American Journal of Recreation TherapyAbstracts
American Journal of Recreation Therapy ®


American Journal of Disaster Medicine

Journal of Opioid Management

Opioid Management Society
Opioid Education Programs

Journal of Neurodegeneration & Regeneration

Activities Directors' Quarterly for Alzheimer's & Other Dementia Patients

American Journal of Recreation Therapy

Journal of Emergency Management

Healing Ministry

Advertising information

Subscription information

Reprint information

Manuscript submission

Current table of contents

Contact information

American Journal of Recreation Therapy
Winter 2007, Volume 6
, Number 1

Letter to the editor. Narratives.
Susan ‘BOON’ Murray, EdD, CCLS, CTRS
Winter 2007; pages 5-5

Individualizing group music therapy for residents with dementia: Challenges and strategies for data collection and presentation of treatment results
Robert E. Krout, EdD, RMTh, MT-BC; Beth Beathard, BM, MT-BC
Winter 2007; pages 6-12

Music therapy can be an effective treatment modality for working with seniors with dementia in a number of needs areas, and it has been shown to be particularly successful with seniors living in residential placements. This project was designed as a pilot study to assess sample outcomes of an 11-session music therapy program. This program sought to individualize group interventions while addressing the varying needs and ability levels of each resident, as well as to collect sample evidence-based data on each resident’s performance in the group across multiple sessions. The program was implemented with nine residents with moderate to late-stage dementia in an elderly care facility. The program and individualization of the group experiences are described, along with data collection procedures designed to represent sample progress of residents across time. Examples of the data collection forms and graphs representing residents’ progress are included. Implications for music and recreation therapists who wish to replicate the methods used in this project are shared. Key words: music, Alzheimer’s, group, data collection

Adolescents with spinal cord injury: Indications and suggestions for recreation therapy practice
Don Rogers, PhD, CTRS; Youngkhill Lee, PhD, CTRS; Heewon Yang, PhD
Winter 2007; pages 13-24

The purpose of this article is to examine rehabilitation indications and recreation therapy interventions for spinal cord injury (SCI) occurring during adolescence. For the adolescent with SCI, the impairments associated with paralysis result in significant disabilities that potentially complicate the physical, psychological, and social transitions typical of that life stage. There are leisure-related concerns that include lowered activity levels, boredom, and diminished social interaction. Transitioning from childhood to adulthood may be more complicated than usual for the adolescent with SCI. It is during this time that critical roles and values are explored with the hope of achieving the foundation for adult identity. With the introduction of SCI, there is greater potential for lingering identity crisis. It is suggested that recreation therapy interventions utilize a resilience/competence framework within a comprehensive biopsychosocial rehabilitation/habilitation model. Key words: adolescence, leisure, spinal cord injury, resilience, biopsychosocial

Recreational games: Simple and effective cognitive stimulation programs for residents with dementia in long-term care settings
Linda Buettner, PhD, CTRS; Ann Kolanowski, PhD, RN, FGSA, FAAN; Fang Yu, PhD, CRNP, RN
Winter 2007; pages 25-30

The purpose of this article is to illustrate how recreation therapy games can be used to help older adults with Alzheimer’s disease or related disorders successfully engage in cognitive programs in long-term care (LTC) settings. LTC residents with dementia often exhibit psychological and behavioral symptoms such as depression, withdrawal, anxiety, emotional outbursts, and negative interactions with others that are frequently related to a lack of appropriate stimulation. This article discusses the current literature supporting the use of games and cognitively stimulating activities that can be provided by recreation therapists in LTC settings. Key words: recreation therapy, cognitive games, stimulation, long-term care

Local coverage determinations in psychiatric treatment settings
Tim Passmore, EdD, CTRS; Donna K. Lindenmeier, PhD; Hugh Gibson, EdD
Winter 2007; pages 31-39

Coverage of recreation therapy in psychiatric treatment settings has been a topic of discourse for close to 30 years. The American Therapeutic Recreation Association has been at the center of the discussions for approximately 15 years, making exerted efforts to obtain clarification on interpretations of the Medicare regulations that govern psychiatric treatment settings. The Centers for Medicare and Medicaid Services has developed a process of providing public clarification of Medicare regulations through local coverage determinations (LCDs), issued through fiscal intermediaries and Medicare administrative contractors. This manuscript reviews those LCDs and the Medicare regulations the LCDs interpret and dictate medical policy for. Key words: recreation therapy, psychiatric treatment settings, local coverage determinations, Centers for Medicare & Medicaid Services

