420 Exam 1

Intervention

the act of stepping into a situation to improve it, change a course of events, or stop something from getting worse

What is intervention in RT?

designed category or set of therapeutic activities designed to meet predetermined objectives/outcomes for a specific group of clients

Characteristics of intervention

Broad in nature

intends to improve a client’s condition (purposeful)

evidence-based (supported by research)

other names for Intervention

specific programs

treatment methods

facilitation techniques

Intervention examples

aquatic therapy

leisure education

physical activity

therapeutic horticulture

Modalities

specific therapeutic agent or activity implemented during treatment to produce a desired effect

Characteristics of Modalities

Specific in nature

further specifies the intervention

intends to produce a specific outcome (purposeful)

evidence-based (supported by research)

other names for modalities

therapeutic activities

treatment approaches

Modality examples

Intervention: Aquatic Therapy

• aqua running

• halliwick method

• watsu

Intervention: Physical Activity

• strength training

• endurance training

• aerobic activity

Facilitation Techniques

method used by recreational therapist to carry out or deliver the modality to a specific client or group of clients

Characteristic of facilitation techniques

based on client’s leaning style and nature of the task/skill

other name for facilitation technique

teaching techniques

examples of facilitation techniques

forward chaining; backward chaining

prompts; cues

environmental modification

When do the bulk of interventions occur in APIED?

IMPLEMENTATION

Assessment

What are your client’s goals, personal leisure interest, and preferences?

Journals

Which interventions are evidence-based and shown to be effective?

Feasibility

What is feasible to facilitate in setting? Do you have necessary space and materials/equipment/supplies to facilitate the intervention?

Pharmacological

medicine to treat conditions

RTs cannot prescribe medication

Non-Pharmacological

prevents, treats, or manages health conditions and improve quality of life without the use of medications or chemicals

RTs specializes in non-pharmacological interventions

Common RT Interventions

Reminiscence/Life Review

Sensory

Bibliotherapy

Adventure

Social Skills Training

Horticulture Therapy

Parameters & Precautions

guide assessment process & clinical decisions about interventions

applies to all settings

must get participant’s medical information in community settings

maximize RT outcomes while minimizing risk

What should RT’s know at minimum

how to check a pulse, monitor respiration & oxygen level, take blood pressure, and check temperature

Common precautions

cardiac, exercise, fall risk, pulmonary, seizures, suicide, weight bearing, diet & swallowing. surgical/movement/activity

Cardiac precautions

RT must know the diagnosed cardiac condition, must be followed very closely

usually involves monitoring vital signs: respiration rate, heart rate, blood pressure, fatigue, rest breaks

Exercise precautions

MUST always have physician clearance prior to exercise

usually involves monitoring vitals, blood sugar, balance, coordination, and lifting techniques

Symptoms of Hypoglycemia

shakiness, dizziness, irritability, confusion, cold sweat, blurry vision

solution: raise glucose levels using fruit juice, candy, glucose tablets, etc

Symptoms of Hyperglycemia

increased thirst, frequent urination, feeling tired, nausea, tingling in feet & hands, dry/itchy skin, unexplained rash

contact doctor if glucose level above 180

Fall Risks

must assess in all settings and follow precaution

common indicators of fall risks: history of falls, confusion, shuffling gait, poor balance, unstable glucose levels, orthostatic hypotension, impaired judgement, impulsivity, bowel/bladder urgency

reduce risk fall: using call bells, patient safety attendants, wheels (bed/wheelchair) locked, alarms, orientation to room, clutter removed, good lighting, bed rails, non-slip footwear, using appropriate mobility aids

Pulmonary precautions

need to understand saturation levels (measured with pulse oximeter)

Methods for delivering Oxygen: nasal cannula, nasal catheter, oxygen mask, can be attached to the wall or a portable O2 tank, amount typically in client/patient charts

be sure O2 tanks are secured, tubing is not blocked/kinked, O2 is highly combustible

Seizure precautions

often seen in epilepsy, brain tumors, TBI, stroke, functional neurological disorder

common triggers loud noises, bright/flashing lights, fatigue, low blood sugar, dehydration, stress, missed medications, hormones, illness

know how to use a Vagus Nerve Stimulator (VNS)

seizure procedure: protect head, ease to floor, turn on side, clear area of objects, loosen clothing, and time it

DO NOT restrain or put anything in mouth

after seizure allow rest until fully awake

Suicide precautions

systematic team approach

person identified to be at risk for committing suicide

all objects that can be used for harm are removed from room and environment

environmental hazards are agency specific, some require 1:1 supervision

search person before leaving area, risk is continually assessed

Weight Bearing Precautions

determines the individual’s ability to bear weight on extremities, usually seen in bone fractures & joint replacements, evaluated by physicians and physical therapy

