What is Recreation Therapy?
We all have pastimes that we enjoy. For children affected by cerebral palsy, this should be no different. Our activities, whether it be swimming or playing basketball, or nurturing a love for painting or dancing, provide us with hours of pleasant leisure. Recreation enhances our ability to relate to others and engage in the environment around us.
Therefore, recreation therapy, or therapeutic recreation, is an important step in helping an individual with cerebral palsy become a well-rounded individual afforded the benefits that physical, mental, and social experiences provide. Recreation therapy focuses on inclusion, not exclusion, by allowing the individual to participate and be an integral part of activities they enjoy and learn from.
However, recreation therapy also has another purpose – to enhance the ability of a child with cerebral palsy to plan, strategize and perform tasks in an effort to achieve improved physical functioning and encourage emotional well-being by facilitating inclusion into activities they benefit by and enjoy. This provides quality of life.
Recreation therapy is a treatment that helps children with cerebral palsy develop and expand physical and cognitive capabilities while participating in recreational activities. Though a child may participate in other therapies that specifically address physical function need, recreation therapy is specifically designed to allow children to partake in leisure pursuits by eliminating the roadblocks that impede the pursuit of sports, arts, crafts, games and other life-enhancing activities.
‘Where there is a will, there is a way’ montra applies to recreation therapy. When children with impairment are presented with an obstacle to perform a life-enhancing activity, recreation therapists work to identify the interest level, capabilities, adaptive approaches, and in some cases modified processes required to complete the activity successfully.
Recreation opportunities have advanced through the years. Sports like rugby, soccer and tennis have been modified for individuals in wheelchairs. Hockey can be played using an innovative, custom-designed sled and extreme sports, such as modified downhill bike racing, prove that those with impairment have more sporting options – and fewer limits – than ever before.
Recreation therapy also addresses arts and cultural pursuits. Children with compromised fine motor hand strength can use softer than average clay to make ceramic pots. Organized painting instruction using vibrant colors can help children build crucial neurological connections. Artwork can be created by using specialized applications and assistive equipment. Children are participating in dance recitals using adaptive equipment, modified movements and accepted grace.
The goals of recreation therapy include:
- Determining a child’s capacity for recreational performance
- Minimizing a child’s disability by teaching him or her adaptive strategies
- Motivating a child to take part in activities with encouragement and support
- Modifying process and procedures to enhance inclusion
- Expanding a child’s ability to socialize and make friends
- Enhancing a child’s self-concept and self-confidence
- Helping a child develop interests
What are the Benefits of Recreation Therapy?
Recreation therapy has numerous benefits for children with cerebral palsy – it can improve physical functionality, improve neurological connections associated with processing activities, and provide opportunities for inclusion. Children involved with recreation therapy benefit within both group or solitary environments. The time spent within activities of interest decreases opportunities for depression, loneliness and frustration. In fact, recreation therapy provides a greater sense of self-worth and accomplishment.
Another benefit that a child will enjoy is the ability to take part in activities with his or her family, neighborhood children, school mates and others with like interests. When an individual is accepted into a group, other members of that group are exposed to the ever-increasing capabilities of those with impairment. Often siblings, friends, and co-workers would like to interact with individuals with cerebral palsy, but are discouraged by their ability to know how. Those trained in recreation that participate in activities often become the examples of human possibility, understanding and inspiration for those with and without impairment.
Physical benefits of recreation therapy include:
- Improved physical adeptness
- Increased strength and flexibility
- Improved physical fitness and health
- Improved athletic prowess
- Improved coordination
Psychological benefits of recreation therapy include:
- Acceptance of disability
- Increased social skills
- Increased ability to manage stress and depression
- Decreased anger and anxiety
- Diminished social isolation
- Improved body image
- Improved well-being and relaxation
Cognitive benefits of recreation therapy include:
- Improved behavior
- Increased analytical and decision-making skills
- Improved confidence
- Increased organization
- Increased perception
When is Recreation Therapy Advised?
Recreation therapy is advised by professionals in a special education setting at the child’s school; through behavioral counselors that are working to build the child’s self-esteem; or by concerned parents looking for enhanced opportunities for their child.
There is no specific age in which recreation therapy begins, or ends. However, recreational modalities that are introduced should always be age appropriate. Toddlers and young children will likely be introduced to light sports, playground activities, games and arts. As children get older, more organized recreational approaches, team sports, and complex creative activities such as drama and music can be introduced.
When in teen years, children may wish to participate in an area of interest such as golf, swimming, diving, dance, school plays, talent shows, or debate competitions. When adult, interests and opportunities present which may interest in the individual with impairment. The focus is on expanding interests and the ability to know opportunities once thought unavailable, can be modified to accommodate. This can be empowering.
A child’s medical team will assist a recreational therapist in devising recreation interventions that meet the child’s treatment needs and satisfies his or her interests.
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How is Recreation Therapy Performed?
Recreation therapy makes use of activity-based interventions that are rooted in functional performance, communication, behavior, adaptation and modification to physical conditions and cognitive processes.
Plans of treatment are highly-individualized; techniques that work on one child may not easily translate to another. Recreation therapists must systematically identify any physical and emotional roadblocks; they explore adaptations and, when required, modifications. Adaptations are distinctly different from modifications in that adaptations may require the assistance of orthotics, adaptive equipment or assistive technologies, while modifications are alternate methods for a child to perform an activity. The desired result can render a limitation manageable or nonexistent, thus allowing full participation and successful inclusion opportunities.