Effects of inpatient rehabilitation on the metabolic system and physical capacity of obese children and adolescents
Meike Küster, PhD; Burkhild Knauth, MD; Helmut Langhof, MD
Winter 2007; pages 40-48

Background: The prevalence of obesity in children and adolescents is increasing enormously and causing high costs to the healthcare system. The purpose of this study was to examine metabolism in obese children and adolescents and the effects of treatment in a pediatric rehabilitation clinic on their physical capability. Methods: In 87 patients between the ages of 10 and 19, BMI, body composition, lipoproteins, insulin resistance, thyroid hormones, and leptin were assessed at the beginning and end of a four-to-six-week inpatient treatment. Results: The arithmetic mean of patients’ insulin resistance was above the normal range at the beginning of the study. In addition to the expected weight loss, there were significant reductions in cholesterol, LDL cholesterol, triglycerides, and cholesterol/HDL quotient (p < 0.001 for each). Significant reductions were also seen in fasting insulin, HOMA, leptin, and TSH (p < 0.001 for each). Physical fitness, which did not correspond to average age, was improved decisively. Conclusion: Significant protective improvements can be made through intensive interdisciplinary treatment within a few weeks. The treatment can reduce risk factors for metabolic syndrome and cardiovascular diseases such as insulin resistance. This study is the most intensive exercise intervention ever implemented in children to be entirely in line with the recent recommendations of Strong et al. Key words: obesity, inpatient rehabilitation, metabolic profile, physical capability

American Journal of Recreation Therapy
Spring 2007, Volume 6
, Number 2

Editorial. Nonpharmacological approaches to care: The need for an interdisciplinary and evidence-based approach
Linda L. Buettner, PhD, CTRS; Suzanne Fitzsimmons, MS, ARNP
Spring 2007; pages 5-6

Clinical supervision program design in recreation therapy
David B. Jones, EdD, CTRS; Barbara R. Harvey, MEd, MS, LCPC, CTRS
Spring 2007; pages 7-18

As recreation therapy matures as a profession, various mechanisms will need to be put into place to ensure the professional development of practitioners, and thus the protection of clients served. Clinical supervision is one such mechanism for improving professional competence, helping with difficult clients, clarifying ethical issues, exploring feelings toward clients, and gaining professional support. This article provides an overview of clinical supervision, including a definition and goals. One example of a clinical supervision program for recreation therapy is presented in a program-design format. Related ethical and legal issues are addressed. Key words: clinical supervision, recreation therapy, program design

Investigation of graduate therapeutic recreation curricula in the United States
Norma J. Stumbo, PhD, CTRS, FALS; Marcia J. Carter, ReD, CPRP, CTRS; Jean E. Folkerth, ReD, CTRS
Spring 2007; pages 19-31

The intent of the present investigation was to examine graduate therapeutic recreation curricula across the United States. Although several studies have examined undergraduate curricula or addressed various educational issues, no previous study has been conducted solely on graduate curricula. This study used a mail-survey approach and focused on six elements: 1) university and unit characteristics, 2) faculty, 3) students, 4) curricular offerings and degree requirements, 5) assistantship characteristics, and 6) graduation and employment rates. A list of 47 universities purported to have graduate programs in therapeutic recreation was culled from professional and credentialing organizations. Thirty-two surveys were returned (68.1 percent return rate), 19 (59.4 percent) of which reported graduate programs in therapeutic recreation. Graduate programs were most likely to be housed at public institutions, in blended colleges of education, and in recreation and leisure departments. On average, the 19 responding institutions with graduate programs had 7.0 full-time recreation faculty and 2.1 full-time therapeutic recreation faculty. The average teaching load of therapeutic recreation graduate faculty was six courses per year. An average of 10.1 full-time master’s and 2.5 full-time doctoral students were enrolled in therapeutic recreation education programs. Nearly 80 percent of both master’s and doctoral students were female. Most master’s and doctoral programs reported stable enrollments. Curricular configurations at both levels varied widely. Slightly over half of master’s students and virtually all doctoral students were employed in assistantships. Graduation and employment rates are reported, for the most part, to have remained steady. The discussion includes the implications of these findings for the field, as well as 10 recommendations based on the data. Key words: therapeutic recreation, graduate curriculum, master’s degree, doctoral degree, degree requirements

