Recreational Therapy Practice Research Articles

Recreational Therapists’ Usability Perceptions of the Meta Quest 2 VR System

This study used survey methods to examine recreational therapists’ perceptions of the usability of the Meta Quest 2, a popular commercial virtual reality (VR) system, for recreational therapy (RT) practice. Participants (N = 22) completed the System Usability Scale (SUS) following attendance at a six-hour continuing education workshop that included didactic education and experiential learning with the Meta Quest 2 and eight different VR applications. The SUS scores ranged from 37.50–97.50 (M = 64.31, SD = 17.93) which corresponds with a “high marginal” acceptability rating, a letter grade of C-, and an adjective rating of “good” based on three separate SUS interpretation guidelines. There were no significant differences in SUS scores across several personal (age, gender, race) and professional (years of RT practice experience, primary service setting, client diagnostic characteristics, age of clients served) demographic groups. Findings add to the evidence-base in the emerging area of VR use in RT practice, and suggest opportunities for future research.

Understanding Pain in Individuals with Spinal Cord Injury: Implications for Recreational Therapy Practice

For individuals with spinal cord injury, pain is the leading secondary health condition. SCI-related pain is complicated because it is multifaceted in nature. Individuals with SCI-related pain may experience visceral, neuropathic, and musculoskeletal pain at different locations and with varying intensities at the same time or intermittently. In recent years, SCI scholars created a taxonomy to classify SCI-related pain. This classification was to communicate the complexity of SCI-related pain, as well as to help clinicians and individuals with SCI explain pain experiences. Because of the multifaceted nature of SCI-related pain, many individuals with SCI do not experience relief with conventional oral pharmacological options. The purpose of this manuscript is to describe pain and SCI-related pain and to provide implications for recreational therapy practice. Implications include the identification of potential reliable and valid pain measures for individuals with SCI and evidence-based interventions such as physical activity, complementary and alternative therapies, and multidisciplinary pain management techniques to manage SCI-related pain. Recommendations for research and practice note continuing needs to gather evidence on treatment time and recreational therapy interventions employed with SCI-related pain while developing and testing pain management protocols.

A Need for Increased Awareness of Disability Models in Recreational Therapy Practice

Inherently embedded within the descriptions, models, and practices of the field of therapeutic recreation, dis-ability models conceptualize disability, guide therapeu-tic processes and service delivery, and influence client experiences and outcomes. Despite their significance, disability models have received limited attention by the field resulting in inconsistencies within the philosophi-cal underpinnings of the recreational therapy profession. The purpose of this article is to increase awareness of disability models and their implications for recreational therapy practice. A brief conceptual overview of three disability models, including the medical, social, and In-ternational Classification of Functioning, Disability, and Health (ICF) models, is provided, and the models’ cur-rent applications in the field of therapeutic recreation are explored. Utilizing a disability studies lens, a critique of the relationships between each disability model and the core concepts of recreational therapy practice is pre-sented. Commentary is provided to stimulate discussion regarding the need for philosophical consistency of dis-ability values across the profession.

Changes in Engagement for Adults with Dementia: Effects of an Intergenerational Program

Finding ways to engage adults living with dementia in meaningful and social activities as well as elicit positive emotions and behaviors is important. Intergenerational programs (IGPs) involving young children have been shown to benefit the physical, emotional, and social health of older adults, including those living with dementia, and are often positively received by this population. This study examined how involvement in an IGP was associated with the way that individuals living with dementia engaged and the behaviors that they exhibited during the activities. Fourteen older adults living in a shared-site long term care facility participated in an onsite IGP. Their interactions were recorded over a five-day period immediately prior to the children’s arrival and throughout the duration of the program; adults’ engagement and behaviors were coded using the Menorah Park Engagement Scale (MPES). Findings indicated that there were significant changes in engagement type and the behaviors exhibited by these adults during the IGPs. Constructive engagement significantly increased while non-engagement and other engagement were significantly reduced when the children were present. Greater displays of pleasure and helping behaviors were also exhibited during the IGPs. These findings have implications for recreational therapy practice in long-term care settings and support the use of IGPs with adults living with dementia as a nonpharmacological intervention to improve social engagement in this population.

Chronic conditions, lifestyle medicine, and recreational therapy

Lifestyle medicine is a relatively new and emerging discipline within the practice of medicine dedicated to using lifestyle changes in the prevention, management, and reversal of chronic diseases. Information on lifestyle medicine has not appeared in the literature of recreational therapy. Recreational therapists need to understand lifestyle medicine because recreational therapy practice is closely tied to lifestyle medicine. This article is about chronic conditions and the recently established discipline of lifestyle medicine as they relate to the delivery of recreational therapy services. It is concluded that the recreational therapy profession should make itself known to those in the lifestyle medicine community and take a rightful place in the movement to prevent, manage, and reverse chronic diseases by assisting clients to engage in healthy lifestyle behaviors.