Taking the step into recreational activities can be stressful for children with cerebral palsy; many of the techniques used by therapists are designed to motivate children; it’s the therapist’s job to instill confidence in the child. It can be frustrating for the child to learn new ways to perform or overcome obstacles. However, when the child experiences the benefit of being accepted and included into areas of their own interest children often quickly accept and learn, especially if the learning environment is positive and supportive.
Interventions that are used include:
- Specific physical training in activities
- Cognitive retraining
- Wellness training
- Stress management strategies
- Behavior counseling
- Play skills
- Socialization and one-on-one conversation role play
- Small group interactions and activities
- Community integration
- Guided imagery and meditation
- Relaxation and biofeedback
Where is Recreation Therapy Performed?
Recreation therapy is performed at several locations, many of which are clinical settings. However, because recreation therapy is based on the child’s capabilities and interests, therapy can take place indoors or outdoors, or any place where individual is to engage in activities that provide pleasure and leisure.
Therapists will also instruct children on how to engage in recreational pursuits with their child at home, or in public. At times, the recreational therapist may be on hand to assist others in learning how to include and embrace the efforts of the child with impairments, such as classrooms, gyms and community programs. In some cases, the child is enrolled in programs specifically designed for others with like impairment, thus once trained they are integrated with others who have also overcome their obstacles to participate.
Indoor locations include:
- Medical offices
- Mental health facilities
- Centers for independent living
- Outpatients centers
- Rehabilitation centers
- Skilled nursing facilities
- Vocational centers
- Community centers
- Public and private recreation facilities
Outdoor locations include:
- Community centers
Who Provides Recreational Therapy?
Recreation therapy is provided by trained, often-certified professionals that are dedicated to empowering and enabling disabled children. Most therapists earn a bachelor’s degree in recreation therapy, but others receive degrees in other health-related fields of study. Therapists will most likely have also completed an on-site internship as part of their education.
Required coursework for recreations therapists include:
- Client assessment and evaluation
- First aid and safety
- Group dynamics
- Human development
- Medical terminology
Certification is not required in all states, however, it’s considered desirable by employers, especially those in a clinical setting. For more information, contact your state’s medical licensing board.
Certification is obtained through the National Council for Therapeutic Recreation Certification, which offers the Certified Therapeutic Recreation Specialist credential. Applicants must have completed a bachelor’s degree from an approved degree program, pass the CTRC written exam, and successfully complete a 480-hour internship.
Additionally, therapists may obtain specialty licensure in specific areas of practice, including behavioral health, physical rehabilitation, or developmental disabilities, to name a few. Certified therapists are required to re-apply every five years, and as part of the process must show additional professional work experience or education, or take the national exam.
What Happens During Recreational Therapy?
Parents are typically relieved to learn there are so many opportunities for their child to participate. Children are empowered by the possibilities, particularly if they can socialize with their peers.
For a child – typically one with more severe physical impairment – to be included, an evaluation is made of the child’s capabilities, interests, temperament and adaptive needs by a therapist. Therapists consult with the child’s primary care physician to coordinate treatment plans. They also consult with the child’s physical and occupational therapists to ascertain ability levels already achieved. Therapists also analyze the child’s support team, daily routines and social skills.
A recreation therapist will then fully analyze the physical and cognitive functioning required to perform the activities of interest, including the physical demands of mobility and function, the cognitive process of learning, processing and decision-making, as well as the emotional demand of performance, interaction and competition. Adaptation and modification methods may be incorporated, if needed.
Evaluation may include:
- Review of medical records
- Observation in a clinical setting
- Standardized tests
- Collaboration with other medical team members
A therapist will then outline a plan of treatment. Before a plan is implemented, a therapist must determine several factors, including:
- Whether the plan meets a child’s interests and goals
- How a child’s body mechanics enhance, or impede, an activity
- What, if any, assistive and adaptive equipment is needed
- If a child needs additional coping strategies
- If a child requires enhanced social skills for group activities
- How to incorporate positive support systems during therapy
The treatment plan may employ several strategies to help a child develop physical, cognitive and social gaps. For instance, a child that is shy, or uncomfortable in social situations might be placed in more group activities so that he or she has an opportunity to build socials skills along with mastering the activity.
Therapists will also teach children how to use any specialized equipment that is required for activities, and will teach children alternate methods to engage in activities. This may include teaching a child how to properly position himself or herself for specific activities, how to pace for physically taxing activities like sports, and how to breathe throughout the process.
Therapists must also identify and inform children and caregivers of local community resources programs and transportation that could further their opportunities for recreation beyond therapeutic and school settings. They may have access to funding sources that may be required to cover expenses beyond that which the health insurance may cover.
Therapists also show parents and caregivers how to maintain and properly clean the equipment. In some activities, equipment must be worn and used in a manner that does not harm the child. Safety guidelines are provided.
Throughout therapy, the recreation therapist will continually assess a child’s level of participation and progress, and will make changes to a child’s treatment plan as they are required.
Are There Special Considerations or Risks to Recreational Therapy?
As with all activities – especially sports – a certain level of risk is involved. However, when a child is being treated by a qualified therapist that has implemented a well-thought out treatment plan, the risk is minimized and continually supervised and monitored until safety levels are obtained.