We’re very happy and relieved that Jean Woods, Laura’s Grandma is now able to move on to specialist elderly and dementia care. She is so much better than she was when she was admitted to The Richardson Mews at Christmas. We are hugely grateful to Registered Manager, Helen Petrie, and the whole team.
We know that it’s a big responsibility caring for anyone’s loved one who is vulnerable and can present with challenging behaviour. Add to that being at the height of a pandemic and the fact that it’s the bosses’ 87-year-old grandmother, and the stress levels are even higher.
After Jean broke her hip, she spent six weeks in hospital. As there were no rehab places available and she needed specialist care, we decided to admit her to The Richardson Mews. She arrived at Christmas 2020 after she had finished her isolation period. She does not fit our usual demographic, who have sustained a brain injury and are often younger adults. However, the multi-disciplinary team and the care team used their skills and experience to focus on Jean’s personal needs – as they do with any service user.
When Jean arrived, she couldn’t weight-bear and was in a very confused state. There was also a confirmed case of Covid-19 in the home. Protocols were followed and most of the service users, Jean included, managed to avoid catching Covid.
Jean is now able to walk with a frame and is cognitively much better, despite her advancing dementia. The input of the multi-disciplinary team delivering physiotherapy, and psychological therapy as well as changing her medication, had a marked improvement in her well-being. She is now well, strong and fit.
What we have noticed most of all, has been the benefit that all of the staff interactions have had on her well-being. Where she was previously left for long periods of time on her own, the constant care and attention of staff has paid huge dividends. Despite the restrictions of lockdown, it appears that none of the service users have suffered from isolation.
Jean’s care has brought home to us how other families must feel when their loved one is cared for by others. This positive outcome is a credit to Helen, the multi-disciplinary team and the whole staff team at The Richardson Mews.
Many thanks from Laura & Greg Richardson-Cheater and the whole family.
Martin Reeves (or Martin the Music Man), our Music Enrichment Leader, returned to Richardson Care homes again in March after the Coronavirus lockdown, performing in the gardens of the homes. Martin sings and plays the guitar and ukulele. He also has a collection of fun percussion instruments (one is shaped like a banana, for instance) and he tailors his activities to the preferences and personalities to the residents in each care home.
His weekly music sessions certainly enrich the lives of the service users (as well as the staff) within the homes, in various different ways.
Martin says: “I have been humbled by the response of service users and staff since I came back. In many cases, it’s as though I’d never been away. It struck me how everyone got straight back into the music. They started requesting songs and singing along immediately. It was incredible.”
Martin’s return was an emotional and uplifting experience for all, and, as you’d expect, people responded in different ways.
Martin continues: “Some of the guys who have learning disabilities just asked for the same songs as usual (Happiness/Michael Row the Boat Ashore/This OId Man etc). They hadn’t forgotten any of the words. The guys at 8 Kingsthorpe Grove are probably the most engaged and the best for sheer enthusiasm. They can sing really loudly and be really joyous.
“Music embeds itself into your psyche. Singing is a different cognitive process to talking, and sometimes, people who sing don’t always talk. This is particularly important for people who have an acquired brain injury and may struggle with memory issues or speech. The words and melodies are entrenched. It’s as though the brain has a separate shelf that it keeps all the music on.”
Music enrichment for adults with learning disabilities and complex needs
At our home in Duston, two young ladies in particular get really involved and are very enthusiastic. Martin says: “Whatever the song, one gives it the full operatic treatment. Another was given a guitar for her birthday, which she plays left handed even though she’s right-handed! One of the reasons is that she can mirror what I’m playing….in her own unique way. She’s also been taking videos and sending them to her Mum. You can see the joy in her and it’s clear the music really brings that out.”
Music enrichment for adults with acquired brain injury
Martin adds: “Playing for the guys at 144 Boughton Green Road is more like playing for a bunch of blokes down the pub. We have a joke and a laugh and there’s a fair bit of heckling and banter. I have worked out what sort of music stimulates them, so I can play more obscure music, such as the Bluetones/Jack Johnson/Divine Comedy/Squeeze…anything that comes into my mind and they really get something out of it. The music takes them out of themselves and gives them a sense of normality. They can relax, have a laugh and be entertained.”
