American Journal of Recreation TherapyAbstracts
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American Journal of Recreation Therapy
Winter 2004, Volume 3
, Number 1

Newsbriefs
NARHA adopts standardized certification requirements. Advanced equipment enhances aquatic therapy outcomes. State-of-the-art recreation center receives federal funding. Music therapy may have analgesic effect on chronic conditions. Exercise training improves long-term survival in CHF patients.
Winter 2004; pages 5-7


Article
An investigation of multicultural awareness and sensitivity of therapeutic recreation educators
Charlsena F. Stone, PhD, CTRS; Nancy J. Gladwell, ReD, CPRP
Winter 2004; pages 9-19

Abstract
The purpose of this study was to examine the relationship between demographic and educational variables on multicultural awareness and sensitivity levels of therapeutic recreation (TR) educators. A sample of 33 TR educators, who were currently teaching full-time, participated in this investigation. The results of the study highlighted the importance of offering multicultural professional development workshops or seminars and developing personal contacts with minority groups. These findings are discussed in terms of preservice education and continued professional in-service training for TR educators. Key words: cultural competence, multicultural awareness and sensitivity, therapeutic recreation


Article
Promoting health in community-dwelling older adults using recreational activities
Ann Kolanowski, PhD, RN; Linda L. Buettner, PhD, CTRS
Winter 2004; pages 20-28

Abstract
Recreation therapy can improve quality of life for older adults by affecting physical, cognitive, and emotional health. The aging US population is increasingly diverse and has diverse recreational interests. This exploratory survey of 104 community-dwelling older adults was undertaken to determine the recreational interests of older adults from diverse racial or ethnic, gender, residential, and educational backgrounds. The findings indicated a great deal of diversity of interest within the group as a whole. This was especially true for social activities. There were few differences between subgroups, but older adults with more education had greater interest in cultural activities than those with less education. Survey results can guide the development of health promotional programs appropriate for community-dwelling older adults and are discussed in terms of practice implications. Key words: recreation therapy, older adults, community-dwelling, multicultural


Article
Predictors of competitive trait anxiety in adolescent wheelchair basketball players
Frank M. Brasile, PhD, CTRS; Bradley N. Hedrick, PhD
Winter 2004; pages 29-35

Abstract
Wheelchair sports have long been recommended for facilitating the physiological, social, and psychological development of persons with permanent locomotor disabilities that preclude them from participating in ambulatory sports. The purpose of the present study is to ascertain the determinants of competitive trait anxiety (CTA) within adolescent wheelchair basketball players. Specifically, this study analyzes the relationship between CTA and perceived threats, perceived physical competence, self-esteem, and other interpersonal variables such as age, sex, severity of disability, and wheelchair sports experience. The sample was comprised of 71 youth wheelchair basketball participants engaged in Junior Wheelchair Basketball competitions. The study measured perceived personal competence in wheelchair basketball, self-esteem, evaluative worry, and performance worry. The multivariate Analysis of Variance (ANOVA) procedure revealed that, for boys, significant differences did exist between CTA groups personality variable scores, (F 8, 100) = 2.40, p < .03. The study descriptively analyzed data for girls separately because the sample number was small. Results revealed that performance and evaluative worry are two variables that warrant concern and action by parents and coaches of young athletes. Key words: adolescence, competitive trait anxiety, wheelchair, performance anxiety, adaptive sports


Article
Therapeutic recreation music intervention to decrease mealtime agitation and increase food intake in older adults with dementia
Nancy E. Richeson, PhD, CTRS; David J. Neill, BS
Winter 2004; pages 37-41

Abstract
This study examined the effects of a therapeutic recreation music intervention on agitation and food intake on 27 nursing home residents diagnosed with dementia (mean age 87 years). In a quasi-experimental time-series design (ABAB), agitated behaviors and percentage of food eaten were recorded during two phases: 1) a four-day baseline, and 2) a four-day intervention during which compact discs (CDs) of relaxing music were played for one hour at dinnertime. Agitation was measured using the Modified Cohen-Mansfield Agitation Inventory (Modified CMAI); percentage of food eaten was determined by reviewing participants’ medical records. Agitation decreased and percentage of food eaten increased with the music intervention. The authors suggest replicating the study using more rigorous methodology and additional dependent variables. Key words: Therapeutic recreation, dementia, agitation, food intake, mealtime music intervention


