Therapeutic recreation and physical disabilities: controversial issues

Therapeutic recreation or TR is a rather new and not fully appreciated intervention, which aims at improving the overall functioning and independence of the sick or disabled. Studies have shown its benefits and values in all ages and social classes. It is available in many communities and institutions. Fund grants for it have, however, been cut short. TR professionals are at times open to tort liabilities. And the government has yet to fully appreciate its worth in the face of mounting demand for it.

Therapeutic Recreation

Recreation therapy, also called therapeutic recreation or TR, is the kind that aims at improving the functioning and independence of the ill or disabled (Asenjo 2005). Recreation therapists' incorporate into patients' conditions and treatment needs particular activities, meant to help them cope with the stresses of their illness or disability. Examples of these activities are wheelchair sports, exercises, and social activities. These activities enhance physical, cognitive and emotional health and reduce the need for medications and medical services. TR services are available in clinical facilities and in the community (Asenjo).

A recreation therapist assesses the patient's physical, mental, emotional and social function, drawn from all collected information (Asenjo 2005). Information consists of standard evaluations, observations, medical records, input by medical staff, family and the patient himself. From these inputs, the therapist plans out, develops and implements the therapeutic interventions according to the patient's needs and interests. A patient who prefers isolation may be asked to just play games with others. A paralyzed patient may take on strategies to throw a ball or swing a racket. His therapy may consist in relaxation techniques to reduce stress, appropriate stretching exercises, body mechanics, walking and other appropriate techniques (Asenjo).

Recreation therapists in hospitals are usually members of a team, which develop treatment plans for patients (Asenjo 2005). They take charge of group activities for patients each day. These may be stress management, community outing, family activities, exercise, and leisure education. Recreation therapists provide programs, which include adapted aquatics, wheelchair basketball, social recreation, downhill skiing for the physically disabled, summer camps or adapted golf. They also document the patient's progress in charts, transmit the information to his family and consult with other professionals about it. Therapists employed by the institution plan evening and weekend activities, special events and holiday activities. Patients are often encouraged to join in the planning and implementation of these activities (Asenjo),

They are employed by many establishments (Asenjo 2005). These are hospitals, rehabilitation centers, nursing homes, psychiatric hospitals, community recreation centers, pediatric hospitals, group homes, correctional facilities and private practice. Patients of all ages and life status can benefit from their services. Their services can be used in the park, recreation centers, special education centers or programs for older adults and the disabled. The therapist provides them the opportunities for exercise, mental stimulation, creativity and fun. In schools, the therapist helps counselors, parents, and special education teachers meet the special needs of disabled students. She helps disabled children transition to adult life. She functions as advocate for the disabled when she tackles issues for the patient. These include limited transportation resources, inaccessible facilities, and laws for the benefit of the disabled. She also participates in the work of advisory committees in consulting with outside agencies for the constant and adequate provision of resources and services for her disabled patients (Asenjo).

Downhill Skiing

This was the sport of adolescent patients with orthopedic and neurological defects at the Shriners Hospital for Children in Chicago (Bent et al. 2003). In the hands of rehabilitation professionals, the patients received creative and innovative treatment. The professionals veered out of ordinary therapy into something new. The adventure consisted of physical therapy, occupational therapy, recreation therapy, social work and volunteers. The professionals took the patients to Chestnut Mountain Resort in Galena, Illinois. There they learned adaptive skiing techniques. From this new experienced, they gained a sense of accomplishment, new friends and fresh belief in their abilities (Bent et al.).

Downhill skiing is physically-oriented. It aims at acquiring strength, fitness, balance and coordination (Bent et al. 2003). Its social and emotional goals include group involvement, enhance of group feeling and a sense of independence from family and caregivers. The program goes by a holistic and cost-effective approach to treatment. To insure the success of the program, participants are required to be capable of self-care and activities. They need to be at least ambulatory and capable of fair standing balance. The program accepts participants aged 1-19 who want to attempt skiing. Adolescents with upper extremity amputations, below-knee amputations, myelomeningocele, spinal cord injury and residual brain injury have joined the program. They are selected through chart interviews and recommendations from therapy team members. The programs are staff-intensive. Ambulatory patients are on a one-to-one or one-to-two therapist-to-patient arrangement (Bent et al.).