Individual responses to the music
“There are different levels of interest and activity among the service users and if I’m playing outside some of the guys will just listen to the music in their room through the window. It can have a calming and relaxing effect, as well as enhancing their mood.
“I’m very aware of how people respond. Some people respond well to some gentle encouragement and join in, while others need more time. I’m even pleased when people sleep through some of the music sessions as this means that they are completely relaxed.”
Martin concludes: “When I first started coming to Richardson Care over 10 years ago it struck me then how the organisation thinks outside the box to enhance and enrich the lives of people in their care. It’s wonderful to be back. Returning to doing some meaningful activity after lockdown and seeing everyone’s response gave me a real boost. It’s massively rewarding and enriches my life too, giving me a sense of purpose and value. I feel part of the team, but I never forget that I’m a guest in someone else’s home. It’s about creating the right atmosphere, so I’m not pushy at all.”
After the most challenging year that many of us can remember, we look forward to 2021 with hope. We will be ready to offer our service users the Covid-19 vaccine as soon as it’s available to them. In the meantime, Christmas preparations are well underway.
Christmas in our care homes is usually a lively time with much excitement. This year is no exception. We have adapted to staying at home and finding ways to keep our service users active, engaged, safe and happy. They are supported to take decisions on what happens within the home, and we have a wide range of festive activities going on, including:
The summerhouse at 8 Kingsthorpe Grove has been converted into a beautiful grotto ready for Santa to visit
The team at The Richardson Mews had a fun, Australian-themed Christmas barbecue with a visit from ‘Kenny the Kangaroo’ to distribute presents!
Saturday nights in December are Christmas movie nights at 144 Boughton Green Road
Christmas karaoke is always popular at 23 Duston Road
There’s also mince pie making, cookie decorating, making cards, decorations and Christmas wreaths, carol singing, Christmas bingo and much more…
We would like to thank the staff teams in each home, who have come together and supported each other to ensure that we provide the best possible care for our service users. It’s been incredibly tough and we’re very proud them.
The importance of communication is the subject of the fourth blog post in our series about what we’ve learnt so far during the pandemic. It may sound obvious, but it’s easy to get it wrong. The situation was changing on a daily basis and the pressure and expectation on the management team was extraordinary. Never had the responsibility of being a Registered Homes Manager been so great. Here we share some of their thoughts and experiences.
Open communication channels
We learnt the importance of honesty, with ourselves, with our staff, with our service users, with our families and with each other as a management team. Had it not been for the openness that we have adopted in all our communications then this period would have been more challenging. It brought a sense of togetherness, a shared experience and an opportunity to change the way in which we build our relationships both professionally and personally.
None of us had ever experienced anything like this before so we were all learning together. We didn’t pretend to know all the answers, but we listened to WHO advice and took decisions swiftly in the interests of our service users. We reduced risks as much as possible to make our homes as safe as we could – both for our service users and our staff. We didn’t have all the answers but we did what we thought was best with the information that we had available at the time. We didn’t want to look back and wish we’d acted sooner.
We had to be honest about our fears and anxieties so we could support each other in finding ways to overcome them. It was important to maintain a positive attitude as we knew our response would affect the atmosphere within each home and impact our service users. They need to feel safe and secure within their home.
Our management meetings moved online. Although we couldn’t meet in person, we all took part in weekly management meetings, which were crucial in ensuring the smooth running of the homes. Facing the crisis together and being open and honest with each other has given all of us a better understanding of each other’s role and greater respect for each other. Together we worked out solutions to difficulties that arose, assessed risks, made contingency plans and boosted morale. It was vital to keep all communication channels open.
We managed staff teams so that there was no movement of staff between the homes. This had the positive effect of more continuity for service users. They had more 1:1 time with support workers so bonded more with staff. In some cases this has improved their communication skills, and some have demonstrated more empathy towards each other.
We’ve realised the importance of open communication, showing how we value, support and appreciate each other, talk more, respect and, most importantly, listen to each other. We’ve learning that praising and valuing people is so important in these difficult times.
We’re hugely grateful for the support of service users’ families, who have been unable to see their loved for long periods of time. We explained the difficult decision to close our doors to them and they understood that we had the service users’ interests at heart. We kept in touch as much as we could, getting to grips with new technologies, until they were able to meet in person again. They showed a lot a love and appreciation for all the staff, working under very difficult circumstances.
