Foundational Knowledge Flashcards
Human Growth and Development throughout the Lifespan
- Early childhood- ages between birth to around 6. During this time a child should be developing fundamental motor skills and social skills; a child’s body is changing rapidly and most children are very interested in finding out what exactly their limits are cognitively, physically, socially and emotionally. Communication skills are developing. Play is very important for children of these ages and it is through play that many of their skills are developed and enhanced.
- Children- Between the ages of 6 and 12. During this time the child’s social world expands and he/she begins to be involved in organized sports, games and extracurricular activities such as dance classes and music lessons. Very involved in play and their hand/eye coordination is improving. As the child grows older, friends become more important than family and being like everyone else becomes very important.
- Adolescence- Ages between 13 and 21, approximately. The time when peer groups (peer pressure) become more important than family and an individual struggles to become more independent from the family. Body begins to reach maturation and the interest in intimate relationships increases. Sexuality becomes intense with hormones influencing behaviors. Organized sports, music and “the mall” may become very important. Beginning to define themselves in their own right (ex., as athletes). Peer groups continue to be important, but by the end of older adolescence, family is regaining its importance.
- Early Adulthood- Ages 21-30. Usually establish their independence by completing their education and seeking their own occupation. During this time they may begin to have more serious intimate relationships in order to establish families of their own. Bodies have reached maturation and the interest may be on more challenging leisure activities such as rock climbing or other activities that allow for the growth of relationships, such as movies and dinners. The time when a person may develop an interest in more life-long leisure pursuits such as golf, tennis or running.
- Middle Adulthood- Ages 30-45. A person’s family and career take priority. During this time many adults find themselves actively involved in their children’s leisure pursuits. Their activities may be very family oriented such as game nights and family vacations. Occasionally, the person is involved in individual pursuits.
- Older Adulthood- Between the ages of 45 and 60. For most people there is a slowing down and as the metabolism begins to change, there is a weight gain. Physical abilities change with reductions in strength and flexibility. Cognitively their skills and abilities remain strong. The life stage where people may experience midlife crises and depression. Children have moved out and the parents of people in this life stage are becoming dependent. It can be a stressful time in life, yet it can also be very freeing when parents are still healthy and their own children are having children and advancing in their own careers.
- Senior Adulthood- The stage between 60 and 75. Most people have great amounts of free time and are retired. Although many individuals are beginning to experience health problems, most individuals are healthy, energetic and have the freedom to travel and participate in activities of their choosing.
- “Old-Old” Stage- Occurs from the age 75 to death. For some people, physical deterioration is rapid and for others it is cognitive deterioration that seems to occur rapidly. Vast majority of people in this age group will experience health problems and need assistance. Their world may become smaller due to the death of friends and the need to live in a facility that can provide the assistance they need. Although many people will be limited in their abilities, there are others who will continue to be active.
Lifespan Development Definition
the field of study that examines patterns of growth, change and stability in behavior that occur throughout the lifespan.
3 DOMAINS OF DEVELOPEMENTAL PSYCHOLOGY
BIO-SOCIAL, COGNITIVE, PSYCHO-SOCIAL. Important at every age, interact in influencing development.
Development definition
Patterns of change over time which, begin at conception and continue throughout the life span. Development occurs in different domains, such as the biological (changes in our physical being), social (changes in our social relationships), emotional (changes in our emotional understanding and experiences), and cognitive (changes in our thought processes).
•Development is multidimensional and multidirectional. Multidimensionality refers to the fact that development cannot be described by a single criterion such as increases or decreases in a behavior. The principle of multidirectionality maintains that there is no single, normal path that development must or should take.
•Child development is the study of development between conception and adolescence.
Chronological age
the time, which has elapsed since an individual’s birth.
Classical conditioning
a type of learning in which a new stimulus can come to evoke a familiar response after the repeated pairing of the new stimulus with a stimulus, which already evokes the response.
Normative age-graded influences
the biological and environmental influences that are similar for individuals in a particular age group.
Normative history-graded influences
the biological and environmental associated with historical periods in time and which influence people of a particular generation.
4 Major Theories of Helping: Apply to Behavioral Health
1) Psychoanalytic
2) Behavioristic
3) Growth or Positive Psychology
4) Cognitive-Behavioral
Psychoanalytic
Theory of helping in behavioral health. Developed by Freud and is based on the influence of instincts on thought and behavior. Freud proposed a balance model identifying 3 divisions of personality: id, ego and superego. Freud focused a lot on the sexual instinct and proposed 5 psychosexual stages: oral, anal, phallic, latency and genital. Freud formulated defense mechanisms used by the ego: denial, repression, displacement, projection, sublimation, rationalization and intellectualization.
Behavioristic
Theory of helping in behavioral health. Often referred to behavior modification. Behaviorists believe that behavior is learned, so abnormal behavior has been learned, thus it can be changed.
Humanistic behavior
Theory of helping in behavioral health. Sees people as “being self-aware, capable of accepting or rejecting environmental influences and generally in conscious control of their own destiny.” Carol Rogers developed person-centered therapy; he stated that the therapist must demonstrate an unconditional positive regard for the client, that techniques are secondary to how the therapist treats the client. Many of the beliefs of Rogers are taught in TR courses to develop open communication with clients. Reality therapy and gestalt therapy are included in this category.
Cognitive-Behavioral
Theory of helping in behavioral health. Most widely accepted method of behavioral change is the cognitive-behavioral change process. Based on the premise that “a person’s thoughts or cognitions, dictate how he/she reacts emotionally and behaviorally to any particular situation.”→ 3 Components to this principle: 1st component antecedents- the thoughts, perceptions or beliefs that a person has about a topic or experience. 2nd component action- the actual behavior of the patient or client. Last component is consequences- refers to the actual response to the action. This response can reinforce the original thoughts, beliefs or perceptions. The client will have specific beliefs or thoughts and perceptions (antecedents) about something and behave in a way the displays those antecedents. The TR specialist will use a structured therapeutic recreation intervention that will have an impact on the outcome thus influencing the consequences.
Principles of Behavioral Change
- Self-efficacy theory- When a person displays self-efficacy, essentially he/she is demonstrating the expectations of his/her ability to cope with his/her problems. A person must be confident of his/her abilities and not give up when the results of his/her actions are not immediate. Ex.- If a person has recently become a paraplegic and is able to begin thinking of changes in his or her leisure activities (adaptations necessary, trying them out, and not giving up when the results are not perfect), the person is beginning to cope and probably has good self-efficacy.
- Attribution model- Deals with a person’s explanation of the cause of events that occurred in a person’s life. A person may explain the event due to internal/external attributes. Ex.- a client might believe that he was fired due to the boss’s dislike of him, which is an external attribute rather than his not completing tasks on time, which is an internal attribute. Understanding what attributes the client assigns to events will help the therapist work with the client. Helping the client to understand his role in an event is very important for the client’s growth. The causal analysis of behavior. The process by which a person attributes or makes causal inferences. “To what I attribute my successes and failures”.
- Learned helplessness- theory of behavior change. Learned helplessness is “the phenomenon in which experience with uncontrollable events creates passive behavior toward subsequent threats to well-being.” Ex.- when a client experience consistent failure in physical activities as a child, she may refuse to try new physical activities as an adult because of that early failure, or she may try them but put little effort into achieving success because of her belief that she will not succeed.
- Leisure efficacy- To meet your own leisure needs, benefits from good circumstances. You need a repertoire of skills to be self-capable. Meet own needs/goals.
- Transtheoretical Model- examines an individual’s motivation and readiness to modify a particular behavior. Suggests there are 5 major steps to change: 1) pre-contemplation 2) contemplation 3) decision 4) action 5) maintenance.
- Theory of Reasoned Action/Planned Behavior- one of the most recognized theories. Looks at a person’s attitudes toward a behavior, his/her perceptions of norms and beliefs about how easy or difficult it will be to change.
- Experiential learning model- Experiential learning is also referred to as learning through action, learning by doing, learning through experience, and learning through discovery and exploration. “the process where knowledge is developed through the transformation of the learner’s experience”; requires that students take responsibility for deriving meaning from their experiences; Factors: 1) reality of experience or relevance to the student, 2) level of risk and uncertainty (meaningfulness to student), 3) student reflection; characterized by adventurous learning.
- Perceived freedom- When a person does not feel forced or constrained to participate & does not feel inhibited or limited by the environment. (LDB) The freedom to choose your activity; feel competent; “I can do this.”
- Intrinsic motivation-To do something for yourself. Internal desires to do something as a sense of satisfaction.
- Locus of control -internal: You have the control/can change/good self esteem.
- Locus of control -external: Low self esteem, helpless; “he made me do it”.
Diversity factors
Includes: social, cultural, educational, language, spiritual, financial, age, attitude, geography. There are cultural differences in relation to beliefs about recreation, leisure and disability. As a therapist it is important to respect those differences. Important to understand the impact of diversity because it can increase the benefits of the treatment process. 5 primary dimensions of diversity that generate the strongest emotional response: 1) race/ethnicity 2) gender 3) physical impairments and qualities 4) sexual orientation 5) age. Secondary characteristics impact judgments about people as further interactions takes place. The secondary characteristics include: economic status, religion, military experience, education, geographic location, marital status, parental status and type of job.
Medical Model
Focuses almost exclusively on physical health and has been (and in some places continues to be) prevalent among physicians. It views health as being at the opposite end of the continuum from disease, illness and/or disability and focuses on functional ability, morbidity and mortality. In this view, if an individual had a disease, disability and/or illness, he/she was not capable of being healthy. The converse was also true- anyone without disease, disability and/or illness was viewed as being healthy.
