Cupping Techniques to Improve Quality of Life for Geriatric Patients

By Jimmy Dale Smith, PT, DPT, The Healthcare Resort of Plano, TX

Myofascial decompression (MFD), or cupping, is a form of IASTM (Instrument Aided Soft Tissue Manipulation), where a pump and a cup are used to create negative pressure and placed on the skin to improve circulation/blood flow, reduce pain, improve tissue pliability/mobility and to improve healing.

Additional benefits of cupping may include improved quality/quantity or ROM, improved tolerance to ROM/PROM exercises, and excellent neural input to improve motor output. Contraindications include open wounds, fever/active infection, severe disease (cardiac, renal failure, bleeding disorder, hemophilia, active cancer and dermatitis), first trimester of pregnancy, unhealed or possible fracture, severe strain/sprain, or already inflamed/swollen tissue, burns and acute flare-ups of skin disease (psoriasis, eczema or rosacea).

  • When: Depends; early in POC to assess patient’s response
  • Where: Location of pain/perceived stiffness, myofascial line, neurovascular junction
  • Why: ROM, pain, blood flow, soft tissue adhesions
  • Who: Patients who do not have contraindications
  • What: Reassess, test and retest

Pilot Study: Plano Health Care Resort

The Physical Therapy department at Plano HCR is currently one of our affiliates in Keystone that is piloting usage of cupping across patients with differing diagnoses, which has resulted thus far in varying degrees of success. Predominantly, the facility has observed a positive response to MFD. Through the observations, benefits range from an hour (to the end of the session) up to five to seven days of pain relief. One specific “home run” of treatments is the following case study.

Case Study: Mr. T.

Mr. T. is a mid-70s male s/p R TKA. He presented to PT as an outpatient seeking further rehab after his SNF stay. His primary limiting impairments were stiffness, pain and weakness. When he initially attempted basic OKC (open kinetic chain) activities, the patient would report moderate to severe pain at end-range knee extension. The team attempted to modify to a CKC (closed kinetic chain) to assess differences in symptoms. Stiffness remained. Moving to manual therapy, the patient responded decently well with anterior tibiofemoral mobilizations. The patient reported less pain, but the stiffness remained. The PT team applied three hard plastic cups with 1.5 pumps of pressure proximal to the knee as a gross stabilization point for the fascial system and one silicone cup just distal to those cups with the intent to perform a dynamic mobilization technique. Post-treatment, the patient reported that not only was the pain nearly eliminated, but the stiffness was gone as well.

SLPs’ Role in Discharge to Home/Community

By Tamala Sammons, MA CCC-SLP, Senior Therapy Resource

Contributed from the American Speech and Hearing Association (ASHA.org) https://www.asha.org/practice/reimbursement/medicare/medicare-patient-driven-payment-model/#Fall

SLPs can help increase the rate of discharge back to the community and decrease avoidable rehospitalizations. Specifically, SLPs can positively influence the following factors that contribute to discharge back into the community:

Communication: A primary purpose for addressing communication and related disorders is to affect positive measurable and functional change(s) in a person’s communication status so that they may participate in all aspects of life — social, educational and vocational.

Communication is central to discharge back into the community, especially in individuals with speech/language impairments or cognitive deficits associated with a variety of diagnoses. Several studies have indicated that communicative competence predicts individuals’ safe discharge back to the community.

  • For example, a 2013 study found that deficits in auditory and reading comprehension and oral spelling to dictation were significantly associated with increased odds of discharge to a health care facility (e.g., SNF), rather than to a community-based environment, after adjustment for physical therapy and occupational therapy recommendations (González-Fernández, et al., 2013).
  • Functional dependence and comorbidities, such as chronic aphasia, have been found to be a significant predictor of a non-home-based discharge setting in post-stroke individuals (Mees, et al., 2016).

The SLP’s scope of practice and unique training specifically equips them to prepare individuals to return home with appropriate communication facilitators, as needed, ensuring maximum safety.

Cognition: Cognition is an important predictor of safety and functional independence in determining discharge to home, even in individuals undergoing purely orthopedic-related rehabilitation (Ruchinskas, et al., 2000).

