NOTICE: The textbook we bought for class only has 14 chapters, So, I made this page assuming that you wanted a fact sheet on each of the presentations given in class.
At Risk Youth
Population: Youth who are, or have the potential to be, negatively influenced by family, environment, or peers. (Stupid definition because all of us at one point or another have the potential to be negatively affected by our surroundings/situations.)
Risk factors that determine whether or not a youth is considered "at risk":
- Attempted suicide during the past year
- Used drugs or engaged in substance abuse
- Has been a drug pusher/seller during the past year
- Consumes alcohol regularly
- Was arrested for illegal activity
- Parents have negative attitudes toward education
- Has several brothers or sisters who dropped out
- Was sexually or physically abused last year
- Failed two courses last school year
- Was suspended from school twice last year
- Attend three different schools within 5 years
- Children of divorce
- Being home alone a lot as an adolescent
specific needs: needs vary depending on individual. programs show most need a good influence/mentor in their life, like with the big brother/sister programs
TR implications:
Private:
- Residential Treatment Centers
- Outpatient Treatment Centers
- Wilderness Programs
State:
- Residential Treatment Centers
- Juvenile Detention Centers
- Foster Care
- Proctor Homes
Community
- After School Programs
- Recreation Centers
- Mentor Organizations
- Boys & Girls Club
- Big Brother & Big Sister
Resources:
- LifeLine for Youth
- Helping youth who are suffering from substance abuse, depression, family relationship problems, etc.
- North Salt Lake, Utah; 801-788-4704
- Center for Change
- Helping adult women and adolescent girls recover from eating disorders.
- Orem, Utah; 888-840-8329
- Family Bootcamp
- Youth and parents are invited to a life-changing five-day intense, therapeutic wilderness experience.
- St. George, Utah; 866-370-0317
- Heritage School
- Serving boys and girls age 12-17; long term psychiatric residential treatment facility with a wide variety of disorders (such as: oppositional defiant, anxiety, major depression, bipolar, PTSD, etc.)
- Provo, Utah; 866-877-1315
- Lighthouse Recovery Center
- Adult clients seeking treatment for chemical and/or alcohol dependency, substance abuse, and the associated coexisting behavioral health conditions.
- Midvale, Utah; 801-386-5015
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Depression
Definition: Severe symptoms that interfere with your ability to work, sleep, study, eat, and enjoy life.
Diagnosis: Must have five to be classified as a disorder
-irritable mood
-loss of pleasure in usual activities
-trouble sleeping/ sleeping too much
-change in appetite
-tired/lack of energy
-feeling worthless, self-hate
-guilt
-difficulty concentrating
-hopeless or helpless
-repeated thoughts of death or suicide
Specific Needs:
-Don’t isolate yourself. Stay in touch with your loved ones and friends, your religions advisor and your family doctor.
-Don’t make major life decisions (for example, about separation or divorce). You may not be thinking clearly while you are depressed, so the decisions you make at this time may not be the best ones for you.
-Don’t blame yourself for your depression. You didn’t cause it.
-Don’t be discouraged about not feeling well right away. Be patient with yourself.
-Don’t give up.
-Do exercise often to make yourself feel better. Exercise will also give you more energy.
-Do eat balanced meals and healthy food.
-Do get enough sleep.
-Do take your medicine and/or go to counseling as often as your doctor tells you to. Your medicine won’t work if you don’t follow the doctor’s recommendations.
Specific Treatment:
- Hospitalization: For those who are suicidal
- Psychotherapy: Talk therapy
- Phototherapy: Light therapy, for S.A.D. patients
- Medication: SSRI’s, serotonin reuptake inhibitors
- Electro Shock Therapy: Used in extreme cases
TR Implications:
Resources:
Local Treatment
1500 WSC
801-422-3035
The BYU Counseling and Career Center offers free personal counseling for full-time BYU students.
State
LDS Family Services (Link has contact information for different offices in Utah)
National
National Alliance for the mentally ill utah
Hotlines
National Suicide Prevention Lifeline
1-800-273-TALK
TTY: 1-800-799-4TTY
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Traumatic Brain Injury
Definition: Traumatic Brain Injury occurs when an external force acts on the brain and causes any level of dysfunction. It typically results from a blow to the head or jolt to the body. It can also happen when a object protrudes into the skull like during a car accident or when shot.
Diagnosis:
- Was there an accident, fall, etc. that caused impact to the head?
- Call 911 or go to ER
- Check for symptoms
- Spinal fluid (thin water-looking liquid) coming out of the ears or nose
- Loss of consciousness; however, loss of consciousness may not occur in some concussion cases
- Dilated (the black center of the eye is large and does not get smaller in light)or unequal size of pupils
- Vision changes (blurred vision or seeing double, not able to tolerate bright light, loss of eye movement, blindness)
- Dizziness, balance problems
- Respiratory failure (not breathing)
- Coma (not alert and unable to respond to others) or semicomatose state
- Paralysis, difficulty moving body parts, weakness, poor coordination
- Slow pulse
- Slow breathing rate, with an increase in blood pressure
- Vomiting
- Lethargy (sluggish, sleepy, gets tired easily)
- Headache
- Confusion
- Ringing in the ears, or changes in ability to hear
- Difficulty with thinking skills (difficulty “thinking straight”, memory problems, poor judgment, poor attention span, a slowed thought processing speed)
- Inappropriate emotional responses (irritability, easily frustrated, inappropriate crying or laughing)
- Difficulty speaking, slurred speech, difficulty swallowing
- Body numbness or tingling
- Loss of bowel control or bladder control
Special Needs:
I need a lot more rest than I used to.
