Approaches in Therapeutic Recreation: A case study
At Sensation Station our therapists work in a multi-disciplinary setting that offer various therapy approaches including DIR floortime and Original Play. This multidisciplinary environment also supports internal referrals from one therapy discipline to another. This blog will provide information about four types of therapy approaches via a case study.
This is a story about a little girl who transitioned from pre-school to primary, we call her Lilly (not her real name). Due to a mild to moderate speech delay, Lilly’s parents signed her up for Speech-Language Therapy. When Lilly first started with Speech-Language Therapy she presented with anxiety, fearful reactions to both familiar and new people, controlling behaviours, social difficulties, and an inability to engage.
The Speech-Language Therapist found it appropriate to refer her internally to another discipline, Therapeutic Recreation, as further progress was deterred by some of her social, behavioural, and emotional issues. The Therapeutic Recreation Specialist (TRS) devised an action plan to focus on these issues.
Lilly’s span of attention during social interaction and Original Play was one minute. Eye contact and ability to engage in activities requiring joint attention was minimal. During her first sessions, Lilly was resistant to changes in routine and was unable to listen to an age appropriate story to the end. Lilly’s reaction to anyone asking her a question, giving her a task/placing demands, or greeting her was to start screaming and running-away.
Lilly was unable to verbally express and identify her feelings in an appropriate manner. She usually reacted fearfully when her name was called by a person she is not comfortable with. Her anxiety/fear had spilled over to her behaviour. Lilly often reacted fearfully when the slightest demands were placed on her in order to avoid tasks. Lilly did not respond well to psychiatric input/recommendations.
Therapeutic Recreation, which combined the following:
Original Play (OP)
Original Play involves the adult interacting with the child, in a soft room clear of distractions. The adult’s focus is to facilitate opportunities for the child to feel safe, validated, and engaged by presenting themselves as an inviting play-mate/communication partner. OP is ideal for modeling appropriate touch, deconditioning inappropriate behaviors, building trust, and creating the foundational base essential for more complex social interaction. Original Play is a technique developed by Dr. Fred Donaldson.
Social Stories (SS)
These are stories that tackle the challenges the child struggles with and are usually followed up by role play, drawing (artistic expression), musical or vocal expression and problem solving reflections.
Emotional Self-regulation Skills (ESS)
These are skills the therapist models through specific exercises that teach: identification of emotions, rating their intensity, getting to know what triggers them in our environment, and practicing actions that will help their regulation and appropriate expression. ESS may include brain gym and Tai Chi exercises.
Parental Guidance (PG)
This is when a portion of the sessions are dedicated to assisting parents adopt a more holistic approach/plan that can include the whole family and be transferrable to the home environment. Since this therapy is a dynamic process that changes as the child progresses, a PG session is recommended every block of 8 sessions or when the need arises.
The Outcomes for Lilly
Following two blocks of eight sessions Lilly demonstrated improved attendance in both Original Play and listening to social stories. The duration Lilly is able to participate in Original Play has increased to 7 minutes. Her fearful reactions and behaviors reduced in intensity and frequency around others. Her ability to socially engage with and respond has improved with familiar people who used to elicit anxiety/fear (without reason) such as other therapists, teachers, and children.
Lilly continues to develop skills in identifying/expressing her emotions, rating stress or comfort levels certain people/things/places elicit in her, and utilizing self-calming emotional regulation techniques.
Lilly’s parents have changed their approach and are providing her with more consistent/clear feedback, clarifying boundaries, and adopting more constructive parental attitudes. Lilly’s social responses have become more appropriate for her age. For example, the therapist can now assign Lilly a task and she is able to choose to participate or decline participation calmly.
At Sensation Station we try to reach-out and help as many families as possible within a holistic approach and a multidisciplinary setting.
Therapeutic Recreation, also known as Recreation Therapy, is a goal-orientated, holistic approach that focuses on the social, behavioural and emotional development of an individual child, practiced in Canada and the USA; and now for the first time available here in the United Arab Emirates. As a holistic approach, Recreational Therapy looks at developing not only the individual child but also the external environment, working with family members and any significant others, to assist the development of the necessary skills, knowledge and behaviours for everyday living and community interaction.
Therapeutic recreation incorporates sensory art, music and movement, including for example elements of martial arts, Thai-chi for children and Brain Gym. In its goal orientated nature, recreational therapy focuses on the interests, abilities and achievements of the child to create a meaningful and child-led therapy that builds the psycho-social foundations for a full and integrated life. The achievement of goals through each individualized scheme aims to create an independent, safe and nurturing environment maintained with and without the help of a therapist, creating a responsible, able and creative young adult ready to take on the challenges that they may face.
Rawan Al Husseini
BSc.TR, and Therapeutic Recreation Coordinator at Sensation Station