RECTH 4320

Recreational Therapy Assessment of an Individual with a Physical Disability

Identifying Data
Name (use alias for confidentiality) OP
Age 45
Gender Male
Date of Admission to Facility/Program Oct 26th, 2021
Primary Diagnosis T5 Spinal Cord Complete Injury
(The dx/s that caused the admission or referral of the client)
Secondary Diagnoses none
(Other dx/s that are still active – the person is still experiencing – that are
not the primary reason for admission/referral of the client)
Past medical history n/a
(Other dx/s that the client had in the past that are no longer active)
Precautions Spinal Precautions
Diet High fiber, lots of fluid, eats healthy.
Medications Tramadol (at night to treat pain)
Education (highest level achieved) Has a degree from Oklahoma State in Adaptive Leisure Recreation.
City & state of residence; characteristics of home & living situation Born and raised in Puerto Rico, currently lives in Bountiful, Utah
Employment status & occupation Joined the U.S Army at 18, now works for Salt Lake County Adaptive
Social roles/social support Family is very supportive, as well as teammates and others from adaptive
recreation communities that cl. participates in play a big role in social
support. His fiancee, her daughter, and his three adult children also socially
support him.
Religious and cultural values Believes in God and believes in “being wholesome”, but doesn’t adhere to a
specific religion or attend church.
Life habits Spending time with family, working, very active leisure life
Client goals (What does he/she hope to accomplish?) Wants to make the 2022 Beijing Paralympics for the GS and Super-G skiing
events, and is only 100 points away from doing so. He wants to potentially be
able to meet this goal within two races.
Reasons for admission The reason the client is at this facility is for community reintegration and
(What is the main reason the person is at your particular facility or leisure participation opportunities.
participating in this program; e.g., respite, decreased independence in
functioning, rehabilitation)
Reason for referral to RT
(Reason for referral will vary by setting/program, please be sure to talk with
your supervisor to find out the specific reason for RT treatment/services;
what is hoped to be accomplished through Rec Therapy services at this
facility/program?)
The reason for referral to RT is because the client has shown continued
interest in adaptive sports and leisure. Another reason for RT treatment
services is to be able to continue to increase/maintain physical functioning
levels, explore leisure interests and gain leisure education, and develop social
relationships.

Functional Skills Assessment

Using the facility RT assessment tool, secondary sources (e.g. chart, family, staff, etc.), and/or a standardized RT assessment tool, conduct a functional skills
assessment of your client and list your assessment findings in the chart below. This section should be reflective of skills of a 2nd year RT Student.

Assessment Methods Assessment Domains Assessment Findings Interpretation of Findings