Doctor is primary therapist, determines what role others play, assumes client has a disease or illness that needs to be treated, cured, or healed, treats illness without regard for broader needs of client. Recreation is guided by doctor’s diagnosis and prescription. Settings: Physical med. & rehab; general med/surgical hospitals. The recreation therapist can prescribe leisure to a client. Begins as RT directed, equal participation between client and RT and lastly client directed.
Community Model
Special recreation. Provided in the community at large. Influences people to return to community life; beginning contacts and involvements have been made while they are still under care in the treatment setting. Comprehensive approach includes 3 services- therapy, leisure education, and recreation participation & is based on the continuum of care principle. Critical aspect of recreation service is the provision of a wide range of leisure opportunities in the community. Provide opportunities to select experiences & acquire skills to participate in inclusive community-based programs. Settings: City recreation departments, SRAs, Easter Seals.
Education Model
Often used with people with mental retardation. Places a heavy emphasis on occupational therapy, remedial education, vocational training, and similar modalities. Rec is used to teach basic cognitive or social skills and may be used as part of behavior modification programs.
Psychosocial Rehabilitation Model
The process of restoration of community functioning and well-being of an individual who has a psychiatric disability. Seeks to effect changes in a person’s environment and in a person’s ability to deal with his/her environment, so as to facilitate improvement in symptoms or personal distress. These services often “combine pharmacologic treatment, independent living and social skills training, psychological support to clients and their families, housing, vocational rehabilitation, social support and network enhancement, and access to leisure activities.”
Health & Wellness Model
Health = wellness, go hand in hand. Need health in all domains. Health- the state of complete physical, mental and social well-being and not merely the absence of disease; healthfulness is a multifaceted phenomenon, encompassing physical, emotional and social well-being. Wellness- a personal, positive and proactive approach to health that emphasizes individual responsibility for well-being through the practice of health-promoting lifestyle behaviors. High-level wellness for the individual is an integrated method of functioning that is oriented toward maximizing the individual’s potential within the environment in which he/she is functioning.
Person-centered Model
The model that is used by therapeutic recreation personnel in ALL service areas. Provides the conditions for a growth-promoting climate, a relationship that enables people to discover the capacity to use the relationship for growth and change. The facilitative ingredients referred to that must be present in order for a climate to be growth-promoting, whether the relationship be that of leader and team, business partnership, humanitarian and community, teacher and student, therapist and client, parent and child, any relationship in which growth is a goal are: Congruence (Authenticity & Realness), Unconditional Positive Regard (Non-judgmental Respect & Acceptance) and Empathy (process of understanding).
Health Promotion/Health Protection Model
Purpose is to facilitate recovery and functional improvement. Uses a humanistic perspective. Health occurs when physical, psychological and environment areas lead to self-actualization. Health is dynamic and relationship between leisure and health is focus. Therapeutic recreation is different from recreation participation and is not part of model; model reflects purposeful nature of TR. Designed to stop at hospital/Rehab center. Works better in outcome oriented agencies ATRA embraces this philosophy. Recover filtering threats to health and to achieve as high a level of health that is possible. Humanistic perspective, capable of change. Prescriptive activities: stabilizing force + re-engage in activities but not ready for rec or leisure. Rec: allow client tip learn new skills, values and ways of thinking. Leisure: greatest amount of choice and control + primary outcome of TR services. Health protection/promotion model- by Austin: Dr. prescribes TR treatment. Recreation is treatment>»_space; as a means to and end, is more clinical; Begins as (1) TRS directed >(2)equal participation between client/TRS>(3) client directed. Poor health>to >optimal health. Prescribed activity>directed by CTRS>Recreation mutual participation>Leisure self directed by client. TR PRESCRIBED!!!
Human Services Models
1) Long-term Care (Custodial) Model: To maintain one’s functioning, to be diversional. To enable individuals whose functional capabilities are chronically impaired to be maintained at the maximum level of health & well-being.
2) Therapeutic Milieu Model: Where every person & interaction can be therapeutic. Everyone has equal impact. 3) Medical Model: TR prescribed
International Classification of Functioning, Disability and Health (ICF) Model
Established by the World Health Organization (WHO) in effort to describe holistic health and to make possible a worldwide system of standardized communication and collaboration in health care. ICF is an interactive model that illustrates the relationship between the concepts of a person’s health condition, body structures and body function activities and participation and environmental and personal factors. Compatible with therapeutic recreation due to its focus on body function, activities and participation.
Activity Therapy Model
Similar to medical model. TR is prescribed but is a blurring of different departments (music therapy, art therapy, occupational therapy, dance therapy). Uses things the resident enjoys to prevent boredom and frustration.
Ecological Model
Addresses the environment, what has to change in the environment: Looks at individual needs & environmental needs. The people around you: Community/family. Changes can occur encompassing both the promotion of abilities & the elimination of individual barriers.
Human Service Model
A treatment approach that utilizes problems solving to work with clients and their problems within the context of the environment.
Group Definition
made up of 2 or more people whose reactions and behavior patterns are modified because of some interpersonal relationship developed over time and created during the pursuit of some common interest, utilizing this entity to achieve satisfaction of needs. Group is composed of 2+ persons who come together with a similar interest, it is not coincidental that they are there together for a purpose/goal. There are many times of groups, they not only can vary in their aims but also in the: number of people who compose their membership, longevity (length group stays together), efforts, level of formalization, structure and significance to their members. •Groups provide opportunities for interactions among clients, and recreation therapists use these interactions to facilitate therapeutic outcomes. •As a therapeutic recreation specialist, you are expected to be able to place clients in the most appropriate intervention group based on their needs and abilities.
Structural Elements of a Group
size, format (closed or open groups), type of clients in a group and duration of the group (is it ongoing or does it cease functioning after so many meetings?).
Types of Groups
1) Primary- Characterized by the feeling of: personal involvement (family, friends, schoolmates), intimate face to face association and cooperation and the fact that they are fundamental in the forming of the social nature and ideals of the individual. 2) Secondary- can be divided into 2 categories: Informal and Formal. Informal- usually leaderless, no defined hierarchy, the longer the group exists the more chance that a leadership hierarchy will be formed. Formal- brought together for a specific purpose/goal, has defined hierarchy with clearly defined leadership, rules and rituals.
3 Important Parts of Structuring a Group Session
1) opening of the session 2) body of the session 3) closing of the session. In the opening of the group session, the therapeutic recreation specialist helps the clients relax and get to know each other. The CTRS also lets the group members know what is going to occur during the session as far as the activity is concerned. The body is the focus of the group’s session. Whether it is a game, arts and crafts project, leisure awareness activity or experiential activity, it is up to the CTRS to be prepared with the activity ready to go. CTRS needs to keep in mind the outcomes of the activity and then facilitate so the purpose and goals are attained. At the end of the activity it is important to process the activity. Processing involves taking with the clients about what they think, how they feel, and anything else that relates to the behavior displayed during the activity. Processing is a very important part of the session because it focuses on what just happened and can help the client generalize his/her behavior into other aspects of his/her life. In order to be able to process effectively, the CTRS needs to be able to do the following: FOCUS, REDIRECT, BLOCK, LINK & SUMMARIZE. CTRS needs to be able to summarize and effectively bring closure to the session.
Groups: Stages of Development
1) orientation: insecurity, reliance on the leader, needs help to “break the ice.” 2) conflict: as people reveal themselves, values may clash 3) cohesion resolve conflict, develop sensitivity 4) performance or productivity: group members become functional & devote themselves to achieving individual and group goals. Group development- Occurs in four stages: Mutual acceptance, Communication and decision making, motivation and productivity, and control and organization., forming, storming, norming, performing, adjourning.
Group Roles
1) group building & maintenance: (social-emotive functions) tone setting, harmonizing, tension reducing, promoting group development 2) task functions: promote the work or task of the group. Activities that help group members to achieve their goals. (coordinating, testing, initiating) 3) Negative Roles: Non-functional behavior activities which interfere with the processes of the group: blocking, dominating, withdrawing etc. The shared expectations group members have regarding each individual’s communication behavior in the group and behaviors or duties each member is expected to fulfill; Each member may perform a different role; Roles maybe determined by one’s position within the group of their place of leadership. May be determined by specialization or expertise.
Role of the Leader
Can be looked upon as a parent figure or be placed in the role of enabler, teacher or coordinator. Leader is responsible for: guidance and coordination, group morale, stimulating achievements and productivity and decision making.
Group Factors That Influence Leadership
1) Size- as the size of the group increases the demands on the leader increases, as there are greater differentiated interests and needs of the group members, smaller groups want consideration from the leader to be recognized.
2) Attitudes of Members- members expectations often determines choice of leader, previous systems, experiences and values affect attitudes.
Syntality Factors
Syntality factors are characteristics/ traits that make up a group. 14 Factors: 1) Autonomy- degree to which a group function independently of other groups. 2) Control- degree to which a group regulates the behavior of individuals while they are functioning as group members. 3) Flexibility- degree to which a groups activities are marked by informal procedures rather than by adherence to established procedures. 4) Hedonic Tone- degree to which a group membership is accompanied by a general feeling of pleasantness or agreeableness (laughing/fun); this is the major reason people join groups 5) Homogenity- degree to which members of a group are similar with respect to socially relevant characteristics; relative uniformity of members- age, sex, race, etc. 6) Intimacy- degree to which members of a group are mutually acquainted with each other and are familiar with the most personal details of one anothers’ lives. 7) Participation- degree to which members of a group apply time and effort to group activities. 8) Permeability- degree to which a group permits ready access to membership 9) Polarization- degree to which a group is oriented and works toward a single goal which is clear and specific to all members 10) Potency- degree to which a group has primary significance for its members 11) Size- number of members in group 12) Stability- degree to which a group persists over a period of time with essentially the same characteristics, rate of membership turnover 13) Stratification- degree to which a group orders its members into status hierachies14) Viscidity- degree to which members of a group function as a unit, there is no dissention and conflict, no cliques, makes members feel important and want to continue w/ group; this is the number 1 reason people join and remain with groups.