My stamina fluctuates, even though I may look good or all better on the outside. Some days are better than others. Pushing too hard usually leads to setbacks, sometimes to illness.
Brain injury rehabilitation takes a very long time; it is usually measured in years. It continues long after formal rehabilitation has ended. Please resist expecting me to be who I was, even though I look better.
Crowds, confusion, and loud sounds quickly overload my brain, it doesn't filter sounds as well as it used to. Limiting my exposure is a coping strategy, but a behavioral problem.
If there is more than one person talking, I may seem uninterested in the conversation. It is exhausting to keep trying to piece it all together.
If we are talking and I tell you I need to stop. I need to stop now! I need time to process our discussion and "take a break" from all of thinking. Later I will be able to rejoin the conversation and really be present for the subject and for you.
Try to notice the circumstances of the behavior problem arises. Behavior problems are often an indication of my inability to cope with a specific situation and on mental health issue. I may be frustrated, in pain, overtired, or there may be too much confusion or noise for my brain to filter.
Patience is the best gift you can give me. It allows me to work deliberately and at my own pace. Rushing and multitasking inhibit cognition.
Please listen to me with patience. Try not to interrupt. Allow me to find my words and follow my thoughts. It will help me rebuild my language skills.
Please have patience with my memory. Know that not remembering does not mean that I don't care.
Please don't be condescending or talk to me like I'm a child. I'm not stupid, my brain is injured and that doesn't work as well as it used to. Try to think of me as if my brain were in a cast.
If I seem "rigid," needing to do tasks the same way all the time; it is because I am retraining my brain. It's like learning main roads before you can learn the shortcuts. Repeating tasks in the same sequence is a rehabilitation strategy.
If I seem "stuck," my brain may be stuck in the processing of information. Suggesting other options and asking what you can do to help may help me figure it out. Taking over and doing it for me will not be constructive and it will make me feel inadequate.
Medications:
Medications to limit secondary damage to the brain immediately after an injury may include:
- Diuretics.
- Anti-seizure drugs.
- Coma-inducing drugs.
TR Implications:
- —RT’s provide activities to improve and enhance self-esteem, social skills, motor skills, coordination, endurance, cognitive skills, and leisure skills.
- —RT’s plan community outings to allow the person to directly apply learned skills in the community.
- —Additional programs provided by RT’s may include leisure education, wheelchair sports, special social functions or holiday functions.
Resources:
Phone: (801) 716-4993
Toll Free: (800) 281-8442
Email: info@biau.org
Division of Services for People with Disabilities
Utah Depart. of Human Services
Phone: (801) 538-4200
Toll Free: 1-800-837-6811
Email: dspd@utah.gov
WEBSITES
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Substance Abuse
Definitions:
Substance abuse: Defined in terms of how significantly substance use interferes with the user's life. If substances disrupt your education, job, or relationships with others, and/or put individuals in physically dangerous situations, and/or if they have related legal problems they would be considered a drug abuser.
Substance dependence: A maladaptive pattern of substance use in which people organize their lives around a drug, possibly building a tolerance to it or experiencing withdrawal symptoms when they stop taking it, or both. Leads to clinically significant impairment or distress.
Diagnosis:
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Special Needs:
- Don’t attempt to punish, threaten, bribe, or preach.
- Don’t try to be a martyr.
- Avoid emotional appeals that may only increase feelings of guilt and the compulsion to drink.
- Don’t cover up or make excuses for the alcoholic or problem drinker or shield them from the realistic consequences of their behavior.
- Don’t take their responsibilities, leaving them with no sense of importance or dignity
- Don’t argue with the person when they are impaired.
- Don’t try to drink along with the problem drinker
- Above all, don’t feel guilty or responsible for another’s behavior.
Treatment.
Medication. A variety of formulations of nicotine replacement therapies now exist-including the patch, spray, gum, and lozenges-that are available over the counter. In addition, two prescription medications have been FDA-approved for tobacco addiction: Bupropion and varenicline.
Counseling. Therapy, support groups, and smoking cessation programs offer assistance to those wishing to quit smoking.
TR Implications:
Effective leisure education activities can help patients reduce the leisure boredom they experience, (Brademas, 1994).
Women report being able to use leisure to take healthy risks helped enable full recovery (Hood, 2003).
Second, the physiologic effect of exercise often brings a ‘natural high,’ or increased blood flow to the brain and increased dopamine, serotonin, and other neurotransmitters.
Finally, a focus on family recreation participation for the family of patients can help everyone strengthen relationships that may have been strained by addiction (Caldwell, 2005).
Additional Resources:
National drug abuse website: http://www.drugabuse.gov
Government:
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Cerebral Palsy
Definitions:
Cerebral palsy: a group of disorders that affect a person’s ability to move and maintain balance and posture.
