American Journal of Recreation TherapyAbstracts
American Journal of Recreation Therapy ®

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American Journal of Recreation Therapy
Winter 2009, Volume 8
, Number 1


Article
Revisiting the philosophical foundations for recreational therapy: An imperative for survival
Thomas K. Skalko, PhD, LRT, CTRS
Winter 2009; pages 7-14

Abstract
The establishment of a philosophical orientation for the field of recreational therapy has been a pressing issue for decades. The article addresses the historical foundations of the field and the evolution of the philosophical orientation debate. Contemporary social, health care, and legislative issues are addressed. Key words: recreational therapy, therapeutic recreation, philosophical positions


Article
Toddlers with autism: A sensory tree house intervention for recreation therapy
Linda L. Buettner, PhD, CTRS, LRT; Amber Lesovoy
Winter 2009; pages 15-18

Abstract
This is a new section of AJRT and we would like to request submissions for upcoming issues. If you have an innovative program idea to share please submit your program to ajrt@pnpco.com.


Article
Mr. A: A study of spinal cord injury
Brianne Martindale, MS
Winter 2009; pages 19-24

Abstract
This paper provides the “how” and the “why” of recreation therapy practice in a major teaching hospital for a patient with a spinal cord injury. Research methods tell us we base our preferred methods on the amount of control over and access to an actual behavior event. Histories are the preferred method when there is no control over the situation and we collect artifacts. A case study is the preferred method when the patient is interviewed and there is direct observation of the events unfolding. For researchers in recreation therapy the case study model is an important record to provide evidence for our practice. This student case study was completed under the close supervision of a clinical internship supervisor and the university supervisor during an internship. Key words: recreation therapy practice, case study model


Article
Uses of therapeutic thematic arts programming, TTAP Method©, for enhanced cognitive and psychosocial functioning in the geriatric population
Linda Levine-Madori, PhD, CTRS, ATR-BC, LCAT
Winter 2009; pages 25-31

Abstract
Currently, there is a need for strength-based recreation therapy approaches which promote the retention of skills and abilities of the growing older adult population. This article introduces an emerging multimodal intervention: Therapeutic Thematic Arts Programming for Older Adults (TTAP Method©), an approach that provides stimulation to three distinct brain systems, encouraging brain wellness and neural regeneration, thereby providing a viable means for enhancing cognitive functioning in older adults. Research on TTAP Method© efficacy is currently being explored at Cornell University and previous pilot studies strongly indicate that the TTAP Method© may be an effective intervention for slowing the progression of mild cognitive impairment to Alzheimer’s disease. TTAP Method© is person centered and culturally competent, and engages a variety of creative activities. Key words: TTAP Method, Alzheimer’s disease, cognitive functioning, psychosocial wellbeing, multimodal intervention, creative arts therapies


Article
The recreational therapist’s role in treating delirium
Suzanne Fitzsimmons, MS, GNP, ARNP; Linda L. Buettner, PhD, CTRS, LRT
Winter 2009; pages 33-47

Abstract
Delirium is a common syndrome in older adults especially for those in hospital and acute settings. Delirium is sometimes reversible; however, it is associated with increased mortality, increased hospital costs, and long-term cognitive and functional impairment. Fortunately if recognized early, it can be treated successfully without complications and declines in health and function. Delirium can also be prevented with identification of highrisk patients and the implementation of interventions. Because delirium may be underrecognized by physicians and nurses, routine screening for delirium should be part of comprehensive nursing care of older adults. Recognition of delirium is complicated as it may be difficult to differentiate delirium from dementia and depression. This article will review the risks, signs and symptoms, consequences, and assessment techniques for the detection of delirium in this population. Key words: delirium, recreational therapy, screening

American Journal of Recreation Therapy
Spring 2009, Volume 8
, Number 2


Article
Service-learning focused on the professional advancement of recreation therapy
David B. Jones, EdD, CTRS
Spring 2009; pages 5-6

Abstract
Service-learning can provide students with opportunities to gain invaluable insight related to the context of professional practice while offering practical benefits to the recreation therapy profession. Recreation therapy students, through their senior capstone management course at the University of Southern Maine, planned, implemented and evaluated a professional conference that focused on recreation therapy licensure. Students not only obtained practical knowledge and training, they also provided a timely educational opportunity for recreation therapy specialists in Maine and New England. Just as importantly, participation in this service-learning project greatly enhanced the students’ professional identities. Key Words Service-learning, licensure, professional conference, recreation therapy