Types of Leaders
Programmer- functional level. Direct Service: face to face, direct work with clients; Supervisory: Middle management level, facilitate agency service; Administrative. Executive, major focus on planning and development or policy making level.
Leadership Styles
Autocratic: authoritarian, directive style, close supervision, responsibility with leader, appropriate for groups of people with psychiatric problems, MR/DD, confusion, etc. Democratic: participative, involves group decision making & ideas, Use with participants not needing direction but, able or needing to make choices, develop decision making skills, self esteem, self confidence. Laissez-faire: minimal control of leader, open style, permissive, participants make decisions. Useful for group problem solving, team building, and leader does not exercise authority. Administrative leadership- (Executive Leadership) Responsible for budgeting, organizing, maintaining structure, and having a vision. Ex. Agency Director, Presidents, VP’s. Demagogue- rules by fear. Dictator- Hitler. Head- power imposed position.
Roles of Leaders
Problem solvers, guides, enablers, authority figures, significant others, have voluntary followers and they do not use. Group leaders need to be enthusiastic and be able to act as a link between the individual group members and the group. Not only do therapeutic recreation specialists need to be able to lead specific activities but they also need to watch members for any potential problems, help with necessary activity adaptations and engage the patient/client in discussions.
Characteristics/ Attributes of a Leader
charisma, empathy, consistent/reliable, enthusiasm, self-confident, competent (has knowledge and skills to move towards task/goal and rapport.
Leading Activities: D.D.A.D.A.
Describe, Demonstrate, Ask for questions, Do the activity, Adaptations. Small groups: role playing, brainstorming, fish bowl, case studies, committees. Large groups: clinics, conferences, conventions, institutes, retreats, and workshops.
Safety
Therapeutic recreation specialists need to know how to safely work with persons who might need assistance in transferring from a bed to a wheelchair. Any specific techniques that will assist a client in participating in a group or activity are important for the CTRS to know.
Developmental Disabilities
Cognitive impairment. a severe and chronic disorder involving mental and/or physical impairment that originates before age 22. The disorder is likely to persist indefinitely and cause substantial functional limitations in at least 3 of the 7 major life activity, including self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living and economic self-sufficiency. Most people who have an intellectual disability are developmentally disabled. People who are developmentally disabled DO NOT HAVE an intellectual disability. Some health conditions, such as asthma, gastrointestinal symptoms, eczema and skin allergies, and migraine headaches, have been found to be more common among children with developmental disabilities. Sub-average intellectual functioning; IQ<70, is displayed during the developmental period. Symptoms: low frustration level, short attention span, social immaturity, unable to function independently, poor judgment. Significant impairments in adaptive functioning. Delays in motor, language, self care. A person who is classified as intellectually has scored significantly (a minimum of 2 standard deviations) below average on a standardized IQ test. Classification system (American Psychiatric Association)- mild, moderate, severe and profound.
Purpose of TR w/ Individuals w/ Developmental Disabilities
Offers choice, inclusion, mainstreaming. Age appropriate chronological, not mental age, specially valued integration activities, promote high success activities for low self esteem. Simplify/Adapt/Repetitive Movements: give choice, structure age appropriate activities.
Mental Retardation
(Developmental Handicap) Mental retardation “means significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a child’s educational performance”. Mental retardation: is indicated by subaverage intellectual functioning (e.g., IQ score of under 70), originated during the development period (e.g., occurs before age of 22) and is attributed associated with impairment in adaptive behavior (e.g., delays across all areas of development, including motor, cognitive, language and social skills; deficits in personal independence and social responsibility). Have deficits in adaptive behavior/skills. Adaptive skills are daily living skills. Adaptive skills- communication, self-care, home living, social, community use, self-direction, health and safety, functional academics, leisure and work. Needed supports are determined through 4 dimensions of- intellectual functioning and adaptive skills, psychological/emotional considerations, physical/health/etiology considerations and profile and intensities of needed supports. Symptoms: low frustration level, short attention span, social immaturity, unable to function independently, poor judgment. Significant impairments in adaptive functioning. Delays in motor, language, self care.
Purpose of TR w/ Individuals w/ Mental Retardation
To facilitate the development, maintenance and expression of an appropriate leisure lifestyle for the person w/ physical, mental, emotional or social limitations. Leisure lifestyle refers to the day-to-day behavioral expression of one’s leisure-related attitudes, awareness and activities revealed within the context and composite of the total life experience. TR places special emphasis on the development of an appropriate leisure lifestyle as an integral part of independent functioning. Leisure lifestyle is a routine engaged in as a part of the individual’s daily existence. TRSs should provide comprehensive TR services for people w/ MR to develop leisure-related skills that allow them to enhance their quality of life each day. 3 specific areas are used to provide comprehensive leisure ability approach that facilitates appropriate leisure lifestyles- therapy (treatment), leisure education and recreation participation. Interventions should encourage the development of cognitive skills such as understanding and remembering rules and procedures, concentrating on the task, maintaining scores and following directions should be the focus of TR treatment for people w/ MR. Leisure education should teach individuals how to appreciate leisure, be aware of self in leisure, be self-determined in leisure, interact socially during leisure, use resources facilitating leisure, make decisions about leisure and acquire recreation activity skills. Recreation Participation- Ultimate goal of any leisure education program is to facilitate self-initiated independent use of free time w/ chronically age-appropriate recreation activities. The importance of recreation participation in the lives of people w/ MR- relative to having opportunities to make choices and decisions, as well as being able to participate in age-appropriate recreation activities. Allow them choice and decision making. TRSs establish the most appropriate service setting for people w/ MR by least restrictive environment, deinstitutionalization, normalization, integration, inclusion and transition (moving from being in a school to living actively in the community). Assessment- Preference analysis, Activity analysis, environment analysis and task analysis. Preference analysis- individual’s preferences. Activity analysis- after assessment information concerning the abilities of people w/ MR has been collected, important for TRS to analyze the recreation activities. Analyzation will permit specialists to match the appropriate activities with the individual participants. Environmental analysis- Useful for the TRS to examine the total environment in which the person w/ MR will attempt to participate in a recreation activity. Provides TRS with a systematic approach to analyze the leisure context and facilitate leisure involvement. Offers choice, inclusion, mainstreaming. Age appropriate chronological, not mental age, specially valued integration activities, promote high success activities for low self-esteem. Simplify/Adapt/Repetitive Movements: give choice, structure age appropriate activities. Task analysis- the identification of all the necessary participant responses and component skills and the sequence in which these responses or skills must occur for successful participation. What is to be assessed, NOT a statement of how to assess. The use of task analysis assessment procedures has been suggested as an alternative approach for assessing performance of people w/ MR. Implementation- Strategies that are useful: partial participation, reciprocal communication, cooperation and competition, behavior modification and instructional prompts. Partial participation- the use of adaptations and provides assistance needed to facilitate leisure participation. Adaptations to enhance participation or make partial participation possible include- providing personal assistance, adapting activities by changing materials, modifying skill sequences, altering rules, and using adaptive devices and alternative communication systems and change physical and social environments to promote friendships. Reciprocal communication- May take some people w/ MR considerable time to formulate and communicate their thoughts. Often, professional do not provide them with adequate time to formulate a communication turn. Supportive environment is created when professionals: approach person, attend to person and wait at least 10 seconds for that person to initiate conversation. Cooperation and competition- Recreation activities should encourage success. TRS should include activities that encourage cooperation and indirect competition- activities that encourage/celebrate their abilities and skills rather than compare them with others (ex.- competition against oneself- aerobics, dance, martial arts) vs. direction competition. The challenge that TRSs should instill in participants w/ MR is to develop and grow through indirect competition and cooperation rather than defeat or destroy through direct competition. Behavior modification- systematic, evaluative, performance-based method for changing any observable and measurable act, response or movement by an individual. Instructional prompts- information provided before an action is performed. Useful in demonstrating/modeling the appropriate leisure behavior. Practice and repetition- People with MR need greater repetition of experiences and more frequent explanations of the principles presented. TRSs may incorporate numerous opportunities for people w/ MR to practice leisure skills (ex.- provide longer times segments). Evaluation- Observational strategies appear to be the most reliable method of evaluation of individuals w/ MR.
Types of Mental Retardation/Classifications
- Mild (IQ range 50-69) Able to develop acceptable social and communication skills, but experience slight retardation in sensorimotor skill development. Does not require constant support, but may need support on a short-term basis.
- Moderate (IQ range 35-49) Able to learn with special help to communicate with a fair degree of success, develop motor skills but at a slower rate than someone who is mildly retarded. Requires a certain support consistently over time (handling finances, employment training, etc.).
- Severe (IQ range 20-34) Poor motor development, can learn simple tasks, speech may not be fully developed. Needs a daily support in some aspects of living such as job support, etc. 4. Profound (IQ range below 20). Minimal capacity for development of motor skills, totally incapable of self maintenance, constant high intensity support for ALL aspects of life. IQ range 70-84 is “Borderline” and no longer considered mental retardation.