As the pandemic continues for longer than many of us expected, reflecting on how far we’ve come helps us to remain positive. We have protected our service users, kept them engaged and happy, and supported their families. We know we have the strength and resilience to continue.
As we’re always supporting our service users with acquired brain injury or learning disabilities to move forward, we rarely reflect on how far we’ve come. Our short series of blog posts looks at the views and experiences of our management team during the pandemic: what we’ve learnt so far about ourselves and how we manage our specialist residential care services. Although we have never experienced anything like this in our 30-year history, we have always focussed on the needs of the individual service users in our care. Every individual, whether they have a brain injury or learning disabilities is different. Therefore in order to deliver person-centred care, we often have to be creative in our approach.
Finding innovative solutions
For many service users, routine is a major part of their life. When their usual activities are no longer possible – no home visits, day services, community activities – we need to support and reassure them, creating new routines and structure in their lives. We have promoted health and exercise as well as bringing joy and laughter.
Although the service users have missed going out, we have had plenty of scope and opportunity to develop in-house activities. Our large gardens and outdoor spaces have been used for gardening: we’ve grown our own vegetables for the first time. We’ve had al fresco lunches and barbecues with a disco, played sports and games, done trampolining and completed treasure hunts. The in-house ‘coffee shops’ have been a great success, giving service users an opportunity to relax and build relationships between each other – often finding that spending more time together enables a greater understanding and appreciation of each other.
Restricting family visits was really tough, but we’ve maintained family contact through Skype, WhatsApp, Facetime and Zoom, as well as phone calls and letters. We even managed to track down a service users’ mother who had lost contact with her son several years ago. We were able to reunite them virtually using Skype, and this lead to seeing other family members too. This was a very positive and emotional experience for all.
At The Richardson Mews (inspired by Joe Wicks) the day now starts with ‘Morning Motivation’ – exercising to music every day to improve fitness, flexibility and well-being. We’re also making more use of our in-house gym equipment. One service user who has a brain injury thrived during lockdown: he was in a wheelchair in February and now he can walk 70 lengths of the parallel bars.
Staff have stepped into new roles – organising craft activities, baking sessions, quizzes or film nights. Some service users have also found new roles within the home too – one of the guys has become the house DJ!
We’ve celebrated birthdays with gifts, parties and barbecues. We’ve maintained structure when needed, providing mental stimulation, social interaction and fun, while supporting well-being and skills development.
We have always strived to create a relaxed family environment within each home. Facing the challenge of coronavirus together has brought everyone closer. The whole team and service users have felt and behaved even more like a family – there are good friendships and strong bonds. As we approach Christmas we maintain our focus on keeping everyone happy, safe, healthy and secure.
The second in our series of blog posts reflecting on the experiences of our management team during the coronavirus pandemic looks at our use of resources. We may have some way to go, but our team’s resilience, strength and adaptability means that we can face the challenges ahead.
Rethinking our use of resources
We wanted to minimise the impact of any changes on our service users, who have learning disabilities or an acquired brain injury. Although we had made the difficult decision to close our doors to family and friends, we knew that we needed to protect our service users, many of whom are vulnerable.
We found different ways to communicate and share experiences. We have all become much more tech-savvy, using the internet, apps, photos and video calls as well as phone calls so service users can keep in touch with their family and friends.
We learnt that many elements of our jobs can be completed using technology, so this can save us time for the things that matter. Regular management meetings went online in early March. These were crucial to keep up with the evolving situation and navigate the way ahead. They provided support, boosting morale when needed, an opportunity to share insight and experiences and to check in with each other.
We’re completing assessments for new referrals using online video tools, which means our admissions team no longer spend hours on the road.
The majority of our service users, whether they have an acquired brain injury or learning disabilities usually take part in a wide range of activities, accessing the community on a regular basis. Coronavirus restrictions meant that more activities would take place in-house.
We deployed central staff to various homes, so each home had enough admin and maintenance support and there was no movement of people between homes. The admissions team stepped in to support the care staff, running a wide range of activities from physical exercise to craft projects, keeping the service users engaged and happy. We also allocated care staff to specific homes, ensuring we had enough staff to operate safely if staff numbers were reduced due to increased sickness levels.
With members of our in-house maintenance team allocated to different homes, it’s meant they have been able to form closer relationships with the service users. Some service users have been helping out with maintenance jobs – developing their fine motor and cognitive skills while completing meaningful activities, they feel valued and gain a sense of satisfaction.
