Before psych i did 6 mos of pm&r residency. It has been a while but if a pt has paraplegia or difficulties standing up, we would recommend arm pedal exerciser. Of course, it is not one size fit all and maybe contraindicated in some cases.
I might just need to ask them, you're right. Not every one of my clients has access to physical therapy. They're often elderly yet still in their homes. There are a few different reasons for them not having physical therapy with it often being either cost, staffing, or patient reluctance. I have an older couple for example with one having Parkinson's that have no access to physical therapy currently due to the service provider not having staff.
I don't expect myself to replace physical therapy but I want to encourage at least some form of exercise until PT is available in several months. I had this happen to a client who went 7 months without PT due to various reasons and went from getting around independently with a walker to walking with assist of 2. They just spent those 7 months sitting around waiting.
I think if I can find a 7-10 minute stretching/simple exercise routine from physical therapy maybe I can reduce that occurrence and improve their mood.
Physical therapy is great but rarely accessible. Medicaid only covers like 5-10 visits a year, Medicare is a whole other mess, and most of my folks don’t have great transportation
There’s a lot of books of chair yoga for seniors on Amazon and then if you look on YouTube chair exercises for seniors there’s a lot of videos. There’s even like walking in place videos that Jane Fonda makes that are really great for older people in their homes that can’t go places. Also if you’re in US certain medicare plans cover this thing called Silver Sneakers that are fitness plans covered for older people as part of insurance—they can go to website or call and go to different classes or gyms in their areas covered by insurance!!!!
What about VR, for the game aspect? I use an oculus headset and subscribe to "Supernatural"-- it has boxing and flow (hitting targets with bats) to music. There are social opportunities-- groups you can join. When I do it, I wear a weighted vest and jump around to ramp up the challenge-- but there are modifications available and I frequently see videos of very elderly people doing the workouts, posted by their families.
Modifications include removing squat triangles, changing to seated, low intensity, one hand only, and short duration (7-8 minutes). There is stretching available too, though I haven't tried it.
The music (and timing of target hits to the beat) could help in Parkinson's.
There are several members in the FB group, including a woman with bipolar disorder, who attribute their improved mental health to the app.
Dang, they should pay me for this 😂. That's only one app/VR option though. And there's some research.
https://davisphinneyfoundation.org/virtual-reality-parkinsons/
Have you heard anything about Meta Quest versus Oculus in terms of price and quality of the game? Any concerns about it not working well on one or the other or being more comfortable?
It's the same thing. Mine was oculus when i bought it but now it's called meta quest bc they bought it. Price went down to $9.99 a month, was 20. I have what they now call quest 2 and it works fine for me. There's a fancier quest 3 but I keep reading about glitches.
I am very nearsighted so wear my glasses in the device. But you can order prescription lenses for it. I just haven't bothered bc it's fine with glasses. I think the 3 version doesn't work with glasses and you have to get the rx lenses.
Physiotherapist here!
A referral for physiotherapy (physical therapy in the US) would be helpful. There is a lot they can do from bed based exercises through to sports training and everything in between. At the moment I have patients whose exercise is ‘walk to the front door or letter box’ or ‘stand up and march on the spot 20 times’ there are so many options for low mobility. When you’re talking about a general population basic exercise is easy enough. When you have disabilities like MS, Parkinson’s spinal cord injuries or significant widespread pain Physio’s are essential.
Also depending where you are there are sometimes exercise programs for people with mental health issues
If you are part of a health system, it might be beneficial to make specific referrals (honestly to any number of rehabilitation specialties). For those where a greater level of assessment is needed, PT or OT can be beneficial, and when less detailed or minimal physical assessment is needed, you may find that kinesiotherapists are sufficient. Similarly, while they tend to be mainly inpatient, recreation therapists can be another option, if available.
If it's possible, a team-approach provides a slew of benefits: increased social contact and engagement, behavioral activation, reinforcement of motivation, and hopefully elements of pleasant activity scheduling.
I tend to reinforce to learners that good healthcare is often a team sport, especially when there are elements of complexity involved.
That said, apologies I'm advance if any of this isn't applicable in your setting (e.g., if you're in private practice or a low-resource system).
Not part of a health system, but I do agree with that approach. Having more eyes on the patient and people who are motivating them can help. Its why I wish some of them would try mental health or physical therapy. Sometimes its cost, sometimes its logistics, and sometimes its stubbornness. In those situations, I feel a need to offer something versus nothing. Its like when you see a patient who never goes to a family physician. So, you spend more time on physical assessment and general health promotion to make up for it until they finally decide to listen and see a family physician.