Autism
Individuals with autism have functional characteristics that enable them to be classified as developmentally disabled. 3 out of 4 children with autism have an intellectual disability. Considered to be a spectrum disorder because the symptoms and characteristics present themselves in a wide variety of combinations. These disorders are on a continuum from classic autism (severe) to a lesser impairment referred to as Asperger’s syndrome. Behavioral symptoms can range from hyperactivity, short attention span, impulsivity, to self-injurious behavior. An individual can have problems with sensory stimulation (oversensitivity to sound or touch), eating, sleeping, and an absence of emotional reaction (no reaction to pain) or excessive fear. There may also be a problem with speech (echolalia), poor eye contact, resistance to change, and sustained odd play. Autism “means a developmental disability significantly affecting verbal and nonverbal communication and social interactions, generally evident before age 3, that adversely affects the child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental changes or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has a serious emotional disturbance. Those whose language develops before age 5, even if very concrete (not figurative), are able to develop minimal social skills. With some supervision they can live independently and hold jobs. However, they will be unable to form intimate relationships. If language does not emerge by age 5, it is possible that it may not occur, and the prognosis for these children is believed to be very poor. However, this concept is being challenged. Parents need to be encouraged to keep learning about current research findings and advances. Autism cannot be cured, and there is no medication or drug treatment. Behavior modification or communication therapy can, to some degree, help some children develop language and basic adaptive skills. Some do dietary modifications. Limitations- deficits in social behavior, communication and learning skills.
Role of TR in Social and Behavioral Treatment for Autism
Deficits in appropriate social and behavioral skills in persons w/ autism have been described as a major contributor to failure in family life, school life and vocational placements. Onset in childhood; language difficulty; echolalia; 1/3 have epilepsy, 75% Mental Retardation. Role of TR is to support global treatment goals in behavior management, socialization/social skill development and leisure skill development.
Purpose of TR w/ Individuals w/ Autism
need structure; may need to address family needs>respite. Emphasis is placed on those social, behavioral and leisure skills that are age-appropriate and will be used throughout the life course. Treatment objectives that are applicable in TR programming include: teaching functional academic skills such as money skills, time skills, reading and giving/requesting information; teaching self-care skills such as personal grooming, socially appropriate manners, appropriate sexual behavior, and care of personal belongings; teaching interpersonal skills such as cooperation, appropriate ways of interacting socially w/ others within situational context (handshake, hugs, etc.); teaching social communication skills such as proper greetings, use of personal names when greeting or requesting attention, requesting permission to borrow others’ possessions; teaching specific leisure skills such as playing games, following rules and etiquette, choosing independently from leisure activity options, recognizing and distinguishing picture cues of leisure activities and work activities; and teaching community living skills such as ordering food and eating properly at a restaurant, shopping skills, and using public transportation.
Asperger’s
There is severe and sustained impairment in social interaction, with repetitive patterns in behavior, interest, and activities. Some motor clumsiness manifests. No delays in language or cognitive development are caused, including self-help skills, adaptive skills, or curiosity of environment. Onset occurs later than autism, and condition is more common in boys. It may be recognized particularly in school settings. Adults may have significant problems exhibiting empathy.
Traumatic Brain Injury (TBI or Cognitive disorder not specified)
Head injury and brain trauma are synonymous terms, meaning any brain injury caused by an external force. Injury to the brain caused by an external force often leads to coma; confusion, disorientation, mood swings, aphasia, Main causes are car crashes, falls, sports and assaults. Different from stroke, infection, cancer or other processes that can produce brain injuries. People with a traumatic brain injury usually have been involved in an accident and may have other complications that involve their physical abilities. Impaired attention span, concentration, memory, lower tolerance for noise, low frustration tolerance. TR: Cognitive impairment > attention deficit, inability to plan; physical impairments > aphasia, apraxia, ataxia, perceptual deficits; social-emotional impairments> impulsivity, depression, lowered inhibition.
Purpose of TR w/ Traumatic Brain Injury
Help to reintegrate into the community, become aware of resources, develop physical well being, develop support systems, Ameliorate depression and loss of independence through creative arts & social events; computer games, physical games reading. Utilize social skills; need for socialization, community reintegration, build independence, physical development, reading/writing/computer game.
Severity Levels of Brain Injury
MILD- awake, eyes open. Also called a concussion. Symptoms can include confusion, memory and attention difficulties, headaches and behavioral problems. MODERATE- lethargic, eyes open to stimulation. Some brain swelling or bleeding causing sleepiness, but still arousable. SEVERE- Coma, eyes do not open, even with stimulation. Associated w/ 20-50% death rate or severe disabilities. Stages of Recovery- for severe TBI: Coma, Vegetative state, Minimally conscious state, Recovery of full consciousness, which often includes post-traumatic amnesia.
Glasgow Coma Scale (GCS)
Predicts degree of recovery and severity of TBI. Most common scoring system used to describe the level of consciousness in a person following traumatic brain injury. It is used to help gauge the severity of an acute brain injury. The test is simple, reliable and correlates well with outcome following sever brain injury. GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. It is used by trained staff at the site of an injury like a car crash or sport injury and in emergency departments and intensive care units. Measures the following functions: Eye Opening (E): 4= spontaneous; 3= to voice; 2= to pain; 1= none. Verbal Response (V): 5= oriented, normal conversation; 4= disoriented conversation; 3= words, but no coherent; 2= no words, sounds only; 1= none, no response. Motor Response (M): 6=normal, obeys commands for movement; 5=localized to pain, 4= withdraws to pain; 3= decorticate posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out and arms bent inward toward the body with the wrists and fingers bent and held on the chest); 2= decerebrate posture (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backwards); 1=none. Clinicians use this scale to rate the best eye-opening response, best verbal response, and best motor response an individual makes. The final GCS score/grade is the sum of these numbers. Using the Glasgow Coma Scale- Every brain injury is different, but generally, brain injury is classified as: Severe- GCS 3-8 (Can’t score lower than a 3). Moderate- GCS 9-12, Mild- GCS 13-15. Mild brain injuries can result in temporary or permanent neurological symptoms. Moderate and severe brain injuries often result in long-term impairments in thinking skills, physical skills and/or emotional/behavioral functioning.
Rancho Los Amigos Scale of Cognitive Functioning
Identifies 8 levels of cognitive functioning organized into 4 intervention stages. The Rancho Los Amigos Scale of Cognitive Functioning is a system of evaluation used to follow the recovery of the TBI patient and to design an appropriate rehabilitation program.
8 Levels of Rancho Los Amigos Scale of Cognitive Functioning
The scale is divided into eight stages, from coma to appropriate behavior and cognitive functioning.
•Level I: No Response- Total Assistance- Patient does not respond to external stimuli and appears asleep. Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive (movement of body), vestibular (inner ear, sense of balance) or painful stimuli.
•Level II: Generalized Response- Total Assistance- Patient reacts to external stimuli in nonspecific, inconsistent, and non-purposeful manner with stereotypic and limited responses. Demonstrates generalized reflex response to painful stimuli. Responds to repeated auditory stimuli w/ increased or decreased activity. Responds to external stimuli w/ physiological changes generalized gross body movement and/or not purposeful vocalization. Responses noted above may be the same regardless of type and location of stimulation and responses may be significantly delayed. Medications- Amantidine and considers other stimulants.
•Level III: Localized Response- Total Assistance- Patient responds specifically and inconsistently with delays to stimuli, but may follow simple commands for motor action. Demonstrates withdrawal of vocalization to painful stimuli. Turns toward or away from auditory stimuli. Blinks when strong light crosses visual field. Follows moving objects passed within visual field. Responds to discomfort by pulling tubes or restraints. Responds inconsistently to simple commands. Responses directly related to type of stimulus. May respond to some persons (especially family and friends) but not to others. Medications- Ritalin, Provigil, Nuvigil, Bromocriptine. Need to monitor Ammonia levels.
•Level IV: Confused, Agitated Response- Maximal Assistance- Patient exhibits bizarre, non-purposeful, incoherent or inappropriate behaviors, has no short-term recall, attention is short and nonselective. Alert and in a heightened state of activity. Purposeful attempts to remove restraints or tubes or crawl out of bed. May perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another’s request. Very brief and usually non-purposeful moments of sustained alternative and divided attention. Absent short-term memory. May cry out or scream out of proportion to stimulus even after its removal. May exhibit aggressive or flight behavior. Mood may swing from euphoric to hostile with no apparent relationship to environmental events. Unable to cooperate with treatment efforts. Verbalizations are frequently incoherent and/or inappropriate to activity or environment. Medications: BuSpar, Resperdal, Topamax, Inderol, Zyprexa. Interventions: Sensory regulation to decrease over stimulation, Sitter and/or Bed Enclosure as needed, Behavioral Medicine-Set-up Behavioral Modification Program.
•Level V: Confused, Inappropriate, Nonagitated Response- Maximal Assistance- Patient gives random, fragmented, and non-purposeful responses to complex or unstructured stimuli - Simple commands are followed consistently, memory and selective attention are impaired, and new information is not retained. Alert, not agitated but may wander randomly or with a vague intention of going home. May become agitated in response to external stimulation, and/or lack of environmental structure. Not oriented to person, place or time. Frequent brief periods, non-purposeful sustained attention. Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity. Absent goal directed, problem solving, self-monitoring behavior. Often demonstrates inappropriate use of objects without external direction. May be able to perform previously learned tasks when structured and cues are provided. Unable to learn new information. Able to respond appropriately to simple commands fairly consistently with external structures and cues. Responses to simple commands without external structure are random and non-purposeful in relation to command. Able to converse on a social, automatic level for brief periods of time when provided external structure and cues. Verbalizations about present events become inappropriate and confabulatory (distorted or misinterpreted memories about oneself or the world) when external structure and cues are not provided. Interventions: Sensory regulation, May still need Bed Enclosure-intermittently, Mobility skills, Self-care skills, Cognition/communication and Behavioral Modification.
