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Therapeutic Recreation and Developmental Disabilities
chapter 9 Therapeutic Recreation and Developmental Disabilities Alice Foose, PhD and Patricia Ardovino, PhD, CTRS, CPRP
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Learning Outcomes Describe the commonalities and differences in diagnoses of the described developmental disabilities Identify the main knowledge areas that a therapeutic recreation specialist should possess when working with a person with a developmental disability Explain the importance of age-appropriate interventions and give at least two examples Explain why taking the life-span approach is important when working with people with developmental disabilities Describe the best practices for working with people of different ages and different developmental disabilities Explain what precautions need to be taken for contraindications associated with at least five types of developmental disabilities
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What Are Developmental Disabilities?
Definition Lifelong impairments Occur before adulthood (age 22) Affect multiple aspects of life Types Intellectual impairment – Spina bifida Autism – Deafness Cystic fibrosis – Blindness Cerebral palsy – Other conditions National blueprint to improve health of persons with intellectual impairment Legislation (table 9.1), advocacy, research, and service program availability have improved.
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Understanding the Developmental Process
Identified by examining three domains Physical Cognitive Socio-emotional Table 9.2: Typical developmental process Acknowledge strengths Not all areas of functioning are delayed Common to excel in other areas
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Broad Nature and Location of Practice Settings
Public and municipal parks and recreation Year-round programs Summer camps After-school and workshop enrichment programs Inclusive recreation services Least restrictive environment Maximize involvement in general programs Private agencies (for profit and nonprofit) Community based Work training and support, socialization opportunities, and other support services Long-term residential agencies
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Intellectual Impairment
Descriptives Largest subclass of developmental disabilities (DD) 1% to 3% of U.S. population has some intellectual impairment Definition Diagnosis is used to determine eligibility for services Often dually diagnosed with another DD Adaptive skills Communication – Self-direction Self-care – Functional academic skills Home living – Work Social and interpersonal skills – Leisure Use of community resources – Health and safety (continued)
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Intellectual Impairment (continued)
Causes Genetic conditions Events during pregnancy, birth, or childhood Therapeutic recreation Childhood Supplements and extends educational services and provides socialization Vocational, social, and cognitive development (with age) Majority of services considered leisure education Social skill development Leisure awareness Appropriate use of leisure resources Activity skill development Behavior modification: chaining, shaping, fading, prompting
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Down Syndrome Most common chromosomal DD
Syndrome: group of symptoms or abnormalities Caused by extra chromosome during cell development Symptoms Poor muscle tone Hyperflexibility Lowered resistance to infection Visual problems Slower physical and mental development Premature aging as an adult
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Fragile X Syndrome Most common inherited form of intellectual impairment More severe in males Occurrence 1 in 3,847 people have the fragile X mutation Body produces insufficient protein for development Symptoms Intellectual impairment Sensitivity to sensation Behavioral problems similar to autism Unique physical characteristics
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Phenylketonuria (PKU)
Inherited metabolic disorder Body can’t break down the protein phenylalanine Brain damage can occur Important to be aware of medical history during pregnancy Occurrence: 1 in 14,000 births Treatment: change in diet to limit intake of phenylalanine
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Autism and Other Pervasive Developmental Disorders
Pervasive developmental disorders (PDD) Autism is most common form of PDD PDDs are neurological disorders Affect communication, understanding, play, and socialization Symptoms Lack of social or emotional reciprocity Stereotyped or repetitive motions Lack of varied or spontaneous make-believe play Descriptives Approximately 1 in every 150 children Four times more common in boys than in girls Three out of four people with autism also diagnosed with intellectual impairment (moderate to severe in 50% of those dually diagnosed) 25% to 33% experience seizures
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Therapeutic Recreation for Those With Autism and Other PDD
Focus on improving communication, social, academic, behavioral, and daily living skills. Use a variety of sensory inputs as cues. Interaction with peers without disabilities is important for modeling. Programs are found in various places. The therapist assesses and identifies needs and abilities. Relaxation rooms reduce sensory overload.
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Cerebral Palsy Group of disorders
Inability to control muscular and postural movements due to brain damage before age 12 Causes Genetic conditions Infections Child abuse Stroke Head injury
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Types of Cerebral Palsy (CP)
Spastic Most common form of CP, affecting 70% to 80% of those with CP Tightness of muscles resulting in stiff movements Three forms Diplegia: only legs are affected Hemiplegia: only half of the body is affected Quadriplegia: both arms and legs are affected Athetoid (dyskinetic) Low muscle tone Slow, uncontrollable movements of entire body Ataxic Poor sense of balance Trouble controlling muscle length or position; may overshoot when reaching for objects Mixed: combination of the above types
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Characteristics of Cerebral Palsy
Ranges from mild to severe Typically affects: locomotion gross and fine motor coordination communication Higher incidence of seizures Sensation, vision, or speech can worsen when overexertion occurs Higher risk of obesity due to inactivity
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Therapeutic Recreation for People With Cerebral Palsy
Pathological reflexes due to brain injury Asymmetrical tonic neck reflex triggered by head movement Activities that develop motor skills can help inhibit pathological reflexes Imbalances in engagement of flexor and extensor muscle groups Reduce imbalances with massage, stretching, and trunk rotations Warm-water aquatic programs: buoyancy makes movement easier Popular modalities Therapeutic horseback riding Hippotherapy
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Spina Bifida Spinal column does not close during gestation
40% of Americans have some form of spina bifida 90% of people with spina bifida live normal life span Often classified as orthopedic disability Sometimes classified as developmental due to early onset
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Three Types of Spina Bifida
Spina bifida occulta Mild with no symptoms One or more openings in the spinal column Meningocele Sac protecting the spinal column is pushed through the opening Can easily be repaired Myelomeningocele Spinal cord protrudes through the back Commonly identified as spina bifida Fewer than 1 in 1,000 children Symptoms include muscle weakness or paralysis below exposed area; loss of bowel and bladder control; and hydrocephalus or water on the brain (70% to 90% of cases), requiring shunt
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Therapeutic Recreation for People With Spina Bifida
Common Goal Areas: Muscle strength and flexibility Adaptation of activities Esteem and empowerment Precautions Possible seizures Swallowing difficulty Cognitive impairment Neck pain Apnea Bowel and bladder infections
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Muscular Dystrophy Descriptives
Group of chronic genetic diseases Progressive degeneration and weakness of voluntary muscles Hereditary or mutated gene on X chromosome Therapeutic recreation: activities to improve movement, flexibility, and adapting activities for participation
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Types of Muscular Dystrophy
Early childhood Duchenne Most common type (accounts for over half of all cases) 1 in 3,500 births Most aggressive Signs noticeable around age 2 Wheelchair-bound by age 12 Death by early 20s Becker Congenital Emery-Dreifuss Later childhood and adolescence Facioscapulohumeral Limb-girdle
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Best Practices Promoting leisure Activity analysis
Person, not diagnosis Behavioral modification Multiple modes of communication and instruction Least restrictive environment Leisure education
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Discussion Questions Describe the commonalities and differences of the diagnoses of developmental disability, intellectual impairment, learning disability, pervasive developmental disorder, autism, cerebral palsy, Down syndrome, and spina bifida. What are the main knowledge areas that a therapeutic recreation specialist should understand to work with a person with a developmental disability? Explain the importance of age-appropriate interventions and give at least two examples. (continued)
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Discussion Questions (continued)
Explain why taking the life-span approach is important when working with people with developmental disabilities (DD). Explain what precautions need to be taken for the contraindications for each of the presented types of DD. Identify potential goal areas for each of the presented types of DD.
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