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American Journal of Recreation Therapy
Winter 2013, Volume 12
, Number 1


Article
Guest editorial. On not taking ourselves seriously as individuals working in a vital profession
David R. Austin, PhD
Winter 2013; pages 7-8

Abstract
DOI: 10.5055/ajrt.2013.0034


Article
"Getting better" or "getting worse": What practitioners can learn from older adults with high depressive symptoms
Kenneth E. Mobily, PhD
Winter 2013; pages 9-15

Abstract
The purpose of this study was to identify concrete markers of older adults scoring high in depressive symptoms. Through identification of depressive symptom covariates, practitioners may more accurately chart a course of interventions to assist the person in coping with depressive symptomatology. Subjects were members of an earlier longitudinal study. The present study was restricted to 133 subjects 60 and older who had high depressive symptom scores at baseline or follow-up or both. The findings suggest that somatic maladies were the distinguishing variables separating subjects who were able to reduce their depressive symptoms compared to those who stagnated at a high depressive symptom scores over 3 years. The present findings suggest a direct course of action--address the somatic concomitants of depression and the affect is likely to improve. Key words: older adults, depressive symptoms, chronic conditions, functional disability, pain DOI: 10.5055/ajrt.2013.0035


Article
Understanding the intentions of families with a child with autism to participate in a family recreation program: A pilot study
Jasmine Townsend, PhD, CTRS; Marieke Van Puymbroeck, PhD, CTRS
Winter 2013; pages 16-22

Abstract
Family systems theory and the Core and Balance Model of Family Leisure Functioning are useful frameworks that can provide guidance in the development of family recreation services for families with children with autism. These families may experience positive and successful outcomes from family leisure participation, yet few family recreation programs exist that can appropriately accommodate their needs. A Web-based study was conducted following the principles of the reasoned action approach to understand the beliefs and intentions surrounding participation in a family recreation program. Findings revealed that families have high intentions to participate, as well as positive attitudes toward participation. This information can prove useful to recreational therapy service providers as they consider developing family services. Key words: family recreation, autism, leisure attitudes, reasoned action approach, recreational therapy DOI: 10.5055/ajrt.2013.0036


Article
The prevalence of evidence-based practice by the Certified Therapeutic Recreation Specialist in the intervention planning process for client treatment
Michelle D. Gerken, PhD, CTRS, CPRP, CDSS; Patti Costello, PhD; Linda Mrkic, MS
Winter 2013; pages 23-30

Abstract
Currently, there is a paucity of research examining the extent to which evidence-based practice (EBP) is being used by the Certified Therapeutic Recreation Specialist (CTRS). The purpose of this study was to examine the prevalence of EBP used by the CTRSs in the National Council for Therapeutic Recreation Certification (NCTC) southern district of the United States. This observational study investigated the use of EBP in the intervention planning process for client treatment. A sample of 500 randomly selected CTRS from the National Council for Therapeutic Recreation Certification (NCTRC) was surveyed, and 102 completed the survey, yielding a 20.4 percent response rate. The results clearly demonstrate that EBP is used at least some of the time by a majority of all CTRS. However, this survey indicates that EBP is not being used by most CTRS a majority of the time. Other results showed that only 27.7 percent of the respondents seek out research related to their clinical practice and evidence for validation 75 percent of the time or always. 31.7 percent apply research results to clinical practice 75 percent of the time or always. 33.7 percent use research to assist in developing recreation therapy (RT) intervention plans 75 percent of the time or always. 25.7 percent base their clinical decisions on research evidence 75 percent of the time or always, and 45.6 percent use RT interventions based on EBP 75 percent of the time or always. The goal of the RT profession should be to increase the use of research results and EBP so that all practicing CTRS are using them most, if not all of the time. EBP is a means toward effective client treatment which furthermore may aid in the survival and permanent inclusion of the RT profession in the healthcare world. Key words: evidence-based practice in recreation therapy, client treatment for recreation therapy interventions, effective client treatment for recreation therapy interventions DOI: 10.5055/ajrt.2013.0037


