Foundational Knowledge Flashcards

Question

Activity Therapy Model

Answer 1

Similar to medical model. TR is prescribed but is a blurring of different departments (music therapy, art therapy, occupational therapy, dance therapy). Uses things the resident enjoys to prevent boredom and frustration.

Answer 2

Addresses the environment, what has to change in the environment: Looks at individual needs & environmental needs. The people around you: Community/family. Changes can occur encompassing both the promotion of abilities & the elimination of individual barriers.

Answer 3

A treatment approach that utilizes problems solving to work with clients and their problems within the context of the environment.

Answer 4

made up of 2 or more people whose reactions and behavior patterns are modified because of some interpersonal relationship developed over time and created during the pursuit of some common interest, utilizing this entity to achieve satisfaction of needs. Group is composed of 2+ persons who come together with a similar interest, it is not coincidental that they are there together for a purpose/goal. There are many times of groups, they not only can vary in their aims but also in the: number of people who compose their membership, longevity (length group stays together), efforts, level of formalization, structure and significance to their members. •Groups provide opportunities for interactions among clients, and recreation therapists use these interactions to facilitate therapeutic outcomes. •As a therapeutic recreation specialist, you are expected to be able to place clients in the most appropriate intervention group based on their needs and abilities.

Answer 5

size, format (closed or open groups), type of clients in a group and duration of the group (is it ongoing or does it cease functioning after so many meetings?).

Answer 6

1) Primary- Characterized by the feeling of: personal involvement (family, friends, schoolmates), intimate face to face association and cooperation and the fact that they are fundamental in the forming of the social nature and ideals of the individual. 2) Secondary- can be divided into 2 categories: Informal and Formal. Informal- usually leaderless, no defined hierarchy, the longer the group exists the more chance that a leadership hierarchy will be formed. Formal- brought together for a specific purpose/goal, has defined hierarchy with clearly defined leadership, rules and rituals.

Answer 7

1) opening of the session 2) body of the session 3) closing of the session. In the opening of the group session, the therapeutic recreation specialist helps the clients relax and get to know each other. The CTRS also lets the group members know what is going to occur during the session as far as the activity is concerned. The body is the focus of the group’s session. Whether it is a game, arts and crafts project, leisure awareness activity or experiential activity, it is up to the CTRS to be prepared with the activity ready to go. CTRS needs to keep in mind the outcomes of the activity and then facilitate so the purpose and goals are attained. At the end of the activity it is important to process the activity. Processing involves taking with the clients about what they think, how they feel, and anything else that relates to the behavior displayed during the activity. Processing is a very important part of the session because it focuses on what just happened and can help the client generalize his/her behavior into other aspects of his/her life. In order to be able to process effectively, the CTRS needs to be able to do the following: FOCUS, REDIRECT, BLOCK, LINK & SUMMARIZE. CTRS needs to be able to summarize and effectively bring closure to the session.

Answer 8

1) orientation: insecurity, reliance on the leader, needs help to “break the ice.” 2) conflict: as people reveal themselves, values may clash 3) cohesion resolve conflict, develop sensitivity 4) performance or productivity: group members become functional & devote themselves to achieving individual and group goals. Group development- Occurs in four stages: Mutual acceptance, Communication and decision making, motivation and productivity, and control and organization., forming, storming, norming, performing, adjourning.

Answer 9

1) group building & maintenance: (social-emotive functions) tone setting, harmonizing, tension reducing, promoting group development 2) task functions: promote the work or task of the group. Activities that help group members to achieve their goals. (coordinating, testing, initiating) 3) Negative Roles: Non-functional behavior activities which interfere with the processes of the group: blocking, dominating, withdrawing etc. The shared expectations group members have regarding each individual's communication behavior in the group and behaviors or duties each member is expected to fulfill; Each member may perform a different role; Roles maybe determined by one's position within the group of their place of leadership. May be determined by specialization or expertise.

Answer 10

Can be looked upon as a parent figure or be placed in the role of enabler, teacher or coordinator. Leader is responsible for: guidance and coordination, group morale, stimulating achievements and productivity and decision making.

Answer 11

1) Size- as the size of the group increases the demands on the leader increases, as there are greater differentiated interests and needs of the group members, smaller groups want consideration from the leader to be recognized. 2) Attitudes of Members- members expectations often determines choice of leader, previous systems, experiences and values affect attitudes.

Answer 12

Syntality factors are characteristics/ traits that make up a group. 14 Factors: 1) Autonomy- degree to which a group function independently of other groups. 2) Control- degree to which a group regulates the behavior of individuals while they are functioning as group members. 3) Flexibility- degree to which a groups activities are marked by informal procedures rather than by adherence to established procedures. 4) Hedonic Tone- degree to which a group membership is accompanied by a general feeling of pleasantness or agreeableness (laughing/fun); this is the major reason people join groups 5) Homogenity- degree to which members of a group are similar with respect to socially relevant characteristics; relative uniformity of members- age, sex, race, etc. 6) Intimacy- degree to which members of a group are mutually acquainted with each other and are familiar with the most personal details of one anothers’ lives. 7) Participation- degree to which members of a group apply time and effort to group activities. 8) Permeability- degree to which a group permits ready access to membership 9) Polarization- degree to which a group is oriented and works toward a single goal which is clear and specific to all members 10) Potency- degree to which a group has primary significance for its members 11) Size- number of members in group 12) Stability- degree to which a group persists over a period of time with essentially the same characteristics, rate of membership turnover 13) Stratification- degree to which a group orders its members into status hierachies14) Viscidity- degree to which members of a group function as a unit, there is no dissention and conflict, no cliques, makes members feel important and want to continue w/ group; this is the number 1 reason people join and remain with groups.

Answer 13

Programmer- functional level. Direct Service: face to face, direct work with clients; Supervisory: Middle management level, facilitate agency service; Administrative. Executive, major focus on planning and development or policy making level.

Answer 14

Autocratic: authoritarian, directive style, close supervision, responsibility with leader, appropriate for groups of people with psychiatric problems, MR/DD, confusion, etc. Democratic: participative, involves group decision making & ideas, Use with participants not needing direction but, able or needing to make choices, develop decision making skills, self esteem, self confidence. Laissez-faire: minimal control of leader, open style, permissive, participants make decisions. Useful for group problem solving, team building, and leader does not exercise authority. Administrative leadership- (Executive Leadership) Responsible for budgeting, organizing, maintaining structure, and having a vision. Ex. Agency Director, Presidents, VP's. Demagogue- rules by fear. Dictator- Hitler. Head- power imposed position.

Answer 15

Problem solvers, guides, enablers, authority figures, significant others, have voluntary followers and they do not use. Group leaders need to be enthusiastic and be able to act as a link between the individual group members and the group. Not only do therapeutic recreation specialists need to be able to lead specific activities but they also need to watch members for any potential problems, help with necessary activity adaptations and engage the patient/client in discussions.

Answer 16

charisma, empathy, consistent/reliable, enthusiasm, self-confident, competent (has knowledge and skills to move towards task/goal and rapport.

Answer 17

Describe, Demonstrate, Ask for questions, Do the activity, Adaptations. Small groups: role playing, brainstorming, fish bowl, case studies, committees. Large groups: clinics, conferences, conventions, institutes, retreats, and workshops.

Answer 18

Therapeutic recreation specialists need to know how to safely work with persons who might need assistance in transferring from a bed to a wheelchair. Any specific techniques that will assist a client in participating in a group or activity are important for the CTRS to know.

Answer 19

Cognitive impairment. a severe and chronic disorder involving mental and/or physical impairment that originates before age 22. The disorder is likely to persist indefinitely and cause substantial functional limitations in at least 3 of the 7 major life activity, including self-care, receptive and expressive language, learning, mobility, self-direction, capacity for independent living and economic self-sufficiency. Most people who have an intellectual disability are developmentally disabled. People who are developmentally disabled DO NOT HAVE an intellectual disability. Some health conditions, such as asthma, gastrointestinal symptoms, eczema and skin allergies, and migraine headaches, have been found to be more common among children with developmental disabilities. Sub-average intellectual functioning; IQ<70, is displayed during the developmental period. Symptoms: low frustration level, short attention span, social immaturity, unable to function independently, poor judgment. Significant impairments in adaptive functioning. Delays in motor, language, self care. A person who is classified as intellectually has scored significantly (a minimum of 2 standard deviations) below average on a standardized IQ test. Classification system (American Psychiatric Association)- mild, moderate, severe and profound.

Answer 20

Offers choice, inclusion, mainstreaming. Age appropriate chronological, not mental age, specially valued integration activities, promote high success activities for low self esteem. Simplify/Adapt/Repetitive Movements: give choice, structure age appropriate activities.

Answer 21

(Developmental Handicap) Mental retardation “means significantly subaverage general intellectual functioning existing concurrently with deficits in adaptive behavior and manifested during the developmental period that adversely affects a child’s educational performance”. Mental retardation: is indicated by subaverage intellectual functioning (e.g., IQ score of under 70), originated during the development period (e.g., occurs before age of 22) and is attributed associated with impairment in adaptive behavior (e.g., delays across all areas of development, including motor, cognitive, language and social skills; deficits in personal independence and social responsibility). Have deficits in adaptive behavior/skills. Adaptive skills are daily living skills. Adaptive skills- communication, self-care, home living, social, community use, self-direction, health and safety, functional academics, leisure and work. Needed supports are determined through 4 dimensions of- intellectual functioning and adaptive skills, psychological/emotional considerations, physical/health/etiology considerations and profile and intensities of needed supports. Symptoms: low frustration level, short attention span, social immaturity, unable to function independently, poor judgment. Significant impairments in adaptive functioning. Delays in motor, language, self care.

Answer 22

To facilitate the development, maintenance and expression of an appropriate leisure lifestyle for the person w/ physical, mental, emotional or social limitations. Leisure lifestyle refers to the day-to-day behavioral expression of one’s leisure-related attitudes, awareness and activities revealed within the context and composite of the total life experience. TR places special emphasis on the development of an appropriate leisure lifestyle as an integral part of independent functioning. Leisure lifestyle is a routine engaged in as a part of the individual’s daily existence. TRSs should provide comprehensive TR services for people w/ MR to develop leisure-related skills that allow them to enhance their quality of life each day. 3 specific areas are used to provide comprehensive leisure ability approach that facilitates appropriate leisure lifestyles- therapy (treatment), leisure education and recreation participation. Interventions should encourage the development of cognitive skills such as understanding and remembering rules and procedures, concentrating on the task, maintaining scores and following directions should be the focus of TR treatment for people w/ MR. Leisure education should teach individuals how to appreciate leisure, be aware of self in leisure, be self-determined in leisure, interact socially during leisure, use resources facilitating leisure, make decisions about leisure and acquire recreation activity skills. Recreation Participation- Ultimate goal of any leisure education program is to facilitate self-initiated independent use of free time w/ chronically age-appropriate recreation activities. The importance of recreation participation in the lives of people w/ MR- relative to having opportunities to make choices and decisions, as well as being able to participate in age-appropriate recreation activities. Allow them choice and decision making. TRSs establish the most appropriate service setting for people w/ MR by least restrictive environment, deinstitutionalization, normalization, integration, inclusion and transition (moving from being in a school to living actively in the community). Assessment- Preference analysis, Activity analysis, environment analysis and task analysis. Preference analysis- individual’s preferences. Activity analysis- after assessment information concerning the abilities of people w/ MR has been collected, important for TRS to analyze the recreation activities. Analyzation will permit specialists to match the appropriate activities with the individual participants. Environmental analysis- Useful for the TRS to examine the total environment in which the person w/ MR will attempt to participate in a recreation activity. Provides TRS with a systematic approach to analyze the leisure context and facilitate leisure involvement. Offers choice, inclusion, mainstreaming. Age appropriate chronological, not mental age, specially valued integration activities, promote high success activities for low self-esteem. Simplify/Adapt/Repetitive Movements: give choice, structure age appropriate activities. Task analysis- the identification of all the necessary participant responses and component skills and the sequence in which these responses or skills must occur for successful participation. What is to be assessed, NOT a statement of how to assess. The use of task analysis assessment procedures has been suggested as an alternative approach for assessing performance of people w/ MR. Implementation- Strategies that are useful: partial participation, reciprocal communication, cooperation and competition, behavior modification and instructional prompts. Partial participation- the use of adaptations and provides assistance needed to facilitate leisure participation. Adaptations to enhance participation or make partial participation possible include- providing personal assistance, adapting activities by changing materials, modifying skill sequences, altering rules, and using adaptive devices and alternative communication systems and change physical and social environments to promote friendships. Reciprocal communication- May take some people w/ MR considerable time to formulate and communicate their thoughts. Often, professional do not provide them with adequate time to formulate a communication turn. Supportive environment is created when professionals: approach person, attend to person and wait at least 10 seconds for that person to initiate conversation. Cooperation and competition- Recreation activities should encourage success. TRS should include activities that encourage cooperation and indirect competition- activities that encourage/celebrate their abilities and skills rather than compare them with others (ex.- competition against oneself- aerobics, dance, martial arts) vs. direction competition. The challenge that TRSs should instill in participants w/ MR is to develop and grow through indirect competition and cooperation rather than defeat or destroy through direct competition. Behavior modification- systematic, evaluative, performance-based method for changing any observable and measurable act, response or movement by an individual. Instructional prompts- information provided before an action is performed. Useful in demonstrating/modeling the appropriate leisure behavior. Practice and repetition- People with MR need greater repetition of experiences and more frequent explanations of the principles presented. TRSs may incorporate numerous opportunities for people w/ MR to practice leisure skills (ex.- provide longer times segments). Evaluation- Observational strategies appear to be the most reliable method of evaluation of individuals w/ MR.

Answer 23

1. Mild (IQ range 50-69) Able to develop acceptable social and communication skills, but experience slight retardation in sensorimotor skill development. Does not require constant support, but may need support on a short-term basis. 2. Moderate (IQ range 35-49) Able to learn with special help to communicate with a fair degree of success, develop motor skills but at a slower rate than someone who is mildly retarded. Requires a certain support consistently over time (handling finances, employment training, etc.). 3. Severe (IQ range 20-34) Poor motor development, can learn simple tasks, speech may not be fully developed. Needs a daily support in some aspects of living such as job support, etc. 4. Profound (IQ range below 20). Minimal capacity for development of motor skills, totally incapable of self maintenance, constant high intensity support for ALL aspects of life. IQ range 70-84 is “Borderline” and no longer considered mental retardation.

