Top 5 Digital Activities for Cognitive Stimulation

Here is a summary of Professor Gazzaley's recommendations for maximising cognitive stimulation through technology, including working memory and attention span.


1.  Combining a physical activity with a cognitive activity (multitasking)
2.  Using apps that utilise rhythm
3.  Virtual surround creating activity in a multidimensional space
4.  Lowering external stimuli and creating an environment for meditation
5.  Restore and refresh the brain by using nature


Game development in this field utilises these 5 areas to make games more targeted, personalised and multi-modal.  Looking forward to using these games when they are released some time next year (I hope!)

Accessing Nature through Digital Technology

Exposure to the natural environment can decrease stress and enhance brain restoration.  Using multiple senses such as sound and vision (and as previously described in past posts - smell and taste!) it is possible to modulate cognitive stimulation with a calming effect, using the principle of challenge/restore/challenge/restore.  Access to nature gives us the capacity to restore and refresh our mind.  Older people sometimes have less opportunity to experience nature and its nurturing effect.

Two apps I have previously discussed that can be used to create the ambience of nature are "Pocket Pond" and "Nature Sound".  Another app that can be wonderful for getting back to nature is "Relax M. HD" (free).  As well as river, ocean and wind sounds, there are birds, a purring cat, frogs croaking and thunder.  My personal favorite is the campfire sound.  The crackling of the fire sets my mind into a relaxed state almost immediately.

 I have previously used it with Henry who through his life had enjoyed camping.  We "boiled the billy for a cup of tea" and sat with the campfire sound, lights down low and frogs, birds and wind chimes in the background.  Lovely!

Meditation

Meditation is the lowering of awareness of external stimulus to promote internal focus and attention.  It also allows the brain to exclude unwanted thoughts and promote calmness.  Obviously when you are learning the technique of effective meditation, it is important to begin in a quiet and low stimulus environment. There are a number of apps that teach meditation concepts, or can be used during a meditation session.


"Smiling Mind" (free) is a meditation app designed by psychologists.  It is based on research that shows meditation mindfulness (the ability to pay attention to the present moment) can help manage stress, improve attention and increase resilience.  It has three levels of session times from 5 minutes to longer periods.  If your not sure it will suit you, have a go at the 5 minute trial session "Exploring Breath".  A voice guides you through the sessions.  It therefore requires a person to have adequate hearing and the ability to understand directions.


"Line Art" (free) uses music and visual stimulation to promote relaxation and potentially a meditative effect.  It does not require instructions.  Thousands of tiny particles change colours and pattern shapes as you touch the screen.  The pattern shapes vary depending on how many fingers you use to touch the screen.  If you are planning on using four or five fingers, make sure you turn off the "Multi-tasking Gestures" in settings, to prevent the screen from moving to other apps.  Repetitive touching of the screen can produce a meditative effect.  Slow breathing can also be incorporated during the session if desired. 


My next post will discuss the importance of constantly connecting with nature for the older person.

Virtual Reality and Older People

Virtual Surround Games are being developed to create an immersive 360 degree effect.  Once again a physical component is being added to enhance cognitive stimulation.  Their design elicits a distributed attention (multitasking, divided attention) effect, in a multidimensional space.

I have not had the opportunity to use virtual reality technology with my clients, but as the price of this type of equipment comes down and choices in games increase, I predict they will start being used in the near future.

However, their is a way of creating a graduated attention distribution effect in any environment.  For individuals with significant attention problems, it is best to start interaction with touchscreen games in a quiet, low stimulus environment.  Over time as they become more familiar with the activity and their performance improves you can add another stimulus.  This might be background music, a change of environment, or small groups to larger groups.  Constantly reassess a person's progress to select the best environment for each individual.

My next post will be on meditation.

Rhythm and Cognitive Stimulation

Offering rhythmic, repeated activities such as drumming may facilitate improvements in attention.  'You've got Rhythm' (free) teaches rhythm and how to play drums.  There are, choices of congas, bongos and African drums.  When playing the 'LearnNPlay' section the drum will light up when hit at the right times.  There are beginner, intermediate and advanced levels, although I found the beginner section quite hard enough!

The drum 'Game' section is more difficult to manage, so I would advise practising the 'LearnNPlay' before attempting the games.

For an easier app using rhythm, you could try 'Magic Piano' (free).  You can select a song and then tap music 'balls' as they travel down the screen.  To hear the song, you tap the sound icon on the left of the song name.  To play the music by touching the music balls, tap the name of the song and there are choices of easy, medium, hard.  Once again I have found 'easy' to be hard enough.  Start by selecting some easier songs such as 'Amazing Grace' or 'Minuet'.

Next post will be about Virtual Surround games.

 You've Got Rhythm

An Example of Multitasking with a Physical Component

'Air Hockey' (free) is a very popular game in the app store.  Each player has a mallet (round play disc) and has to keep the puck out of their goal.  It can be set at one or two player.  As a two player game it has the benefit of a social and interactive component and the level of difficulty depends on the skill of the players.  When it is set on one player there is a choice of 6 different levels of difficulty, so it can be graded to a persons ability.  For both one and two player, you can select 2 pucks instead of one, which increases the multitasking component.


Adding the physical component depends on the physical ability of an individual.  For sitting balance you might have them sitting in a chair without armrests, or sitting at arms length from the table.  I have used it as a standing balance activity with either one hand resting on the table or for more advanced exercise, one hand behind their back.  The level of supervision required depends on a persons assessed balance ability.


Below are a series of photos demonstrating the different possible positions that can be used.


