In the Mix

Subscribe | Advertise | About Us | Contact Us | Home

October 2001

By Peg Connolly, PhD, CTRS, and Erika Tindell, MSEd, CTRS

Recreational therapy has grown significantly in the area of rehabilitation services over the past 20 years. Today, more than 20% of the 17,000 certified therapeutic recreation specialists (CTRS) work in rehabilitation.1 While growth has been significant, understanding the purpose, nature, and value of recreational therapy has not been as far-reaching. Confusion on the best use of recreational therapy and whether it is a treatment or just something nice to add to rehabilitation offerings sometimes persists .

We interviewed eight CTRSs with nationally recognized expertise in recreational therapy and rehabilitation. The participants are: Karen Luken, MS, CTRS, research associate, University of North Carolina, Chapel Hill; Ruth Roeder, CTRS, manager, Inpatient Rehabilitation Therapies, St Francis Medical Center, Peoria, Ill; Missy Armstrong Beyerlin, MS, CTRS, supervisor of occupational and physical and recreational therapy, Harborview Medical Center, Seattle; Diane Wagner-Heffner, MA, CTRS, clinical coordinator, Gentiva Rehab Without Walls, Ann Arbor, Mich; Joanne Finegan, MEd, CTRS, CEO, ReMed Recovery Care Centers, Conshohocken, Pa; Joseph Murawski, MA, CTRS, operations manager, New York Presbyterian Hospital, New York; John Jacobson, MS, CTRS, rehabilitation planning specialist, Department of Veterans Affairs, Richmond, Va; and Linda Hutchinson-Troyer, MGA, CTRS, patient therapy manager, Kernan Hospital, Baltimore.

The patient population in rehabilitation services is diverse-spanning all ages and geographic and economic sectors. While treatment may be applied systematically and consistently, all health care professionals can cite those patients who succeed and even thrive versus those who have recurring complications and even failures in the rehabilitation process. While a patient may learn skills required for functional independence, the success and long-term health of an individual often require more.

Our survey group indicated that one of the greatest contributions of recreational therapy to the interdisciplinary team is the application of treatment and modalities that support holistic recovery and integration of skills.

Finegan explains, "Rehabilitation services are typically provided to individuals after a significant injury and/or illness. Quality rehab services take a holistic look at patients to assist in their recovery as well as to identify any long-standing adjustment issues that the illness or disability may create. A skilled recreational therapist looks at all aspects of the patient including past lifestyle, support networks, and the focus of current treatment to determine activities that complement this focus and have a direct connection to reentry to home and community."

Luken indicates that CTRSs reinforce patient treatment goals of other members of the health care team, and provide "purposeful use of recreation, activities, and interventions to promote skill development and enhancement, [and] community integration." She emphasizes the important role CTRSs play in providing skill development in the patient's use of social supports. So while recreational therapists offer unique treatments focused on the holistic concerns of the patient's rehabilitation, they also develop interventions that complement other rehab services and goals.

The treatment plan may include goals for improved mobility, speech, and self-care, ie, other activities of daily living. The CTRS develops interventions that incorporate those treatment goals as well as interests that motivate the patient. Thus, when the patient engages in the selected intervention and respective activity, treatment goals are integrated into a normalized life experience that the patient is motivated to pursue.

"The recreational therapist provides the bridge to community reentry for the patient. Other integral therapies help a patient be more mobile, to dress and feed himself, and to communicate better. CTRSs reinforce those functional skills learned by applying them to the home environment. The main goal for most patients is to go home.... Effective rehabilitation is dependent on a full functioning team. If recreational therapy is not part of the team, often what the patient has learned during intensive rehabilitation is lost once he goes home," says Jacobson.

Recreational therapists bring a unique perspective to the interdisciplinary treatment team including a focus on the holistic needs of the patient; development of healthy and active lifestyle values, and pursuits that alleviate negative lifestyle patterns; community reentry interventions for a successful return home; and integration of skills developed through other therapies in meaningful activities relevant to the patient's life and interests.

As Wagner explains, "CTRSs address the critical issue of keeping patients active and healthy after they're discharged despite the presence of a disability, and recreational therapy can affect a patient's functioning months after discharge from rehabilitation. It has durability."

Despite its value, recreational therapy, like many other health care specialties, has experienced cuts in positions over the past 5 years. Armstrong has noted some losses in jobs, but she believes these losses are commensurate with the total percentages of cuts in all health care disciplines.

She says that in some facilities the job market for CTRSs has improved: "This is directly related to the acknowledgment of rehab professionals that rec therapy promotes the value of integration of skills to the community. New jobs are being created as alternative medicine approaches are valued by the consumer."

New areas of service continue to open with greater emphasis on community and home treatment options. As CTRSs already have extensive experience in community reintegration, home-based care is an excellent working environment for them.

