Grow Through Flow NCTRC Exam

Duration Recording:

When you are interested in how long a behavior occurs, you record the amount of time that the client displays the behavior

Interval Recording:

Indicates how frequently a behavior is displayed during a specified time interval.

Continuous Recording:

When the therapist records both the beginning of the behavior and the end of the behavior, it is called

Standardized Observation:

o Two major forms:

1.) Standardized or norm-references instrument - measure of how an individual performs in relation to others who are from the same classification of persons.

2.) Criterion referenced tests - measures achievement toward some established standard.

o Reliability: produces stable results over time

o Validity: measures what it is designed to measure

Specific Goal Observation:

o Assess a well-defined behavior.

o Might include observing an adult playing a card game or observing an adolescent square dancing. These activities make certain cognitive, psychomotor, or social demands on the client.

o Role playing - client is told to act as though he/she normally would in the situation

Naturalistic Observation:

o No attempt to manipulate or change natural environment.

o Keeping an on-going account of the client's behavior through written anecdotal notes

o What to look for while completing observations:

1) General appearance

2) Motor activity

3) Interpersonal interaction

4) Body language o Areas of observation: Personal appearance, posture & movement, manner, facial expressions, general level of activity, intentional activity, cognitive ability, communication.

Casual Observation:

o Type of non-systematic observation in which we engage on a daily basis.

o It is responding to our environment in a somewhere random fashion and out of our personal bias and background.

o Not skilled, directed or purposeful.

Skilled Observation:

o Carefully completed in an organized manner and are as free as possible from personal bias.

o Knowing what to look for & what to expect, learn to disregard irrelevant information.

o Unobtrusive so as not to alter or change client's behaviors.

Anecdotal Records:

• Provide factual description if actual behavior in natural situations that are significant indicator of total behaviors

• Allows recording in non-standardized form

• Issues:

o Can be time consuming

o Hard to be objective

o Difficulty in deciding level of detail to record

• Techniques:

o Determine in advance what to observe

o Develop procedures for coding

o Train observers

Interview:

• The interview has three purposes:

1. Opportunity to gain information from the client and to observe the client

2. Begin to develop a relationship, or gain rapport with the client

3. Orientation to the program or programs available to the client

• Areas for information seeking during interviews:

1. Readiness for treatment

2. Degree of rationality

3. Relationship with others

4. Resources for support

5. Leisure related problems

6. Leisure values

7. Awareness of leisure

8. Basic skills needed to develop leisure skills

9. Leisure history

10. Appearance

11. Other problem areas

Interview Techniques:

• Need to be consistent

• Conduct interview in a quiet, private and comfortable environment

• Introduce self

• Introduce therapeutic recreation services

• Establish rapport

• Determine strengths and weaknesses

• Close interview •

Specific Techniques include:

o Open-ended questions

o Closed ended-questions

o Reflection

o Facilitation

o Silence

o Confrontation

o Clarification

o Interpretation

o Summation

o Transition

o Self-Revelation

o Positive reinforcement

o Reassurance

o Advice

Probing:

is a question that is directed toward yielding information in order to gain empathetic understanding. Probes are open-ended questions requiring more than a yes or no reply. The purpose of the confronting response is to assist the client to achieve congruency in what he or she says and does, to help him or her be fully aware and honest in gaining self-understanding

Confrontation:

involves "telling it like it is," without being accusatory or judgmental

Informing:

transpires when objective and factual information is shared with the client

Self-disclosing:

allows personal disclosure on the part of the helper with the intent of providing the client with an opportunity to perceive the helper as another human being who has encountered situations, thoughts or feelings similar to those faced by the client

Subjective vs Objective data

Subjective Data: what "client" tells you

Objective Data: anything else you or others observe

Types of affect/facial expressions:

• Flat affect = none

• Broad affect = wide range

• Blunted = little, very slow

• Inappropriate = range, but inconsistent and inappropriate

• Restricted= one type

Principles of Quality Client Documentation:

1.) Consistency and Accuracy of Information

2.) Conciseness in Client Documentation

3.) Clarity in Client Documentation

Consistency and Accuracy of Information:

must be accurate, objective and consistent

• Objectivity: only info that is factual and objective.