My next post will on rhythm and cognitive stimulation!


  Demonstrating the game


  Having a go in sitting (chair with no armrests)


  Standing with left hand resting on table


  Having fun with left arm behind the back!

Combining Physical and Cognitive Activity

What attributes of touchscreen games might help maximise cognitive stimulation?

Professor Gazzaley's research found that games which included a multitasking component achieved greater effects on the brain than individual tasks.  He stated the science also clearly shows that physical exercise benefits cognitive activity (music to my physiotherapy ears!)

He then postulated that combining physical activity and cognitively stimulating apps may produce an overall enhanced cognitively stimulating effect.

It is interesting that my recent previous posts had been discussing this very principle!  Anecdotally I have found this concept to hold true.  Whenever I use an app and add a physical component, often the individual has an increased attention span and engages in the activity for a longer period.

My next post will give an example of an app I have used in this way.

Technology and Dementia Conference September 2014

"The Dementia and Technology: A Game Changer" conference was run by Alzheimer's Australia.  It provided some thought provoking content.  My next few posts will be on the variety of presentations and what it means for older people now and into the future!

Professor Adam Gazzaley is the director of Neuroscience Imaging Centre, Neurology, Physiology and Psychiatry at the University of California , San Francisco, USA.  His current research looks at how we can enhance our cognitive abilities using custom-designed video games.  His overall goal is to improve quality of life in both healthy and impaired individuals.

His work included the development of a video game "Neuroracer" which was responsive to each users individual performance.  The game included multitasking performance of car racing and identification of shapes and colours along the course.  His work demonstrated the importance of the multitasking component for stimulating aspects of cognition.  His research found sustained benefits in both attention span and working memory.

Through the work of Neuroscape Lab he is now researching the development of touchscreen and virtual reality games that combine our understanding of emerging technologies and neuroscience.  All very exciting.  Have a look at www.neuroscapelab.com/

Professor Gazzaley's research includes 5 areas of cognitive stimulation.  I'll discuss these in the next post.

In the meantime I found this news piece from the Wall Street Journal with Professor Gazzaley talking about his research.

Touchscreen Infection Control in Practice

Last week I ran my course "iPad Use in Activity and Leisure for the Older Person"  in the beautiful regional Victorian town of Mansfield.  Part of the running of my courses always includes an infection control protocol.

1.  Prior to the course I performed a thorough clean of the iPad using the deBac App procedure and antibacterial wipes.  I logged the cleaning on the log file of the app.

2.  When all the participants were seated, I explained how I perform infection control when doing an iPad group activity by ensuring the iPad is clean and everyone's hands are clean.  This can either be done by hand washing with soap and water then drying, prior to joining a group activity, or use of disinfectant wipes or hand gels before an activity begins.  I then applied disinfectant hand gel to my own and each participants hands, which they rubbed in.

3.  The participants and I had a great morning exploring and trying out different apps (using the one iPad) and how they can be used in a person-centered way.  I also demonstrated the deBac App and log to show how easy it can be to clean the iPad and log infection control procedures.

4.  At the conclusion of the course I performed a thorough clean of the iPad using antibacterial wipes and again applied some antibacterial gel to my hands .

If people are only allowed to access touchscreens using stylus pens, this can inappropriately discriminate against those individuals that cannot hold a pen.  It also prevents people being able to use apps as they are supposed to be used such as "Piano" which requires two hands and multiple finger activity.  It also removes the ability to use the physical components I have previously described, such as "Cake Doodle" or "GT Racing".

So my advice is, develop an appropriate infection control policy based on the evidence, that does not unfairly and unnecessarily discriminate against older people and allow them the same opportunities of choice, social interaction and fun that we have.

My next post will be about the exciting apps discussed at the Dementia and Technology Conference.

 

Infection Control Recommendations for iPads/Tablets

These recommendations are based on the research listed in my previous post as well as;

Hand Hygiene Australia
Hand Hygiene in Outpatient and Home-based Care and Long-term Care Facilities
www.hha.org.au

WHO (World Health Organization)
Clean Care is Safer Care (2005)
Save Lives: Clean Your Hands (2009)

Australian Guidelines for the Prevention and Control of Infection in Healthcare (2010)
www.nhmrc.gov.au
B1.4.2 Routine Environmental Cleaning

Recommendations for Infection Control in the Use of iPads/Tablets/Mobile Phones;

1.  Implement staff/carer education in the need for regular cleaning of touchscreen devices and knowledge of protocols (including mobile phones)
2.  Provide education in hand hygiene for both staff/carers and users/residents/patients - recommend before and after using device
3.  Develop guidelines on method of cleaning the device. Do not use antibacterial sprays or liquids directly on the devices.  Apply to a cloth first, or use wipes.
4.  State frequency of cleaning -after each use and thorough cleaning at the end of the day
5.  Provide documentation of cleaning protocol- de Bac App includes a log record

In my next post I will discuss a working example of how infection control can be managed using iPads.

Unnecessary Barriers to Accessing Touchscreen Technology for Older People

There are already challenges, both physical and cognitive, for older people accessing technology.  So it is very disappointing when practices are implemented that unnecessarily create barriers for older people.  Particularly when these approaches are not based on best practice or evidence based research.

Last week I had a discussion with some carers who were concerned that some nursing homes are only allowing residents to use iPads with a stylus pen.  The residents are not allowed to touch the touch screen.  An oxymoron if ever I heard one!

Infection control is a very important issue and appropriate use and cleaning of equipment should always be included in policies and procedures.  The iPad should be managed the same way as every other type of  equipment, by undertaking an appropriate risk assessment and implementing an effective management plan.