Instructions: What assessment
tool/source/method did you utilize
(e.g., medical chart review,
observation within activity,
discussion with a specific team
member/team/physician, client or
family interview, standardized
assessment tool, etc)? What
specifically did you look for/do?
Why did you do this (how does it
relate to the client’s diagnoses)?
The source of the assessment that I
used was observation and
self-report via a recorded client
interview. During the interview, I
was looking for responses that came
Do not write anything in this
column.
Note: While all domains are
important, since this course
focuses on clients with physical
disabilities, be certain you have
comprehensively assessed physical
functioning.
Physical functioning
Instructions: Report measureable
assessment findings. After each
finding, indicate the source where you
obtained the information using the
below codes: (e.g. Hard of Hearing
–O,MC; Loneliness – SR; R
Hemiparesis – O, MC, P)
O Observation
M Medical Chart
C *Pay careful attention to when it is
T Standardized Assessment Tool
(administered by you)
P Pt hx (anything told you to by
the family, other team
members, etc.)
SR Self Report (items told you to
you by the client)
SR- Muscle Spasms, W/C ambulation,
pain, paraplegia/reduced mobility
below t5, muscular spasticity. O,SR -
frozen shoulders
Instructions: After reviewing your
assessment findings, what
preliminary conclusions can you draw
from the assessment data? How do
you foresee the client’s
strengths/weaknesses impacting
his/her recreation/leisure
engagement, health, and quality of
life (RT scope of practice)?
appropriate to use absolute (e.g.,
will) verses flexible (e.g., could,
might, may) terms.
Client’s physical functioning levels
would impact health and leisure by
potentially limiting their access to
certain leisure activities and
up more than once, as that told me
what was most important to the
client, and during the interview, I
only took brief notes so as to get the
most information from the
interview, and practice being
engaged. The reason I did this was
because I think this is important
with any client and population.
I noticed that the interviewer made
an effort to make the interview flow,
so if the conversation went one
direction, but she still had more
questions about physical
functioning, that was something
that she came back to later. I feel
that this is important because it is
important to not always make an
assessment feel like a test, or an
interview, that can be really
intimidating for a client. This
technique made it more like a
conversation, and while this
situation was unique because it was
Cognitive functioning
Speech/language/communication
functioning
Psychological/emotional
functioning
Sensory functioning
O,SR - high level cognitive functioning
SR- sometimes has difficulty sleeping
due to pain
O,SR - high level communication, does
not experience difficulty with speech
and language
O,SR- healthy emotional functioning,
high levels of confidence with his
ability levels have developed over
time, likes being an advocate and
mentor.
SR - limited sensation below T5, no
issues with vision, hearing, etc.
preventing participation due to pain
or reduced mobility/spasticity.
Lack of sleep would have a negative
impact on quality of life and ability to
engage in leisure. Cl.’s high cognitive
functioning positively impacts those
factors.
Cl.’s
communication/speech/language is a
strength. They enjoy being an
advocate and communicating with
others, and this improves their
quality of life. Interacting with others
is an important part of their leisure
functioning.
Psychological/emotional functioning
positively impacts recreation because
high levels of confidence have
encouraged him to pursue any
activities he was interested in.
Limited sensation impacts leisure
functioning because it limits mobility,
however, the client does not see that
as a reduction to opportunity
because he finds ways to adapt
for a class assignment and the client
understood that, I think it can still be
applied.
Identify leisure interests and activity patterns for your client. Each activity should be coded as a current, past and/or future interest.
Social functioning
Self-care functioning
Play/leisure/recreation/communit
y functioning
Leisure Lifestyle Review
Add additional rows if needed.
O,SR- high level social functioning,
large support system. Wants to
connect with more individuals who
are veterans with injuries.
O,SR- is able to independently
function for most tasks and take care
of self, shows understanding of
importance of meeting individual
health needs in all categories
O,SR- very involved in the community,
has many leisure interests and
participates in a variety of leisure
activities, has a fairly active leisure
lifestyle
around it, or advocates for the need
to be accessible.
Supports leisure engagement. Cl.
engages in leisure because he likes
engaging with people, and vice versa.
High social functioning increases his
quality of life because it has helped
him to reintegrate back into the
community quickly and well.
Relates to psychological functioning,
is very confident in ability to self
care. Cl. positively impacts quality of
life by meeting self care needs and
going beyond to meet the needs of
others through mentoring,
community work, and advocacy.
This very positively impacts the
client’s quality of life, he is very
passionate about leisure and
recreation and his community. This
engagement in leisure increases his
overall health and well-being in a
variety of different ways.
Current (C), Activity How often With who Where Other Notations (possible information to include):
Past (P), & 1) Provide other specific notations about the activity that does
Future (F) not fit in the previous columns.
interests 2) Explain the barriers (or foreseeable barriers/challenges) to
performing the activity.
*List in this 3) Explain the facilitators that could enhance the client’s ability to
order participate in the activity.
4) Explain any reasons to be concerned about the activity (e.g.,
unhealthy, could cause harm to self or others).
5) Explain reasons (if known) about why past activities are not
being done any more.
6) Explain motivation for participating in this activity.
CPF Soccer Daily after Used to play School, parks, Has always been a big interest of the client. Unclear if the client
school with community plays an official adapted version of soccer, but enjoys playing in a
when he classmates spaces, home. variety of ways with many different people. Enjoys both playing
was and friends, and watching because it connects him with people, he enjoys the
younger, now sport, and likes some competitiveness.
Weekly now sometimes
plays with
friends, more
often plays
with family,
especially his
nephews.
CPF Skiing 5x a week in NAC NAC/Utah, Has a great support system with the NAC that has helped him
the winter, Colorado train for the upcoming Paralympic events he wants to participate
occasional in, he has been skiing for years and plans to continue.
camps
throughout
the year
CP Wheelchair 5x a week Puerto Rico Paralympic Played with the Paralympic team from 1999-2017. Cl. states that
Basketball for years Paralympic practice in 2015 he knew he only had a couple more years of basketball
with Team/With spaces/comm left, felt like he just wasn’t as athletic or as competitive in the
paralympic Friends and unity spaces sport and now just plays recreationally with friends or in the
team and community community.
now members
occasionally
with friends
CF Adaptive/Accessible Occasionally Alone/with Outdoor Would like to do this more, and while there are some spaces in
Trails/Hiking , weekly, Fiancee and spaces in the Utah that are more accessible, there really aren’t many. Wants to
monthly, her daughter surrounding be able to explore more spaces, see new things. Client has a
depending area strong desire to do this and has potentially put himself at risk in
on weather, the past attempting to crawl along a trail that was inaccessible.
etc.
C Yoga/Stretching Daily (at Alone or At home Client has found that this helps to prevent/reduce pain, especially
night, with fiancee in the shoulder. Fiancee alse really enjoys these leisure activities
sometimes
in the
morning
too)
C Pilates Daily/Weekl Alone or At home Client has found that this helps to prevent/reduce pain, especially
y with fiancee in the shoulder.