• Accuracy: needed in correct spelling, grammar and punctuation

• Behavioral Language: focus on clients behavior, descriptive action words and meaningful language

• Consistency in Information: client to client, and between clients and specialists

Conciseness in Client Documentation:

Short, succinct sentences are recommended, also consistent

Clarity in Client Documentation

Using meaningful phrases and making sure it is clear to the reader

• Meaningful phrases: descriptive, behavioral terms

• Technical Guidelines: legible and written with ink, only approved abbreviations

o Mistaken entry: simply cross out the word with a single horizontal line, write "error" and initial/date it.

o Signing notes: every note should be signed with professional credentialing (i.e. CTRS)

o Abbreviations: only ones approved by agency

• Writing styles: inappropriate wording (i.e. a lot of = many, several), absolutes (i.e. all the time = frequently), redundant phrases (i.e. necessary requirements = requirements)

Charting Methods:

Four Major types:

1.) Narrative Format Source Oriented Medical Records (SOMR)

2.) Problem Oriented - Problem Oriented Medical Record (POMR)

3.) Focus Charting (DARP)

4.) Charting by Exception (CBE)

Narrative Format Source Oriented Medical Records (SOMR) Charting

Each professional group or source typically keeps data separate from the other professional groups or sources

• Separates recordings according to discipline

• Sections of the chart are designated for medical notes, nursing notes, TR notes etc.

• + Side = easier for each discipline to record all data in one place

• - Side = places data in too many locations making it fragmented & cumbersome to retrieve data & more difficult for a team approach.

• Unstructured

• The following need to be included:

a) Change in patients condition

b) Patients response to treatment or medication

c) Lack of a change in condition

d) Patient or family members response to teaching

Problem Oriented Medical Record (POMR) Charting

Organized around the client's problems rather than source of data:

• Is a comprehensive evaluation

• Five parts:

1) Data base: data collected during assessment

2) Problem list: analysis of data base establishes a problem list, in numbered order with date.

3) Initial plan: outlines an approach to be used to meet each of the identified problems.

4) Progress notes: record the results of interventions/client progress. Using SOAP, SOAPIE or SOAPIER forms

5) Discharge summary: noting problems and resolutions

Subjective, Objective, Assessment and Plan (SOAP)

Focus Charting (DARP) Charting

Method for organizing information in the narrative portion of the client's record to include data, action and response for each identifies concern.

• Client-centered approach to documentation

• Utilizes a column formal

• Advocates state the "Focus" is much more comprehensive then "Problem"

• Focus = current concern or behavior, or a significant event in client status

• Includes four categories:

1. Data - subjective and/or objective information supporting the stated focus or describing observations at the time of significant events

2. Action - a description of the actions taken by the therapist in the form of interventions or programs

3. Response - a description of the client's response to the interventions, activities, or situation. It can include a statement that treatment plan goals have been attained. Client outcomes are included in this section

4. Plan - next interventions to be implemented

Charting by Exception (CBE) Charting

Purpose is to make trends in patient status more obvious, reduce the amount of time spend in documentation, and make current information about the patients status readily available.

• Only findings that are significant, abnormal or that deviate from professional standards or protocols are recorded.

• Contains several components:

o Flow sheets

o Documentation referencing standards

o Protocols and incidental orders

o A database

o Diagnosis-based care plan

o SOAP (IER) progress notes

SOAP

Daily progress report in the patients chart

• Should express:

o Any changes in the patient's symptoms and complaints?

o Current physical findings? Any changes?

o New developments

o Current formulation and plan for the patient

• Can write a SOAP(IER) progress note: Subjective data: gathered from client - Example: stated feelings.

Objective data: based on observation & other sources - Example: engaged in activity for 40 minutes.

Assessment: conclusions based on data review - Example: anxiety level is slowly decreasing & there appears to be an inability to express feelings.

Plan: plan believed to resolve the problem - Continue plan as outlined in initial plans.

Interventions: specific intervention implemented

Evaluation: Patient's response to interventions

Revision: changes made from the original treatment plan

Discharge/Transition Planning

Usually the final component included in the clients record

• Some agencies use SOAP (IER) format while other prefer a more narrative summary or a combined narrative- standardized form.

• "Begin making plans for discharge the day the client is admitted."

• Summary of the client's involvement and progress within the therapeutic recreation programs.

