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American Journal of Recreation Therapy
Winter 2010, Volume 9
, Number 1

Editorial. Commission on Accreditation of Allied Health Education Programs and the Committee on Accreditation of Recreational Therapy Education: A long-needed initiative for the profession
Thomas K. Skalko, PhD, LRT/CTRS; Ray E. West, MS, LRT/CTRS; Peg Connolly, PhD, LRT/CTRS; Terry Kinney, PhD, LRT/CTRS; Pam Wilson, MS, LRT/CTRS
Winter 2010; pages 7-8

The recreation therapist versus the certified activity director: Which professional receives fewer deficiencies in long-term care facilities?
Timothy J. Legg, PhD, CNHA, GNP-BC, FACHCA; Sharon A. Nazarchuk, PhD, MHA, RN; Deborah Adelman, PhD, RN, CNS
Winter 2010; pages 9-14

The literature reports no studies that sought to determine which professional group (certified therapeutic recreation therapist versus certified activity director) achieves fewer survey deficiencies in the skilled nursing facility. This article will examine the scant and dated literature that is available to demonstrate which of these activity professionals has superior outcomes specific to the OBRA ’87 requirements. The article concludes with an articulation of the need for the discipline of recreation therapy to involve itself in outcomes research specific to which of the two disciplines better achieves the objectives of OBRA ’87. Key words: activity professional, long-term care, nursing home, CMS DOI: 10.5055/ajrt.2010.0001

The influence of mindfulness-based stress reduction and walking on the psychological well-being of female informal caregivers: A pilot study
Marieke Van Puymbroeck, PhD, CTRS; Pei-Chun Hsieh, MS
Winter 2010; pages 15-25

Informal caregivers, who provide unpaid care for family or friends, often experience numerous threats to their psychological well-being as a result of providing care. This study compared a traditional physical activity (mall walking, MW) to an alternative therapeutic intervention (mindfulness-based stress reduction, MBSR) to examine the impact on the psychological well-being of informal caregivers. While both groups experienced a decrease in psychological well-being, caregivers in the MBSR group experienced fewer exacerbations in depressive symptoms and subjective burden when compared with caregivers in the MW group. It is possible that mindfulness techniques may provide some protection against the exacerbation of negative effects on caregivers’ psychological wellbeing. The use of MBSR as a therapeutic intervention in therapeutic recreation practice may be warranted, but requires further study. Key words: informal caregivers, psychological well-being, mindfulness-based stress reduction, walking DOI: 10.5055/ajrt.2010.0002

Theory of human flourishing for therapeutic recreation
James B. Wise, PhD, CTRS
Winter 2010; pages 27-34

The purpose of this article is to present an overview of a theory of human flourishing and to outline how the theory can guide therapeutic recreation specialists as they strive to improve the lives of people with disabilities and illnesses. According to the theory, a flourishing life is marked by excelling in one or more leisure practices, authoring a coherent personal narrative, formulating and pursuing a meaningful telos, negotiating traditions, and acting virtuously. These constituent elements are described and then quad rugby is used to illustrate how a particular leisure practice contributes to flourish through its effects on each element. The article concludes with tasks that therapeutic recreation specialists should undertake to promote flourishing in people with disabilities and illnesses. Key words: narrative, practice, telos, tradition, virtues DOI: 10.5055/ajrt.2010.0003

Leisure time activities, free time boredom, and aggressive behavioral tendencies among at-risk youth in a poverty area: Implications for recreational therapy
Heewon Yang, PhD, CTRS; Kevin N. Schraer, MS; Marjorie Malkin, EdD, CTRS; Hansook Yi, PhD
Winter 2010; pages 35-47

The primary purpose of this study was to examine sociobehavioral characteristics [ie, leisure time activities, free time boredom (FTB), and aggressive behavioral tendencies] of at-risk youth in an area of general poverty. The participants of this study were attendees of an after-school program provided by a local social service agency, and the majority of the participants was African American (n = 75, 87.2 percent). This study examined their leisure participation patterns as well as barriers to leisure participation and desired facilities in the area. This study also revealed the participants’ perceived FTB level and aggressive behavioral tendencies. This article, lastly, suggests guidelines for therapeutic recreation practitioners who work with youth at-risk in poverty areas. Key words: leisure time activities, free time boredom, aggressive behavioral tendencies, at-risk youth DOI: 10.5055/ajrt.2010.0004

American Journal of Recreation Therapy
Spring 2010, Volume 9
, Number 2

Guest editorial. Back to school: Recreation therapy, it’s not just for camps anymore
Phillip A. Pengelly, CTRS
Spring 2010; pages 5-6

Innovative program idea. Adaptive kayaking for persons with physical disabilities
Tiffany Atkinson, BS
Spring 2010; pages 7-12