RT must know: Non-weight bearing (NWB), Toe-touch weight bearing (TTWB), Partial weight bearing (PWB), weight bearing as tolerated (WBAT), Full weight bearing (FWB), Coffee cup weight bearing

Diet & swallowing precautions

Dysphagia - often in stroke, TBI, dementia, etc

IDDSI framework: standard for food texture and drink thickness

0-4: (thin, slightly thin, mildly thick, moderately thick, extremely thick)

3-7 (liquidized, pureed, minced/moist, soft & bite-sized, easy to chew/regular

Surgical/Movement/Activity Precautions

often seen after major surgeries, restricts movement, lifting, and range of motion

No BLT the Bending, Lifting, or Twisting

common precautions: sternal (move in the tube), C-spine (cervical spine), back, hip (anterior/posterior approach)

Agency

the organization or system that oversees service delivery of healthcare and human services

Department

the administrative structure that houses, manages, and supervises RTs

Units

a distinct floor, ward, or specialized program in a department or agency

Balanced Programming

RT environment

RT groups

RT program format

RT scheduled programs

Guidelines for balanced programming

client recreational interest

covering all behavioral domains

accommodating participants

variety of spaced

varied scheduling

varied program formats

Addressing behavioral domains

physical, cognitive, social, emotional, and spiritual

addressing the domains is extremely important

should have programs that cover all domains

general rule - offer 1 of each program type a day if applicable

Co-treatment in Unit-Wide Programming

fosters collaboration, respect, trust, unity

RT may need to educate other staff about TR/RT

collab with: PT, OT, SLP, SW, Psych, Art, Music

Scheduling

in both public and private spaces

different settings require or use different types of space

Activity Analysis

systematic process that involves the break down and examination of a given activity to determine the behavioral requirements needed for successful participation and achievement of client outcomes

Goal of activity analysis

to understand the activity and typical characteristics

CRUCIAL in planning process

Benefits of activity analysis

CTRS able to select appropriate activities/modifications for clients

prevent incorrect activity selection

ensure client outcomes are reached

Principles of activity analysis

analyze activity as it’s normally engaged in

• modification is AFTER analysis not before/during

analyze activity based on minimal level of skill required for successful participation

analyze activity without regard for specific disability group

Conducting activity analysis

Physical: identify actual demands of activity

Cognitive: mind regulates body movement and behavior, *most important

Emotional (affective): difficult to analyze, response is vital

Social: many activities require some degree of social skill

Interaction Patterns

Intraindividual, extraindividual, aggregate, interindividual, unilateral, multilateral, intragroup, intergroup

Intraindividual

action taking place within the mind/body of a person, but requires no contact with another person or external object (meditation, day dreaming)

Extraindividual

action directed by a person toward an object in the environment, requires no contact with another person (watching tv, gardening)

Aggregate (parallel play)

action directed by a person toward an object in the environment while in the company of others who are doing the same, no interaction required (bingo, crafts)

Interindividual

action of a competitive nature directed by one person to another (checkers, tennis)

Unilateral

action of a competitive nature among 3+ people, one of whom is an antagonist (tag, hide and seek)

Multilateral

action of a competitive nature among 3+ people, with no antagonist (every player against each other) (poker, scrabble, monopoly)

Intragroup

action of a cooperative nature by 2+ people who are intent on reaching a mutual goal (band/choir, projects)

Intergroup

action of a competitive nature between 2+ intragroups (team sports/games)

Administrative activity analysis

determine the:

required leadership style

type of equipment/facilities needed

duration of the activity

number of required participants

Body Mechanics

efficient use of the body to complete a task

Ergonomics

how to position the body and objects to maximize performance & decrease injury

Transfer

movement of something or someone from one place to another

RT risk of injury

poor posture, lifting & transfer technique, out of shape, lower back pain

Client risk of injury

center of gravity & base support changed due to illness/injury, cognitively can’t understand body mechanics, change (typically decrease) in balance, energy, and endurance

Good body mechanics

Bending & leaning: involves hips, knees, feet, base of support, more than back muscles, widen base of support, engage stomach and thigh muscles

Lifting objects: keep feet shoulder width apart & stagger stance to increase base of support, bend knees, lift legs, head aligned with back, shoulders aligned with hips

Client transfers

physically moving client, get training from OT and PT if possible, communication is very important, counterbalance with knees, know type of transfer used and level of assistance

use slide boards, hoyer lifts, and other available transfer equipment/machines

Transfer level of assistance

Independent: client perform all aspects of transfer 100%

Assisted transfers: client participates but require assistance of 1+ individual

• Max assist: client perform <25%

• Mod assist: client perform min 50%

• Min assist: client perform min 75%

• contact guard

• supervision - verbal cues

Dependent transfers: client unable to actively participate, Type - Total Assistance