The program has produced dramatic effects on the patient-participants. Ski-trip has motivated them to become more independent in self-care (Bent et al. 2003). They became more active in home exercise programs and overcame learned helplessness because of their disability. Moreover, they bonded among themselves. This bond served as a support system, which contributed significantly into making the program a success for all of them (Bent et al.).

Recreation Grants in Jeopardy

Considering a large and increasing sedentary population, the medical community predicts that close to 50 million persons could develop temporary or permanent disabilities (Hamilton & Cody 2002). One current problem is access to community recreation services for the disabled, which contributes to the further rise in chronic ill health. The termination of funding for the federal Rehabilitation Services Administration made the situation worse. In response, health recreation and sports advocates lobbied Congress to restore the scrapped $2.6 billion appropriation. RSA funds were first authorized in 1973 for people with disabilities to encourage innovation. But only small annual amounts, often less than $5 million, have been allocated since the early 1980s (Hamilton & Cody).

Yet this modestly-funded RSA grant program has helped save health care providers and governments hundreds of millions of dollars worth of health care costs (Hamilton & Cody 2002). Savings consisted in reduced stays in hospitals, rehabilitation and residential institutions as well as prevention of secondary health risks. As a result, those who could have gotten ill and spent on health care got employed, enjoyed improved health and a richer or more comfortable lifestyle. In 20 years of funding, RSA has helped 200 communities, according to most recent records. Outstanding results came from the University of North Carolina's Center for Recreation and Disability Studies; the Sports and Outdoor Assistive Recreation program in Laramie, Wyoming; the Boise, Idaho Department of Parks and Recreation; and the San Francisco State University Southeast Alaska Trail. Assistant Professor of Recreation Candice Ashton-Shaeffer at the University of Florida commented on the well-documented and significant positive impact of participation in recreation and sports by disabled persons. She said that such participation increases mobility, independence, socialization, health management and community integration. At the same time, it reduces a decline in physical, cognitive and psychosocial function among these disabled persons (Hamilton & Cody).

The demand for community recreation services for the disabled continues to mount with more than 300 agencies applying yearly for grants (Hamilton & Cody 2002). Yet fewer than 10 receive funding. The fate of the RSA program remains in the hands of congressional appropriators on labor, health and human services, education and related agencies. They should remember that the grants are more for demonstrable outcomes like employment and reduced health care costs than fun. Recreation services should be expanded to enhance the lifestyle of millions of disabled people in the country (Hamilton & Cody).

Tort Liability for TR Professionals

Tort is a wrongful act, which results in the injury of another person for which the injured person is entitled to compensation (Taniguchi et al. 2008). TR professionals may be found guilty of ordinary negligence, gross negligence, or a failure to exercise ordinary care. Elements of gross negligence are an intentional act or failure, an awareness of the risk, knowledge of the acts, which entail the risk, and the creation of extreme and outrageous risk of harm. Willful and wanton negligence is disregard to a known risk and accompanied by a conscious indifference to the consequences. The age, intelligence and experience of the complainant are major considerations in determining contributory negligence. Sovereign immunity, waivers and releasers do not protect from gross negligence. Athletics are part of an educational institution's curriculum and, thus, the school district cannot be immune to lawsuits. TR programs face the same risk and responsibility (Taniguchi et al.).

The increasing incidence of injury in sports and physical education has placed the solution to disputes to the courts (Taniguichi et al. 2008). The courts determine the extent and cost of the damage or injury. Injuries have been a main source of liability and this issue intensifies in the case of persons with disabilities. The chances of injury are higher among these persons. The potential for a law suit rises correspondingly. Quite often, education professionals lack knowledge about the disabilities, particularly within the context of sports and physical activity. The problem is aggravated by the student's need for physical activity and exercise. This is the gap and the solution filled in by TR programs. They have the knowledge about disabilities and provide alternatives for specific needs not included in the curriculum. But they have to be as knowledgeable about legal obligations and risks related to their programs as they are about the programs. The failure to recognize such risks or observe pertinent legal obligations not only exposes them to legal threats. It also substantially slows down the progress of the practice in schools. Updated knowledge on legal obligations and risks should then be incorporated into their guidelines so as to reduce exposure to liability suits (Taniguchi et al.).