Comprehensive Guide

StandingTall is a digital home-based exercise program designed to improve balance.  

The program is delivered through a tablet device, like an iPad, or computer. The user follows the prompts to complete their exercise sessions.   

It is a flexible exercise program! The users are suggested a weekly target to reach, and they can exercise whenever it suits them. There is no limitation to what time of day, or day of the week they can exercise. 

With over 6,000 exercise variations, every StandingTall exercise session will be tailored to the user's ability. This makes StandingTall a great option in between healthcare appointments, ensuring users remain active in a way that challenges them appropriately.  

The CMS (Content Management System) for StandingTall allows you, the healthcare professional, to monitor a client’s progress in between visits.  

StandingTall has been used extensively in research trials and has been proven to significantly reduce the rate of falls and injurious falls over two years.  

StandingTall is for anyone who: 

• has any degree of concern about their balance; 
• has had fall/s; 
• wants to keep active; 
• wants to maintain their balance; 
• wants to increase the longevity of their independence. 

This training guide has been specifically designed for Healthcare Professionals to: 

1. Set-up a new client with StandingTall; 
2. Teach a client how to use StandingTall; 
3. Support the client by monitoring their progress. 

Before you introduce the StandingTall program to your client, you will need to set up an account on the CMS with their details.   

The CMS (Content Management System) is a web portal that allows you to set-up a client’s profile and modify their program. The CMS stores your clients exercise information for you to view at any time.   

The following steps are to be completed prior to the first StandingTall appointment with you client

On your own computer/tablet, open the CMS website: https://standingtall.neura.edu.au  

Enter your registered* Email Address. Then, click on the “Send Token via Email” button.  

*This is the email address you registered with a member of the StandingTall team. Only email addresses logged in to the system will be able to access the CMS.  

Open your inbox, and find the email with Subject: StandingTall – 2FA login and choose one of the following options in the email: 

• Option 1: By clicking on ‘Click this link’ – this will take you directly to the login page, enter your email address and password Exercise000 
• Option 2: On the login screen for the admin area click "Sign in with Token" and copy & paste the token, along with your email address and password Exercise000 

If you would like to change your password, you can do this by first logging in, then clicking your profile in the top right corner, then click the 'Password' tab to change.
 

If you are having difficulty logging into the CMS, please email: standingtall@neura.edu.au  

Once you are logged in, you can now set up a new client on the CMS.  

1. To add a new client, click on ‘Users & Patients’, then ‘Patients’ in the side bar/menu. 

   

2. Click on the maroon plus button on the bottom right-hand side of the page. 
3. There will be a pop-up box that will appear on the screen, with tabs at the top:

You only need to enter information under the following tabs:  

User Details, Password, Site Details, Program Details, and Exercise Settings.  

Fields marked with a red Asterix are mandatory.   

User Details tab: enter basic login and personal details about the client. 

• Leave the ‘Patient is in RCT’ box unchecked as this box is for research purposes only.   
• Fill in the fields marked by the red asterisk (Email address, first and last name fields). The other fields are not compulsory.  

Password tab: create a password for your client, so they can login to StandingTall. 

• The password requirements are: 
• 10 characters minimum; with 
• 1 upper case 
• 1 lower case 
• 1 number 
• There is an ‘eye’ symbol on the far-right of the field to click on to view the password in text form. Check this to ensure you have entered the password correctly.  

Site Details tab: makes keeping track of your clients simple. 

• In the ‘Stream‘ field, select ‘Community (not research)’ in the drop-down menu.  
• In the ‘Group Acronym’ field, enter ‘ST’ plus the first initial of your partner site (e.g., Uniting = STU, HammondCare = STH). This is a case-sensitive field.  
• All other fields can be left blank. 

Adding a Group Acronym gives the CMS a way to group clients into a cohort. You are only able to access the client if they are set up with the correct group acronym and thus, in the cohort. 

This will be important when it comes to monitoring & modifying the client. 

Program Details tab: determines the exercise program details for the client. 

• Date Program Started: enter the date of your first StandingTall appointment. 