 What does the research show?
Bacterial contamination does occur with touchscreen devices when they are not managed by an adequate infection control procedure.
Gould et al (2009)
Brady et al (2009)
Brady et al (2012)
Ramesh et al (2008)
Sadat Ali M et al (2010)
These research articles are based on mobile phone technology.  An area still overlooked in terms of infection control.

When regular cleaning of devices occurs using antibacterial wipes, there is effective reduction and inactivation of residual bacteria.
Use of wipes other than dry fleece may affect warranty of a product.

Urs-Vito Albrecht et al (2013)
This article is a review of an iPad cleaning protocol using antibacterial wipes and the deBac App which I described in my post on 14 July 2014.  They found that regular cleaning with antibacterial wipes was more effective than a clean cloth in providing effective disinfection of the iPad.

My next post will discuss management recommendations for iPad/tablet infection control.

A Busy Week!

Last week was a very busy week.  I attended the Technology and Dementia Conference run by Alzheimers Australia, I ran an "iPad in Activity and Leisure" aged care course in regional Victoria and tried out a few new apps with my delightful residents. Networking is always an integral part of these events and some interesting issues where discussed.  My next series of posts will be about these, as well as the exciting work being done in the development of apps for cognitive stimulation and reminiscence for people with dementia.

Lets get some balance!

As well as adding range of movement and strengthening, the iPad can also assist with coordination and balance.  A very popular game that can be used on phones or tablets is "Teeter" (free).  A small metal ball is rolled around with the aim of getting it into the green hole, while avoiding the black holes.  The premise is simple, but the combinations get more tricky at each level!

This relies on good control of the iPad and small, fine adjustments, as well as concentration.  This is great for subtle control of upper limb coordination.  It is possible to add sitting balance or standing balance to this activity, but if an older person has issues with their balance it is important to get them assessed by a physiotherapist and close supervision may be required if you are using it in this way.

If a person has a tremor, such as with Parkinson disease or due to medication etc, this game may be too tricky.  So as usual, do your assessment.

Physical Activity with iPads and Tablets

There are a number of ways you can use iPads and tablets to include a physical component.  My next few posts will look at a variety of apps which can be used this way.

There are apps that use tilting and turning of the iPad/tablet to move or control elements on the screen.  These are great for upper limb activity.  If a person rests on their elbows at a table, then it produces a hand/wrist activity.  If a person holds the device without resting on their elbows then shoulder control is added.

The weight of the device can add a strengthening component.  If the weight is too much for a frail older person, then an iPad mini may be more suitable.

"GT Racing 2.  The Real Car Experience" (Free. Offers In-App-Purchases) is a car racing game with great graphics.  It requires fairly straight forward instruction, using your right hand to control speed, while turning the whole iPad/tablet left or right to turn the car.  Compared to some of the more complex car apps, this one is quite simple to use, while being great fun.  (However, as I have said in my previous post, if I watch someone else use it, I get motion sick!)

The Older Person and Dizziness

There are variety of reasons for dizziness in the older person.

Problems with the inner ear;
- Benign Paroxysmal Positional Vertigo (BPPV) caused by crystal deposits in the inner ear
- Vestibular Neuritis caused by inflammation of the inner ear

Migraine, low blood pressure, some cardiac arrhythmias, hypoglycaemia, anxiety disorders, or motion sickness.

Dizziness can cause symptoms such as nausea, headache and loss of balance (which may increase the risk of falls).

If a person has a history of dizziness, care should be taken with choice of apps that have visual motion. Yesterday I was demonstrating an app to a carer called "Pocket Pond HD" (free).  I have used it with great success for relaxation and behaviour modification.  It is a beautifully realistic pond with fish.  As you run your fingers across the screen it creates the sounds and vision of rippling water.  You can feed the fish, add lily pads and dragonflies.  However for the first time I found someone who didn't like it!  The carer has a history of migraine and almost immediately it made her feel a little unwell.  So it was a reminder to monitor the effect of an app and change it if required.  Some of the driving apps such as "GT Racing 2.  The Real Car Experience" are great fun, but can cause motion sickness for me!!

Pocket Pond HD

Top 5 Taste and Smell Apps for Older People

Top 5 Taste and Smell Apps for Older People

1.  "Cake Doodle" ($1.29).  A cake baking app.  Selecting and combining the ingredients adds a physical component.  Decorating allows for personal creativity.

2.  "Daily Water" (free).  You can set the desired fluid intake and log each drink consumed.  There is an alarm option.

3.  "Video Cookbook-Patisserie" ( free).  Photos and videos of different recipes and how to make them.

4.  "Coffee Maker" (free).  The sounds of a cafe and choices for making your own coffee.

5.  Make your own photo album on the iPad or tablet.  This can include food photos to assist with choice or other themes such as flowers.

Touchscreen Technology and Dementia-UK Research

The University of Worcester UK in 2011 published a very interesting article named "Evaluation of the Impact of Touchscreen Technology on People with Dementia and their Carers within Care Home Settings".  The article by D Upton, P Upton, T Jones, K Jutla and D Brooker aimed to assess the effectiveness of the use of touchscreen on the lives of people with dementia and their carers.

They used interviews, focus groups, case studies and field observations to describe the experiences of the participants.  The study went for 6 months.