The effect of the N.E.S.T. approach on a dementia-specific unit
Jo A. Lewis, MS, CTRS
Spring 2007; pages 32-38

Research has supported the perspective that behaviors exhibited by individuals with dementia are expressions of unmet needs. The N.E.S.T. approach offers a systematic, nonpharmacological approach to addressing these disturbing behaviors. In the project described in this article, the N.E.S.T. approach was implemented in a skilled nursing facility. The effectiveness of the N.E.S.T. approach was evaluated through pre- and post-tests test comparing the number of falls and the number of resident-to-resident acts of aggression by individuals residing on these units prior to and upon completion of the N.E.S.T. training. As a result of the implementation of the N.E.S.T. approach, the number of falls decreased by 47 percent and the number of resident-to-resident acts of aggression decreased by 80 percent. Limitations and barriers, as well as future recommendations for the implementation of this program in other skilled nursing facilities, are discussed. Key words: dementia, disturbing behaviors, nonpharmacological approach, N.E.S.T.

The experience of ambivalence: A return to recreation activities by a woman with rheumatoid arthritis
Lei Guo, PhD; Youngkhill Lee, PhD, CTRS; Marjorie J. Malkin, EdD, CTRS
Spring 2007; pages 39-47

Researchers have conducted various studies to find out how individuals with chronic illness attempt to achieve and/or maintain as “normal” a life as possible in spite of sometimes devastating changes. The phenomenon of “comeback” captures such efforts to establish normalcy by individuals with chronic illness. This case study examines a comeback to recreation activities by a woman with rheumatoid arthritis (RA). Through analysis of the data collected in four in-depth interviews with the participant, ambivalence toward leisure experience was identified as a theme characterizing the comeback phenomenon for this woman. Specifically, ambivalence concerning her recreation experience was expressed by conflicting feelings regarding a) normalcy and abnormalcy (the client’s terms), b) confidence and lack of confidence, and c) continuity and discontinuity. The ambivalent feelings are a significant aspect of the client’s attempts to overcome disruption resulting from her RA through recreation activities and to establish a new balance of self while living with her illness. Key words: rheumatoid

Tips to consider. The geriatric recreation therapist’s role in disaster preparedness
Melissa J. Long, CTRS
Spring 2007; pages 48-48

American Journal of Recreation Therapy
Summer 2007, Volume 6
, Number 3

Editorial. Recreation therapy: On the winds of change
Linda L. Buettner, PhD, CTRS
Summer 2007; pages 5-6

The impact of animal-assisted therapy on patient ambulation: A feasibility study
Rita K. Bode, PhD; Brienne R. Costa, CTRS, BSc; Joseph B. Frey, BA
Summer 2007; pages 7-19

Objectives: To explore the feasibility of evaluating the effectiveness of animal-assisted therapy (AAT) in a rehabilitation setting; conduct a pilot study of effect of AAT on ambulation. Design: Prospective study. Setting: Inpatient rehabilitation facility in a large Midwestern city. Patients: 23 persons with neurological conditions. Intervention: Ambulation with and without a dog and volunteer trainer. Main outcome measures: Walking time, distance, and speed; participant evaluations. Results: A standardized protocol to evaluate the effectiveness of AAT in improving ambulation was successfully implemented. Participants liked working with a dog, felt a dog helped them walk better, and would work with a dog again if they could. Participants and observers recommended a number of changes in the protocol for future studies. Although the results of the pilot study on ambulation were not statistically significant, there was a trend toward greater time spent walking, distance walked, and speed when walking with the dog. Conclusions: It was possible to develop a standardized protocol to evaluate the effectiveness of AAT. Walking with a dog improved patient ambulation and patients responded positively to the experience. Key words: Animal-assisted therapy, ambulation, standardized protocol