Diagnosis:
Since there is no definitive test that can diagnose cerebral palsy, doctors may utilize one, or a combination, of the following to aid the diagnosis process:
- Assessing reproductive health factors
- Reviewing paternal health records
- Reviewing pregnancy, labor and delivery records
- Reviewing newborn screens conducted at birth
- Considering APGAR score
- Reviewing baby birth, medical, developmental and growth records
- Performing a physical examination of baby
- Performing additional screens (hearing, fatty acids, amino acids and hemoglobinopathies)
- Conducting neuroimaging tests to determine if brain damage exists
Special needs:
Kids and teens with CP may:
- have learning disabilities, visual impairments, hearing problems, speech problems, drooling
- issues, and behavior problems
- need braces, crutches, or a wheelchair to get around
- need help moving around in class or reaching things
- need assistive devices for writing and speaking
- have difficulty sitting still and have uncontrolled movements
- have difficulty with bladder and bowel control and may need to use a bathroom frequently have seizures
- need occupational therapy (OT), physical therapy (PT), and speech therapy during the school day
Special Medications:
- Anticholinergic medications
- Anticonvulsants (seizure medications)
- Antidepressants (depression medications)
- Antispastics
- Anti-inflammatories
Special Equipment:
1. Wheelchairs
2. Adaptive Tricycle (for therapeutic cycling)
3. Stool Scooters and Standing Equipment
4. Stair Glides/Elevators and Mechanical Lifts
5. Car Seats
6. Adapted Vehicles
7. Communication Devices
8. Adaptive Art Supplies
9. Commode and Bath Chairs
10. Writing tools
TR Implications:
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
Resources:
United Cerebral Palsy (UCP)
1825 K St NW
Suite 600
Washington, DC 20006
info@ucp.org
http://www.ucp.org
Tel: 202-776-0406 800-USA-5UCP (872-5827)
Fax: 202-776-0414
Pediatric Brain Foundation (formerly Children's Neurobiological Solutions)
2925 E. Battlefield Road
Suite 225B
Springfield, MO 65804
info@pediatricbrainfoundation.org
http://www.pediatricbrainfoundation.org
Tel: (310) 889-8611
Cerebral Palsy Foundation
3 Columbus Circle, 15th Floor
New York, NY 10019
info@yourcpf.org
http://yourcpf.org
Tel: 212-520-1686
Fax: 917-599-0431
National Institute of Child Health and Human Development (NICHD)
National Institutes of Health, DHHS
31 Center Drive, Rm. 2A32 MSC 2425
Bethesda, MD 20892-2425
http://www.nichd.nih.gov
Tel: 301-496-5133
Fax: 301-496-7101
My Child at CerebralPalsy.org
(800) 692-4453
Utah Division of Services for People with
Disabilities
120 North 200 West Room 411
Multiple Sclerosis
Multiple Sclerosis: an unpredictable, often disabling disease of the central nervous system that disrupts the flow of information within the brain, and between the brain and body.
Diagnosis:
In order to make a diagnosis of MS, the physician must:
- Find evidence of damage in at least two separate areas of the central nervous system (CNS), which includes the brain, spinal cord and optic nerves
- Find evidence that the damage occurred at least one month apart
- Rule out all other possible diagnoses
Special Needs:
- A motorized wheelchair which has adaptabilities for their condition.
- Also they will eventually need assistance with daily activities such as going to the bathroom, walking, dressing, and eating food.
- To encourage the individuals to become as independent as they can, household tools should be adapted to the needs of the individual.
Special equiptment:
- Power Scooters
- Walkers and Canes
- Wheelchairs
- Orthopedic Devices
- Lifts
Bathroom Aids
- Raised toilet seats or commode chairs
- Bidets
- Adaptive Bathtubs
- Adapted Beds and Mattresses
Communication Aids
- communication letter boards
- speaking valves
- small, hand-held electronic speaking devices
- computer-based systems
Other Equipment
- special cutlery and dinnerware with larger handles
- doorknob adaptors
- thicker pens and pencils
- electronic switches for environmental controls
- modified telephones
TR Implication:
- help them to keep up the muscle skills that they have for as long as possible.
- Help them to remain active and do things on their own.
- Help to mitigate the side effects of prednisone weight gain
Resources:
Provo Neurological Clinic
1157 N 300 W
Provo UT, 84604
801-357-4070
https://intermountainhealthcare.org/locations/
provo-neurological-clinic/
Utah State Chapter National Multiple Sclerosis
Society
2995 S. West Temple, Suite C
Salt Lake City, UT 84115
Telephone: (801) 493-0113 or (800) 527-8116
Multiple Sclerosis Association of America
706 Haddonfield Road
Cherry Hill, NJ 08002
webmaster@msassociation.org
http://www.mymsaa.org
Tel: 856-488-4500 800-532-7667
Fax: 856-661-9797
Multiple Sclerosis Foundation
6520 North Andrews Avenue
Ft. Lauderdale, FL 33309-2130
support@msfocus.org
http://www.msfocus.org
Fax: 954-351-0630
Accelerated Cure Project for Multiple Sclerosis
460 Totten Pond Rd. Suite 420
Waltham, MA 02451
info@acceleratedcure.org
http://www.acceleratedcure.org
Tel: 781-487-0008
Fax: 781-487-0009
American Autoimmune Related Diseases Association
22100 Gratiot Avenue
Eastpointe, MI 48021-2227
aarda@aarda.org
http://www.aarda.org
Tel: 586-776-3900 800-598-4668
Fax: 586-776-3903
Myelin Repair Foundation
18809 Cox Avenue
Suite 190
Saratoga, CA 95070
info@myelinrepair.org
http://www.myelinrepair.org/
Tel: 408-871-2410
Muscular Dystrophy
Muscular Dystrophy: a group of diseases that cause progressive weakness and loss of muscle mass. In muscular dystrophy, abnormal genes (mutations) interfere with the production of proteins needed to form healthy muscle.