•Level VI: Confused, Appropriate Response- Moderate Assistance-Patient gives context appropriate, goal-directed responses, dependent upon external input for direction. There is carry-over for relearned, but not for new tasks, and recent memory problems persist. Inconsistently oriented to person, time and place. Able to attend to highly familiar tasks in a non-distracting environment for 30 minutes with moderate redirection. Remote memory (ability to remember things that happened years ago) has more depth and detail than recent memory. Vague recognition of some staff. Able to use assistive memory aide with maximum assistance. Emerging awareness of appropriate response to self, family and basic needs. Moderate assist to problem solve barriers to task completion. Supervised for old learning (ex., self care). Shows carry over for relearned familiar tasks (ex., self care). Maximum assistance for new learning with little or no carry over. Unaware of impairments, disabilities and safety risks. Consistently follows simple directions. Verbal expressions are appropriate in highly familiar and structured situations. Interventions: Sensory Regulation, Mobility Skills, Self-care Skills, Cognition/Communication and Behavioral Modification/Adjustment.
•Level VII: Automatic, Appropriate Response- Minimal Assistance for Daily Living Skills- Patient behaves appropriately in familiar settings, performs daily routines automatically, and shows carry-over for new learning at lower than normal rates. Patient initiates social interactions, but judgment remains impaired. Consistently oriented to person and place, within highly familiar environments. Moderate assistance for orientation to time. Able to attend to highly familiar tasks in a non-distraction environment for at least 30 minutes with minimal assistance to complete tasks. Minimal supervision for new learning. Demonstrates carry over of new learning. Initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what he/she has been doing. Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance. Superficial awareness of his/her condition but unaware of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely carry out his/her household, community, work and leisure ADLs. Minimal supervision for safety in routine home and community activities. Unrealistic planning for the future. Unable to think about consequences of a decision or action. Overestimates abilities. Unaware of others’ needs and feelings. Oppositional/uncooperative. Unable to recognize inappropriate social interaction behavior.
•Level VIII: Purposeful, Appropriate Response- Stand-By Assistance- Patient oriented and responds to the environment but abstract reasoning abilities are decreased relative to premorbid levels. Consistently oriented to person, place and time. Independently attends to and completes familiar tasks for 1 hour in distracting environments. Able to recall and integrate past and recent events. Uses assistive memory devices to recall daily schedule, “to do” lists and record critical information for later use with stand-by assistance. Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance. Requires NO assistance once new tasks/activities are learned. Aware of and acknowledges impairments and disabilities when they interfere with task completion but requires stand-by assistance to take appropriate corrective action. Thinks about consequences of a decision of action with minimal assistance. Overestimates or underestimates abilities. Acknowledges others’ needs and feelings and responds appropriately with minimal assistance. Depressed, irritable, low frustration tolerance/ easily angered, argumentative, self-centered, uncharacteristically dependent/independent. Able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance.
•Interventions/Treatment for Level 7 & 8- Mobility skills, Self-care skills, Cognition, Continue reintegration into the community, Behavioral Medicine/Psychology, Adjustment/Depression, Neuropsychological Testing, Preparing to return to work/school and Vocational Rehabilitation.
•Level IX: Purposeful, Appropriate- Able to shift attention and use memory aides. Insight, judgment, problem solving, and self-monitoring require stand-by assistance. Independently shifts back and forth between tasks and completes them accurately for at least two consecutive hours. Uses assistive memory devices to recall daily schedule, “to do” list and record critical information for later use with assistance when requested. Initiates and carries out steps to complete familiar personal, household, work, and leisure tasks independently, and unfamiliar personal, household, work, and leisure tasks with assistance when requested. Aware of and acknowledges impairments and disabilities when they interfere with task completion and takes appropriate corrective action, but requires stand-by assistance to anticipate a problem before it occurs and take action to avoid it. Able to think about consequences of decisions or actions, with assistance when requested. Accurately estimates abilities; requires stand-by assistance to adjust to task demands. Acknowledges others’ needs and feelings and responds appropriately with stand-by assistance. Depression may continue. May be easily irritable. May have low frustration tolerance. Able to self monitor appropriateness of social interaction with stand-by assistance. The patient requires Stand-By Assistance on request.
•Level X: Purposeful, Appropriate- Modified Independent- Independently uses strategies if needed for: memory, attention, judgment, problem solving, self-monitoring. Aware of strengths and weaknesses. Able to handle multiple tasks simultaneously in all environments; may require periodic breaks. Able to independently procure, create, and maintain own assistive memory devices. Independently initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work, and leisure tasks, but may require more than usual amount of time and/or compensatory strategies to complete them. Anticipates impact of impairments and disabilities on ability to complete daily tasks and takes action to avoid problems before they occur, but may require more than the usual amount of time and/or compensatory strategies. Able to independently think about consequences of decisions or actions, but may require more than the usual amount of time and/or compensatory strategies to select the appropriate decision or action. Accurately estimates abilities and independently adjusts task demands. Able to recognize the needs and feelings of others and automatically respond in an appropriate manner. Periodic periods of depression may occur. Irritability and low frustration tolerance when sick, fatigued, and/or under emotional stress. Social interaction behavior is consistently appropriate. Interventions/Treatment- Behavioral Medicine for Depression/Adjustment, Neuropsychological testing, VR, Return to work/school issues and PT/OT/ST as needed.
Cognitive Disorder Definition
Mental conditions that cause people to have difficulty thinking clearly and precisely. Many symptoms of cognitive disorders, but they generally share the following impairments: awareness, perception, reasoning and memory and judgment. Causes: depression, infectious diseases, improper medications, excessive alcohol or drug abuse, brain tumor, vitamin/mineral deficiency, stroke (leading cause of adult disability) and head injury from an accident or violence (mostly motor vehicle accidents).
Cognitive Impairments
result of impaired mental perception.
Cortex
Outermost layer of brain cells. Thinking and voluntary movements begin in the cortex.
Brain Stem
Between the spinal cord and the rest of the brain. Basic functions like breathing and sleep are controlled here. It performs many automatic functions such as breathing, heart rate, body temperature, wake and sleep cycles, digestion, sneezing, coughing, vomiting, and swallowing. Ten of the twelve cranial nerves originate in the brainstem.
Basal ganglia
Cluster of structures in the center of the brain. Coordinate messages between multiple other brain areas. Includes the caudate, putamen and globus pallidus. These nuclei work with the cerebellum to coordinate fine motions, such as fingertip movements.
Cerebellum
At the base and the back of the brain. Located under the cerebrum. Responsible for coordination and balance. Function is to coordinate muscle movements, maintain posture, and balance.
Cerebrum
largest part of the brain and is composed of right and left hemispheres. It performs higher functions like interpreting touch, vision and hearing, as well as speech, reasoning, emotions, learning, and fine control of movement.
Brain Lobes
Frontal Lobes: Responsible for problem solving and judgment and motor function. Personality, behavior, emotions, Judgment, planning, problem solving, Speech: speaking and writing (Broca’s area), Body movement (motor strip), and Intelligence, concentration, self awareness. Parietal Lobes: Manage sensation, handwriting and body position. Interprets language, words, Sense of touch, pain, temperature (sensory strip), Interprets signals from vision, hearing, motor, sensory and memory and Spatial and visual perception.
Temporal Lobes: Involved with memory and hearing. Understanding language (Wernicke’s area), Memory, Hearing and Sequencing and organization.
Occipital Lobes: The brain’s visual processing system. Interprets vision (color, light, movement).
Meninges
brain is surrounded by a layer of tissue called the meninges. The skull (cranium) helps protect the brain from injury.
Right Hemisphere/Left Hemisphere
The right and left hemispheres of the brain are joined by a bundle of fibers called the corpus callosum that delivers messages from one side to the other. Each hemisphere controls the opposite side of the body. If a brain tumor is located on the right side of the brain, your left arm or leg may be weak or paralyzed. Not all functions of the hemispheres are shared. In general, the left hemisphere controls speech, comprehension, arithmetic, and writing. The right hemisphere controls creativity, spatial ability, artistic, and musical skills.
Hypothalamus
It plays a role in controlling behaviors such as hunger, thirst, sleep, and sexual response. It also regulates body temperature, blood pressure, emotions, and secretion of hormones.
Pituitary gland
Known as the “master gland,” it controls other endocrine glands in the body. It secretes hormones that control sexual development, promote bone and muscle growth, respond to stress, and fight disease.
Pineal gland
Located behind the third ventricle. It helps regulate the body’s internal clock and circadian rhythms by secreting melatonin. It has some role in sexual development.
Thalamus
serves as a relay station for almost all information that comes and goes to the cortex. It plays a role in pain sensation, attention, alertness and memory.
Limbic system
the center of our emotions, learning, and memory. Included in this system are the cingulate gyri, hypothalamus, amygdala (emotional reactions) and hippocampus (memory).
Cranial Nerves
The brain communicates with the body through the spinal cord and twelve pairs of cranial nerves. Ten of the twelve pairs of cranial nerves that control hearing, eye movement, facial sensations, taste, swallowing and movement of the face, neck, shoulder and tongue muscles originate in the brainstem. The cranial nerves for smell and vision originate in the cerebrum.