Answer 24

Individuals with autism have functional characteristics that enable them to be classified as developmentally disabled. 3 out of 4 children with autism have an intellectual disability. Considered to be a spectrum disorder because the symptoms and characteristics present themselves in a wide variety of combinations. These disorders are on a continuum from classic autism (severe) to a lesser impairment referred to as Asperger’s syndrome. Behavioral symptoms can range from hyperactivity, short attention span, impulsivity, to self-injurious behavior. An individual can have problems with sensory stimulation (oversensitivity to sound or touch), eating, sleeping, and an absence of emotional reaction (no reaction to pain) or excessive fear. There may also be a problem with speech (echolalia), poor eye contact, resistance to change, and sustained odd play. Autism “means a developmental disability significantly affecting verbal and nonverbal communication and social interactions, generally evident before age 3, that adversely affects the child’s educational performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental changes or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a child’s educational performance is adversely affected primarily because the child has a serious emotional disturbance. Those whose language develops before age 5, even if very concrete (not figurative), are able to develop minimal social skills. With some supervision they can live independently and hold jobs. However, they will be unable to form intimate relationships. If language does not emerge by age 5, it is possible that it may not occur, and the prognosis for these children is believed to be very poor. However, this concept is being challenged. Parents need to be encouraged to keep learning about current research findings and advances. Autism cannot be cured, and there is no medication or drug treatment. Behavior modification or communication therapy can, to some degree, help some children develop language and basic adaptive skills. Some do dietary modifications. Limitations- deficits in social behavior, communication and learning skills.

Answer 25

Deficits in appropriate social and behavioral skills in persons w/ autism have been described as a major contributor to failure in family life, school life and vocational placements. Onset in childhood; language difficulty; echolalia; 1/3 have epilepsy, 75% Mental Retardation. Role of TR is to support global treatment goals in behavior management, socialization/social skill development and leisure skill development.

Answer 26

need structure; may need to address family needs>respite. Emphasis is placed on those social, behavioral and leisure skills that are age-appropriate and will be used throughout the life course. Treatment objectives that are applicable in TR programming include: teaching functional academic skills such as money skills, time skills, reading and giving/requesting information; teaching self-care skills such as personal grooming, socially appropriate manners, appropriate sexual behavior, and care of personal belongings; teaching interpersonal skills such as cooperation, appropriate ways of interacting socially w/ others within situational context (handshake, hugs, etc.); teaching social communication skills such as proper greetings, use of personal names when greeting or requesting attention, requesting permission to borrow others’ possessions; teaching specific leisure skills such as playing games, following rules and etiquette, choosing independently from leisure activity options, recognizing and distinguishing picture cues of leisure activities and work activities; and teaching community living skills such as ordering food and eating properly at a restaurant, shopping skills, and using public transportation.

Answer 27

There is severe and sustained impairment in social interaction, with repetitive patterns in behavior, interest, and activities. Some motor clumsiness manifests. No delays in language or cognitive development are caused, including self-help skills, adaptive skills, or curiosity of environment. Onset occurs later than autism, and condition is more common in boys. It may be recognized particularly in school settings. Adults may have significant problems exhibiting empathy.

Answer 28

Head injury and brain trauma are synonymous terms, meaning any brain injury caused by an external force. Injury to the brain caused by an external force often leads to coma; confusion, disorientation, mood swings, aphasia, Main causes are car crashes, falls, sports and assaults. Different from stroke, infection, cancer or other processes that can produce brain injuries. People with a traumatic brain injury usually have been involved in an accident and may have other complications that involve their physical abilities. Impaired attention span, concentration, memory, lower tolerance for noise, low frustration tolerance. TR: Cognitive impairment > attention deficit, inability to plan; physical impairments > aphasia, apraxia, ataxia, perceptual deficits; social-emotional impairments> impulsivity, depression, lowered inhibition.

Answer 29

Help to reintegrate into the community, become aware of resources, develop physical well being, develop support systems, Ameliorate depression and loss of independence through creative arts & social events; computer games, physical games reading. Utilize social skills; need for socialization, community reintegration, build independence, physical development, reading/writing/computer game.

Answer 30

MILD- awake, eyes open. Also called a concussion. Symptoms can include confusion, memory and attention difficulties, headaches and behavioral problems. MODERATE- lethargic, eyes open to stimulation. Some brain swelling or bleeding causing sleepiness, but still arousable. SEVERE- Coma, eyes do not open, even with stimulation. Associated w/ 20-50% death rate or severe disabilities. Stages of Recovery- for severe TBI: Coma, Vegetative state, Minimally conscious state, Recovery of full consciousness, which often includes post-traumatic amnesia.

Answer 31

Predicts degree of recovery and severity of TBI. Most common scoring system used to describe the level of consciousness in a person following traumatic brain injury. It is used to help gauge the severity of an acute brain injury. The test is simple, reliable and correlates well with outcome following sever brain injury. GCS is a reliable and objective way of recording the initial and subsequent level of consciousness in a person after a brain injury. It is used by trained staff at the site of an injury like a car crash or sport injury and in emergency departments and intensive care units. Measures the following functions: Eye Opening (E): 4= spontaneous; 3= to voice; 2= to pain; 1= none. Verbal Response (V): 5= oriented, normal conversation; 4= disoriented conversation; 3= words, but no coherent; 2= no words, sounds only; 1= none, no response. Motor Response (M): 6=normal, obeys commands for movement; 5=localized to pain, 4= withdraws to pain; 3= decorticate posture (an abnormal posture that can include rigidity, clenched fists, legs held straight out and arms bent inward toward the body with the wrists and fingers bent and held on the chest); 2= decerebrate posture (an abnormal posture that can include rigidity, arms and legs held straight out, toes pointed downward, head and neck arched backwards); 1=none. Clinicians use this scale to rate the best eye-opening response, best verbal response, and best motor response an individual makes. The final GCS score/grade is the sum of these numbers. Using the Glasgow Coma Scale- Every brain injury is different, but generally, brain injury is classified as: Severe- GCS 3-8 (Can’t score lower than a 3). Moderate- GCS 9-12, Mild- GCS 13-15. Mild brain injuries can result in temporary or permanent neurological symptoms. Moderate and severe brain injuries often result in long-term impairments in thinking skills, physical skills and/or emotional/behavioral functioning.

Answer 32

Identifies 8 levels of cognitive functioning organized into 4 intervention stages. The Rancho Los Amigos Scale of Cognitive Functioning is a system of evaluation used to follow the recovery of the TBI patient and to design an appropriate rehabilitation program.

Answer 33

The scale is divided into eight stages, from coma to appropriate behavior and cognitive functioning. •Level I: No Response- Total Assistance- Patient does not respond to external stimuli and appears asleep. Complete absence of observable change in behavior when presented visual, auditory, tactile, proprioceptive (movement of body), vestibular (inner ear, sense of balance) or painful stimuli. •Level II: Generalized Response- Total Assistance- Patient reacts to external stimuli in nonspecific, inconsistent, and non-purposeful manner with stereotypic and limited responses. Demonstrates generalized reflex response to painful stimuli. Responds to repeated auditory stimuli w/ increased or decreased activity. Responds to external stimuli w/ physiological changes generalized gross body movement and/or not purposeful vocalization. Responses noted above may be the same regardless of type and location of stimulation and responses may be significantly delayed. Medications- Amantidine and considers other stimulants. •Level III: Localized Response- Total Assistance- Patient responds specifically and inconsistently with delays to stimuli, but may follow simple commands for motor action. Demonstrates withdrawal of vocalization to painful stimuli. Turns toward or away from auditory stimuli. Blinks when strong light crosses visual field. Follows moving objects passed within visual field. Responds to discomfort by pulling tubes or restraints. Responds inconsistently to simple commands. Responses directly related to type of stimulus. May respond to some persons (especially family and friends) but not to others. Medications- Ritalin, Provigil, Nuvigil, Bromocriptine. Need to monitor Ammonia levels. •Level IV: Confused, Agitated Response- Maximal Assistance- Patient exhibits bizarre, non-purposeful, incoherent or inappropriate behaviors, has no short-term recall, attention is short and nonselective. Alert and in a heightened state of activity. Purposeful attempts to remove restraints or tubes or crawl out of bed. May perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another’s request. Very brief and usually non-purposeful moments of sustained alternative and divided attention. Absent short-term memory. May cry out or scream out of proportion to stimulus even after its removal. May exhibit aggressive or flight behavior. Mood may swing from euphoric to hostile with no apparent relationship to environmental events. Unable to cooperate with treatment efforts. Verbalizations are frequently incoherent and/or inappropriate to activity or environment. Medications: BuSpar, Resperdal, Topamax, Inderol, Zyprexa. Interventions: Sensory regulation to decrease over stimulation, Sitter and/or Bed Enclosure as needed, Behavioral Medicine-Set-up Behavioral Modification Program. •Level V: Confused, Inappropriate, Nonagitated Response- Maximal Assistance- Patient gives random, fragmented, and non-purposeful responses to complex or unstructured stimuli - Simple commands are followed consistently, memory and selective attention are impaired, and new information is not retained. Alert, not agitated but may wander randomly or with a vague intention of going home. May become agitated in response to external stimulation, and/or lack of environmental structure. Not oriented to person, place or time. Frequent brief periods, non-purposeful sustained attention. Severely impaired recent memory, with confusion of past and present in reaction to ongoing activity. Absent goal directed, problem solving, self-monitoring behavior. Often demonstrates inappropriate use of objects without external direction. May be able to perform previously learned tasks when structured and cues are provided. Unable to learn new information. Able to respond appropriately to simple commands fairly consistently with external structures and cues. Responses to simple commands without external structure are random and non-purposeful in relation to command. Able to converse on a social, automatic level for brief periods of time when provided external structure and cues. Verbalizations about present events become inappropriate and confabulatory (distorted or misinterpreted memories about oneself or the world) when external structure and cues are not provided. Interventions: Sensory regulation, May still need Bed Enclosure-intermittently, Mobility skills, Self-care skills, Cognition/communication and Behavioral Modification. •Level VI: Confused, Appropriate Response- Moderate Assistance-Patient gives context appropriate, goal-directed responses, dependent upon external input for direction. There is carry-over for relearned, but not for new tasks, and recent memory problems persist. Inconsistently oriented to person, time and place. Able to attend to highly familiar tasks in a non-distracting environment for 30 minutes with moderate redirection. Remote memory (ability to remember things that happened years ago) has more depth and detail than recent memory. Vague recognition of some staff. Able to use assistive memory aide with maximum assistance. Emerging awareness of appropriate response to self, family and basic needs. Moderate assist to problem solve barriers to task completion. Supervised for old learning (ex., self care). Shows carry over for relearned familiar tasks (ex., self care). Maximum assistance for new learning with little or no carry over. Unaware of impairments, disabilities and safety risks. Consistently follows simple directions. Verbal expressions are appropriate in highly familiar and structured situations. Interventions: Sensory Regulation, Mobility Skills, Self-care Skills, Cognition/Communication and Behavioral Modification/Adjustment. •Level VII: Automatic, Appropriate Response- Minimal Assistance for Daily Living Skills- Patient behaves appropriately in familiar settings, performs daily routines automatically, and shows carry-over for new learning at lower than normal rates. Patient initiates social interactions, but judgment remains impaired. Consistently oriented to person and place, within highly familiar environments. Moderate assistance for orientation to time. Able to attend to highly familiar tasks in a non-distraction environment for at least 30 minutes with minimal assistance to complete tasks. Minimal supervision for new learning. Demonstrates carry over of new learning. Initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what he/she has been doing. Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance. Superficial awareness of his/her condition but unaware of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely carry out his/her household, community, work and leisure ADLs. Minimal supervision for safety in routine home and community activities. Unrealistic planning for the future. Unable to think about consequences of a decision or action. Overestimates abilities. Unaware of others’ needs and feelings. Oppositional/uncooperative. Unable to recognize inappropriate social interaction behavior. •Level VIII: Purposeful, Appropriate Response- Stand-By Assistance- Patient oriented and responds to the environment but abstract reasoning abilities are decreased relative to premorbid levels. Consistently oriented to person, place and time. Independently attends to and completes familiar tasks for 1 hour in distracting environments. Able to recall and integrate past and recent events. Uses assistive memory devices to recall daily schedule, “to do” lists and record critical information for later use with stand-by assistance. Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance. Requires NO assistance once new tasks/activities are learned. Aware of and acknowledges impairments and disabilities when they interfere with task completion but requires stand-by assistance to take appropriate corrective action. Thinks about consequences of a decision of action with minimal assistance. Overestimates or underestimates abilities. Acknowledges others’ needs and feelings and responds appropriately with minimal assistance. Depressed, irritable, low frustration tolerance/ easily angered, argumentative, self-centered, uncharacteristically dependent/independent. Able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance. •Interventions/Treatment for Level 7 & 8- Mobility skills, Self-care skills, Cognition, Continue reintegration into the community, Behavioral Medicine/Psychology, Adjustment/Depression, Neuropsychological Testing, Preparing to return to work/school and Vocational Rehabilitation. •Level IX: Purposeful, Appropriate- Able to shift attention and use memory aides. Insight, judgment, problem solving, and self-monitoring require stand-by assistance. Independently shifts back and forth between tasks and completes them accurately for at least two consecutive hours. Uses assistive memory devices to recall daily schedule, “to do” list and record critical information for later use with assistance when requested. Initiates and carries out steps to complete familiar personal, household, work, and leisure tasks independently, and unfamiliar personal, household, work, and leisure tasks with assistance when requested. Aware of and acknowledges impairments and disabilities when they interfere with task completion and takes appropriate corrective action, but requires stand-by assistance to anticipate a problem before it occurs and take action to avoid it. Able to think about consequences of decisions or actions, with assistance when requested. Accurately estimates abilities; requires stand-by assistance to adjust to task demands. Acknowledges others’ needs and feelings and responds appropriately with stand-by assistance. Depression may continue. May be easily irritable. May have low frustration tolerance. Able to self monitor appropriateness of social interaction with stand-by assistance. The patient requires Stand-By Assistance on request. •Level X: Purposeful, Appropriate- Modified Independent- Independently uses strategies if needed for: memory, attention, judgment, problem solving, self-monitoring. Aware of strengths and weaknesses. Able to handle multiple tasks simultaneously in all environments; may require periodic breaks. Able to independently procure, create, and maintain own assistive memory devices. Independently initiates and carries out steps to complete familiar and unfamiliar personal, household, community, work, and leisure tasks, but may require more than usual amount of time and/or compensatory strategies to complete them. Anticipates impact of impairments and disabilities on ability to complete daily tasks and takes action to avoid problems before they occur, but may require more than the usual amount of time and/or compensatory strategies. Able to independently think about consequences of decisions or actions, but may require more than the usual amount of time and/or compensatory strategies to select the appropriate decision or action. Accurately estimates abilities and independently adjusts task demands. Able to recognize the needs and feelings of others and automatically respond in an appropriate manner. Periodic periods of depression may occur. Irritability and low frustration tolerance when sick, fatigued, and/or under emotional stress. Social interaction behavior is consistently appropriate. Interventions/Treatment- Behavioral Medicine for Depression/Adjustment, Neuropsychological testing, VR, Return to work/school issues and PT/OT/ST as needed.

Answer 34

Mental conditions that cause people to have difficulty thinking clearly and precisely. Many symptoms of cognitive disorders, but they generally share the following impairments: awareness, perception, reasoning and memory and judgment. Causes: depression, infectious diseases, improper medications, excessive alcohol or drug abuse, brain tumor, vitamin/mineral deficiency, stroke (leading cause of adult disability) and head injury from an accident or violence (mostly motor vehicle accidents).

