SilverFit Compact

The SilverFit Compact is used to provide exercises for the older person in the comfort of someone's own room. Clients can do functional exercises in their own time. The aim of intensifying the therapy is to reduce the time spent in bed during rehabilitation. It can also help the client to continue the exercises at home. The game-based exercises motivate clients and are intuitive. 

Use

The SilverFit Compact is a portable system with a built-in computer and 3D camera. The SilverFit Compact can be used in different ways. The client can do exercises in their own room independently or with family, in addition to therapy. If the client cannot come to the therapy room, the therapist can do exercises using the SilverFit Compact in the bedroom or at the home of the client. 

Progress

The therapist and client discuss which goals should be set for the treatment. Together they will determine which exercises are required to achieve that goal. These exercises are stored in a protocol, in which the frequency of the exercises is also agreed upon. The scores are saved whenever the client exercises. As such, progress to the ultimate treatment goal can be viewed at all times by the client, their family, and therapist. These exercises can always be altered in the protocol that has been set.

If the client starts doing exercises independently or accompanied by a caregiver, the exercises are offered sequentially. Prior to each exercise is a short video with instructions. During exercise, the SilverFit Compact provides verbal assistance for the exercises. After each exercise, the SilverFit Compact offers a short break, after which the next exercise starts. To prevent that exercises are forgotten, an alarm clock can be set that goes off at a predetermined time. The computer will start at that time, and the exercises can be commenced.

 For whom

  • Can be employed for a large number of clients; from people with balance issues who are unable to stand, to people who are able to walk with or without a tool.
  • The SilverFit Compact is applicable for the following: 
    • Post-stroke survivors
    • Total knee- and hip arthroplasty 
    • Fractures of lower and upper extremity
    • Amputations
    • COPD
    • Fragile older people
    • Neurological problems
    • Malaise

Where

  • Bedroom of client independent use or under supervision of family
  • Bedroom of client under supervision of therapist
  • At home 

Why

  • Faster results
  • Shorten duration hospitalisation
  • Multiple training moments in a day
  • The game element and the scores motivate clients which lead to greater therapy adherence
  • Strength training for arms, upper extremity, and legs; transfer training (ability to sit and stand); mobilising exercises for arms, legs, and upper extremity.

How

  • The therapist/supervisor can select the exercises in the protocol suited to the physical and cognitive abilities of the client
  • In order to offer a varied program, each day a different exercise protocol can be set
  • When a client is training independently, the alarm function reminds them to do their exercises
  • If the protocol is set, the client can perform the exercises independently or together with family
  • The therapist can also supervise the exercises when training in someone's bedroom or at home
  • No separate folders or papers with homework assignments
  • Therapist and client can review the results together and customise the exercises if necessary
  • The Compact can be used in small spaces. (The distance between the Compact and the person who exercises should be about 150 cm)

More exercise leads to greater recovery of function

There is increasing scientific evidence that more therapy contributes to a faster and fuller functional recovery after a CVA (Veerbeek et al. 2014, Kwakkel 2009, Kwakkel et al. 2004). This applies to the early and late rehabilitation phase, from 24 hours up to 6 months; but also for the chronic rehabilitation phase (> 6 months; Stroke Guideline by KNGF, 2014). Kwakkel et al. (2004) concluded on the basis of a systematic review that an increase (two times as much on average) of physical and occupational therapy during the first 6 months after a stroke resulted in improvements in the performance of daily activities. The results indicated no ceiling effects of physical therapy. No limit to therapeutic activity was found after which no further improvements were shown. The Stroke Guideline (2014 by KNGF) advises clients who are limited in daily functioning (Barthel Index < 19) to exercise for at least 45 minutes daily while hospitalised, whether supervised or not.

kwakkel picture EN

The recommended intensity of exercise is not reached

Huijben et al. (2009) examined how much time CVA clients in Dutch skilled nursing facilities spent on therapy every day. But only 20% of the day (103.5 minutes) was spent on therapeutic activities. Only 9% of this was spent on physiotherapy (19 minutes a day). Huijben et al. (2012) and Kwakkel (2009) discuss various other studies conducted in hospitals and rehabilitation departments. Invariably only a small part of the day is devoted to therapeutic activities (between 13 and 45% a day).

Recommendation to exercise more, also outside of therapy time

The above results show that CVA clients are under-treated. As such, the Stroke Guideline (KNGF, 2014) recommends treating CVA clients multiple times a day during the rehabilitation process, not only during the week but also in weekends. This includes the opportunity for clients to also practice outside of therapy time, possibly with a caregiver.

Independent exercise at the ward

Additional exercise could be done at the ward, for instance. In a study by Huijben et al. (2012), CVA clients were supported and encouraged by nurses to exercise more often and more independently outside of therapy time. Time spent on therapeutic activities rose from 103.5 minutes to 156.5 minutes per day (an increase of 50%).