Several studies emphasize the importance of cognition in the ability to return to completely independent living after medical rehabilitation in geriatric patients (MacNeill, et al., 1997). The Scope of Practice in Speech-Language Pathology (ASHA, 2016), as it relates to cognitive-communication impairments, indicates that the practice of speech-language pathology includes providing prevention, screening, consultation, assessment and diagnosis, treatment, intervention, management, counseling, and follow-up for disorders of cognitive aspects of communication (e.g., attention, memory, problem solving, executive functions).

Swallowing: SLPs with appropriate training and competence diagnose and manage oral and pharyngeal dysphagia. SLPs also recognize causes, signs and symptoms of esophageal dysphagia and make appropriate referrals for diagnosis and management. Presence of dysphagia represents a significant barrier to returning home, specifically in neurogenic diagnoses. Those individuals with dysphagia, post-stroke, are more likely to be discharged to institutional settings, such as SNFs, after inpatient stroke rehabilitation, and experience longer stays at these facilities (Nguyen, et al., 2015). Aside from the significant costs resulting from chronic dysphagia and associated care, these conditions have a negative impact on an individual’s quality of life.

Health Literacy: More than just a measurement of reading skills, health literacy also includes writing, listening, speaking, arithmetic and conceptual knowledge.

According to the IOM report (2004), health literacy is “the degree to which individuals have the capacity to obtain, process and understand basic information and services needed to make appropriate decisions regarding their health.” Inadequate health care literacy affects all population segments but is predictably more common in certain demographic groups such as the elderly.

Patients with aphasia or other neurological disorders affecting speech, language or cognition, or those with severe hearing loss, are at risk when presented with vitally important written or verbal medical information. In addition, patients who face the stress of a medical crisis, possibly without an advocate or a significant other being present, or while in a state of pain, confusion or depression, may have difficulty understanding written or verbal medical information.

SLPs have a vital role in effective patient-provider communication. As federal laws, regulations, guidelines and accreditation standards mandate improved patient provider communication, it is vital to maximize the SLP’s contributions to this significant area of practice that impacts patients’ safe discharge back to the community. The rate of hospitalization and use of emergency services is higher among patients with limited health literacy (Kindig, et al., 2004). SLPs can assist with discharge planning while considering an individual’s health literacy to minimize these costs (Rasu, et al., 2015).

Combining Heart Rate Variability Training and SLP COPD Treatment

Submitted by San Marcos Nursing & Rehab, San Marcos, TX

By now, many of us are aware of the benefits of using Heart Rate Variability Training (HRVT) with our patients: improved resilience, improved function, reduction in pain and increased therapeutic activity tolerance. At San Marcos Rehab, we have begun to integrate HRVT with a COPD protocol developed by Michele Scribner, SLP, at our affiliate Northeast Nursing and Rehab in San Antonio, Texas, which was based on the work of Jocelyn Alexander. We have seen some truly excellent outcomes as a result.

COPD patients often present with increased anxiety during completion of daily functional tasks and social interactions due to difficulty breathing. This labored breathing often results in increased blood pressure, coughing, fatigue and loss of appetite. This barrage of symptoms in COPD patients is often advanced enough that social isolation becomes a risk due to voice deficits and insufficient respiratory support for communication needs.

In the past, our focus for COPD patients was on compensatory breathing techniques, including pursed-lip breathing, diaphragmatic breathing, deep breathing and the huff-cough technique, followed by stretching/strengthening training. This protocol achieved positive results, with many patients decreasing the volume of supplemental O2 and some patients being completely weaned off supplemental O2. Additionally, many patients were able to incorporate the breathing techniques into their day-to-day routines, but some reported that the techniques “didn’t work” if they became short-of-breath and that it caused a spike in their anxiety, leading to rapid, shallow breathing and spiraling anxiety. To combat these spikes that sometimes occur, we incorporated HRVT in conjunction with the breathing techniques training, and this has led to improved overall outcomes.

Allowing the patient to be more centered and heart-engaged, while focusing on positive feelings, creates coherence.

Lois Ferguson and therapist Taylor Webb-Culver at San Marcos Nursing & Rehab, San Marcos, TX

Trained breathing techniques provided our patients with the tools necessary to short-circuit their anxiety when they started feeling short-of-breath. We typically have the patients use the pursed-lip and diaphragmatic breathing techniques during HRVT sessions. Meanwhile, we’ve found that the deep breathing with the hold technique and huff-cough technique actually interrupt attempts at achieving coherence.

