"Rec-Reating" The Healthcare Paradigm - creating recreation programs for handicapped

For centuries recreation, leisure and play have all been thought to have some sort of therapeutic value for persons with disabilities. However, the ways in which cultures have perceived the various healing qualities of recreation have changed within the context of societal transformations. Today, managed care continues to play an integral part in healthcare reform. Initial hospital stays are decreasing, and patients are being integrated into their communities faster than ever before. With decreased length of stays, it is becoming increasingly difficult to focus on individualized treatment plans. In order to successfully keep up with the changing times, hospital professionals must look to change and transcend traditional approaches of treatment.

Innovative Programming

With that philosophical foundation, the Recreation Therapy Department at Shiners Hospital for Children in Chicago is proactively leading change by implementing new and unique programs for children and teenagers with physical disabilities. The majority of these programs are outpatient based to help in transitioning from clinical to community recreation involvement as well as teaching life skills. Transitioning into community recreation often compliments healthcare objectives therefore making persons with disabilities active in a quest for better health and quality of life. These programs also seek to creatively combat two significant issues that often accompany physical disability: sedentary lifestyles and social isolation.

Spinal Cord Injury Sports and Conditioning Camp

One program gaining particular attention is the annual Spinal Cord Injury (SCI) Sports and Conditioning Camp held at Shriners Hospital in Chicago. Studies have shown that rehabilitation facilities with strong recreation programs can have a tremendous impact on the population they serve, and individuals who specifically participate in wheelchair sports as a part of their rehabilitation process often continue some affiliation with the sport upon discharge. This increase in physical activity is correlated with the reduction in frequency and severity of secondary medical complications and increase in self-esteem. Thus, children and adolescents who participate in sports activities as a part of their rehabilitation are more likely to be independent as well as physically and psychologically healthy post discharge.

With this in mind, Shriners Hospital began its SCI Sports and Conditioning Camp in 1996 as a proactive approach to treatment. Each year eight teenagers with spinal cord injuries are admitted to the hospital exclusively for a weeklong exposure to a wide variety of sports. The goal of the camp is to facilitate extensive leisure education by involvement in hands-on experiences with as many sports as possible in a socially comfortable environment. The camp covers a variety of activities that include kayaking, tennis, basketball, bowling, scuba diving, sled hockey, horseback riding, and sailing. Body composition and fitness levels are also assessed to give campers an idea of their overall competency and progress.

The eight adolescents are selected by an interdisciplinary team. Campers are selected on the basis of their ability and injury level. All campers are independent in bowel and bladder programs, transfers, and are free of pressure ulcers. The campers are also individuals who have demonstrated an interest and motivation to become involved in sports. Campers come from all over the United States -- some from inner cities and others from rural areas. The camp is free of charge, and every camper receives a subscription to Sports N' Spokes, a scuba mask and snorkel, a basketball, a tennis racquet and balls, a camp T-shirt, a Spinal Network book, and expert instruction by a community recreation agency/individual in up to eight sports.

Continuing Involvement is Encouraged

Leisure education is prevalent throughout the camp. Following each sport, the recreation therapist and SCI program coordinator speak to the campers about their continuing involvement in that sport in their communities. Many of the campers offer suggestions to their peers and help them to problem solve specific situations in relation to their spinal cord injury. The peer support and camp environment allow the teenagers to explore new social roles and become comfortable within the group.

Participants have noted the camp to be beneficial in several aspects. The first is leisure awareness through participation in the various sports. This was reflected in comments such as, "The camp showed me things I thought I couldn't do" and "The camp spurred me on to join a wheelchair basketball team". The teenagers also stated social benefits in that they enjoyed meeting and conversing with people of similar age, developing new friendships, and problem solving with peers having comparable life situations. The camp's goals have seemingly impacted their lives. Most participants have indicated they were more active, going to school, socializing more, and planning to continue to increase their involvement in sports following the camp experience.