Cranial nerves 1-12: 1) Olfactory-smell 2) Optic- sight 3) Oculomtor- moves eyes, pupil 4) Trochlear, moves eye 5) Trigeminal- face sensation 6) Abducens- moves eye 7) Facial- moves face, salivate 8) Vestibulocochlear- hearing, balance 9) Glossopharyngeal- taste, swallow 10) Vagus- heart rate, digestion 11) Accessory- moves head 12) Hypoglossal- Moves tongue
Blood Supply in Brain
Blood is carried to the brain by two paired arteries, the internal carotid arteries and the vertebral arteries. The internal carotid arteries supply most of the cerebrum. The vertebral arteries supply the cerebellum, brainstem, and the underside of the cerebrum. After passing through the skull, the right and left vertebral arteries join together to form the basilar artery. The basilar artery and the internal carotid arteries “communicate” with each other at the base of the brain called the Circle of Willis (Fig. 9). The communication between the internal carotid and vertebral-basilar systems is an important safety feature of the brain. If one of the major vessels becomes blocked, it is possible for collateral blood flow to come across the Circle of Willis and prevent brain damage.
Language In Brain
In general, the left hemisphere of the brain is responsible for language and speech and is called the “dominant” hemisphere. The right hemisphere plays a large part in interpreting visual information and spatial processing. In about one third of individuals who are left-handed, speech function may be located on the right side of the brain. Left-handed individuals may need special testing to determine if their speech center is on the left or right side prior to any surgery in that area. Aphasia is a disturbance of language affecting production, comprehension, reading or writing, due to brain injury – most commonly from stroke or trauma. The type of aphasia depends on the brain area affected- Broca’s area lies in the left frontal lobe. If this area is damaged, one may have difficulty moving the tongue or facial muscles to produce the sounds of speech. The individual can still read and understand spoken language but has difficulty in speaking and writing (i.e. forming letters and words, doesn’t write within lines) – called Broca’s aphasia. Wernicke’s area lies in the left temporal lobe. Damage to this area causes Wernicke’s aphasia. The individual may speak in long sentences that have no meaning, add unnecessary words, and even create new words. They can make speech sounds, however they have difficulty understanding speech and are therefore unaware of their mistakes.
Memory
Memory is a complex process that includes three phases: encoding (deciding what information is important), storing, and recalling. Different areas of the brain are involved in memory depending on the type of memory.
Types of Memory
Short-term memory, also called working memory, occurs in the prefrontal cortex. It stores information for about one minute and its capacity is limited to about 7 items. For example, it enables you to dial a phone number someone just told you. It also intervenes during reading, to memorize the sentence you have just read, so that the next one makes sense.
Long-term memory is processed in the hippocampus of the temporal lobe and is activated when you want to memorize something for a longer time. This memory has unlimited content and duration capacity. It contains personal memories as well as facts and figures.
Skill memory is processed in the cerebellum, which relays information to the basal ganglia. It stores automatic learned memories like tying a shoe, playing an instrument, or riding a bike.
Treatment of Persons w/ Brain Injury & Value of Therapeutic Recreation in Treatment & Specific Protocols Used w/ this Population
TR is to help patient cope and adapt to their disability, divert from a rigorous rehabilitative care and motivate to resume life and participate fully in rehab. Some cases due to severity of injury, there may be no TR intervention. As patient moves out of emergency care into intensive care and rehabilitation starts TR intervention becomes more critical as part of the treatment team. Activities would be designed to apply and refine the functional skills being addressed in physical, occupational and speed therapy. When rehabilitation starts the focus of TR would be on knowledge, skills, abilities and attitudes needed to resume an active leisure lifestyle and return to the community or work. When a patient transitions to a group home or their home, TR refers patient to special recreation associations, wheelchair sports, accessible outdoor programs and facilities, continuing education programs. Values Clarification. Cognitive Rehabilitation- aims at maximum restoration of lost cognitive skills including, perception, attention, memory, judgment, thinking, decision making, language (both speaking and comprehension), nonverbal communication, problem solving, rote learning and generalization of learning. Purposes of TR w/ cognitively impaired is 1) thereapeutic/clinical, in which therapeutic outcomes is paramount; 2) leisure/recreational- quality of life and subjective experience are important and 3) educational- development of leisure awareness, skills and resources. Vocational goals are important due to radical changes in lifestyle from accident. TR purposes in the affective domain may seek to reduce excessive/inappropriate affect or may to attempt to facilitate release through expression. Cognitive retraining- a potential restoration of functioning. Using a particular recreation activity to build a particular skill. Value of TR- relationship to real world skills, stress on client self-determination and positive attitude toward client as a whole person.
Impact of Brain Injury on a Person’s Family
When someone suffers a brain injury, the entire family is affected. Studies show that caregivers of people who have suffered a brain injury may experience feelings of burden, distress, anxiety, anger and depression. For most family members, life is not the same after TBI. We want you to know that you are not alone in what you are feeling. While everyone’s situation is a bit different, there are some common problems that many family members experience such as less time for yourself, financial difficulties, role changes of family members, problems with communication, and lack of support from other family members and friends. These are just some of the problems that family members may face after injury. Sometimes these problems can seem too much and you may become overwhelmed, not seeing any way out. Family members have commonly reported feeling sad, anxious, angry, guilty, and frustrated.
Purpose of TR for Stroke/CVA & Head Injury/TBI
1) Contribute to the optimum outcome clinically for the client to acquire or reacquire physical, affective, cognitive, and social skills to help meet vocational goals or return to work goals. Major purpose is to prepare client for re-entry into community living as far as possible.
2) Optimize quality of life through leisure and recreation. For clients who cannot go back to work, leisure education is important to reduce the risk of boredom. TR can reduce excessive/inappropriate affect many times through providing a release for expression. Head injury- TR Utilize social skills; need for socialization, community reintegration, build independence, physical development, reading/writing/computer games.
Program Descriptions for Stroke/CVA & Head Injury/TBI
Activities for this group emphasize accepting, compensating for or retraining due to cognitive losses. Emphasis will include learning to compensate for emotional and physical losses as well. Activities should duplicate community based activities as much as possible and include: social activities, hobbies, games, arts and crafts, horticulture, cooking and puzzles.
•Writing- physical action of writing, enables expression of what one is thinking, increased control of one’s thoughts, self knowledge, personal logs, double entry notebooks, directed and undirected free writing, provides something to share with therapist, family/friends if one chooses.
•Music- listening, participating, singing (brain retraining)
•Art- creating an expression, following directions, organizing, contemplating a piece of art.
•Computer Assisted Programs- brain retraining
•Creative Arts- can be used as a source of writing
•Wheelchair Sports- basketball, bowling, swimming, archery, table tennis, softball, etc.
•Exercise- any kind that a client can participate in.
•Trips/Movies- Can be used to help retrain organization and decision making skills.
Definition of Cardiac Diseases & Statistics
Heart and blood vessel disease — also called heart disease — includes numerous problems, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke. More than 787,000 people in the U.S. died from heart disease, stroke and other cardiovascular diseases in 2010. That’s about one of every three deaths in America. About 2,150 Americans die each day from these diseases, one every 40 seconds. Cardiovascular diseases claim more lives than all forms of cancer combined. About 83.6 million Americans are living with some form of cardiovascular disease or the after-effects of stroke. Direct and indirect costs of cardiovascular diseases and stroke total more than $315.4 billion. That includes health expenditures and lost productivity. Nearly half of all African-American adults have some form of cardiovascular disease, 49 percent of women and 44 percent of men. Heart disease is the No. 1 cause of death in the world and the leading cause of death in the United States, killing almost 380,000 Americans a year. Heart disease accounts for 1 in 6 deaths in the U.S. Someone in the U.S. dies from heart disease about once every 90 seconds. Heart disease is the No. 1 killer of women, taking more lives than all forms of cancer combined. Over the past 10 years for which statistics are available, the death rate from heart disease has fallen about 39 percent. About 720,000 people in the U.S. have heart attacks each year. Of those, about 122,000 die. About 620,000 people in the U.S. have a first-time heart attack each year, and about 295,000 have recurrent heart attacks. Stroke is the No. 4 cause of death in the United States, killing more than 129,000 people a year.
Cardiac- 4 Functional Levels
1) experience no limits; generally exhibit no symptoms with ordinary activity 7.5+ cal.
2) experience slight limitations; comfortable at rest, some symptoms with ordinary activities. up to 7.5 cal.
3) experience marked limitations, comfortable at rest, ordinary symptoms with less the activity up to 5.0 cal.
4) experience discomfort with almost any activity, may perform sedentary activities; 2.5 cal. TR modalities: Stress management, relaxation, exercise, awareness of environmental factors.
Congestive Heart Failure (CHF)
unable to obtain adequate level of output. RT side, legs swelling, left side fluid in lungs. Hypertension> leads to heart attack.
Cardiovascular Accident (CVA) or Stroke (or Cognitive disorder not specified)
Most heart diseases are actually vascular diseases that constrict or block normal blood flow either in or out of the heart. Other diseases such as, rheumatic fever, syphilis and infections also can cause heart damage. Congenital heart disease results from some defect in the development of the heart before birth. In hypertensive heart disease, the heart is forced to pump harder because of its constriction of the arteries caused by increased blood pressure. Coronary heart disease/ischemic heart disease results from the narrowing of coronary arteries and a resulting decrease in blood supply to the heart. Cardiac arrest or cessation of the heartbeat, results in a drop in blood pressure and limitation of circulation to the blood. Often no warning signs. Similar effects to person with a traumatic brain injury. It causes an interruption of the blood-flow to the brain. Strokes may be caused by cerebral thrombosis (when a blood clot forms in the brain’s venous sinuses that prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage, hemorrhage (rapid loss of blood) or embolism (obstruction of an artery, typically by a clot of blood or an air bubble). Hemiplegia (paralysis of one side of the body) is a sign of a stroke. Damage to the right side of the brain may cause may cause left hemiplegia, problems with depth perception, visual neglect, problems or orienting to the environment and estimating abilities. Damage to the left side of the brain will cause right hemiplegia, and individuals may have problems speaking (aphasia), understanding, reading, writing and judgment. May also have problems with new situations.