Answer 35

result of impaired mental perception.

Answer 36

Outermost layer of brain cells. Thinking and voluntary movements begin in the cortex.

Answer 37

Between the spinal cord and the rest of the brain. Basic functions like breathing and sleep are controlled here. It performs many automatic functions such as breathing, heart rate, body temperature, wake and sleep cycles, digestion, sneezing, coughing, vomiting, and swallowing. Ten of the twelve cranial nerves originate in the brainstem.

Answer 38

Cluster of structures in the center of the brain. Coordinate messages between multiple other brain areas. Includes the caudate, putamen and globus pallidus. These nuclei work with the cerebellum to coordinate fine motions, such as fingertip movements.

Answer 39

At the base and the back of the brain. Located under the cerebrum. Responsible for coordination and balance. Function is to coordinate muscle movements, maintain posture, and balance.

Answer 40

largest part of the brain and is composed of right and left hemispheres. It performs higher functions like interpreting touch, vision and hearing, as well as speech, reasoning, emotions, learning, and fine control of movement.

Answer 41

Frontal Lobes: Responsible for problem solving and judgment and motor function. Personality, behavior, emotions, Judgment, planning, problem solving, Speech: speaking and writing (Broca’s area), Body movement (motor strip), and Intelligence, concentration, self awareness. Parietal Lobes: Manage sensation, handwriting and body position. Interprets language, words, Sense of touch, pain, temperature (sensory strip), Interprets signals from vision, hearing, motor, sensory and memory and Spatial and visual perception. Temporal Lobes: Involved with memory and hearing. Understanding language (Wernicke’s area), Memory, Hearing and Sequencing and organization. Occipital Lobes: The brain’s visual processing system. Interprets vision (color, light, movement).

Answer 42

brain is surrounded by a layer of tissue called the meninges. The skull (cranium) helps protect the brain from injury.

Answer 43

The right and left hemispheres of the brain are joined by a bundle of fibers called the corpus callosum that delivers messages from one side to the other. Each hemisphere controls the opposite side of the body. If a brain tumor is located on the right side of the brain, your left arm or leg may be weak or paralyzed. Not all functions of the hemispheres are shared. In general, the left hemisphere controls speech, comprehension, arithmetic, and writing. The right hemisphere controls creativity, spatial ability, artistic, and musical skills.

Answer 44

It plays a role in controlling behaviors such as hunger, thirst, sleep, and sexual response. It also regulates body temperature, blood pressure, emotions, and secretion of hormones.

Answer 45

Known as the “master gland,” it controls other endocrine glands in the body. It secretes hormones that control sexual development, promote bone and muscle growth, respond to stress, and fight disease.

Answer 46

Located behind the third ventricle. It helps regulate the body’s internal clock and circadian rhythms by secreting melatonin. It has some role in sexual development.

Answer 47

serves as a relay station for almost all information that comes and goes to the cortex. It plays a role in pain sensation, attention, alertness and memory.

Answer 48

the center of our emotions, learning, and memory. Included in this system are the cingulate gyri, hypothalamus, amygdala (emotional reactions) and hippocampus (memory).

Answer 49

The brain communicates with the body through the spinal cord and twelve pairs of cranial nerves. Ten of the twelve pairs of cranial nerves that control hearing, eye movement, facial sensations, taste, swallowing and movement of the face, neck, shoulder and tongue muscles originate in the brainstem. The cranial nerves for smell and vision originate in the cerebrum. Cranial nerves 1-12: 1) Olfactory-smell 2) Optic- sight 3) Oculomtor- moves eyes, pupil 4) Trochlear, moves eye 5) Trigeminal- face sensation 6) Abducens- moves eye 7) Facial- moves face, salivate 8) Vestibulocochlear- hearing, balance 9) Glossopharyngeal- taste, swallow 10) Vagus- heart rate, digestion 11) Accessory- moves head 12) Hypoglossal- Moves tongue

Answer 50

Blood is carried to the brain by two paired arteries, the internal carotid arteries and the vertebral arteries. The internal carotid arteries supply most of the cerebrum. The vertebral arteries supply the cerebellum, brainstem, and the underside of the cerebrum. After passing through the skull, the right and left vertebral arteries join together to form the basilar artery. The basilar artery and the internal carotid arteries “communicate” with each other at the base of the brain called the Circle of Willis (Fig. 9). The communication between the internal carotid and vertebral-basilar systems is an important safety feature of the brain. If one of the major vessels becomes blocked, it is possible for collateral blood flow to come across the Circle of Willis and prevent brain damage.

Answer 51

In general, the left hemisphere of the brain is responsible for language and speech and is called the "dominant" hemisphere. The right hemisphere plays a large part in interpreting visual information and spatial processing. In about one third of individuals who are left-handed, speech function may be located on the right side of the brain. Left-handed individuals may need special testing to determine if their speech center is on the left or right side prior to any surgery in that area. Aphasia is a disturbance of language affecting production, comprehension, reading or writing, due to brain injury – most commonly from stroke or trauma. The type of aphasia depends on the brain area affected- Broca’s area lies in the left frontal lobe. If this area is damaged, one may have difficulty moving the tongue or facial muscles to produce the sounds of speech. The individual can still read and understand spoken language but has difficulty in speaking and writing (i.e. forming letters and words, doesn't write within lines) – called Broca's aphasia. Wernicke's area lies in the left temporal lobe. Damage to this area causes Wernicke's aphasia. The individual may speak in long sentences that have no meaning, add unnecessary words, and even create new words. They can make speech sounds, however they have difficulty understanding speech and are therefore unaware of their mistakes.

Answer 52

Memory is a complex process that includes three phases: encoding (deciding what information is important), storing, and recalling. Different areas of the brain are involved in memory depending on the type of memory.

Answer 53

Short-term memory, also called working memory, occurs in the prefrontal cortex. It stores information for about one minute and its capacity is limited to about 7 items. For example, it enables you to dial a phone number someone just told you. It also intervenes during reading, to memorize the sentence you have just read, so that the next one makes sense. Long-term memory is processed in the hippocampus of the temporal lobe and is activated when you want to memorize something for a longer time. This memory has unlimited content and duration capacity. It contains personal memories as well as facts and figures. Skill memory is processed in the cerebellum, which relays information to the basal ganglia. It stores automatic learned memories like tying a shoe, playing an instrument, or riding a bike.

Answer 54

TR is to help patient cope and adapt to their disability, divert from a rigorous rehabilitative care and motivate to resume life and participate fully in rehab. Some cases due to severity of injury, there may be no TR intervention. As patient moves out of emergency care into intensive care and rehabilitation starts TR intervention becomes more critical as part of the treatment team. Activities would be designed to apply and refine the functional skills being addressed in physical, occupational and speed therapy. When rehabilitation starts the focus of TR would be on knowledge, skills, abilities and attitudes needed to resume an active leisure lifestyle and return to the community or work. When a patient transitions to a group home or their home, TR refers patient to special recreation associations, wheelchair sports, accessible outdoor programs and facilities, continuing education programs. Values Clarification. Cognitive Rehabilitation- aims at maximum restoration of lost cognitive skills including, perception, attention, memory, judgment, thinking, decision making, language (both speaking and comprehension), nonverbal communication, problem solving, rote learning and generalization of learning. Purposes of TR w/ cognitively impaired is 1) thereapeutic/clinical, in which therapeutic outcomes is paramount; 2) leisure/recreational- quality of life and subjective experience are important and 3) educational- development of leisure awareness, skills and resources. Vocational goals are important due to radical changes in lifestyle from accident. TR purposes in the affective domain may seek to reduce excessive/inappropriate affect or may to attempt to facilitate release through expression. Cognitive retraining- a potential restoration of functioning. Using a particular recreation activity to build a particular skill. Value of TR- relationship to real world skills, stress on client self-determination and positive attitude toward client as a whole person.

Answer 55

When someone suffers a brain injury, the entire family is affected. Studies show that caregivers of people who have suffered a brain injury may experience feelings of burden, distress, anxiety, anger and depression. For most family members, life is not the same after TBI. We want you to know that you are not alone in what you are feeling. While everyone's situation is a bit different, there are some common problems that many family members experience such as less time for yourself, financial difficulties, role changes of family members, problems with communication, and lack of support from other family members and friends. These are just some of the problems that family members may face after injury. Sometimes these problems can seem too much and you may become overwhelmed, not seeing any way out. Family members have commonly reported feeling sad, anxious, angry, guilty, and frustrated.

Answer 56

1) Contribute to the optimum outcome clinically for the client to acquire or reacquire physical, affective, cognitive, and social skills to help meet vocational goals or return to work goals. Major purpose is to prepare client for re-entry into community living as far as possible. 2) Optimize quality of life through leisure and recreation. For clients who cannot go back to work, leisure education is important to reduce the risk of boredom. TR can reduce excessive/inappropriate affect many times through providing a release for expression. Head injury- TR Utilize social skills; need for socialization, community reintegration, build independence, physical development, reading/writing/computer games.

Answer 57

Activities for this group emphasize accepting, compensating for or retraining due to cognitive losses. Emphasis will include learning to compensate for emotional and physical losses as well. Activities should duplicate community based activities as much as possible and include: social activities, hobbies, games, arts and crafts, horticulture, cooking and puzzles. •Writing- physical action of writing, enables expression of what one is thinking, increased control of one’s thoughts, self knowledge, personal logs, double entry notebooks, directed and undirected free writing, provides something to share with therapist, family/friends if one chooses. •Music- listening, participating, singing (brain retraining) •Art- creating an expression, following directions, organizing, contemplating a piece of art. •Computer Assisted Programs- brain retraining •Creative Arts- can be used as a source of writing •Wheelchair Sports- basketball, bowling, swimming, archery, table tennis, softball, etc. •Exercise- any kind that a client can participate in. •Trips/Movies- Can be used to help retrain organization and decision making skills.

Answer 58

Heart and blood vessel disease — also called heart disease — includes numerous problems, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This buildup narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke. More than 787,000 people in the U.S. died from heart disease, stroke and other cardiovascular diseases in 2010. That’s about one of every three deaths in America. About 2,150 Americans die each day from these diseases, one every 40 seconds. Cardiovascular diseases claim more lives than all forms of cancer combined. About 83.6 million Americans are living with some form of cardiovascular disease or the after-effects of stroke. Direct and indirect costs of cardiovascular diseases and stroke total more than $315.4 billion. That includes health expenditures and lost productivity. Nearly half of all African-American adults have some form of cardiovascular disease, 49 percent of women and 44 percent of men. Heart disease is the No. 1 cause of death in the world and the leading cause of death in the United States, killing almost 380,000 Americans a year. Heart disease accounts for 1 in 6 deaths in the U.S. Someone in the U.S. dies from heart disease about once every 90 seconds. Heart disease is the No. 1 killer of women, taking more lives than all forms of cancer combined. Over the past 10 years for which statistics are available, the death rate from heart disease has fallen about 39 percent. About 720,000 people in the U.S. have heart attacks each year. Of those, about 122,000 die. About 620,000 people in the U.S. have a first-time heart attack each year, and about 295,000 have recurrent heart attacks. Stroke is the No. 4 cause of death in the United States, killing more than 129,000 people a year.

Answer 59

1) experience no limits; generally exhibit no symptoms with ordinary activity 7.5+ cal. 2) experience slight limitations; comfortable at rest, some symptoms with ordinary activities. up to 7.5 cal. 3) experience marked limitations, comfortable at rest, ordinary symptoms with less the activity up to 5.0 cal. 4) experience discomfort with almost any activity, may perform sedentary activities; 2.5 cal. TR modalities: Stress management, relaxation, exercise, awareness of environmental factors.

Answer 60

unable to obtain adequate level of output. RT side, legs swelling, left side fluid in lungs. Hypertension> leads to heart attack.

Answer 61

Most heart diseases are actually vascular diseases that constrict or block normal blood flow either in or out of the heart. Other diseases such as, rheumatic fever, syphilis and infections also can cause heart damage. Congenital heart disease results from some defect in the development of the heart before birth. In hypertensive heart disease, the heart is forced to pump harder because of its constriction of the arteries caused by increased blood pressure. Coronary heart disease/ischemic heart disease results from the narrowing of coronary arteries and a resulting decrease in blood supply to the heart. Cardiac arrest or cessation of the heartbeat, results in a drop in blood pressure and limitation of circulation to the blood. Often no warning signs. Similar effects to person with a traumatic brain injury. It causes an interruption of the blood-flow to the brain. Strokes may be caused by cerebral thrombosis (when a blood clot forms in the brain’s venous sinuses that prevents blood from draining out of the brain. As a result, blood cells may break and leak blood into the brain tissues, forming a hemorrhage, hemorrhage (rapid loss of blood) or embolism (obstruction of an artery, typically by a clot of blood or an air bubble). Hemiplegia (paralysis of one side of the body) is a sign of a stroke. Damage to the right side of the brain may cause may cause left hemiplegia, problems with depth perception, visual neglect, problems or orienting to the environment and estimating abilities. Damage to the left side of the brain will cause right hemiplegia, and individuals may have problems speaking (aphasia), understanding, reading, writing and judgment. May also have problems with new situations.

