Practice of Therapeutic Recreation/Recreation Therapy Flashcards

Question

Leisurescope Plus

Answer 1

The Leisurescope Plus testing kit helps the therapist quickly identify: 1. Areas of high interest; 2. Emotional motivation for participation and 3. A patient's need for high arousal experiences. For adults; Teenscope for adolescents. Preferences are divided into 9 categories (game, music, art). Clients respond after viewing “collages” (pictures on cars or slides) Which do they like better? Validity & reliability studies reported.

Answer 2

Measures past leisure participation & intentionality of future involvement through a three (3) point rating scale. Leisure participation categories include Mechanics, Sports. Past involvement = 6 categories; future = 8 categories. Manual includes instructions, validity & reliability information.

Answer 3

Examines leisure barriers in 8 categories (time, money, transportation, partners, etc. client responds to 48 items on 3 point scale (agree, don’t know, disagree)

Answer 4

to assess clients cognitive, sensory and perceptual motor skills as prerequisite to leisure participation. 87 behaviors to be observed during 20 activities, rated on a 3 point scale. Intended for children but, reportedly used in psychiatric and long term care settings.

Answer 5

Adults with physical disabilities, measures general scope of leisure activity skills in order to provide a basis for program decision making regarding a more balanced & leisure skill repertoire.

Answer 6

measure motivation in leisure skills: 1. Intellectual; 2. Social; 3. Competency/mastery and 4. Stimulus/avoidance.

Answer 7

to measure the participant’s perceived life satisfaction. 5 Dimensions of Satisfaction:1) pleasure vs. apathy; 2) determination; 3) difference between desired and achieved goals; 4) mood at time of assessment and 5) self concept.

Answer 8

Functional Independence Measure (FIM), American Spinal Injury Association Scale (ASIA) and the Children’s Coma Scale, which are used primarily in rehabilitation units and hospitals.

Answer 9

Measures the level of a patient’s disability and indicates how much assistance is required for the individual to carry out activities of daily living. The Functional Independence Measure (FIM) scale assesses physical and cognitive disability. This scale focuses on the burden of care – that is, the level of disability indicating the burden of caring for them. Items are scored on the level of assistance required for an individual to perform activities of daily living. The scale includes 18 items, of which 13 items are physical domains based on the Barthel Index and 5 items are cognition items. Each item is scored from 1 to 7 based on level of independence, where 1 represents total dependence and 7 indicates complete independence. The scale can be administered by a physician, nurse, therapist or layperson. Possible scores range from 18 to 126, with higher scores indicating more independence. Alternatively, 13 physical items could be scored separately from 5 cognitive items. Dimensions assessed include: grooming, eating, bathing, upper and lower body dressing, toileting, bladder management, bowel management, bed to chair transfer, toilet transfer, shower transfer, locomotion (ambulatory or wheelchair level), stairs, cognitive comprehension, expression, social interaction, problem solving and memory. FIM Scoring Criteria- NO HELPER REQUIRED: Score 7- complete independence, Score 6- modified independence (patient requires use of a device, but no physical assistance),HELPER (MODIFIED DEPENDENCE) Score 5- supervision or setup, Score 4-minimal contact assistance (patient can perform75% or more of the task), Score 3-moderate assistance (patient can perform 50% to 74% of the task). HELPER (COMPLETE DEPENDENCE) Score 2- maximal assistance (patient can perform 25% to 49% of tasks). Score 1- Total assistance (patient can perform less than 25% of the task or requires more than 1 person assist). Score 0- activity does not occur.

Answer 10

The ASIA is a multi-dimensional approach to categorize motor and sensory impairment in individuals with SCI. It identifies sensory and motor levels indicative of the most rostral spinal levels demonstrating “unimpaired” function currently on its 6th edition. 5 point ordinal scale, based on the Frankel scale, classifies individuals from A” (complete SCI) to “E” (normal sensory and motor function): A: complete. No sensory or motor function is preserved in the sacral segments S4-S5. B: sensory incomplete. Sensory but not motor function is preserved below the neurological level and includes the sacral segments S4-S5 (light touch, pin prick at S4-S5 or deep anal pressure), AND no motor function is preserved more than three levels below the motor level on either side of the body. C: motor incomplete. Motor function is preserved below the neurological level and more than half of key muscle functions below the single neurological level of injury (NLI) have a muscle grade less than 3. D: motor incomplete. Motor function is preserved below the neurological level and at least half of key muscle functions below the NLI have a muscle grade of 3 or greater. E: normal. If sensation and motor function as tested with the ISNCSCI are graded as normal in all segments, and the patient had prior deficits, then the AIS grade is E. Someone without an initial SCI does not receive an AIS grade. Twenty-eight dermatomes are assessed bilaterally using pinprick and light touch sensation and 10 key muscles are assessed bilaterally with manual muscle testing. The results are summed to produce overall sensory and motor scores and are used in combination with evaluation of anal sensory and motor function as a basis for the determination of AIS classification. AIS scores are considered essential when classifying persons with SCI as to their neurological status. AIS scores are routinely collected in administrative databases such the Model Systems and CIHI National Rehabilitation Reporting System.

Answer 11

One of the components of the Glasgow coma scale is the best verbal response which cannot be assessed in nonverbal small children. A modification of the original Glasgow coma scale was created for children too young to talk. Parameters:  (1) eyes opening (2) best verbal or nonverbal response (depending on development status) (3) best motor response. Eye opening scores- Spontaneously=4, To verbal stimuli=3, To pain=2 and Never=1. Nonverbal children/Best verbal response- Smiles oriented to sound follows objects interacts=5, Consolable when crying and interacts inappropriately=4, Inconsistently consolable and moans; makes vocal sounds=3, Inconsolable irritable and restless; cries=2, No response=1. Verbal children/Best verbal response (as in Glasgow scale)- Oriented and converses=5, Disoriented and converses=4, Inappropriate words=3, incomprehensible sounds=2, No response=1. Best motor response- Obeys commands=6, Localizes pain=5, Flexion withdrawal=4, Abnormal flexion (decorticate rigidity)=3, Extension (decerebrate rigidity)=2, No response=1. Children's coma scale = (score for eye opening) + (score for best nonverbal or verbal response) + (score for best motor response). Interpretation: minimum score is 3 which has the worst prognosis, maximum score is 15 which has the best prognosis, Scores of 7 or above have a good chance for recovery and Scores of 3-5 are potentially fatal especially if accompanied by fixed pupils or absent oculovestibular responses or elevated intracranial pressure. Normal children under 5 years may have lower scores than adults because of reduced best verbal and motor responses.

Answer 12

Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI). The Functional Independence Measure (FIM) also is imbedded within the IRF-PAI. Inpatient Rehabilitation Facility-Patient Assessment Instrument (IRF-PAI).

Answer 13

assessment data collected on all Medicare Part A fee-for-service patients who receive services under Part A from an inpatient rehabilitation facility (IRF) at admission and upon discharge. IRF-PAI items address the physical, cognitive, functional, and psychosocial status of the IRF patients. The data collected for IRF-PAI is used for quality of care purposes and items were developed primarily for IRF prospective payment system (PPS).

Answer 14

Global Deterioration Scale (GDS), Mini-Mental State Examination and for Medicare reimbursement they must use the Minimum Data Set for Resident Assessment and Care Screening (MDS).

Answer 15

A psychiatric tool charting stages of dementia. The scale sets out seven (7) stages: 1) Normal; 2) Objectively normal but complaints of mild memory loss; 3) Mild cognitive impairment; 4) Early dementia; 5) Moderate dementia, 6) Moderately severe dementia; and 7) Severe dementia. According to the GDS, the ability to, live independently is compromised as of the 4th stage. "Complex care" is the usual care for those in stages 6 or 7. The Global Deterioration Scale (GDS), developed by Dr. Barry Reisberg, provides caregivers an overview of the stages of cognitive function for those suffering from a primary degenerative dementia such as Alzheimer's disease. It is broken down into 7 different stages. Stages 1-3 are the pre-dementia stages. Stages 4-7 are the dementia stages. Beginning in stage 5, an individual can no longer survive without assistance. Within the GDS, each stage is numbered (1-7), given a short title (i.e., Forgetfulness, Early Confusional, etc. followed by a brief listing of the characteristics for that stage. Caregivers can get a rough idea of where an individual is at in the disease process by observing that individual's behavioral characteristics and comparing them to the GDS. Level 1= No cognitive decline- No subjective complaints of memory deficit. No memory deficit evident on clinical interview. Level 2= Very mild cognitive decline (Age Associated Memory Impairment)- Subjective complaints of memory deficit, most frequently in following areas: (a) forgetting where one has placed familiar objects; (b) forgetting names one formerly knew well. No objective evidence of memory deficit on clinical interview. No objective deficits in employment or social situations. Appropriate concern with respect to symptomatology. Level 3= Mild cognitive decline (Mild Cognitive Impairment)- Earliest clear-cut deficits. Manifestations in more than one of the following areas: patient may get lost traveling to an unfamiliar location, coworkers become aware of person’s relatively poor performance, word and name finding deficit becomes evident to intimates; patient may read a passage or a book and retain relatively little material; patient may demonstrate decreased facility in remembering names upon introduction to new people, patient may have lost or misplaced an object of value, concentration deficit may be evident on clinical testing. Objective evidence of memory deficit obtained only with an intensive interview. Decreased performance in demanding employment and social settings. Denial begins to become manifest in patient. Mild to moderate anxiety accompanies symptoms. Level 4= Moderate cognitive decline (Mild Dementia)- Clear-cut deficit on careful clinical interview. Deficit manifest in following areas: (a) decreased knowledge of current and recent events; (b) may exhibit some deficit in memory of ones personal history; (c) concentration deficit elicited on serial subtractions; (d) decreased ability to travel, handle finances, etc. Frequently no deficit in following areas: (a) orientation to time and place; (b) recognition of familiar persons and faces; (c) ability to travel to familiar locations. Inability to perform complex tasks. Denial is dominant defense mechanism. Flattening of affect and withdrawal from challenging situations frequently occur. Level 5= Moderately severe cognitive decline (Moderate Dementia)- Patient can no longer survive without some assistance. Patient is unable during interview to recall a major relevant aspect of their current lives, e.g., an address or telephone number of many years, the names of close family members (such as grandchildren), the name of the high school or college from which they graduated. Frequently some disorientation to time (date, day of week, season, etc.) or to place. An educated person may have difficulty counting back from 40 by 4s or from 20 by 2s. Persons at this stage retain knowledge of many major facts regarding themselves and others. They invariably know their own names and generally know their spouses' and children's names. They require no assistance with toileting and eating, but may have some difficulty choosing the proper clothing to wear. Level 6= Severe cognitive decline (Moderately Severe Dementia)- May occasionally forget the name of the spouse upon whom they are entirely dependent for survival. Will be largely unaware of all recent events and experiences in their lives. Retain some knowledge of their past lives but this is very sketchy. Generally unaware of their surroundings, the year, the season, etc. May have difficulty counting from 10, both backward and, sometimes, forward. Will require some assistance with activities of daily living, e.g., may become incontinent, will require travel assistance but occasionally will be able to travel to familiar locations. Diurnal rhythm frequently disturbed. Almost always recall their own name. Frequently continue to be able to distinguish familiar from unfamiliar persons in their environment. Personality and emotional changes occur. These are quite variable and include: (a) delusional behavior, e.g., patients may accuse their spouse of being an impostor, may talk to imaginary figures in the environment, or to their own reflection in the mirror; (b) obsessive symptoms, e.g., person may continually repeat simple cleaning activities; (c) anxiety symptoms, agitation, and even previously nonexistent violent behavior may occur; (d) cognitive abulla, i.e., loss of willpower because an individual cannot carry a thought long enough to determine a purposeful course of action. Level 7= Very severe cognitive decline (Severe Dementia)- All verbal abilities are lost over the course of this stage. Frequently there is no speech at all -only unintelligible utterances and rare emergence of seemingly forgotten words and phrases. Incontinent of urine, requires assistance toileting and feeding. Basic psychomotor skills, e.g., ability to walk, are lost with the progression of this stage. The brain appears to no longer be able to tell the body what to do. Generalized rigidity and developmental neurologic reflexes are frequently present.