Impact of CVA on a person
Having a stroke can result in a number of vision problems—also called visual disturbances. There are many types of vision problems and treatments. Depending on where a stroke occurs in the brain, survivors can face balance and posture problems, disorientation, trouble focusing or a reduced blink rate. A stroke survivor may experience changes related to sleep. One of the biggest sleep-related issues that can develop after a stroke is sleep-related breathing disorders. Other common ways stroke affects sleep is changing sleep patterns, as in sleeping more during the day than at night, and insomnia. A seizure is a sudden episode of abnormal or disorganized electric activity in the brain. Stroke is the most common cause of seizures in the aging population and approximately 10 percent of stroke survivors experience a seizure after a stroke. Seizures can be characterized by spasms or convulsions. Incontinence refers to a lack of ability to control bladder and/or bowel movements. Incontinence affects 40 to 60 percent of patients admitted to a hospital after having a stroke. Paralysis is the inability of a muscle or group of muscles to move voluntarily. Muscles are controlled by messages sent from the brain that trigger movement. When part of the brain is damaged after a stroke, messaging between the brain and muscles may not work properly. Paralysis or muscle weakness are sometimes referred to as “movement” impairments, and they affect up to 90 percent of stroke survivors who lose or have impaired motor function. Paralysis or weakness can affect any part of the body. Stroke is the leading cause of dysphagia, which is paralysis of the throat muscles. This condition can disrupt the swallowing process and make eating, drinking, taking medicine and breathing difficult. The most common movement impairment is hemiparesis, which refers to one-sided (“hemi”) weakness (“paresis”). Hemiparesis affects roughly 80 percent of stroke survivors, causing weakness or the inability to move one side of the body. Weakness can impact arms, hands, legs and facial muscles. Those impacted may have trouble performing everyday activities such as eating, dressing, using the bathroom and grabbing objects. Spasticity is a condition in which muscles become tight and stiff, which makes movement, especially of the arms or legs, difficult or uncontrollable. Foot drop is common after a stroke. The condition is characterized by weakness or paralysis that limits the ability to raise the front part of the foot. The foot or ankle drops down when the leg is lifted to take a step. A person with foot drop may trip and fall if the foot and ankle are not supported by a brace at all times. Each person feels pain differently. Damage to the brain due to stroke can sometimes make the sense of touch hurt. Pain can result from things like muscle tightness or weakness. Post-stroke fatigue, the invisible symptom, affects between 40 and 70 percent of stroke survivors. Fatigue is a normal condition in healthy individuals—a protective mechanism that alerts the body when it is time to rest or modify activity. This type of fatigue is usually related to one cause and is short-lived. Post-stroke fatigue is usually linked to chronic dysfunction of some kind and can significantly impair a person’s physical, cognitive and psychosocial (emotional and behavioral) functioning. Post-stroke fatigue is often confused with “being tired.” It is not necessarily the same as tiredness, because it arrives without warning and rest does not always make it better. Post-stroke fatigue can occur days, weeks, months or even years after a stroke. It occurs differently in every individual. Fatigue can greatly impact daily life and slow down recovery. Cognitive/Emotional Affects- Vascular dementia (VaD) is a common post-stroke complication characterized by the loss of cognitive function or thinking abilities. VaD occurs when brain tissue is damaged because of reduced blood flow to the brain during a stroke or a series of strokes. Aphasia is a disorder of communication that impairs a person’s ability to use and comprehend language. Many people experience memory problems after a stroke. In particular, people who have had a stroke in the right hemisphere of their brain commonly have problems paying attention. Stroke survivors can experience the following types of memory loss: verbal-memory of names, stories and information having to do with language; visual- memory of shapes, faces, routes and things seen; informational-memory of information and skills or trouble learning new things and Vascular dementia. A stroke survivor’s emotional health is just as important as his or her physical health and can promote or disrupt post-stroke recovery. Many stroke survivors experience feelings of anger, frustration, anxiety, sadness, fear and hopelessness in varying degrees. These emotions are common with post-stroke depression, which affects more than a third of stroke survivors. The National Institute of Neurological Disorders and Stroke characterizes post-stroke depression by a feeling of hopelessness that interferes with functioning and inhibits quality of life. If not treated and managed appropriately, post-stroke depression can slow down recovery. Pseudobulbar affect (PBA) is a medical condition characterized by sudden and uncontrollable episodes of crying or laughing. It is sometimes referred to as emotional lability, pathological crying and laughing or emotional incontinence. An episode of PBA can occur at any time, even in inappropriate social situations. PBA can occur in stroke survivors or people with other neurologic conditions such as dementia, multiple sclerosis, Lou Gehrig’s disease (ALS) or traumatic brain injury.
A general protocol used to treat a person with CVA in TR
help patient cope and adapt to their disability, divert from a rigorous rehabilitative care and motivate to resume life and participate fully in rehab. Some cases due to severity of injury, there may be no TR intervention. As patient moves out of emergency care into intensive care and rehabilitation starts TR intervention becomes more critical as part of the treatment team. Activities would be designed to apply and refine the functional skills being addressed in physical, occupational and speed therapy. When rehabilitation starts the focus of TR would be on knowledge, skills, abilities and attitudes needed to resume an active leisure lifestyle and return to the community or work. When a patient transitions to a group home or their home, TR refers patient to special recreation associations, wheelchair sports, accessible outdoor programs and facilities, continuing education programs. Emotional and social recovery is harder for the patient than the physical recovery. Focus on physiology as well as lifestyle. Patient needs help learning how to deal w/ the event/coping skills of the cardiac event and develop strategies that optimize recovery and reduce the likelihood of further problems. Includes exercise, diet and behavior modification. TRS must assist the client in developing new lifestyle patterns that will contribute to cardiac wellness. Leisure counseling, activity analysis and stress reduction techniques. When planning activities TRS needs to known what a metabolic unit (MET) is. Metabolic Unit (MET) determine activities energy costs and a measure of patient functioning and progress. Assessment- For cardiac patients it is designed to gather date in 2 main areas: medial and lifestyle. The medical information is used primarily to develop an appropriate exercise regimen for the patient. Lifestyle assessment is done to identify risk factors, such as poor nutrition or inactive leisure that will become the focus of a behavioral modification program. TRS will be most involved in lifestyle assessment. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR) identifies the purpose of the assessment of patients receiving cardiac rehab services as a thorough evaluation of the realms affecting participation in rehabilitation. Areas including functional ability, work limitations, risk-factor status and barriers to optimal functioning are assessed. The precise nature of the assessment process varies across the 4 phases of rehabilitation process. During phase 1, data related to early education needs of patient, as well as physiological needs of the patient such as heart rate and blood pressure are crucial. Focus during phase 2 shifts to assessing activity readiness as well as determining the educational needs of the patient in areas such as stress reduction, nutrition, smoking, medical procedures or activity management. Assessment during phase 3 focuses on gathering subjective information related to demographics, cardiac history, general health and a psychosocial history dealing w/ the client’s lifestyle. In addition, exercise testing is done to measure work capacity. Phase 4 assessment revolves around a nursing history, cardiovascular examination and an exercise stress test. Information about medications and their side effects are also needed. TR specialist should be most heavily involved in assessing the patient’s social history. Social history includes, occupational physical activity, job satisfaction, family and work responsibilities, physical activity in leisure time, family medical and socioeconomic history, smoking, drinking and eating habits, sexual activity and geographic history. Planning- Basic term TRS needs to know is MET or Borg rating of perceived exertion (RPE) is a useful tool for understanding exercise intensity. The patient self-determines the Borg scale score for activities. TRS should work with the exercise physiologist or physician who has developed an exercise prescription for the patient in order to incorporate recreation activities into that prescription. TRSs must also foster the client’s long-term lifestyle changes by using educational activities. Plan programs that are aimed at stress reduction, use of leisure in productive ways, and appropriate levels of leisure involvement within the patient’s level of physical fitness.
Impact of CVA on Family Life
Impact on family life- Caring for stroke survivors at home can cause high levels of emotional, mental and physical stress. Disruption of employment and family life makes caregiving very challenging. Family caregivers can promote positive post-stroke recovery outcomes; however, they need to care for themselves as well. Post-stroke recovery varies for each person; even if the stroke survivor returns to work and maintains a large amount of autonomy, family members may play a bigger role in the stroke survivor’s live than before the stroke.
Purpose of TR for Patient w/ Stroke
Left CVA > Right hemi: affects the right side; affects speech, may cause aphasia; Right hemi > impaired emotions. social interactions, poor memory, difficulty with spoken language & written communication. TR: Use demonstration, modeling, reality orientation. Right CVA>left hemi: loss of perceptual/intellectual functioning, logic, visual and spacial depth, difficulty in perceiving around them. TR: Use words rather than gestures, keep environment clear of distractions, leisure education.