Article
The influence of participation in outdoor adventure programs for persons with cognitive disabilities
James A. Newman, PhD, CTRS
Winter 2004; pages 42-46

Abstract
A wealth of anecdotal information supports the opinion that inclusive outdoor adventure programs can assist people with cognitive disabilities by expanding opportunities for social interaction within the community. However, there is a paucity of empirical evidence to support this benefit.1 For many years, it has been assumed that outdoor adventure programming is meeting a need in the community, and that people with cognitive disabilities need to get out of their daily routine and experience life in ways similar to the typical population.2 This issue has received greater attention since the passage of the Americans with Disabilities Act of 1990. Increasingly, opportunities are being opened to people of all ability levels as the law removes architectural and programmatic barriers. What cannot be legislated are individual attitudes toward disability. Physical inclusion is not equivalent to social inclusion.3 For people with mental retardation in the community, social contact is crucial to the quality of life. Therefore, the right to high-quality social contact should share equal footing with the legal and civil rights of the individual. Key words: cognitive disabilities, social development, recreation therapy, outdoor adventure program

Book review
Dementia Practice Guidelines for Treating Disturbing Behaviors, by Linda L. Buettner, PhD, CTRS, and Suzanne Fitzsimmons, MSN, RN, GNP. Alexandria, VA: American Therapeutic Recreation Association, 2003; 400 pages.
Nancy E. Richeson, PhD, CTRS
Winter 2004; pages 47-47

American Journal of Recreation Therapy
Spring 2004, Volume 3
, Number 2

Newsbriefs
National Therapeutic Recreation Week builds support and awareness. Pilot online course in phototherapy introduced by AATA. NCLD calls for stepped up support of Individuals with Disabilities Education Improvement Act. NCA booklet lists camps for children with disabilities
Spring 2004; pages 5-6


Article
Constructing self-efficacy scales
James B. Wise, PhD, CTRS
Spring 2004; pages 9-14

Abstract
Previous articles have thoroughly explained how self-efficacy and social cognitive theory can guide each step of the therapeutic recreation (TR) process: 1) assessment, 2) planning, 3) implementation, and 4) evaluation.1,2 This article expands that knowledge base by providing therapeutic recreation specialists (TRSs) with information on how to construct measures of self-efficacy. This information is important because many scales currently available are not appropriate for TRSs. If TRSs follow the guidelines presented in this article, the scales they develop should collect accurate appraisals of personal capability. Armed with this data, TRSs can place clients in appropriate programs and use the same scales to check the effectiveness of those programs in altering perceptions of efficacy and consequential behaviors. Key words: health promotion, measurement, self-efficacy, social cognitive theory


Article
Music therapy in facility-based aged care in Aotearoa New Zealand
Robert E. Krout, EdD, MT-BC, RMTh
Spring 2004; pages 15-17

Abstract
In Aotearoa New Zealand (Aotearoa is the Maori name for the country), diversional therapy is defined as a professional clinical practice that makes use of purposeful recreational leisure activities with individuals and groups to improve the intellectual, spiritual, physical, and emotional well-being of people in supportive environments. For older people, these environments can include facilities such as rest homes, nursing homes, and hospitals. Currently, the New Zealand Society of Diversional Therapists, Incorporated includes recreational professionals. Diversional therapy is described as client-centered and acknowledges that recreational experiences improve the quality of life of older people. Therapeutic recreation is fairly new as a professional field in Aotearoa New Zealand. The country’s first academic program was established in 1999. This paper describes how music therapy has been used to augment diversional therapy programs at sample aged-care facilities in Aotearoa New Zealand. The author describes his work with diversional therapists to provide music therapy group programming. This study outlines some sample session experiences and goals for the residents. Key words: music therapy, diversional therapy, older adults, New Zealand


Article
Air mat therapy for the treatment of agitated wandering: An evidence-based recreational therapy intervention
Marcia Shalek, CTRS; Nancy E. Richeson, PhD, CTRS; Linda L. Buettner, PhD, CTRS
Spring 2004; pages 18-26