Answer 16

A brief psychologic test designed to differentiate among dementia, psychosis, and affective disorders. It may include ability to count backward by7s from 100, to identify common objects such as a pencil and a watch, to write a sentence, to spell simple words backward, and to demonstrate orientation by identifying the day, month, and year, as well as town and country. The Mini Mental State Examination (MMSE) is the most commonly used test for complaints of memory problems. It can be used by clinicians to help diagnose dementia and to help assess its progression and severity. The MMSE is a series of questions and tests, each of which scores points if answered correctly. If every answer is correct, a maximum score of 30 points is possible. The MMSE tests a number of different mental abilities, including a person's memory, attention and language. The MMSE is a tool that is used by clinicians such as a GP or a neuropsychologist (a psychologist who specializes in the brain and its function) to help them diagnose and assess dementia. It is only one part of these processes and clinicians will often consider a person's MMSE score alongside the results of other tests. In general, scores of 27 or above (out of 30) are considered normal. However, getting a score below this does not always mean that a person has dementia - their mental abilities might be impaired for another reason or they may have a physical problem such as difficulty hearing, which makes it harder for them to take the test. The MMSE can also be used to assess changes in a person who has already been diagnosed with dementia. It can help to give an indication of how severe a person's symptoms are and how quickly their dementia is progressing. On average, people with Alzheimer's disease who are not receiving treatment lose two to four MMSE points each year. The MMSE is made up of a range of different questions and tests. Below are four sample questions that give an indication of the style of the MMSE.1 Orientation to time-'What is the date? 2 Registration- 'Listen carefully. I am going to say three words. You say them back after I stop. Ready? Here they are... apple [pause], penny [pause], table [pause]. Now repeat those words back to me.'[Repeat up to 5 times, but score only the first trial.] 3 Naming-'What is this?' [Point to a pencil or pen.] 4 Reading- 'Please read this and do what it says.' [Show examinee the following words on the stimulus form: Close your eyes.]

Answer 17

Recording format for a standardized assessment tool required by the federal government in long-term care facilities. The Long-Term Care Minimum Data Set (MDS) is a standardized, primary screening and assessment tool of health status that forms the foundation of the comprehensive assessment for all residents in a Medicare and/or Medicaid-certified long-term care facility. The MDS contains items that measure physical, psychological and psychosocial functioning. The items in the MDS give a multidimensional view of the patient's functional capacities and helps staff to identify health problems. Part of the U.S. federally mandated process for clinical assessment of all residents in Medicare or Medicaid certified nursing homes. This process provides a comprehensive assessment of each resident's functional capabilities and helps nursing home staff identify health problems.

Answer 18

Multiaxial Assessment System, specifically the Global Assessment of Functioning (GAF).

Answer 19

AXIS 1-5-DSMIV: Axis I Clinical Disorders/ Other Conditions That May Be a Focus of Clinical Attention: Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence (excluding Mental Retardation, which is diagnosed on Axis II), Delirium, Dementia, and Amnestic and Other Cognitive Disorders, Mental Disorders Due to a General Medical Condition, Substance-Related Disorders, Schizophrenia and Other Psychotic Disorders, Mood Disorders, Anxiety Disorders, Somatoform Disorders, Factitious Disorders, Dissociative Disorders, Sexual and Gender Identity Disorders, Eating Disorders, Sleep Disorders, Impulse-Control Disorders Not Elsewhere Classified, Adjustment Disorders. Axis II Personality Disorders Mental Retardation: Paranoid Personality Disorder, Schizoid Personality Disorder, Schizotypal Personality Disorder, Antisocial Personality Disorder, Borderline Personality Disorder, Histrionic Personality Disorder, Narcissistic Personality Disorder, Avoidant Personality Disorder, Dependent Personality Disorder, Obsessive-Compulsive Personality Disorder, Personality Disorder Not Otherwise Specified and Mental Retardation. Axis III General Medical Conditions: Infectious and Parasitic Diseases, Neoplasms, Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders, Diseases of the Blood and Blood-Forming Organs, Diseases of the Nervous System and Sense Organs, Diseases of the Circulatory System, Diseases of the Respiratory System, Diseases of the Digestive System, Diseases of the Genitourinary System, Complications of Pregnancy, Childbirth, and the Puerperium, Diseases of the Skin and Subcutaneous Tissue, Diseases of the Musculoskeletal System and Connective Tissue, Congenital Anomalies, Certain Conditions Originating in the Perinatal Period, Symptoms, Signs, and Ill-Defined Conditions and Injury and Poisoning. Axis IV Psycho-social and Environmental Problems: Problems with primary support group, Problems related to the social environment, Educational problems, Occupational problems, Housing problems, Economic problems, Problems with access to health care services, Problems related to interaction with the legal system/crime and other psychosocial and environmental problems. Axis V Global Assessment of Functioning: Global Assessment of Functioning (GAF) Code: 91-100-Superior functioning in a wide range of activities, life’s problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms. 81-90-Absent or minimal symptoms (e.g. mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members). 71-80-If symptoms are present, they are transient and expectable reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork). 61-70- Some mild symptoms (e.g. Depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships. 51-60- Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g. few friends, conflicts with peers or co-workers). 41-50- Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job). 31-40- Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgement, thinking, or mood (e.g. depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school). 21-30- Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g. sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day, no job, home, or friends). 11-20- Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute). 1-10- Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear-cut expectation of death. 0- Inadequate information. DSM-5 combines the first three axes into one that contains all mental and other medical diagnoses. Doing so removes artificial distinctions among conditions, benefitting both clinical practice and research use. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) has dropped the multiaxial diagnostic system and moved to a dimensional system of diagnostic classification. This change means that there is no longer a separate Axis V or specific diagnostic category for assessment of functioning. In addition, the Global Assessment of Functioning Scale (GAF), the previously endorsed numerical rating scale used for assessment of functioning and reported on Axis V, has been eliminated.

Answer 20

a numeric scale (1 through 100) used by mental health clinicians and physicians to rate subjectively the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living.

Answer 21

Ex.- records or charts, staff, support system •Sometimes it is not possible for the patient to provide all the necessary information for a complete assessment. *Important as an entry-level TRS you know to use other sources of assessment information, such as medical records, educational records, interviews w/ family and friends, and other members of the treatment team.

Answer 22

purpose, reliability, validity, usability, and practicability. •In order to select the most appropriate assessment tool, you need to have an understanding of reliability, validity, usability, and practicability. •Reliability- Refers to the estimate of the consistency of measurement. •Validity- Refers to the extent to which the assessment meets its intended purpose. Does the assessment measure what is necessary to place the patient in the appropriate program and has it been tested on the population in the agency for which it is intended? •Usability & Practicability- Involves whether the assessment is “doable” as far as time constraints, ease of use, cost, availability, and staff knowledge and ability.

Answer 23

•When implementing the assessment, it is important that the therapist completely understands the assessment tool and is able to administer it with ease following the directions that were given to ensure test reliability. TRS needs to easily use strategies of interviews, observations, self-administered questionnaires and record reviews depending on the information desired.

Answer 24

1) Reviewing the assessment protocol. 2) Preparing for the assessment. 3) Administering assessment to the patient. 4) Analyzing or Scoring the assessment. 5) Interpreting results for placement into programs. 6) Documenting results of assessment. 7) Reassessing the patient as necessary/monitoring progress. Competencies under assessment procedures, observation, interviewing and functional skills testing are important knowledge items in this category. Observation, interviewing and functional skills testing are 3 of the most important tools an entry-level TRS can have.

Answer 25

Observation: Casual; engage in on a daily basis. Skilled: knowing what to look for & what to expect, learn to disregard irrelevant information. Naturalistic: no attempt to manipulate or change natural environment, personal appearance, posture & movement, manner, facial/expressions. Specific goal observation: assess a well defined behavior. Standardized observation: Reliability: produces stable results over time and Validity: measures what it is designed to measure. What to look for (observations)- 1) general appearance, 2) motor activity, 3) interpersonal interaction, 4) body language. Subjective Data: what “client” tells you. Objective Data: anything else you or others observe. ASSESSMENT: Always ask open-ended questions during assessment. (1) Multi-disciplinary and a gathering of information; collect information on leisure interests, do clients value leisure & recreation? Do they value and understand it & what it means in their life? Can they identify their own personal resources, talents, skills, interests, equipment & supplies? Money, family, transportation, likes & dislikes? Can these skills be transferred to their present lifestyle? Can they identify leisure partners? Can they describe a healthy leisure lifestyle? Do they have knowledge of leisure resources? Do they have the ability to make decisions and take responsibility for their leisure involvement? who does client interact with? how do others react to the client? what is the nature of the verbal/no-verbal communications?

Answer 26

the most frequently used type of observation in the field today. It standardizes the procedures used including identifying the targeted behavior, developing specific recording techniques for the observation of the targeted behavior and scoring and interpreting the observation.

Answer 27

Checklists, rating scales, anecdotal records (a description of behavior; a reporting of observed behavioral incidents) along with frequency or tally methods (An exact count of how many times a specific behavior occurs) and duration (measuring time), interval and instantaneous time sampling (used to gather quantitative data regarding how many times ADHD behaviors are recorded during a 10-minute time period (frequency) techniques.

Answer 28

An exact count of how many times a specific behavior occurs

Answer 29

measuring time

Answer 30

used to gather quantitative data regarding how many times ADHD behaviors are recorded during a 10-minute time period (frequency) techniques.