Article
Active lifestyle for older adults with dementia: Wheelchair biking versus other recreational therapy interventions
Linda Buettner, PhD, LRT, CTRS; Suzanne Fitzsimmons, MSN, GNP, ARNP; Jeffrey D. Labban, MS, PhD; Beth E. Barba, PhD, RN, FAGHE, FAAN
Winter 2013; pages 31-40

Abstract
This article provides a secondary analysis of data collected from a recreation therapy intervention trial for older adults with dementia and neuropsychiatric symptoms. In a subsample of 54 individuals who received wheelchair (WC) biking on some days and other recreation therapy interventions on other days, a comparison of engagement levels, time engaged, and encouragement needed was completed. The analysis showed that WC biking provided significantly more time on task and significantly higher levels of engagement, and less encouragement was needed. Collecting recreation therapy session engagement data was found to be a simple and useful method of comparing effectiveness of recreation therapy interventions. Key words: recreation therapy intervention, older adults with dementia, long-term care, engagement, wheelchair biking DOI: 10.5055/ajrt.2013.0038


Article
Intergenerational science programming: A catalyst for motivation in older adults
Ila Schepisi, MTS, CTRS-Specialization in Geriatrics; Caitlin Faas, MS
Winter 2013; pages 41-48

Abstract
The purpose of this study was to determine if increased use of science processing skills would in turn increase motivation in older adults. There were three complimentary curricular topics that informed this project: intergenerational (IG) programming, natural motivation, and science, technology, engineering, and math (STEM) curriculum. For this study, a facilitator in-service intervention was developed to specifically focus on STEM practices in IG programming. Overall, increasing use of science processing skills in the context of an IG program engaged certain natural motivators in older adults. Following the training, the same older adult participants experienced improved life satisfaction with trends in decreasing depression. Increased use of communication-related science processing skills is an effective method to improve well-being among older adults with dementia. Key words: Intergenerational, STEM, geriatric, depression, quality of life, motivation, intervention, adult day services DOI: 10.5055/ajrt.2013.0039

American Journal of Recreation Therapy
Spring 2013, Volume 12
, Number 2


Article
Editorial. Megatrends in health care: How is recreational therapy responding?
Nancy E. Richeson, PhD, CTRS
Spring 2013; pages 7-7

Abstract
DOI: 10.5055/ajrt.2013.0040


Article
The use of biofeedback in recreational therapy practice
Carmen V. Russoniello, PhD, LRT, LPC, BCB, BCN; Matthew Fish, MS, LRT, BCB; Tami Maes, MS, LRT, LPC, BCB; Holly Paton, BS, CTRS; Ruth-Ann Styron, BS, LRT
Spring 2013; pages 8-18

Abstract
The purpose of this article is to provide a brief history of biofeedback and a review its use as a clinical intervention in recreational therapy. Several specific biofeedback modalities; electromyography, electrodermal response, electroencephalography, and skin temperature biofeedback techniques will be discussed in terms of recreational therapy practice to demonstrate biofeedback’s usefulness in a variety of settings where recreational therapists currently practice. Criteria for becoming board certified in biofeedback and neurofeedback as well as recommendations for inclusion of biofeedback and stress management course work into recreational therapy curriculum are presented. Key words: biofeedback, neurofeedback, operant conditioning, electromyography, electrodermal response, electroencephalography, thermal biofeedback, recreational therapy intervention DOI: 10.5055/ajrt.2013.0041


Article
Operationalizing the Health Protection/Health Promotion model using taxonomies
Sarah Burnett-Wolle, PhD
Spring 2013; pages 19-26

Abstract
The Leisure Ability model continues to be the pervasive framework used to guide the provision of recreation therapy, yet it is flawed in several respects. Several alternatives have been proposed as replacements, including the Health Protection/Health Promotion (HP/HP) model. However, the HP/HP model has not been widely adopted. One reason the HP/HP model has languished is uncertainty regarding how to promote clients’ growth. Although the model clearly states that clients have two primary needs (stability and actualization), it does not indicate how to address them. This article will suggest one method for operationalizing the HP/HP model, using taxonomies to clarify clients’ goals and objectives. Four examples, one taxonomy for each domain of health, will be presented and implications for program planning will be discussed. To facilitate the use of taxonomies in program planning, a short excerpt of a specific program design will be provided. Finally, although the HP/HP model does not expressly include leisure education and recreation participation, a method for reconciling these services will also be discussed. The overall intent is to make the HP/HP model a more accessible guide to program planning and, ultimately, to design more effective interventions. Key words: Health Protection/Health Promotion model, service model, taxonomy, recreation therapy, therapeutic recreation DOI: 10.5055/ajrt.2013.0042