The table below demonstrates how StandingTall gradually builds from 40- minutes to 120- minutes per week based on the program start date.  

The weekly exercise dosage is a suggested target for the client. There is no impact to the exercise program if the exercise target is not reached. 

• Program Type: Select StandingTall Balance. 
• StandingTall Balance   
• Balance categories: Floor, Foam, Box, Dartboard & Grid 
• Strength categories: Upper and Lower Body Strength 
• Cardio. 
• The Cognitive Program is still in a research development phase. 
• Uncheck all the boxes for client settings: this prevents the client from being able to change their exercise settings. 
• Balance Exercise Dosage: Select 2 Hours.   

 Exercise Settings tab: allows you to modify your clients exercise settings. 

There are eight categories listed under the Exercise Settings tab: 

All the exercises in each category are shown in maroon or red: 

ACTIVE EXERCISES		Exercises in maroon are ‘Active’ and will appear in your client’s exercise sessions
INACTIVE EXERCISES		Exercises in red are ‘Inactive’ and will not appear in your client’s exercise sessions.

The Current Checkpoint should be set to 1 for all categories (shown below). This is the starting level for the program, do not change it.  

• The checkpoints will change automatically based on how your client performs in the Balance Assessment.  
• Once your client has started using StandingTall, you can manually adjust their checkpoints, and set a ‘Max Checkpoint’ (so the program won’t go beyond a set level) based on your clinical judgement e.g. they’ve been unwell, they’ve been travelling etc.  

All the categories are set to ‘Active’ indicated by a green tick (shown below) 

You will need to manually ‘Disable Exercise Type’ for Box. The category should now be shown as Inactive, indicated by a red cross 

Press ‘Save’ once all steps are complete! 

Your client has successfully been added to the CMS. The next step is to introduce your client to StandingTall! Please continue to Part 2.

Book an appointment with your client to introduce them to StandingTall. Ideally this appointment should take no longer than one hour. 

Setting up the exercise space 

StandingTall is a home-based exercise program. Your client will need a safe and practical space to exercise in their home. Ideally the space should: 

• Be at least 1m2 
• Have a stand or table for the iPad at eye level; 
• Be free from clutter and trip hazards, such as rugs or electrical cords. 

Your client will need: 

• iPad;  
• An internet connection; 
• A chair or something sturdy to hold onto for support; 
• Foam pad/folded towel/sofa cushion  

The ‘Foam’ is a piece of equipment included in the program to challenge the user’s balance. Foam is used in the Balance Assessment and during Exercise sessions. 

Download StandingTall from the App Store 

On the client’s iPad: 

1. Go to App Store; search for ‘StandingTall’ 
2. Tap ‘Install’ and wait for it to download 
3. 'Open’ StandingTall or return to the home page and search for the StandingTall app. 

Opening StandingTall for the first time with your client 

Locate StandingTall app on the home screen and open 

Note: To proceed to the login screen, you must accept all notifications at the bottom of the screen by pressing ‘OK’.  

On the Login screen:  

1. Click on ‘I am an existing user’ 
2. Enter the email address and password used to set up the client's profile in the CMS; 
3. Click ‘Login’. 

Getting Started  

Do a Balance Assessment 

The first thing to take your client through is the Monthly Balance Assessment, which must be completed for your client to access their exercise session. 

The Balance Assessment: 

• Consists of 5-10 exercises 
• Determines the exercise starting level for the client 
• Requires a chair/support nearby for safety 
• May require the ‘Foam’ (see above section ‘Setting up the exercise space’) 

For safety, ensure you are standing close to the user and/or there is always a support for them to hold nearby. 

On the main menu, tap 'Do a Balance Assessment' and follow the on-screen instructions. 

Confirm the items on the Safety Checklist: 

The Safety Checklist appears before every balance assessment, exercise session and the trial session.  

Check each item and press ‘Continue’. The user cannot commence exercise until all items are checked, as indicated by a tick. 

The Safety Checklist ensures that the user has a support nearby, is wearing appropriate footwear and will watch the demonstration videos if unfamiliar with an exercise. 

During the Balance Assessment 

Note the Exercise Title and foot position in the top right corner of the screen.  