Answer 31

Entry-level TRS needs to understand and use interview skills, keeping in mind the purpose of the assessment interviews, which is to gather information about a client. Most TRSs use the directive approach to interviewing, which involves a series of questions targeted for a specific end result. Different types of questions can be asked in the interview, ranging from close-ended questions (ex., “What is your favorite leisure activity?” to open-ended questions (ex., “Tell me what you like to do for fun”.). •A rule of thumb for interview questions is that they should directly relate to the purpose of the interview/assessment. •Every interview should have an opening, a body of the interview and a closing. •All TR departments should have developed an interview protocol to use in assessment to ensure everyone is collecting the necessary information in the same way.

Answer 32

* For functional skills testing, the TRS needs to be able to use mechanical measurement tools, (ex.- stop-watches, measuring tapes, or other objects) that will provide standardized information. * Functional abilities should be considered baseline abilities that are a prerequisite to typical leisure behavior that most individuals without disabilities would possess. Functional skills include, cognitive ability, social skills, communication skills, behavior skills, motor skills) related to independent leisure functioning and community reintegration as well as the assessment of leisure behavior (e.g., interest, satisfaction, values, attitudes, motivation).

Answer 33

Ex.- vision, hearing, tactile Sensory domain is a patient’s ability to see and hear. Can he/she see to read? Is it functional sight, or is the patient essentially blind? Can the person hear? How much can he/she hear? Is it better to sit to one side of the patient when working with him/her because his or her hearing is better on one side? Also, how is the person in relationship w/ tactile abilities? Are they tactile defensive?

Answer 34

Ex.- memory, problem solving, attention span, orientation, safety awareness) When considering a patients’/clients’ cognitive domain it is important to look at his/her functional abilities. In general, a TRS is concerned with a patient’s memory, both long and short term, his/her ability to solve problems and his/her attention span. Also concerned with our patient’s orientation, is he/she oriented to person, place and time? Another big concern is safety awareness. Is the patient aware of danger and can he/she take care of him/herself in public? All of these are examples of functional skills that can be assessed in the cognitive domain. •Cognitive examples of functional abilities include memory, orientation, attention span, reading ability, ability to follow directions and other mental functions that are a prerequisite for leisure behavior.

Answer 35

Ex.- communication/interactive skills, relationships A unique assessment. TRS is concerned with whether the patients have good communication/ interactive skills. Can they initiate a conversation, maintain a conversation and respond appropriately to questions? Are they able to maintain friendships and can they develop a support network? All of these are examples of functional skills in the social domain. •Social functional abilities include such targets as those fundamental behaviors that meet minimal social expectations. Baseline social skills need to be taught to some client groups of TR services prior to attempting higher level social skills, such as relationship building, taught within the leisure education component.

Answer 36

Ex.- fitness, motor skills function In the physical domain the behaviors are more explicit. TRS assess a person’s fitness, gross motor and fine motor skills. Assess patient’s eye-hand coordination and other physical functional skills. Physical functional abilities include coordination, endurance, mobility, strength, hand-eye coordination, fine and gross motor sills and other basic functions that are a prerequisite to participation in leisure activities.

Answer 37

the ability to use large muscle groups that coordinate body movements involved in activities such as walking, running, jumping, throwing, and maintaining balance.

Answer 38

the use of precise coordinated movements in such activities as writing, buttoning, cutting, tracing, or visual tracking.

Answer 39

Ex.- attitude toward self, expression •Affective domain is a little more difficult to assess. •When assessing emotional skills, a TRS wants to know what the patient’s attitude is toward self. How does he/she express emotions? Can he/she express anger appropriately? These are considered functional skills in the affective/emotional domain. •Emotional or affective functional abilities include anger management, emotional control and emotional expression.

Answer 40

* Child w/ Behavior Disorder- Social skills deficits (hitting, kicking, scratching, biting) to the degree that s/he cannot participate w/ others in a socially appropriate manner. Until these disruptive behaviors are minimized or replaced by appropriate social behaviors, the child will not be very successful in learning about or experiencing leisure. These deficits need to be reduced, at least to an acceptable minimal level, prior to the client’s involvement with others. * Teen who is At-risk- Emotional and/or affective skill deficits (lack of impulse control and risk assessment, decreased empathy and perspective-taking skills, inability to predict consequences of actions). Attention to these emotional and affective limitations may greatly enhance the individual’s ability to interact more appropriately w/ others, problem solve and make healthy, life-affirming decisions. These are important skills for maintaining social relationships and getting involved in leisure activities. * Young Adult w/ Brain Injury- Cognitive skill deficits (attention span, sequencing, memory) to the extent the s/he has difficulty w/ age-appropriate activities. Until this person’s cognitive skill deficits can be improved or compensated for, it will be difficult for the person to learn or relearn recreation activities, especially those that involve, rules, strategies and specific modes of play. * Middle-Aged Adult w/ Depression- Physical skill deficits (lack of energy and activity tolerance, decreased stamina and cardiovascular capacity, muscle atrophy) that need to be addressed before the individual can actively participate in leisure or other life activities.

Answer 41

Cognitive: intellectual processes of learning or knowing learning capability; decision making; follows directions, short term memory, problem solving, concentration/attention span, attention to details. Psycho/Social: psychological & social functioning; Independence, ability to form relationships, frustration tolerance, self concept, evaluate and value oneself. Engagement : 1st phase of social interaction. Affect: outward expression of feeling. Social appropriateness: manners, etiquette, hygiene, & dress. Social anxiety: confidence, competent, appear to be anxious, tense. Physical: Physical functioning in the environment. Overall coordination: functioning of sensory system & body parts. Activity level: intensity of sensory system & body parts. Strength: capacity for exertion, flexibility, bending/stretching Balance> Endurance> Physical Health: Ability to right self>Withstand exertion over time>mobility> & overall state of wellness. Affective: facial expression, body gesture, self-esteem.

Answer 42

Ex.- barriers, interests, values, patterns/skills, knowledge Necessary that a TRS assess a patient’s leisure functioning. What leisure barriers does the person have? What are his/her leisure interests? What are his/her leisure attitudes? What leisure skills does the person have, and is he/she well rounded? What does the person know about leisure and is he/she able to get his/ her leisure needs met? Some of the areas to be assessed in leisure domain.

Answer 43

Attitude that leisure is not important, lack of planning time or skills devoted to leisure, inability to make leisure-related decisions, fear of entering new situations or facilities, lack of leisure and recreation skills, lack of motivation to seek new alternatives, lack of lifelong leisure skills, negative feelings associated with playing instead of working, too tired to play, lack of sense of competence in relation to leisure, lack of spontaneity; over planning, decrease in time (real or perceived) available for leisure and limited physical ability. Inappropriate social skills, lack of internal locus of control, concepts of “acceptable” age-related adult leisure behavior, lack of knowledge of recreation facilities and events, lack of experience in seeking leisure information, refusal to take responsibility for personal leisure, perceived inability to effect personal change, lack of financial means, limited knowledge of leisure opportunities, lack of reliable transportation, lack of ability to establish leisure as a priority, inability to control anger, fear of rejection, lack of personal hygiene skills, inability to appropriately manage emotions, inability to plan for leisure expenses, inability to manage time, lack of knowledge of transportation options, inability to attend to a task, lack of physical coordination, decreased mobility due to disability or distance, lack of awareness of personal disabilities and strengths, lack of leisure partners and inability to manage stress.

Answer 44

Increased emotional control, improved physical condition, decreased disruptive behavior in group situations, improved short and long term memory, decreased confusion and disorientation, decreased symptoms of anxiety and depression, improved mobility in community environments and situations, improved health indicators such as bone density, heart rate and joint mobility, improved coping and adaptation skills, increased awareness of barriers to leisure, improved ability to prevent, manage, and cope w/ stress, improved adjustment to disability and illness, improved understanding of importance of leisure to a balanced lifestyle, improved communication among family members, improved intrinsic motivation to participate in meaningful leisure activities, increased ability to use assertiveness skills in a variety of social situations, improved ability for planning, making choices, and taking responsibility, improved ability to locate leisure partners for activity involvement, improved knowledge of agencies and facilities that provide recreation services, greater belief in ability to produce positive outcomes in leisure, improved knowledge of leisure opportunities in community, increased life and leisure satisfaction and increased ability to develop and maintain social support networks.

Answer 45

A child's leisure experiences, particularly in their early years, are often a direct reflection of the values and preferences of the parents and other family members, as well as teachers and friends. We all know or at least can reasonably guess at the amount of peer pressure that will be exerted on your child when he or she becomes a teenager! If you are concerned about your child's leisure future, you are not alone. The expression "it takes a community to raise a child" is especially true when talking about the leisure future of children - all children. Technology has a huge impact on the type of recreation pursued by children today. Now information about anything in the world can be accessed over the internet instantly. Telephones smaller than a child's fist, which are wireless, take pictures and videos, play games, and allow instant communication anytime of day. Video games, so realistic that you can almost touch the figures on the TV monitor replace board games, comic books, and Saturday morning cartoons.

Answer 46

A broad category of services that focus on leisure-related skills, attitudes & knowledge. For leisure to add to one’s well-being and not just take up time. Affirms what you know & what you can do. Five Target Areas: 1) Self Awareness: more knowledgeable about yourself; understanding one’s own attitude toward leisure. 2) Decision Making: requires knowledge of opportunities; what would be the result of consequence of a decision. 3) Leisure Skill Development: ability to do alone or with another person indoors, outdoors. a person should have the skills that they value & society values. 4) Resource Awareness & Utilization: Need to process the ability to access and gain information & resources. 5) Social Skills Development: a) initiation skills: greeting someone, exchange information, offer inclusion into group b) maintenance skills: effective communication; to give positive attention and approval. c) conflict resolution skills: to negotiate, to be a “good sport;” to use persuasion, to compromise. Program Structures: One to one, group, instructional classes, competition, specific events, mass activities, open facility, drop-in.

Answer 47

physical abilities that allow leisure participation, appropriate emotional control and expression, social abilities for interaction with self and others, cognitive abilities for naming, reasoning, recalling, strategizing and associating, valuing leisure as an important aspect of life, decision making, planning, problem solving, and prioritizing abilities, financial planning in relation to leisure, communication and relationship-building skills, health and hygiene skills, awareness of personal abilities and attitudes, access to leisure resources in the home and community, typical and nontypical leisure activity skills, social support for leisure participation and trying new experiences, balance between being able to plan for and spontaneously participate in activities, ability to try new experiences and activities, taking personal responsibility for leisure, seeking and utilizing information about leisure opportunities and locating and securing transportation to leisure experiences.

Answer 48

Ex.- side effects of medications, medical precautions. •Any impairment that occurs will have an impact on the individual’s life and the lives of the people who love and care for that individual. •A person cannot assume that if a disability is physical in nature, that only that area of the individual’s life will be impacted. Most likely the disability will present the person with secondary conditions, such as changing social life that can then create other emotional problems. It may also create difficulties in his/her role in the family and in the world of work. •When working with a person with a disability, the TR professional needs to keep in mind that the entire family may need assistance in coping and then learning to accept and manage all the new information and skills now necessary.