By reducing risk we’ve also found more efficient ways of operating. For example, instead of going out to the shops several times a day, there’s just one trip per day. This means planning ahead, so service users have been helping to plan the menus, write shopping lists and prepare for their daily needs. All these activities are helping to develop their cognitive skills.
The service users remain at the centre of what we do. By rethinking our resources, we have maintained the active, positive, safe and caring community within each home. We have ensured wherever possible that we meet each service user’s individual needs and minimise disruption to their lives.
Activities of daily living require a huge range of cognitive skills, which we develop from childhood as we grow. However, someone who has an acquired brain injury has to re-learn many of these skills. At Richardson Care we take an holistic approach, where members of our clinical team work with each service user to develop the skills they have lost. These include communication and cognitive skills, physical abilities and mental well-being.
In addition to the therapeutic interventions from the clinical team, our service users take part in a wide range of daily activities, depending on their personal preferences. We aim for these activities to be fun and inclusive, catering for a wide range of skill levels and tastes so the service users enjoy the activities and engage in them. These activities support the work of the therapists, without actually feeling like therapy, and can have a positive and lasting effect.
During the coronavirus pandemic, we have had to be more resourceful and creative as our service users have not been able to access the local community for their usual range of activities. This has meant providing a varied schedule within the home, and these ‘science experiments’ were an imaginative way to support cognitive skills in a group setting.
Experiment 1: Travelling Rainbow Water
This simple experiment shows colours travelling through kitchen roll and mixing together to make new colours. We started with three cups of water, one red, one blue and one yellow. We separated the cups of coloured water with empty cups and connected them all with kitchen roll. It takes a bit of time for the magic to happen, but the group were very patient with the experiment and the results were definitely worth the wait.
Experiment 2: Storm in a Cup
With water, shaving foam and food colouring, we recreated the science of the rain clouds! We half-filled our cups with water and added a layer of shaving foam, ensuring it floated flat above the water. We then added coloured water, drop by drop to the shaving foam. When the water became too heavy for the foam, the sudden swirling clouds of colour sparked plenty of gasps and giggles.
Experiment 3: DIY Lava Lamps
We made our own lava lamp reactions using vegetable oil, water, food colouring and an Alka-Seltzer tablet – the contents of the cup bubble around together mimicking the reaction of a lava lamp.
This activity lasted for over an hour and all service users who took part were engaged for the entirety of the session and helped to clean up afterwards. This activity promoted cognitive skills such as reading and following instructions, patience, coordination, listening to direction, creativity and curiosity. Members of the group were also encouraged to think about how the reactions worked. A number of them commented on the difference weights of the materials in the Storm in a Cup activity, how the materials separated in the DIY Lava Lamps and how the tissue paper absorbed the colour to make the Travelling Rainbow Water.
Gill Ayris talks about her role at Richardson Care and why she loves it so much.
“I moved to Richardson Care from the corporate world six years ago, swapping event management and promotions for the complex processes of Admissions & Referrals. I was made to feel really welcome: it’s a great team and there’s good support from the business owners and managers. In March 2019, I became Admissions & Referrals Manager.
“Along with Admissions & Referrals Co-ordinators, Sharon & Ebony, we are responsible for promoting our services to social workers, case managers, solicitors and other professionals. We attend events as well as keeping in touch by phone and email. As Richardson Care has been established for over 30 years and we accept service users from all over the country, we have a large network of contacts to manage. Thanks to our track record and the reputation of our services, many of our referrals come from word of mouth.
“I love my role. What gives me the most job satisfaction is receiving a referral and following it through to the end. That means securing a placement in one of our homes, knowing that we can support the person’s needs and knowing that they will fit in with the current population. I love seeing them settle in and watching them progress in their therapies and their behaviours, and improving their quality of life. And it’s really rewarding to see them move on – either back home or to supported living. Even if they stay with us over the longer term, it’s lovely to see them develop their daily living skills and be happy.
“That’s what it’s all about. If you’re working in care you have to have that passion to improve someone’s life. At the end of the day, we’re dealing with real people. If someone’s had a brain injury, they are still that person. They are still Joe Bloggs. They might have a diagnosis now, but they are still Joe.”