Article
What’s in a name? Exploring the preferred terminology of professionals in the field of recreation therapy
Angela J. Wozencroft, PhD, CTRS; Emily J. Kennedy, MS, CTRS; Angie N. Pihera, MS, CTRS
Spring 2009; pages 7-16

Abstract
Although it is widely recognized within the field of Therapeutic Recreation/Recreation Therapy (TR/RT) that there is discrepancy involving terminology used to describe our field, there have been no professional studies focusing on this issue. This study examined professionals’ preferences surrounding terminology in the field of TR/RT. The data were collected through online discussion boards on the social networking site “Facebook” and analyzed using a qualitative analysis of the discussion responses. Of the 47 respondents, 10 members preferred the term Therapeutic Recreation to Recreation Therapy, and 22 preferred Recreation Therapy. In addition, there were 10 members who preferred a combination of the two terms and five others who did not express a preference. Among all of the responses, five themes were identified: 1) setting/service specific, 2) consistency with other allied health professional, 3) title related to certification, 4) unity, and 5) respect and credibility. Key words: Therapeutic Recreation, Recreation Therapy


Article
Culturally competent recreation therapy: Individualism and collectivism
Junhyoung Kim, MS; Michelle King, MS, CTRS; Junsurk Park, MS
Spring 2009; pages 17-21

Abstract
To provide effective recreational therapy for clients who have collectivistic cultural values and beliefs, recreational therapists need to recognize cultural differences and understand how each cultural background affects a client’s health beliefs and behaviors. The goal of this article is to examine different cultural perspectives to improve cultural competence of recreational therapists to provide more effective recreation programs for clients who have collectivistic cultural values and beliefs. This article represents three basic different frameworks: the meaning of self; cultural meanings of happiness; and the relationship between therapists and clients. Key words: cultural competence, cultural difference, individualistic, collectivistic, self, happiness


Article
Ambiguous loss and shared leisure barriers of family caregivers
Leandra A. Bedini, PhD, LRT/CTRS; Nancy J. Gladwell, ReD, CPRP
Spring 2009; pages 23-30

Abstract
Ambiguous loss is a concept that describes the loss of a significant other through illness or disabling condition rather than death. With regard to leisure, ambiguous loss is experienced when one’s loved one has a physical or mental disability that prevents him or her from being actively involved in shared leisure experiences with his or her spouse/partner. For many family caregivers, ambiguous loss creates an additional constraint to their leisure pursuits because of the importance placed on participating with their leisure partners. In addition, these dyads often lack information and strategies to negotiate this barrier. This article addresses specific ways that therapeutic recreation professionals can reduce the sense of loss and increase access to satisfying leisure experiences for both the family caregiver and their care-recipient. Key words: ambiguous loss, caregiving, shared leisure


Article
Efficacy of an adventure therapy program for brain injury survivors and caregivers
James Newman, CTRS; Elizabeth Newstadt
Spring 2009; pages 31-37

Abstract
The Adventure Therapy Program for Traumatic Brain Injury Survivors and Caregivers at Radford University is a recreation therapy program that uses adventure-based activities to decrease the stress, approach, and understanding of the traumatic brain injury survivor and caregiver relationship and individual experiences. There is empirical support for the use of inclusive outdoor recreation programs, in bringing about positive social behavior changes. The specific benefits reported in this area are as follows: increased group cooperation, increased individual and group socialization, reduction of maladaptive behaviors, increased acceptance and quality of life for individuals with disabilities, and increased social adjustment and inclusion. These benefits coincide with the needs of the study population, and the results of this study suggest that further development in this area have potential for increasing the success of community transitions. Key words: TBI, adventure programming, caregivers, ropes course


Article
Emergency planning and people with disabilities: Massachusetts’ lessons learned
Erin McGaffigan, MSW, MS, Public Policy; Chris Oliveira, BS; Diane Enochs, BA, MA
Spring 2009; pages 39-46