When ready to begin, press the red ‘Start’ button. A three-second countdown timer will run before the exercise starts. 

During the balance assessment, if the client loses their balance or uses their support the timer must be stopped via the ‘Tap to stop balancing’ button. From here, the exercise's duration can be adjusted using the drop-down menu to reflect how long the position was held. Press ‘Confirm’ then the next exercise will appear on screen. 

If the client is unfamiliar with an exercise, watch the demonstration video by tapping the ‘How to perform this exercise’ button. 

When the Balance Assessment is finished, it will return to the main menu. 

The Balance Assessment is repeated monthly to ensure the exercises are at an appropriate level for the user.  

Before starting an exercise program, your client should be taken through the Trial Session with your guidance.  

This can be accessed from the main menu, by clicking ‘Trial Session’.

After clicking ‘Start Trial Session’ you will be prompted to complete the safety checklist, confirming that your client is safe to commence exercise. 

The Trial Session demonstrates an exercise from each of the Balance Exercise categories offered in StandingTall: 

Explaining the exercise screen 

Below is a screenshot of the first exercise in the Trial Session. The screen for each new exercise has the following features: 

• ‘Exercise Title’ describes the foot stance or action, and any equipment required e.g. Foam. 
• ‘Foot Position’ in the top right corner shows in a grid if an exercise is Standing Feet Together, Feet Hip Width, Feet Semi-tandem, Feet Tandem or Standing on One Leg. 
•  ‘How to perform this exercise’ will take you to an instructional video and summarised step-by-step version of this exercise. 
• View ‘Tips and Hints’ for the exercise. E.g. How to make the exercise easier or more challenging, why exercise is important for balance.  
• ‘Start’ the exercise if you are already familiar with it. 

NOTE: Box (shown below) and Cognitive exercises are currently disabled and will not appear in the Exercise Program. Press the ‘Skip’ button to jump over these in the Trial Session.  

You have now completed the Trial Session. Next up is the Exercise Session!

Starting an Exercise session 

It is time for your client to start their first ‘Exercise’ session. You will only need to complete 1 exercise (3 sets), to take them through the user flow. It is important to show them the ratings page that appears after 3 sets, as well as how to exit a session early.  

To start, tap ‘Exercise’ on the main menu. You will then be prompted to: 

1. Select how long your client wants to exercise.  

Initially the program offers 10- and 15-minute sessions. As your client progresses through the program, duration options will increase to include 20- to 30- minute sessions. 

Research suggests that doing at least 2 hours of balance exercise per week can reduce falls.   

1. Complete the safety checklist 

Confirm your client has something to hold onto for support, is wearing appropriate shoes, and will watch the demonstration video if unfamiliar with an exercise. Once all items are ticked, press ‘Confirm’. 

1. Start Exercise 

Press the red ‘Start’ button. The exercise will begin after a 3-second countdown. Make sure the volume is turned up on the iPad. 

Under the Exercise Title you will see the number of exercises included in the session; the duration of each exercise and the number of sets completed for that exercise. Each exercise is performed 3 times.

Exercise Rating Scale 

At the end of each exercise (3/3 sets), the client will be asked to complete the Rating Scale to tell us how they felt when doing the exercise.  

Firstly, the client must indicate if a support was used to perform the exercise and then to rate the difficulty of the exercise on a scale of 1 (Unstable) to 5 (Very Stable). 

If Yes, then the program automatically selects 1- ‘Unstable’ as the rating. 

If No, the client must select a rating between 1- and 5 - to indicate how they felt performing the exercise. 

Press ‘Complete exercise’, and the program moves onto the next exercise. 

 How does the rating scale work? 

The client’s rating for each exercise will determine whether the exercises in the next session will remain the same, progress to a more challenging level, or become easier. 

This is what the rating scale screen looks like when indicating ’Yes’ to using a support to complete the exercise. The rating scale is disabled, and the program automatically selects 1 to ensure the exercises remain safe for the client.  

Additional features on the Exercise screen 

Instructional video and Quick refresh 

Every exercise in StandingTall has an instructional video. This video is accessed by tapping the ‘How to perform this exercise’ button at the bottom of the page.  