At the end of the study the authors noted their were a number of benefits in the use of iPad's for those with dementia, their families and the staff that worked with them.  These benefits included;

*Reminiscence-past events, family, experiences
*Memory recall-food choices
*Socialisation- including intergenerational socializing, with more children interacting with  grandparents in the facility
*Resident focus-increased person centred practice by staff
*Increased quality of life

They also discussed some issues that were challenges to using the iPad's;

*Ergonomics- the weight of the iPad's
*Visual difficulty-reflection off the screen in certain light conditions
*Staff confidence with device
*Wifi connectivity at some facilities

These issues can be overcome by using some specific management strategies;

*Support the iPad on a table.  There are a wide variety of iPad covers that include stands which can have the iPad either in a upright or side-on angle
*If a person is in a bed or daybed, there are iPad support pillows designed specifically for using iPad's on laps or reclined position.  Standard cushions or pillows can also be used
*Use anti-glare screen covers and avoid sunlight or artificial light from coming in over the users shoulder
*Educate staff and family members on favourite apps so they can initiate activity
*If Wifi connectivity is unreliable (such as at my facility!) you can download apps at a reliable Wifi source and then return it to the facility.  This does not assist with internet enabled apps, but at least it allows you to download apps to the iPad or tablet.

Make your own photo album

The sense of smell is not just about food.  The scent of freshly cut grass, newly turned earth or the sweet perfume of flowers are all things we can enjoy.  I have made my own floral album (which is like creating your own app!) for those times when there aren't many flowers available or the weather is too bad to go outside. I have a delightful rose garden at home and have photographed my own roses on their bushes or in different types of bouquets.  You can have a go at making one yourself.   When I use the album, I get the person to scroll through the pictures and I can then add scents with pot pourri, floral sprays, perfumes or hand creams such as lavender.

Care still needs to be taken in relation to people's previous experiences.  I tried using lavender spray with Henry, only to discover that he had fallen into a lavender bush as a child and been stung by a number of bees.  He hated the smell of lavender ever since!

Anyone for Coffee?

Sounds can also have a place in helping simulate appetite.  A simple app called "Coffee Maker" (free)
has the background noises of a cafe.  The clinking of cups, the swishing of heating milk and the chatter of people have a real coffee shop feel.  You can select the coffee you want such as cappuccino, then the type of coffee.  You then grind and brew, pick a cup, then tip the coffee and milk in ( of course all these things add a physical component which as a physio I love!)  A variety of decorations are available for toppings.  This can be a great app for people who are unable to get out and about, but enjoy the atmosphere of a cafe.

Lily was a client with frontal lobe dementia.  When she was anxious she could be quite obsessive about food and drink.  She would continuously ask for coffee, but then never drink it.  One particular day she was very distressed and demanding a drink.  I sat down next to her and asked if she would like to make her own coffee.  I had the volume control turned up and she loved all the cafe sounds and took her time decorating the milk foam.  My very clever friend in the catering staff saw what I was doing and quickly made up a coffee for Lily and myself, so that by the time we had finished, I moved the iPad away and there were our coffees!  I left the cafe sounds on while we drank, so that it was like we were out on our own coffee adventure.  Another lovely moment.

Cooking Apps for the Elderly

Visual and auditory cooking activities can help stimulate appetite and encourage people with food choices.  How often have you watched a cooking show and ended up feeling hungry!  There are a whole variety of cooking and food apps, including apps for specific cultural groups as well as different food groups.  Some apps offer very creative decorating options ( such as Cake Doodle mentioned in an earlier post).

"The Video Cookbook-Patisserie" (free, with in-app purchases) uses photographs and video to demonstrate the preparation and cooking of different desserts.  Ingredients are listed and each recipe is rated for difficulty.  The quality of the videos is great and they are enjoyable to watch, even if you don't plan on cooking anything!  There are many simple recipes that would be easy to do for any population. A great one for getting kids involved!

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Hydration App for the Older Person

Appropriate hydration is very important for well being.  In older people it can contribute to significant health issues.  For some older people, particularly with altered smell and taste, it can cause drinking pattern changes.  Some individuals need to limit their fluid intake, while others do not drink regularly enough.  Lack of adequate hydration can contribute to falls in the elderly.  A very useful app for fluid intake is "Daily Water" (free).

The desired number of glasses of fluid per day can be nominated and there is an option to set an alarm as a reminder.  It can be used by those on fluid restriction or people who require prompting with drinking.

I was working with  Henry who had significant constipation issues and used the app to encourage increased fluid intake.  He was surprised at how much he needed to drink, but within days his constipation had improved.

Taste and Smell and Digital Technology

Our sense of smell and taste helps us to enjoy food and drink.  Smell also helps us to enjoy perfumes and aromas.  Good smells and taste make food more attractive, so we are more likely to get appropriate nutrition and hydration.  Interestingly, research has shown adequate nutrition and hydration are closely linked to a decrease in the risk of falls.
Both senses also provide a safety mechanism, telling us when food has gone off, or if there are dangerous fumes such as smoke or gas.

There are many causes for altered smell and taste such as colds and flu's, allergies, smoking and some medications.  As some people age, they often have some reduction in smell and taste.  Head injuries, Parkinson's disease and Alzheimer's disease can also cause a loss of smell.

Management

Treat colds, flu's and allergies
Cease smoking
Have a medical review of medication
Present food in an attractive way with different colours and food types.  This uses vision and texture to stimulate smell and taste and therefore appetite.

There are many ways to use technology to help stimulate appetite, monitor fluid intake and have some cooking and food fun.  My next few posts will look at some of these apps.

Let's Bake a Cake!

