Therapeutic Recreation for Developmental Disabilities: Commonalities, Interventions, and Best Practices

1. chapter9 Therapeutic Recreation and Developmental Disabilities Alice Foose, PhD and Patricia Ardovino, PhD, CTRS, CPRP

2. 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

3. 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.

4. 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

5. Broad Nature and Location ofPractice 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

6. 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)

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. Best Practices • Promoting leisure • Activity analysis • Person, not diagnosis • Behavioral modification • Multiple modes of communication and instruction • Least restrictive environment • Leisure education

23. 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)

24. 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.