Major Concerns

Given your assessment findings, what are three priorities for
treatment/service? List one overarching area in each box.
Make sure at least one of these relates to physical functioning.
Reduce pain, especially in the shoulder, and muscle spasticity.
Further deepen psychological functioning by focusing on individual
reflection and self-awareness.
Find new opportunities to create meaningful social relationships.
Why is this a priority? Explain how it relates to participation in healthy
leisure activities (especially those that are meaningful to the client), as
well as how it relates to health promotion, rehabilitation, and/or quality
of life.
This impacts the clients everyday functioning and functional
independence, and reduces their overall quality of life. It prevents them
from full participation in their preferred leisure activities.
This is a priority for service because it promotes healthy individual
participation in leisure. It would increase quality of life by providing
opportunities to be more fully present, be able to better process
emotions, and better co-manage internal and external stimuli.
Social relationships hold a lot of importance to this individual, and are
crucial in creating a healthy leisure lifestyle. This promotes health and
rehabilitation through a form of reintegration/connection and through
building self-esteem and self-efficacy, and promoting leadership,
mentorship, and group identity.
 RECTH 4320
Evidence Based Recreational Therapy Treatment Plan

Instructions
● Client Requirements: This treatment plan must be developed for the individual you assessed in assessment portion of this assignment.
● Select one of the major concerns identified in the RT Assessment and write a treatment plan for your client with one goal (related to the
identified concern), and one corresponding objective.
● Connect your plan to evidence-based practice. Evidence-based practice (EBP) refers to the integration of the best available research, the
knowledge and experience of the practitioner, and the characteristics and preferences of the client. RT practitioners are encouraged to
use evidence from research studies to plan their treatment and goals/ objectives for clients. This promotes consistency and
accountability within the profession. As a relatively young research profession, we often need to rely on research generated by other
disciplines about similar modalities and populations. This is acceptable as long as we are able to adapt the practice in a way that results
in positive outcomes for our clients.
● Search the literature to find an article from a professional journal within the last ten years (2010 – 2020) to support your plan. The
article must relate to your interventions/activities and treatment outcomes (e.g., the use of physical activity – intervention – to address
endurance – treatment outcome), and recommended techniques related to implementing the intervention/activities (e.g. adaptive
equipment, group based physical activity that offers peer support and motivation). The population and setting in the article should be
either the same or similar to your setting and client served. The article selected must be an intervention study (not a review article). You
will need to attach a copy of the complete article with your assignment submission.
● Keep the content of your article in mind when writing your treatment plan. It is important that your plan is informed by evidence in the
planning process, as opposed to referencing an article conveniently afterwards. Therefore, you will most likely need to complete sections
of the attached form in a different order than items are listed.
● See the big picture. Be sure to consider the client’s diagnoses (abilities, challenges, course of the disease/illness), personal and structural
facilitators and barriers that could impact your treatment plan.
● Make it realistic. The plan you are proposing should be realistic for the individual and the setting where they are currently accessing
services. Complete this assignment as if you were a recreational therapist employed by the agency/program where you are completing
your clinical experience.
● Remove red text. The text noted in red is intended to guide you in completing the form. It should be deleted, however, and all red text
should be removed once you provide the specific information and details for your client.