Virtual cooking is great fun, but can also be useful in stimulating appetite and looking at food choices for the elderly.  "Cake doodle" ($1.29) is one of those apps I think is worth paying for.  There are a number of free cake baking apps, but as far as I have found, none are as good as this one! 

Start with selecting a cake recipe, Red Velvet is one of my favourites (The ingredients are listed, so that if you want to bake the cake in your own kitchen you can).  On the screen you have your bowl with all the ingredients on the table.  You get to sift your flour, cut your butter, crack the eggs, squeeze, shake, tap, twist, tilt, grate and stir!  All these actions are also good for promoting hand and arm dexterity.

Then there are lots of choices for frosting, letter decoration, toppings and toppers!  You can make a cake for any occasion.  When you are finished, you can tap to eat the cake with corresponding munching sound effects.  You can take a screen shot and save it to your photos or send it to a friend.

My next series of posts will be about taste and smell and how it relates to digital technology.  You didn't think it could?  Well stay posted!

My "Old and Appy" lemon cake.  Deeelicious!!!

Top 5 Auditory Apps for the Elderly

I forgot to add the summary of the 'Top 5 Auditory Apps'! So here it goes...

1.  "Nature Sound" (free).  Create sounds of nature and relaxation music.
2. " Tiny Piano" (free).  An easy to use piano app with built in success.
3.  "guess your song" (free).  Allows you to use your own music library to create a song guessing game.
4.  "RIDBC Auslan Tutor:  Key Signs" (free).  Australian sign language pictures and videos from the Royal Institute for Deafness and Blind Children.
5.  "Verbally" (free).  Wonderful communication app.  Use words, phrases or write your own words.  Sentences can be read or the 'Speak' option can be used.

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Management Techniques to Assist with Touch and Dexterity

Here's a summary of simple tips to assist with touch and dexterity;

1.  Have clean and well moisturised hands.
2.  Keeps nails shorter.
3.  If required use a stylus pen.
4.  Turn off "Multitasking Gestures"
5.  Demonstrate apps and screen navigation.

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iPads and infection control

Since we have been talking about touch, lets consider how touchscreens can be a potential source of infection.  They may be touched multiple times a day, perhaps by more than one person, they are coughed and sneezed on and are often very rarely cleaned!

"deBac-app" (free) is an interactive cleaning guide for the iPad.  As well as how to clean the iPad, it also records each successful clean.  This log file is very useful in checking that the device is being cleaned regularly.

Disinfectant wipes are recommended for medical settings, therefore it is important to read the "Instructions for cleaning and disinfection" before using the app.

Please note that this app is not an Apple product.

Touchscreen and Skin Changes

Touchscreens are not as responsive when a person has thickened, dry skin on their fingers.  With ageing, glands produce less oil.  This can mean skin is much dryer.  Thickening of skin can be caused by a number of conditions, such as rheumatoid arthritis and eczema.

Management of Skin Changes;

Before using touchscreens clean hands.
Use moisturisers on hands.  Allow the cream to be fully absorbed before touching the screen.
Manage any skin conditions that may cause dryness and skin thickening.

Dexterity and Touchscreens

If a person has hand dexterity problems such as arthritis or a stroke, they can have difficulty extending their fingers to put their fingerpads on a touchscreen.  An older person may find it hard to individually manipulate each finger independently from each other. This may cause a problem with a feature of the iPad called "Multitasking Gestures".  This usually allows the user to use four or five fingers to swipe the screen to access the multitasking bar or move left to right between apps.  For people with dexterity issues this causes the screen to keep moving to other apps.  In this instance it is possible to turn off the feature to make it easier to use the touchscreen.

Turning off the Multitasking Gesture

Go to "Settings"
Look down the left tool bar
Select "General"
Scroll down to "Multitasking Gestures"
Swipe the "on/off" button to "off"
To turn the Multitasking Gesture back on, simply swipe the button back to "on"

Touchscreens and Age Related Finger Nail Changes

Nails change with increasing age and can make using a touchscreen difficult.  Nails tend to grow more slowly and can become brittle and discoloured.  Fingernails may crack and split.  Nutritional deficiencies such as iron deficiency or kidney disease can cause changes in nail health.  Long nails can sometimes make it difficult to use touchscreens, as they do not react to input from nails.

Managing Nail Issues

Keep nails shorter and file rough edges.  Older people may need assistance with this, as it requires a high level of fine motor skills to do it safely.
If there are ridges, pits or lines on nails, check with your health professional for health related issues.
If a person still has difficulty with nails touching the screen or with hand dexterity, try using a tablet or iPad pen.  These look like a pen, but have a soft tip, which can be used on the touchscreen instead of using your fingers pads.

This one is a working ink pen, but the other end is used as an iPad stylus pen.

Sensation Changes in Old Age-Touch

Touch includes the sensations of pain, temperature, body position, pressure and vibration.

With ageing there can be decreased blood flow to the nerve endings, spinal cord or brain, changing or decreasing the bodies ability to recognise variations in all these areas.

There can be reduction in sensory levels of vibration, touch and pressure.  Sensation of pain can be decreased or increased.  People may overdress or underdress because they cannot accurately feel temperature differences.

Strategies to manage age related changes in touch;

Ensure pain is well controlled.  Pain is far too often poorly managed in older people.  It's hard to enjoy yourself when you are in pain.
Have a comfortable room temperature and appropriate clothing.
Ensure supported seating and if using a table, have it set around elbow height.
Demonstrate apps and navigation of the screen to show how little pressure is needed.  Older people sometimes 'hit' the touchscreen as they are used to pushing buttons.  My Mum originally looked like she was trying to crack my iPad!