Kayaking is a fun outdoor recreational activity well known by many. Often times, people assume that kayaking is too dangerous and risky for individuals with disabilities to participate. Kayaking can be adapted either through adaptation of the actual kayak, paddle, and/or assistive devices to allow various individuals to partake. With shared enjoyment of kayaking, apparent differences between participants become insignificant. Adaptive kayaking is rarely considered as a useful therapeutic intervention to be used by recreational therapist, but upon involvement can produce benefits such as increased self-esteem, increased upper body strength, learned adjustment to new situations, increased independence, and many more. This article will address the benefits, barriers, and future research of adaptive kayaking. Key words: adaptive kayaking, recreational therapy, therapeutic recreation, physical disabilities

RT in the community. Medical Home: Is there a place for recreational therapy?
Mary Ann Keogh Hoss, PhD, CTRS, FACHE, FDRT; Kari Kensinger, PhD, CTRS
Spring 2010; pages 13-20

The purpose of this article is to explore the role of recreational therapy within a medical home model. Medical home is a movement to manage the care of individuals with complex and chronic health needs through their primary care physician and the physician’s team. The concepts of medical home are discussed. These concepts are the same as those on which recreational therapists have been trained. This article demonstrates the various ways in which recreational therapists can meet the challenges posed by serving individuals with chronic disease. The medical home model provides a rare opportunity for recreational therapists to combine clinical skills with community skills to meet the needs of those individuals in the community with chronic and complex needs. This article demonstrates that recreational therapists are already engaged and invested in this model. What is lacking is the promotion of skills and services of the recreational therapists to market and communicate this to primary care providers. Key words: medical home, recreational therapy, chronic disease management

Student issues. Perceived benefits of and attitudes about alcohol use among therapeutic recreation students
Heewon Yang, PhD, CTRS; Hansook Yi, PhD
Spring 2010; pages 21-32

A previous study1found that therapeutic recreation (TR) students are more heavily engaged in a variety of alcohol-related activities than are other recreation major students. Thus, the main purpose of this study was to provide both educators in TR and TR professionals in practice with more information about alcohol use among TR students. First, this study examined the participants’ perceptions on the benefits of alcohol use. The study results were compared with the perceived benefits that are reported by other recreation students and general public in the United States. This study further examined beliefs and attitudes about alcohol use among TR students. As supplemental data, the participants’ attitudes were compared with those of other recreation students (ie, outdoor, community, and commercial).Key words: alcohol use, attitudes about alcohol, perceived benefits of alcohol use

RT in rehabilitation. Self-efficacy, sports, and rehabilitation: Implications for therapeutic recreation
Anne M. Cornett, BS; Marieke Van Puymbroeck, PhD, CTRS
Spring 2010; pages 33-39

As the military medical trauma care system continues to improve and become more effective at preserving the lives of veterans wounded in combat, recreation therapists are con-fronted with an increasing number of individuals facing rehabilitation for complex injuries that were once fatal. This article explores the literature surrounding the use of sports programming in improving self-efficacy perceptions among individuals with physical disabilities. In addition, the relationship between improved self-efficacy perceptions and attitudes toward rehabilitation will be examined. Grounded in the existing evidence, implications for the therapeutic recreation treatment process are presented. Key words: self-efficacy, rehabilitation, sport, disability, recreation therapy, veterans

RT in long-term care. The importance of autonomy in nursing home facilities
Leah J. Carter, BS; Marieke Van Puymbroeck, PhD, CTRS
Spring 2010; pages 41-45

The benefits of autonomy have long been studied. This article seeks to explicate the importance of autonomy in nursing home facilities and the effect that autonomy can have on the quality of life of the residents in these long-term facilities. Autonomy is crucial in these facilities because of the impact it has on self-determination and intrinsic motivation. The benefits that come from these principles include increased participation, decreased depressive symptoms, and increased quality of life among residents. Although the importance of autonomy in nursing homes may seem elementary for many practitioners, efforts to promote autonomy are not commonly operationalized. It is important to revisit this topic because there will be an increasing number of older Americans in the years to come and it has direct implications for recreation therapy service delivery. Key words: autonomy, participation, nursing homes, self-determination theory, intrinsic motivation, recreation therapy

American Journal of Recreation Therapy
Summer 2010, Volume 9
, Number 3

Guest editorial Medical home: Where are recreation therapists?
Mary Ann Keogh Hoss, PhD, CTRS, FACHE, FDRT
Summer 2010; pages 5-6

Recreation therapy professionals serve the world
David B. Jones, EdD, CTRS
Summer 2010; pages 7-9

MDS 3.0 Section O: An update for recreational therapy practice with Medicare patients
Linda L. Buettner, PhD, LRT, CTRS, FGSA
Summer 2010; pages 10-11

