Recreational Therapy with Regards to Traumatic Brain Injury

Welcome to the TBI-HELP Live Chat

Today's topic is: "Recreational Therapy with Regards to Traumatic Brain Injury"

Our Guest is: Mrs. Elke Lacey and Mr. Thomas McDonald, Recreational Therapists, Jamaica Hospital Medical Center

[19:02:19] Mod: Welcome everyone! Tonight The TBI Help Desk for Caregivers is very happy to have Mrs. Elke Lacey and Mr. Thomas McDonald as our guest speakers. Mrs. Lacey and Mr. McDonald are recreation therapists at Jamaica Hospital Medical Center. Their topic tonight is "recreation Therapy with Regards to Traumatic Brain Injury." Welcome Lacey and Tom!
[19:03:26] Tom: Thank you very much. It is a pleasure to be here.
[19:03:35] Mod: Rail: What is recreation therapy?
[19:05:09] Tom: Recreation Therapy is the application of Recreational activities as an intervention with the purpose of maintaining or improving health, functional ability, and quality of life for the patient.
[19:06:38] Mod: Rail: What can recreational therapy do for a coma patient?
[19:09:32] Tom: Recreational Therapists, on most TBI units, participate along with other disciplines in providing Coma Stimulation. This is a treatment where a set protocol is followed during which patients are provided a wide range of different stimuli. The patient's responses are interpreted by the therapist and quantified using a scale. The patient is provided this stimulation several times throughout the day. The patient's progress is tracked and stimuli are adjusted to fit the level of the patient..
[19:13:28] Mod: Amanda: Does rec therapy include active as well as non active activities for those able to participate? Do these activities help stretch the pts. thinking to possibly include other areas of interest?
[19:14:54] Tom: Of course, all activities provided to patients are based on their functional ability as well as their leisure interests. Recreational Therapy includes a lot of education as well as participation in activities. Based on the interests of the patient we may introduce new activities that perhaps the patient has never thought to try..
[19:18:08] Mod: Amanda: How about music which can be soothing, uplifting and is used to teach children with a lot of success. It also seems to work with adults?
[19:19:11] Tom: Depending on the patient, music can be very useful to decrease restlessness, improve mood, and increase arousal. But also, it is important to note that it can have the exact opposite effect if not applied properly or if the patient is not tolerant to that type of stimuli..
[19:21:28] Mod: What are some other ways of reducing restless and impulsive behavior in a patient with TBI?
[19:23:08] Tom: One approach would be to use diversionary activities. These are activities that are provided for the main purpose of filling unoccupied time with enjoyable and purposeful activities. Patients with TBI are very often restless, impulsive ,and display unsafe behavior. This can be reduced just by giving them something to do that is not boring to them. Simple activities such as small puzzles, reading magazines, picture books, movies, video games, and as we mentioned music can occupy the attention of the patient. Some redirection will probably always be required, however it is easier to redirect a patient back to a task than it is to return them to doing nothing. When providing diversionary activities it is vital to be aware of the patient's interests. Always find out what the patient likes to do and try to provide those activities whenever possible..'
[19:28:19] Mod: Amanda: Is this done in a group as well as an individual basis? By not tolerant do you mean gets over stimulated?
[19:29:28] Tom: Patients are always seen individually. However, group sessions are provided several times daily. Of course groups can be a stressful experience for TBI patients depending their level of agitation and restlessness. Also taken into consideration is the size of the group. Smaller groups seem to be more appropriate on the TBI unit. And yes over stimulation is a large concern during all activities..
[19:32:43] Mod: How do you redirect to make it successful and seem like the patients own idea to rejoin or continue?
[19:33:10] Tom: Very good question. The answer is simply knowing your patients. Recreational Therapist try to develop a good rapoire with the patient from initial contact. Knowing their personality and being friendly and not demanding. Sometimes it is better not to continue and start something new. It is always possible to return to a task at a later time. Making the patient agitated will certainly be a negative result to an activity..
[19:38:33] Mod: How can friends and family play a role in Recreational Therapy?
[19:40:44] Tom: Friends and family often play a vital role in out treatment of patietns. They are a great resource for us to learn more about the patient. Also, we find that the patients often are more motivated to participate while someone close to them is present. In terms of improving mood, family and friends are extremely important. Being away from home and in a very strange place can negatively affect mood. Having people close to the patient come and visit seems to always lift the spirits. We always encourage family to attend out patient sessions so that they may learn more about the patient's condition. Our overall goal is to allow the patient to be as independent as possible.
At times, family caregivers try too hard and end up sheltering the patient from the out side world and make the patient dependent on them. This can adversely affect the patient in many ways one of them being something called learned helplessness. This is where the patient believes that they can do nothing for themselves because everything is always done for them. We allow the family to closely observe the progress of the patient and also educate them on resources and precautions that they should be aware of when providing recreational opportunities for their loved one. This may allow the family to have more confidence and allow the patient to continue with life after discharge..
[19:47:53] Mod: Is the recreation therapist involved with discharge planning?
[19:49:59] Tom: In our department we do a lot of planning with the patient. We do a lot of education sessions with the patient regarding reentry into the community. This is especially vital for those patients who will not be returning to employment. We educate the patient on leisure resources and also on ways to manage their time properly. This is different than most time management discussions in that we try to organize their free time instead of their busy time. Combating boredom are key issues in the prevention of learned helplessness and depression. Staying home and watching TV is entertaining for only so long. We educate the patient on how to seek out resources and how to plan their days. Mostly to use the open time they have involved in positive activities that can give them a sense of purpose. By having new and enjoyable things scheduled regularly they will always have something to look forward to do..
[19:57:31] Mod: Is there anything that you believe should be more focused on in TBI rehabilitation?
[19:58:36] Tom: As of now at Jamaica Hospital there are several different areas for the TBI patient. Every effort is being made to rehabilitate the whole person at once. We believe the for the most part that is achieved successfully. Within the Recreational Therapy Dept. we are always looking for new areas that we may have overlooked in the past. Recently, we have begun a social skills group, which offers the patient to master skills in the areas of cognitive communication and pragmatics. This type of program has recently been introduced by Recreational Therapists on other TBI units as well. It is always important to offer the patients the best and most complete type of therapy available so that they can have the best chance of recovery.We are always working to stay ahead of that..
[20:02:38] Mod: Well, I see that our time is up. I would like to thank our audience for participating. I would also like to thank Tom and Lacey for a very informative session and hope they come back soon. Thank and be safe!
[20:03:18] Tom: Thank you, this was very enjoyable.