Communication App

There are a whole range of communication apps available.  Many people with hearing loss also have some speech problems.  Pen and paper are often used to assist with communication. However this can be time consuming and sometimes people may have difficulty writing due to physical impairment (i.e. tremors, stroke).  Understanding others people's writing can also pose problems.

The app "Verbally" (free) allows the person to enter words and phrases as well as typing in their own words.  Simple sentences can be constructed by touching the relevant words on the screen.  The entries can either be read on the screen or the 'Speak' option can say it out loud.  Therefore it can be used by people with both hearing and speech problems.

Sign Language App

RIDBC Auslan Tutor: Key Signs (free)

The Royal Institute for Deaf and Blind Children has created and app for Auslan (Australian Sign Language).  It contains 150 common Auslan signs.  There is a photo of each handshape and some video clips which demonstrate how to form the sign.  It also includes the Auslan alphabet for use in finger spelling.  I have used the alphabet for finger spelling with a person with a hearing impairment and managed to make myself quite well understood.  More of a surprise to me then the person I was speaking with!

For more information go to the Auslan Signbar website;

www.auslan.org.au

An app that turns your music library into a game!

"guess your song" (free-in app purchases available) is an app which uses your own music library to create a song game.  Each round, a short sound bite of a song is played.  You are given three choices to pick which song you think it is.  You can repeat the sound bite as many times as you like.  After you have made your choice, the app lets you know whether you are right or not, and will play the full song.  Alternatively you can just go to the next round if you prefer.  By using your own music library, you can include songs that are familiar to the people playing the game.  This increases the fun and level of success.  This can be enjoyable to play as a group (of like minded music lovers).  Some people also enjoy playing with friends via Facebook.

App for Piano

"Tiny Piano" (free) is probably one of the most enjoyable and easy to use musical apps.  There are more than 100 free songs to choose from, ranging from 'Amazing Grace' (1779), to 'Do Re Mi' (1959), to One Direction's 'What Makes You Beautiful' (2011).

There is in-built success, because when you start playing the screen keyboard, the tune starts playing irrespective of which part of the screen is touched.   In fact you can play it with your eyes closed!  However the user is in charge of the tempo so can play faster or slower, depending on their preference.

Last year I was with a delightful lady Lily, who was feeling quite flat and a little teary.  She wore hearing aids in both ears, but found extended conversations hard to understand and exhausting.  I suggested music to cheer her up.  She looked at the music list and selected Fur Elise.  (Another benefit - choice!). When she started playing a look of amazement came over her face.  She said,
" I never knew I could play the piano!!"  You couldn't wipe the smile off both our faces!

More App Pictures

You might have noticed, if you look back on some of my older posts, that I have added some extra pictures and videos to give more information about the apps I am discussing.  Keep an eye out for more to come!

An App to Create the Sounds of Nature

"Nature Sound" (free) is an app that can create a delightful ambience.  It includes a whole range of sounds from nature such as, the forest, jungle, beach, animal calls and spa music.  It can be used as soothing background sound, or perhaps to create atmosphere for a group activity.

If you swipe "Mixer" on the bottom tool bar, there are a whole range of extra sounds you can add.  Just remember to touch the stop button when your finished, otherwise it keeps playing!

Management Strategies for Age Related Hearing Loss

Lets look at some strategies to assist with hearing to help maximise enjoyment of technology;

Wear your hearing aids
Use the volume control.  Remember loudest is not always better.  Judge the volume which best suits you.
Use caption/subtitles to help follow screen activity i.e.  DVD's, TV's, online videos
Minimise external noise.  Headphones can help cut out background noise.  There are Blue tooth and Wireless versions, which are sometimes easier to use, as there are no cords attached.  Often older people find earbuds uncomfortable and obviously they cannot be used with hearing aids.

Avoid areas with echo and reverberation (i.e. a room with carpet and soft furnishings is better)
When listening to music on a tablet or iPad, select YouTube or iTube to include the lyrics
If you are having difficulty with phones try an amplified telephone
Alternatively try FaceTime or Skype to help with facial expression cues, speech and lip reading.
Email and messaging are another useful alternative

For a wonderful example of the power of hearing music and its effect on an older person, go to YouTube and meet Henry.  I dare you not to shed a tear!

Hearing Aids

This blog is about older people and helping them use digital technology.  Modern hearing aids are actually high tech digital devices that can provide good quality sound and other features that can significantly improve quality of life.  If a person has hearing difficulties encourage them to have a hearing assessment.  If hearing aids are suitable get them and use them!  Some people do not like wearing them, so perhaps compromise and wear them for certain activities, such as social outings, listening to music or games on a tablet or iPad.  Losing hearing aids is often an expensive problem.  I can't tell you the number of clients that have popped their hearing aids in their shirt pocket and them had them go through the wash when they forgot to take them out!  I suggest having a special container clearly marked "Hearing Aids".  This can even be attached to a lanyard around their neck.

For advice on hearing loss and different types of hearing aids contact;

Better Hearing Australia
www.betterhearing.org.au

The 5 Senses - Hearing

Your ears are involved in two roles, hearing and balance.  We will discuss balance at another time.  Hearing loss is a common problem as we age, yet the majority of people with hearing loss do not use any specific strategies to manage it.  Lets look at some of the issues and how it is possible to minimise and manage them, including the use of technology.

 Age Related Hearing Loss

With ageing, structures and their functions in the ear can gradually deteriorate.  Age related hearing loss usually affects both ears.  Often the ability to hear high frequency sound declines.  The older person can find background noise can affect understanding of speech and ability to communicate. Quality of life and enjoyment of everyday activities can be seriously compromised.