• The following are suggestions of info included in a discharge summary:

o Major client problems or goals

o Services received by the client

o Clients response to functional interventions, leisure education and recreation participation services

o Remaining problems or concerns

o Plan for post-discharge leisure involvement

Client Goals:

• General objectives

• Broad in nature and may be contrasted with objectives

• Proposed changes in the individual or their environment

• A broad statement of desired behavior that the participant will demonstrate

• Set in a positive term; sense of direction

• i.e. increase social interaction with others

Client Objectives:

• Specific behavioral objectives

• Describe proposed changes in the individual client or in the client's environment.

• States what the participant will do

• A statement that describes an outcome

• A course of action to meet a goal

• Clear and descriptive of observable behavior

• Written in terms of participants behavior

• Narrowly written and deal with very specific, objective and measurable behaviors.

• i.e. initiates conversation with others during social recreation activities without staff prompting

• most common type is behavioral objectives because they translate into client outcomes

Objectives have:

Criterion

Condition

Behavior

Behavior

A specific behavior to be demonstrated by participant - verb

Criterion

The measurable outcome how well must it be done, correctness, time span, percentage, what is acceptable or successful performance

▪ The criterion in the behavioral objective delineates the exact amounts and nature of the behavior that can be taken as evidence that the objective has been met.

▪ A criterion is a precise statement or standard that allows individuals to make judgments based on the observable, measurable behavior

• I.e. after ten lessons (condition) the participant will swim (behavior) one length of the pool (criteria).

Condition

When and where the behavior will occur - a given or a restriction

Stres

Relationship between person and environment that is appraised by the person as taxing or exceeding his or her resources or endangering his or her well-being.

• A state that results from an actual or perceived imbalance between the demand and the capability of the individual to cope with and/or adapt to that demand that upsets the individual's short-or-long term homeostasis.

• When stress is perceived, people engage in a cognitive appraisal process:

o Primary - Appraise the risk or threat

o Secondary - Appraise options for responding

Stress - Coping

The process of dealing with stress and your response to the stress

• Any effort to master conditions of harm, threat or challenge and bring the person back into equilibrium.

• Four buffers to help manage stress with recreation/leisure:

1. Sense of competence

2. Nature and extent of exercise

3. Sense of purpose

4. Leisure activity

• Cognitive and behavior efforts to manage external and/or internal demands (i.e. stress)

• Two types of coping:

1. Problem-focused

2. Emotion-focused

Attribution Model:

• The casual analysis of behavior

• The process by which a person attributes or makes casual inferences "to what I attribute my success and failures".

• People formulate explanations for their own and others successes and failures.

• Involves two dimensions:

1.) Stability (stable/unstable)

2.) Locus of control (internal/external)

• Involves four determinants of success or failure:

o Ability (stable-internal)

o Effort (unstable-internal)

o Task difficulty (stable-external)

o Luck (unstable-external).

Learned Helplessness:

A perceived lack of control over events

• no matter how much energy is expended, the situation is futile and you are helpless to change things

• people learn to be helpless and become dependent

• behaviors and outcomes are out of one's control

• occurs when people are exposed to repeatedly to uncontrollable events and being to learn that responding is futile

• When people learn that responding does not work they cease to explore other behavioral options

Perceived Freedom:

When a person does not feel forced or constrained to participate and does not feel inhibited or limited by the environment

• Means that the activity or setting is more likely to be viewed as leisure when individuals attribute their reasons for participation to themselves (i.e. actions are freely chosen) rather than determined externally by someone else of by circumstances.

• The freedom to choose your activity; feeling competent; "I can do this"

• LAM relies heavily on concepts of perceived freedom and personal choice

Intrinsic Motivation

To do something for yourself

• Internal desires to do something as a sense of satisfaction

• Is the impetus to do something for internally or personally rewarding reasons

• Individuals often are intrinsically motivated toward behavior in which they can experience competence and self-determination

Locus of Control - Internal

Believe to largely control outcomes

• Possess the control to change

• Good self-esteem

• Typically, individuals with an internal locus of control take responsibility for their decisions and the consequences of their decisions.

• Obviously, an internal locus of control is important for the individual to feel self-directed or responsible, be motivated to continue to seek challenges, and develop a sense of self-efficacy or self-competence

Locus of Control - External

Believe luck, the environment or powerful others are responsible for the outcomes.

