Texas OT Association November 21-23 Austin, TX (www.tota.org)

2009

Florida OT Association February 7-8 Orlando, FL (www.flota.org)

Connecticut OT Association March 28, 2009 North Haven, CT (www.connota.org)

Rhode Island OT Association May 2, 2009 CCRI Newport Campus (www.riota.org)

If you are studying for the NBCOT exam, please become a free member of the study groups for OTA students and OT students.  OT-ADVANTAGE.COM members, click on 'search profiles' and you will see the groups listed on the right side.  If you are not a member, you can become a FREE member today by clicking on 'Become a Member.'

Today, OT-ADVANTAGE.COM added a case study and matching questions for those studying.  Take a look and quiz your knowledge.  Please feel free to comment below and add how we can help you better prepare.

If you are an Occupational Therapy practitioner or even a Level II student at a skilled nursing facility, you have probably found it difficult to strike a balance between giving quality treatments in accordance with meeting a Medicare RUG (Resource Utilization Group) level.  Typically, when a patient is admitted to a skilled nursing facility from a hospital, and has Medicare coverage, the MDS coordinator sets reference periods.  If you are new to this area of practice, the reference periods are critical when establishing how many treatment minutes a client can/will receive for Physical, Occupational, and Speech therapy. 

To give you a crash course with reference periods, there are different levels a patient can reach, dependent upon their therapy treatment minutes, nursing intervention (i.e., IV antibiotics), and the period of time the patient will be receiving these.  Furthermore, the assessment period becomes Medicare's crystal ball.  They have preset reimbursement rates, given the set criteria.  For example, if the patient is receiving 150 minutes of therapy a day during a reference period, Medicare will reimburse accordingly.  If a patient is receiving 30 minutes of therapy combined (OT/PT/SLP) and IV antibiotics, Medicare will reimburse according to the designated RUG level as well.  Generally speaking, the more therapy treatment time the greater the reimbursement.

What becomes even more tricky is coordinating a patient's medical status (e.g., patient is nauseated and cannot participate with therapy on the day of admit), the amount of time Occupational/Physical/Speech Therapy has to evaluate and treat the patient upon admission (evaluation minutes do not count), nursing assessment (e.g., wound care or IV antibiotics), and how all of this can be combined to determine a patient's RUG level.  Usually, the MDS Coordinator and Rehabilitation Coordinator work together when setting assessment dates and the treating therapists assist in carrying out the plan. 

Now that you have a small background on what happens when a patient is admitted to a skilled nursing facility, it is time to tap into a frustrating area for Occupational Therapy practitioners.  Many times OT clinicians feel the pressure to see patients for 75 minutes of therapy a day, from their rehabilitation managers.  Rightfully, the patient's Medicare coverage is paying your facility based on the reference period RUG level for the patient's stay.  This is the key reason you cannot see a patient for 75 minutes a day during a reference period and then immediately taper them down to 30 minute treatment sessions a day.  This is a fraudulent act.  The reason being, the crystal ball that I previously mentioned, Medicare wants assessment periods set to pay for future dates of therapy.  If a patient was seen for 30 minutes a day by Occupational and Physical Therapy combined during a reference period, Medicare will pay that designated RUG amount for X amount of future days.

Many patients admitted to a skilled nursing facility from a hospital setting, were likely receiving inpatient rehabilitation (3 hours of therapy a day).  Therefore, their expectations may be to receive a few hours of therapy a day.  As an Occupational Therapist evaluating a new client, it is your responsibility to determine how much therapy this client can benefit from.  It becomes overwhelming thinking you should see a patient for 50 or 75 minutes a day, as well as see your regular caseload of Occupational Therapy clients.  So, how do you maximize your time with a client and help them reach quantitative results?  Here are some tips:

• Start Early: Begin seeing patients at 7am to address ADLs.  You may not be able to do the entire ADL, but you can initiate a portion each day (communicate with the nursing aid if you cannot complete a patient's ADL).  Seeing 2-3 patients for an ADL each day, rotating the patients you see to address everyone, you will soon see carryover of treatment.  This will also help eliminate the stress of seeing a patient for 50-75 minutes straight, who may not be able to tolerate that much time at once. 
• Group Patients:  Usually, a patient receiving Occupational Therapy can receive group treatment up to 25% of their regular treatment time for the week.  Have set daily groups that your patients can benefit from.  For example, set an adaptive equipment group up for 30 minutes on Tuesdays and address "How to Use Adaptive Equipment."  Or have a weekly exercise group, home safety, homemaking, or community re-integration group.  This will help utilize your time with a client for Occupational Therapy treatments, as well as aid a client in reaching a functional outcome.
• Dovetail:  This is a term many Occupational Therapy Clinicians should become familiar with.  Dovetail means you can see two Medicare Part A patients at the same time, but not charge them for a group treatment.  Keep in mind, if you are having the clients do the same activity it is a group treatment.  But if you are seeing 2 patients with different start/stop times this is considered a dovetail.  For example, say you are treating John from 9am-9:50am and Jane from 9:30am-10:20am.  Both are Medicare Part A clients receiving different types of treatment (e.g., e-stimulation, exercise...) and can be billed separately.  This helps Occupational Therapy practitioners utilize their time more effectively, while still addressing goal-oriented tasks.
• Education: Much of our time as Occupational Therapy clinicians is spent communicating with family, staff, other clinicians, and the patient about the therapy plan of care or how to use equipment appropriately.  If the patient is present, you can bill for this time.  For example, educating restorative staff or family/patient on a splint wear/care schedule is billable time.  Try to take advantage of this, as it will strengthen your documentation and justification for services, as well as improve the client's quality of care.

Keep in mind, all of the above tips and suggestions should be referenced in accordance with your facility's regulatory standards.  Please consult with you rehabilitation manager or your policy and procedure manual to accurately determine how to best utilize your time with your client, in accordance with Medicare Part A guidelines.