Answer 62

Having a stroke can result in a number of vision problems—also called visual disturbances. There are many types of vision problems and treatments. Depending on where a stroke occurs in the brain, survivors can face balance and posture problems, disorientation, trouble focusing or a reduced blink rate. A stroke survivor may experience changes related to sleep. One of the biggest sleep-related issues that can develop after a stroke is sleep-related breathing disorders. Other common ways stroke affects sleep is changing sleep patterns, as in sleeping more during the day than at night, and insomnia. A seizure is a sudden episode of abnormal or disorganized electric activity in the brain. Stroke is the most common cause of seizures in the aging population and approximately 10 percent of stroke survivors experience a seizure after a stroke. Seizures can be characterized by spasms or convulsions. Incontinence refers to a lack of ability to control bladder and/or bowel movements. Incontinence affects 40 to 60 percent of patients admitted to a hospital after having a stroke. Paralysis is the inability of a muscle or group of muscles to move voluntarily. Muscles are controlled by messages sent from the brain that trigger movement. When part of the brain is damaged after a stroke, messaging between the brain and muscles may not work properly. Paralysis or muscle weakness are sometimes referred to as “movement” impairments, and they affect up to 90 percent of stroke survivors who lose or have impaired motor function. Paralysis or weakness can affect any part of the body. Stroke is the leading cause of dysphagia, which is paralysis of the throat muscles. This condition can disrupt the swallowing process and make eating, drinking, taking medicine and breathing difficult. The most common movement impairment is hemiparesis, which refers to one-sided (“hemi”) weakness (“paresis”). Hemiparesis affects roughly 80 percent of stroke survivors, causing weakness or the inability to move one side of the body. Weakness can impact arms, hands, legs and facial muscles. Those impacted may have trouble performing everyday activities such as eating, dressing, using the bathroom and grabbing objects. Spasticity is a condition in which muscles become tight and stiff, which makes movement, especially of the arms or legs, difficult or uncontrollable. Foot drop is common after a stroke. The condition is characterized by weakness or paralysis that limits the ability to raise the front part of the foot. The foot or ankle drops down when the leg is lifted to take a step. A person with foot drop may trip and fall if the foot and ankle are not supported by a brace at all times. Each person feels pain differently. Damage to the brain due to stroke can sometimes make the sense of touch hurt. Pain can result from things like muscle tightness or weakness. Post-stroke fatigue, the invisible symptom, affects between 40 and 70 percent of stroke survivors. Fatigue is a normal condition in healthy individuals—a protective mechanism that alerts the body when it is time to rest or modify activity. This type of fatigue is usually related to one cause and is short-lived. Post-stroke fatigue is usually linked to chronic dysfunction of some kind and can significantly impair a person’s physical, cognitive and psychosocial (emotional and behavioral) functioning. Post-stroke fatigue is often confused with “being tired.” It is not necessarily the same as tiredness, because it arrives without warning and rest does not always make it better. Post-stroke fatigue can occur days, weeks, months or even years after a stroke. It occurs differently in every individual. Fatigue can greatly impact daily life and slow down recovery. Cognitive/Emotional Affects- Vascular dementia (VaD) is a common post-stroke complication characterized by the loss of cognitive function or thinking abilities. VaD occurs when brain tissue is damaged because of reduced blood flow to the brain during a stroke or a series of strokes. Aphasia is a disorder of communication that impairs a person’s ability to use and comprehend language. Many people experience memory problems after a stroke. In particular, people who have had a stroke in the right hemisphere of their brain commonly have problems paying attention. Stroke survivors can experience the following types of memory loss: verbal-memory of names, stories and information having to do with language; visual- memory of shapes, faces, routes and things seen; informational-memory of information and skills or trouble learning new things and Vascular dementia. A stroke survivor’s emotional health is just as important as his or her physical health and can promote or disrupt post-stroke recovery. Many stroke survivors experience feelings of anger, frustration, anxiety, sadness, fear and hopelessness in varying degrees. These emotions are common with post-stroke depression, which affects more than a third of stroke survivors. The National Institute of Neurological Disorders and Stroke characterizes post-stroke depression by a feeling of hopelessness that interferes with functioning and inhibits quality of life. If not treated and managed appropriately, post-stroke depression can slow down recovery. Pseudobulbar affect (PBA) is a medical condition characterized by sudden and uncontrollable episodes of crying or laughing. It is sometimes referred to as emotional lability, pathological crying and laughing or emotional incontinence. An episode of PBA can occur at any time, even in inappropriate social situations. PBA can occur in stroke survivors or people with other neurologic conditions such as dementia, multiple sclerosis, Lou Gehrig’s disease (ALS) or traumatic brain injury.

Answer 63

help patient cope and adapt to their disability, divert from a rigorous rehabilitative care and motivate to resume life and participate fully in rehab. Some cases due to severity of injury, there may be no TR intervention. As patient moves out of emergency care into intensive care and rehabilitation starts TR intervention becomes more critical as part of the treatment team. Activities would be designed to apply and refine the functional skills being addressed in physical, occupational and speed therapy. When rehabilitation starts the focus of TR would be on knowledge, skills, abilities and attitudes needed to resume an active leisure lifestyle and return to the community or work. When a patient transitions to a group home or their home, TR refers patient to special recreation associations, wheelchair sports, accessible outdoor programs and facilities, continuing education programs. Emotional and social recovery is harder for the patient than the physical recovery. Focus on physiology as well as lifestyle. Patient needs help learning how to deal w/ the event/coping skills of the cardiac event and develop strategies that optimize recovery and reduce the likelihood of further problems. Includes exercise, diet and behavior modification. TRS must assist the client in developing new lifestyle patterns that will contribute to cardiac wellness. Leisure counseling, activity analysis and stress reduction techniques. When planning activities TRS needs to known what a metabolic unit (MET) is. Metabolic Unit (MET) determine activities energy costs and a measure of patient functioning and progress. Assessment- For cardiac patients it is designed to gather date in 2 main areas: medial and lifestyle. The medical information is used primarily to develop an appropriate exercise regimen for the patient. Lifestyle assessment is done to identify risk factors, such as poor nutrition or inactive leisure that will become the focus of a behavioral modification program. TRS will be most involved in lifestyle assessment. The American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR) identifies the purpose of the assessment of patients receiving cardiac rehab services as a thorough evaluation of the realms affecting participation in rehabilitation. Areas including functional ability, work limitations, risk-factor status and barriers to optimal functioning are assessed. The precise nature of the assessment process varies across the 4 phases of rehabilitation process. During phase 1, data related to early education needs of patient, as well as physiological needs of the patient such as heart rate and blood pressure are crucial. Focus during phase 2 shifts to assessing activity readiness as well as determining the educational needs of the patient in areas such as stress reduction, nutrition, smoking, medical procedures or activity management. Assessment during phase 3 focuses on gathering subjective information related to demographics, cardiac history, general health and a psychosocial history dealing w/ the client’s lifestyle. In addition, exercise testing is done to measure work capacity. Phase 4 assessment revolves around a nursing history, cardiovascular examination and an exercise stress test. Information about medications and their side effects are also needed. TR specialist should be most heavily involved in assessing the patient’s social history. Social history includes, occupational physical activity, job satisfaction, family and work responsibilities, physical activity in leisure time, family medical and socioeconomic history, smoking, drinking and eating habits, sexual activity and geographic history. Planning- Basic term TRS needs to know is MET or Borg rating of perceived exertion (RPE) is a useful tool for understanding exercise intensity. The patient self-determines the Borg scale score for activities. TRS should work with the exercise physiologist or physician who has developed an exercise prescription for the patient in order to incorporate recreation activities into that prescription. TRSs must also foster the client’s long-term lifestyle changes by using educational activities. Plan programs that are aimed at stress reduction, use of leisure in productive ways, and appropriate levels of leisure involvement within the patient’s level of physical fitness.

Answer 64

Impact on family life- Caring for stroke survivors at home can cause high levels of emotional, mental and physical stress. Disruption of employment and family life makes caregiving very challenging. Family caregivers can promote positive post-stroke recovery outcomes; however, they need to care for themselves as well. Post-stroke recovery varies for each person; even if the stroke survivor returns to work and maintains a large amount of autonomy, family members may play a bigger role in the stroke survivor’s live than before the stroke.

Answer 65

Left CVA > Right hemi: affects the right side; affects speech, may cause aphasia; Right hemi > impaired emotions. social interactions, poor memory, difficulty with spoken language & written communication. TR: Use demonstration, modeling, reality orientation. Right CVA>left hemi: loss of perceptual/intellectual functioning, logic, visual and spacial depth, difficulty in perceiving around them. TR: Use words rather than gestures, keep environment clear of distractions, leisure education.

Answer 66

Considered a cognitive impairment. There are a variety of types of dementia including Alzheimer’s Disease, Vascular Dementia and Dementia w/ Lewy Bodies, Pick’s Disease, Parkinson’s disease, Alcohol-related dementia and Wernicke-Korsakoff Syndrome. 2 sets of symptoms that an entry-level TRS needs to be aware of: 1) behavioral symptoms- apathy, physical aggression or nonaggression, verbal nonaggression or aggression, or refusal of care or medication, etc. and these cause the most difficulty to caregivers. 2) cognitive symptoms. Persons with dementia may also experience depression, paranoia, social withdrawal or suicidal ideation. Dementia displays itself by the onset of mental deterioration that exceeds normal aging. Attributed to diseases or injuries that affect the brain and occurs in more than just the elderly population.

Answer 67

(no official categories)- Early stage: Forgetfulness of recent events. Impaired ability to perform challenging mental arithmetic—for example, counting backward from 100 by 7s. Greater difficulty performing complex tasks, such as planning dinner for guests, paying bills, or managing finances. Forgetfulness about one's own personal history. Becoming moody or withdrawn, especially in socially or mentally challenging situations. Mid stage: Gaps in memory and thinking are noticeable, and individuals begin to need help with day-to-day activities. At this stage, those with dementia may: Be unable to recall their own address or phone number, or the high school or college from which they graduated. Become confused about where they are or what day it is. Have trouble with less challenging mental arithmetic—for example, counting backward from 40 by subtracting 4s or from 20 by subtracting 2s. Need help choosing proper clothing for the season or the occasion. Still remember significant details about themselves and their family. Still require no assistance with eating or using the toilet. Late stage- Memory continues to worsen, personality changes may take place, and individuals need extensive help with daily activities. At this stage, individuals may: Lose awareness of recent experiences as well as of their surroundings. Remember their own name but have difficulty with their personal history. Distinguish familiar and unfamiliar faces but have trouble remembering the name of a spouse or caregiver. Need help dressing properly and may, without supervision, make mistakes such as putting pajamas over daytime clothes or shoes on the wrong feet. Experience major changes in sleep patterns—for example, sleeping during the day and becoming restless at night. End stage- In the final stage of the disease, individuals may: Be able to say words or phrases but may need help with much of their daily personal care, including eating and using the toilet. Lose the ability to respond to their environment or to carry on a conversation. Lose the ability to smile, to sit without support, and to hold up their heads. Lose the ability, eventually, to control movement: reflexes become abnormal, muscles grow rigid and swallowing is impaired.

Answer 68

TRSs must view the life course as a series of changes marked by the succession of age-related roles prescribed by the culture, by the biological and cognitive development of the individual and by the particular historical events that define the context in which the individual lives. TR practices and procedures are grounded in this life review process. Assessment- mental status exam to asses their major cognitive and emotional difficulties and help define the proper psychological treatment, social and vocational history focusing on previous roles, personality assessment focused on the individual’s self perception, interpersonal relationships, person’s own perception of the rehabilitation process, assessment of current family situation, and interview of the patient’s family if patient agrees. Planning- Objectives for psychosocial intervention include 1) assessment of client’s cognitive, affective and functional status; 2) resolving the crisis of disability, depression and grieving; 3) helping clients maintain independence; 4) promoting self-esteem; 5) improving family relations and 6) identifying suspected organic ailments that may impair optimal functioning. Programs include physical fitness, reminiscence, nutritional programming, activities for daily living (ADL) and creative arts. Implementation- Developing programs that enhance dignity requires the structuring of program autonomy, independence and meaningful involvement. Leadership considerations- demonstrate respect for mature adults, cultivate understanding and empathy through the demonstration of interest and genuine concern for the individual, show enthusiasm, be flexible and adaptable and recognize planning and creativity as important cornerstones to successful programs and services. Also think of environmental design and modifications. Evaluation- Evaluate programs in reference to impairments, functional disabilities and handicapped conditions. The impact the program has on functional abilities that are represented by basic living skills. Instrumental living skills assessments include the Functional Status Index, Functional Independence Measure and the Older Americans Resource Service Multidimensional Functional Assessment Questionnaire. Purpose of TR Dementia (including Alzheimer’s)- Psychosocial rehabilitation programs. TR is most affected with individuals in the mild to moderate stages if dementia. One of the goals is to ensure the patient in any stage has the best quality of life possible. This is accomplished by emphasizing the patient’s sense of worth, focusing on the individual’s interests and skills, prompting recent and past memories, and providing friendships (when done in group settings).

Answer 69

Recreation for this population can be very varied but depends on the stage of the disease and especially the skills and interests of the individual. TR is an integral part of a holistic approach to Alzheimer’s or any dementia. Activities can include- art, cooking, gardening, interacting with animals, music, walking, memory exercises, cognitive stimulation, visual stimulation, tactile stimulation, reminiscence and exercise.

Answer 70

Most common form of dementia. There are 3 stages of AD: Stage One or Mild lasts between 2 and 4 years, Stage Two or Moderate lasts from 2 years to 7 years, and the Third Stage is Severe and lasts from 1-3 years. Each stage is distinctive and has its own symptoms. Alzheimer’s is a specific type of dementia. Causes confusion, memory loss, irritability, aggression and mood swings. This progresses to a breakdown in language, withdrawal from those around them, bodily functions deteriorate and ultimately leads to death. Terminal disease.

Answer 71

A chronic brain disorder is characterized by recurring attacks of abnormal sensory, motor and psychological activity. Convulsion or seizure is an involuntary spasm or contraction of muscle resulting from chemical imbalances in the body. A seizure disorder is a common neurological condition that can be either primary or secondary epilepsy. If a seizure has no identifiable etiology, then it can be classified as “primary.” If it happens after an impact to the brain and seizure occur, it would be classified as a “secondary” condition. A “partial” seizure involves only one cerebral hemisphere, while a “generalized” seizure involves both hemispheres. Seizures may be also classified as “simple,” NO loss of consciousness or “complex” in which a person loses consciousness. Partial seizures begin in 1 specific body site- 1) simple partial seizures- consciousness is NOT impaired; 2) complex partial seizures - consciousness is impaired; 3) partial seizure evolving into a generalized seizure. Generalized seizures- not confined to one body site. Includes absence, myoclonic, clonic, tonic, tonic-clonic, atonic, akinetic and infantile spasm seizures. Also are Unilateral and Unclassified seizures. People with a seizure disorder may also have another disorder that is psychological or mental retardation. Limitations- long term difficulties and challenges for clients w/ epilepsy are chronic side effects from anticonvulsant medications and lifestyle modifications. These areas affect the stabilization of their seizures. If a patient has a seizure it is important to not try to stop the seizure but keep the patient safe. Important for TRS to know the duration and observable nature of the seizure.

Answer 72

TRSs who work with clients with convulsive disorders typically are focusing on either a secondary diagnosis (MR, mental illness, physical handicaps), psychopathology associated with epilepsy (learned helplessness, anger, depression) or specific needs related to lifestyle adaptations/modifications that would benefit from leisure counseling. In focusing on a 2nd diagnosis the clinician needs to remain aware of certain activity limitations, medication side effects, and appropriate procedures for handling seizures. TRSs should take an active role in addressing some of the psychosocial needs of this population. 3 topics to focus on w/ this population are stress reduction, leisure lifestyle and locus of control as well as social skills. Clients with epilepsy tend to reflect a higher external locus of control. TRSs will encounter clients w/ convulsive disorders in ALL service delivery areas, but the majority are in long-term residential treatment centers. Encourage normalization, reduce stress, fears & stigma; relaxation, community activities, increase locus of control.