Article
Using symbolic interactionism to improve recreational therapy practice for individuals with eating disorders
Alysha A. Walter, BS, CTRS; Marieke Van Puymbroeck, PhD, CTRS
Spring 2013; pages 27-32

Abstract
This article provides a description of eating disorders (ED) as a social psychological phenomenon by focusing on how self-processes are formed through social interaction. This phenomenon, known as symbolic interactionism, allows practitioners to better understand the social underpinnings of the destructive thought patterns prevalent in ED. Individuals with ED are highly reactive in social situations, often misinterpreting responses toward them as highly judgmental. Internalizing others’ perceptions creates interpersonal problems. Identifying the self-processes that surround ED will provide recreational therapists the valuable tools needed to develop successful interventions to treat people with ED. Particular attention will be paid to how symbolic interactionism can help recreational therapists understand how individuals with an eating disorder react to social interactions. Finally, implications for recreation therapy research and practice are discussed. Key words: Eating disorders, symbolic interactionism, recreational therapy DOI: 10.5055/ajrt.2013.0043


Article
Association between accelerometer-assessed physical activity and biological markers among adults with HIV
Paul D. Loprinzi, PhD; Carissa Martin, BA; Christy Kane, PhD; Jerome F. Walker, EdD
Spring 2013; pages 33-38

Abstract
The purpose of this study was to examine the association between physical activity and CD4+ T cells and various biological markers among those with HIV. Data from the 2003-2006 National Health and Nutrition Examination Survey were used. Participants were asked to wear an accelerometer for 7 days. A blood sample was used to detect HIV and measure various biological parameters. Nineteen adults between 18 and 48 years of age had HIV and provided sufficient accelerometry data. Physical activity was not associated with CD4+ T cells. After adjustments, moderate-to-vigorous physical activity was inversely associated with systolic blood pressure (r = -0.44), fasting glucose (r = -0.78), and waist circumference (r = -0.45). These findings suggest that HIV-infected individuals are similar to those in the general population in that that their bodies are able to adapt to the many benefits associated with physical activity. Key words: accelerometry, biological markers, HIV, physical activity, sedentary behavior DOI: 10.5055/ajrt.2013.0044


Article
Accessible golf for individuals with Autism Spectrum Disorder
Leah M. Cox, MS, CRC, LRT/CTRS; Dan Johnson PhD, LRT/CTRS; Candace Ashton, PhD, LRT/CTRS
Spring 2013; pages 39-49

Abstract
Golf is a popular sport played by many people of varying ages. Recently, individuals with disabilities are becoming more interested in this sport with the help of community programs such as Project Golf: Accessible and Inclusive Networks (GAIN). The purpose of this paper is to provide recreation therapy professionals with background information on the game of golf, information about the benefits and barriers common to golf, as well as information on the effectiveness of using golf as a therapeutic treatment intervention. Examples of adaptations for individuals with Autism Spectrum Disorder are provided as well as recommendations for recreation therapists. Key words: Accessible golf, recreation therapy, recreation, leisure, Autism Spectrum Disorder DOI: 10.5055/ajrt.2013.0045


Article
Book review
David R. Austin, PhD
Spring 2013; pages 48-48

Abstract
Reflection, Recognition, Reaffirmation: An Engaging Frame of Reference for Leisure Education (2nd edition) by Jeff Witman, EdD, CTRS and Mary Ligon, PhD, CTRS. Published in 2011 by Idyll Arbor, Inc., Enumelaw, WA. DOI: 10.5055/ajrt.2013.0046