Answer 49

psychiatric medications generally are classified into categories that reflect the chemistry of how they work in the body (mechanisms of action) or the symptoms they help relieve. Many medications fall into more than one category. For example, the same medication might improve symptoms of both depression and anxiety. These are some major types of psychiatric medications: anti-depressant medications, which include tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), and selective serotonin reuptake inhibitors (SSRIs), anti-anxiety medications (tranquilizers), which include barbiturates, benzodiazepines, and the atypical anxiolytic buspirone, anti-manic medications (mood stabilizers), Anti-convulsant medications, Anti-psychotic medications (neuroleptics) and stimulants. Antidepressants- amoxapine (Asendin), bupropion (Wellbutrin), clomipramine (Anafranil), doxepin (Sinequan or Adapin), maprotiline (Ludiomil), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel) and venlafaxine (Effexor). Antidepressants/Tricyclics (TCAs)- amitriptyline (Elavil), desipramine (Norpramin, Pertofrane), imipramine (Tofranil) and nortriptyline (Pamelor, Aventyl). Antidepressants/Monoamine Oxidase Inhibitors (MAOIs)- isocarboxazid (Marplan), phenelzine (Nardil), and tranylcypromine (Parnate). Antidepressants/Selective Serotonin Reuptake Inhibitors (SSRIs)- citalopram (Celexa), fluoxetine (Prozac), fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft). Antianxiety Medications (Anxiolytics, Minor Tranquilizers)- alprazolam (Xanax), buspirone (BuSpar), chlordiazepoxide (Librium, Librax, Libritabs), clorazepate (Tranxene, Azene), diazepam (Valium), halazepam (Paxipam), lorazepam (Ativan), oxazepam (Serax) and prazepam (Centrax). Antimanic Medications (Mood Stabilizers)- carbamazepine (Tegretol), divalproex sodium (Depakote), lithium carbonate (Eskalith, Lithane, Lithobid) and lithium citrate (Cibalith-S). Anticonvulsants- carbamazepine (Tegretol), clonazepam (Klonopin), divalproex sodium (Deppakote), gabapentin (Neurontin), lamotrigine (Lamictil), oxcarbazepine (Trileptal), topiramate (Topamax) and valproic acid (Depakene). Antipsychotic Medications-chlorpromazine (Thorazine), chlorprothixene (Taractan), clozapine (Clozaril), fluphenazine (Prolixin, Permitil), haloperidol (Haldol), loxapine (Loxitane, Daxolin), mesoridazine (Serentil), molindone (Moban, Lidone), olanzapine (Zyprexa), perphenazine (Trilafon), pimozide (Orap), quetiapine (Seroquel), risperidone (Risperdal), thioridazine (Mellaril), thiothixene (Navane), trifluoperazine (Stelazine),triflupromazine (Vesprin) and ziprasidone (Geodone). Stimulants- dextroamphetamine (Adderall, Dexedrine), methylphenidate (Concerta, Ritalin), pemoline (Cylert) and mixed amphetamine salts (Adderall). Most Common Prescribed Medications- Hydrocodone (combined with acetaminophen) -- 131.2 million prescriptions; Generic Zocor (simvastatin), a cholesterol-lowering statin drug -- 94.1 million prescriptions; Lisinopril (brand names include Prinivil and Zestril), a blood pressure drug -- 87.4 million prescriptions; Generic Synthroid (levothyroxine sodium), synthetic thyroid hormone -- 70.5 million prescriptions; Generic Norvasc (amlodipine besylate), an angina/blood pressure drug -- 57.2 million prescriptions; Generic Prilosec (omeprazole), an antacid drug -- 53.4 million prescriptions (does not include over-the-counter sales); Azithromycin (brand names include Z-Pak and Zithromax), an antibiotic -- 52.6 million prescriptions; Amoxicillin (various brand names), an antibiotic -- 52.3 million prescriptions; Generic Glucophage (metformin), a diabetes drug -- 48.3 million prescriptions and Hydrochlorothiazide (various brand names), a water pill used to lower blood pressure -- 47.8 million prescriptions. Lipitor, a cholesterol-lowering statin drug -- $7.2 billion; Nexium, an antacid drug -- $6.3 billion; Plavix, a blood thinner -- $6.1 billion; Advair Diskus, an asthma inhaler -- $4.7 billion; Abilify, an antipsychotic drug -- $4.6 billion; Seroquel, an antipsychotic drug -- $4.4 billion; Singulair, an oral asthma drug -- $4.1 billion; Crestor, a cholesterol-lowering statin drug -- $3.8 billion; Actos, a diabetes drug -- $3.5 billion and Epogen, an injectable anemia drug -- $3.3 billion.

Answer 50

Isolation precautions create barriers between people and germs. These types of precautions help prevent the spread of germs in the hospital. Anybody who visits a hospital patient who has an isolation sign outside their door should stop at the nurses' station before entering the patient's room. The number of visitors and staff who enter the patient's room may be limited. Standard precautions- you should follow standard precautions with all patients. When you are close to, or are handling, blood, bodily fluid, bodily tissues, mucous membranes, or areas of open skin, you must use personal protective equipment (PPE). Depending on the anticipated exposure, types of PPE required include: Gloves, Masks, goggles, Aprons, gowns, and shoe covers. It is also important to properly clean up afterward. Transmission-based precautions are extra steps to follow for illnesses that are caused by certain germs. Transmission-based precautions are followed in addition to standard precautions. Some infections require more than one type of transmission-based precaution. Follow transmission-based precautions when an illness is first suspected. Stop taking these precautions only when that illness has been treated or ruled-out and the room has been cleaned. Patients should stay in their rooms as much as possible while these precautions are in place. They may need to wear masks when they leave their rooms. Airborne precautions may be needed for germs that are so small they can float in the air and travel long distances. Airborne precautions help keep staff, visitors, and other patients from breathing in these germs and getting sick. Germs that warrant airborne precautions include chickenpox, measles, and tuberculosis (TB)bacteria. Patients who have these germs should be in special rooms where the air is gently sucked out and not allowed to flow into the hallway. This is called a negative pressure room. Anyone who goes into the room should put on a well-fitted respirator mask before they enter. Contact precautions may be needed for germs that are spread by touching. Contact precautions help keep staff and visitors from spreading the germs after touching a patient or an object the patient has touched. Some of the germs that contact precautions protect from are C. difficile and norovirus. These germs can cause serious infection in the intestines. Anyone entering the room -- who may touch the patient or objects in the room -- should wear a gown and gloves. Droplet precautions are used to prevent contact with mucus and other secretions from the nose and sinuses, throat, airways, and lungs. When a patient talks, sneezes, or coughs, droplets that contain germs can travel about 3 feet. Illnesses that require droplet precautions include influenza (flu), pertussis (whooping cough), and mumps. Anyone who goes into the room should wear a surgical mask.

Answer 51

* After administering the assessment, it is important that you interpret the assessment correctly. * If you use a published assessment instrument, it is imperative that you interpret the assessment as the manual recommends. * Scores need to be interpreted through norm-referenced or criterion-referenced means if they are published assessments. * Interpretation of the assessment needs to be documented into the person’s record.

Answer 52

After carefully assessing the patient, it is necessary to enter the assessment information into the medical chart or treatment plan. When documenting the assessment results, the CTRS summarizes the assessment information. It is important to include information about the patient’s strengths, weaknesses, the process used to collect the assessment information and mutually agreed upon treatment goals and interventions. Each problem and strength needs to be written in measurable terminology; diagnostic labels (ex.- depressed) must NOT be used as a problem statement. The method of documentation used will determine the format of the assessment documentation. If it is narrative, the assessment date can be written in paragraph format; if using Problem-Oriented Medical Records, it may be acceptable to list the information. Placement of the assessment is dependent on whether the agency uses source-oriented records or problem-oriented records. If source-oriented is used, the assessment information would be entered in the therapeutic recreation section of the chart. If problem-oriented is used, the assessment information will be entered in the assessment or data base section of the chart.

Answer 53

After entering assessment information, the CTRS will enter progress notes depending on the requirements of the agency. After working with a patient, the CTRS must provide periodic updates on the patient’s/client’s progress toward meeting his/her goals. The frequency of providing updates on the patient’s progress is determined by agency guidelines, accreditation standards and regulatory agencies.

Answer 54

Different types of record-keeping systems are used for documentation, such as narrative charting, problem-oriented medical records (POMR), and charting by exception (CBE).

Answer 55

Used frequently by community-based agencies, adult-day care facilities, and residential settings. Information must be about progress towards goals, but there is no uniform structure or format.

Answer 56

A way to organize a chart. Organized around the client’s problems rather than source of data: (is a comprehensive evaluation.) There are 5 components to this kind of medical record keeping: Data-base- 1) initial assessment results, data collected during assessment 2) client problem list, analysis of data base establishes a problem list, in numbered order with date. 3) initial treatment plan, outlines an approach to be used to meet each of the identified problems. 4) progress notes using SOAP, SOAPIE OR SOAPIER, record the results of interventions/client progress. 5) Discharge summary.

Answer 57

SOAP is a common form of charting progress notes and is primarily used in hospital settings. SOAP is an acronym that stands for Subjective, Objective, Analysis and Plan. Subjective data is a direct quote from a patient. Objective data is data that is gathered by observation of the patient’s actions or behaviors. Analysis is the interpretation the CTRS makes from the subjective and objective behavior. Plan is the plan that is recommended based on the previous information. SOAPIE adds Intervention- what specific intervention was used and Evaluation- how the client responded to the intervention. SOAPIER adds Revision- for changes made in the original treatment plan.

Answer 58

Used in agencies that have clearly detailed clinical pathways or long-term care facilities. When an agency has a clearly detailed clinical pathway that is being followed, the only time it is necessary to chart is when there is a variance or exception from the typical course of recovery. In a long-term care facility, as long as the person is not having any changes in functioning or health, there is not charting on the individual.

Answer 59

Computers impact charting and different software for electronic charting is being developed. Computers are found throughout the facility to ease retrieval of information and the entry of information. Electronic Health Record (EHR) refers to a patient’s computerized health record. The EHR allows the team to have easy access to a patient’s record and to easily enter assessment data and progress notes.

Answer 60

World Health Organization (WHO). Has 2 separate but complementary classification systems that a TRS may run across. One of WHO's classification systems. Used to classify a disease and is written as a code. A code is given to each disease/disability/disorder that a patient presents. The ICD-10 can be used to compile health statistics and compare reports of disease occurrences between countries. The International Classification of Diseases (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. This includes the analysis of the general health situation of population groups. It is used to monitor the incidence and prevalence of diseases and other health problems. It is used to classify diseases and other health problems recorded on many types of health and vital records including death certificates and health records. In addition to enabling the storage and retrieval of diagnostic information for clinical, epidemiological and quality purposes, these records also provide the basis for the compilation of national mortality and morbidity statistics by WHO Member States. It is used for reimbursement and resource allocation decision-making by countries. A TRS will not be coding but must understand the various codes. Used w/ International Classification of Functioning, Disability and Health (ICF).