Diagnosis:
A doctor will likely to start with a medical history and physical examination.
After that, they will recommend one of the following tests to medically diagnose the disease:
- Enzyme tests- High blood levels of CK suggest a muscle disease
- Electromyography- Changes in the pattern of electrical activity can confirm a muscle disease.
- Genetic testing- Blood samples can be examined for mutations in some of the genes that cause different types of muscular dystrophy.
- Muscle biopsy- Analysis of the tissue sample can distinguish muscular dystrophies from other muscle diseases.
- Heart-monitoring tests (electrocardiography and echocardiography). These tests are used to check heart function, especially in people diagnosed with myotonic muscular dystrophy.
- Lung-monitoring tests. These tests are used to check lung function
Equipment:
- Orthotics
- Leg braces
- Canes
- Walkers:
- Wheelchairs or scooters
- Velcro, buttons, zippers, and hooks on clothing, Sock pull, Long-handled shoehorn,
- Buttonhook,
- A stool to sit while you get dressed
- Utility cart with wheels, Electric can opener, Pot stabilizer, Reacher devices
- Special utensils,
- Special grips for pens and pencils, Wrist supports
- Electric beds or mattresses
TR Implications:
Psychosocial:
- Enhance body image
- perceptions.
- Change attitudes toward
- disability.
- Improve sense of self.
- Achieve control over stress.
- Enhance self-efficacy.
- Develop sense of mastery.
Cognitive:
- Increase mental alertness.
- Increase attention span.
- Enhance memory skills.
- Improve organizational skills.
- Improve problem-solving.
Physical:
- Increase immune system activity.
- Reduce pain.
- Increase muscular strength.
- Improve flexibility and balance.
- Improve cardiovascular functioning.
- Develop consistent activity routine for diabetes
- maintenance.
- Reduce of decubiti and urinary tract complications.
- Increase endurance.
Community:
- Prevent social isolation.
- Develop/maintain social skills.
- Develop self-advocacy skills.
- Build skills to minimize disability stigma.
- Master skills for managing environmental barriers (i.e. stairs).
- Increase knowledge of community resources.
- Increase overall activity level.
Resources:
Muscular Dystrophy Association
MDA Clinic serving the Salt Lake City area:
University of Utah Medical Center
Department of Neurology
Salt Lake City, UT
Director: Mark B. Bromberg M.D., Ph.D.
Myotonic Dystrophy Foundation
1004 O'Reilly Avenue
San Francisco, CA 94129
info@myotonic.org
http://www.myotonic.org/
Tel: 86-MYOTONIC 415-800-7777
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
31 Center Dr., Rm. 4C02 MSC 2350
Bethesda, MD 20892-2350
NIAMSinfo@mail.nih.gov
http://www.niams.nih.gov
Tel: 301-496-8190 877-22-NIAMS (226-4267)
Parent Project Muscular Dystrophy
800-714-5437
info@parentprojectmd.org
MyChildWithoutLimits.org
Muscular Dystrophy Family Association
P.O. Box 776
Carmel, IN 46082
(317) 615-9140
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Schizophrenia
Definition:
Schizophrenia is a serious mental illness that interferes with a person’s ability to think clearly, manage emotions, make decisions and relate to others. It is a complex, long-term medical illness. Contrary to popular belief, schizophrenia is not a split or multiple personality disorder. Schizophrenia is a psychosis, a type of mental illness in which a person cannot tell what is real from what is imagined.
Diagnosis:
To be diagnosed with schizophrenia, a person must have two or more of the following symptoms occurring persistently in the context of reduced functioning:
- Delusions
- Hallucinations
- Disorganized speech
- Disorganized or catatonic behavior
- Negative symptoms
Special Needs:
Physical Health
People who have a diagnosis of schizophrenia are more likely to develop physical health problems, including weight gain, high blood pressure, heart disease and diabetes.
Research has shown that these physical health problems contribute to premature death; people who have a serious mental health problem like schizophrenia have shorter lives compared to the national average. Some early deaths are because of suicide; in fact, as much as 40 percent of people affected by schizophrenia have attempted suicide.
Peer Support and Self-Management
Mental health professionals should consider offering peer support from someone who has experienced the symptoms of psychosis, or has a diagnosis of schizophrenia, and who has received training to be a peer support worker. Mental health professionals may also consider offering a place on a self-management program led by a health or social care professional. Both peer support and self-management aim to help people understand more about their symptoms and diagnosis, about their medication and treatment, about recovery and staying well, and about what to do in a crisis.
Special Medication:
There are two major types of antipsychotic medication:
- Conventional Antipsychotics These effectively control the positive symptoms such as hallucinations, delusions, and confusion of schizophrenia.
- New Generation Antipsychotics These are also called atypical antipsychotics, and treat both the positive and negative symptoms of schizophrenia often with fewer side effects.
TR Implications:
The following is a list of potential groups that a recreation therapist could use in treating someone with schizophrenia.
- Current Events Discussion Group This can help build concentration and attention span, which can help those affected by schizophrenia with cognitive symptoms.
- Cooking Group This can help with organization, decision-making, and attention to detail.
- Photography and Creative Writing These interventions can offer outlets for creativity and expression.