• Low self-esteem

• Helpless

• "he made me do it"

Self-Efficacy Theory

Is the measure of one's own competence to complete tasks and reach goals

• Generalizes to other areas

• Can be influences through:

o Performance accomplishments

o Vicarious experiences

o Persuasion

o Physiological arousal

• Client's personal evaluations of their abilities directly affect how they cope with their problems.

• Client's expectations of themselves largely determine how willing they will be to deal with their problems, how much effort they will be willing to expend, and whether they will make a perseverant effort

Performance Accomplishments:

The client preforms the action and derives the desired outcome

• Strongest influence on self-efficacy beliefs

• Repeated success builds a sense of competence

• Practice - with and without support

Leisure Efficacy

To meet your own leisure needs, benefits from good circumstances.

• You need a repertoire of skills to be self-capable.

• Meet own needs/goals

Experiential Learning Model

The process of making meaning from direct experience.

• Experiential Learning is learning from experience.

• The experience can be staged or left open.

• Staged experiential learning is often called a Dynamic Learning Experience (DLE)

Kolb's model of experiential learning:

Act

Reflect

Conceptualize

Apply

Repeat in a cycle

Neulinger's Theory of Leisure:

• A psychological "state of mind" that encompasses freedom of choice and internal motivation

• Individuals can be said to be in a state of leisure if they simply perceive that they have the freedom to choose activities and are motivated by an activity for its own sake, not just for its consequences

• Interactions are between:

o Perceived freedom

o Perceived constraints

o Interactions contribute to outcomes

Attitude Model

A learned predisposition to respond in consistently favorable and unfavorable manner:

o Beliefs

o Attitudes

o Intention

o Behavior

Theory of Reasoned Action (TRA):

• Derived from the attitude model

• Can predict actions based on personal attitude and perception of how others will view them

• Used as a basis for the practices of health education

• Developed in the 1960's

• Tool for observing behavior and developing interventions based on those observations

• Person intention is the main factor

• Intention is a function of attitude and subjective norm:

1. Attitude: concerns a person's belief that their behavior will produce a beneficial outcome

2. Subjective norm: whether key people in the person's life support the behavior, and whether the subject Is inclined to agree with them

Theory of Planned Behavior (TPB):

• Developed in the 1980's

• A persons intention of doing something is the main factor in determining whether he will actually do it

• Behavior attention does not necessarily result in action

• Builds on TRA by adding a their indicator of a person's intent:

Perceived behavioral control:

Whether the person believes he can control the conditions necessary for change to occur

Health Belief Model (HBM):

• Health is defined in WHO's constitution as a state of complete physical, mental and social well-being

• Not merely the absence of disease or infirmity

• Recognizes the person with the disability (PWDs) can be healthy

• Used as a basis for the practices of health education

• Developed in the 1950's

• Take health action to avoid consequences

• Four key beliefs that make a person more likely to perform a specific behavior:

1. The person believe that the condition which the behavior will address is a threat

2. The person is prompted to perform the behavior, either by people or by messages

3. The person is confident he is able to carry out the behavior

4. The person believes that the benefits of doing the specified behavior outweigh the negatives

Transtheorietical Model/Stages of Change:

• Six stages of behavior change and advocated various interventions to keep clients motivated:

1. Pre-contemplation - client does not feel they have a problem. ▪ Interventions would involve making him/her aware of the problems

2. Contemplation - client admits a problem, but is still not sure if he/she wants to change. ▪ Interventions would include encouraging the subject to make specific plans to change.

3. Preparation/commitment - client realizes a need to change and gathers information. ▪ Interventions would include setting goals; awareness of the positives vs. the negatives of change

4. Action - client follow a plan for change behaviors. ▪ Interventions involve providing feedback and support.

5. Maintenance - client sees the benefits of the new behaviors. ▪ Interventions including helping in case of relapse; continues feedback and support

6. Termination - client can't imagine ever doing the old behavior. ▪ Interventions include proving help when needed and continuing to offer support.