Answer 61

WHO's 2nd classification system. Rather than focusing on disease, disorder or disability like the ICD, the ICF focuses on a person’s health and functioning. ICF provides codes that health professionals score on a Likert scale to reflect a client’s level of impairment with a body structure and function (ex., moderate impairment on the frontal lobe, severe difficulty with long-term memory) the level of difficulty that a client has with a specific life activity (ex., mild difficulty carrying out a daily routine), and barriers and facilitators that affect impairment and difficulty (ex., attitude of family is a moderate facilitator, financial assets are a sever barrier). The focus on a person’s functioning and potential barriers rather than their disease/disorder easily fits into TR. ICF is a multipurpose classification intended for a wide range of uses in different sectors. It is a classification of health and health related domain—domains that help us to describe changes in body function and structure, what a person with a health condition can do in a standard environment (their level of capacity), as well as what they actually do in their usual environment (their level of performance). These domains are classified from body, individual and societal perspectives by means of 2 lists: a list of body functions and structure and a list of domains of activity and participation. In the ICF, the term functioning refers to all body functions, activities and participation, while disability is similarly an umbrella term for impairments, activity limitations and participation restrictions. Also lists environmental factors that interact with all these components.

Answer 62

Separates recordings according to discipline; sections of the chart are designated for medical notes, nursing notes, TR notes etc. + side = easier for each discipline to record all data in one place - side = places data in too many locations making it fragmented & cumbersome to retrieve data & more difficult for a team approach.

Answer 63

Should begin the day the patient arrives on the unit. Discharge usually occurs when goals have been achieved. The patient needs to be involved with his/her discharge planning in order for discharge to be successful. Topics that need to be included in the discharge plan: major goals or problems, services received by the patient, the patient’s response to the intervention or services, received condition of patient when discharged, specific referrals/information or instructions given to the patient or patient’s family.

Answer 64

When charting it is important to know the various charting symbols, any accepted descriptive words, and exactly how to chart. List of charting guidelines: write legibly, always use a black pen, NEVER a pencil, don’t tamper w/ the record, ex., change the sequence of notes, if an error was made, draw a single line through the error and then date and initial it, do not vent anger or frustration with the family or patient in the chart, document services provided and document if services are refused, document any incidents and sign and date every entry. Generally speaking, if you are unsure about whether or not to document something, if it is not documented, it did not happen. The entry-level TRS needs to have a good understanding of and ability to use medical terminology.

Answer 65

Black ink only, initials, date and time, behaviors, observations only, timely manner, protocol of specific organization’s documentation procedures, simple and to the point, confidential, no back dating, if you make a mistake cross it out w/ 1 line and write error and sign initials, proper grammar, objective NOT subjective (ex.- appears depressed as evidenced by head down, crying), do not erase or use white out, use only approved abbreviations.

Answer 66

One of the most important skills a TRS needs to have is to be able to write measurable goals and behavioral objectives. Based on the client’s strengths and weaknesses as determined by the assessment, measurable goals and behavioral objective are written. Many people refer to Bloom’s Taxonomy as they create their cognitive goals and objectives. Bloom identified a 7 level taxonomy starting w/ knowledge as the lowest level, then comprehension, application, analysis, synthesis and then evaluation at the highest level. So, our clients must know something before they can understand it before they can apply it, etc. 1) Knowledge- Remember previously learned information. Verbs- Arrange, Define, Describe, Duplicate, Identify, Label, List, Match, Memorize, Name, Order, Outline, Recognize, Relate, Recall, Repeat, Reproduce, Select and State. 2) Comprehension- Demonstrate an understanding of the facts. Verbs- Classify, Convert, Defend, Describe, Discuss, Distinguish, Estimate, Explain, Express, Extend, Generalized, Give example(s), Identify, Indicate, Infer, Locate, Paraphrase, Predict, Recognize, Rewrite, Review, Select, Summarize and Translate. 3) Application- Apply knowledge to actual situations. Verbs- Apply, Change, Choose, Compute, Demonstrate, Discover, Dramatize, Employ, Illustrate, Interpret, Manipulate, Modify,Operate, Practice, Predict, Prepare, Produce, Relate, Schedule, Show, Sketch, Solve, Use and Write. 4) Analysis- Break down objects or ideas into simpler parts and find evidence to support generalizations. Verbs- Analyze, Appraise, Breakdown, Calculate, Categorize, Compare, Contrast, Criticize, Diagram, Differentiate, Discriminate, Distinguish, Examine, Experiment, Identify, Illustrate,Infer, Model, Outline, Point out, Question, Relate, Select, Separate, Subdivide and Test. 5) Synthesis- Compile component ideas into a new whole or propose alternative solutions. Verbs- Arrange, Assemble, Categorize, Collect, Combine, Comply, Compose, Construct, Create, Design, Develop, Devise, Explain, Formulate, Generate, Plan, Prepare, Rearrange, Reconstruct, Relate, Reorganize, Revise, Rewrite, Set up, Summarize, Synthesize, Tell and Write. 6) Evaluation- Make and defend judgments based on internal evidence or external criteria. Verbs- Appraise, Argue, Assess, Attach, Choose, Compare, Conclude, Contrast, Defend, Describe, Discriminate, Estimate, Evaluate, Explain, Judge, Justify, Interpret, Relate, Predict, Rate, Select, Summarize, Support and Value. Krathwohl Taxonomy is used for the affective domain- the taxonomy is ordered according to the principle of internalization. Internalization refers to the process whereby a person’s affect toward an object passes from a general awareness level to a point where the affect is internalized and consistently guides or controls the person’s behavior. A 5 level taxonomy starting w/ receiving, then responding, valuing, organization and the highest level is characterization by value set. Goals flow directly from the needs list and are statements that reflect what the client is going to be able to do at the completion of that aspect of his/her treatment plan.

Answer 67

Based on the goal statement, behavioral objectives will be written. Behavioral objectives are indicators that a goal has been achieved. Objectives (sometimes referred to as outcome measures) must have 3 components: 1) conditions that state when or where the outcome behavior should occur, 2) an action verb that describes the expected behavior and 3) criteria that describes how well/often the client must perform the behavior. Based on a goal, an appropriate outcome measure or objective might be: When asked a question by staff the client will respond politely within 30 seconds. The conditions are “when asked a question by staff”, the action verb is “will respond” and the criteria is “politely within 30 seconds.” During internship shortcuts may have been taken by CTRS but the “shortcuts” are not universally accepted. Contains 3 parts: 1. Behavior: a specific behavior to be demonstrated by participant 2. Condition: When & where the behavior will occur; a “given” or a “restriction.” 3. Criteria: the measurable outcome; how well must it be done, correctness, time span, percentage, what is acceptable or successful performance. Ex: after x# of lessons (condition) the participant will swim (behavior) one length of the pool (criteria).

Answer 68

A broad general statement of direction & purpose; proposed changes in the individual or their environment; a broad statement of a desired behavior that the participant will demonstrate. Set in a positive term; a sense of direction.

Answer 69

states what the participant will do, a statement that describes an outcome, a course of action to meet goal, clear and descriptive of observable behavior and written in terms of participant’s behavior.

Answer 70

Understanding the range of activities from outdoor to board and table games to spectator sports and the breadth of activities within those categories gives a professional a greater depth of knowledge thus be able to provide a more diverse and perhaps, needed program for clients/patients

Answer 71

1) Activities must have a direct relationship to the client goal. 2) Functional intervention activities should focus on the ability of the activity to help the client reach his/her goals, rather than on the activity for the activity’s sake. 3) Functional intervention and leisure education activities should have very predominant characteristics that are related to the problem, skill or knowledge being addressed. 4) Activity characteristics are important considerations for the successful implementation of a program. 5) Clients should be able to place an activity in some context in order for them to see it as useful and applicable to their overall rehabilitation and treatment outcomes. A single activity or session is not likely to produce a desired behavioral change. 6) *check Stumbo textbook 7) Consider the types of activities in which people will engage when they have the choice. 8) Program to the client’s outcomes and priorities. 9) Client involvement in activities should be enjoyable. Need to know a variety of activities that could be used to help clients reach their goals. These activities need to range from board and table games to sports to stress and relaxation activities to social activities. The more activities the TRS knows the more diverse and useful the programming can be.

Answer 72

Need an understanding of 3 things: clients, activity-based interventions and yourself. 3 major factors that influence the selection and implementation of intervention activities: activity content and process, client characteristics, and resource factors. •2 ways that a TRS can determine appropriate activities based on client goals or select client goals based on activities. Most activities can be designed and implemented to meet a client goal, but not every activity can meet every client goal. •When determining programs, activities and interventions, it is useful to review the diagnostic protocol that has been developed for each diagnosis and the program protocol that has been developed for each program. Determining program, activities and intervention will also depend on the agency philosophy, type of program, space available, resources available, and length of stay and frequency of involvement in therapeutic recreation program. •Clinical practice guidelines are now under development for many diagnostic groups, which will help practice become more standardized. As of mid 2012 only Dementia Practice Guidelines have been published and widely accepted.

Answer 73

As a TRS you need to be able to determine which activity would be the most appropriate for a specific program and why one program would be more appropriate for a specific client population than another.

Answer 74

Defined as a process that involves the systematic application of selected sets of constructs and variables to break down and examine a given activity to determine the behavorial requirements inherent for successful participation and that may contribute to the achievement of client outcomes. Breaking down activities into their component parts allows the TRS to become aware of what participatory skills and abilities are needed by the client in order to engage in the activity. The specialist can then determine whether the activity is appropriate for a group of clients or if modifications are needed. Activity analysis occurs independently of specific clients. The TRS can take an activity and analyze it for its basic requirements and demands in terms of actual participation factors. Of basic concern are physical, cognitive, affective (emotional), and social components of the activity as it is traditionally engaged in. Helps the TRS examine an activity’s physical, social, emotional and cognitive requirements in order to determine the skills, equipment and materials necessary to successfully participate in the activity. Activity analysis enables a TRS to determine if an activity is appropriate for the patient at the patient’s current functioning level or if the activity will assist the patient in reaching his/her goals. Which activity will provide the greatest benefit for the patient? After completing an activity analysis, the activity can be modified if needed, to assist the client/patient in meeting specific goals. Several activity analysis forms have been developed and can be found in textbooks. The whole process and each task is examine in terms of four behavioral domains. A process which involves the systematic application of selected sets of constructs and variables to breakdown and examine a given activity to determine the behavioral requirements inherent for successful participation. What will doing the activity do to an individual and does the individual possess the skills needed for the activity? Gives a rationale for therapeutic benefits of the activity > permits the practitioner to break down activities into component parts. A total comprehension of a given activity is acquired so that the activity may be properly utilized to meet goals and objectives of the individual program plan.

