Erica’s Corner: A Note from the Chief
When I was younger, I did not like to play video games. I would play for a few minutes and just feel kind of bored. So, when my PT and trainer told me one day a few months ago that we were going to spend some time in the new video gaming room at Walk The Line I was initially skeptical. I had seen other clients playing video games, but I figured they “liked” gaming.
Before I tell you how it went let me back up a bit and explain how we are using video gaming to facilitate recovery. The type of video gaming we use is referred to as augmented reality. Augmented reality differs from virtual reality in that it overlays digital information onto physical surroundings and does not require a headset. Augmented Reality is transparent and allows you to see and interact with your environment. It adds digital images and data to enhance views of the real world. It is not as immersive as Virtual Reality but Augmented Reality can still enrich a physical reality and there is research to support its benefit for neuro recovery therapy.
Much of the individual’s success with the augmented reality gaming also comes from how we are incorporating it into their sessions based on their goals. When you picture someone playing video games you probably see them seated holding a controller but at Walk The Line gaming is done in a variety of postures and positions using either the individual’s upper extremities or body as the controller. For example, an individual can be standing in a standing frame or on their feet, in quadruped or kneeling, seated on a dynamic surface on a table etc. That individual may be working on balance, weight shifts, coordination, muscle activation and this, along with their goals and interests, determines which gaming system and which game is used.
So, getting back to my first experience in the gaming room. One of the areas of focus for my sessions is weight shifting and making appropriate weight shifts from left to right or forward and back in dynamic positions like gait. To break this down we sometimes focus on this standing in the parallel bars or before we begin gait training but that can be quite mundane and doesn’t always seem to translate to gait. For my first gaming session, I was going to be standing in the Pacer device with my feet on the Wii Fit balance board playing the downhill ski game where you shift your weight to from side to side in order to go through the gates and you shift forward to increase your speed down the hill. The main objective of the game is to get through the most gates in the least amount of time.
Once I started playing, my focus shifted from what I needed to do in order to achieve weight shifting to just playing the game and in order to play the game and do well, I had to shift my weight. We continued playing for another 15-20 minutes and each round I was able to get my avatar through more gates and down the hill faster. Once we felt like I was consistently shifting from side to side and forward we moved on to gait training with the hopes of some carry over which we did achieve that day. That day we also found a new tool that could be used to further my recovery which after many years of physical therapy is always welcomed.
Since that day, I’ve been back in the gaming room a few times and have even tried some other games. As it turns out, I don’t mind video gaming as much as I thought I did. Proof once again that an open mind can lead you to new places no matter how old you are or how long you’ve been doing something.
WTL RED AND WTL BLUE: What are they and how do we utilize them?
As physical therapists, we work hard to make sure that our clients feel supported to express their goals and work on the activities that matter most to them. A very important part of this recovery process is to provide an environment that is conducive to success, one that provides comfort and motivation.
Everyone finds their motivation in a different way. Some are visual learners, and some are conceptual; some do better when given a task and some want to know what they are doing and why they are doing it; some look at the end result and some view the process AND some prefer to have it calm to focus, and some like it busy. This is not necessarily determined by the nature of their injury being a SCI, BI or any other neurological condition but is rather based on their current liking, goals, and ultimately what recovery means to them.
This brought about the creation of two different programs at Walk The Line: WTL RED and WTL BLUE.
WTL RED is geared more for the individuals who are inclined to understanding the ‘what am I working towards’, ‘why am I doing it’, ‘how do I do it’ before doing it. Through this process they trigger an ‘Intrinsic Feedback Loop’ during the movement, which consists of the nerve endings and receptors in the joints and muscles, sensory and motor nerves carrying electrical impulses to and from the spinal cord and brain and the muscles and joints involved.
WTL BLUE is for the individuals who are more inclined to having a task to do and want to know whether they were successful. It utilizes visual cueing through activities and various games, sometimes even through augmented reality video gaming. This task driven approach triggers an ‘Extrinsic Feedback Loop’, which consists of the visual cueing from the task, targets to reach, throw and step over and the end result of how many times they were successful at doing it. It is the nervous system which then works to transfer these external cues to make internal changes within itself.
WTL BLUE presents itself with a visual definition which is filled with externally cued floor and wall decals. It is allows the individual to focus on the tasks and avoid distractions when they are not favorable.
As an example of how things would be done in each program lets consider an exercise: sit to stand. In the RED program, the individual would work on seated posture, static and dynamic balance, loading the legs followed by the transition into standing with the assistance they need. The same exercise in the BLUE program might look different. Here, the individual may be given a task like throwing a ball upon standing. When going through these transitions he/she naturally works on the same components while maintaining the focus only on the outcome of throwing the ball to a target.
The question one may have is whether one approach is better than the other? The answer is, no. The goal of both approaches is the achievement of the desired function through neuroplastic changes.
Keeping this in mind, the WTL team works hard to find an answer to the basic question of ‘what motivates their client?’ and then designs their program accordingly. It may result in an individual BLUE or RED program or a hybrid of the two.
Recovery is the process and Recovery is the goal, however you view it.
Shruti Joshi, PT, MHS, CBIS, C-LSVT Big
Lead PT, Walk The Line
Meet The Team
Walk The Line Admin Team
Walk The Line Admin Team is headed by our office manager, Lisa van der Groef.