Social Cognitive Theory (SCT):

• Grew out of Social Learning Theory (SLT)

• Introduced in the mid-1980's

• Follows the realization that people learn by watching others

• Behavior is influenced by three things:

1. The characteristics of the person

2. The characteristics of the behavior

3. And the environment in which the behavior would take place

• The relationship among the three characteristics is called - Reciprocal determinism

• Changing behavior is most likely to occur if the person has:

o Self-efficacy: confidence in the ability to do something

o Behavioral capability: the skills and knowledge to do the specified behavior

o Outcome expectance: a belief that the expected outcome of the new behavior will be beneficial

Diffusion of Innovation Theory (DIT):

• Explains how new ideas spread and why some ideas never do

• Gained popularity in the 1960's

• Innovation = an idea, practice or object that is perceived as new by a population

• Diffusion = the process by which an innovation spreads through a social system over time

• Five key factors influence whether an innovation will diffuse:

1. Characteristics of the target population

2. Environmental context into which the innovation will be introduced

3. Credibility and likability of the agent promoting to innovation

4. Quantity of information communicated to the population about the innovation

5. Quality of information communicated to the population about the innovation

Stage Theory of Adaptation:

• Based on Kubler-Ross's theories on acceptance of death

• Elements of Stage Theory:

o Shock o Defensive

o Depression or mourning

o Personal questioning

o Adaptation, change and integration

Maslow's Hierarchy of Needs:

• Motivation based theories

1. Subsistence needs

2. Safety needs

3. Need for love and affection

4. Achievement

5. Self-actualization

Family Systems:

• Members have different roles, so a change in ones behavior will affect the others

Diversity Factors

• A persons cultural orientation will impact how he/she will react to the assessment and programming process:

o Traditional - original culture has been retained

o Marginal - an uneasy mixture of original and other cultures

o Bicultural - acceptable comfort with original and newly acquired culture

o Assimilation - adopting and internalizing values, beliefs, and behaviors of dominant society

• Stereotyping - making assumptions about an individual based on ideas about a group

• Prejudice - a negative opinion about someone based simply on that person's race, gender, or religion

• Bias - preference for one over another

• Discrimination - unfair treatment of someone based on personal prejudice

Medical Model

Focuses on the individual and pathology and includes identification of underlying disorder, interventions, treatment and cures.

• Assumes that the impairment or condition a person has is the key problem.

• The response is to "cure" or "care"

• Health is the opposite end of the continuum from disease, illness and or disability and focuses on functional ability, morbidity and mortality.

• Believes that is the individual has a disability, he/she is not capable of being healthy.

• The medical model promotes the view of a disabled person as dependent and needing to be cured or cared for, and it justifies the way in which disabled people have been systematically excluded from society. The disabled person is the problem, not society. • Poor health → optimal health

• Dr. prescribes TR treatment

• Recreation is treatment - as a means to an end, is more clinical

Public Health Model

Focuses on achieving good health and a sense of well-being

• Basic human rights

• Proposes that opportunities (diagnosis/treatment) to achieve health and well-being should be available to all groups

Activity Therapy Model

TR is prescribed, similar to medical model

• "blurring" of different departments including music therapy, art therapy, occupational therapy, dance therapy)

Ecological Model

Addresses the environment, what has to change in the environment

• Looks at the individual needs and environment needs

• The people around you: community and family

• Changes can occur encompassing both the promotion of abilities and the elimination and individual barriers

Person-Centered Model

Believes that people have the capacity to be rational thinkers who can assume responsibility for themselves and whose behavior will be constructive when given freedom to set directions in life.

• People are seen as motivated by a basic tendency to seek growth and self-enhancement.

• The role of the helping professional in person-centered therapy is to display unconditional positive regard.

• The helper never tells the client what to do, is non-judgemental and nondirective.

• The therapeutic relationship is key.

Human Service Model (2)

1.) Long-term Care model:

• To maintain one's functioning, to be divisional

• To enable individuals whose functional capabilities are chronically impaired to be maintained at the maximum level of health & well-being.

2.) Therapeutic Milieu Model:

• Where every person & interaction can be therapeutic.

• Everyone has equal impact.