Answer 75

Activity analysis evaluates the requirements of the activity and client assessment evaluates the capabilities and limitations of the client(s). Being able to provide intervention—that is, programs that produce behavioral changes in clients—depends on the correct matching of the right clients in the right programs.

Answer 76

a better comprehension of the expected outcomes of participation, a greater understanding of the complexity of activity components, which then can be compared to the functional level of an individual or group to determine the appropriateness of the activity, a basis for comparing and contrasting relative contributions of several activity options to the desired participant outcomes, information about whether the activity will help the client achieve intended outcomes, direction for the modification or adaptation of an activity for individuals with limitations or for a particular program outcome, useful information for selecting a facilitation, instructional or leadership technique and a rationale or explanation for the therapeutic benefits of activity involvement.

Answer 77

These must be considered before performing an activity analysis. •Analyze the activity as it is normally engaged in. Means that the specialist should consider the activity as it is normally carried out by the “rules.” Any additional modifications to the activity come after the complete analysis, not before or during. Analyze the activity in its truest form. •When completing the Activity Analysis Rating Form, rate the activity as compared to all other activities. Ex.- when rating the hand-eye coordination necessary for participation, the specialist should consider how much of the activity in question requires hand-eye coordination in comparison to all other possible activities. Helps in deciding which activities best meet client needs. •Analyze the Activity without regard for any specific disability per se. Ex.- When analyzing bingo, the TRS should not consider modifications that may be made for individuals with reduced coordination. Bingo should be analyzed as it is played by the rules for a person w/out a disability. The disability or special need is considered during the activity modification stage. •Analyze the activity with regard to the minimal level of skills required for basic, successful participation. Ex- when analyzing golf, the TRS should consider the activity requirements needed for successful participation in golf as a recreational activity, not the level of skill needed for professional tournament participation. Since many TR clients are learning or relearning basic activity skills, this is the level of anticipated involvement that should be analyzed.

Answer 78

Developed to help TRSs analyze activities according to a standardized rating system. It is intended to help systematize they way in which activities are scrutinized for their potential to meet client needs and thus produce predictable client outcomes. The form has 5 sections: 1) physical, 2) social, 3) cognitive, 4) affective (joy, guilt, pain, anger, fear, frustration) and 5) administrative- factors such as required leadership style, type of equipment and facilities needed, duration of activity and number of required participants are crucial for smooth delivery of an activity.

Answer 79

Age, Number of Clients, Facilities available, Equipment & Supplies, Staff Skills and Carry-over skills.

Answer 80

1) Psycho-motor (physical domain): body positions > muscles, range of motion, hand-eye, foot-eye coordination, cardio-vascular fitness, endurance level, exertion required, need specific height, weight, skill and sensory demands: hearing, seeing, fine motor manipulation of an object 2) Affective (psychological) domain: does activity release tensions; stress? what emotions will be expressed? Joy, fear, jealousy, do any have to be hidden? do you need past emotions? potential for enhancement of self-esteem? does activity cause frustration? to what degree can one express creativity? 3) Social (interactional) domain: Skills cooperation emphasized, element of competition? is activity: individual, group, are teams necessary? how much leadership needs to be provided? what types of interaction patterns occur? are traditional sex roles emphasized, is physical contact required? are eating skills required? what communication skills: verbal, body language? independent conversation stimulated among the group ``` 4) Cognitive (intellectual) domain: is the level of complexity appropriate, concentration needed age group is best suited? academic skills required ( math, spelling, reading) academic thinking needed? how many steps are required? short, long term memory needed? how much time is required? ```

Answer 81

environmental requirements, physical setting

Answer 82

Breaking down an event or larger behavior into smaller, discrete and specific sub-behaviors that are performed in a particular order. Helps the TRS examine and teach and sub-behavior so that it can be learned and taught more easily. Takes a task and breaks it down step by step into small steps, explaining each single part of the activity. Ex.- tie a shoe/throw a Frisbee.

Answer 83

perform the task yourself, write down each step in sequence as you perform it, watch others perform the task, edit your list of each step and its place in the sequence and finalize the steps in sequence to be learned/taught.

Answer 84

Ex.- assistive techniques, technology and adaptive devices, rule changes •Important to determine if any assistive techniques or adaptive technology is needed by the client in order to become more independent. •After understanding the needs of the patient and completing an activity analysis, the TRS should be able to make accurate activity modifications and determine necessary assistive techniques and equipment.

Answer 85

Modification for individual participation and modification to enhance the therapeutic benefit.

Answer 86

(1) Keep the activity and action as close the original or traditional activity as possible. (2) Modify only the aspects of the activity that need adapting. (3) Individualize the modification. (4) The modification should be as temporary as possible.

Answer 87

can also be used and range from simple cardholders to adapted fishing poles to specialized wheelchairs to computer based devices. Telephone amplifiers for improving accessibility for hearing/speech impairments. Assistive Listening Systems (ALS)- designed to help people w/ hearing loss to improve auditory access in large areas. Augments a public address system. Real-time reporters- type what is said in a meeting and the text is displayed on a video monitor or projection screen. Telecommunication Display Device (TDD) or Teletypewriter (TTY)- portable electronic machine used with a telephone and has a visual display and or printer so that both the caller and the receiver can type and read their conversation. Telecommunication Relay Services- enable someone using a TDD or TTY to communication with someone using a telephone. Interpreters.

Answer 88

1) When certain functional abilities are absent or impaired (disabled individuals)- a rule can be eliminated or simplified, a procedure changed, a change of equipment and only modify what needs to be adapted. 2) Treatment of Rehabilitation programs- minor modifications for those so that a therapeutic benefit can be obtained (ex. rolling bowling ball from sitting position).

Answer 89

Ex.- therapeutic recreation/recreation therapy activities, leisure skill development, assertiveness training, stress management, social skills, community reintegration •Different interventions used in TR programs dependent upon the client population, needs of the client, agency philosophy and program. Many interventions used in TR.

Answer 90

Therapeutic recreation is the provision of Treatment Services and the provision of Recreation Services to persons with illnesses or disabling conditions. The primary purposes of Treatment Services which are often referred to as Recreational Therapy, are to restore, remediate or rehabilitate in order to improve functioning and independence as well as reduce or eliminate the effects of illness or disability. The primary purposes of Recreational Services are to provide recreation resources and opportunities in order to improve health and well-being. Therapeutic Recreation is provided by professionals who are trained and certified, registered and/or licensed to provide Therapeutic Recreation.

Answer 91

Important component of leisure education. Leisure skills can range from traditional leisure activities like sports, arts and crafts, mental games and activities, etc. to non-traditional activities like shopping, spectator and audience behavior, pets, etc.

Answer 92

Important intervention skill that a TRS needs to understand and be able to teach patients/clients. Assertiveness skills are useful in everyone’s life, especially for individuals who have problems expressing their feelings or needs. Our patients need to learn the difference between passive, aggressive, and assertive behavior and learn to use assertive behavior in their interactions. Enables one to more effectively stand up for one’s rights & beliefs. An off-shoot of behavioral therapy desensitization. Develops inter-personal skills. Uses behavior rehearsal; modeling assertive behaviors in real life situations; role play; reinforcement.

Answer 93

Factor in everyone’s life. Ability to teach clients to understand and manage stress using relaxation techniques is a function of the entry-level TRS. Variety of relaxation techniques that the TRS needs to understand and use. Relaxation techniques include: deep-breathing exercises, progressive relaxation techniques, creative visualization, autogenic training (AT is a technique that teaches your body to respond to your verbal commands. These commands "tell" your body to relax and control breathing, blood pressure, heartbeat, and body temperature. The goal of AT is to achieve deep relaxation and reduce stress. After you learn the technique, you can use it whenever you need or want relief from symptoms of stress, or you can practice it regularly to enjoy the benefits of deep relaxation and prevent the effects of chronic stress. Most people use autogenic training (AT) to relieve the symptoms of stress. It can also be helpful with problems such as generalized anxiety, fatigue, and irritability. Some people use it to manage pain, reduce sleeping disorders such as insomnia, and increase their resistance to stress). Tai Chi - originally developed for self-defense, tai chi has evolved into a graceful form of exercise that's now used for stress reduction and a variety of other health conditions. Often described as meditation in motion, tai chi promotes serenity through gentle, flowing movements. Tai chi is an ancient Chinese tradition that, today, is practiced as a graceful form of exercise. It involves a series of movements performed in a slow, focused manner and accompanied by deep breathing. Tai chi is low impact and puts minimal stress on muscles and joints, making it generally safe for all ages and fitness levels. In fact, because tai chi is low impact, it may be especially suitable if you're an older adult who otherwise may not exercise. Stretching. Learning to cope is another important technique to relieve stress. Coping is a deliberate process and not an automatic adaptive behavior. The use of diversional activities can help people learn to cope w/ stressors. Some people found that exercise can help an individual reduce tension and cope w/ stress. People can also learn to rely on social support systems to assist them in their coping skills. Mind & body are inter-related. Used to ease stress of flight or fight responses of body. A variety of techniques: breathing exercises, progressive relaxation, meditation, guided imagery, aerobic/physical exercise, jogging etc.

Answer 94

Promotes discussion of topics relating to the real world and improves interpersonal relationships and communication. An intervention technique used with older adults in long-term care facilities. It encourages the individual to reestablish contact with the outside world by introducing topics of interest to the individual through group activities that encourage the use of verbal and cognitive skills, especially long-term memory. It usually occurs in a group setting and lasts from 30 minutes to an hour. Five Step Program: a group process promoting the discussion of topics using picture, papers, magazines that relate to the real world, renewed interest in the environment & avoidance of stressful & emotional issues. There is a specific format used with remotivation and includes: 1) a climate of acceptance (introductions and welcome), 2) the bridge to reality (focusing attention on a specific topic by reading a poem, singing a song, etc.), 3) sharing the world we live in (inviting responses to specific questions based on the previously introduced topic), 4) appreciation of the work of the world (focuses on jobs and tasks familiar to them and related to the topic of the day), and 5) a climate of appreciation (summarization of the day’s topic and discussion).

Answer 95

Daily program using repetition to teach information about name, place, & time. Frequent follow-up during the day. To reduce confusion and increase autonomy and life satisfaction. Visual aids may be used: clocks, calendars, maps etc. An intervention technique used with older adults who are confused, disoriented, and have memory loss. Reality orientation can occur all day through the use of a reality orientation board with basic facts like time, place, day of the week, date, next meal, next holiday, etc. It can also be run as a group with the TRS as the facilitator. In a group setting, the groups might review the facts on the board, use various activities to help diminish confusion, and review various aspects of activities of daily living.