To the authors' knowledge, there is no other hospital in the country that admits children specifically for recreation therapy and funds the entire program. This program remains an anomaly in clinical recreation programming.

Downhill Ski Program

Outdoor adventure programming is another area receiving a lot of attention. These programs are becoming an effective treatment modality in rehabilitation. Outdoor adventure programs allow teenagers to work on problem-solving skills, increase effective communication and socialization skills, enhance self-esteem, and inspire recreation pursuits. In fact, adolescents in general are well suited for adventure programs because of their youthful energy and propensity for risk-taking.

One such example is the recent implementation of a downhill ski program. It represents another break from traditional clinical recreation programming. Several teenage outpatients with various disabilities from Shriners Hospital were selected to participate in a weekend downhill ski trip. Due to the intensity of the sport, a 1:1 ratio of patients to staff members was present on the trip to give individual attention to each of our skiers. At the resort, Chestnut Mountain in Galena, Illinois, a one-hour private lesson was provided for each of our patients by a professional ski instructor. This lesson provided the participants with the basic techniques of downhill skiing and allowed them to be more comfortable on the slopes. The private lessons were key in the success of the program, because they eliminated the participants' feeling of self-consciousness regarding their various ability levels.

The techniques in adaptive downhill skiing are similar to those of able-bodied skiing. However, a person with a disability may require different equipment. The ski resort was able to provide adaptive equipment designed to assist our patients in their learning process. This equipment included tall outriggers, which is a device resembling a crutch with a small ski attachment at the base. By pulling a grip cord attached to the handle of the crutch, the participant can change the ski attachments from a horizontal skiing position to a vertical position. The outriggers are used to assist balance while progressing down the slope.

Another piece of adaptive equipment used was a ski stabilizer, also called a "ski bra". This device can be used to hold the front of the skies a safe and manageable distance apart. These are used as a training mechanism and can easily be attached and detached. When a skier does not possess the necessary leg strength or balance to keep the skis together, a ski stabilizer is used. It is attached to the front tip of the skis. The ski stabilizer still allows enough movement for the participant to perform snow plowing and edge turns.

The last piece of adapted equipment used on the trip was a mono-ski. This has a bucket seat positioned on a single ski using a suspension system. The participant uses a pair of short outriggers to assist in balance. The ski is controlled by using the outriggers and leaning side to side, much like you would on a bicycle. An able-bodied skier can ski behind the mono-ski if the participant needs extra assistance in balancing or maneuvering the ski. For a beginner, the mono-ski also requires two staff members to assist the participant onto and off of the ski lift. However, because of the design of the mono-ski an advanced skier can ride the lift and downhill ski independently.

One of our participants with a spinal cord injury benefited from use of the mono-ski. She initially required a staff member's support for balance from behind, but showed a steady progression of skills throughout the weekend. In the end, she was able to control the ski on the beginner hills independently. For this participant, the sense of accomplishment was overwhelming as evidence by her facial expression -- an unending and irreversible smile.

Overall, the participants perceived the downhill ski program to be a positive occurrence. The experience of being away from their families and being completely independent was invaluable. Many left with the feeling of accomplishment, not only in being able to take care of themselves, but also in learning a new sport. One of the participants even referred to this program as a "gift". He now possessed the skills and confidence to join his father on a ski trip next winter.

Rock Climbing Program

Yet another adventure program enabling adolescents to learn more about themselves and their environment is a one-day rock-climbing trip aimed at outpatient adolescents with prosthetic arms or legs. This experience was created by a recreational therapist in conjunction with a physical therapist to challenge people with amputations to safely step outside their comfort zones, problem solve, and explore physical and mental abilities. This one-day trip is a means of applying treatment in an outdoor venue. The outcomes of this program include the participants examining the rock climbing experience and transferring those accomplishments to everyday life situations.

This program will take place in July 2001. Nine participants will be chosen with amputations of varying degrees and extremities. They will be between the ages of 14 and 18, and recommended for the program by an interdisciplinary team composed of doctors, nurses, and therapists. They must also be independent in self-care activities, and meet basic physical care criteria.