Abstract
Continued challenges responding to large-scale emergencies are recognized in the aftermath of events such as Hurricanes Katrina and Rita. Elders and people with disabilities often included under the label of “vulnerable” or “special populations,” are especially hard hit given communication and accessibility barriers often faced even prior to an emergency. Approximately 15 percent of those living within our communities have disabilities, which jumps to 41 percent for those 65 years or older.1 The prevalence of functional limitations due to age or disability indicates the need for these factors to be accounted for in planning, response, recovery, and mitigation efforts at the national, state, and local level to ensure a truly effective emergency response system that meets the needs of all residents. To achieve this effort emergency management, public health, disability and elder stakeholders within Massachusetts joined together to identify the existing planning gaps and to explore potential solutions to support emergency preparedness so that emergency management systems are responsive to all individuals in the community, regardless of age or disability. The Commonwealth’s process and lessons learned are discussed later. Key words: special populations, vulnerable populations, planning, policy design, inclusion, stakeholders, disability, elderly


Article
Book review
Leandra A. Bedini, PhD, LRT/CTRS
Spring 2009; pages 47-48

Abstract
Leisure and Aging: Ulyssean living in later life 4th edition by Francis A. McGuire, Rosangela K. Boyd, and Raymond E. Tedrick. Sagamore Publishing, 2009.

American Journal of Recreation Therapy
Summer 2009, Volume 8
, Number 3


Article
Editorial Pop culture and recreation therapy education
Linda L. Buettner, PhD, CTRS, LRT, Editor-in-Chief
Summer 2009; pages 5-6


Article
Community reintegration: Therapeutic dining program for older adult following stroke
Christina Harper
Summer 2009; pages 7-18

Abstract
Therapeutic dining programs are part of the community reintegration process for clients recovering from a stroke. It is a supervised program performed in social settings that consists of a combination of techniques to improve the eating situation. Therapeutic dining programs are a beneficial form of therapy for many rehabilitative groups. This specific program has been tailored to older adults who are recovering from a stroke. Its main goals, aside from improving the eating situation, are to prevent another stroke from happening and decrease depression symptoms and increase self-esteem by reintegrating clients back into the community. I looked into several different community reintegration program and nutrition and eating after stroke studies in which positive outcomes were found for post-stroke clients. All studies and research used has provided a strong support for the specific proposed intervention program for my client Kelly, who is an older adult female recovering from a stroke. Assessments selected: The Barthel Index, Nutritional Status, and Geriatric Depression Scale (GDS). Plan: Small group therapeutic dining program with other older adults in the afternoon. Intervention: Therapeutic Dining Program three times a week for eight weeks to improve eating situation, promote healthy eating, decrease symptoms of depression, and increase self esteem and social activity. Evaluation: The Barthel Index, Nutritional Status, Geriatric Depression Scale plus a Stroke Recovery Scorecard. Clients Goals: 1) Client will lower the risks of having another stroke. 2) Client will increase their eating situation experience and self-esteem while decreasing their depression symptoms. 3) Client will get involved in one support group or leisure activity outside of recreational therapy (RT) dining program for community reintegrated leisure pursuits. Key words: community reintegration, stroke, therapeutic dining


Article
Assessments for East Asian clients: Culturally competent recreational therapy
Junhyoung Kim, MS; Donna Lozano, MEd, CTRS
Summer 2009; pages 19-24

Abstract
Recreational therapists who have developed a level of understanding and awareness of other cultural norms, specifically East Asian cultural norms, will be better prepared to accurately interpret assessment results, to establish a treatment plan, and to implement the therapeutic recreation process within a recreational therapy setting. These therapists are more likely to provide effective healthcare services which will enhance the quality their clients’ lives. In addition, the development of assessment processes that take into consideration the therapist’s own cultural identity as well as the patient’s cultural orientation, primary language, level of acculturation, acculturation stress, level of functioning, family relationships, support systems and concepts, and definitions of health, disease, healthcare utilization, and healing are necessary to foster successful therapeutic relationships and recreational interventions with East Asian clients. Key words: cultural competence, assessment, cultural variables, cultural awareness, therapeutic recreation process


Article
Effects of modified Tai Chi Chuan on balance in older adults
Brian R. Snapp, MS; Marjorie J. Malkin, EdD, CTRS; Leslie F. Lloyd, RhD, CRC
Summer 2009; pages 25-30