Factors that may contribute to age related hearing loss include;

Smoking
Some medicines
Medical conditions such as diabetes
Impacted ear wax

Minimise age related hearing loss by;

Cut back or even better, quit smoking
Review medications that may affect ear structures
Manage medical conditions such as diabetes 
Impacted ear wax can be diagnosed and removed by your health care provider.  Do not encourage a person to put anything in their ears to clean them (such as cotton tip applicators).  Visit your health care provider every 6-12 months for an ear health check up and cleaning if required.

How to use iPads for the Older Person

This blog reflects on the physical effects of ageing and how we might accommodate and manage these when using digital technology.  However there are various resources that can teach you how to  use digital devices.  A useful book I came across recently is targeted specifically at the older person.  It minimises complicated technical jargon and works its way step by step through lots of different aspects of the iPads such as; choice of device attributes, communication, iTunes,  adding and managing apps.

"iPad for the Older and Wiser" 4th Edition.
Author: Sean Mc Manus
(Make sure it's the 4th edition as this has been updated to include iPad with iOS7, iPad Air and iPad Mini)
It is available in hard copy and as an e book.

Information on his book and blog are available at
www.sean.co.uk

Top 5 Visual Apps for the Older Person

1.  PhotoFunia (free) - have fun with photos.  Over 300 options.
2.  Ant Smasher (free) - not to everyone's taste.  Squash ants and hear the squish as well!
3.  Art of Glow (free) - create moving artwork in shapes and colours.  New version generates music as well.
4.  Fluidity (free) - colourful flowing liquid.  Relax to the max.
5.  Iquarium (free) - care for your own pet fish, without the hassles

Top Ten Vision Tips for Older People Using Digital Technology

1.  Have regular eye checks
2.  Always ask to have your macular checked too
3.  If you need to use glasses, wear them!
4.  Ensure eye glasses and technology screens are cleaned regularly
5.  Use clear screen covers with anti-glare properties
6.  Avoid sitting where lights or sunlight can reflect off the screen
7.  Larger screens such as iPads or tablets may be easier to use
8.  Use the zoom in/out feature on touch screens to enlarge objects and text
9.  Use phones with large type keys
10.  Be aware of individuals with visual hallucinations. Start with low stimulus apps and progress slowly

Macular Disease

Macular degeneration (MD) describes a group of diseases of the retina of the eye.  These conditions cause painless, progressive loss of central vision.  It can affect a persons ability to perform everyday tasks including driving, recognising faces, reading and also the ability to use digital technology such as following activities on a screen.  A few indiviuals can also suffer from visual hallucinations due to damage from MD.

The main risk factors for MD are increasing age, family history and smoking.  There are treatments that can help slow down the disease process.  When having regular eye checks make sure to ask to have your macula assessed.

If you notice difficulty reading, distortion where straight lines appear bent, or problems following what is happening on a screen, seek an immediate eye assessment.

For further information on Macular Disease go to;

Macular Disease Foundation
www.mdfoundation.com.au

When is a fish not a fish? An App for a Pet

For something completely different you can look after a pet fish!  The app "iquarium" is an aquarium with all sorts of options.  As you look after the fish, new features can be unlocked and used to enhance or decorate the aquarium.  There are different types of tank set ups, tank accessories, plants and fish.  Regular cleaning is required which involves swiping the screen to remove algae....not too taxing!  If you forget to feed the fish they become colourless.  There is nothing more satisfying then watching them have a good feed and turn back to gold.  This is quite relaxing and fun to do by yourself, but can also be something to do with a grandchild.  It can be used on a large screen such as a TV or computer monitor as a calming background.  As of way of having a pet without the cost or hassles, it's priceless (it really is.....the app is free!)

Let it Flow-Relaxation App

"Fluidity"

This is a really beautiful app.  It is an interactive fluid dynamics simulator.  The fluid floats across the screen and when the screen is touched it swirls and flows.  It is possible to change the colour, speed, and viscosity, as well as the ability to make the bubbles sparkle.

I have used this app a lot for relaxation in individuals with anxiety, or with behaviours of concern due to dementia.   I have been known to use it myself to help me to unwind!

It would be appropriate to use on a TV screen to create a calm environment.  Music can also be added.

I would rate this as a lower stimulation visual app.

App for an Artistic Glow

Some apps only purpose is to generate visually stimulating shapes and colours.  These can create an opportunity for being creative, without actually having to be artistic!

"Art of Glow" (free)

This app allows you to create glow artworks.  There are choices in shapes, speed and colours, which layer themselves on top of each other and whizz around the screen.  There is built in success as there is no right or wrong way to do it.  When you have had enough, just clear and start again.  It is also possible to use this app with your own choice of music. The new version adds its own musical sounds, although they can have a "tinny" tone at the higher pitches.  I would rate this app as a high visual stimulation app.

One App - Two Reactions in the Older Person

One app- two reactions

To demonstrate the differing effects the same app can have, lets 

Look at Henry and Lily.  The app used was "Ant Smasher" which I have mentioned before.

Ant Smasher

Ant Smasher is an arcade game where the goal is to squash ants as they cross the screen.  If the sound is turned on, there is a very realistic squishing sound as each ant is crushed.  Bees also pass by and the player should try and avoid these.  My family finds the game hilarious, while my sister thinks it is revolting.  And here in lies a potential problem.  It is important not to insist on your own personal likes and dislikes.  We are all individuals!