- Exercise Exercise helps to elevate mood, as well as build muscle strength and energy levels. Competitive sports can improve impulse control and frustration tolerance.
- Animal Assisted Therapy This can decrease isolation and withdrawal, which are symptoms that tend to be had by many with schizophrenia.
Resources:
NAMI Utah
1600 West 2200 South, Suite 202
West Valley City, UT 84119
Phone Number: (801) 323-9900
Toll Free Number: (877) 230- 6264
Suicide Hotline
Phone: (800) 273-TALK (8255)
http://www.suicidepreventionlifeline.org/
National Schizophrenia Foundation
Schizophrenia and Related Disorders Alliance of America
National Institute of Mental Health
Phone Number: 301-443-4513
Toll Free Number: 1-866-615-6464
Fax Number: 301-443-4279
Email Address: nimhinfo@nih.gov
Website URL: www.nimh.nih.gov
National Alliance for Mental Illness
3803 N. Fairfax Drive Suite 100
Arlington, VA 22203
Helpline: 800-950-6264
Phone Number: 888-999-6264
Website URL: www.nami.org
International Schizophrenia Foundation
16 Florence Avenue
Toronto, Ontario
M2N 1E9, Canada
Phone: 416-733-2117
Fax: 416-733-2352
Email: centre@orthomed.org
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Geriatrics-Alzheimer’s and Parkinson’s
Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Symptoms usually develop slowly and get worse over time, becoming severe enough to interfere with daily tasks.
Diagnosis:
The most common early symptom of Alzheimer's is difficulty remembering newly learned information. As Alzheimer's advances it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking.
Medication:
Antidepressants for low mood and irritability:
- citalopram (Celexa)
- fluoxetine (Prozac)
- paroxeine (Paxil)
- sertraline (Zoloft)
- trazodone (Desyrel)
Anxiolytics for anxiety, restlessness, verbally disruptive behavior and resistance:
- lorazepam (Ativan)
- oxazepam (Serax)
Antipsychotic medications for hallucinations, delusions, aggression, agitation, hostility and uncooperativeness:
- aripiprazole (Abilify)
- clozapine (Clozaril)
- haloperidol (Haldol)
- olanzapine (Zyprexa)
- quetiapine (Seroquel)
- risperidone (Risperdal)
- ziprasidone (Geodon)
Special needs:
- Monitor personal comfort. Check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation. Maintain a comfortable room temperature.
- Avoid being confrontational or arguing about facts. For example, if a person expresses a wish to go visit a parent who died years ago, don't point out that the parent is dead. Instead, say, "Your mother is a wonderful person. I would like to see her too."
- Redirect the person's attention. Try to remain flexible, patient and supportive by responding to the emotion, not the behavior.
- Create a calm environment. Avoid noise, glare, insecure space and too much background distraction, including television.
- Allow adequate rest between stimulating events.
- Provide a security object.
- Acknowledge requests, and respond to them.
- Look for reasons behind each behavior. Consult a physician to identify any causes related to medications or illness.
- Explore various solutions.
- Don't take the behavior personally, and share your experiences with others.
Parkinson's disease (PD) is a neurodegenerative brain disorder that progresses slowly in most people.The brain slowly stops producing a neurotransmitter called dopamine. With less and less dopamine, a person has less and less ability to regulate their movements, body and emotions.
Symptoms:
- Tremor or Shaking
- Small Handwriting
- Loss of Smell
- Trouble Sleeping
- Trouble Moving or Walking
- Constipation
- A Soft or Low Voice
- Masked Face
- Dizziness or Fainting
- Stooping or Hunching Over
Complementary Treatments: The following is a list of complementary treatments:
TR Implications:
some things recreational specialists do with geriatric patients:
Active sports and games of choice
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• Fall prevention
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• Cognitive stimulation programs with motor component
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• Geriatric exercise
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• Walking group
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• Air mat therapy (balance and strength or relaxation)
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• Kitchen activities
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• Assisting with special events: decorating, food preparation, pushing wheelchairs, greeting and assisting
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• Leisure lounge and leisure education
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Resources:
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Military Service Members
Population: Member of the military, likely to suffer injuries due to exposure to war. most common injuries include PTSD and hearing loss.
Diagnosis:
- Exposure to actual or threatened death, serious injury, or sexual violence to self or others
- Presence of intrusion symptoms associated with traumatic event
- Persistent avoidance of stimuli associated with traumatic event
- Negative alterations cognition/mood
- 1+ months (if it does not reach this criteria considered Acute Stress Disorder)
Specific needs:
Here are ways you can help:
- Learn as much as you can about PTSD. Knowing how PTSD affects people may help you understand what your family member is going through. The more you know, the better you and your family can handle PTSD.
- Offer to go to doctor visits with your family member. You can help keep track of medicine and therapy, and you can be there for support.
- Tell your loved one you want to listen and that you also understand if he or she doesn't feel like talking.
- Plan family activities together, like having dinner or going to a movie.
- Take a walk, go for a bike ride, or do some other physical activity together. Exercise is important for health and helps clear your mind.
- Encourage contact with family and close friends. A support system will help your family member get through difficult changes and stressful times.
- Agree that either of you can call a time-out at any time.
- Agree that when someone calls a time-out, the discussion must stop right then.
- Decide on a signal you will use to call a time-out. The signal can be a word that you say or a hand signal.