Usability of the HTC Vive virtual reality system in recreational therapy

Commercial virtual reality (VR) systems have become increasingly popular, affordable, and accessible in recent years. Resultantly, recreational activities involving VR are providing new ways to engage in leisure experiences and innovative treatments in the health care arena. Little is known, however, regarding the usability of commercial VR systems for recreational therapists and their clients. Therefore, the purpose of this study was to evaluate the usability of a popular commercial VR system, the HTC Vive, in terms of its potential use in recreational therapy practice. Using a cross-sectional design, data were collected from recreational therapy professionals (N = 8) working in diverse service settings. Following exposure to the HTC Vive equipment through a professional workshop that included didactic instruction and clinical role-play activities, participants evaluated the system’s usability for themselves as well as for the clients they serve. Data collected through both an online survey and a focus group discussion revealed strong agreement from the therapists that the HTC Vive is a usable commercial VR system for themselves as well as their clients. Specific comments related to the head-mounted display (HMD), controllers, sensors/base stations, positioning, and Steam software provide valuable insights on features viewed positively, possible adaptations for specific client groups, and unique considerations by service setting.

A Model for Clinical Supervision in the Field of Therapeutic Recreation: The APIE/D Model of Clinical Supervision

Clinical supervision in the field of therapeutic recreation is emphasized as part of the internship experience, but is not widely provided to practicing CTRSs beyond that time. While the American Therapeutic Recreation Association does not address clinical supervision in its Standards for Practice, the National Council for Therapeutic Recreation Certification notes clinical supervision as part of its Job Analysis. In order to yield improved client outcomes, improved wellness in direct-care CTRSs, and improved clinical skills, a model for clinical supervision for CTRSs is proposed. Due to the familiarity that all CTRSs have with the APIE/D process of recreation therapy practice, the authors suggest implementing the APIE/D model of clinical supervision with practicing CTRSs.

Recreational Therapists Consider Leisure Motivation when Evaluating Virtual Reality Games

Virtual reality (VR) interventions can be motivating for clients when presented as treatment in healthcare settings. Researchers know little, however, about the elements of specific VR games that contribute to this motivation. This study aimed to describe differences among a sample of commercially available VR games using the four subscales of the Leisure Motivation Scale (LMS). The research team used a mixed-methods design, and compiled an expert panel of recreational therapists (N = 5) who evaluated eight VR games using Q-sort methodology. Semi-structured interviews generated additional data for the evaluation. Results indicated participants viewed certain VR games as containing elements more closely aligned with each of the LMS subscales of intellectual, social, competence-mastery, and stimulus avoidance than others. These findings represent a critical step in developing guidelines for the purposeful selection of VR games as treatment interventions in recreational therapy practice based on a client’s leisure motivation. Subscribe to TRJ

Usability of the HTC Vive virtual reality system in recreational therapy

Commercial virtual reality (VR) systems have become increasingly popular, affordable, and accessible in recent years. Resultantly, recreational activities involving VR are providing new ways to engage in leisure experiences and innovative treatments in the health care arena. Little is known, however, regarding the usability of commercial VR systems for recreational therapists and their clients. Therefore, the purpose of this study was to evaluate the usability of a popular commercial VR system, the HTC Vive, in terms of its potential use in recreational therapy practice. Using a cross-sectional design, data were collected from recreational therapy professionals (N = 8) working in diverse service settings. Following exposure to the HTC Vive equipment through a professional workshop that included didactic instruction and clinical role-play activities, participants evaluated the system’s usability for themselves as well as for the clients they serve. Data collected through both an online survey and a focus group discussion revealed strong agreement from the therapists that the HTC Vive is a usable commercial VR system for themselves as well as their clients. Specific comments related to the head-mounted display (HMD), controllers, sensors/base stations, positioning, and Steam software provide valuable insights on features viewed positively, possible adaptations for specific client groups, and unique considerations by service setting.