American Journal of Recreation Therapy
Summer 2013, Volume 12
, Number 3


Article
Editorial. Center for Medicare and Medicaid Services (CMS) initiative reducing antipsychotic medications: Why recreational therapy should care
Nancy E. Richeson, PhD, CTRS; Angie Sardina, MS, CTRS
Summer 2013; pages 6-7

Abstract
DOI: 10.5055/ajrt.2013.0047


Article
Efficacy of an adaptive kayaking intervention for improving health-related quality of life among wounded, ill, and injured service members
Matthew R. Scherer, PT, PhD, NCS; Daniel M. Gade, PhD; Kathleen E. Yancosek, PhD, OTR/L, CHT
Summer 2013; pages 8-16

Abstract
Adaptive sports are popular within military and civilian rehabilitation communities as a means to promote fitness, independence, self-efficacy, and return to participation in life roles. Although widely prescribed, there is little evidence to demonstrate the efficacy of such interventions. This study surveyed 40 wounded, ill, and injured active duty and veteran service members (SMs) who participated in a week-long adaptive kayaking program. Validated health-related quality of life instruments assessing physical and behavioral health domains following trauma were administered before and after participation in a week-long adaptive kayaking trip. Postintervention analysis of these measures revealed clinically significant improvements in depression (+7 percent), anxiety (+5 percent), posttraumatic stress disorder (+4 percent), and social interaction (+7 percent) subscales on the Trauma Outcome Profile (TOP) which trended toward, but did not achieve, statistical significance. Analysis of Veterans RAND (VR-12) data revealed a mean four-point improvement in participant mental health component summary (MCS) scores (p <= 0.05) following intervention indicating clinically and statistically significant improvement in behavioral health symptoms. No improvement was observed on the mean postintervention physical health component summary (PCS) score suggesting minimal short-term effects of kayaking on self-assessment of physical well-being. In aggregate, findings from this study suggest that adaptive kayaking may be an effective intervention to remediate behavioral health sequelae commonly experienced by SM following trauma. Future research should explore the effectiveness of adaptive kayaking relative to standard of care clinical rehabilitation strategies to optimize physical as well as mental health outcomes. Key words: adaptive kayaking, reintegration, wounded, ill, and injured service members, polytrauma, health-related quality of life DOI: 10.5055/ajrt.2013.0048


Article
Therapeutic recreation and the Twelve Steps
Colleen A. Cooke, EdD, CTRS
Summer 2013; pages 17-24

Abstract
This article focuses on the Twelve Steps of Alcoholics Anonymous, and specifically on how recreational therapists can aid the recovery process by providing interventions that facilitate the working of the steps. Little has been written about Twelve Step application in recreational therapy practice, thus the meaning and work of each of the steps is explained, along with suggestions for how recreational therapy services can be applied to aid the individual in the work toward recovery from alcoholism. Key words: alcoholism, the Twelve Steps, therapeutic recreation, recreational therapy DOI: 10.5055/ajrt.2013.0049


Article
Physiological effects of a technology-based music-making program in skilled nursing residents
Brigid Lyons, BS, CTRS; Rhonda Nelson, PhD, CTRS; Pei-Chun Hsieh, PhD, CTRS
Summer 2013; pages 25-35

Abstract
This study evaluated the effectiveness of a technology-based music-making intervention (the Beamz) in elevating heart rate and producing a relaxation response in skilled nursing home residents. Using a quasi-experimental counterbalanced design, results indicated that this brief intervention produced a statistically significant elevation in heart rate and systolic blood pressure when played at a fast tempo. Heart rate was also significantly elevated when slow tempo music was used. In addition, participants reported a statistically lower level of relaxation following the slow tempo session and expressed that they found this new activity intervention enjoyable. Implications of findings and future research possibilities using technology- based music-making interventions in recreation therapy practice are discussed. Key words: Beamz, geriatrics, music, older adults, physical activity, relaxation, skilled nursing, technology, therapeutic recreation DOI: 10.5055/ajrt.2013.0050


Article
Designing and implementing a rifle shooting clinic as leisure skill development for adults with physical disabilities
Amy R. Burns, MS; Susan 'BOON' Murray, EdD, CCLS, CTRS; Dennis C. W. Fater, PhD, PT, Cert MDT
Summer 2013; pages 34-48