Patients who have worked with our speech therapy team learning both HRVT and the COPD techniques report significantly decreased anxiety, improved communication abilities and increased activity tolerance upon discharge. Many have reported that they were independently able to use the techniques to control their anxiety when a SOB episode occurred. We even had a patient come back to visit our team so that she could show us that she taught her husband with COPD the techniques!

If you are currently using HRVT in your facility, I highly recommend incorporating this protocol into treatment regimens with your COPD residents.

From Therapist to AIT: Matt Scott Mission Hills, San Diego, CA

Submitted by Jamie Funk, Therapy Recruiting Resource

Why did you decide to make the leap from DOR to AIT?

Loaded question. Before I started as DOR at The Springs, I worked for a contract therapy company. At one time I had been approached by the Admin in one of the buildings we were contracted into. My answer was a hard “no.” Nothing about it appealed to me. It was so corporate, and the only things the Admin seemed to do was discipline people and put out fires. Then, I started at The Springs and worked with administrators like Matt Rutter and Matt Stevenson. It was eye-opening to see the autonomy and freedom they had to operate. They were disciplined yet were able to have fun. They acted like true owners of the operation. This sparked my adventurous and entrepreneurial spirit. And after being in therapy management since 2008, I was ready to start a new challenge, and they inspired me to be an ED.

What fuels your passion as a therapist/facility administrator?

As a therapist, my passion was my team. To see them grow and develop as clinicians was the most gratifying. Lucky for me, there is the same opportunity as an Administrator to grow and develop team members. Internal hiring and growth is a keystone to our culture. Helping others understand Ownership, Accountability and the Ensign Experience is the base of what I do. Beyond that I am very passionate about growing our business and achieving great financial results.

If you could change one thing about your job, what would it be?

This is a tough job. But it is not supposed to be easy. Wouldn’t change it.

Who is your mentor/motivator/hero at Ensign?

Matt Stevenson. He really empowered, motivated, educated and advocated for me. From being a DOR to becoming an AIT and eventually an Administrator, he was always generous with his time, knowledge and experience.

Who is your favorite Star Wars character and why?

Han Solo. He’s funny and cool.

What makes your facility team extraordinary?

They get “IT.” They don’t come to work to punch the clock. They understand that we aren’t just some old folks home/convalescent center. We want to be the number one choice for Post Acute Care. Period. They are making that happen. They are all inspiringly dedicated, intelligent, funny and engaged. Humor is important, and we like to laugh together.

What is your favorite thing about being a facility administrator?

Not having to staff! Always being on the hunt for weekend and holiday coverage was the worst.

What is your favorite business book and why?

Currently it’s Leadership and Self Deception. I like the narrative form, and the message transcends business. It’s applicable to every relationship in your life.

What is your most consuming hobby/sport/etc.?

I’m a gym rat. But I love to surf.

Optima Update: What’s So Great About Clinisign?

By Mahta Mirhosseini, Therapy Resource

I recently had a chance to interview Lana Mathis about her experience with Clinisign. Lana is an OTA who has been with Ensign since 2012 as a DOR at Granite Mesa and now at Legend Oaks Kyle in Texas. When she is not “DORing,” she loves archery, and likes to travel, fish, take long motorcycle trips, and read. Her favorite ice cream flavor is Haagen-Dazs® Caramel Cone.

How long have you been using Clinisign?

LM: I have been using CliniSign since 2017

Did you have any challenges in getting started and how did you overcome them?

LM: The main challenge that I had was getting the Physicians to sign. Once I explained how it works and gave them a copy of the CliniSign for Physicians they were more open to it. I think the key words here are “time saving” and “it’s as easy as punching a button.” It is a lot easier to get Nurse Practitioners to sign up. I signed on a Nurse Practitioner here at Legend Oaks Kyle. She stated, “Oh that was really easy and very convenient.”

How does Clinisign impact your therapy program?

LM: CliniSign has a tremendous impact on the therapy program. It affects productivity/time. It saves so much time and chance for errors. It helps with compliance and especially with MSCA audits. The amount of time saved is enormous. I changed buildings recently and I had forgotten how cumbersome and outdated it was to have to chase signed papers.

How does Clinisign impact your therapists?

LM: The therapists love Clinisign because it saves them time from having to complete clarification orders. It also saves time from having to rewrite clarification orders because the through dates were different from the evaluation dates. They also don’t have to print their evals and recerts anymore.

Did your IDT have to do anything different to adapt to Clinisign?