Dementia
Considered a cognitive impairment. There are a variety of types of dementia including Alzheimer’s Disease, Vascular Dementia and Dementia w/ Lewy Bodies, Pick’s Disease, Parkinson’s disease, Alcohol-related dementia and Wernicke-Korsakoff Syndrome. 2 sets of symptoms that an entry-level TRS needs to be aware of: 1) behavioral symptoms- apathy, physical aggression or nonaggression, verbal nonaggression or aggression, or refusal of care or medication, etc. and these cause the most difficulty to caregivers. 2) cognitive symptoms. Persons with dementia may also experience depression, paranoia, social withdrawal or suicidal ideation. Dementia displays itself by the onset of mental deterioration that exceeds normal aging. Attributed to diseases or injuries that affect the brain and occurs in more than just the elderly population.
Stages of Dementia
(no official categories)-
Early stage: Forgetfulness of recent events. Impaired ability to perform challenging mental arithmetic—for example, counting backward from 100 by 7s. Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills, or managing finances. Forgetfulness about one’s own personal history. Becoming moody or withdrawn, especially in socially or mentally challenging situations.
Mid stage: Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with dementia may: Be unable to recall their own address or phone number, or the high school or college from which they graduated. Become confused about where they are or what day it is. Have trouble with less challenging mental arithmetic—for example, counting backward from 40 by subtracting 4s or from 20 by subtracting 2s. Need help choosing proper clothing for the season or the occasion. Still remember significant details about themselves and their family. Still require no assistance with eating or using the toilet.
Late stage- Memory continues to worsen, personality changes may take place, and individuals need extensive help with daily activities. At this stage, individuals may: Lose awareness of recent experiences as well as of their surroundings. Remember their own name but have difficulty with their personal history. Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver. Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothes or shoes on the wrong feet. Experience major changes in sleep patterns—for example, sleeping during the day and becoming restless at night.
End stage- In the final stage of the disease, individuals may: Be able to say words or phrases but may need help with much of their daily personal care, including eating and using the toilet. Lose the ability to respond to their environment or to carry on a conversation. Lose the ability to smile, to sit without support, and to hold up their heads. Lose the ability, eventually, to control movement: reflexes become abnormal, muscles grow rigid and swallowing is impaired.
Purpose of TR w/ Dementia Patient
TRSs must view the life course as a series of changes marked by the succession of age-related roles prescribed by the culture, by the biological and cognitive development of the individual and by the particular historical events that define the context in which the individual lives. TR practices and procedures are grounded in this life review process. Assessment- mental status exam to asses their major cognitive and emotional difficulties and help define the proper psychological treatment, social and vocational history focusing on previous roles, personality assessment focused on the individual’s self perception, interpersonal relationships, person’s own perception of the rehabilitation process, assessment of current family situation, and interview of the patient’s family if patient agrees. Planning- Objectives for psychosocial intervention include 1) assessment of client’s cognitive, affective and functional status; 2) resolving the crisis of disability, depression and grieving; 3) helping clients maintain independence; 4) promoting self-esteem; 5) improving family relations and 6) identifying suspected organic ailments that may impair optimal functioning. Programs include physical fitness, reminiscence, nutritional programming, activities for daily living (ADL) and creative arts. Implementation- Developing programs that enhance dignity requires the structuring of program autonomy, independence and meaningful involvement. Leadership considerations- demonstrate respect for mature adults, cultivate understanding and empathy through the demonstration of interest and genuine concern for the individual, show enthusiasm, be flexible and adaptable and recognize planning and creativity as important cornerstones to successful programs and services. Also think of environmental design and modifications. Evaluation- Evaluate programs in reference to impairments, functional disabilities and handicapped conditions. The impact the program has on functional abilities that are represented by basic living skills. Instrumental living skills assessments include the Functional Status Index, Functional Independence Measure and the Older Americans Resource Service Multidimensional Functional Assessment Questionnaire. Purpose of TR Dementia (including Alzheimer’s)- Psychosocial rehabilitation programs. TR is most affected with individuals in the mild to moderate stages if dementia. One of the goals is to ensure the patient in any stage has the best quality of life possible. This is accomplished by emphasizing the patient’s sense of worth, focusing on the individual’s interests and skills, prompting recent and past memories, and providing friendships (when done in group settings).
Program Descriptions for Dementia/Alzheimer’s
Recreation for this population can be very varied but depends on the stage of the disease and especially the skills and interests of the individual. TR is an integral part of a holistic approach to Alzheimer’s or any dementia. Activities can include- art, cooking, gardening, interacting with animals, music, walking, memory exercises, cognitive stimulation, visual stimulation, tactile stimulation, reminiscence and exercise.
Alzheimer’s Disease (AD)
Most common form of dementia. There are 3 stages of AD: Stage One or Mild lasts between 2 and 4 years, Stage Two or Moderate lasts from 2 years to 7 years, and the Third Stage is Severe and lasts from 1-3 years. Each stage is distinctive and has its own symptoms. Alzheimer’s is a specific type of dementia. Causes confusion, memory loss, irritability, aggression and mood swings. This progresses to a breakdown in language, withdrawal from those around them, bodily functions deteriorate and ultimately leads to death. Terminal disease.
Epilepsy/Convulsive disorder
A chronic brain disorder is characterized by recurring attacks of abnormal sensory, motor and psychological activity. Convulsion or seizure is an involuntary spasm or contraction of muscle resulting from chemical imbalances in the body. A seizure disorder is a common neurological condition that can be either primary or secondary epilepsy. If a seizure has no identifiable etiology, then it can be classified as “primary.” If it happens after an impact to the brain and seizure occur, it would be classified as a “secondary” condition. A “partial” seizure involves only one cerebral hemisphere, while a “generalized” seizure involves both hemispheres. Seizures may be also classified as “simple,” NO loss of consciousness or “complex” in which a person loses consciousness. Partial seizures begin in 1 specific body site- 1) simple partial seizures- consciousness is NOT impaired; 2) complex partial seizures - consciousness is impaired; 3) partial seizure evolving into a generalized seizure. Generalized seizures- not confined to one body site. Includes absence, myoclonic, clonic, tonic, tonic-clonic, atonic, akinetic and infantile spasm seizures. Also are Unilateral and Unclassified seizures. People with a seizure disorder may also have another disorder that is psychological or mental retardation. Limitations- long term difficulties and challenges for clients w/ epilepsy are chronic side effects from anticonvulsant medications and lifestyle modifications. These areas affect the stabilization of their seizures. If a patient has a seizure it is important to not try to stop the seizure but keep the patient safe. Important for TRS to know the duration and observable nature of the seizure.
Purpose of TR w/ Epilepsy/Convulsive disorder
TRSs who work with clients with convulsive disorders typically are focusing on either a secondary diagnosis (MR, mental illness, physical handicaps), psychopathology associated with epilepsy (learned helplessness, anger, depression) or specific needs related to lifestyle adaptations/modifications that would benefit from leisure counseling. In focusing on a 2nd diagnosis the clinician needs to remain aware of certain activity limitations, medication side effects, and appropriate procedures for handling seizures. TRSs should take an active role in addressing some of the psychosocial needs of this population. 3 topics to focus on w/ this population are stress reduction, leisure lifestyle and locus of control as well as social skills. Clients with epilepsy tend to reflect a higher external locus of control. TRSs will encounter clients w/ convulsive disorders in ALL service delivery areas, but the majority are in long-term residential treatment centers. Encourage normalization, reduce stress, fears & stigma; relaxation, community activities, increase locus of control.
Learning Disabilities
IDEA (Individuals with Disabilities Educational Act) defines learning disabilities as a “disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to: listen, think, speak, read, write, spell, or to do mathematical calculations.” The Federal definition includes such conditions as: perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia and developmental aphasia. According to the law, learning disabilities do not include learning problems that are primarily the result of: visual, hearing or motor disabilities, mental retardation or environmental, cultural or economic disadvantage. The label “learning disability” assists in the classification of children, NOT in teaching them. These problems may mildly, moderately, or severely impair the learning process. Helpful strategies for learning disabled patients: capitalize on the strengths, provide high structure and clear expectations, use short sentences and a simple vocabulary, provide opportunities for success in a supportive atmosphere to help build self esteem, flexible classroom procedures (use of tape-recorders for note-taking and test taking; note-takers, etc.) when the child has difficulty with written language, immediate feedback without embarrassment, use computers for drill and practice, provide positive reinforcement of appropriate social skills at school home (and the community) and access to the Individualized Educational Plan (IEP) by the parent(s)/caregiver is of great benefit to reinforce at home the work being done in school.
Types and Purpose of TR for Learning Disabilities
dyslexia, deficits in language development, hyper activity, thought process difficulty, low attention span, distractible, behavior problems in school, low self-esteem. Provide choice, challenge, & age appropriate activities which are structured for success.
Median plane
an imaginary vertical plane of section that passes longitudinally through the body and divides it into right and left halves. The median plane intersects the surface of the front and back of the body at what are called the anterior and posterior median lines. It is a common error, however, to refer to the” midline” when the median plane is meant.
Anterior
front of body
Posterior
back of body
Sagittal plane
any vertical plane through the body that is parallel with the median plane is called a sagittal plane. The sagittal planes are named after the sagittal suture of the skull, to which they are parallel. The term “parasagittal” is redundant: anything parallel with a sagittal plane is still sagittal.
Coronal/ frontal plane
any vertical plane that intersects the median plane at a right angle and separates the body into anterior and posterior parts.
Horizontal plane
refers to a plane at a right angle to both the median and coronal planes: it separates the body into superior and inferior parts. This is often termed an axial plane, particularly in radiology.
Transverse
means at a right angle to the longitudinal axis of a structure. Thus, a transverse section through an artery is not necessarily horizontal. A transverse section through the hand is horizontal, whereas a transverse section through the foot is coronal.
Medial
nearer to the median plane.