GOAL #1 (broad):
Client will increase levels of mindfulness and contentment
Objective for Goal #1
Condition: After two rec
therapy sessions,
Behavior: demonstrate
enhanced mindfulness by
indicating decreased scores
Criteria: 3 of 5 of the items on
Brown & Ryan’s scale
Full objective:
After two recreational therapy
sessions, client will
demonstrate enhanced
mindfulness by indicating
decreased scores (indicating
higher levels of mindfulness)
on 3 of 5 of the items on
Brown & Ryan’s scale.
RT Treatment Plan
List an intervention/activity that you
could use to address the objective.
Explain your clinical reasoning for
choosing each (provide a STRONG
justification, possibly reference your EBP
article).
Intervention/Activity:
Adaptive scuba diving could be used to
address this objective.
Clinical Reasoning:
A study done by Blumhorst et al. (2020),
suggests that scuba diving has very
similar psychological benefits to
mindfulness. Many find that the
breathing techniques required bring a
sense of peace and calm, and decrease
the feelings of stress. Some divers find
that the environment forces them to
“surrender their urge to control their
movement and environment” which
results in a state of mindfulness by the
acceptance of a state where one can
List the treatment structure that would be How will you
best to address the objective and explain your evaluate/measure the
clinical reasoning for choosing the specific client’s progress toward the
treatment structure (1:1, 2:1, small group, objective?
large group). Remember, variation is good.
Ideally not all interventions will be Are there any other
implemented in the same structure. outcomes that could be
addressed and measured
Describe the technique/s you will use in your within the proposed
treatment sessions to address the objective interventions? If yes,
and explain HOW you are going to apply the explain. For example, does
technique/s to address the objective. What are the client have needs or
YOU going to do (specifically) within the deficits in other areas that
treatment sessions to help the client progress could also be addressed and
in meeting the objective (educate, prompt, measured within the
cue, encourage, reinforce, etc.)? proposed interventions?
How? Explain.
Tx structure: Explain Evaluation/Measurement:
The treatment structure that would be best to Explain
address the objective would be a small group. By using mindfulness
A small group would allow for socialization measurement scales such as
when one is not on a dive, discussion about Brown and Ryan’s, or
the diving experience, and social connection Taylor’s contentment scale.
with others who are also participating in this These were the ones used in
leisure activity. the study.
Technique/s: Explain Other Outcomes
Some techniques that I would use would be Addressed/Measured:
education on mindfulness, and what it is. I Explain
would also explain some techniques for Scuba also has physiological
mindfulness such as body scanning or mindful benefits that could address
breathing, which are techniques that could be needs that the client has.
used in everyday life, as well as during dive The feeling of being in the
sessions, or immediately before or after. I water provides a unique

During a 1 on 1recreational
therapy session, client will be
able to define and
demonstrate two different
mindfulness techniques, as
observed by the recreational
therapist.
accept both internal and external would encourage use of mindfulness sense of freedom and can
stimuli. techniques outside of scuba, and reinforce the be a way to provide feelings
importance of mindfulness by sharing how it of bodily control. For some,
can help us regulate, stay in tune with our it can also increase
body and emotions, and help us to deepen our sensitivity to light touch and
relationship with ourselves, our bodies, and decrease muscle spasticity.
our confidence. (Blumhorst et al., 2020). A
group setting with a scuba
diving intervention could
also have social outcomes. It
could provide a sense of
community and belonging
for an individual, and
promote self-esteem and
connection.