Abstract
The effects of a recreational therapy intervention, air mat therapy, on agitated wandering and agitated behaviors in elders with dementia were examined using the Algase Wandering Scale (AWS) and the Cohen-Mansfield Agitation Inventory (CMAI). Twenty nursing home residents with dementia (Mini-Mental State Examination mean score 4.9, mean age 83.2) participated in a two-week clinical trial of daily air mat therapy led by a Certified Therapeutic Recreation Specialist (CTRS). The clinical trial used a pretest/post-test experimental design. Results revealed a significant decrease in agitated wandering on two of the five subscales (spatial disorientation and eloping behavior) in the experimental group. In addition, a significant difference on the CMAI from pretest to post-test for the experimental and control groups was noted. Key words: air mat therapy, recreation therapy, agitated wandering, agitated behaviors, evidence-based practice, Algase Wandering Scale, Cohen-Mansfield Agitation Inventory


Article
Therapeutic use of sports
Kelly-Blaine Hoffman; John Dattilo, PhD
Spring 2004; pages 27-35

Abstract
This literature review examines the effects of sport participation on people who have disabilities, the relationship between sport participation and physical and mental disabilities, and the perception of athletes with disabilities about sports. Sports addressed include those that provide opportunities for people with disabilities to participate with people without disabilities, as well as sports that include only people with disabilities. Participants in the reviewed studies include people with spinal cord injuries, physical, mental, and sensory disabilities, Parkinson’s disease, substance abuse, and oppositional disorder. Participants ranged in age from children to older adults. The influence of sports on people who have disabilities has been examined via correlational, experimental, or interpretive studies. Relationships between sport participation and variables such as self-efficacy, mood, strength, physical competence, self-worth, control, intrinsic motivation, self-determination, and independence have been examined, and results support some positive associations and outcomes derived from sport participation. Generally, sport participation is associated with positive behaviors for people with disabilities and is a facilitation technique that may be useful for many therapeutic recreation specialists. Key words: therapeutic recreation, sports, disabilities, self-efficacy


Article
Exercise training and fall-risk prevention for community-dwelling elders
Kevin Sykes, PhD; Ling Wai Mun, MSc
Spring 2004; pages 36-42

Abstract
Purpose: To investigate how a group of community-dwelling Hong Kong Chinese elderly persons with a history of falling can benefit from an eight-week home-based program of exercise. Methods: From an initial group of 69 volunteers, 40 participants (mean age = 80 ± 4.5years) with a history of falling were selected and randomly assigned into Group 1—the exercise group (n = 20) and Group 2—the control group (n = 20). Following an introductory talk and exercise instruction session, Group 1 engaged in a daily 45-minute home-based exercise session, plus a 30-minute walk twice per week, for eight weeks. Measurements, taken at baseline and after eight weeks, included strength of hip flexors and knee extensors, mobility, dynamic balance, and functional reach. Participants were requested to complete a daily activity diary. Physiotherapists followed up by phone in the first, second, fourth, and sixth week, with regard to the exercise program, health status, motivation, and advice if necessary. Results: Twenty-seven participants successfully completed the eight-week program (Group 1 = 5; Group 2 = 12). There was no difference between the groups in any outcome measure at baseline. However, following the eight-week intervention, Group 1 demonstrated significant improvements in strength of hip flexors and knee extensors (p < 0.000). Performance in Functional Reach (p = 0.008), Time to Get-up and Go (p = 0.034), and Berg Balance Scale (p = 0.022) test scores improved markedly. There was no significant change in any outcome measures in Group 2. Conclusion: Participation in a home-based exercise program is an effective intervention to enhance strength, gait, and balance and to reduce the functional declines associated with aging in the elderly. Lower-limb strength, gait, and balance training exercises should be a major component within a fall-risk reduction program for the elderly. Keywords: exercise, falls, elderly, mobility, home-based therapy


Article
Competing responses hypothesis
Kenneth E. Mobily, CTRS, PhD; Eric W. Randall, CTRS, MA, PhD ©
Spring 2004; pages 43-48