If funding prevented the involvement of recreational therapy on the treatment team, there would be several losses to patient care such as a decreased focus on community reintegration, loss of interventions that emphasize coping and adjustment to disability, a greater risk for the development of secondary disabilities when patients do not develop healthy lifestyles, and an overall decrease in the quality of care. Focusing on community reentry, reduction of secondary disabilities, and improved quality of life are unique and needed interventions for treatment in the 21st century. When patients are successful post rehab, they have greater control of their life and are thus more productive members of society. So, perhaps the greater question is how can recreational therapy be used most effectively in rehab?

The interdisciplinary treatment team needs to understand that recreational therapy provides unique interventions that bring together functional skills acquired through other team interventions. Recreational therapy helps integrate treatment goals into meaningful activity in real life situations. The emphasis on home and community is an essential goal of comprehensive rehab services. Meaningful activity significantly impacts the individual's self-esteem and aids in building support networks. Jacobson states: "Other team members really seem to see the role of rec therapy in community reentry.... In those situations where it is not well known or effectively used, I think the most effective use of recreational therapy interventions is preparing the patient to live in the home community and being a productive citizen by being active in chosen leisure pursuits."

Wagner stresses that rehab professionals understand that inpatient care is only a small part of a patient's journey: "Many patients will live with some type of lifelong deficit and these impairments may threaten to keep them sidelined from society and life. Recreational therapy can provide them with the tools to continue an activity that will assist them in multiple life domains. Such pursuits can be a means to keep them physically active, cognitively active, emotionally satisfied, and socially involved."

Just as important as assuring that professionals understand the role of recreational therapy is the need for the patient and family to understand how to best use this service. Most patients are in unique situations during the rehab experience and may not understand that the most important question to ask is "What happens when I go home?" Working with patients and their families helps prepare for and assess the patient's needs post treatment.

Roeder says that treatment should not just be about getting better. It should be about getting stronger, learning effective adaptations, and then learning how to live. "When a patient is first injured, recreation and leisure are usually the last thing on their mind. With rec therapy as an integral part of patients' therapy, they will be able to make adaptations to premorbid leisure activities, learn new leisure skills, increase their adjustment to their new abilities, and use leisure and recreation activities to increase their cognitive and physical skills as well as a means to maintain general health," says Roeder.

Case Study
Steve was injured in an automobile accident in 1982 and experienced a severe traumatic brain injury. After acute rehabilitation, he was admitted to a postacute brain injury program where he presented with a history of drug and alcohol abuse, poor coping skills, mood instability, disinhibition, sequencing difficulties, anticipatory awareness difficulties, limited natural social supports and structure, poor problem-solving skills, and a limited vocational history. Upon admission, he exhibited extreme sexual behaviors (staring at women, masturbation, performing sexually suggestive actions with strangers, making sexually charged comments). The team focused on providing consistent, repetitive feedback about these behaviors and actions as well as using role plays, pre-sets, cues, and wrap-ups to help orient Steve on a daily basis to what expectations of behavior are acceptable to move about independently in the community.

As he responded to this feedback, the CTRS focused on teaching Steve how to take care of his mind and body, capitalizing on the fact that he was an athlete prior to his injury. He began to eat healthy meals, run on a daily basis, ride a bicycle, and enter races. Initially, all of his community outings were closely supervised and structured to continue to work on his disinhibition and inappropriate sexual comments and actions. As his social skills improved, supervision decreased and his social network expanded.

While he still had a few difficult encounters, he would openly discuss them with his therapist and team. Some 12 years later, Steve still is an active runner and cyclist, eats healthy, and does a variety of meditation and relaxation activities regularly. He is married and operates his own dog-walking business (case provided by J. Finegan).

Perhaps it is unfortunate that the title of recreational therapist includes the word recreation. It gives the connotations that it is not serious, not essential, and just diversionary. Yet, most in society know that family, social networks, and free-time pursuits are some of the greatest motivations for living. Recreational therapy has developed as a viable treatment in rehabilitation services over the past 30 years.

Reference
1. NCTRC Report of the National Job Analysis Project for Certified Therapeutic Recreation Specialists. Presented at: National Council for Therapeutic Recreation Certification; 1997; New City, NY.

Peg Connolly, PhD, CTRS, is the executive director of the National Council for Therapeutic Recreation Certification and served as the president of the American Therapeutic Recreation Association, Alexandria, Va, and the Great Lakes Regional Director on the Board of the National Therapeutic Recreation Society. Erika Tindell, MSEd, CTRS, is a credentialing specialist at the National Council for Therapeutic Recreation Certification.

LOOKING FOR EXPERT ADVICE?

Experts here are available to answer all your questions!

Please contact us for more information about this feature, or to become an expert.

MEDIA CENTER

Interactive Media

Resources

	Calendar
	Consumer Resources
	Media Kit
	Advertiser Index EAB Reprints Submit an Article

ADDITIONAL ONLINE RESOURCES

Allied Media
24X7mag Clinical Lab Products (CLP) Orthodontic Products The Hearing Review Hearing Review Products Rehab Management		Physical Therapy Products Plastic Surgery Practice Imaging Economics RT Magazine Sleep Review