Answer 73

IDEA (Individuals with Disabilities Educational Act) defines learning disabilities as a “disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to: listen, think, speak, read, write, spell, or to do mathematical calculations.” The Federal definition includes such conditions as: perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia and developmental aphasia. According to the law, learning disabilities do not include learning problems that are primarily the result of: visual, hearing or motor disabilities, mental retardation or environmental, cultural or economic disadvantage. The label “learning disability” assists in the classification of children, NOT in teaching them. These problems may mildly, moderately, or severely impair the learning process. Helpful strategies for learning disabled patients: capitalize on the strengths, provide high structure and clear expectations, use short sentences and a simple vocabulary, provide opportunities for success in a supportive atmosphere to help build self esteem, flexible classroom procedures (use of tape-recorders for note-taking and test taking; note-takers, etc.) when the child has difficulty with written language, immediate feedback without embarrassment, use computers for drill and practice, provide positive reinforcement of appropriate social skills at school home (and the community) and access to the Individualized Educational Plan (IEP) by the parent(s)/caregiver is of great benefit to reinforce at home the work being done in school.

Answer 74

dyslexia, deficits in language development, hyper activity, thought process difficulty, low attention span, distractible, behavior problems in school, low self-esteem. Provide choice, challenge, & age appropriate activities which are structured for success.

Answer 75

an imaginary vertical plane of section that passes longitudinally through the body and divides it into right and left halves. The median plane intersects the surface of the front and back of the body at what are called the anterior and posterior median lines. It is a common error, however, to refer to the" midline" when the median plane is meant.

Answer 76

front of body

Answer 77

back of body

Answer 78

any vertical plane through the body that is parallel with the median plane is called a sagittal plane. The sagittal planes are named after the sagittal suture of the skull, to which they are parallel. The term "parasagittal" is redundant: anything parallel with a sagittal plane is still sagittal.

Answer 79

any vertical plane that intersects the median plane at a right angle and separates the body into anterior and posterior parts.

Answer 80

refers to a plane at a right angle to both the median and coronal planes: it separates the body into superior and inferior parts. This is often termed an axial plane, particularly in radiology.

Answer 81

means at a right angle to the longitudinal axis of a structure. Thus, a transverse section through an artery is not necessarily horizontal. A transverse section through the hand is horizontal, whereas a transverse section through the foot is coronal.

Answer 82

nearer to the median plane.

Answer 83

farther from the median plane.

Answer 84

nearer to the front of the body.

Answer 85

nearer to the back of the body.

Answer 86

nearer to the top or upper end of the body.

Answer 87

nearer to the lower end of the body.

Answer 88

* Organisms are made of organ systems, which are made of organs, which are made of tissues, which are made of cells, which are made of molecules, which are made of atoms. * Homeostasis is the balance, or equilibrium, of the body. Regulation of all the body’s systems seeks to keep the body in homeostasis. * The heart is a muscular pump. Contractions by the heart push blood through the circulatory system. * Within the circulatory system, blood travels in arteries to carry oxygen from the lungs to the tissues and returns through veins to carry carbon dioxide from the tissues to the lungs. Blood also carries nutrients from the digestive system to the cells of the body and removes wastes from the cells. * Exchange of the respiratory gases, oxygen and carbon dioxide, occurs in the lungs. * Digestion involves the mechanical and chemical breakdown of food molecules into their smallest subunits. Digestion begins in the mouth and continues in the stomach and small intestine. * Absorption of nutrients in the digestive system occurs through the cells of the small intestine. * Glands are organs in the endocrine system that secrete hormones. Hormones are chemical messengers that can alter the behavior of target cells. * The nervous system consists of two main systems, the central nervous system (CNS) and the peripheral nervous system. The CNS is made up of the brain and spinal cord and sends out instructions. The peripheral nervous system contains the nerves that send the messages from the CNS to the rest of the body. * The muscular and skeletal systems work together to allow movement. The muscles contain fibers that can contract, while the skeleton provides support and structures for muscles to pull against.

Answer 89

studies physical activity and human movement, and explores their impact on health, society, and quality of life. American Kinesiology Association defines kinesiology as “the academic discipline, which involves the study of physical activity and its impact on health, society, and quality of life.”

Answer 90

Superior/Cranial/Cephalic-toward the top of the head. Inferior/Caudal-toward the feet or tail end. Palmar/Volar-Toward the palm of the hand. Plantar-Toward the bottom of the foot. Deep-Toward the inside of the body. Superficial-Toward the outside of the body. Ipsilateral- On the same side of the body. Contralateral-On the opposite side of the body. Flexion-Motion that shortens a limb. Extension-Motion that lengthens a limb. Hyperextension-Extension past neutral. Circumduction-Motion of a limb that draws a circle. Abduction-Motion away from the midline. Adduction-Motion toward the midline. Rotation-Motion that turns a body part. Axis of Rotation-An imaginary line around which rotation occurs. Longitudinal Axis-Along the length of the limb. Sagittal Plane-Divides the body into left & right sides. Frontal/Coronal Plane-Divides the body into anterior/posterior sides. Transverse/Horizontal Plane-Divides the body into superior/inferior sides.

Answer 91

•Arthritis- As we age, our joint tissues become less resilient to wear and tear and start to degenerate manifesting as swelling, pain, and oftentimes, loss of mobility of joints. Changes occur in both joint soft tissues and the opposing bones, a condition called osteoarthritis. A more serious form of disease is called rheumatoid arthritis. The latter is an autoimmune disease wherein the body produces antibodies against joint tissues causing chronic inflammation resulting in severe joint damage, pain and immobility. •Osteoporosis- “Porous bone.” The bane of the old, especially, women. The hard, rock-like quality of bone is dependent upon calcium. When too much calcium is dissolved from bones or not enough replaced, bones lose density and are easily fractured. Estrogen, the female sex hormone, helps maintain proper calcium levels in bones. Once the ovaries stop producing the hormone, women are at higher risk of developing osteoporosis. A collapse of bony vertebrae of the spinal column results in loss of height and stooped posture. Hip fractures are a common occurrence. •Osteomalacia- “Soft bones.” If not enough calcium is deposited during early childhood development, the bones do not become rock-hard, but rubbery. Both adequate calcium in the diet and vitamin D, primarily, from normal sunlight exposure or supplementation, are necessary for normal bone development. Before vitamin supplementation to milk, “rickets,” another name for osteomalacia in children, was common resulting in the classic bowed legs of the afflicted child. •Carpal tunnel syndrome - People whose job involves repeated flexing of their wrist (typing, house painting) may develop tingling and/or pain in their thumb, index and middle fingers along with weakness of movements of the thumb, especially, grasping an object. The main nerve for finely controlled thumb movements passes through a bony/ligamentous canal on the bottom of the wrist. Repetitive flexing movements may inflame and thicken the ligament over the “tunnel” through the carpal (wrist) bones trapping and compressing the nerve. •Tendonitis- Repeated strain on a tendon, attachment of a muscle to bone, can inflame the tendon resulting in pain and difficulty with movement involving the muscle. Tendons have a poor blood supply; therefore, they typically take a long time to heal on the order of six weeks or more. •Rotator cuff tear - Muscles surrounding the shoulder joint are involved in rotating the shoulder with upper arm and hand forward and backward, among other movements. The tendons of these muscles also contribute to the structural strength of the shoulder joint. Hard, fast movements, such as in tennis and baseball can tear one of these tendons resulting in pain and decreased mobility of the shoulder. Surgery may be needed to repair a torn tendon. •Bursitis - A bursa is a small, closed bag with a minimum amount of lubricatory fluid that serves as a shock absorber where bones make close contact and to minimize trauma and friction where tendons cross bones and joints. Inflammation leads to pain and immobility in a joint area. •Muscular dystrophy - Muscular dystrophy is a group of inherited diseases in which the muscles that control movement progressively weaken. The prefix, dys-, means abnormal. The root, -trophy, refers to maintaining normal nourishment, structure and function. The most common form in children is called Duchenne muscular dystrophy and affects only males. It usually appears between the ages of 2 to 6 and the afflicted live typically into late teens to early 20s. •Myasthenia gravis - “Muscular weakness, profound”. This is an autoimmune disease that involves production of antibodies that interfere with nerves stimulating muscle contractions. Face and neck muscles are the most obviously affected, manifesting as drooping eyelids, double vision, difficulty swallowing and general fatigue. There is no actual paralysis of muscles involved, but a rapid fatiguing of function. -Lupus erythematosus - An autoimmune disease wherein the body produces antibodies against a variety of organs, especially connective tissues of skin and joints. Mild Lupus may involve a distinctive butterfly-shaped rash over the nose and cheeks. Mild lupus may also involve myalgia and arthralgia (remember these words?) Severe or systemic lupus (SLE) involves inflammation of multiple organ systems such as the heart, lungs, or kidneys. By the way, lupus means “wolf” in Latin. Maybe a reference to the facial rash that might give a patient a wolf-like appearance.

Answer 92

- Vascular disorders, such as stroke, transient ischemic attack (TIA), subarachnoid hemorrhage, subdural hemorrhage and hematoma, and extradural hemorrhage. Infections, such as meningitis, encephalitis, polio, and epidural abscess. - Structural disorders, such as brain or spinal cord injury, Bell's palsy, cervical spondylosis, carpal tunnel syndrome, brain or spinal cord tumors, peripheral neuropathy, and Guillain-Barré syndrome. - Functional disorders, such as headache, epilepsy, dizziness, and neuralgia. Degeneration, such as Parkinson's disease, multiple sclerosis, amyotrophic lateral sclerosis (ALS), Huntington's chorea, and Alzheimer's disease.

Answer 93

•Atherosclerosis- Literally, “hardening of the fatty stuff.” High fat diets can lead to formation of fatty plaques lining blood vessels. These fatty areas can become calcified and hard leading to arteriosclerosis, hardening of the arteries. When blood vessels become less stretchable, blood pressure rises and can result in heart and kidney damage and strokes. •Myocardial infarction (MI)- You know we are talking about heart muscle, right, myocardial? An infarction is blockage of blood flow resulting in death of muscle tissue. Layman’s language for this is a “heart attack.” The blockage occurs in one of the arteries of the heart muscle itself, a coronary artery. Depending upon how much tissue dies, a victim of an MI may survive and undergo cardiac rehabilitation, strengthening the remaining heart muscle, or may die if too much muscle tissue is destroyed. •Mitral prolapse, stenosis, regurgitation- Blood flows through four chambers in the heart separated by one-way valves. A major valve is the one separating the upper and lower chambers on the left side of the heart. The left side is especially important because freshly oxygenated blood returning from the lungs is circulated out of the heart to the rest of the body. The left valve, called atrioventricular, for the chambers it separates, is also called the mitral valve, because it is shaped like an upside down Bishop’s hat, a miter. If the flaps of this valve tear away due to disease, the process is called prolapse, “a falling forward.” This results in leakage and backward flow called “regurgitation” (get the picture?). Sometimes a valve is abnormally narrow causing partial obstruction constricting flow. Stenosis means “a narrowing.” •Angina pectoris- Literally, “pain in the chest.” But, this is a special kind of pain associated with the heart and is distinctive as “crushing, vise-like”, and often accompanied by shortness of breath, fatigue and nausea. Anginal pain indicates not enough blood is getting to the heart muscle, and the heart is protesting and begging for more. People with a history of angina often take nitroglycerine tablets to relieve the pain by increasing blood flow to the heart muscle. •Arrhythmia/dysrhythmia- Abnormal heart rates and rhythms all have special names like ventricular tachycardia, fibrillation, but generically are termed arrhythmias or dysrhythmia, meaning “no rhythm” and “abnormal rhythm.” There are fine distinctions between the two, but they are often used interchangeably. The heart can beat too slow, too fast or irregularly. Bradycardia is when the heart rate is less than 60 beats per minute. Tachycardia is when the heart rate is more than 100 beats per minute. An arrhythmia can affect how well the heart works. The heart may not be able to pump enough blood to meet the body's needs. •Ischemia- Sometimes the heart muscle is not getting enough blood flow, more importantly, the oxygen the blood carries is insufficient to sustain muscle which has a very high metabolic rate, and oxygen demand. The term loosely means “not quite enough blood.” Typically, the patient suffers angina pain (see above) and they may think they are having a heart attack. And, they may be! •Heart attack- occurs when the blood flow to a part of the heart is blocked by a blood clot. If this clot cuts off the blood flow completely, the part of the heart muscle supplied by that artery begins to die. Most people survive their first heart attack and return to their normal lives to enjoy many more years of productive activity. But having a heart attack does mean you have to make some changes. The doctor will advise you of medications and lifestyle changes according to how badly the heart was damaged and what degree of heart disease caused the heart attack. •Ischemic stroke- (the most common type) happens when a blood vessel that feeds the brain gets blocked, usually from a blood clot. When the blood supply to a part of the brain is shut off, brain cells will die. The result will be the inability to carry out some of the previous functions as before like walking or talking. •Hemorrhagic stroke- occurs when a blood vessel within the brain bursts. The most likely cause is uncontrolled hypertension. •Heart failure- This doesn't mean that the heart stops beating. Heart failure, sometimes called congestive heart failure, means the heart isn't pumping blood as well as it should. The heart keeps working, but the body's need for blood and oxygen isn't being met. Heart failure can get worse if it's not treated. If your loved one has heart failure, it's very important to follow the doctor's orders Heart valve problems- When heart valves don't open enough to allow the blood to flow through as it should, it's called stenosis. When the heart valves don't close properly and allow blood to leak through, it's called regurgitation. When the valve leaflets bulge or prolapse back into the upper chamber, it’s a condition called mitral valve prolapse. When this happens, they may not close properly. This allows blood to flow backward through them.

Answer 94

* Pneumoconiosis- literally, “an abnormal condition of dust in the lungs.” A generic name for conditions where toxic particles become trapped in the lungs and cause symptoms and disability such a “black lung” or “miner’s lung” disease. Terms specific to the particulate matter may be given such as asbestosis. * Epistaxis- nose bleed * Cystic fibrosis - an inheritable disease that affects not only the lungs but other systems producing mucous such as the digestive system. Patients suffer frequent lung infections that are hard to treat because mucous is thick and sluggish and result in increased scarring (fibrosis) of the lungs. They also take multiple enzyme pills because of digestive abnormalities related to abnormal mucous production. * Emphysema (COPD) - Chronic Obstructive Pulmonary Disease, of which emphysema is one of, results in progressive destruction of the air sacs in the lungs and loss of respiratory membrane for oxygen exchange. The bane of long-term smokers. * Atelectasis - a collapsed lung.

Answer 95

Diabetes is the most common endocrine disorder diagnosed in the U.S. The endocrine system is a network of glands that produce and release hormones that help control many important body functions, especially the body's ability to change calories into energy that powers cells and organs. The endocrine system influences how your heart beats, how your bones and tissues grow, even your ability to make a baby. It plays a vital role in whether or not you develop diabetes, thyroid disease, growth disorders, sexual dysfunction, and a host of other hormone-related disorders.