Health inequities in long-term care: Through the eyes of the consumer
Cristina Meneses, MS, CTRS; Janice Elich Monroe, PhD, CTRS
Summer 2007; pages 20-26

Current trends in healthcare focus on eliminating healthcare inequity by training practitioners to be culturally competent providers of services. This article argues that providing equitable healthcare services goes beyond developing an awareness of individuals’ cultural background and developing sensitivity to their needs. To eliminate healthcare inequity, the government and healthcare professionals need to understand the role of systematic institutional oppression and how it affects marginalized individuals in society. A theoretical framework describing institutional oppression is provided. Focus will be on four specific areas of oppression faced by nursing home residents. Four interviews are incorporated into this article, which illustrate the racism, anti-Semitism, heterosexism, and ageism experienced by residents in a nursing home in Boston, Massachusetts. Recommendations for the elimination of institutional oppressions are presented. Key words: ageism, anti-Semitism, healthcare inequity, heterosexism, oppression, racism, sexism

Coverage, not reimbursement, of recreational therapy in the four primary treatment settings
Tim Passmore, EdD, CTRS
Summer 2007; pages 27-34

The coverage of recreational therapy in all four primary treatment settings (inpatient physical rehabilitation, inpatient psychiatric treatment, partial psychiatric hospitalization, and skilled nursing facilities) is often an area of concern for recreational therapists and administrators of active treatment settings. This manuscript provides an insight into current interpretations by Fiscal Intermediaries and Medicare Administrative Contractors that interpret the Medicare regulations for the Centers for Medicare and Medicaid Services. Key words: coverage, inpatient physical rehabilitation, inpatient psychiatric treatment, partial psychiatric hospitalization, recreational therapy, skilled nursing facilities

Using poetry in therapeutic recreation interventions with a focus on applications in behavioral healthcare
Erin K. Moore, EdM Candidate; Catherine P. Coyle, PhD, CTRS
Summer 2007; pages 35-47

Recreation therapists incorporate a wide variety of therapeutic modalities into their interventions and practice. This article reviews the literature on the use of poetry as a therapeutic modality. Information on 1) the inherent therapeutic nature of poetry, 2) the various poetic styles available for use, and 3) “traditional” sequence and structure followed when using this art form as a therapeutic modality within therapeutic recreation practice is reviewed. Information related to resources for selecting poems and obtaining advance training in the use of this modality is provided, as well as a review of the evidence-base for using poetry within behavioral healthcare settings. Key words: poetry-based interventions, poetry therapy, mental illness, bibliotherapy, creative arts in therapy

Vignette. On being heard
Suzanne Fitzsimmons, ARNP
Summer 2007; pages 48-48

American Journal of Recreation Therapy
Fall 2007, Volume 6
, Number 4

Cognitive Calisthenics pilot program
Deborah A. Hutchins, EdD, CTRS; Sara Zeno
Fall 2007; pages 5-6

Physical activity and older individuals: Benefits, barriers, and interventions
Norma J. Stumbo, PhD, CTRS; Shane Pegg, PhD; Elisabeth Lord, MA
Fall 2007; pages 7-18

As life expectancy increases and the population ages around the globe, concerns about growing levels of physical inactivity and decline, and community changes in the self-assessed levels of health, are becoming key issues for individuals and governments alike.1 While one of the key factors found to be vital for good health and for an enhanced quality of life is physical activity, it is becoming increasingly evident that a growing number of older adults do not engage at any meaningful level.1 This issue is critical yet remains one not well addressed by those within the therapeutic recreation (TR) profession to date. As such, the purpose of this article is to highlight the barriers to, and benefits accrued from, physical activity for older individuals, and to outline specific recommendations for the planning and provision of physical activity programs for older individuals. Importantly, this article also seeks to exemplify the key role that TR can play in enhancing the lives of older adults. It is anticipated that this article will be of substantial value to TR specialists interested in using physical activity as an intervention for older adults, hopefully spurring further contemplation, discussion, and action about lifestyle choices and active leisure options made available to this growing and consumer-savvy segment of the population. Key words: barriers, benefits, interventions, older adults, physical activity