• Emotional problems are often the product of unhealthy interactions with one's environment

• Staff are organized as a caring community

• Primary therapist = most effective relationship

Educational Training Model

Gain vocational skills

• Focuses on the acquisition of knowledge and skills that are required to become a contributing member of society

• Used in sheltered workshops, vocational rehab centers, day-care centers, school

• Heavy emphasis on classroom-like framework

Community Model

Focuses on steps that communities can take to develop preventative programs to effect change

• Special Recreation:

o the provision of recreation programs and services that are provided for people who require special accommodations because of unique needs they have owning to some physical, cognitive, or psychological disability

• Social Recreation:

o Non-clinical approach for disabled in the community

o Recreation as an end to itself

Social Model

Impairment is seen as not vitally important

• The environment attitudes of others, and institutional structures are the problems

• Prejudice, discrimination, inaccessible building

• This model was enthusiastically received by the disability movement

Rehabilitative Model

Activities of Daily Living: Activities related to personal care

• These Include: bathing, showering, dressing, getting in and out of bed or a chair, using the toilet, and eating 10

• A plan of care must be developed that allows for meeting both the physical and psychosocial needs of the client/patient

• Two types of goals:

1. Rehabilitative - the goal of restoring independence

2. Habilitative - helping the person function at their highest level

Psychosocial Rehabilitation Model

Focuses on restoring those with mental disorders to the community as functioning society members with a sense of well-being

Disability Categories:

Cognitive disabilities - i.e. Traumatic Brain Injury, learning disabilities

• Physical disabilities - i.e. Visual Impairment, Hearing Impairment, Cerebral Palsy

o Least amount of prejudice

o Longer history of self-identification

o Stronger advocacy groups

• Intellectual disabilities - i.e. Cognitive Impairment (Mental Retardation), Autism

• Psychiatric disabilities - Mental Illness, Substance abuse

o Last to receive government services or benefits

Cognitive: Mental Retardation/Developmental Disability:

• Sub-average intellectual functioning

• IQ<70, is displayed during the developmental period.

• Symptoms: low frustration level, short attention span, social immaturity, unable to function independently, poor judgement.

• Significant impairments in adaptive functioning.

• Delays in motor, language, self-care.

• Onset prior to age 18.

• TR: Offers choice, inclusion, mainstreaming. Age appropriate (chronologically not mental age), specially valued integration activities, promote high success activities for low self-esteem.

• Simplify/Adapt/Repetitive Movements: give choice, structure age appropriate activities.

Cognitive: Prader-Willi syndrome:

• Is a congenital (present from birth) disease.

• It affects many parts of the body.

• People with this condition are obese, have reduced muscle tone and mental ability, and have sex glands that produce little or no hormones

Cognitive: Head Injury

Traumatic injury from a head wound

• Impaired attention span, concentration, memory, lower tolerance for noise, low frustration tolerance.

o TBI of the Frontal lobe = change in personality, impulsive risk behavior, little facial emotion.

o Frontal lobe controls personality and emotions

o Right FL = pseudo psychopathic behaviors - emotional/social instability

o Left FL = pseudo depression, Broca's Aphasia (expressive)

• TR: Utilize social skills; need for socialization, community reintegration, build independence, physical development, reading/writing/computer games

Cognitive: TBI - Cognitive, physical and social-emotional

An injury to the brain caused by an external force 11 • often leads to coma; confusion, disorientation, mood swings, aphasia

• Cognitive Impairment → attention deficit, inability to plan

• Physical Impairments → aphasia, apraxia, ataxia, perceptual deficits

• Social-Emotional Impairments → impulsivity, depression, lowered inhibition

• TR: help to reintegrate into the community, become aware of resources, and develop physical well-being, develop support systems, ameliorate depression and loss of independence through creative arts & social events; computer games, physical games reading.

Cognitive: Learning Disability

i.e. - Dyslexia

• Deficits in language development

• Hyper activity: ADHA and ADD

• Thought process difficulty, low attention span, distractible, behavior problems in school, low self-esteem.

• TR: Provide choice, challenge, & age appropriate activities which are structured for success.

Physical: Spina Bifida:

• Defective closure of spinal canal causing protrusion of spinal cord.

• Can cause paralysis & can have an emotional impact.

• Three major types:

o Myelomeningocele: an out pouching of the spinal cord through the back of the bony vertebral column that has failed to form.

o Meningocele: an out pouching consisting of only the coverings of the spinal cord and not the cord itself

o Spina Bifida Occulta: the failure of the back arch formation.