On the ‘How-to’ page, you can watch the video (with audio) by pressing the red play button (circled). Alternatively, to access a summarised set of step-by-step instructions on how to perform the exercise, press ‘Quick refresh instead’. When ready to return to the main exercise screen, press ‘Continue session’. 

Tips & hints 

For tips and hints on why you a reperforming this exercise, which muscle groups you’re working and how to make the exercise more challenging, tap ‘Tips and Hints’ at the bottom right corner of the screen. To resume exercise, tap ‘Continue exercise’. 

Pause Exercise & Ending a session early 

There are a few ways to pause an exercise. Firstly, when an exercise is running you can tap ‘Pause exercise’ in the top left corner. Sessions can be paused for up to 120 minutes (this includes time spent exercising, paused, or when the screen is turned off) before the session expires.  

The session is also paused when watching instructional videos or reading the tips & hints section. Only the amount of time spent exercising counts towards the weekly exercise total. 

If for whatever reason the session needs to finish early, select the ‘Return Home’ button on the Exercise screen and click ‘Save and Quit’. 

This will save your exercise minutes up to this point.  

Other program features  

From the main menu, clients can track their Progress, schedule sessions in the Calendar, set Goals, and get Help with the program.  

Clients can also see on the main menu how much exercise (as a percentage and time) they need to do to reach their weekly target.

Progress 

The Progress feature shows how many minutes of exercise have been completed in the current week, in relation to the weekly exercise target (2 hours). It also tracks your scores from the monthly balance assessments and gives a 6-month overview of your progress.  

Calendar 

The calendar allows you to set a schedule to exercise at specific times of the week, and helps you to reach your target.  

Goals 

Setting goals can highlight what’s important to you and help keep you on track to reach your weekly target.  

Help 

Don’t worry, we’re here to help. You can rewatch the StandingTall tutorial or check out the FAQ’s section.   

Who to contact for help 

The client should have your contact details. For any further enquiries, please refer to the Quick Guides, or your sites Resident Expert. 

The following table shows how to check user adherence, based on the level of detail you’re looking for.  

General Summary: 

1. On the CMS, find your client by clicking on the ‘Users & Patient’ side bar/menu. Click on ‘Patients’.
2. The image below shows the Patient Dashboard, and will show all the clients assigned to you in the group cohort. The Patient Dashboard is how you can quickly view the general overview of client adherence regularly. You may also search for your client's email address in the search bar.  

The three columns (TW, -1W, -2W) highlighted in the screenshot above shows adherence for: 

• This Week (TW) - This will be a partial week from Monday this week to today. 
• Previous Week (-1W) - The last complete week from Monday to Sunday. 
• Previous Fortnight (-2W) - The last complete fortnight from Monday to Sunday. 

Cohort Summary Report 

To view the entire cohort adherence through the CMS, go back to the Patient dashboard, and you will see everyone in your cohort.  

Click on the three vertical dots on the far right, and select ‘Export CSV’. 

Open the .csv file in Excel. You can view the entire cohorts details, with information on: 

• Last balance assessment; 
• Current week in the study; 
• Total minutes exercised each week for the balance, as well as cognitive program; 
• Reasons for not having adhered (eg. Unwell, travelling, technical issues). 

Individual Summary Report 

1. Follow steps 1 & 2 above. 
2. Select the client’s row. A pop-up box will show on your screen. At the bottom, you will see a ‘Download Patient’ button. Click on this. 
3. A .csv file will download. Open the file in Excel.  
   1. The top section is a summary of client details (program, dosage), weekly and daily adherence/exercise minutes completed, reasons for adherence failure, and session times. As you scroll down further, there is specific information on: 
      1. Category & Custom Max Checkpoints: what checkpoint the exercise category is currently on, as well as whether there is a Max Checkpoint specified for a category. 
      2. Information on Floor/Foam/ Dartboard/4x4 Grid: This section highlights how many exercise sessions an exercise has been given, the average rating for each exercise they’ve completed & the last date of attempt.  
      3. ALL Exercises: this section highlights even further details: the last date of attempt, how long it took to complete that one exercise, the order the exercise was in the entire session, the duration of the exercise, what rating it was given, the checkpoint the exercise category is on, whether the chair was used for an exercise, whether a weight was used (for strength exercises), and what week in the program they’re on.  
   2. Scanning the “Average Rating” column in the Floor Exercise section, can give you an idea of where a client might be struggling. E.g. this participant has rated ‘Standing – Left Leg’ on average a 2 (unstable).   