Abstract
Background/rationale: Adults with physical disabilities are an underserved population among Americans who participate in adaptive shooting sports. A basic rifle marksmanship clinic has potential to promote a low impact outdoor physical activity for adults with physical disabilities as leisure skill development. Methods: This grant-funded service project of a therapeutic recreation (TR) graduate student utilized program design and evaluation. The specific program design included best practices for teaching basic rifle marksmanship and measured participants’ performance outcomes related to shooting skills and knowledge. A half-day rifle marksmanship clinic was conducted as a university-funded community service grant which provided rifle instructor certification, ammunition and supplies. The clinic was a collaboration between physical therapy (PT) and TR faculty and PT, OT, and TR majors. Results: All participants gained shooting knowledge and skill through this program. A shooting clinic format with classroom instruction followed by practice on a live firing range was effective. The use of a leisure partner for each participant helped sustain interest and continued support to develop skill after the clinic. Doing an in-home exercise program prior to the clinic reduced muscle soreness from the intensity of target practice in a clinic format. Conclusions: TR specialists may promote shooting sports as treatment for functional improvement or as leisure skill development. They may collaborate with physical and occupational therapy to emphasize psychosocial aspects of shooting sports. Recommendations: Shooting skills instructors could expand live fire training time at clinics, start training with virtual shooting or air or laser rifles to assess participant readiness, promote inclusive practice specific to shooting sports, and apply empowerment evaluation as a signature program strategy. Key words: adaptive shooting, adaptive sports, leisure partners, performance measures, physical disabilities, specific program design and evaluation, empowerment evaluation DOI: 10.5055/ajrt.2013.0051

American Journal of Recreation Therapy
Fall 2013, Volume 12
, Number 4


Article
Editorial Listening at a [+2]: Communicating professionally
Nancy E. Richeson, PhD, CTRS
Fall 2013; pages 6-6

Abstract
DOI: 10.5055/ajrt.2013.0052


Article
A global therapeutic recreation discussion: An overview from Rimini, Italy
Miklos Banhidi, PhD; Fran Stavola Daly, EdD; Eduardo De Paula Azzine, MS; Rodney B. Dieser, PhD; Shannon Hebblethwaite, PhD; David Jones, EdD, CTRS; Fumika Kimura, MS; Sharon E. McKenzie, PhD; Charlé Meyer, PhD; Marié E.M. Young, Dphil
Fall 2013; pages 7-14

Abstract
The 2012 World Leisure Congress (hosted by the World Leisure Organization) took place in Rimini, Italy, from September 30 to October 3. The World Leisure Organization currently has 12 global commissions on various topics (eg, children and youth, leisure education, tourism and the environment, and women and gender), which is focused on having global interactions and discussions related to the three main objectives of research, information dissemination, and advocacy.1 The purpose of this article is to summarize the World Leisure Commission on Accessibility and Inclusion academic labor related to the topic of global therapeutic recreation. To this end, the question at hand for this global commission to discuss was as follows: Is the United States National Council for Therapeutic Recreation Certification (NCTRC) an appropriate credentialing framework for professionals in different countries who are dedicated to working with people with disabilities/special needs in the area of accessibility, inclusion, and therapeutic recreation? The purpose of this article is to share, to the wider United States therapeutic recreation profession, responses and thoughts of members of the global therapeutic recreation commission. Key words: global therapeutic recreation, National Council for Therapeutic Recreation Certification, World Leisure Organization DOI: 10.5055/ajrt.2013.0053


Article
Leisure in hospitals and its interface with health: A study about the reality of a Brazilian city
Gabriela Baranowski Pinto, Master in Leisure/UFMG; Christianne Gomes, Doctor in Education/UFMG
Fall 2013; pages 15-24

