chapter 8

1. chapter8 Orthopedic and Neurological Impairment: From Rehabilitation to Community Reentry Terry Long, PhD and Terry Robertson, PhD

2. Learning Outcomes • Recognize common orthopedic and neurological conditions experienced by therapeutic recreation clients • Explain the role that therapeutic recreation plays in providing services to people with such conditions • Understand modalities typically used to address orthopedic and neurological conditions in both rehabilitation and reintegration settings • Identify appropriate application of these modalities to various orthopedic and neurological conditions • Describe best practice mechanisms for the delivery of such modalities, including use of protocols and critical pathways

3. Physical Rehabilitation Programs • Introduction • Designed to address disturbances or deterioration of physiological functions • Physical impairments can affect all area of function • Prevalence • Approximately 16% of CTRSs work in rehabilitation • Role of therapeutic recreation specialist • Implement programs to address impacted areas of function • Most notably areas necessary for successful recreation participation in the future

4. Common Diagnostic Groups: Orthopedic Impairments • Definition: conditions caused by disruption of skeletal muscle system • Forms of arthritis • Osteoarthritis • Rheumatoid arthritis • Degenerative bone diseases or severe fractures • Soft tissue injuries • Limb amputations • Prosthetic devices • Therapy • Phantom pain • Mastery of ADLs • Mastery of recreation and leisure skills

5. Common Diagnostic Groups: Neurological Impairments • Definition – injuries or impairments that originate in the nervous system • These are often classified as orthopedic, as they impact the ability to use to skeletal-muscle system • Spinal cord injury (SCI) • Trauma to the spinal cord that creates disturbances in motor control, sensation, or both • Location and severity of injury determines the nature of disability • Paraplegia and quadriplegia • Complete and incomplete injury (continued)

6. Common Diagnostic Groups: Neurological Impairments (continued) • Traumatic brain injury (TBI) • Typically impacts multiple areas of function • Requires a comprehensive approach • Severity varies widely as well • May involve penetrating (open) or closed injury • Neither degenerative nor congenital • Glasgow Coma Scale (continued)

7. Common Diagnostic Groups: Neurological Impairments (continued) • Cerebral vascular accidents (CVA) • Types • Stroke • Aneurism • Multi-infarct dementia • Transient ischemic attack (TIA) • Common consequences • Left brain vs. right brain stroke • Hemiplegia • Aphasia • Dysarthria

8. Common Diagnostic Groups:Other Notable Conditions • Various other conditions may also be observed in rehabilitation settings • Examples • Parkinson’s disease • Guillian Barre syndrome • Cardiovascular conditions • Pulmonary conditions

9. Common Therapeutic Recreation Modalities in Rehabilitation • Recreation as physical rehabilitation • Recreation as cognitive rehabilitation • Other specific modalities • Sensory stimulation • Pain management and relaxation techniques • Aquatic therapy • Animal-assisted therapy • Horticulture therapy (continued)

10. Common Therapeutic Recreation Modalities in Physical Rehabilitation (continued) • Community reintegration • Leisure education • Leisure awareness • Leisure resources • Social skills • Activity skills • Community-based services

11. Working as Part of aTreatment Team • Clinical pathways • Treatment protocols • Importance

12. Discussion Questions • Differentiate between a neurological injury and an orthopedic injury. What commonalities and differences do you see between these two diagnostic areas? • Discuss the role of the therapeutic recreation specialist as a client moves through the recovery process. Do you think that this role would change as the client progresses? How is this concept reflected in the therapeutic recreation models presented in chapter 5? • Can you think of other modalities that could be integrated into the therapeutic recreation process for any of the described conditions? State your case about why you believe that this particular modality would be useful for the chosen condition (client group). (continued)

13. Discussion Questions (continued) • Why is the use of standardized procedures outlined in protocols or critical pathways important? Do you see any drawbacks to using such a system? • Of the described modalities, which do you currently feel most comfortable with, and which are most intimidating? What steps can you take to ensure that you are professionally capable of using these modalities? Do you think that any of these modalities have the potential to harm a client if used inappropriately?