Answer 96

•Adrenal insufficiency. The adrenal gland releases too little of the hormone cortisol and sometimes, aldosterone. Symptoms include fatigue, stomach upset, dehydration, and skin changes. Addison's disease is a type of adrenal insufficiency. •Diabetes. Type 1- diabetes occurs when the body's own immune system destroys the insulin-producing cells of the pancreas (called beta cells). Normally, the body's immune system fights off foreign invaders like viruses or bacteria. But for unknown reasons, in people with type 1 diabetes, the immune system attacks various cells in the body. This results in a complete deficiency of the insulin hormone. Normally the hormone insulin is secreted by the pancreas in low amounts. When you eat a meal, sugar (glucose) from food stimulates the pancreas to release insulin. The amount that is released is proportional to the amount that is required by the size of that particular meal. Type 2 diabetes, once called non-insulin-dependent diabetes, is the most common form of diabetes, affecting 90% to 95% of the 26 million Americans with diabetes. Unlike people with type 1 diabetes, the bodies of people with type 2 diabetes make insulin. But either their pancreas does not make enough insulin or the body cannot use the insulin well enough. This is called insulin resistance. When there isn't enough insulin or the insulin is not used as it should be, glucose (sugar) can't get into the body's cells. When glucose builds up in the blood instead of going into cells, the body's cells are not able to function properly. Other problems associated with the buildup of glucose in the blood include: Damage to the body. Over time, the high glucose levels in the blood can damage the nerves and small blood vessels of the eyes, kidneys, and heart and lead to atherosclerosis, or hardening of the arteries that can cause heart attack and stroke. Dehydration. The buildup of sugar in the blood can cause an increase in urination, causing dehydration. Diabetic coma (hyperosmolar nonketotic diabetic coma). When a person with type 2 diabetes becomes very ill or severely dehydrated and is not able to drink enough fluids to make up for the fluid losses, they may develop this life-threatening complication. •Cushing's disease. Overproduction of a pituitary gland hormone leads to an overactive adrenal gland. A similar condition called Cushing's syndrome may occur in people, particularly children, who take high doses of corticosteroid medications. •Gigantism (acromegaly) and other growth hormone problems. If the pituitary gland produces too much growth hormone, a child's bones and body parts may grow abnormally fast. If growth hormone levels are too low, a child can stop growing in height. •Hyperthyroidism. The thyroid gland produces too much thyroid hormone, leading to weight loss, fast heart rate, sweating, and nervousness. The most common cause for an overactive thyroid is an autoimmune disorder called Grave's disease. •Hypothyroidism. The thyroid gland does not produce enough thyroid hormone, leading to fatigue, constipation, dry skin, and depression. The underactive gland can cause slowed development in children. Some types of hypothyroidism are present at birth. •Hypopituitarism. The pituitary gland releases little or no hormones. It may be caused by a number of different diseases. Women with this condition may stop getting their periods. •Multiple endocrine neoplasia I and II (MEN I and MEN II). These rare, genetic conditions are passed down through families. They cause tumors of the parathyroid, adrenal, and thyroid glands, leading to overproduction of hormones. •Polycystic ovary syndrome (PCOS). Overproduction of androgens interfere with the development of eggs and their release from the female ovaries. PCOS is a leading cause of infertility. -Precocious puberty. Abnormally early puberty that occurs when glands tell the body to release sex hormones too soon in life.

Answer 97

an illness caused by a microbe—an organism too small to be seen with the naked eye. Disease causing microbes are bacteria, virus, fungi and protozoa (a type of parasite). These are what most people call “germs.” Most infectious diseases will be caused by 1 of the 4 types of germs: bacteria- single-celled organisms that reproduce themselves, by themselves; virus- unlike bacteria, viruses cannot reproduce themselves, they take over the cells they infect in order to reproduce and spread; fungi- look like plants, but live off animals, people and plants (ex. mushrooms and yeast); protozoa- small parasites that live in water and live off other organisms, such as humans (ex. malaria).

Answer 98

- Influenza, MRSA, Norovirus and Bloodborne pathogens. Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness and at time can lead to death. Some people, such as older people, young children and people w/ certain health conditions are at high risk for serious flu complications. The flu is usually more severe than a cold and includes symptoms of fever, body aches, extreme tiredness and dry cough. It is mostly spread in respiratory droplets of coughs and sneezes. MRSA refers to Methicillin-Resistant Staphylococcus Aureus, a type of staph infection that are resistant to a type of antibiotic methicillin and other types of antibiotics. Staph infections, including MRSA occur most frequently among persons in hospitals and healthcare facilities who have weakened immune systems. These healthcare associated staph infections include surgical wound infections, urinary tract infections, bloodstream infections and pneumonia. Staph or MRSA infection in the community are usually manifested as skin infections that look like pimple or boils and occur in otherwise healthy people. - Noroviruses are a group of viruses that cause acute gastroenteritis (stomach bugs). The most common symptoms of acute gastroenteritis are diarrhea, vomiting, and stomach pain. Norovirus is the official genus name for the group of viruses previously described as “Norwalk-like viruses.” - Viruses carried by blood are known as bloodborne pathogens (disease producing microorganisms found in the blood). Diseases classified as bloodborne include Viral Hepatitis and HIV/AIDS. "Hepatitis" means inflammation of the liver and also refers to a group of viral infections that affect the liver . The most common types are Hepatitis A, Hepatitis B, and Hepatitis C. Viral hepatitis is the leading cause of liver cancer and the most common reason for liver transplantation. An estimated 4.4 million Americans are living with chronic hepatitis; most do not know they are infected. Hepatitis A is a liver disease that results from infection with the Hepatitis A virus. It can range in severity from a mild illness lasting a few weeks to a severe illness lasting several months. Hepatitis A is usually spread when a person ingests fecal matter — even in microscopic amounts — from contact with objects, food, or drinks contaminated by the feces or stool of an infected person. Hepatitis B is caused by infection with the Hepatitis B virus (HBV). The incubation period from the time of exposure to onset of symptoms is 6 weeks to 6 months. HBV is found in highest concentrations in blood and in lower concentrations in other body fluids (e.g., semen, vaginal secretions, and wound exudates). HBV infection can be self-limited or chronic. Hepatitis C virus (HCV) infection is the most common chronic bloodborne infection in the United States; approximately 3.2 million persons are chronically infected. Although HCV is not efficiently transmitted sexually, persons at risk for infection through injection drug use might seek care in STD treatment facilities, HIV counseling and testing facilities, correctional facilities, drug treatment facilities, and other public health settings where STD and HIV prevention and control services are available.Hepatitis D, also known as "delta hepatitis," is a serious liver disease caused by infection with the Hepatitis D virus (HDV), which is an RNA virus structurally unrelated to the Hepatitis A, B, or C viruses. Hepatitis D, which can be acute or chronic, is uncommon in the United States. HDV is an incomplete virus that requires the helper function of HBV to replicate and only occurs among people who are infected with the Hepatitis B virus (HBV). HDV is transmitted through percutaneous or mucosal contact with infectious blood and can be acquired either as a coinfection with HBV or as superinfection in persons with HBV infection. There is no vaccine for Hepatitis D, but it can be prevented in persons who are not already HBV-infected by Hepatitis B vaccination. Hepatitis E is a serious liver disease caused by the Hepatitis E virus (HEV) that usually results in an acute infection. It does not lead to a chronic infection. While rare in the United States, Hepatitis E is common in many parts of the world. Transmission: Ingestion of fecal matter, even in microscopic amounts; outbreaks are usually associated with contaminated water supply in countries with poor sanitation. Vaccination: There is currently no FDA-approved vaccine for Hepatitis E.

Answer 99

A developmental disorder that is characterized by problems controlling movement. A non-progressive disorder. CP can be classified by limb involvement (quadriplegia, paraplegia, diplegia, hemiplegia, triplegia or monoplegia) or by exhibited symptoms (spasticity, athetosis or ataxia). The type and severity of cerebral palsy will depend on the location and extent of brain damage. The damage can occur before birth, during birth, and after birth.

Answer 100

All will have difficulty controlling body movement. Lack of balance, tremors, stiffness, jerky involuntary movements, poor control of facial muscles, difficulty sitting, standing, grasping, walking, etc. Accompanying or associated problems: speech and language difficulties, mental retardation, visual impairments (eye muscle imbalance problems), hearing impairment, emotional and social adjustment issues and seizures. Common Features of CP: Difficulties in communication due to dysarthria, impaired ability to articulate sounds for words due to poor control of voluntary muscles involved in the production of speech or to limitations in processing and using language- aphasia, the loss or lack of the ability to speak. CP is NOT inherited. Life long condition but with early intervention and therapeutic management geared to habilitation and rehabilitation, individuals may be able to maximize their ability to perform daily life skills independently.

Answer 101

Primary etiological (cause of a disease or abnormal condition) factor in CP is injury to the motor cortex of the brain due to anoxia (absence of oxygen supply to an organ or tissue) during the birth process or following birth. Infections of the brain and it linings (meningitis, encephalitis), exposure to toxic substances such as lead, absorption by the fetus of alcohol or drugs and severe malnutrition can cause CP. Majority of individuals w/ CP have a congenital form, but the disorder can be acquired at any point during the developmental period due to head trauma resulting from auto accidents, falls and physical abuse. Environmental causes of cerebral palsy may be: (1) accidental head injury (e.g., injury resulting from a car accident) and (2) child abuse. Recent studies document that for as many as 25% of abused children with cerebral palsy, the abuse caused the condition. Sexual abuse and Cerebral Palsy- Among children with disabilities, children with cerebral palsy are at highest risk for sexual abuse. In approximately 99% of the reported cases of sexual abuse of children with cerebral palsy, the abuser is well known to the child.

Answer 102

Based on the quality of movement produced and the parts of the body affected. No 2 individuals w/ CP will manifest exactly the same characteristics. Basic categories: Spastic type- characterized by hypertonus muscle (stiff and their movements may look stiff and jerky) and is the most common form. Athetoid type- characterized by wavelike, uncoordinated movements. Muscles may also exhibit hypotonus. Ataxic type- primarily affects the individual’s balance. Gait may be unsteady and poorly coordinated. Rigidity- quality can also be found with other types and may be intermittent. Tremor- intention tremor, an involuntary movement with a regular rhythm, may occur when the individual is making a directed movement. Resting tremor can occur at any time. Tremor may occur in combination with other types. Cerebral palsy is further classified according to the part of the body and number of limbs affected: Monoplegia- 1 arm or leg. Paraplegia- both legs. Hemiplegia- 1 side of the body, both limbs. Triplegia- 3 limbs. Quadriplegia- ALL 4 limbs. Degree of Severity of Muscle Control (also used to classify): Mild impairment- usually ambulatory; speech is understandable. Moderate- some impairment of mobility, may require assistive device for ambulation, speech is impaired. Severe- uses wheelchair for mobility, unable to use speech.

Answer 103

Children w/ CP should be stimulated and encouraged to move in order to develop gross motor skills (ability to use large muscle groups that coordinate body movements, ex. walking), eye-hand coordination, to develop and improve spatial/motor concepts and to improve their sense of vestibular balance (sense of balance). Young children w/ CP need activities that provide adapted physical education and adapted aquatics sessions. Muscle atrophy and reduced range of motion can result from prolonged inactivity and disuse. Adolescents and adults w/ CP should be encouraged to participate in physical activities in order to prevent atrophy and reduced range of motion. Spasticity and hypertonus are exacerbated by cold. Swimming in warm water (95 degrees) relaxes and lengthens the muscle fibers and will increase range of motion (ROM).

Answer 104

Adaptions of equipment used in sports, and art activities will be required in many cases. Individuals with CP experience difficulty organizing and coordinating their movements: activities that call for adherence to a pattern of movement or to a fixed rhythm, as in aerobic dancing, can be overly frustrating for them. Expressive modalities such as art, music, photography and writing, using assistive technology can expand the range of communication and the social network for the individual w/ CP. Intellectual functioning of the individual needs to be taken into account in recommending specific activities and in modifying some aspects of an activity. Some individuals w/ CP have seizures and this may limit an individual’s participation in certain types of activities. Factors relevant to an individual’s seizure threshold, such as temperature and degree of emotional stimulation, will have to be taken into account. Sensory impairments such as visual and auditory difficulties also have to be considered in selecting modalities to work with and in adapting communication and instruction to individual needs. Neuromuscular disorder- athetosis: involuntary motor movement, spasticity; speech disturbance; poor balance=ataxia; stiffness, non-progressive: is not degenerative. TR: relaxation, water aerobics, social activities, Increases self confidence. Primarily a TRS will work w/ individual w/ CP in community settings or camps.

Answer 105

Group of progressive related diseases that affect the musculoskeletal system. Neuromuscular conditions caused by a genetic defect in protein metabolism, which affects the production of muscle tissue on the cellular level. Primary symptom is weakness in the movements of the affected muscles. Muscle tissue wastes away and is replaced by connective tissue or by fat. The wasting of muscle tissue affects not only voluntary movement but also static posture (physical exertion in which the same posture or position is held throughout the exertion. These types of exertions put increased loads or forces on the muscles and tendons, which contributes to fatigue) and respiratory function. With MD, nerve impulses transmitted over efferent nerve fibers (carry nerve impulses away from the central nervous system to effectors such as muscles or glands and also the ciliated cells of the inner ear) to the voluntary muscles (muscle whose action is normally controlled by an individual's will) do not produce an effect because the muscle tissue has atrophied and is not capable of responding. Early symptoms are difficulty in climbing stairs and in rising from a recumbent posture. Usually there is a swayback posture and a waddling gait caused by weak gluteal muscles. Most of the varieties of MD have an early onset with a slow a progression. Other varieties of MD occur in the 2nd to 3rd decades and may affect facial muscles, shoulder girdles or both limb girdles. Diagnosis of MD is confirmed by analysis of cerebrospinal fluid (CSF) and by serum proteins, muscle biopsies, tests of muscle strength and by respiratory tests. Early Onset- Duchennes or childhood muscular dystrophy is the most severe and common form of MD. Affects male children who begin to show symptoms by the age of 2 or 3. A progressive disease. Duchennes dystrophy is usually manifested by the age of 6. Its progression is rapid, by the age of 10, most children w/ Duchennes are in wheelchairs. Spinal Muscular atrophy (SMA) and Friedrich’s ataxia (FA) are the other types of childhood muscular dystrophy. Duchennes and Spinal Muscular atrophy (SMA) affect the deltoid muscles of the shoulders, impairing the child’s ability to raise and lower the arms and restricting range of motion (ROM) and the spine itself, causing frequent falling and poor balance. In Duchenns and SMA types, the diaphragm and intercostal muscles of the rib cage become weakened and this affects respiration. Shallow breathing leads to frequent pulmonary infections and greater fatigue. Friedrich’s ataxia (FA) manifests itself in early adolescence and is inherited as an autosomal recessive trait. There is atrophy with demyelinization (degenerative process that erodes away the myelin sheath that normally protects nerve fibers and causes problems in nerve impulse conduction that affects many physical systems) of involving the posterior columns and spinocerebellar and corticospinal tracts of the spinal cord. In an attempt to compensate for poor balance, the person with FA walks with a wide-based gait. The life span of those with early onset forms of MD is shortened. Most will only live until their 2nd decade. Adult Onset Varieties- These are limb girdle dystrophy (LGD), fascioscapular-humeral dystrophy (FSH) and amyotrophic lateral sclerosis (ALS). ALS progresses the most rapidly of all the late-onset dystrophies and is always fatal. In limb girdle dystrophy (LGD) the muscles of the pelvic girdle are primarily affected. The degree of muscle weakness ranges from mild to severe. IN ALS and fascioscapular-humeral dystrophy (FSH) the muscles of the tongue, lips and jaw are ultimately affected, making verbal communication difficult and in some cases, impossible. FSH also affects the deltoid muscles of the upper shoulder and the scapula. The progression of FSH tends to be more gradual than in other adult onset types. Advances in computerized technology can facilitate communication for some individuals with advanced cases of ALS and FSH, but there is an increase in social isolation. There is no loss of intellectual disability with any of the dystrophies and pincer grasp (the ability to use the thumb and forefinger in opposition to pick up or grasp small objects) is usually retained until the final stages. By adolescence, most persons who have Duchennes use a wheelchair and by adulthood usually are confined to a bed. Most men w/ Duchennes die in their early 20s. There are 2 other types of MD that affect adults: facio-scapulo-humeral and limb-girdle. These types affect both males and females. Important to understand the effects of MD on the person’s leisure, help them make necessary adaptations and as the MD progresses help the person and the families deal with the changes. Most TRS will work with persons who have MD in a community or camp setting.