Answer 96

Socially oriented training program. Focuses on: consistency, patterns, caring & rewards for acceptable behaviors. Uses verbal & non-verbal communication (pictures, instruction cards etc.) to demonstrate the “irrationality” to the assumptions on which the behavior is based. Used with people who have had a traumatic brain injury or Cardiovascular Accident/Stroke (CVA). It helps the person work on regaining some of the cognitive processes such as memory or sequencing that were injured or impaired. Various activities such as computer games and crafts that would rely on planning skills and decision-making skills are used in cognitive retraining groups. Cognitive retraining also teaches them to use a variety of compensatory strategies. If short-term memory is a problem, the client learns various memory techniques or how to effectively use assistive devices like using a personal data assistant (PDA) to keep track of important information.

Answer 97

To improve perceptions, alertness & the opportunity of interaction with the environment by stimulation of the Five senses: Tactile: touching, feeling objects of different sizes, textures, softness and hardness. Olfactory: smelling to Strengthen senses, foods, spices, flowers, etc. Listening: musical instrument, records, tapes, sound effects, nature sounds, children playing etc. Tasting: pickles, herbs, candy, foods etc. Visual: mirrors, colorful objects, movement, mobiles etc. Used to bombard the senses with a variety of stimulants. Sensory stimulation may be used with older adults who are experiencing dementia or children with developmental or neurological deficits. The idea is to use sensory cues to relate to familiar life activities. Any one of the 5 senses is selected and the individual is expected to relate that sensual experience to the environment or to a memory. For example, a person is given a certain scent to smell and then asked to relate it to something in his past or present, like the scent of vanilla being related to baking.

Answer 98

Gives the withdrawn, regressed person opportunities to improve interaction w/ the environment through the senses. The person is provided w/ activities and objects that stimulate or exercise the senses.

Answer 99

Used primarily with older adults experiencing dementia. It does not try to orient them to reality but to accept their feelings and assist the older adult in resolving unfinished business/conflicts experienced earlier in life. Its techniques are relatively simple, needing only the ability to accept people who are confused or disoriented for where they are right now and to use good listening and communication skills. It allows the older adult to express his/her feelings, acknowledge his/her life through reminiscence, and come to terms with his/her losses. Most effective w/ persons w/ dementia. Focus on feelings and emotions.

Answer 100

Used with persons who have psychiatric impairments, mental impairments, traumatic brain injuries, with many other populations. Many people within our society have problems with social interaction skills, understanding the importance of friendship and how to make friends, the use of manners, etc. Since most recreation and leisure activities take place in a social situation, it is important for TRSs to teach social skills to their patients/clients. Typically people who do social skills training use techniques such as modeling, role-playing, social reinforcement, and homework used to practice learned skills in real-life situations.

Answer 101

Focuses on interpersonal relations and feelings within the group. Group members are encouraged to relive happy experiences from the past and to address the problems of living in a community.

Answer 102

Used in almost every setting by therapeutic recreation specialists. It is resuming roles and activities, including independent or interdependent decision-making and productive behaviors with family and social supporters in natural community settings. Many of the clients who a TRS works with have issues returning to the community whether they are social or cognitive or their issues that may be dealing with architectural issues that may be new to the clients. Very often community reintegration is a reimbursable program for TR. Facilitation techniques and/or approaches (e.g., behavior management, counseling skills). Address environmental barriers.

Answer 103

Focuses on thinking about the past and recalling the positive aspects of the past.

Answer 104

Psychodynamic: emphasis on fixation or progress the psycho-sexual stages; experiences in early childhood leave a lasting mark on adult personality. Behavioral: Personality evolves gradually over life-span, not in stages. Responses followed by reinforcement become more frequent. Humanistic: children who receive unconditional love have less need to be defensive; they develop more accurate congruent self-concepts.

Answer 105

Many facilitation skills that a TRS needs to possess in order to effectively assist their clients. Facilitation skills are what create and maximize a therapeutic relationship or experience. They represent the humanistic side of TR. Observation skills, active listening, and counseling skills all work together to enable personal growth. Briefing- involves informing the clients about what is to happen, describing associated behavioral expectations and establishing goals related to the session activities and maximizes interest of clients in the activity. When leading a session, the TRS works consistently to ensure that the events that take place relate to the targeted goals. Debriefing therapeutic sessions, also known as processing, includes reviewing the events that occurred during the session, experiences and emotions of clients and the relevance of this progress to overall therapy goals.

Answer 106

Includes behavior modification and coping skills. Using behavior modification techniques to help patient/clients learn to manage their own behavior may be necessary. Information on specific concepts of behavior modification: Positive reinforcement is the provision of a reinforcer that will cause the behavior to be repeated. A reinforcer is anything that causes a behavior to be repeated; it can be attention, food, etc. Punishment decreases the occurrence of a negative behavior. Modeling is the demonstration of desired behavior and combined with reinforcement, causes the patient/client to want to repeat the behavior. Time out is the removal of the child or individual from a reinforcer or stimulating event. It is used frequently with children who are having difficulty coping with an overstimulating environment. Token economies are used in some residential settings. Residents receive tokens for specified behaviors; at the end of a day or week those tokens can be redeemed for something of value to the individual. Interventions: Pavlov & Skinner: operant conditioning > eliminate inappropriate responses & substitute appropriate or positive responses. Behavior Management includes- Positive reinforcement: techniques to change behavior; Shaping: reinforcement only when certain standard is reached; Chaining: linking one learned response to another; Prompting: leader physically guides; Fading: gradual removal of physical guidance; Token Economies: tokens as rewards for behavioral performance and Contracts: written for agreement to perform certain behaviors.

Answer 107

Client-centered therapy: Carl Rogers: Active listening- attending: pay attention, eye contact, posture, gestures, verbal affirmation of listening; paraphrasing: listen for basic message, restate in own words; clarifying: admit your confusion, ask for clarification; perception: checking; paraphrase what you think you heard; probing: questions directed to obtain information, to gain an understanding; reflecting: to reflect feelings received; interpreting; confronting: point out what seems apparent in an honest manner without blame; informing: providing factual information; affective listening: voice, tone, volume and summarizing: to bring together ideas, to synthesize. Sometimes referred to in the literature as communication skills. Effective communication is important when working w/ patients/clients. One of the most important skills a TRS can have is the ability to listen; active listening lets the patient/client know you heard what was said. Listening skills are both verbal and non-verbal. Attending skills consist of the following non-verbal behaviors: eye contact, posture, and gestures, it also consists of various verbal behaviors, but primarily are the ones that keep the patient/client talking like “uh-huh” or “I see.” There are also other verbal behaviors that let the patient/client know you are listening and encourage patients/clients to talk, these include: paraphrasing, clarifying, perception checking, probing, reflecting, interpreting, confronting, informing, self-disclosing and summarizing.

Answer 108

attending: pay attention, eye contact, posture, gestures, verbal affirmation of listening

Answer 109

listen for basic message, restate in own words

Answer 110

admit your confusion, ask for clarification

Answer 111

checking; paraphrase what you think you heard

Answer 112

questions directed to obtain information, to gain an understanding

Answer 113

to reflect feelings received; interpreting

Answer 114

point out what seems apparent in an honest manner without blame

Answer 115

providing factual information; affective listening: voice, tone, volume

Answer 116

to bring together ideas, to synthesize.

Answer 117

Used frequently in leisure education programs. Its requirements of choosing, cherishing, and acting on values have benefited persons who are chemically dependent, have psychiatric impairments—both adolescents and adults—or who have mental impairments. 3 Value Clarification Strategies that are Useful in Leisure Education: 1) Individual clarifying response (help individuals think about what they just said or did) 2) Group discussion (encourages reflection of the patient’s ideas within a group setting) 3) Value sheets (raise a value issue within a group). Value clarification groups help a person clarify their own value system. to help individuals explore & make decisions based on their personal values. Can be use in leisure counseling program. 1) become aware of beliefs and values; 2) choose among alternatives and3) matching stated beliefs with actions.

Answer 118

visual cues: physical appearance, use of jewelry, clothing, facial expression, eye contact, body movement, vocal cues, volume, pitch, availability, personal space.

Answer 119

Assists people in regaining a fulfilling leisure lifestyle and may help them understand the importance of leisure in their life, or gain a new leisure skill.

Answer 120

A broad category of services that focuses on the development and acquisition of various leisure-related skills, attitudes and knowledge. •Leisure education is an important part of a program because it is an area that is often forgotten when working with patients in a hospital or health care agency and is sorely needed when the patient returns home. In the hospital, much of the time is programmed, but at home, it is not. Many people will return home and be unable to return to work. •Leisure education can help patient/clients understand the importance of using leisure wisely, developing a healthy leisure lifestyle, expanding their knowledge of leisure activities and developing new skills. •Patients may have participated in many leisure activities previously, but for one reason or another may not be participating in them now. Leisure education can help them learn how to adapt activities or determine any specialized equipment needed to participate. •Leisure education can also help with learning about and utilizing leisure resources. These resources can range from personal resources to community resources or even activity opportunities.

Answer 121

A service that requires considerable counseling expertise, and unlike leisure education, is usually provided without predetermined content on the part of the counselor.

Answer 122

Intraindividual, Extraindividual, Aggregate, Interindividual, Unitlateral, Multilateral, Intragroup and Intergroup.

Answer 123

Action taking place within the mind of a person or action involving the mind and part of the body, but requiring no contact with another person or external object. Ex.- twiddling thumbs, daydreaming, meditation, fantasizing.

Answer 124

Action directed by a person toward an object in the environment, requiring no contact with another person. Ex.- watching T.V., doing individual craft projects, playing solitaire, playing videogames, reading, shopping online, gardening.

Answer 125

Action directed by a person toward an object in the environment while in the company of other persons who are also directing action toward objects in the environment. Action is NOT directed toward one another and no interaction between participants is required or necessary. Ex.- watching movies in a theatre, doing crafts projects while in a group, bingo, attending auctions, attending entertainment programs.

Answer 126

Action of a competitive nature directed by one person toward another. Ex.- chess, checkers, honeymoon bridge, singles tennis, horseshoes, racquetball, singles ping-pong.

Answer 127

Action of a competitive nature among three or more persons, one of whom is an antagonist or “it.” Ex.- tag games, hide and seek, chase games, charades.

Answer 128

Action of a competitive nature among three or more persons, with no one person as an antagonist. Ex.- scrabble, poker, monopoly, tossing bean bags, tossing horseshoes.

Answer 129

Action of a cooperative nature by two or more person intent upon reaching a mutual goal. Action requires positive verbal and nonverbal interaction. Ex.- being a member of music bands or choirs, being a cast member in a play, doing service projects, painting a mural w/ a group.

Answer 130

Action of a competitive nature between two or more intragroups. Ex- team sports such as volleyball, basketball, football, ice hockey, rugby.