In the All Exercises section: scanning the “Rating” column can give you an idea of where a client might be currently struggling. E.g. this participant has recently rated ‘Standing with Eyes Closed: Near Tandem’ a 1 (unstable). 

There may be circumstances in which you will need to modify your clients exercise program. The client may be finding their exercises challenging, easy, may need regular follow-ups before deciding to progress with their exercises, or even deactivating some exercises temporarily. 

1. On the CMS, find your client by clicking on the ‘Users & Patients’ side bar/menu. Click on ‘Patients’. 
2. In the orange bar, click on ‘By Cohort’ and select the relevant cohort name (this will be dictated by your site name, eg. HammondCare ST, Uniting ST). You may also search for your client if you remember the email address registered to the client.  
3. When you find your client on the dashboard, click on the row with your clients' details. 
4. The same pop-up box that appeared when you first registered the client will show on your screen. Click on the ‘Exercise Settings’ tab to modify their exercise settings. You may need to scroll down to search for the other exercise categories. 

An exercise type (including all of Balance categories Floor, Foam, Dartboard, Grid, Upper/Lower body Strength, and Cardio) can also be modified in 3 ways: 

1. Disabling Exercise type/category: this means a client won’t receive this category of exercises.  

An exercise type/category can always be enabled again. This may be helpful if a client reports an issue with their shoulders with a particular exercise category. You could disable the Upper body Strength exercises.  

1. Adjusting checkpoints: a checkpoint is a level in the exercise category.  

The higher the checkpoint, the more advanced the exercises become. A client may express a concern about their exercises being too easy, or too challenging. Adjust the Current Checkpoint by increasing, or decreasing the checkpoint number. You will see the exercise tiles with the titles (as seen in the image above) turn maroon if it is active in the program, or red if it is inactive in the program. The higher the checkpoint, the more maroon exercise tiles you will see, and vice versa. 

Adjusting a checkpoint beyond any Max Checkpoint entered will not work.  

1. Setting a maximum checkpoint: Limitations can be set on an exercise type checkpoint.  

This may be helpful to ensure a client doesn’t advance too far in the program without a check-in with you. If a client reports an issue with their shoulders, you can set a limit by entering a checkpoint number 2-4 numbers higher than their Current Checkpoint. Once the client reaches the Max Checkpoint, you must consult with your client to determine if they feel ready to continue progressing, or stay at this level. 

Adjusting a Max Checkpoint will not be reflected in the maroon/red exercise tiles.  

1. Click on ‘Save’ to save any changes made.  

1. “I’m unable to log in, it says the trial code doesn’t exist!”  

   Please click on ‘I am an Existing User’, as this refers to the client existing on the CMS system. 

2. “I’m unable to log in, it says the log in details were incorrect” 

   Client log-in information can be found in the CMS. Reconfirm email address & password is being entered correctly. You also have the option to reset their password on the CMS. 

3. “I can’t do my exercises, it’s telling me I need to do a balance assessment!” 

   Balance assessments are scheduled every month and provide health care professionals with updates on how your balance is progressing as you continue to use the program. They must be completed before StandingTall allows the client to access their regular exercise sessions. The assessment should take no more than 5-10 minutes. 

4. “I was away/unwell for a few weeks, what do I do?” 

   If the client has not used the app for 2 weeks, they will be prompted to select a few reasons. After selecting one of the options, they can continue with the program as usual. You may use your clinical judgement to determine whether the client should have their exercise settings modified on the CMS (ie. Lower their current exercise checkpoints, or set their maximum checkpoint until the next follow up). 

Please contact your sites Resident Expert for further assistance.