- Agree to tell each other where you will be and what you will be doing during the time-out. Tell each other what time you will come back.
Specific tests, equipment, medication,etc:
Therapies for PTSD:
Cognitive behavioral therapy
exposure therapy
Eye movement desensitization and reprocessing (EMDR)
Selective serotonin reuptake inhibitors (SSRIs)
group therapy
Brief psychodynamic psychotherapy
TR Implications:
- Fly fishing
- Couple’s Retreats
- Adaptive sports
These can be helpful coping mechanisms for veterans
Resources:
Wounded Warriors Project
U.S. Department of Veterans Affairs
National Center for PTSD
THe Utah Veteran (UTVet)
Brain Injury Rehabilitation Center (BIRC)
Greenlight a Vet - Lauren’s Story
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Intellectual Disabilities
Definition/ Diagnosis:a generalized neurodevelopmental disorder characterized by significantly impaired intellectual and adaptive functioning. It is defined by an IQ score below 70 in addition to deficits in two or more adaptive behaviors that affect everyday, general living.
Specific Needs:
Tips that may help when talking with someone with a disability:
• Ensure you have the person’s attention. Address the person by name, use eye contact and/or touch
• Be aware of known communication difficulties – Receptive (e.g. deafness, cognitive impairment, autism spectrum disorder) and/or Expressive (e.g. cerebral palsy, autism
spectrum disorder)
• When unsure of ability to understand assume competence and adjust accordingly. It is more appropriate and respectful to assume competence than assuming a lack of
understanding.
• If uncertain ASK about communication preferences/style/techniques. How does s/he say yes/no? Does s/he use a communication device or aid?
• Use appropriate and respectful: Language: simple, clear words & short uncomplicated sentences. Visual information: pictures, diagrams, signs, gestures. Tone & volume: a
respectful approach reflects your degree of familiarity with the person, their age and
the context of your interaction. Interpreter if required.
• Wait for response. Allow person time to listen, process what you say and respond. DONT RUSH!
• Check understanding in the person’s own words Do not simply ask “do you understand?” (Most people say “yes”!) Remember: receptive language may be better
than expressive language (or vice versa).
• Be honest and take responsibility for communication breakdowns e.g. I’m sorry I’m not understanding. NEVER PRETEND to understand!
• If they don’t understand – KEEP TRYING. Repeat. Use clear simple words and concepts. Say it in a different way. Use different words. Use pictures.
• If you don’t understand – KEEP TRYING. Try alternative strategies. Would you say
that again please? ii. Is there another way you can think of saying it? Could you use
another word? Involve family member/career/support worker if appropriate –
remember to ASK FIRST!
TR Implications:
- Improve functional Behavior
- develope skills
- form meaningful relationships
- maintain and improve quality of life
Resources for ID and ASD:
Local Resources
Scenic View Academy
Daniel’s Academy
Courage Reins
(http://couragereins.org)
State Resources
Aggies Elevated
CAMPUS LIFE & SUPPORT SERVICES
USU Regional Campus and Distance Education Program
National Resources
Special Olympics
(http://www.specialolympics.org/mission.aspx)
International Resources:
Best Buddies International (BBI)
(http://www.bestbuddies.org)
YAI’s International Conference
(http://www.yai.org/resources/)
Many more at http://www.pacer.org/funtimes/recreation-and-sports.asp
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Eating Disorders
Definition: An eating disorder is an unhealthy relationship with food and weight that interferes with many areas of a person’s life. One’s thoughts become preoccupied with food, weight or exercise
Diagnosis:
- Persistent restriction of energy intake leading to significantly low body weight (in context of what is minimally expected for age, sex, developmental trajectory, and physical health).
- Either an intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain (even though significantly low weight).
- Disturbance in the way one's body weight or shape is experienced, undue influence of body shape and weight on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Specific Needs:
complications due to anorexia/bulimia include:
- a drop in blood pressure, pulse, and breathing rate
- hair loss and fingernail breakage
- loss of periods
- lanugo hair — a soft hair that can grow all over the skin
- lightheadedness and inability to concentrate
- anemia
- swollen joints
- brittle bones
- constant stomach pain
- damage to the stomach and kidneys
- tooth decay (from exposure to stomach acids)
- "chipmunk cheeks," when the salivary glands permanently expand from throwing up so often
- loss of periods
- loss of the mineral potassium (this can contribute to heart problems and even death)
Specific Treatment:
Inpatient Care (including hospitalization and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life threatening, or when an eating disorder is causing severe psychological or behavioral problems. Inpatient stays typically require a period of outpatient follow-up and aftercare to address underlying issues in the individual’s eating disorder.
TR Implications:
Adequate nutrition, reducing excessive exercise, and stopping purging behaviors are the foundations of treatment. Specific forms of psychotherapy, or talk therapy, and medication are effective for many eating disorders. However, in more chronic cases, specific treatments have not yet been identified. Treatment plans often are tailored to individual needs and may include one or more of the following:
Examples:
- Art therapy
- Music therapy
- Self-defense, martial arts
- Cooking skills
- Since movement is a primary influence on both development and change in body image, dance/movement therapy is particularly suited to this work
- Mind-body and stress-reduction techniques, such as yoga, tai chi, and meditation, may help increase awareness of the body and form a more positive body image
- A 6-week clinical trial showed that guided imagery helped people with bulimia reduce bingeing and vomiting, feel more able to comfort themselves, and improve their feelings about their bodies and eating
Resources:
Local
Starts in the home by building self-confidence with children, but government agencies such as these can help immensely.