Abstract
The purpose of this article is to construct a framework for discussion and exploration of the “competing responses hypothesis,” an explanation for the potential effectiveness of some aspects of therapeutic recreation (TR) service provision. The challenge to TR is how to translate intrinsic motivation into effective and systematic interventions that improve client function and behavior. The reasoning is as follows: If stereotypic behaviors have some sort of intrinsic appeal to the client—some self-maintaining characteristic—then substituting another intrinsically appealing activity could diminish the stereotypic behavior. The leisure activity that holds intrinsic appeal for the client is the competing response. Key words: stereotypic behaviors, intrinsic motivation, neurogenic motive, schizophrenia, autism

American Journal of Recreation Therapy
Summer 2004, Volume 3
, Number 3

Newsbriefs
Recreational therapy recognized by HPN as Allied Health Profession of the Month. NRPA launches new online presence. ATRA announces new community inclusion treatment network. Levelgames® to release adapted single-switch video games for the physically disabled. Early Risers sports, arts, and recreation program significantly decreases childhood aggression. ACSM recommends stepped up exercise regime to combat hypertension. HHS launches new program to promote physical activity in children and youth with disabilities.
Summer 2004; pages 5-8


Article
Mobility-related self-efficacy scale: An outcome tool for the geriatric recreation therapist
Nancy E. Richeson, PhD, CTRS; Karen A. Croteau, EdD; David B. Jones, EdD, CTRS
Summer 2004; pages 11-16

Abstract
Mobility and self-efficacy are believed to be important to functional independence and quality of life for older adults. This article reviews the construct of mobility and self-efficacy and presents the Mobility-Related Self-Efficacy Scale (MRSES) as an outcome tool for the geriatric recreation therapist. The article describes the process for implementing physical activity interventions and examples of interventions that can increase the mobility-related self-efficacy of older adults. It also documents the validity and reliability of MRSES. Key words: mobility, self-efficacy, recreation therapy, therapeutic recreation


Article
Contingent music: A powerful technique for facilitating therapeutic objectives
Jayne M. Standley, PhD, MT-BC
Summer 2004; pages 17-24

Abstract
This study reviews the literature on music used as reinforcement for therapeutic and educational objectives with implications for the field of recreation therapy. Cited in detail are two meta-analyses on contingent music conducted by the author—one an overview across all therapeutic settings,1 and the other a more recent effort focused specifically on infant learning.2 Results of these meta-analyses demonstrate that contingent music is more effective than other reinforcers and more effective than continuous music. It is also effective with individuals of all ages, from premature infants to elderly people with Alzheimer’s disease. These data provide definitive evidence that contingent music is one of the most powerful techniques in any therapist’s repertoire. Key words: contingent music, meta-analysis, music therapy


Article
Diversity in therapeutic recreation: Why now?
Colleen A. Cooke, EdD, CTRS
Summer 2004; pages 25-29

Abstract
These days, it is common to hear about the need to respect diversity and the richness that is gained through diversity. Unfortunately, it is also common to hear comments that indicate disdain for diversity. The truth is that diversity does enrich our lives, and our society is becoming increasingly diverse with each passing day. This article defines diversity and discusses its impact on therapeutic recreation services. The population of the United States is evolving. Minority groups are expected to become a majority of this society within the next two to five decades. Professional therapeutic recreation service providers must be aware of the changing demographics of their clientele, and the profession should recruit diverse members. This article discusses issues related to therapeutic recreation service provision, profession membership, and strategies for diversity training. Key words: diversity, workforce diversity, diversity education


Article
Recreation interventions for individuals with attention deficit hyperactivity disorder
Erik Rabinowitz, PhD
Summer 2004; pages 31-35

Abstract
This article examines the current research in and outside the field of recreation therapy as applied to individuals with attention deficit hyperactivity disorder (ADHD). Particular attention is given to the cognitive, gross motor and balance, social, thrill seeking, and attention functional areas. Intervention recommendations are made based on experience, quantitative data, and trials in clinical and nonclinical settings conducted by the author over a seven-year period. Key words: Recreation therapy, attention deficit hyperactivity disorder (ADHD), nonpharmacologic intervention, balance


Article
A 12-week prospective randomized controlled trial to investigate the effects of aerobic training on type 2 diabetes patients
Kevin Sykes, PhD; Tin Lo Victor Yeung, MSc; Gary T. C. Ko, FRCPI
Summer 2004; pages 36-42