Effects of a recreation therapy aquatics intervention: A case study on an older adult with uncontrolled orthostatic hypotension
John Mikula, CTRS, CSCS, HFS; Paul Smith, CTRS, HFS; John Meuleman, MD; Charles E. Levy, MD
Summer 2010; pages 13-16

Uncontrolled orthostatic hypotension (OH) is a devastating disorder that affects activity and participation in daily life. The authors report the benefits of a recreation therapy aquatics intervention on a 74-year-old man with longstanding OH refractory to both pharmacological treatment and conventional land-based physical rehabilitation. Through regular participation in aquatic therapy twice a week for 18 months, this individual progressed from being confined to bed to regaining the ability to ambulate short distances on land without the aid of an assistive device and to resume some of his premorbid leisure interests. The patient reports a significant improvement in his quality of life. Aquatic therapy should be considered for individuals with OH refractory to standard medical and rehabilitation interventions. Key words: orthostatic hypotension, recreation therapy, aquatic therapy, physical rehabilitation, quality of life

Positive psychology: A theoretical foundation for recreation therapy practice
David R. Austin, PhD; Bryan P. McCormick, PhD, CTRS; Marieke Van Puymbroeck, PhD, CTRS
Summer 2010; pages 17-24

Positive psychology is a burgeoning field that has great application in the field of recreation therapy. It provides a context for the application of recreation therapy interventions and offers an examination of clients in a manner that is holistic and focused on the strengths (rather than the deficits) of the individual. In this article, the roots of positive psychology are discussed and defined, the three pillars of positive psychology are described, and finally, the relationship between positive psychology and recreation therapy is delineated. Positive psychology offers the field of recreation therapy with a firm foundation for theoretical growth and practice. Key words: positive psychology, recreation therapy, strengths

Perceptions of learners in a Reiki/Energy Medicine course toward facilitating a complimentary and alternative approach to medicine
Nancy E. Richeson, PhD, CTRS; Sophie Hill, BS
Summer 2010; pages 25-32

This article explored the perceptions of students who completed a Reiki/Energy Medicine course offered during the fall semester of 2009. One focus group was offered and scheduled during finals week after grades had been turned into the registrar’s office. Seven participants, five females and two males, volunteered from the 20 students who were enrolled in the course. Analysis of the data revealed an overarching theme of self responsibility in applying Reiki as a mindful practice in three specific topical areas: (a) gaining practical skills in applying Reiki with intention; (b) enhancing personal growth in reducing stress and expanding self-awareness; and (c) acquiring a sense of community through Reiki shares or certificate. Furthermore, the participants made recommendations on how to improve future classes. Overall, focus group participants found that the course was beneficial and would recommend it to other students interested in holistic and integrative health. Key words: Reiki, complimentary and alternative medicine, therapeutic recreation, energy medicine, focus group

Use of Wii™ with older adults: A potential new recreational therapy intervention to increase physical activity
Hyangmi Kim, BS; Marieke Van Puymbroeck, PhD, CTRS
Summer 2010; pages 33-39

Because of increases in life expectancy, there is a greater focus on enhancing and maintaining quality of life for older adults. One method to improve quality of life is to increase everyday physical activity, and a new approach to this is through virtual reality video games such as the Nintendo Wii™. This is a new tool for recreational therapists to use, and preliminary evidence from several trials supports the claim that Wii™ intervention is beneficial. This article will review the benefits of physical activity for older adults, the obstacles keeping older adults from physical activity, the framework of physical activity according to self-efficacy theory and principles, and will apply the self-efficacy theory to examine the Wii™ as an assistive tool for use as physical activity, as well as the resulting implications for recreational therapy practice and research. Key words: recreational therapy, Nintendo Wii™, virtual reality, intervention, older adults, physical activity, quality of life, self-efficacy theory

Effects of a supported program for horseback riding on inpatients diagnosed with schizophrenia: A qualitative exploratory study
Deborah J. Corring, PhD; Megan E. Johnston, MA; Abraham Rudnick, MD, PhD
Summer 2010; pages 41-46

Therapeutic horseback riding (THR) for inpatients with schizophrenia has not been examined, although it may benefit this particularly impaired population. This exploratory study aimed at studying THR for such individuals. Six inpatients with schizophrenia participated in 10 weekly sessions of THR. Validated transcriptions of semistructured interviews with these patients and with their accompanying staff as well as with the THR instructor over a few points in time were analyzed for themes. THR was found to be beneficial for this group of inpatients; in particular, they enjoyed themselves. In conclusion, THR has promise for this population, possibly as an enhancer of enjoyment, among other things, and should be further developed and studied for individuals with schizophrenia of varying severity. Key words: schizophrenia, therapeutic horseback riding, therapeutic recreation, equine therapy, rehabilitation