Answer 106

Limitations- Due to the progression of the disease of both early and adult onset types, there will be a steady reduction in the individual’s ROM and muscle strength. Rate of progression varies for each individual and will necessitate ongoing, periodic assessment of ROM, muscle strength, and evaluation and grading of functional abilities. The psychosocial and psychosexual development of children w/ these early onset varieties of MD is delayed due to their reduced ability to participate with age peers, which leads to isolation and marked restriction of their experiences. Eventually, they are unable to perform many self care skills independently, such as dressing, washing, feeding and toileting themselves. Dependency in turn lowers their self-esteem and self-confidence, which further inhibits socialization. Individuals should be encouraged to do as much for themselves as possible. The adaption of household tools, including the telephone and television, can make it possible for the person to be more independent. Moderate physical activity should be encouraged within the capabilities of the individual. Usually fine motor control and pincer grasp are retained until the final stage, making writing, artistic expression, and many craft projects possible. Loss of self-esteem and depression are psychological affects of the progressive reduction of personal abilities. They can be countered by creating opportunities for the individual to experience success and social validation through volunteer work, exhibiting artwork, involvement in advocacy work, and participation in support and social groups. Leisure counseling throughout the course of the disease process can help the individual focus on utilizing the intellectual and creative capacities, which do not diminish. Intellectual and expressive activities such as poetry writing, current events discussions, reading, journalism and calligraphy could be a source of continuing gratification and pride for the person w/ MD. Due to the tendency to withdraw into social isolation, the person should be encouraged to maintain contact with friends by telephone and letter writing. For ALL adults w/ MD, major changes in work and social activities will be necessary as the condition progresses and abilities diminish. Individual who is part of a couple will become more dependent upon his/her partner for caretaking w/ dressing, feeding, toileting, and personal care. This may make the individual feel more like a dependent child than an adult. There is an impact on the couple’s sexual relationship dues to the limitations that restrict movement, as well as from the feelings of inadequacy, loss of self-esteem and general feelings of unattractiveness that negatively affects sexual expression. Support groups in addition to individual counseling can be extremely helpful to adults as well as adolescents w/ MD, by helping individuals deal with the “mourning” of lost abilities and by cultivating new sources of self-esteem. Individual w/ MD needs to be included in family gatherings and activities to the fullest extent possible. Participation in a support group or in structured leisure activities provided by a local chapter of the MD association is desirable to optimize socialization and active participation throughout the course of the disease. Loss of respiratory function and shallow breathing are the causes of most secondary infection among those w/ MD and exacerbate fatigue. Proper positioning in the wheelchair and the importance of deep breathing need to be promoted. Yoga breathing (diaphragmatic breathing) should be taught as a tool for maximizing lung volume and maintaining good lung function.

Answer 107

Maintain muscle tone-promote movement, accomplishment, exercise, aquatics, assistive devices, promote creativity through crafts.

Answer 108

Spine consists of 30 vertebrae arranged in a column surrounding the spinal cord. Neural messages to and from the brain are transported by the cord. Any damage to the cord itself will result in impairment of this function. The nature and degree of the impairment depend on the location and extent of the injury. Injuries to the spinal cord are not reversible, but it is possible for a person w/ a spinal cord injury (SCI) to reestablish some degree of voluntary control over muscles located even below the site of the injury, with physical therapy augmented by biofeedback training (a technique you can use to learn to control your body's functions, such as your heart rate. With biofeedback, you're connected to electrical sensors that help you receive information (feedback) about your body (bio). This feedback helps you focus on making subtle changes in your body, such as relaxing certain muscles, to achieve the results you want, such as reducing pain). A complete injury to the cord results in total loss of sensation and movement below the site of the injury. A partial injury to the cord results in some loss of sensation and diminution of mobility, depending on location and extensiveness of the injury. Fractures of the thoracic and lumbar vertebrae can be repaired in some cases through surgery to realign them in the hop that they will fuse. With a cervical fracture, a metal device known as a “halo” is worn by the patient in an effort to achieve realignment externally. SCI is usually the result of a traumatic injury and happens suddenly. The term ‘spinal cord injury’ refers to damage to the spinal cord resulting from trauma (e.g. a car crash) or from disease or degeneration (e.g. cancer). There is no reliable estimate of global prevalence, but estimated annual global incidence is 40 to 80 cases per million population. Every year, around the world, between 250 000 and 500 000 people suffer a spinal cord injury (SCI). Up to 90% of these cases are due to traumatic causes, though the proportion of non-traumatic spinal cord injury appears to be growing. Males are most at risk in young adulthood (20-29 years) and older age (70+). Females are most at risk in adolescence (15-19) and older age (60+). Studies report male-to-female ratios of at least 2:1 among adults, sometimes much higher. Most frequent causes are automobile accidents and accidents resulting from participation in high-risk sports like diving, motorcycle riding, and surfing.

Answer 109

Injury can be to the vertebrae (fractures of compressions) or to the spinal cord itself. Vertebrae are arranged by area of the body in which they are located. Cervical (region of the neck and shoulders), thoracic (chest and trunk to the top of the pelvis), lumbar region (lower back, top and posterior of the pelvis) and sacral area. Each vertebrae is numbered and preceded by the alphabetical letter corresponding to its region of the body. Injuries are classified by referring to the letter of the area of the body in which the injury is located (C, T, L, S) and by the number of the vertebrae affected. Ex.- vertebrae in the neck region are numbered C1-C8. There are 12 vertebrae in the thoracic region, number T1-T12. Vertebrae in the lumbar region are number L1-L5 and vertebrae of the sacral area are numbered S1-S5. Injury to the cord at the L5 level will cause a loss of sensation and movement in the legs and may cause incontinence of bowel and bladder due to loss of sensation. Classification of SCI is also made according to the degree of voluntary function and sensation: partial or complete and according to the number of body parts affected, paraplegia (both limbs affected) and quadriplegia (all limbs affected). With a COMPLETE INJURY, there will be NO motor function and NO sensation below the level of injury. With an INCOMPLETE INJURY, there will be some motor function and some sensation will be present below the level of injury. The higher the location of the site of injury, the more severe the impairment of movement will be since nerve transmission to muscles located below the level of injury will be interrupted. Cervical—Vertebrae in the neck region are numbered C1—C8. Damage at the level of the 4th cervical vertebra is referred to as a “C4 injury.” Since any injury to the spine results in loss of sensation and movement (complete or partial) to areas below the site of injury, injury to the cord at the C2 level (referred to as a “high cord” injury) will affect everything from the upper neck down to the toes. Persons with high-level cervical injuries (C1-C3) will usually need to use motorized wheelchairs equipped w/ sip and puff switches, as their movements will be very limited. Cervical level injuries cause paralysis or weakness in both arms and legs (quadriplegia). All regions of the body below the level of injury or top of the back may be affected. Sometimes this type of injury is accompanied by loss of physical sensation, respiratory issues, bowel, bladder, and sexual dysfunction. This area of the spinal cord controls signals to the back of the head, neck and shoulders, arms and hands, and diaphragm. Since the neck region is so flexible it is difficult to stabilize cervical spinal cord injuries. Patients with cervical level injuries may be placed in a brace or stabilizing device. Thoracic—There are 12 vertebrae in the thoracic region, number T1—T12. Injury at this level will affect muscles of the back and chest. Trunk stability will be poor, requiring support and stabilization. The patient will be able to use a manual wheelchair independently. Injury at this level may cause incontinence of bowel and bladder due to loss of sensation and voluntary control of the muscles involved. Thoracic level injuries are less common because of the protection given by the rib cage. Thoracic injuries can cause paralysis or weakness of the legs (paraplegia) along with loss of physical sensation, bowel, bladder, and sexual dysfunction. In most cases, arms and hands are not affected. This area of the spinal cord controls signals to some of the muscles of the back and part of the abdomen. With these types of injuries most patients initially wear a brace on the trunk to provide extra stability. Lumbar—Vertebrae of the lumbar region are numbered L1—L5. Any injury at this level will affect flexion of the hips and movement of the legs. A person with an injury at this level may be able to ambulate independently using assistive devices. Lumbar level injuries result in paralysis or weakness of the legs (paraplegia). Loss of physical sensation, bowel, bladder, and sexual dysfunction can occur. The shoulders, arms, and hand function are usually unaffected. This area of the spinal cord controls signals to the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the leg. These injuries often require surgery and external stabilization. Sacral—Vertebrae of the sacral area are numbered S1—S5. Persons may have control of bowel and bladder functions. Sexual functioning may be normal. Sacral level injuries primarily cause loss of bowel and bladder function as well as sexual dysfunction. These types of injuries can cause weakness or paralysis of the hips and legs. This area of the spinal cord controls signals to the thighs and lower parts of the legs, the feet, and genital organs.

Answer 110

Injuries may involve the vertebrae w/ or w/out damage to the spinal cord. These injuries are classified as: 1) Fracture dislocation; 2) Compression fracture; 3) Hyperextension injury. Damage to the cord itself can be detected by the used of X-rays, myelograms (radiographic examination that uses a contrast medium to detect pathology of the spinal cord) and tomograms. Generally, the greatest readjustment to the disability will occur during the first 6 months following the injury. Long-term treatment involving an interdisciplinary rehabilitation team will focus on helping the individual to redevelop self-esteem and a sense of self-worth, develop coping skills, develop a support system, develop an appropriate leisure lifestyle that maximizes independent functioning, reenter vocational training or develop an educational plan and engage in rehabilitation for mobility, work and sexual functioning. Includes persons who have paraplegia or quadriplegia. Spinal cord injuries are usually acquired through trauma. The level of injury is identified by the initial area of the spinal cord where the lesion occurs. A person whose cord is severed above the 2nd thoracic vertebra (T2) has quadriplegia and a person who has an injury at or below the 2nd thoracic vertebra has paraplegia. The lesion can be labeled complete or incomplete.

Answer 111

Individual w/ an SCI injury suffers greatly from the psychological ramifications of the disorder, as well as from the physical changes in functioning brought about by the damage to the spinal cord or vertebrae. Self-image of the individual changes from that of an active and independent person to one dependent on others for personal care and one who may not even be in control of basic bodily needs and functions. These effects, combined w/ the effects of the injury on independent functioning, may have a devastating impact on the individual’s leisure lifestyle in the absence of interventions such as leisure counseling. Depression, denial, and anger are commonly experienced as the individual struggles to adapt to the limitations and losses brought about from the injury. The individual’s social and sexual functioning undergo dramatic changes as a result, as many aspects of self-image, body image and sexuality are interrelated. The ability to achieve erection and orgasm will depend on the level of injury to the cord. A sex therapist can assist the individual in examining values on which his/her ideals of sexual functioning and identity are based, facilitate in the development of more positive self image and help the partner in the relationship develop creative and loving ways of relating. Individual with SCI experiences several types of pain: pain above the level of the lesion, which may affect muscles, joints and tendons; pain at the level of the lesion (hypesthesia) and pain below the level of the lesion (phantom pain or paresthesia). Pain may decrease or limit interest in participation in leisure activity and may increase depression. The use of self-hypnosis, mediation and relaxation techniques may reduce perceived pain. Respiratory problems, including difficulty in coughing, are common in instances of high cervical or thoracic damage. These individuals require careful respiratory management. Deep breathing exercises and frequent changes of position help prevent the formation of a pulmonary embolism (when one or more pulmonary arteries in your lungs become blocked. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from the legs or rarely other parts of the body deep vein thrombosis, or DVT). Those with severely compromised respiration may require a respirator. Changes in blood pressure and circulation, which result from the injury, necessitate ensuring that the person is properly dressed and insulated. Phlebitis (inflammation of the walls of veins), hypotension (abnormally low blood pressure, heart, brain and other parts of the body do not get enough blood) and cardiac arrhythmias (problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm. A heartbeat that is too fast is called tachycardia) can also develop and those w/ these conditions need to have their physical activity level monitored closely. Physical activity performed at high intensity or for long durations would be contraindicated (of a condition or circumstance suggest or indicate that (a particular technique or drug) should not be used in the case in question). Generally, SCI results in disturbed bowel and bladder functions. This needs to be taken into consideration in planning for outings or swimming activities. Urinary infections are common and symptoms need to be monitored by the individual and the therapist. It is important for the entry-level TRS to understand the effects of the location of the lesion and what it means when a lesion is complete or incomplete on a person’s functioning level. The TRS is expected to help the individual use his residual skills to regain as much independence as possible and to assist in the treatment of secondary conditions such as depression or adjustment to disability. It is important to understand the treatment protocols for persons with spinal cord injury, the benefits of TR and equipment adaptations. Community reintegration is an important treatment component for persons who are coping with spinal cord injury.

Answer 112

Disease that impacts the nervous system. It is commonly diagnosed in individual who are between the ages of 20 and 50. MS causes deterioration of the myelin sheath. Cause of the disease is unknown, but it has been strongly suggested that it may result from the individuals’ exposure to a virus that causes them to produce antibodies that then attack the myelin sheathing protecting their nerves and spine. Myelin is a fatty substance that coats and insulates the nerve cells in the spinal cord and brain. The destruction of the myelin, a process called demyelination, causes scar tissue (sclera) to form in place of the myelin, a process called gliosis. The symptoms of MS result from the demyelination of the spinal cord, peripheral nerves, midbrain, and cerebrum. The lesions, or sclera interfere with the transmission of nerve impulses to various parts of the body and produce characteristic symptoms of numbness, blurred or double vision, impaired coordination, dragging of the feet, intention tremor of the hand and partial or complete paralysis of parts of the body, among others. The location and extent of the scarring will determine the specific symptoms and the functional impairments the individual experiences. More than 2.3 million people are affected by MS worldwide. Because the Centers for Disease Control and Prevention (CDC) does not require U.S. physicians to report new cases, and because symptoms can be completely invisible, the prevalence of MS in the U.S. can only be estimated. More than two to three times as many women as men develop MS and this gender difference has been increasing over the past 50 years. Studies suggest that genetic risk factors increase the risk of developing MS, but there is no evidence that MS is directly inherited. Environmental factors, such as low Vitamin D and cigarette smoking have also been shown to increase the risk of MS. MS occurs in most ethnic groups, including African-Americans, Asians and Hispanics/Latinos, but is most common in Caucasians of northern European ancestry. There is no set pattern of symptoms, but commonly a person has speech disturbances, balance problems, vertigo, blurred vision, walking difficulties and tremors. There is a pattern of exacerbation and remission, but there is never a complete recovery to the original functioning level. Most people are diagnosed between the ages of 20 and 50, although MS can occur in young children and significantly older adults. The disease is noncontagious. A lifelong condition and there is no known cure. The treatments are focused on symptom reduction and management. The goal is to maximize the individual’s independent functioning and to maintain as much of his/her pre-illness lifestyle as possible.