Lisa has been with Walk The Line for 10 years and has been an integral part of our successful growth. Our admin staff has grown and in the process we have assembled an expert team: Ashley Karcher, who has been with us for two years and has provided expert organization and communication, Jennifer Popkes, also with us for two years as our biller and has been involved with updating our billing process, and Stephanie Scott is our newest shining star and brings with her a bright personality and enthusiasm.
We are very proud of the dedication our Admin Team puts forth every day in supporting our clients and promoting WTL’s Mission and Vision!
“Walk The Line” is a place of health, wellness, knowledge, social interaction and through these…RECOVERY!
The vision of Walk The Line is that every session we provide for every client will represent their best life experience for that day!
My name is Laura Stark, and in the summer of 2016 I decided to embark on a cross country cycling trip with a group called Bike and Build. We would be cycling almost 4000 miles coast to coast while advocating for affordable housing. 3000 miles into my trip, a teammate, Anne, and I were hit by a distracted driver. Anne did not survive the collision, and I was paralyzed from the chest down.
Being paralyzed has completely changed my world around. The first year was tough; I had to relearn how to do almost everything! It was most difficult having to rely on others and always ask for help. I had always been stubbornly independent and, honestly, I loved a good challenge. Living with a spinal cord injury tested that balance between wanting to challenge myself and needing to ask for help.
After my collision, I had only one goal- to finish my cross country bike ride. Once I had found my independence again, much of my therapy was dedicated to accomplishing this mission. Transferring on and off my bike, building up my endurance, and figuring out a good routine were some of my main focuses. Once I figured these things out and while I was waiting to start my trip, I began looking around for a place to continue improving. This is when someone recommended checking out Walk The Line. I instantly felt at home with Walk the Line and met people who were as determined as I was to meet my goals.
After finishing my cycling trip this past summer, I’d realized all that I had been working towards was now complete. I felt a little lost and desperately needed a new focus. When I started back up at Walk The Line, my trainers helped me find that focus- walking!
When I found out I was paralyzed, I’d assumed I would never use my leg and core muscles again. In my sessions with WTL, all the focus is on activating those muscles and teaching my upper body to relax. My favorite thing we’ve started incorporating into my sessions is using the spin bike. It’s so cool to see my legs back in action riding a bike- something I hadn’t ever dreamed of doing again!
Aside from focusing on walking, I’ve focused on taking advantage of all life has to offer! I’ve found lots of joy in trying out new sports and constantly asking myself, “Why not?”! Cycling will always hold a special place in my heart, but I’ve recently fallen in love with skiing and wheelchair basketball. I had never tried either before my injury! Like I said, becoming paralyzed had completely changed my world. It’s opened up so many opportunities that I would’ve never had and for that I am thankful!
In the News
WTL Recovery Therapy
Walk The Line offers expert Neuro-Recovery Therapy programs; WTL RED and WTL BLUE as well as 90-minute or 3-hour sessions.
In addition, access to the following services is now available onsite: OT services provided by Grace OT, Massage Therapy Services provided by Your Wellness Massage and Speech Therapy provided by Integrated Rehabilitation Services.
These services compliment WTL Recovery Therapy and are available to anyone who is in need of these services.
2018 BIAMI Fall Conference
September 13& 14
Walk The Line was proud to again be a Silver Sponsor at this annual event that promotes Education, Advocacy, Support, Treatment Services and Research in Brain Injury Association of Michigan’s dedication to improving the lives of those affected by brain injury.
As a Neuro-Recovery Clinic, Walk The Line was able to showcase our newest program WTL Blue, a Results Based program with a whole task training approach in a controlled ambient environment offering 90 minute or 3 hour session durations.
Haunt The Line
Walk The Line hosted a fun Halloween party thanks to our Community Events Group. Clients, caregivers and families joined in the fun decorating mini- pumpkins, trick or treating with staff and making their way through the Haunted Halls of Walk The Line!
NeuroQuant CEU Event
Walk The line, M1 Imaging and Caps Remodeling sponsored this interesting CEU event for RN’s, Case Managers, and Certified Case Managers. Dr. Bleiberg presented the main program and Lora Fedeson, PT followed with a case study utilizing NeuroQuant imaging software. 2 CEU credits were available along with great networking before and after. Thank You to those who attended.
This annual event is a great way to kick off the Holiday Season bringing together industry professionals to celebrate another successful year and a look forward to 2019 and all the possibilities a new year can bring.
The evening was enjoyed by over 160 Case Managers along with Physicians, Attorneys and Healthcare Providers.
Walk The Line to SCI Recovery, Advent Home Medical, Caps Remodeling and Entech Staffing Solutions were again happy to host this event. Thank you also to Rehab Pathways Group the Jingle Cart Sponsor, Team Rehabilitation the Dessert Sponsor and Maple Manor the Cocktail Sponsor. The 2019 Jingle Mingle will be held on Friday, December 6th at the Iroquois Club.
Thanks for Reading!
Over the past 11 years, Walk The Line has become recognized as a world-leading program for recovery therapies. Our belief in the human spirit and perseverance fuel our desire and drive to be the best recovery facility in the world.