More Than Just Fun and Games: Recreational Therapy for Children with Disabling Conditions

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By Laurie Jake, CTRS

At first glance it can be deceiving: two people splashing in the pool, the sound of laughter echoing across the water. From the eyes of the child with a disability, this happy scene is far from the daily struggles of therapy. From the perspective of the recreational therapist, however, this session has been very successful as she makes a mental note of the improvement in sitting balance and upper extremity range of motion that the child demonstrated today in the pool. And it was fun.

Recreational therapy is defined by the American Therapeutic Recreation Association (ATRA) as "a health care and human service discipline that delivers treatment services designed to restore, remediate and/or rehabilitate functional capabilities for persons with injuries, chronic illnesses and all types of disabling conditions." Recreational therapy is provided by certified therapeutic recreation specialists (CTRS), usually referred to as recreational therapists. Qualified professionals are certified through the National Council for Therapeutic Recreation Certification (NCTRC), which requires a bachelors degree or higher from an accredited university, a formal internship and the passing of a national certification examination. In addition, a CTRS must also maintain their certification through on-going continuing education activities.

Although recreational therapists may work with a wide range of clinical service areas, they play a very important role in the rehabilitation of children with disabling conditions. According to ATRA, interventions within recreational therapy's scope of practice in pediatric setting may include individualized bedside play or small group activity; physical play focused on restoration or maintenance of functioning; educational play focused on understanding and mastery of upcoming surgical procedures; dramatic or expressive play focused upon coping with fear and anxiety; and family and/or sibling play.

The unique feature of recreational therapy, that makes it different from other therapies, is the use of recreation activities as the mode of treatment. Although many of the treatment goals that a recreational therapist may work towards are similar to other disciplines on the rehabilitation team, the way a recreational therapist achieves those goals are what distinguish this unique service. In addition, the recreational therapist has a unique perspective regarding the leisure, social, cognitive and physical needs of the patient.

Recreational therapists work with children in a wide range of treatment settings including: community hospitals, children's hospitals, community based programs (i.e., Easter Seals), rehabilitation facilities and schools. Recreational therapists may work with a child on one or more of the following functional areas:

• Physical functioning - mobility, gross motor skills, fine motor skills, etc.
• Cognitive functioning - memory, attention span, problem solving, etc.
• Emotional functioning - self-esteem, confidence, coping skills
• Social functioning - communication, social interaction, etc.
• Pain management
• Developmental play skills/ leisure interests and abilities
• Medical preparedness
• Community Reintegration

A recreational therapist may use a wide range of intervention techniques to meet the needs of each child. After completing a comprehensive assessment, the recreational therapist identifies appropriate treatment goals. Examples of interventions used by a recreational therapist might include: leisure skill building, adaptive sports, aquatic therapy, therapeutic art, animal assisted therapy, sensory stimulation, medical play, community reintegration outings, and others.

As a parent, concern for your child's well being is of utmost importance, and you are interested in ensuring that your child receives the best care possible. If the facility where you take your child for treatment offers recreational therapy services, request to your doctor or treatment team that your child be evaluated for recreational therapy services. The recreational therapist will then complete a comprehensive assessment and provide recommendations for additional services if needed. If the facility your child goes to does not offer recreational therapy, don't be afraid to ask for it. As a consumer of health care, you have a right to express your opinion regarding the medical care of your child. This also applies to community and school settings. Recreation is specifically indicated as a Related Service under the Individuals with Disabilities Education Act (I.D.E.A.). Certified therapeutic recreation specialists are recognized in the regulations of I.D.E.A. as the professionals qualified to provide recreation as a related service.

In the pursuit of care for your child, it is helpful for a parent to understand as much as possible about the healthcare team. Each member of the team contributes an important part of the treatment services necessary to help your child achieve goals and maintain the highest level of functioning. Parents can look to recreational therapists to provide treatment interventions that are cost effective and meet the needs of their child. Recreational therapy services are an integral part of the rehabilitation of children with disabling conditions.

For more information about recreational therapy, please visit the ATRA website at http://www.atra-tr.org.