Evidence Based Practice Related to RT Treatment Plan

List article in APA format
(http://apastyle.org/)
*Remember to attach a copy of your full article.
What is the connection between the article and your client’s goal
and/or objective?
Describe how you would implement the intervention/activity in
relation to how it is described in the article. If you are making
changes, explain.
Blumhorst, E., Kono, S., & Cave, J. (2020). An Exploratory Study of Adaptive
Scuba Diving's Effects on Psychological Well-Being among Military Veterans. Therapeutic
Recreation Journal, 54(2), 173-188. http://dx.doi.org/10.18666/TRJ-2020-V54-I2-9954
There is a connection between the article and my client’s goal and objective because
each of them directly relate to mindfulness. The article studied how scuba diving
affected psychological well-being, and one of the main effects that it had was that the
state of the participants after a dive was very similar to a mindfulness state. The client's
goal is to be able to achieve a higher level of mindfulness, and one way to do that might
be to scuba dive, and then to incorporate mindfulness techniques into scuba diving.
I would implement the intervention similarly to the way it was described in the article.
However, the article mainly mentioned how they were simply measuring the effects of
scuba diving, but I would like to also implement some mindfulness practices into
sessions as well. This could mean practicing body scanning during a dive, or making the
connection between mindful breathing and the breathing techniques that must already
be done while diving. I might also choose to instead teach mindfulness techniques after
the dive, to further deepen that mindfulness state.
Describe the population referenced in the article (e.g.,
community-based adults with spinal cord injury, children with
cerebral palsy, veterans with amputations). If it is not the same as
your client’s, explain your reasoning for thinking it is still
appropriate.
Describe the service environment referenced in the article (e.g.,
adapted sports camp, inpatient physical rehab hospital, skilled
nursing facility, community wellness center). If it is not the same
as your client’s, explain your reasoning for thinking it is still
appropriate.
Describe the effectiveness (outcomes) the article reports related
to the identified intervention/activity/technique specifically with
the target population.
How is the effectiveness that is reported in the article useful or
relevant to your situation (your treatment of this specific client)?
In your own words, how would you answer if another
professional, an insurance company, a client and/or a family
member asked you to explain (justify) why you chose to address
the needs of your client with this specific
intervention/activity/technique? Be sure to reference the
research article in your response, citing how the research article
directs or supports your point of view.
Veterans with physical impairments (e.g. spinal cord injuries) and mental health issues
(e.g. post traumatic stress disorder). This is the same population as my client.
The service environment was a community based organization (non-profit). I would
likely also utilize a service environment similar to this one, as it would best meet the
format for this type of group and the needs for instructors and certifications.
This article found that mindfulness levels were significantly higher post-dive than they
were pre-dive for the entire sample, which shows that participation in scuba diving has
a positive effect on mindfulness for veterans with physical impairments and/or mental
health issues. Scuba diving is effective at enhancing mindfulness.
This effectiveness is useful/relevant because it provides evidence that this treatment
plan is evidence based practice. It also informs the decisions that are made in the
implementation of a program based on this study, following the recommendations of
the authors.
The reason that this intervention was selected to address the needs of the client was
because it is an intervention that has evidence to show benefits in social, psychological,
and physical/physiological areas that are relevant to this individual. Mindfulness is
something that this individual could benefit from due to the components of individual
reflection and self-awareness. They already have a high level of psychological
functioning, but this is one way to take it a step deeper and provide them an
opportunity to learn mindfulness practices which can decrease stress reactivity, increase
active coping skills, and increase relaxation. (Blumhorst et al., 2020) In addition to the
psychological benefits, it has also been reported that for some individuals with spinal
cord injuries, muscle spasticity can decrease by 15% while diving, and the sensation of
diving provides a unique experience for those who have decrease bodily freedom due to
their injury. (Blumhorst et al., 2020) The client is also interested in a variety of leisure
activities that involve sports, the outdoors, and exercise, and this activity is a good fit as
it is a similar interest but one that is trying something new and different, and stepping
out of the comfort zone a little bit.