LM: All of the IDT related information is on the portal and very user friendly. I recently had a Nurse Practitioner out on vacation for a week, and the covering Nurse Practitioner was not in Clinisign. It felt like going back in time to life before electronic health records. The amount of time chasing pieces of paper and making sure they were scanned into PCC was ridiculous.

Any advice for therapy programs who are thinking of getting started with Clinisign?

LM: To all programs that are thinking about getting started with Clinisign, I say…

Just Do It!

What are you waiting for?

It’s a life changer for the therapy department!

You will be amazed at how much time you save!

It’s much easier than you think!

Give yourself an early Holiday present and do it now!

You deserve it!

Remember, if you have any questions about getting started with Clinisign, please reach out to Mahta Mirhosseini (mmirhosseini@ensignservices.net) or your local therapy resource.

No Anonymous Altered Textures!

By Lori O’Hara, MA, CCC-SLP, PDPM Resource

In general, altered textures and swallowing problems go hand in hand. While you will occasionally have a patient who wants mechanical soft because they don’t want to struggle with cutting meat, or a patient with severe dysphagia who is NPO, you should almost always see those things happening together.

In PDPM-land, this means that the case mixes that indicate “either” a swallowing component or a mechanically altered diet should be pretty darn rare (less than 10% of the total case mix distribution). For the curious types, those case mixes are SB, SE, SH and SK.

According to ASHA, as many as 45% of patients in nursing homes have swallowing problems, and in most cases those problems (at least in the early days) will be managed with some type of texture alteration.

Here are some tips to capture everything that goes along with those conditions:

  1. Any alteration to solid or liquid that is done with goal of making oral intake easier or safer is considered a mechanically altered diet.
  2. Section K swallowing impairment questions can be answered based on the SLP/OT interpreting clinical language in the therapy documentation – there does not need to be a word-for-word reflection of the MDS language in the therapy documentation to answer “yes” to a section K item.
  3. If the patient doesn’t need dysphagia treatment (typically because the condition is not new or expected to improve), a qualified clinician should always document the reason for the altered diet in a therapy or screening note.

Few patients choose altered textures for pleasure, so the underlying chewing or swallowing problem should be documented. This can include patient report (“I eat the mechanical soft diet because it’s too hard to chew meat” = pain or difficulty with swallowing) or documentation of subtle signs of swallowing impairment that are generally masked to the untrained eye by the altered texture itself. (Trace oral stasis or residue = holding food in mouth; throat clearing or wet voice after eating or drinking = coughing or choking during meals or medications).

Thriving (Not Just Surviving!) With PDPM

By Shelby Donahoo, Bandera Therapy Resource, & Tonya Haynes, DOR, Mountain View Care Center, Tucson, AZ

L to R: Heather Stiles, DON; Talitha Thrasher, Med Records; Jessica Ganz, ADON; Della Richardson MDS; Juanita Skidmore, BOM; Tris Rollins, ED; Tonya Haynes, DOR

Mountain View Care Center in Tucson, Arizona, has been an “all team on board example” of how to manage and succeed with PDPM. Here are some reasons why:

  • Consistent IDT team participation: DON, ADON, MDS, Medical Records, Business Office, DOR, Case Manager and ED!
  • They have a system in regards to timeline of PDPM components to investigate starting day of admission, day two, day three and so on.
  • Day one, they start looking for missing hospital documents; if not present, they are requested immediately in the PDPM meeting. They keep a log of documents and labs requested, reviewed and followed up on daily.
  • They keep looking — not just once, but repeatedly through the five-day assessment process, adding or altering diagnoses, comorbidities, NTAs; daily floor and rehab updates included.
  • They create fun competition — challenging each other to find patient PDPM components first. “We sound like an auction during PDPM meeting!”
  • Their goal is to stay one step ahead; their tracker is color-coded for followup. Red: urgent; yellow: missing info; green: ready to submit
  • They do a full team MDS review to ensure score matching before submission

Success is in the data and feedback from staff, patients and providers.