Transfer aids

Gait belts: nylon or fabric belts placed at waist on outside of client’s clothing, therapist hold on belt during transfers

slide boards: flat, smooth device made of wood used to bridge gap between 2 surfaces

sit to stand aids: help a person pull themselves up into a standing position and pivot to a new seat

patient lifts: manual/powered mechanical lifts used when a client cannot bear weight or assist with transfers

Benefits of transfer equipment

enhance client safety, prevent injury to practitioner, help promote and observe patient growth

Transfer tips

communicate, double check safety precautions, block patient’s knees if needed to prevent buckling, DO NOT have patient put their arms around your shoulders, ask for help if unsure or uncomfortable

Protocol

written to thoroughly describe an intervention or a diagnostic group

two types: diagnostic/intervention protocols

Diagnostic Protocol

format developed by ATRA

written on a specific disability group

description of the disability, assessment, goals, interventions, evaluation

Intervention Protocols

sometimes called treatment/program protocol

written on specific RT interventions

provide framework for designing, delivering, and evaluating RT intervention

• format developed by ATRA

• includes 12 steps

• still somewhat agency specific

Why use intervention protocols?

standardized/consistent treatment

follows evidence-based practice

obtain consistent results, client needs, outcome data, accountability

12 Components of intervention protocol

1. Intervention title

2. Statement of purpose

3. Intervention goals

4. Intervention description

5. Problem areas

6. Target populations

7. Referral criteria

8. Contraindicated criteria

9. RT modalities

10. Staff training

11. Risk management

12. Expected outcomes

1. Intervention title

reflects content of the intervention

avoid “catchy” titles that can be confusing to clients

2. Statement of purpose

intent of the intervention, identifies the intervention’s priorities

3. Intervention goals

the general goals of the intervention

4. Intervention description

overview of what the intervention is about, includes how the intervention is offered to clients

typically several paragraphs, values clarification

5. Problem areas

identify limitations most likely to benefit from the intervention, identify problem areas the intervention will address in the 4 behavioral domains

6. Target population

specify what disability groups will benefit from participating in the intervention

7. Referral criteria

describe how the client will be referred to the intervention, very agency specific

example: treatment team, doctor, RT assessment, teacher

8. Contraindicated criteria

who will NOT benefit from the intervention, problem areas, and/or disability groups

contraindications can be medical or behavioral

9. Recreation therapy modalities

most important component, discuss how the intervention is implemented, similar to a lesson plan

10. Staff training and certifications

total number of staff needed to implement the intervention

type of staff (qualifications/professions)

11. Risk Management

reduce potential liability related to the intervention, not just high-risk outdoor activities

be proactive and have a plan

certify staff in CPR/AED and Basic first aid

12. Expected Outcomes

end result from intervention

change of behavior or functioning level

Signature & date

supervisor(s) and therapists running the intervention

Why do we have RT groups?

therapeutic, educational, skill development, reintegration groups

effective groups seek the same benefits and share common goals, must communicate the purpose and goals of a group

Group leadership

requires multitasking

focus on individual/group needs, observations, listening skills, constant monitoring

RT group leader responsibilities

should be enthusiastic, energetic, flexible, creative, motivated, and a role model

sets tone, establishes morale, communicates group purpose & goals, sets guidelines for behavior/protect members from harm, uses person-first language

Leadership Styles

autocratic, democratic, laissez-faire

Forming

members get to know each other, work on building trust and acceptance, interactions are tentative

Storming

begin to assert own beliefs, conflicts emerge

members begin to take on group roles’

RT must manage behavior/conflict

Norming

rules of behavior & patterns of interaction emerge

express how others should behave

better handle disagreements

traditions/rituals get established

Performing

productivity stage

mutual respect & cooperation

move toward completing purpose, goals, tasks

Adjourning

accomplished task, prepare to disband

many therapy groups do not reach this stage

RT helps group bring closure

plan for the future

solidifies friendship

very important at the end of your internship

RT group phases

warm-up, experience, wrap-up phase

Warm-Up Phase

introductions & learn names

state purpose & benefits from engagement

explain rules and specific activity

might use mixers, icebreakers, get to know you games

Experience Phase

monitors behavior, conflict, & participation levels

create therapeutic experience by giving feedback and facilitating change

debrief the activity through guided reflection and prompting

Forward Chaining

teach first step to mastery first and provide assistance for additional steps, learn the steps in a logical sequence

Backward Chaining

prompt entire chain of behaviors to the last step, last step is done independently to completion