The Initial Development and Validation of the Perceptions of Disability Scale (PoDS): Results from Pilot Studies

The purpose of this study was to report the initial process of developing and validating the Perceptions of Disability Scale (PoDS), a scale designed to map a continuum of sympathy, empathy, and advocacy perspectives on people with disabilities. We first created a 30-item scale based on a thorough literature review and the findings of a previous qualitative study. Then we further refined and validated the scale through 3-phase approach as well as internal consistency reliability evidence and validity evidence based on content, response process, and internal structure. Results suggest that the final 21-item scale has excellent reliability and validity. Suggestions for how the scale can be used in recreational therapy practice and human-service related trainings, and for future research are provided.Subscribe to TRJ

Exploring therapeutic applications for Google Earth VR

Virtual reality (VR) is a technology frequently used for both recreation and healthcare service delivery. Yet, little is known about the applicability and use of specific VR applications in recreational therapy (RT) practice. Google Earth VR is a popular application that allows users to virtually travel to different locations around the world. It could have relevance in patient-centered treatment that addresses a variety of RT treatment goals. Using a focus group of RTs (N = 8), this study examined possible uses of Google Earth VR in RT treatment. Following an education and training session providing an overview of VR equipment and the Google Earth VR application, participants engaged in clinical role play from both a therapist and client perspective. This was followed by a focus group discussion where therapists were asked to identify possible treatment uses for Google Earth VR with the clients they serve. Four main themes emerged, including reminiscing, community integration/leisure education, social skills development, and distraction/pain management. Findings indicate RTs view Google Earth VR as a resource with potential therapeutic applications for new and innovative treatment. The identified treatment focus areas also provide guidance for professional resource development and future research studies.

An Investigation Into the Use of Yoga in Recreational Therapy Practice

Yoga is used in health care with a variety of populations, but limited knowledge exists regarding the details of how yoga is implemented in recreational therapy (RT) practice. Therefore, the purpose of this study was to explore how yoga is implemented in RT practice. As part of a nation-wide survey and through the use of individual interviews, this secondary analysis investigated how yoga is being used in RT practice across the United States. Sixteen recreational therapists completed both a nation-wide online survey and semi-structured interviews. Quantitative results describe the populations in which yoga is being used in RT practice, as well as the characteristics of recreational therapists who also are employing yoga in their RT practice. Then, conventional and summative content analysis identified four categories related to yoga in RT practice: recreational therapists’ practices, treatment planning, outcomes, and yoga intervention. The findings revealed that yoga is implemented with a variety of populations as part of RT practice. Yoga should be implemented by recreational therapists who are trained to teach yoga or provide population-specific yoga sessions to meet specific patient needs. Limitations of the study and implications are discussed.

Patient-Reported Outcome Measures: A Resource for Recreational Therapists

To our knowledge, information on patient-reported outcomes (PROs) and patient-reported outcome measures (PROMs) has not appeared in the literature of recreational therapy. This article provides an introduction to PROs and PROMs so recreational therapists may understand them and see their possible applications within recreational therapy. In this article, PROs and PROMs are described. Specific examples of PROMs, and resources for accessing them are provided. Discussion on the value of PROs in the enhancement of client care, challenges to the use of PROMs, and the relevance of PROMS to recreational therapy practice and research follows. It is concluded that the use of PROMs is an emerging approach that recreational therapists need to explore.

Examining Attitude Change Following Participation in an International Adaptive Sports Training

Adaptive sports participation has been found to benefit participants physically, emotionally, cognitively, and psychologically. These sports may also serve as a vehicle to combat society’s negative attitudes toward individuals with disabilities. To further explore this possibility, the purpose of the present study was to examine the impact of an international adaptive sport training on Thai college student and professor attitudes toward individuals with physical disabilities. Twenty-one participants completed the Multidimensional Attitudes Scale toward Persons with Disabilities (MAS). A series of one-way RM ANOVAs and descriptive statistics were utilized to compare participant scores across time. Findings indicated that there were no significant changes in attitudes as measured by the MAS. Measurement and program design issues are considered. More work is needed to develop an appropriate tool to evaluate changing attitudes. Implications for research and recreational therapy practice are discussed.Subscribe to TRJ

Use of Evidence-Based Practices in Recreational Therapy for Schizophrenia Spectrum Disorder Recovery: A Descriptive Study of Current Practices

Schizophrenia spectrum disorder (SSD) represents a group of complex and chronic psychotic disorders affecting approximately 10.7% of the global population. Even though there is no cure for SSD, most symptoms can improve with active treatment. Effective interventions include pharmaceuticals and psychosocial treatments such as recreational therapy (RT). RT can provide effective and efficient care to individuals with SSD by grounding interventions in evidence-based practices indicated in the Mental Health Recovery Model (MHRM), as well as utilizing recommendations by the Schizophrenia Patient Outcome Research Team (PORT). A cross-sectional survey was used to identify awareness and utilization of MHRM principles and PORT recommendations in RT services for individuals with SSD. Data from 126 surveys completed by recreational therapists who currently or have previously provided treatment for individuals with SSD indicated discrepancies in awareness and utilization of MHRM principles and PORT recommendations. Implications for RT practice are discussed.Subscribe to TRJ