  • Mountain View processes the most PDPM assessments in their market (54 monitored in November); daily rates are up 7.6% with PDPM
  • Average nursing rate is highest in the market
  • Section GG outcomes remain strong and are building
  • Mountain View group/concurrent is 19.6%, highest in market
  • “I actually love the group approach for our patients. They help engage our patients more, help lower-level patients perform ‘up’ and encourage participation.” — James Reyes, PTA
  • “Our patients love coming to group. Some get more out of it than individual treatment, and they get more treatment overall. The opportunity to treat patients from low to high level at the same time with individualized goals during group supports their overall outcome. Groups open up a lot of room for creativity and thinking outside of the box.” — Roger Reyes, COTA
  • Mountain View is opening another skilled unit in January.

Success Is in That CAPLICO Moment

Knowing Mountain View was excelling with PDPM, a cluster facility requested to come observe their PDPM meeting process. But instead, Mountain View came to them. The entire PDPM team drove over to their sister facility and spent two hours offering PDPM support and assisting with transitioning patients. Now that’s culture!

PDPM All Stars - St Joseph Villa

Submitted by Lisa Brook, DOR/PT, St. Joseph Villa, Salt Lake City, UT

St Joseph Villa in Salt Lake City, Utah, has embraced the PDPM process and developed a daily technical and weekly skilled system that optimizes efficiency in their operation. The system they have adopted is one where individuals have accepted specific roles in the process and then those individuals come together as an interdisciplinary team to determine appropriate capturing of each patient’s specific medical condition.

 

IDT Members: BOM, nursing unit manager of sub-acute unit, DON of rehab unit, DOR, RN discharge planner/case manager, MDS coordinator, ED

IDT Roles

  • ED ensures that the right people are in the room, that time is built in the day for the process, gives process oversight, helps to investigate inconsistencies and facilitates collaboration.
  • BOM verifies insurance information and projects daily technical spreadsheet from her computer. Enters information on the spreadsheet. Keeps team on track when determining primary medical diagnosis, NTA, SLP comorbidity, or if any other “rabbit hunting” needs to occur outside of the daily technical meeting.
  • DOR is responsible for having section GG information from therapy evals, SLP comorbidity, and speech related swallowing assessment for swallow disorder and mechanically altered diet. Assists with discussion and searching for NTAs.
  • DON/Unit manager completes medical record scrub for primary medical diagnosis and NTA’s for skilled patients on their unit. Determines necessary medical record inquiries and delegates to medical records. Utilizes paper section GG from staff to collaborate with therapy findings.
  • RN discharge planner/case manager has PCC open looking for nursing documentation and reports the discharge plan to the team.
  • MDS is involved with GG collaboration, reports BIMs and PHQ9 findings to the team, medical record review for NTAs

The Process

To start the meeting, the BOM projects the daily technical spreadsheet. She reads off insurance information including current length of stay, number of days left, and last covered day, if determined. She utilizes the spreadsheet to guide the process and asks questions to the IDT member responsible. This facilitates discussion with primary medical diagnosis, non-therapy ancillaries, section GG collaboration, speech case mix, and nursing case mix.

Primary Medical Diagnosis

Primary medical diagnosis is presented to the team by the DON/UM and is discussed and agreed upon as an IDT.

NTA and Nursing Case Mix

The patient’s active medical condition, in addition to the primary medical condition, is discussed to determine ability to capture NTA’s and to determine appropriate nursing case mix.

Section GG

When section GG is discussed, the DOR has section GG in Optima and the PDPM calculation worksheet open. Nursing utilizes a paper GG document and collaboration occurs. While they discuss each section, the MDS coordinator is entering the information in the MDS. Once the PDPM portion of GG is completed, the DOR and MDS coordinator finish discussion with PLOF information, assistive devices used, discharge goals and other non PDPM related GG information and it is added into the MDS.

BIMS

The BIMs is completed by OT on a paper form, which is given to the MDS coordinator upon completion. The MDS coordinator relays the score to the IDT. There are cases where this triggers discussion around the patient’s cognition that potentially wasn’t captured on the BIMS.

PHQ-9

PHQ-9 is completed by one of the other MDS coordinators and reported to the team in daily technical.

Discussion around all of these items is thorough and concise. If an item needs to be tabled due to lack of documentation available or lack of IDT understanding, the item is logged as a follow up item and the team member responsible is identified according to the role this item fits.

Weekly Skilled Review

The St Joseph team has determined that it makes more sense, for their operation, to have their weekly skilled review ongoing throughout the week. The discussions being held around all PDPM items correlate with what is discussed in a weekly skilled review format. As the PDPM discussion continues and follow up items are completed or listed, the discharge planner has the weekly skilled review progress note open and the IDT completes the discussion for weekly skilled review progress note. What has already been discussed is documented as appropriate and additional items are included as needed to ensure accurate and thorough patient discussion and review. The DON tracks the patients that have been discussed and informs the team of patients that will be discussed during the next meeting to ensure timeliness of the weekly skilled review progress note.