SilverFit at the ward

In the study of Van Wijngaarden (2014), one of the goals was to increase the number of training moments for the geriatric orthopaedic rehabilitant to two moments daily of 20 to 30 minutes. These training moments occurred at the physiotherapist’s and in the ward under the direction of caregivers and occupational therapists. After a period  of 6 weeks, the percentage of clients that trained 2 times a day increased from 0 to 60%. 

Virtual therapy increases motivation

These following elements are of interest for learning motor skills during treatment (Stroke 2014 Guideline by KNGF): 

  • the exercise should be tailored to the client
  • the exercises must have sufficient repetition
  • verbal and non-verbal feedback must be given on implementation 
  • the motivation to learn should be increased by informing the client of the purpose, by coaching and by giving (positive) feedback

A review by Holden (2005) shows that games enhance the motivation of the client. This allows the client to practice longer and much more often, without it being experienced as a burden. The continuous feedback from the games enhances motivation. This includes both direct feedback (am I doing well or not) as well as insight into long-term performance improvement.  

why does adding games

Exercising at home with SilverFit

The challenge is to have clients exercise at home. Games may well be used for this purpose. Remote rehabilitation played a promising role, as described in the Stroke Guideline (KNGF, 2014). In this way, clients can be assisted remotely and encourages self-management: clients exercise independently in their own home or living environment and evaluate the execution and progress with the physiotherapist on a regular basis. Nawaz et al. (2014) looked to an interactive prototype which also enabled exercise at home, focusing on fall prevention. The evaluation showed that the elderly had positive experiences when using a touchscreen.

A systematic review of Miller et al. (2014) assessed the effects and feasibility of virtual mobility games in the elderly at home. Positive effects were found in regard to balance, walking activities, physical body functions, loneliness, mood and quality of life. Many studies described that the elderly enjoyed the virtual games. However, further research is required, since most of the studies conducted by Miller et al. (2014) were not yet of sufficient quality to draw conclusions about effectiveness.

Literature

  • Huijben-schoenmakers, m., Gamel, C. & Hafsteinsdóttir, T.B. (2009). Filling up the hours: How do stroke patients on a rehabilitation nursing home spend the day? Clinical rehabilitation, 23 (12): 1145- 1150.
  • Huijben-schoenmakers, m., Rademaker, A. & Scherder, E. (2012). “Can practice undertaken by patients be increased simply through implementing agreed national guidelines?” An observational study. Clinical rehabilitation, 27 (6): 513-520.
  • Richtlijn Beroerte (2014). Koninklijk Nederlands Genootschap voor Fysiotherapie (KNGF). kwakkel, g., Peppen, van P., Wagenaar, R.C., Dauphinee, S.W., Richards, C., Ashburn, A.,
  • Kwakkel, g. (2009). Intensity of practice after stroke: More is better. Schweizer Archiv für Neurologie und Psychiatrie, 160(7):295-298.
  • Miller, K.J., Adair, B.S., Pearce, A.J., Said, C.M., Ozanne, E. & Morris, M.M. (2014). Effectiveness and feasibility of virtual reality and gaming system use at home by older adults for enabling physical activity to improve health-related domains: a systematic review. Age and Ageing, 43:188-195.
  • Nawaz, a., Helbostad, J.L., Skjaeret, N., Vereijken, B., Bourke, A., Dahl, Y. & Mellone, S. (2014). Designing smart home technology for fall prevention in older people. In: HCI International – Posters’ Extended Abstracts, Communications in Computer and Information Science, 435: 485-490.
  • Oudheusden, van p. (2013). Virtual reality in de ouderenrevalidatie. University of Applied  Sciences Leiden, unpublished MSc-thesis work.
  • Veerbeek, j.m., Wegen, van E., Peppen, van R., Wees, van der P.J., Hendriks, E., Rietberg, M. & Kwakkel,G. (2014). What is the evidence for physical therapy poststroke? A systematic review and Meta-Analysis. PLos ONE 9 (2): e87987.
  • Wijngaarden, van j. (2013). Kan therapeutisch gamen gebruikt worden als extra trainingsmoment bij de geriatrische orthopedische revalidant? Avans Plus University of Applied Sciences, unpublished MSc-thesis work.

The SilverFit Compact provides the following exercises:

  • balance upper body
  • arm exercises
  • transfer training: sit to stand transfers
  • strength exercises for arms and legs
  • cognitive exercises
  • balance and gait exercises. These exercises require more space.  

 

Computer and camera

Comact systeem2 

A simple portable system with built-in computer and 3D camera

Easy to use on the dining table or kitchen table. In terms of installation, all you need is to place the plug in the socket and the system can be used.

Service

Compact training 

Servicepackage (1 year, extendable)

On-site installation, training of physiotherapists, carers and family members, fast on-site service in case of any problems, updates of software