“When we receive a referral, we need to assess whether we can help that person and whether they will fit in with the current population in that home. This is crucial – we are very mindful of this being a person’s home, where they feel safe and happy. We don’t want to disrupt life for our existing service users by introducing someone who won’t fit in. Consequently, we require a lot of information at the point of referral. We need full disclosure of the individual’s current conditions, living skills, cognitive abilities, mental capacity, risk behaviours and medications, as well as their medical and forensic history.
“Then if we feel that they would indeed fit into our community, we arrange an assessment. Under normal circumstances, we travel all over the country to complete assessments. It’s usually the admissions team member who has been dealing with the case, along with the appropriate home manager, who will go. We consult with our clinical team and if we feel that we can support that person, we make an offer by letter. The offer letter details the level of specialist care provision and associated costs.
“At Richardson Care, although we have a strong clinical team, this is not a hospital setting: it’s much more like a home from home. For example, the staff don’t wear uniforms, so there’s more of a relaxed feeling, it’s more of a family environment. Whether you have a brain injury or whether you have a learning disability, when you’re coming to one of our homes, from that time on it’s your home. You wouldn’t wear a uniform at home. We want everyone to feel comfortable and relaxed, so I think the no uniform policy makes a big difference.
“We have six care homes and I always say to families, friends and professionals who come to visit our homes prior to a referral is that they must look at all of the homes. If you walk into a home and half the service users aren’t there – they’re out doing this activity or that activity – it’s completely different to seeing everyone sitting in the lounge not doing anything. By visiting the homes, you can feel the atmosphere. You have to walk out of that home feeling happy and comfortable with leaving your loved one or client there.
“Of course, life has changed for everyone during the Covid-19 crisis. For me and my team, this means that our focus has been more on supporting the service users in our homes. We’re based at The Richardson Mews, so we’ve been going shopping for the service users here or supporting them with activities within the home. Sharon has been providing admin support at 23 Duston Road as staff have not been going from one home to another. In general, the morale has been fantastic and everyone has pulled together to keep our service users safe and happy. When we go back to our normal roles full time, I’m sure we’re going to miss seeing so much of our service users!”
The Coronavirus lockdown is affecting people in many different ways, but it can be particularly difficult for people with learning disabilities, autism and complex needs. They often need routine and structure, which has been disrupted as we’re no longer able to go out and about, visiting the usual places, doing the usual things. People with learning disabilities may not fully understand why their life has changed, or may not be able to verbalise their frustrations. We are supporting them in various ways:
Everyone is different so we are supporting all of our service users according to their own needs and abilities. This can involve using non-verbal communication techniques such as Makaton, TEACHH or the PECS picture exchange system to explain the situation and what we need to do to stay safe.
We’re being creative and introducing new structures and routines to keep everyone calm, entertained, safe and happy. We’ve been able to welcome back Martin the Music Man, whose music sessions enrich the lives of the service users in many ways. He’s been singing and playing his guitar in the gardens of the homes, while maintaining a social distance.
We’ve also had several birthdays to celebrate recently so we’ve made them special with garden parties, pamper sessions or parties in the homes with balloons, cakes, treats and gifts.
Many of our service users with learning disabilities have been with us for years, so we have a deep understanding of their likes, dislikes, needs and preferences. They have developed trusted relationships with our care support workers, which means that we are better able to support them in difficult times.
Feedback from families
We are also keeping in touch with their loved ones and are very grateful for the feedback we have received from families. Here are some examples:
“We spoke on the telephone this morning and I am writing to you to reiterate what I said to you on the ‘phone…
“There was a feature on this morning’s TV News about the very difficult time many autistic people and their carers are having during the Covid-19 lockdown. As I watched it, I was reflecting on how very fortunate we are that our son is in your care and that he is being so well looked after and even more importantly, kept safe. We are truly thankful for your care and for the brilliant work your staff at all levels are doing at during these difficult times. Please circulate this letter to your staff or post it in a prominent position so that all can read it…
I just wanted to write to you as a parent of one of your residents to say how very grateful I am for the care you are providing for my son and the other residents during these difficult times. I know you are doing your very best not just to care for our loved ones but to provide them with as varied and stimulating a time as possible. I know that, like all of us, you are concerned about your own safety and well-being of yourselves and your families and this makes us doubly grateful for the excellent work you are doing.
