chapter 9 Therapeutic Recreation and Developmental Disabilities Alice

chapter 9 Therapeutic Recreation and Developmental Disabilities Alice Foose, Ph. D and Patricia Ardovino, Ph. D, CTRS, CPRP

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

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.

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

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

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-care Home living Social and interpersonal skills Use of community resources – – – Self-direction Functional academic skills Work Leisure Health and safety (continued)

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

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

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

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

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

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.

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

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

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

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

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

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

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

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

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 20 s – Becker – Congenital – Emery-Dreifuss • Later childhood and adolescence – Facioscapulohumeral – Limb-girdle

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

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)

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.