American Journal of Recreation Therapy
Fall 2010, Volume 9
, Number 4

CMS regulatory update MDS 3.0 Section F: Preferences
Michele M. Nolta, CTRS
Fall 2010; pages 5-8

Examining the impact of rheumatoid arthritis on the discontinuity, continuity, and development patterns of physical activities
Lei Guo, PhD, LRT/CTRS
Fall 2010; pages 9-18

Rheumatoid arthritis (RA), one of the most serious diseases in the arthritis family, is a chronic illness affecting about 1.3 million Americans aged 18 and older. For people with RA, participation in their previous physical activities may no longer be an option. They may seek alternative physical activities or change pattern in the pursuit of physical activities. Unfortunately, there are only a limited number of research studies that examined the impacts of RA on physical activities. Therefore, the purpose of this study was to examine the impact of RA on the pattern of physical activities among people with RA. Fourteen women with RA were interviewed to explore their disease history and physical activity participation history. Three themes (discontinuity, continuity, and development) were identified, reflecting the adaptation processes of individuals after having RA, along with the different meanings associated with each adaptation process. The findings of this study also provided some implications for recreation therapists. Key words: physical activity, rheumatoid arthritis, continuity, recreation therapy

Activity engagement in dementia care: A student-delivered home program
Barbara A. Braddock, PhD, CCC-SLP; Ellen Phipps, CTRS
Fall 2010; pages 19-30

Purpose: This study examines activity engagement for persons with Alzheimer’s disease and related dementia (ADRD) and caregiver support through “partnered volunteering” at home. The goal of the program was to provide opportunities for persons with ADRD to reengage in activities that had fallen out of their daily routines. Method: University students engaged participants with ADRD in carefully selected and adapted activity over an eight-week program. Cognitive and engagement observations were completed before and after programing. Caregivers rated burden and self-confidence in implementing activity. Results: Eleven of 12 participants engaged in activity that once held meaning in their lives. Participants with mild cognitive impairment self-initiated activity with adaptation and setup; while those with more severe cognitive impairment were more likely to self-initiate activity following programing. Caregivers reported significantly reduced burden and tended to be more confident in implementing activity following the student-delivered program. Conclusions: The results highlight individual differences in activity engagement and provide rationale for partnered volunteering. Key words: partnered volunteering, dementia, activity engagement

An evaluation of a leisure education intervention for adult male residents in a state minimum-security forensic unit: Leisure resources modules
Patricia S. Ardovino, PhD, CTRS, CPRP; Jennifer Fahey, MS, CTRS; Scott Sprecher, BS, CTRS; Karen Froh, BS, CTRS
Fall 2010; pages 31-37

This study was the collaborative effort of the University of Wisconsin-La Crosse faculty (Ardovino) and therapeutic recreation practitioners (Fahey, Sprecher, and Froh). The intent of the project was to study the effectiveness of a specific leisure education intervention called “leisure resources modules” at the Mendota Mental Health Institute in Madison, Wisconsin. The leisure resources modules were designed and modified by Sprecher, Froh, and Fahey and were implemented by them as an intervention over the past 10 years in a minimum-security forensic unit. The modules studied were overview of leisure resources, use of the telephone book, use of the library, and use of the newspaper. The intervention was evaluated by examining scores from initial and postintervention screens from the past 6 years. These scores measured the competencies of adult males residing in the minimum security unit. Descriptive statistics were derived from the data, and a paired t test showed a significant difference at the 0.01 level, indicating that the leisure resources modules were an effective leisure education intervention for this population. Key words: leisure education, therapeutic recreation, forensic units, curriculum modules

Promoting physical and psychosocial health behavior changes in breast cancer survivors through a community-based workshop: Process and impact evaluation
Amber K. Alsobrooks, MS, LRT, CTRS; Jean Owen, MA; Diane Groff, EdD, LRT; Claudio L. Battaglini, PhD; Elizabeth Evans, MA; Robert Brustad, PhD
Fall 2010; pages 39-46

This article examines the feasibility and effectiveness of delivering a community-based health education workshop to promote positive health behaviors for breast cancer survivors in a predominately rural 13-county region in North Carolina. Curriculum was based on an existing 20-week center-based exercise and recreation therapy program for breast cancer survivors, and it relied on interagency cooperation for promotion and delivery of the intervention. Evaluation of success was based on attendance, ability of participants to demonstrate appropriate health behaviors, and self-reported changes in health behaviors. Challenges and strategies related to partnering with community agencies and generating attendance are discussed. The authors contend that a community-based workshop supported by multiple agencies can be effective in enhancing health-related knowledge and behaviors for breast cancer survivors. Key words: breast cancer, community-based health education, health behaviors, exercise, physical activity, recreational therapy, mindfulness, stress management, quality of life