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7 Areas the ADL Balance Trainer Helps with Cognitive Rehab

The main goal of the ADL Balance Trainer is to improve balance through functional movements, namely reaching. To this end, it was important that reach distance and direction be easy to adjust. Our solution was to make platforms that could easily move and lock into place. Initially, they were all one color, as we were solely focused on making them adjustable. However, soon thereafter, it was suggested that we make the platforms different colors to allow for game play. In this moment, the spark for ADL Balance Games was made, and the use of the Trainer for cognitive rehabilitation began. Below are 7 areas that the ADL Balance Trainer can help improve cognition function (while also improving balance):

  1. Attention is the ability to maintain focus over time to complete a task. Placing Games are good examples of balance games that require attention. In these games, patients are asked to place colored items (cones &/or rings) on matching platforms. For patients with limited attention, fewer items can be used for the game. This helps shorten the task duration and attention needed to complete the game. As the patient improves, additional items can be added, increasing task duration and levels of attention.   
  2. Pattern recognition. Several of the balance games rely on the patient's ability to correctly recognize patterns, colors, and shapes. For example, Scrambler requires the patient to "scramble" the colored items by mixing and placing them on non-matching platforms, e.g., no two items match, nor do they match the color of the platform on which they are placed (see picture). For example on the yellow platform, there is one blue, green, and red cone and/or ring; but no yellow ones. The same pattern is followed for the red, green, and blue platforms. If the patient is unable to recognize the pattern, they will not be able to successfully complete the challenge.  
  3. Self-correction. The ability to identify and correct for a mistake is an aptitude needed when playing games such as Line UpUsing a diagram as a guide, the patient selects and places colored items in the same order, or “line up,” as shown on diagram. If a mistake is made, the patient must identify and correct for it in order to correctly match the items in the diagram. 
  4. Planning. The effective development and execution of plan is needed to complete all of the balance games. For example, during Unscrambler the patient is asked to unscramble mismatched items by rearranging and placing them on their matching platforms, e.g., all of the blue items on the blue platform, red items on red platform, green items on green platform, etc. In order to complete this task, the patient must develop and execute a plan to effectively move items to correctly placing them on same-colored platforms. 
  5. Matching. The ability to make items match is a key cognitive function in Match Maker. In this game, the therapist sets up the game by placing cones, rings, and diagram to be “matched” in front of the patient. Using a Match Maker diagram as a guide, the patient selects and places colored items on platforms. Only items shown on diagram are to be placed on platforms. The game ends when all items are correctly placed on platforms, matching the diagram presented. 
  6. Memory. Short-term memory is important for the patient to be successful in memory-based games like Simon. In this game, the patient touches the colored platform called out by the therapist: red, yellow, blue or green. The therapist adds a new color, building a progressively longer sequence of colors. The patient’s goal is to remember and repeat the color sequence by touching the platforms in the correct order. The therapist continues to add colors until the patient is unable to repeat the color chain in the correct order. Game ends when patient in unable to repeat the color sequence in the correct order. 
  7. Simple calculations. Cashier is balance game that challenges the patient to make simple mathematical calculations. In this game, the therapist assigns values for the rings: Red = 1₵, Yellow = 5₵, Blue = 10₵, Green = 25₵. The therapist then picks an arbitrary value (between 1₵ and 123₵) and instructs the patient to place the equivalent value in rings on the black shelf. For example, therapist picks 7₵ and patient sets 1 yellow & 2 red rings on black shelf. Different values are given to the patient until the rings are depleted.

In sub-acute settings like SNF and IPR it is common to treat patient with both balance deficits and cognitive limitations, e.g., patient recovering from strokes, brain injuries, or other neurological conditions. Treatments that challenge and improve both areas at the same time are valuable to helping get patients better and ready for a safe return home.