• TR: Wheelchair activities: utilize skills to promote independence, leisure education, community re-integration & exercises to strengthen muscles.

Physical: Muscular Dystrophy:

Progressive, inherited disease, gradual wasting of muscle tissue.

• Can lead to wheelchair use, & cause socially impaired interactions.

o Pseudohypertrophic (Duchane) MD = enlargement of fatty infiltration - causes contractures and deformities of joints. In w/c by 12 years of age

o Facioscapulohumeral MD = weakness is upper arms, shoulders, angled forward and lack of facial ability o Limb girdle MD = late childhood to middle age - weakness of proximal muscles of the pelvic and shoulder girdles.

o Oculopharyngeal = 40 to 70 - weakness of eye and throat muscles

• TR: Maintain muscle tone, promote movement, accomplishment, exercise, aquatics, assistive devices, and promote creativity through crafts.

Physical: Spinal Cord Injuries

The higher up the injury occurs, the greater damage.

• Includes loss of sensation below injury

- Cervical

- Thoracic

- Lumbar Sacral

Physical: Spinal Cord Injuries - Cervical

When spinal cord injuries occur in the neck area, symptoms can affect the arms, legs, and middle of the body.

• The symptoms may occur on one or both sides of the body.

• Symptoms can also include breathing difficulties from paralysis of the breathing muscles, if the injury is high up in the neck

Physical: Spinal Cord Injuries - Thoracic

When spinal injuries occur at chest level, symptoms can affect the legs.

• Injuries to the cervical or high thoracic spinal cord may also result in blood pressure problems, abnormal sweating, and trouble maintaining normal body temperature.

• Autonomic Dysreflexia - at or above T6

o Sweating, flushing above the injury, severe headache, nasal congestion, and nausea o medical emergency

Physical: Spinal Cord Injuries - Lumbar/Sacral

When spinal injuries occur at the lower back level, symptoms can affect one or both legs, as well as the muscles that control the bowels and bladder

Nervous System: Multiple Sclerosis

20-40 years of age for onset

• Symptoms: muscle spasms, loss of sensation, bladder control.

• Physical & emotional changes.

• TR: Social activities, success-oriented, Range of Motion.

Nervous System: Cerebral Palsy

Brain paralysis

• Neuromuscular disorder

• Several types due to location of brain damage:

o Spasticity: Feature of altered skeletal muscle performance in muscle tone involving hypertonia; it is also referred to as an unusual "tightness", stiffness, and/or "pull" of muscles.

o Athetosis: involuntary motor movement

o Ridgity

o Ataxia: poor balance

o tremor • speech disturbance and stiffness

• non-progressive: is not degenerative

• TR: relaxation, water aerobics, social activities, Increases self confidence

Nervous System: Epilepsy (seizures)

• Grand mal: A grand mal seizure (also known as a tonic-clonic seizure) features a loss of consciousness and violent muscle contractions.

• Petit mal: A petit mal seizure is the term commonly given to a staring spell, most commonly called an "absence seizure." It is a brief (usually less than 15 seconds) disturbance of brain 13 function due to abnormal electrical activity in the brain.

• TR: encourage normalization, reduce stress, fears & stigma; relaxation, community activities, increase locus of control.

Nervous System: Huntington's chorea

A neurodegenerative genetic disorder that affects muscle coordination and leads to cognitive decline and psychiatric problems.

• It typically becomes noticeable in mid-adult life.

• The most common genetic cause of abnormal involuntary writhing movements called chorea, which is why the disease used to be called Huntington's chorea.

Nervous System: Parkinson's Disease

Affects the neuromuscular systems resulting in cerebral tissue degeneration, severe disability, and death

• a disorder of the brain that leads to shaking (tremors) and difficulty with walking, movement, and coordination

Nervous System: Guillain-Barre syndrome:

• a serious disorder that occurs when the body's defense (immune) system mistakenly attacks part of the nervous system.

• This leads to nerve inflammation that causes muscle weakness and other symptoms

Communication: Visual

legally blind 20-200; the majority of legally blind people are over the age of 55

• 2-5% read Braille

• 5% completely blind

• others see shadows/movement

• TR: talking books, encourage other senses, orientation, environmental cues, movement, aquatics, dance, large print books, bright colors

Communication: Hearing Loss

have minimal noise, lighting is important, have them face you, close-up interactions

• TR: use of other senses, emphasize lip movements & hand gestures; adaptive activities encourage sign language

Communication: Aphasia

Is an impairment of language ability

• Having difficulty remembering words to being completely unable to speak, read, or write.