Abstract
The purpose of this study was to test the overall balance of older adults who participated in a modified 10-step Tai Chi Chuan program. The 19 participants who were chosen for this study all resided in rural southern Illinois at either an assisted living facility or an independent living facility. All of the participants were over the age of 65, and had experienced a reduction in the ability to maintain balance. The Balance Scale served as the instrument to measure balance in participants.18 Measures were taken at the baseline and at the end of program to test for improvement. The test group included 10 participants who practiced Tai Chi. The comparison group included nine participants who practiced non-Tai Chi exercise. The program lasted eight weeks and both groups met for 30-minute sessions three times a week. Results indicate both the test group and the comparison group received health benefits. Data analysis indicated a moderate to strong relationship between the practice of Tai Chi and balance improvement in the test group. Interestingly, the balance measures of the comparison group who participated in the non-Tai Chi exercise also improved. Thus, the data indicate a moderate improvement in balance among an aged population for both non-Tai Chi exercise and Tai Chi exercise. Key words: Tai Chi, older adults, recreational therapy


Article
The development of technical standards for undergraduate studies in recreational therapy
Peg Connolly, PhD, LRT/CTRS; Jennifer L. Hinton, PhD, LRT/CTRS; Bruce Martin, PhD
Summer 2009; pages 31-40

Abstract
The purpose of this article is to present a set of technical standards for recreational therapy professional preparation programs at the baccalaureate level. Technical standards are incorporated into the majority of healthcare professions education programs. Even though recreational therapy is classified as a healthcare profession, technical standards have not been developed for the field. A preliminary set of technical standards for an undergraduate degree program in recreational therapy was developed for a university in the southeastern region of the United States, based on review of technical standards from other fields. Information is provided about policies governing the implementation of these technical standards along with a review of issues relevant to application of technical standards to students with disabilities. Further research is suggested. Key words: technical standards, core standards, competence, recreational therapy undergraduate education, healthcare education


Article
Case history: Use of the NintendoWii to increase fine motor dexterity post cerebral vascular accident
Karen Drexler, MS, LRT/CTRS
Summer 2009; pages 41-46

Abstract
Use of the low cost commercially available gaming console (Nintendo Wii) is a current trend in the rehabilitation environment. Released in 2006 by Nintendo, Veterans Affairs Medical Centers across the country are just setting one, Wii is being used as a physical, social, and cognitive tool. This case report seeks to provide evidence of its use as a rehabilitation tool for individuals who have experienced a recent stroke. By using whole body movements, the Wii sports games help in both gross motor and fine motor skills as well as in hand–eye coordination. This case study involves an older adult who is recovering from a cerebral vascular accident (CVA) and how using the Wii bowling game assisted to increase his fine motor strength and dexterity. CVA or stroke also called a “brain attack” can affect various parts of the brain. There are various signs and symptoms of CVA and these vary in each individual. Some of the signs that an individual having CVA shows are: sudden numbness or weakness of the face, arm or leg (especially on one side of the body), sudden confusion, trouble speaking, or understanding speech, sudden trouble seeing in one or both eyes, sudden trouble walking, dizziness, loss of balance or coordination, sudden severe headache with no known cause. This case study involved an older adult who experienced a CVA involving hemorrhage in the right cerebellum as revealed in a CT scan. This CVA affected the right hand of this individual. Hemorrhagic stroke occurs when a blood vessel in the brain ruptures. This lets blood to spill into nearby brain tissue, which damages the cells. Some brain cells die because their normal blood supply is cut off. Certified Therapeutic Recreation Specialist and Author of this case article utilized the Salisbury Veterans Affairs Medical Center Recreational Therapy initial intake assessment and discovered per patient’s report that he had decreased strength and fine motor dexterity in the fingers of his right hand status post CVA. This patient reported that after his stroke, he was not able to hold a utensil in his right hand. This case study speaks the use of the Nintendo Wii in assisting patient to regain use of the fingers of the hand that was affected by the CVA. This article can provide information for other Certified Therapeutic Recreation Specialists as to the use of the Nintendo Wii™ as a treatment modality. This device can demonstrate outcomes of improving fine motor dexterity for those who are recovering from a CVA. Key words: stroke, fine motor rehabilitation, virtual rehabilitation, Wii gaming system

American Journal of Recreation Therapy
Fall 2009, Volume 8
, Number 4


Article
Gerontological Society of America 2009 conference briefs: Alternative and complementary therapies for healthy aging
Nancy E. Richeson, PhD, CTRS; Linda L. Buettner, PhD, LRT, CTRS; Karen M. Rose, PhD, RN; Sandy Burgener, PhD, GNP-BC, FAAN
Fall 2009; pages 5-7

Abstract
The purpose of this article is to share the findings from the Alternative and Complementary Therapies for Healthy Aging panel that recently disseminated their research at the annual Gerontological Society of American Conference, November 18-22, 2009, in Atlanta, GA. The interdisciplinary panel examined the influence of alternative and complementary therapies for healthy aging. The National Center for Complementary and Alternative Medicine1 (NCCAM) reports that 38 percent of adults in the United States utilize complementary and alternative medicine (CAM). CAMs offer an alternative or adjunct therapy that has lower risk of adverse side effects and offer a new perspective: healing the patient rather than simply treating them. Quality of life must be considered; more medications and medical interventions do not always equally increase the quality of life. The interventions presented promote a holistic approach (mind, body, and spirit) to wellness.