Activity patterns of youth with spina bifida
Erin Fogarty, MS, CTRS; Jan S. Hodges, PhD, CTRS; Barbara Wilhite, EdD, CTRS
Fall 2007; pages 19-26

Activity involvement is believed to contribute to overall health and well-being. However, little is known about the activity involvement of youth with spina bifida. Implications of the condition and barriers that many people with disabilities face can reduce the involvement by youth with spina bifida. This study provides a snapshot of the activity behaviors of 49 youth with spina bifida, obtained through clinical interviews. The youth in this study reported more involvement in sedentary and solitary activities. Discussion includes how therapeutic recreation specialists can be influential in increasing activity participation by youth with disabilities. Key words: active living, physically active leisure, spina bifida, therapeutic recreation, youth

Impact of participation in community-based recreation programs on reported loneliness and feelings of usefulness of individuals diagnosed with early stage Alzheimer’s disease
Tim Passmore, EdD, CTRS; Donna Lindenmeier, PhD; Tyler Tapps, MS; Hugh Gibson, EdD
Fall 2007; pages 27-39

Community-based recreation programs have been discussed as an alternative to utilization of adult day programs and early admission to long-term care facilities for individuals with early stage Alzheimer’s disease exhibiting disruptive behavioral characteristics. This article presents a year-long study of such individuals in the state of Missouri who participated in community-based recreation groups titled Empowerment Groups. The findings of this study suggest that the community-based recreation programs might pose a valid alternative, as the literature suggests, to adult day programs or early admission to long-term care facility. Key words: Alzheimer’s disease, community-based recreation, early stage Alzheimer’s disease, loneliness, usefulness

A longitudinal study—Attitude to physical activity of adolescent substance abusers
Marie Claire Van Hout, MSc, BA(Hons); Sean Connor, PhD, MA, BA(Hons)
Fall 2007; pages 40-48

Background: Involvement in physical activity and sport has been associated with reduced substance misuse patterns, abstinence, and successful rehabilitation.1 Aim: This research investigated the initial short-term (in treatment: six weeks) and long-term impact (in aftercare: two years) on attitude toward physical activity with corresponding participation levels in a group of adolescent addicts (n = 176) who participated in a structured physical activity program during residential treatment. Methods: Physical activity participation level was measured using a self-report questionnaire, and attitudes toward physical activity were measured using the Kenyon Attitude Scales2 at various stages: on commencing treatment, on completion, six weeks posttreatment, and in the two-year aftercare program. Physical activity was conceptualized as social experience, health and fitness, pursuit of vertigo, aesthetic experience, catharsis, or ascetic experience. Results: Physical activity participation level increased during residential treatment and decreased during nonresidential aftercare. Total Kenyon scores revealed a significant difference in overall attitude to physical activity between completion of treatment and when in the two-year after care program (p < 0.01). It is notable that favorable increases in attitude toward all six dimensions of physical activity2 are present during the treatment intervention, and fail to be maintained on reentry to familiar/prior environments and stimuli. Conclusions: The reduction in overall attitude toward physical activity and participation level on return to old environments and stimuli indicate that positive acquired values were not maintained postintervention. Adolescent substance abusers in after care must be provided with support in developing and maintaining a physically active lifestyle post-drug rehabilitation. Key words: adolescent substance abuse, attitude, physical activity, rehabilitation

The Reality Comprehension Clock Test: A brief, reliable, and valid measure of cognitive functioning in adults diagnosed with mental retardation
Ruthie Kucharewski, PhD, CTRS; Lee W. Ellis, PhD; Roy H. Olsson Jr., PhD, CTRS
Fall 2007; pages 49-53

The purpose of this study was to confirm the validity and the reliability of the Reality Comprehension Clock Test (RCCT) as a brief measure of cognitive functioning with adults with mental retardation. The sample size consisted of 117 adults aged 20 to 59 who were diagnosed with mental retardation and were employed by a sheltered workshop. The Wechsler Adult Intelligence Scale (WAIS) score was used to compare it with the RCCT score. The results indicated an acceptable relationship between the full scale WAIS intelligence quotient score and the RCCT score, which would indicate that the RCCT did test cognitive skills and performance. Key words: clock tests, WAIS, cognitive functioning, mental retardation, recreation therapy