- Local in Utah County:
- BYU Counseling and Career Center
801-422-3035
- BYU Comprehensive Clinic
801-422-7759
- Center for Change
801-224-8255
State
Most states have their own community outreach programs. Local in Utah:
- Cirque Lodge
801-222-9200
- The Center a Place of Hope
1-888-771-5166
National
- National Suicide Prevention Hotline
1 (800) 273-8255
- National Eating Disorders Association
1-800-931-2237
- National Association of Anorexia Nervosa and Associated Disorders, Inc.
630-577-1330
International
Programs in Australia, Canada, Germany, New Zealand, the UK, and the US
- Academy for Eating Disorders
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Spina Bifida
Spina bifida is the most common permanently disabling birth defect in the United States. This condition is when a portion of the neural tube fails to develop or close properly, causing defects in the spinal cord and the bones of the spine. Spina bifida translates to literally mean “split spine”.
Diagnosis:
Spina Bifida Occulta
- Involves an opening in one or more vertebrae
- There is no apparent spinal cord damage
- Less severe than other two types
Meningocele
- Protective covering around spinal cord push through opening of vertebrae
- A simpler repair with little or no damage to nerves
- Meningocele is fairly rare compared to other types
Myelomeningocele
- Involves a sac of fluid and portion of spinal cord protruding out of an opening in the back.
- Onset of hydrocephalus
- Most severe of all the types
Specific Needs:
Other conditions associated with Spina Bifida:
- Mobility – walking and getting around is usually more difficult
- Bladder, Bowel & gastrointestinal disorders can accompany spina bifida
- Often people have a Latex allergy
- Development of Obesity
- Skin breakdown
- Learning disabilities can come about
- Social issues
- Tendonitis
- Sexual issues
Specific Medication:
Hydrocephalus
A secondary diagnosis that often comes along with spina bifida, especially myelomeningocele, is called Hydrocephalus. This occurs in 15-25% of children with open myelomeningocele. Often the corrective surgeries that are performed can lessen the probability of a child having hydrocephalus as an added complication.
Hydrocephalus literally means “water in the head”, and essentially it is an accumulation of excess cerebrospinal fluid (CSF) in the head. This happens because of a disruption in the proper flow of CSF. Because people with spina bifida have malformed spinal cords, the fluid is unable to drain and circulate properly, and this causes the build-up of fluid in the brain, or hydrocephalus. Shunts (silicone tubing) are placed inside of a child with hydrocephalus in order to regulate the proper flow of CSF inside of the head and body.
TR Implications:
Through continuous programs, individuals can better develop skills and benefits of the recreation as well as allow a characteristic of commitment and goal setting to build that shorter programs lack. Sports, recreation, and physical activity help push the individual to improve as well as provide social opportunities and build on the benefits mentioned earlier. Some great activities include:
Resources:
National
BlazeSports America www.blazesports.org
Disabled Sports USA www.dsusa.org
Spina Bifida Association www.spinabifidaassociation.org
Mayo Clinic www.mayoclinic.com/health/spina_bifida/spina_bifida.htm
Victory Junction Gang Camp www.victoryjunction.org
National Center for Physical Activity and Disability www.ncpad.org
Local
Intermountain Spina Bifida Support Group utahspinabifida.org
Spina Bifida Association of the Intermountain Region http://www.sbaofir.org/
International
Spina Bifida and Hydrocephalus Association of Southern Alberta www.sbhac.ca
International Federation for Spina Bifida and Hydrocephalus http://www.ifglobal.org/en/
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Forensics
Forensics: The science and practice of examining physical evidence and applying the physical properties of that evidence to the resolution of legal issues, particularly identifying the commission, nature, and perpetrators of crimes.
Forensic Mental Health Services: Forensic mental health services are specialist services for people who have a mental health problem who have been arrested, who are on remand or who have been to court and found guilty of a crime. ‘Forensic’ means ‘pertaining to the law’.
Patients in high-risk forensic therapy include those with “complex and disturbing levels of psychopathology” diagnosed with pathologies such as antisocial personality disorder or schizophrenia/psychotic disorder. Patients in lower-risk settings show fewer tendencies to act aggressively.
Specific needs:
Patients in high-risk forensic therapy include those with “complex and disturbing levels of psychopathology” diagnosed with pathologies such as antisocial personality disorder or schizophrenia/psychotic disorder. Patients in lower-risk settings show fewer tendencies to act aggressively.
TR Implications:
Prison mates have the same needs as other people with their respective mental health disorder, the only difference comes in laws and regulations. Recreational therapists need to be aware of the extra security precautions needed in a prison setting
Resources:
Juvenile detention centers
Correctional institutions
Treatment centers
Community release centers
Programs offered at the centers vary. They include:
Moral Reconation Therapy
Thinking for a Change
The Department's Sex Offender Treatment Program (SOTP)
Con-Quest
HOPE
Excell
Addict To Athlete
Utah Support Advocates for Recovery Awareness (USARA)
Drug Offender Reform Act (DORA)
Utah State Division of Substance Abuse & Mental Health:
Coalition Against Drug Abuse
Life skills
Substance Abuse
Anger Management
Escaping your Prison
Parenting
Seeking Safety
Saying Quit
Moving On
Untangling Relationships
GED
Co-Dependency
Intervention
Relapse Prevention
Employment Assistance
Job Clubs
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Spinal Cord Injuries
Levels of Injury:
Vertebrae are grouped into sections. The higher the injury on the spinal cord, the more dysfunction can occur.