Article
Self-efficacy and arthritis impact on health: The effect of an Arthritis Foundation Aquatic Program
Lei Guo, PhD, CTRS/LRT; Heewon Yang, PhD, CTRS; Majorie M. Malkin, EdD, CTRS
Fall 2009; pages 9-19

Abstract
Arthritis is the leading cause of disability among older adults in the United States. Studies have found that aquatic exercise improves the functional conditions of individuals with arthritis. In addition, self-efficacy has been proposed to be an important variable associated with successful coping with arthritis. The purpose of this study was to measure the effect of an Arthritis Foundation Aquatic Program on arthritis self-efficacy and impact through a three-month aquatic exercise program. Participants (n = 6) completed the Arthritis Impact Measurement Scale 2-Short Form (AIMS2-SF) and the Arthritis Self-efficacy Scale (ASES) at the beginning and also at the end of the program. Significant improvements were found in ASES and the A(a)ffect domain in AIMS2-SF, indicating that the aquatic program increase(d) the participants’ self-efficacy and reduced the negative impact of arthritis. Key words: arthritis, arthritis self-efficacy, arthritis impact


Article
The effects of leisure education on leisure attitudes, perceived leisure control, and barriers to leisure in Chinese older adult immigrants in the United States
Chia Yun Hsieh, MS, RTC/CTRS; Maridith A. Janssen, EdD, RTC/CTRS
Fall 2009; pages 21-28

Abstract
The importance of leisure and its benefits have been studied and promoted in the West for a long time. To have leisure and to be free from labor is what was historically meant as living life on one’s own terms in Western society. However, leisure is perceived and acted upon differently in the Chinese culture. For the Chinese, the concept, values, and activity type of leisure are heavily influenced by their traditional culture. The purpose of this study was to determine the effects that leisure education has on attitudes toward leisure, perceived leisure control, and barriers to leisure experiences in Chinese older adult immigrants in the United States. The results show that there were significant changes in the Affective and the Overall Leisure Attitude Measurement mean scores, as well as the perception of barriers to leisure after participating in a six-week leisure education program among Chinese older adult immigrants. Key words: leisure education, older adults, leisure attitudes, leisure constraints, leisure barriers, Chinese older adult immigrants


Article
Evidence to support an advanced role for recreational therapists: Staff trainer in long term care
Linda L. Buettner, PhD, LRT, CTRS
Fall 2009; pages 29-34

Abstract
This pilot project evaluated change in staff knowledge, stress, and skills in engaging long term care residents in meaningful individualized activity. A recreational therapist provided 10 short training sessions to 29 staff members with the goal of increasing staff skills in providing activities. Data indicates significant improvements in knowledge, stress, and engagement skills occurred in this training project indicating the role of staff trainer provides significant impact. Key words: activities, staff trainer, long term care


Article
Literature analysis of humor therapy research
Laura E. Harkins
Fall 2009; pages 35-47

Abstract
Alternative therapies and creative facilitation techniques assist professionals in overcoming common client barriers such as boredom, passivity, and indifference or unresponsiveness to treatments. Humor therapy or therapeutic humor is one such facilitation technique that is no laughing matter, as research indicates its effectiveness extends much further than fun and smiles. Humor therapy is creating a humorous environment implemented through active and/or passive means to treat participants’ symptoms by eliciting laughter and joy. Little exists, however, that summarizes the status of data-based research on this topic. Therefore, the purpose of this article is to provide a literature analysis comprising the physiological and psychological benefits of humor therapy utilizing research published within the last 10 years. In addition, specific analysis of methodology, identification of limiting factors, exploration of future research implications, and practical recommendations for recreational therapy professionals are addressed. Key words: humor therapy, therapeutic humor, recreational therapy, mirth, literature analysis