Abstract
This study was undertaken to investigate the effects of a 12-week aerobic exercise program in the management of patients with type 2 diabetes. A prospective randomized controlled trial with repeated measures was conducted. Thirty-six Hong Kong Chinese patients with type 2 diabetes (mean age, 58.1 yr) were randomized into Group 1 (exercise, n = 24) and Group 2 (controls, n = 16). Assessments at baseline and at three months included anthropometry, body fat measurement, biochemistry, six-minute walking distance (6MWD) assessment, exercise capacity, and SF-36® quality of life assessment (QualityMetric Inc., Lincoln, RI). Blood glucose was monitored before and after each exercise session. The immediate response to one hour of moderate aerobic exercise was a significant decrease in blood glucose (10.4 ± 3.5 mmol/L to 7.1 ± 2.7 mmol/L, p < 0.05). After 12 weeks, significant differences were noted between the groups in 6MWD (498 ± 128 m versus 299 ± 75 m, p = 0.000), exercise capacity in terms of metabolic equivalent units (5.1 ± 1.0 METs versus 2.8 ± 0.8 METs, p = 0.001), and insulin sensitivity (1.7 ± 1.0 S1 versus 4.3 ± 2.5 S1, p = 0.048). Group 1 also demonstrated an increase in HDL (1.16 ± 0.30 mmol/L to 1.27 ± 0.33 mmol/L, p = 0.002), lower body weight (67.3 ± 12.8 kg to 66.9 ± 12.8 kg, p = 0.045), lower body mass (26.5 ± 4.6 BMI to 26.3 ± 4.6 BMI), reduced glycosylated hemoglobin HbA1c) (8.1 ± 1.3 percent to 7.7 ± 1.0 percent), and improved quality of life. In contrast, participants in Group 2 showed a significant decrease in the SF-36 social functioning domain (p = 0.035), lowered scores in all eight quality of life domains, and no changes in other variables. We conclude that moderate aerobic exercise should be advocated in the management of patients with type 2 diabetes. Key words: aerobic exercise, type 2 diabetes, Hong Kong Chinese, recreation therapy


Article
Therapeutic recreation in palliative care
Andrea M. Ganden, CTRS
Summer 2004; pages 43-45

Abstract
The palliative care team at the Peter Lougheed Centre (PLC), Calgary, Alberta, has been instrumental in promoting therapeutic recreation in palliative care. Opportunities for clinical practice, education, and research in recreation therapy within palliative settings are an emerging area of practice. Limited health funding often prevents the possibility of these opportunities. The palliative team at the PLC has created novel approaches to incorporating recreation therapy within the multidisciplinary team. The sale of a donated painting in 2002 with donor permission permitted the first year of funding of the therapeutic recreation specialist (TRS) position. Therapeutic recreation contributes to individuals’ quality of life during the last stage of life through pain management, reminiscing, and legacy building. This article outlines the role of a TRS on an acute palliative care team. Key words: recreation therapy, palliative care, quality of life, therapeutic recreation specialist, hospice

Book review
Exercise for Frail Elders, by Elizabeth Best-Martini and Kim A. Botenhagen-Digenova. Champaign, IL: Human Kinetics, 2003; 228 pages.
Karen Croteau, EdD; Nancy E. Richeson, PhD, CTRS
Summer 2004; pages 46-47

American Journal of Recreation Therapy
Fall 2004, Volume 3
, Number 4

Newsbriefs
ATRA inducts 2004-2005 board members; NCTRC announces updates, changes to certification standards; NRPA joins "You Can!" campaign for older adults; Cell phone technology employed in accessibility study; APT student research award submissions due January 7, 2005
Fall 2004; pages 5-6


Article
Recreational therapy exercise on the special care unit: Impact on behaviors
Linda L. Buettner, CTRS, PhD; Suzanne Fitzsimmons, MS, ARNP
Fall 2004; pages 8-24