Henry was a gentleman in his seventies with a history of visual  and auditory hallucinations  as a symptom of a mental illness.His sister came in to visit him in the residential care facility (nursing home) and thought she would try "Ant Smasher".  Unfortunately Henry called out that their were ants crawling all over his table and became very distressed.  The iPad was immediately removed and he required an extensive explanation to convince him that they were not real. This app was clearly not suitable for him and demonstrates why an assessment of his interests and dislikes are very important.

At another time I was attempting to encourage Lily, who was a very refined, proper lady in her nineties, to participate in some iPad activities.  I tried apps involving arts, crafts, music and all the areas she was usually interested in, With no luck.  In desperation I asked her if she might like to squash some ants.  Her face lit up and she attacked the game with relish!  From then on, every time I saw her she insisted on a few rounds of "Ant Smasher" to start her day.  

So when what you try doesn't work, try something unexpected, but remember to allow for people's personal dislikes and issues.

Real Life Examples

Real life examples

Real life stories often are the best way to demonstrate benefits and disadvantages of different apps.  To do this I have created two fictional characters named Henry and Lily who will help to tell my stories.  

VISUAL HALLUCINATIONS

There are some conditions that have symptoms of visual hallucinations.  These include mental health conditions such as schizophrenia and some personality disorders, as well as some types of dementia including Lewy Body Dementia.  When using a variety of apps it is important to be careful about visual content.  Apps that include faces on different bodies ( such as PhotoFunia), visually highly stimulating apps or distorting images can be confusing and upsetting to these individuals.  Start with low visually stimulating apps and progress slowly.

LARGE TYPE KEYS

There are a variety of phones available now that have large types keys to make it easier to see the letters and numbers.  Often older people prefer key pad phones rather than touch screen phones.  Smart phones with multiple functions can be confusing and the touchscreen can be overly sensitive when they are using them.

My Mother the Mermaid!

My Daughter and Mother had fun with the PhotoFunia app!

THE OLDER PERSON AND THE 5 SENSES

As a person ages, their senses can be affected.  This has implications for participation in a whole range of activities including technology.  We will explore each of the 5 senses and how we might assist a person in adapting and compensating for any loss in each area.

Vision

This can be affected either locally in the eye structures, or when visual information is sent to the brain.  
There can be changes in the brains ability to process visual information, such as some types of strokes and some types of dementia.

After the age of  60 the sharpness of our vision tends to decline and it can be difficult to focus on close objects.  There can be reduced peripheral vision, sometimes even to the point that a person doesn't realise there is someone standing next to them.  The ability to cope with glare can also be diminished.

Strategies for assisting with Vision when Using Technology

Glasses
Have regular eye checks.
If a person requires glasses for reading or activities make sure they are wearing them.
Ensure the glasses are clean.  I can't tell you the number of times I have had my clients with their glasses on and they can't see a thing because they are so grubby!

Screen Covers
There are a range of clear screen covers that have anti-glare properties and the added benefit of helping to protect the screen.
When using a device, avoid sitting where sunlight can shine on the screen.

Screen Size
iPods and smart phones have small screens.  This can make it difficult to view what is on the screen.  It also limits the choice of apps and activities you might choose to use.  iPads and tablets may be a better choice.  They are mobile, but have the larger screen.

Zoom in feature
iPads and tablets have the feature where the screen can be zoomed in and out to make subject matter easier to view.  Use it!

My daughter and her Grandmother have great fun with an app called PhotoFunia.  It has over 300 options for creating a whole range of photo collages using your own faces.  From celebrities to billboards, mermaids to Cupid.  Here's an example of my mother and daughter. Surprisingly, we discovered they look alike!

Digital technology doesn't  have to be all or nothing!

My Mum's friends complain that when they have their grandchildren visit, all they seem to do is stare at screens.  When offered the choice of owning their own device, they declare they have no interest.  So the stalemate continues, where the older person feels left out and the younger person feels as if their enjoyment in technology has no value to that generation.

How do you reach common ground?

With the wealth of apps available, there is bound to be something that can be of shared interest.  My youngest son grows veggies with his granny using " My Veg Plot".  He demonstrates how to grow yummy stuff and she explains what compost is.  This has led to such and interest in growing things, that we now have our own real to life garden bed with tomatoes and herbs!

My middle son prefers action apps.  He has had many competitions with his grandmother trying to squash ants using "Ant Smasher".  The squelching sound effects leave them in fits of giggles.

My daughter prefers to show her blog.  It includes school activities, interests, comments from readers and lets Granny have a window into her world.

 New experiences can often be daunting, so give some thought to what apps you might try.  Sometimes these shared activities encourage an older person to get their own device, but often they will be happy, just joining in the fun at the time. Get to it and have fun! 

Older People and Digital Technology

Older people, like everyone else, love to have fun and enjoy life.  They want to feel included and relevant in family and social circles.  At the same time, we are all encouraged that digital technology has opened up a new world of information and connectivity which can help up us share and learn. Touch screen technology is now available on a whole range of devices, which potentially increases ease of use and the devices have become more portable.  However for some older people it can be a source of confusion and create a sense of isolation and disconnection from their family and friends.  How can older people have fun with digital technology?

This blog will look at the physical and psychological effects of ageing and how we might accommodate for and manage these issues to increase the ability for older people to take part in the digital world.  I will use my experiences as a Senior Physiotherapist who has worked in aged care for over 12 years, to give examples of how many ways we can assist older persons to access these amazing tools, irrespective of physical or cognitive ability!