For these adolescents, rock climbing will be a new and exciting experience with personal as well as team goals. The challenges set before them will be essential in the development of new skills, inner resources, and self-esteem during the program. For some participants, the goal of merely showing up and putting the equipment on is an accomplishment. For others, the top of the mountain is where their sights are set. Regardless, the participants' willingness to challenge themselves and to work at overcoming obstacles is success in itself.

The program also has tremendous implications for the development of self-esteem. For teenagers, the formation of a group identity is of utmost importance. Therefore, teamwork is an intricate piece of the puzzle. The need for cooperation, development of trust, as well as personal and group goal attainment aid in the development of new friendships with other adolescents.

The debriefing process is the most important part of the adventure experience. During the debriefing process, a framework is set for the disclosure of relevant information. Participants share feelings experienced pre and post activity, and then use metaphors to apply to the experience to their everyday lives. For some climbers it will be the fear of the unknown (i.e., the climb) that is difficult, much like transitioning to college incorporates feelings of uncertainty.

Outpatient Workshops

The combination of challenges and debriefing experiences illustrate how this program could potentially enhance quality of life. Through shared experiences and teamwork, participants develop physical and mental strength, build self-esteem, and enhance social skills. The ultimate goal for the adolescents is that they will move along the heath-care continuum towards independent recreation participation.

To further aid in the transition from clinical to community settings, the Recreation Therapy Department has set up a variety of outpatient sports and craft workshops. These workshops are designed to introduce patients to new leisure interests as well as give them community contacts so they may continue with the activity post workshop. The sports workshops include such programs as an adapted cycling trip along the Fox River and kayaking in the Lincoln Park Lagoon. Craft workshops include a ceramics program lead by an art therapist and a nurse who have started their own business, as well as patients designing and making their own bath soap and body gel.

An organization or business leads all of these workshops with expertise in that particular area, external to the hospital. Patients can access these services at any time after the workshop and may feel more comfortable doing so after they have made an initial contact and have a chance to experience the activity in a safe and comfortable environment.

The Recreation Therapy Department is looking into implementing more of these workshops in the future because the concept has been met with such favor.

Conclusion

It is well documented that communities who welcome constant change are the strongest. If used properly, change inspires diversity, elevates relationships, and ensures survival. The Recreation Therapy' Department at Shriners Hospital in Chicago is constantly striving to create new programs to meet the changing needs of their clients. Creativity and innovation are the cornerstone for the development of unique products and programs, and are the hallmarks of success.

Benchmarking these programs will hopefully encourage other clinical and community recreation facilities to examine current practices. These programs may serve as an aid in welcoming change, forming partnerships, and transitioning clients into independent community recreation involvement. In conjunction with trying to continually improve the scope and quality of care for our patients, these programs have been embraced in efforts to stay on the cutting edge of preventative medicine.

Kristin A. Johnson, MS, CTRS; Melanie K. Bland, CTRS, CCLS; and Shannon M. Rathsam, CTRS, are the authors of "Recreating the Healthcare Paradigm" on page 58. Kristin A. Johnson graduated with a BS in 1986 from the University of Iowa, and went on to receive a MS in 1996 in Recreation Administration from Aurora University. She enjoys sports and outdoor activities such as camping and scuba diving, and firmly believes in the power of experiential learning with her clients. Melanie K. Bland is dually certified as a recreation therapist and a child life specialist. She graduated from Indiana University in 1997. She enjoys all recreation and leisure activities outside running and downhill skiing. Her newest passion is yoga, which she practices weekly. Working with children in hospitals allows her to be creative and compassionate. Shannon M. Rathsam is a recent graduate from Indiana University. She prefers to spend her free time outside rollerblading, swimming, or merely going for a walk. She is new to the professional field and is excited about her involvement in new, innovative programming with her clients.

COPYRIGHT 2001 National Recreation and Park Association
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