High-Cervical Nerves (C1 – C4)
- Most severe of the spinal cord injury levels
- Paralysis in arms, hands, trunk and legs
- Patient may not be able to breathe on his or her own, cough, or control bowel or bladder movements.
- Ability to speak is sometimes impaired or reduced.
- When all four limbs are affected, this is called tetraplegia or quadriplegia.
- Requires complete assistance with activities of daily living, such as eating, dressing, bathing, and getting in or out of bed
- May be able to use powered wheelchairs with special controls to move around on their own
- Will not be able to drive a car on their own
- Requires 24-hour-a-day personal care
Low-Cervical Nerves (C5 – C8)
- Corresponding nerves control arms and hands.
- A person with this level of injury may be able to breathe on their own and speak normally.
- C5 injury
- Person can raise his or her arms and bend elbows.
- Likely to have some or total paralysis of wrists, hands, trunk and legs
- Can speak and use diaphragm, but breathing will be weakened
- Will need assistance with most activities of daily living, but once in a power wheelchair, can move from one place to another independently
- C6 injury
- Nerves affect wrist extension.
- Paralysis in hands, trunk and legs, typically
- Should be able to bend wrists back
- Can speak and use diaphragm, but breathing will be weakened
- Can move in and out of wheelchair and bed with assistive equipment
- May also be able to drive an adapted vehicle
- Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
- C7 injury
- Nerves control elbow extension and some finger extension.
- Most can straighten their arm and have normal movement of their shoulders.
- Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
- May also be able to drive an adapted vehicle
- Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
- C8 injury
- Nerves control some hand movement.
- Should be able to grasp and release objects
- Can do most activities of daily living by themselves, but may need assistance with more difficult tasks
- May also be able to drive an adapted vehicle
- Little or no voluntary control of bowel or bladder, but may be able to manage on their own with special equipment
Thoracic vertebrae are located in the mid-back.
Thoracic Nerves (T1 – T5)
- Corresponding nerves affect muscles, upper chest, mid-back and abdominal muscles.
- Arm and hand function is usually normal.
- Injuries usually affect the trunk and legs (also known as paraplegia).
- Most likely use a manual wheelchair
- Can learn to drive a modified car
- Can stand in a standing frame, while others may walk with braces
Thoracic Nerves (T6 – T12)
- Nerves affect muscles of the trunk (abdominal and back muscles) depending on the level of injury.
- Usually results in paraplegia
- Normal upper-body movement
- Fair to good ability to control and balance trunk while in the seated position
- Should be able to cough productively (if abdominal muscles are intact)
- Little or no voluntary control of bowel or bladder but can manage on their own with special equipment
- Most likely use a manual wheelchair
- Can learn to drive a modified car
- Some can stand in a standing frame, while others may walk with braces.
Lumbar Nerves (L1 – L5)
- Injuries generally result in some loss of function in the hips and legs.
- Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
- Depending on strength in the legs, may need a wheelchair and may also walk with braces
Sacral Nerves (S1 – S5)
- Injuries generally result in some loss of functionin the hips and legs.
- Little or no voluntary control of bowel or bladder, but can manage on their own with special equipment
- Most likely will be able to walk
Specific Tests
One way the doctor s use to diagnose a spinal cord injury is the pinpoint test. This test will determine the level the individual is injured at and also the segments of the body affected. The physician initially uses a cotton ball to understand where and how much sensation the individual is left with. Next, the doctors use a sterile pin pressed on the skin for sharp touch. Knowing the level the individual is injured at can help the experts know what goals can be set and what treatment is most effective.
Specific Needs:
Braces/Orthotics – To keep the spine stable the patient is fitted with a neck brace. And, depending on the level of injury, the patient may need a Halo brace. These devices use screws pressing into the skull to keep the head stable due to a cervical injury. Cervical Thoracic Orthotics are used to stabilize the entire upper portion of the vertebrae. Also lumbar braces are also used for individuals with lower injuries.
Rest – This is very important, the patient needs rest after such a traumatic experience. The body needs rest in order for the body to heal.
TR Implications:
Therapeutic recreation's (TR) primary responsibility in working with patients with SCI is to expose them to appealing and realistic leisure options following injury. Assessment of preinjury lifestyle provides the foundation for moving forward and implementing a treatment plan that facilitates the patient's return to preinjury activities and/or the development of new interests to promote an independent, active lifestyle.
TR can bring about lifestyle and activity modifications that allow the patient to pursue preferred leisure pursuits. Noreau and Fougeyrollas17 found significant disruptions in the areas of recreational and physical activities after injury. They recommend that SCI rehabilitation centers incorporate programs that include structured exercise conditioning18 and suggest that physiological improvements can be gained by engagement in fitness programs. In rehabilitation settings, CTRSs have the chance to expose patients to opportunities to participate in recreational activities that promote fitness.
Resources:
National Spinal Cord Injury Association (NSCIA)
American Spinal Injury Association (ASIA)
Paralyzed Veterans of America (PVA)
Christopher and Dana Reeves
Association of Assistive Technology Act Programs
Utah SSDI form assistance
Disability Services
Disability Resources
Low cost medical facilities
National Ability Center
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