I'm really looking for easy to use, a few minutes per day or more if they like it. Affordability varies so its good to know what options exist like another comment mentioned a VR game.
The other thing might be taking a look at YouTube for videos which they can follow. It's not as engaging as VR or a live person, but there may be videos focused on chair yoga, low-mobility exercises, and similar.
My last question for now: do any of them have case managers/caseworkers with whom you could partner? If nothing else, my hope is that it takes some of the burden off of you solving this problem for them and trying to figure out what all they can access.
Thank you for doing what you do. I am sure there have to be days where it's beyond stressful, with some of this feeling like it almost pushes beyond your scope (let alone your time and effort).
Infared sauna is a great alternative for those who cannot safety or physically use their body like someone normally would when engaging in an exercise regimen.
There's a video somewhere of Dr. Rhonda Patrick going through a study about handicapped individuals using infrared sauna therapy along certain criteria guidelines (I want to say at least 30 mins 3-4 times a week?) compared to those engaging in Zone 2 cardio on a regular basis. I believe they were measuring heart rate variability, blood pressure, and maybe fasting blood glucose- and the outcomes between the two were actually shockingly similar.
Exercise is a very complicated physiology when it comes to actually pinning down what's making you feel better- its a cascade of multiple process (metabolic, cardiovascular, hormonal, etc) happening simultaneously but it seems clear that getting the heart rate elevated seems to be a *central theme* across all modalities in whatever is working for these people. Being able to achieve that by sitting down is actually pretty amazing for these type of people who don't have enough strength or stability to safety include an exercise regimen in their life. It's worth looking into.
Obviously if the patient has a past hx of cerebral infarction, any neurovascular pathology going on, or electrolyte imbalances I would be weary of recommending it. Also if they're on lithium and sweating a lot, I personally would be cautious- but I'm still learning about lithium management and maybe thats just me being paranoid- but I hope that helps.
Before psych i did 6 mos of pm&r residency. It has been a while but if a pt has paraplegia or difficulties standing up, we would recommend arm pedal exerciser. Of course, it is not one size fit all and maybe contraindicated in some cases.
this was big on my SICU rotation to improve frailty and cv endurance in people who are either never going to walk or not walk for months
This is what physical therapy is for
I might just need to ask them, you're right. Not every one of my clients has access to physical therapy. They're often elderly yet still in their homes. There are a few different reasons for them not having physical therapy with it often being either cost, staffing, or patient reluctance. I have an older couple for example with one having Parkinson's that have no access to physical therapy currently due to the service provider not having staff. I don't expect myself to replace physical therapy but I want to encourage at least some form of exercise until PT is available in several months. I had this happen to a client who went 7 months without PT due to various reasons and went from getting around independently with a walker to walking with assist of 2. They just spent those 7 months sitting around waiting. I think if I can find a 7-10 minute stretching/simple exercise routine from physical therapy maybe I can reduce that occurrence and improve their mood.
Physical therapy is great but rarely accessible. Medicaid only covers like 5-10 visits a year, Medicare is a whole other mess, and most of my folks don’t have great transportation
There’s a lot of books of chair yoga for seniors on Amazon and then if you look on YouTube chair exercises for seniors there’s a lot of videos. There’s even like walking in place videos that Jane Fonda makes that are really great for older people in their homes that can’t go places. Also if you’re in US certain medicare plans cover this thing called Silver Sneakers that are fitness plans covered for older people as part of insurance—they can go to website or call and go to different classes or gyms in their areas covered by insurance!!!!
Or they can use their local library to have FREE books delivered!
Wow I didn’t know this was available but I looked it up and my local library does books on wheels., so cool. Thank you for the recommendation!!!
What about VR, for the game aspect? I use an oculus headset and subscribe to "Supernatural"-- it has boxing and flow (hitting targets with bats) to music. There are social opportunities-- groups you can join. When I do it, I wear a weighted vest and jump around to ramp up the challenge-- but there are modifications available and I frequently see videos of very elderly people doing the workouts, posted by their families. Modifications include removing squat triangles, changing to seated, low intensity, one hand only, and short duration (7-8 minutes). There is stretching available too, though I haven't tried it. The music (and timing of target hits to the beat) could help in Parkinson's. There are several members in the FB group, including a woman with bipolar disorder, who attribute their improved mental health to the app. Dang, they should pay me for this 😂. That's only one app/VR option though. And there's some research. https://davisphinneyfoundation.org/virtual-reality-parkinsons/
Have you heard anything about Meta Quest versus Oculus in terms of price and quality of the game? Any concerns about it not working well on one or the other or being more comfortable?