Abstract
The purpose of this research is to understand the role of leisure in shaping the reality of hospitalized patients in Brazil. The methodology combines both bibliography and field research techniques performed in internment units of three hospitals in the city of Belo Horizonte. The field research consisted of direct observations and semistructured interviews with 30 volunteers, among hospitalized subjects, companions, and health professionals. The data were analyzed qualitatively through iterative analysis. Results show that leisure activities can improve the health status of hospitalized subjects. Its role in the hospital is mainly related to compensatory and utilitarian functions, with contributions to rest, pain, and suffering reduction, expansion of friendship network, creativity, ability of doing critics, of educating sensitivity, through the dissemination of content and cultural practices among the subjects. Key words: leisure, health, hospital, hospitalized patients DOI: 10.5055/ajrt.2013.0054


Article
The value of therapeutic outdoor programs with adolescents in a rural residential treatment center: A pilot study
Kenneth M. Coll, PhD; Margaret Sass, EdD; Brenda J. Freeman, PhD; Patti Thobro, MS; Nicole Hauser, MSW
Fall 2013; pages 25-30

Abstract
The purpose of this study is to investigate how therapeutic recreation within a wilderness setting (aka therapeutic outdoor programming) affects youth functionality as measured by the Youth Comprehensive Risk Assessment (YCRA) utilizing pretest and post-test results. For purposes of this article, therapeutic recreation is defined as “a treatment service designed to restore, remediate and rehabilitate a person’s level of functioning and independence in life activities, to promote health and wellness as well as reduce or eliminate the activity limitations and restrictions to participation in life situations caused by an illness or disabling condition.”1 Results showed that youth from a residential treatment center (RTC) engaged in a therapeutic outdoor program in the form of overnight trips of at least 3 days reported overall improvements when compared to a matched control group. Key words: therapeutic recreation, youth offenders, residential treatment center, YCRA DOI: 10.5055/ajrt.2013.0055


Article
Clinical reasoning: A concept for recreation therapy
David R. Austin, PhD, FDRT, FALS; Bryan P. McCormick, PhD, CTRS, FDRT, FALS
Fall 2013; pages 31-38

Abstract
Clinical reasoning is a concept adopted by healthcare disciplines such as nursing, occupational therapy, and physical therapy, but it has been largely neglected in the literature of recreation therapy. The purpose of this article is to acquaint those in recreation therapy with clinical reasoning and to discuss how the concept can be useful within the profession of recreation therapy. The authors believe clinical reasoning should be perceived to be a core skill for recreation therapists. Key words: Clinical reasoning, RT education, Clinical practice DOI: 10.5055/ajrt.2013.0056


Article
Understanding knee biomechanics during physical activity and the implications for individuals with knee osteoarthritis and total knee replacements
Angela J. Wozencroft, PhD, CTRS; Julie L. Pfeiffer, MS; Clare E. Milner, PhD, FACSM
Fall 2013; pages 39-43

Abstract
Evidence-based research on pain management techniques, exercise, and aquatic therapy programs provides guidance for recreation therapists working with patients with orthopedic impairments such as osteoarthritis (OA) and total knee replacements (TKRs). However, substantiated recommendations for specific physical activities to be used with this population are not available. This leaves recreation therapy (RT) practitioners with inadequate direction on the appropriate activities to prescribe to their patients. This research note is an abbreviation of a larger study (J.L.P. et al., unpublished data, 2014) and examines the knee joint kinematics and kinetics in healthy older adults during golf and bowling with comparisons made between those experienced during walking and stair ascent and descent. Understanding the knee biomechanics in a healthy population is an important first step in gathering scientific evidence needed to advance our field. Future research examining knee biomechanics related to various recreation activities will be instrumental in allowing RT specialists to develop practice guidelines for men and women with OA and TKR in the future. Key words: physical activity, osteoarthritis, knee replacement, biomechanics DOI: 10.5055/ajrt.2013.0057


Article
Book review. Therapeutic Recreation Processes & Techni ques: Evidenced-Based Recreational Therapy (7th Edition) by David R. Austin
Robin Kunstler, ReD, CTRS
Fall 2013; pages 44-45

Abstract
DOI: 10.5055/ajrt.2013.0058


Article
Book review. Therapeutic Recreation Practice: A Strengths Approach, Lynn Anderson & Linda Heyne
Susan ‘BOON’ Murray, EdD, CCLS, CTRS
Fall 2013; pages 46-48

Abstract
DOI: 10.5055/ajrt.2013.0059