I hope that you and your families remain well and look forward to being able to resume my regular visits.”
“Dear Jane [Service Manager]
I’m writing to say how thankful I am for the care my son has received while having another chest infection. He’s fine now thanks to your great staff. It must be so hard to keep everything germ free.
What really prompted me to contact you is the great idea of the cafe/tuck shop in the garden. That must make all the difference for everyone to go outside in the sun with their little coupons and buy something. I’m sure there are many challenges with everyone inside. Anyway thanks to all of you for a great job.”
We would like to thank all of the families who have sent in messages of support or gifts, and of course, thank our wonderful team of managers and staff. They are being amazingly positive, creative and dedicated, working hard to support our service users with learning disabilities, complex needs and acquired brain injury in these difficult times.
Many of us who are fortunate to have a garden are giving it much more attention since the Coronavirus restrictions started. The gardens in our specialist care homes are no exception. Not only are the gardens benefiting from extra TLC, so are our service users.
All of our homes have large gardens and/or outdoor space that is used for a variety of activities, depending on the needs and preferences of service users.
The Mews – home for adults with acquired brain injury
One of our service users had taken ownership of some raised flowerbeds, which had been neglected, and as we’re all confined to the home and garden, he had some helpers. He trusted Ebony and Paige (two of our Admissions & Referrals Co-ordinators) along with another service user to get involved. They revamped the whole patch: dug, weeded, replanted some of the existing plants and added new ones. They planted herbs and vegetables as well as sowing some seeds.
Everyone enjoyed it, and one of the guys who suffered low mood said he had a really great day. Research, as well as anecdotal evidence, has shown that gardening activity has many well-being benefits – it’s mindful and calming, reducing stress and the symptoms of anxiety. It’s a meaningful activity, providing focus and hope – seeing plants grow and develop gives us something to look forward to in these uncertain times. In addition, neurological injury can impact on the brain’s ability to control physical movements, so weeding and planting seeds, for example, can help to improve fine motor skills.
The large garden at The Mews was perfect for our Easter treasure hunt and is also used for a wide range of games and activities.
The Coach House – home for adults with acquired brain injury
Adjacent to The Mews, service users at The Coach House have access to all of the gardens. They also have their own outside space with patios next to some of the bedrooms and a lovely sunny terrace at the front of the home. The service users have been enjoying the sunshine – having lunch outside, playing giant noughts and crosses, listening to the birds and enjoying nature.
144 Boughton Green Road – long-term home for men with acquired brain injury
The large rear garden has a big lawn, which is great for football, badminton, croquet and outdoor darts. Families have been very supportive and donated some outdoor games, including giant Snakes & Ladders and Jenga. The patio is perfect for sitting in the sun and chilling out – just being outside has benefits of engaging all the senses, Vitamin D absorption, improving sleep and general well-being. We also have some extra gazebos, so there is plenty of shade and the guys have been eating alfresco when the weather’s been good. We had a barbecue one Friday and everyone really enjoyed themselves. One of the service users was the DJ for the day, and has now nominated himself as the home’s DJ!
There’s also been plenty of gardening activity – we’ve started a vegetable and herb garden, sowing seeds, and potting up plants. We’re hoping to grow potatoes, carrots, sweetcorn, tomatoes, cucumbers, aubergines and chillies.
23 Duston Road – home for adults with learning disabilities and complex needs
The back garden at Duston Road has a summerhouse, trampoline, tables and chairs, so can be enjoyed for a variety of activities. There was great joy recently when Martin the Music Man came to visit. He usually comes to the home every week, but had stopped coming because of social distancing rules. However, an improvement in the weather meant that he could play his guitar and sing, while maintaining a social distance. The guys and girls were really pleased to see him and he spread some musical cheer to everyone at the home.
2 & 8 Kingsthorpe Grove – homes for adults with learning disabilities and complex needs
The garden and patio provide some lovely outside space for games and other activities. However, the service users’ favourite thing at the moment is our new shop! They are all missing their trips to the local shops and cafes so we’ve converted the summerhouse. Tables and chairs are set up in the garden and they are all loving it.
We are trying to provide a sense of normality and routine, as well as some fun, during these difficult times. Outdoor space (especially when the weather is good) gives us additional opportunities to do this. A whole range of activities contribute to well-being and rehabilitation in a number of ways from enhancing mood to improving physical skills.