WELL - A Few Minutes of Meditation Can Transform Your Day

By Angela Ambrose, contributing writer

The hectic holiday season is in full swing and chances are your to-do list has more than doubled in length. When you’re feeling harried and overwhelmed, this is the best time to hit the pause button and find a few minutes to just sit and breathe.

Meditation involves bringing your full attention to a single point, such as following your breath as it flows in and out, repeating a soothing word or phrase to yourself, gazing at an object such as a candle flame or listening to an inspirational song.

“We live in the 21st century where the fast-paced world we’ve built is inundating us with floods of energy constantly, if we allow it. A 10-minute break from that can be very beneficial,” says Benjamin Decker, meditation teacher and author of Practical Meditation: a Holistic Three-fold Approach to Meditation.

Hundreds of research studies show that meditating regularly can help reduce stress, sharpen your focus and memory, manage depression, lower your blood pressure and improve the quality of your sleep. Studies also prove that regular meditation can create positive changes in the physical structure of your brain that may lead to better decision-making, increased empathy and better emotional control.

“The biggest challenge that I find with clients who have resistance to learning meditation is their lack of understanding of what it really is and what the benefits actually are,” says Decker. “The only way to really understand the benefits of meditation is to ‘take the leap,’ so to speak, and begin the experiment of engaging in the practice.”

6 Simple Steps to Meditating

Take a moment now to try this simple meditation technique of counting your breaths:

  1. Find a quiet place free of distractions.
  2. Sit comfortably in a chair with your feet flat on the floor and a straight spine. Avoid leaning against the back of the chair. You can also sit on the floor with your hips elevated on a cushion. If sitting upright is painful, lie on your back with a rolled up blanket or pillow under your head and neck.
  3. Close your eyes, take three big, deep breaths and exhale out your mouth with a “ha” sound.
  4. Bring your lips together and breathe naturally through your nose. Nostril breathing is more calming to the nervous system, but if this isn’t possible, breathe in whatever way is comfortable.
  5. Start to count your breaths backwards from 10 to 1. As you inhale, say to yourself “10” and as you exhale, repeat “10” silently. Continue like this with the numbers 9, 8, 7, and so on, until you reach zero. Then return to 10 and begin again. If you lose the count, simply start over from 10. Aim to complete at least 3 cycles of counting.
  6. When you’re done, slowly open your eyes and take a few moments to notice any thoughts and sensations in your body before moving back into your daily routine.

How to Stay Committed to Your Practice

Set a goal of meditating daily for five minutes, slowly increasing the duration each week. On days when you feel too busy to meditate, just take 10 slow, deep breaths anywhere you can find a few moments to yourself — in your car before you pull out of the driveway, at your desk or even in a bathroom stall.

Be patient with yourself and let go of any judgment about how your practice is going. It’s normal for thoughts to come up while you’re meditating. When they do, just observe them like clouds floating by in the sky. The true benefits of meditation come, not while you’re sitting there in stillness, but rather during times of high stress — when someone cuts you off in traffic, your toddler throws a tantrum in the middle of the grocery store or when you’re dealing with a serious health issue. With regular practice, the heightened sense of awareness and inner calm that you cultivate while meditating will start to spill over into other parts of your life.

“Every moment of our lives can become a meditation. How are you driving? How are you speaking to loved ones and strangers? What kinds of thoughts, feelings and emotions come up for you when you’re moving through life? Begin to bring your awareness into life as you are already living it,” says Decker. “Turn off the radio, turn off the TV, be with yourself and be more present with others.”

Meditation can transform your life by making you more patient, grounded and less reactive in all your relationships and with the unexpected challenges that inevitably come your way— at home, work and on the road.

Try a Free Meditation App on Your Mobile Phone

If you find it difficult to meditate on your own, download a meditation mobile app such as Insight Timer, Calm, Sattva, 10% Happier or Stop, Breathe & Think. These mobile apps track your progress and offer a myriad of meditation styles – from guided meditations and chanting to sounds of nature and relaxing music. The mobile apps are free, but premium content costs extra.