Abstract
This four-week pilot intervention project examined the use of exercise for the treatment of agitation and passivity for nursing home special care residents with dementia. Twenty individuals were randomly assigned to either a morning exercise group (n = 10) or an afternoon exercise group (n = 10). Exercise sessions were offered five times per week for four weeks with measurements taken at baseline, after two weeks, and at the end of four weeks. Variables examined in this project included agitation, passivity, right and left grip strength, and flexibility. Those individuals in the morning exercise session demonstrated significant improvements in agitation, passivity, strength, and flexibility scores. Those individuals in the afternoon session showed a significant increase in agitation and little change in other variables. This study indicates that the morning time schedule is the most beneficial time of day to provide recreation therapy exercise programs and supports the progressively lowered stress threshold theory as it relates to care. Key words: dementia, recreational therapy, exercise, passivity, agitation, time of treatment


Article
The use of leisure education in assisted living facilities
Maridith A. Janssen, EdD, RTC/CTRS
Fall 2004; pages 25-30

Abstract
Increasingly, older adults are choosing to live in assisted living facilities. However, adjustment to their new environments can be difficult. Leisure education programs can help recreational therapists and other recreation professionals understand and design services specifically to meet the needs of residents. The purpose of this study was to measure the effects of a leisure education program on perceptions of quality of life in older adults. Based on an experimental design, the results showed that participation in leisure education affected perceptions of quality of life significantly (based on leisure p = .012 and growth p = .007). Key words: recreation therapy, leisure education, assisted living, geriatrics


Article
Recreation therapy as a nondrug approach to pain management in older adults with dementia
Nancy E. Richeson, PhD, CTRS
Fall 2004; pages 31-36

Abstract
Pain is a major clinical problem among older adults with dementia, whose functional status and comorbidities can present significant challenges to pain diagnosis and treatment. Recreation therapy interventions offer an effective nondrug approach to pain management for this population. However, in most long-term care settings, the certified therapeutic recreation specialist (CTRS) is not considered part of the interdisciplinary pain management team. This paper describes the scope of pain as a clinical problem among older adults, conceptualizes the role of the CTRS on the interdisciplinary pain management team in a long-term care setting, and provides a sampling of recreation therapy interventions for reducing pain in persons with dementia. Key words: recreation therapy, pain, nondrug interventions


Article
Self-efficacy: Underlying psychological structures and processes
James B. Wise, PhD, CTRS
Fall 2004; pages 37-40

Abstract
Self-efficacy has been promoted as a key construct within therapeutic recreation (TR) contexts. Clients who are efficacious continue to perform desired behaviors learned in treatment after they are discharged. A better understanding of the factors that give rise to self-efficacy beliefs could help TR professionals develop interventions that are effective in altering their clients’ confidence. This increased understanding may be supplied by the knowledge-and-appraisal personality architecture (KAPA) recently forwarded by Cervone.1 The theory identifies the psychological structures and process that lead to the formation of self-efficacy judgments. In an attempt to make the information accessible to practitioners, this paper briefly reviews the theory and explores its implications for TR practice. Key words: recreation therapy, knowledge-and-appraisal, self-efficacy


Article
A softer splash: Gentler options for teaching water exercise
Betsy Noll, PTA, WSI
Fall 2004; pages 41-45

Abstract
A gentle aquatic exercise program can improve range of motion, strength, balance, and functional mobility of persons with dementia. Safety in the aquatic environment is of the utmost importance. Therefore, the program requires that you obtain a physician’s consent form, emergency information form, emergency action plan, knowledge of contraindications of participants and pool precautions, and additional caregivers to assist clients in the pool and with dressing. The person running the program must acquire knowledge concerning the pool facility including the location of steps, handrails, surface areas, and accessibility to locker rooms. Once you have identified the staff, facility, and participants and noted any precautions, you can design a simple, fun exercise program. Songs, socialization, and movement performed in the gravity-reduced, resistive environment of the water will improve the participants’ functional mobility, respiratory capacity, endurance, and sense of well-being. Key words: recreation therapy, aquatic therapy, dementia, low-impact exercise

Book review
Music Therapy and Leisure for Persons with Disabilities, written by Alice L. Barksdale, Champaign, IL: Sagamore Publishing, 2003; 148 pages.
Robert E. Krout, EdD, RMTh, MT-BC
Fall 2004; pages 47-48