• Expressive aphasia: loss of the ability to produce language (spoken or written)

• Receptive aphasia: can speak with normal grammar, syntax, rate, intonation, and stress, but they are unable to understand language in its written or spoken form.

• Global aphasia: cannot speak or understand.

Communication: Stroke

The initial interventions TRSs prescribe focus on improving strength, endurance and ROM; adjusting to visual neglect; and preventing contractures and spasticity

Communication: Right CVA

Left hemi: loss of perceptual/intellectual functioning, logic, visual and spatial depth, difficulty in perceiving around them.

o TR: use words rather than gestures, keep environment clear of distractions, leisure education.

Communication: Left CVA

Right hemi: affects the right side; affects speech, may cause aphasia o Impaired emotions, social interactions, poor memory, difficulty with spoken language & written communication

o TR: use demonstration, modeling, reality orientation

Communication: Autism

Onset in childhood

• Primarily exhibiting the following qualities:

o inability to develop normal social relationships

o delay in speech development

o non-communicative use of speech (echolalia)

o insistence on sameness o stereotypical play

o lack of imagination

• Echolalia: the automatic repetition of vocalizations made by another person

• Echopraxia: the automatic repetition of movements made by another person.

• 1/3 have epilepsy

• 75% Mental Retardation.

• TR: need structure; may need to address family needs - respite

Psychological: Anxiety Disorders:

Fear or panic with no apparent reason.

• Approx. twice as many females have panic disorders, posttraumatic stress disorder, generalized anxiety disorder, agoraphobia and other specific phobias

• Obsessive/compulsive behaviors: obsessive thoughts and/or compulsive behaviors/rituals

• Phobias: unrealistic fears of: flying, heights panic; all affect functioning.

• Post-traumatic Stress Disorder (PTSD): headaches, loss of memory

• TR: stress management, expressive activities, exercise

Psychological: Personality Disorder:

Chronic & longstanding & environmental distorted view of relating to others & ourselves.

• Cluster A (Odd, bizarre, eccentric)

o Paranoid PD, Schizoid PD, Schizotypal PD

• Cluster B (Dramatic, erratic)

o Antisocial PD, Borderline PD, Histrionic PD, Narcissistic PD

• Cluster C (Anxious, fearful)

o Avoidant PD, Dependent PD, Obsessive-compulsive PD

• Types:

o Paranoid: characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others.

o Anti-social: a long-term pattern of manipulating, exploiting, or violating the rights of others. This behavior is often criminal.

o Borderline: instability of mood, interpersonal relationships, & self-image. Mood change during the day/several times a day.

Feelings of emptiness/boredom. Will try suicide for attention.

• TR: help make decisions, challenging activities, modeling, contracts

Psychological: Mood Disorders:

Depression: loss of appetite, sleep disturbance, lack of motivation, low self-esteem

• TR: short term activities, success oriented

• Manic: Endless energy, expertise in area, know famous figure.

• TR: set limits, provide structure

• Bi-polar: (manic-depressive): fluctuating moods, lithium to control; from manic>to>depressed

• Schizophrenia: A break from reality, disorder in thinking/reality

o Delusional, bizarre behaviors & hallucinations. (thorazine & stalizine)

o Hallucinations may occur in any sensory modality (e.g., auditory, visual, olfactory, gustatory, and tactile), but auditory hallucinations are by far the most common and characteristic of Schizophrenia.

o Auditory hallucinations are usually experienced as voices, whether familiar or unfamiliar, that are perceived as distinct from the person's own thoughts

o Auditory hallucinations, talking to self, "I'm Jesus", feel others are out to get them, lack of social skills.

• TR: social skills training, stress management, coping skills

Psychological: Eating Disorders

• Anorexia: Thin - force self to vomit up meals to stay thin, organ damage

• Bulimia: gorge & perge, onset to young women, poor self-image

• TR: Leisure Education, social skills, express feelings, values clarification, family groups, meal planning, No physical work