Answer 131

* Vicodin- Treats moderate to moderately severe pain. This medicine contains a narcotic pain reliever. Brand names: Hycet, Xodol, Zydone, Maxidone, Lorcet, Zamicet, Co-gesic, Zolvit, Stagesic, Liquicet, Norco, Lortab, Vicodin. Drug classes: Analgesic, Opioid. Other drugs in same class: Acetaminophen, Oxycodone. Combination of: Acetaminophen, Hydrocodone. * Dexadrine/ Dextroamphetamine- Treats attention deficit hyperactivity disorder (ADHD) and narcolepsy (a sleep problem). This medicine is a stimulant. Brand names: Dextrostat, ProCentra, Dexedrine. Legal status: Schedule II controlled substance. Drug class: Central Nervous System Stimulant. Other drugs in same class: Methylphenidate, Lisdexamfetamine. Possible side effects: Tachycardia, Palpitations, Dry mouth, Hives. May treat: Attention deficit hyperactivity disorder, Excessive uncontrollable daytime sleepiness, Hyperactivity. * Tegretol/ Carbamazepine- Treats seizures. Also treats nerve pain or bipolar disorder (manic-depressive illness). Brand names: Tegretol, Equetro, Carbatrol, Epitol. Possible side effects: Somnolence, Nausea, Vomiting, Dizziness,Unsteadiness. Drug classes: Mood stabilizer, Carboxamide, Anti-epileptic Agent. Other drugs in same class: Gabapentin, Oxcarbazepine. May treat: Epilepsy, Trigeminal neuralgia, Bipolar disorder. * Naproxen- Prescription drug, Over-the-counter drug. Treats fever and pain, including pain caused by arthritis, gout, menstrual cramps, tendinitis, headache, backache, and toothache. This is a nonsteroidal anti-inflammatory medicine (NSAID). Side effects- Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing Blistering, peeling, red skin rash, Change in how much or how often you urinate, Chest pain, trouble breathing, weakness on one side of your body, severe headache, trouble seeing or talking, pain in your lower leg, Chest pain that may spread, trouble breathing, nausea, unusual sweating, fainting, Dark urine or pale stools, nausea, vomiting, loss of appetite, stomach pain, yellow skin or eyes, Severe stomach pain, vomiting blood, bloody or black, tarry stools, Swelling in your hands, ankles, or feet, rapid weight gain, Unusual bleeding, bruising, or weakness and Vision changes. Brand names: Naprelan, Aleve, Naprosyn, Anaprox. May treat: Inflammation, Fever, Gout, Osteoarthritis. Drug class: Non-steroidal anti-inflammatory drug. Other drugs in same class: Ibuprofen, Diclofenac, Aspirin. May prevent: Pain.

Answer 132

Erikson was an ego psychologist. He emphasized the role of culture and society and the conflicts that can take place within the ego itself. According to Erikson, the ego develops as it successfully resolves crises that are distinctly social in nature. These involve establishing a sense of trust in others, developing a sense of identity in society, and helping the next generation prepare for the future. Erikson extends on Freudian thoughts by focusing on the adaptive and creative characteristic of the ego, and expanding the notion of the stages of personality development to include the entire lifespan. Erikson proposed a lifespan model of development, taking in five stages up to the age of 18 years and three further stages beyond, well into adulthood. Erikson suggests that there is still plenty of room for continued growth and development throughout one’s life. Erikson put a great deal of emphasis on the adolescent period, feeling it was a crucial stage for developing a person’s identity. He was interested in how children socialize and how this affects their sense of self. There are eight stages which are: 1. Trust vs. Mistrust (infancy, 0 – 1 1/2) ; 2. Autonomy vs. Shame (early childhood, 1 ½ - 3); 3. Initiative vs. Guilt (play age, 3-5); 4. Industry vs. Inferiority (school age, 5-12); 5. Ego Identity vs. Role Confusion (adolescence 12-18); 6. Intimacy vs. Isolation (young adult, 18-40); 7. Generativity vs. Stagnation (adulthood, 40-65); and 8. Ego Integrity vs. Despair (maturity, 65+).

Answer 133

Also called: Continuum Model, TR Service Model. Four Steps: maximum control by specialist>>to>>>minimum control by specialist 1. Assess: ID problem, gather data; 2. Treatment: improve functional ability; 3. Leisure Education: Acquire knowledge & Skills; 4. Leisure Lifestyle: engage in opportunity>participate voluntarily.

Answer 134

1) Physiological: To achieve organic homeostasis. 2) Psychodynamic: To uncover and work through conscious conflicts. (No free will; you are who you are because of what has happened to you, your experiences.) 3) Learning (behavioral): To learn new, adaptive responses to replace old maladaptive responses. 4. Cognitive: To learn new ways of thinking and behavior. 5) Humanistic: (Maslow/Rogers) Personal Growth, including self-acceptance, increased honesty with self and others, clarification of values and goals...people want “to do good.”

Answer 135

1. Purpose 2. Population 3. Process 4. Setting

Answer 136

1) Assess 2) Plan (goals, objectives, activity analysis) 3) Implement 4) Evaluate & Revise

Answer 137

1) Clients 2) Agency 3) Resources 4) Community 5) TR Profession

Answer 138

A pressure ulcer is an area of skin that breaks down when something keeps rubbing or pressing against the skin. Causes- Pressure on the skin reduces blood flow to the area. Without enough blood, the skin can die. An ulcer may form. You are more likely to get a pressure ulcer if you: Use a wheelchair or stay in bed for a long time, Are an older adult, Cannot move certain parts of your body without help because of a spine or brain injury or disease such as multiple sclerosis, Have a disease that affects blood flow, including diabetes or vascular disease, Have Alzheimer's disease or another condition that affects your mental status, Have fragile skin, Have urinary incontinence or bowel incontinence and Do not get enough nutrition (malnourishment). Need bed rest!

Answer 139

Clouding- Make it seem like you agree. For example, “If I were late as often as you say, it would certainly be a problem”. Broken record- Simply keep repeating what you have said and include slight variations if you like. For example, “Yes, I know, but, like I just said …”, then, “No. I really can’t”. Compromise. Defusing- Try to de-escalate the situation if tension is rising. For example, “I can see that you’re upset, and I’m also getting angry. Let’s delay this … “. Content-To-Process Shift: If you stray from the topic, you need to get back on track. For example, “We’ve drifted away from our discussion, which is that … Let’s focus back on that topic”. Assertiveness Agreement: “You’re right. I botched it. I’ll try again”. Assertive Inquiry: Simply ask for clarification. For example, “I can see you’re upset. What is it about my behavior that made you angry?” Assertive Empathy: Validate how the other person is feeling. For example, “I know that this is unpleasant for you but I really think you should do it”. Self-Disclosure: Disclose information about how you feel. For example, “I’m embarrassed to admit this but … “. Cutting The Sound: If leaving is impossible, let the other talk without paying attention.

Answer 140

focuses on here-and-now experience and personal responsibility. The objective, in addition to overcoming symptoms, is to become more alive, creative, and free from the blocks of unfinished issues which may diminish optimum satisfaction, fulfillment, and growth. existential/experiential form of psychotherapy that emphasizes personal responsibility, and that focuses upon the individual's experience in the present moment, the therapist-client relationship, the environmental and social contexts of a person's life, and the self-regulating adjustments

Answer 141

Rational emotive behavior therapy, also known as REBT, is a type of cognitive-behavioral therapy developed by psychologist Albert Ellis. REBT is focused on helping clients change irrational beliefs.

Answer 142

the granting of licenses especially to practice a profession. the state or condition of having a license granted by official or legal authority to perform medical acts and procedures not permitted by persons without such a license ; also : the granting of such licenses

Answer 143

the official recognition from a professional or governmental organization that a health care facility (or an educational institution) meets relevant standards.

Answer 144

official approval to do something professionally or legally.

Answer 145

the act of process of entering information about something in a book or system of public records. The act or process of entering names on an official list.

Answer 146

A receptive language disorder is an impairment in the comprehension of a spoken, written, gestural or/or other symbol system. Children with a receptive language disorder can have difficulty with any of the following: Understanding what gestures mean, Following directions, Understanding questions, Identifying objects and pictures, Taking turns when talking with others, Understanding the order of words in a sentence, Understanding plurals and verb tenses, Understanding age-appropriate vocabulary and knowledge about objects and sequence of events, Knowledge of the goals or functions of language (e.g. to obtain a desired object, tell a story, ask questions, comment), Knowledge of how to use language to achieve goals (e.g. appropriately using language to get a desired object) and Carrying out cooperative conversations (e.g. perspective-taking and turn-taking).

Answer 147

Clinical indicators assess particular health structures, processes, and outcomes. They can be rate- or mean-based, providing a quantitative basis for quality improvement, or sentinel, identifying incidents of care that trigger further investigation. They can assess aspects of the structure, process, or outcome of health care. Furthermore, indicators can be generic measures that are relevant for most patients or disease-specific, expressing the quality of care for patients with specific diagnoses.

Answer 148

(also called scope of practice) includes the boundaries or limitations placed on the discipline’s professional practice by legislative, legal and professional groups. For TR, the professional scope of practice includes functional interventions, leisure education and recreation participation services. The comprehensive goals and program areas of the department.

Answer 149

also known as person-centered psychotherapy, person-centered counseling, client-centered therapy and Rogerian psychotherapy. PCT is a form of talk-psychotherapy. places much of the responsibility for the treatment process on the client, with the therapist taking a nondirective role. Two primary goals of person-centered therapy are increased self-esteem and greater openness to experience. Some of the related changes that this form of therapy seeks to foster in clients include closer agreement between the client's idealized and actual selves; better self-understanding; lower levels of defensiveness, guilt, and insecurity; more positive and comfortable relationships with others; and an increased capacity to experience and express feelings at the moment they occur.

Answer 150

Myasthenia gravis is a neuromuscular disorder. Neuromuscular disorders involve the muscles and the nerves that control them. A rare chronic autoimmune disease marked by muscular weakness without atrophy, and caused by a defect in the action of acetylcholine at neuromuscular junctions. Most common secondary condition is drooping eyelids.

Answer 151

The taxonomy is presented in five stages: 1) Receiving describes the stage of being aware of or sensitive to the existence of certain ideas, material, or phenomena and being willing to tolerate them. Examples include: to differentiate, to accept, to listen (for), to respond to. 2) Responding describes the second stage of the taxonomy and refers to a committment in some small measure to the ideas, materials, or phenomena involved by actively responding to them. Examples are: to comply with, to follow, to commend, to volunteer, to spend leisure time in, to acclaim. 3) Valuing means being willing to be perceived by others as valuing certain ideas, materials, or phenomena. Examples include: to increase measured proficiency in, to relinquish, to subsidize, to support, to debate. 4) Organization is the fourth stage of Krathwohl’s taxonomy and involves relating the new value to those one already holds and bringing it into a harmonious and internally consistent philosophy. Examples are: to discuss, to theorize, to formulate, to balance, to examine. 5) Characterization by value or value set means acting consistently in accordance with the values the individual has internalized. Examples include: to revise, to require, to be rated high in the value, to avoid, to resist, to manage, to resolve.

Answer 152

The ability to anticipate and react to changes in balance as the body moves through space.