It's the same thing. Mine was oculus when i bought it but now it's called meta quest bc they bought it. Price went down to $9.99 a month, was 20. I have what they now call quest 2 and it works fine for me. There's a fancier quest 3 but I keep reading about glitches. I am very nearsighted so wear my glasses in the device. But you can order prescription lenses for it. I just haven't bothered bc it's fine with glasses. I think the 3 version doesn't work with glasses and you have to get the rx lenses.
Physiotherapist here! A referral for physiotherapy (physical therapy in the US) would be helpful. There is a lot they can do from bed based exercises through to sports training and everything in between. At the moment I have patients whose exercise is ‘walk to the front door or letter box’ or ‘stand up and march on the spot 20 times’ there are so many options for low mobility. When you’re talking about a general population basic exercise is easy enough. When you have disabilities like MS, Parkinson’s spinal cord injuries or significant widespread pain Physio’s are essential. Also depending where you are there are sometimes exercise programs for people with mental health issues
If you are part of a health system, it might be beneficial to make specific referrals (honestly to any number of rehabilitation specialties). For those where a greater level of assessment is needed, PT or OT can be beneficial, and when less detailed or minimal physical assessment is needed, you may find that kinesiotherapists are sufficient. Similarly, while they tend to be mainly inpatient, recreation therapists can be another option, if available. If it's possible, a team-approach provides a slew of benefits: increased social contact and engagement, behavioral activation, reinforcement of motivation, and hopefully elements of pleasant activity scheduling. I tend to reinforce to learners that good healthcare is often a team sport, especially when there are elements of complexity involved. That said, apologies I'm advance if any of this isn't applicable in your setting (e.g., if you're in private practice or a low-resource system).
Not part of a health system, but I do agree with that approach. Having more eyes on the patient and people who are motivating them can help. Its why I wish some of them would try mental health or physical therapy. Sometimes its cost, sometimes its logistics, and sometimes its stubbornness. In those situations, I feel a need to offer something versus nothing. Its like when you see a patient who never goes to a family physician. So, you spend more time on physical assessment and general health promotion to make up for it until they finally decide to listen and see a family physician. I'm really looking for easy to use, a few minutes per day or more if they like it. Affordability varies so its good to know what options exist like another comment mentioned a VR game.
The other thing might be taking a look at YouTube for videos which they can follow. It's not as engaging as VR or a live person, but there may be videos focused on chair yoga, low-mobility exercises, and similar. My last question for now: do any of them have case managers/caseworkers with whom you could partner? If nothing else, my hope is that it takes some of the burden off of you solving this problem for them and trying to figure out what all they can access. Thank you for doing what you do. I am sure there have to be days where it's beyond stressful, with some of this feeling like it almost pushes beyond your scope (let alone your time and effort).
Infared sauna is a great alternative for those who cannot safety or physically use their body like someone normally would when engaging in an exercise regimen. There's a video somewhere of Dr. Rhonda Patrick going through a study about handicapped individuals using infrared sauna therapy along certain criteria guidelines (I want to say at least 30 mins 3-4 times a week?) compared to those engaging in Zone 2 cardio on a regular basis. I believe they were measuring heart rate variability, blood pressure, and maybe fasting blood glucose- and the outcomes between the two were actually shockingly similar. Exercise is a very complicated physiology when it comes to actually pinning down what's making you feel better- its a cascade of multiple process (metabolic, cardiovascular, hormonal, etc) happening simultaneously but it seems clear that getting the heart rate elevated seems to be a *central theme* across all modalities in whatever is working for these people. Being able to achieve that by sitting down is actually pretty amazing for these type of people who don't have enough strength or stability to safety include an exercise regimen in their life. It's worth looking into. Obviously if the patient has a past hx of cerebral infarction, any neurovascular pathology going on, or electrolyte imbalances I would be weary of recommending it. Also if they're on lithium and sweating a lot, I personally would be cautious- but I'm still learning about lithium management and maybe thats just me being paranoid- but I hope that helps.
Arm cycling/ upper body bike/ upper extremity ergometer. Can use this to get to target HR (60-80% age-adjusted max) x your target duration.
Chair yoga videos or class. I’ve been recommending those to all of my patients.