Exploring therapeutic applications for Google Earth VR

Virtual reality (VR) is a technology frequently used for both recreation and healthcare service delivery. Yet, little is known about the applicability and use of specific VR applications in recreational therapy (RT) practice. Google Earth VR is a popular application that allows users to virtually travel to different locations around the world. It could have relevance in patient-centered treatment that addresses a variety of RT treatment goals. Using a focus group of RTs (N = 8), this study examined possible uses of Google Earth VR in RT treatment. Following an education and training session providing an overview of VR equipment and the Google Earth VR application, participants engaged in clinical role play from both a therapist and client perspective. This was followed by a focus group discussion where therapists were asked to identify possible treatment uses for Google Earth VR with the clients they serve. Four main themes emerged, including reminiscing, community integration/leisure education, social skills development, and distraction/pain management. Findings indicate RTs view Google Earth VR as a resource with potential therapeutic applications for new and innovative treatment. The identified treatment focus areas also provide guidance for professional resource development and future research studies.

The Impact of a Sensory Garden for People with Dementia

The purpose of this study was to determine the impact of sensory garden interventions on agitation and quality of life for people with dementia. The sensory garden consisted of plants that stimulated all the senses. Four people diagnosed with dementia residing in assisted living participated in the multiple treatment single-subject design (A1-B-BC-A2) study. Baseline phase A1 lasted two weeks, intervention B and BC were four weeks each, and return to baseline A2 was two weeks, for a total of 12 weeks. Intervention B was an indoor sensory garden, and intervention BC was an approximated outside sensory garden. The Agitated Behavior Mapping Instrument, Cohen-Mansfield Agitation Inventory, and Dementia Quality of Life-Proxy were used to collect data. Data revealed positive trends following the sensory garden interventions on decreasing agitation and improving quality of life. Intervention B worked best for two participants and intervention BC for the remaining two participants. Applications to recreational therapy practice are provided. Subscribe to TRJ

Changes in Family Leisure Functioning Following a Family Camp for Children with Autism Spectrum Disorder (ASD)

The purpose of this study was to examine the immediate and long-term effect of participation in a family camp designed specifically for families with a child with ASD. The variables studied were family recreation, family recreation satisfaction, family communication, satisfaction with family function, and satisfaction with family life, as reported by the parents. Findings indicated changes in family functioning, family communication, satisfaction with family function, and satisfaction with family life. The trend analyses indicated the parents reported a general increase in satisfaction with their family function and family life, and a statistically significant increase was observed in satisfaction with family life (p = .045). These findings partially support previous research demonstrating that increased parental involvement has a positive effect on parental and family well-being for families with a child with ASD. Implications for recreational therapy practice in providing interventions for families with a child with ASD and future research are discussed. Subscribe to TRJ

ATRA COMPETENCY STUDY: PROMOTING DEVELOPMENT OF RECREATIONAL THERAPISTS SERVING OLDER ADULTS

Competency concerns the knowledge, skills, and abilities needed to perform specific job tasks. In the field of recreational therapy (RT), four documents from the certification (NCTRC), accreditation (CARTE), and professional association (ATRA) broadly identify areas of competency for RTs. While broad competencies are defined, no specific competencies (i.e., diagnoses, assessments, interventions, theories) are identified. Sixty-seven RT experts, including 10 verified older adult experts with greater than five years experience and peer-reviewed publications, participated in three rounds of a Delphi study to gain content consensus. After experts in each setting identified key terms in the first round, experts reviewed the consolidated list twice to generate the final competency list. Next, all certified recreational therapists were invited to rate the extent that each competency item is being used in RT practice; the extent of their knowledge/skill for each item; and the degree of interest in gaining more knowledge/skill. A total of 1377 recreational therapists participated in the study (88% females, 11% male, 1% non-disclosed) with participants ranging in age from 20-60+ years of age. The study’s findings related to specific diagnostic populations served; interventions/modalities, techniques, standardized assessment tools, and theories utilized; education, training, and counseling topics in treatment; and on-the-horizon treatment and issues. This comprehensive two-part multi-year study is the first to explore current RT practice at a micro-competency level. In the effort to improve practice, these specific competencies necessary for RT practice with older adults are significant to both educators and practitioners in future curriculum and professional development efforts.

Bibliotherapy as a recreational therapy intervention in pediatric oncology

Objective: To examine the literature, facilitate understanding of the intervention and contribute to the evidence-based practice on the use of bibliotherapy with children who have cancer to facilitate coping skills for anxiety.Methods: A literature review was conducted to examine the practice of bibliotherapy when used with children who have cancer and implications for recreational therapy practice were developed.Results: While the research on bibliotherapy is limited in recreational therapy literature, there is evidence that it can reduce anxiety and facilitate coping skills for children living with cancer.