Answer 113

Today multiple sclerosis (MS) is not a curable disease. Effective strategies can help modify or slow the disease course, treat relapses (also called attacks or exacerbations), manage symptoms, improve function and safety, and address emotional health. The model of comprehensive MS care involves the expertise of many different healthcare professionals — each contributing in a unique way to the management of the disease and the symptoms it can cause. For most people with MS, the neurologist functions as the leader of the team. Modifying the disease course- There are 10 disease-modifying medications to treat relapsing forms of MS. Treating exacerbations- An exacerbation of MS is caused by inflammation in the central nervous system (CNS) that causes damage to the myelin and slows or blocks the transmission of nerve impulses, Managing symptoms-MS symptoms can be effectively managed with a comprehensive treatment approach that includes medication(s) and rehabilitation strategies. Promoting function through rehabilitation- rehabilitation programs focus on function — they are designed to help you improve or maintain your ability to perform effectively and safely at home and at work. Rehabilitation professionals focus on overall fitness and energy management, while addressing problems with accessibility and mobility, speech and swallowing, and memory and other cognitive functions. Rehabilitation is an important component of comprehensive, quality healthcare for people with MS at all stages of the disease. Rehabilitation programs include cognitive and vocational rehabilitation, physical and occupational therapy, therapy for speech and swallowing problems, and more. Providing emotional support-comprehensive care includes attention to emotional health as well as physical health. Mental health professionals provide support and education, as well as diagnose and treat the depression, anxiety and other mood changes that are so common in MS. Neuropsychologists assess and treat cognitive problems.

Answer 114

Each individual case of MS presents a unique pattern of symptoms. Since the course of the disease waxes and wanes with episodes of exacerbations followed by period of remission, MS is classified mainly by the major parts of the body affected and by the symptoms. Ex.- If demyelination affects the optic nerve, the individual could experience blurred vision or a “blind spot in the middle of the field of vision.” This symptom will usually disappear in a day or so and may never recur or it may return sporadically. Symptoms may be classified as sensory (vision, numbness and tingling sensations), muscular (intention tremor, spasticity, muscle weakness, lack of coordination and poor control of bowel and bladder), vestibular (dizziness and loss of balance) and emotional (depression, secondary to impairment and loss of functioning). There is no loss of intellectual functioning throughout the course of the disease. Although return to normal functioning is possible during a period of remission from symptoms, it is no uncommon for individuals to lose functional abilities, never to regain them. Increased dependency on others for personal care may occur over time. Diagnosis of MS is difficult because the symptoms are so variable and the initial presentation may look like other disorders. Analysis of Spinal fluid- Cerebrospinal fluid (CSF) is a clear, colorless liquid that bathes the brain and spinal cord. While the primary function of CSF is to cushion the brain within the skull and serve as a shock absorber for the central nervous system, CSF also circulates nutrients and chemicals filtered from the blood and removes waste products from the brain. Examining the fluid can be useful in diagnosing many diseases of the nervous system, including MS. CSF is obtained by doing a lumbar puncture or “spinal tap” — most often with the person lying on his or her side. After cleansing and injecting an anesthetic into the area, a long, thin, hollow needle is inserted between two bones in the lower spine and into the space where the CSF circulates. One to two tablespoons of the fluid are withdrawn through the syringe. The CSF of people with MS usually contains- elevated levels of IgG antibodies, as well as a specific group of proteins called oligoclonal bands and occasionally there are also certain proteins that are the breakdown products of myelin. These findings indicate an abnormal immune response within the central nervous system, meaning that the body is producing an immune response against itself. Other methods to confirm the diagnosis of MS involves the use of computerized axial tomography (CAT scans) and myelograms or angiograms to detect and localize areas of demyelinination and scarring. Magnetic resonance imaging (MRI) is the diagnostic tool that currently offers the most sensitive non-invasive way of imaging the brain, spinal cord, or other areas of the body. It is the preferred imaging method to help establish a diagnosis of MS and to monitor the course of the disease. MRI has made it possible to visualize and understand much more about the underlying pathology of the disease. Relapsing-remitting MS (RRMS): the most common disease course — is characterized by clearly defined attacks of worsening neurologic function. These attacks — also called relapses, flare-ups or exacerbations — are followed by partial or complete recovery periods (remissions), during which symptoms improve partially or completely and there is no apparent progression of disease. Approximately 85 percent of people. Relapsing-remitting multiple sclerosis (RRMS) is characterized by clearly defined attacks of worsening neurologic function. These attacks — often called relapses, flare-ups or exacerbations — are followed by partial or complete recovery periods (remissions), during which symptoms improve partially or completely, and there is no apparent progression of disease. RRMS is the most common disease course at the time of diagnosis. Approximately 85 percent of people are initially diagnosed with RRMS, compared to 10-15 percent with progressive forms of the disease. The most common symptoms reported in RRMS include episodic bouts of fatigue, numbness, vision problems, spasticity or stiffness, bowel and bladder problems, and problems with cognition (learning and memory or information processing). People with progressive forms of MS are more likely to experience gradually worsening problems with walking and mobility, along with whatever other symptoms they may have. Secondary-progressive MS (SPMS)- The name for secondary-progressive multiple sclerosis (SPMS) comes from the fact that it follows after the relapsing-remitting disease course (RRMS). Of the 85 percent of people who are initially diagnosed with RRMS, most will eventually transition to SPMS, which means that after a period of time in which they experience relapses and remissions, the disease will begin to progress more steadily (although not necessarily more quickly), with or without any relapses (also called attacks or exacerbations).SPMS occurs in people who initially had a relapsing-remitting disease course. In other words, SPMS occurs as a second phase of the disease for many individuals. Primary-progressive MS (PPMS) is the first — and only — phase of the illness for approximately 10 percent of people with MS. In SPMS, people may or may not continue to experience relapses caused by inflammation; the disease gradually changes from the inflammatory process seen in RRMS to a more steadily progressive phase characterized by nerve damage or loss. People with PPMS never experience any relapses. While the disease-modifying therapies may be effective for some people with SPMS who are still experiencing relapses, none of these medications have been shown to be beneficial in PPMS. Primary-progressive MS (PPMS)- Primary-progressive multiple sclerosis (PPMS) is characterized by steady worsening of neurologic functioning, without any distinct relapses (also called attacks or exacerbations) or periods of remission. A person’s rate of progression may vary over time — with occasional plateaus or temporary improvement — but the progression is continuous. Although there is a lot of variability among people with PPMS, we know that as a group, they differ in several ways from people with relapsing forms of MS: Relapsing forms of MS (including relapsing-remitting MS, and secondary-progressive and progressive-relapsing MS in those individuals who continue to experience relapses) are defined by inflammatory attacks on myelin. PPMS involves much less inflammation of the type seen in relapsing MS. As a result, people with PPMS tend to have fewer brain lesions (also called plaques) than people with relapsing MS and the lesions tend to contain fewer inflammatory cells. People with PPMS also tend to have more lesions in the spinal cord than in the brain. Together, these differences make PPMS more difficult to diagnose and treat than relapsing forms of MS. In the relapsing forms, women are affected two to three times as often as men; in PPMS, the numbers of women and men are approximately equal. The average age of onset is approximately 10 years later in PPMS than in relapsing MS. People with PPMS tend to experience more problems with walking and more difficulty remaining in the workforce. In general, people with PPMS may also require more assistance with their everyday activities. Progressive-relapsing MS (PRMS)- Progressive-relapsing multiple sclerosis (PRMS) is the least common of the four disease courses, occurring in approximately five percent of people with MS. Like those with primary-progressive MS (PPMS), people with PRMS experience steadily worsening neurologic function — disease progression — from the very beginning, in addition to occasional relapses like those experienced by people with relapsing-remitting MS. Because PRMS is progressive from onset, it may be initially diagnosed as PPMS, and then subsequently changed to PRMS when a relapse occurs. Although this disease course is progressive from the outset, each person’s symptoms and rate of progression will be different.

Answer 115

MS is a dynamic disorder and the patient’s condition will vary, necessitating frequent assessment of functioning and modification of activities. The stresses of adapting to lifestyle changes and the discomfort of symptoms may create a depressed mood and irritability. Stress and fatigue can in turn exacerbate symptoms. Symptoms of MS become worse upon exposure to heat and persons w/ MS should remain in air conditioned rooms in hot weather. Swimming in cool water can be very beneficial for reduction of symptoms since cold increases the transmission of nerve impulses and the range of motion. Leisure counseling is helpful to guide the patients in selecting and modifying activities as the individual’s condition changes and in maintain as much of his/her previous leisure lifestyle as possible. Support groups have also be found to be helpful in helping them to maintain morale and to exchange information about new types of treatments. Medications that are used to relax rigid muscles such as Valium, produce symptomatic improvement but may also create the undesirable side effects of drowsiness. Inderal may be used to reduce hand tremor. Corticosteroids (prednisone, prednisolone, adrenocorticotropic hormone, etc.) are used to reduce joint inflammation which causes pain and restricts movement. These drugs also produce the unpleasant side effects of fluid retention and weight gain, gastrointestinal irritation and headache. Relaxation training, meditation and modified yoga exercises have been found to promote relaxation of muscles and produce a general sense of well-being. Most people with MS remain ambulatory and never need a wheelchair, so moderate physical exercise should be encouraged. A walking stick can help those whose balance is affected. Individuals w/ MS should be integrated into family and other social activities so that the individuals retain as much of their pre-illness lifestyle as possible. Support groups and special activity groups provided by the local MS chapter can be helpful.

Answer 116

Muscle spasms, loss of sensation, bladder control. Physical & emotional changes.

Answer 117

Social activities, success-oriented, Range of Motion.

Answer 118

a progressive disorder of the nervous system that affects your movement. It develops gradually, sometimes starting with a barely noticeable tremor in just one hand. But while a tremor may be the most well-known sign of Parkinson's disease, the disorder also commonly causes stiffness or slowing of movement. In the early stages of Parkinson's disease, your face may show little or no expression or your arms may not swing when you walk. Your speech may become soft or slurred. Parkinson's disease symptoms worsen as your condition progresses over time. Although Parkinson's disease can't be cured, medications may markedly improve your symptoms. In occasional cases, your doctor may suggest surgery to regulate certain regions of your brain and improve your symptoms. Parkinson's signs and symptoms may include: Tremor. Your tremor, or shaking, usually begins in a limb, often your hand or fingers. You may notice a back-and-forth rubbing of your thumb and forefinger known as a pill-rolling tremor. One characteristic of Parkinson's disease is a tremor of your hand when it is relaxed (at rest). Slowed movement (bradykinesia). Over time, Parkinson's disease may reduce your ability to move and slow your movement, making simple tasks difficult and time-consuming. Your steps may become shorter when you walk, or you may find it difficult to get out of a chair. Also, you may drag your feet as you try to walk, making it difficult to move. Rigid muscles. Muscle stiffness may occur in any part of your body. The stiff muscles can limit your range of motion and cause you pain. Impaired posture and balance. Your posture may become stooped, or you may have balance problems as a result of Parkinson's disease. Loss of automatic movements. In Parkinson's disease, you may have a decreased ability to perform unconscious movements, including blinking, smiling or swinging your arms when you walk. You may no longer gesture when talking. Speech changes. You may have speech problems as a result of Parkinson's disease. You may speak softly, quickly, slur or hesitate before talking. Your speech may be more of a monotone rather than with the usual inflections. A speech-language pathologist may help improve your speech problems. Writing changes. Writing may appear small and become difficult. Medications may greatly reduce many of these symptoms. These medications increase or substitute for dopamine, a specific signaling chemical (neurotransmitter) in your brain. People with Parkinson's disease have low brain dopamine concentrations. In Parkinson's disease, certain nerve cells (neurons) in the brain gradually break down or die. Many of the symptoms are due to loss of neurons that produce a chemical messenger in your brain called dopamine. When dopamine levels decrease, it causes abnormal brain activity, leading to signs of Parkinson's disease. Men are more likely to develop Parkinson's disease than are women. Parkinson's disease is often accompanied by these additional problems, which may be treatable: Thinking difficulties. You may experience cognitive problems (dementia) and thinking difficulties, which usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't very responsive to medications. Depression and emotional changes. People with Parkinson's disease may experience depression. Receiving treatment for depression can make it easier to handle the other challenges of Parkinson's disease. You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms. Swallowing problems. You may develop difficulties with swallowing as your condition progresses. In typical Parkinson's disease, this is rarely a severe problem. Saliva may accumulate in your mouth due to slowed swallow, leading to drooling. Sleep problems and sleep disorders. People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day. People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help your sleep problems. Bladder problems. Parkinson's disease may cause bladder problems, including being unable to control urine or having difficulty urinating. Constipation. Many people with Parkinson's disease develop constipation, mainly due to a slower digestive tract. You may also experience: Blood pressure changes. You may feel dizzy or lightheaded when you stand due to a sudden drop in blood pressure (orthostatic hypotension). Smell dysfunction. You may experience problems with your sense of smell. You may have difficulty identifying certain odors or the difference between odors. Fatigue. Many people with Parkinson's disease lose energy and experience fatigue, and the cause isn't always known. Pain. Many people with Parkinson's disease experience pain, either in specific areas of their bodies or throughout their bodies. Sexual dysfunction. Some people with Parkinson's disease notice a decrease in sexual desire or performance.

Answer 119

Patients are classified by the stage of the disease according to the Hahn-Yahr Scale→ Stage 0- no visible disease; Stage 1- involves one side of the body; Stage 2- involves both sides of the body but no impairment of balance; Stage 3- impaired balance or walking; Stage 4-* Stage 5

Answer 120

Congenital birth defect affecting the spinal column and/or cord. most common permanently disabling birth defect in the United States. Spina Bifida literally means “split spine.” Spina Bifida happens when a baby is in the womb and the spinal column does not close all of the way. Every day, about eight babies born in the United States have Spina Bifida or a similar birth defect of the brain and spine. No one knows was causes spina bifida for sure. Scientists believe that genetic and environmental factors act together to cause the condition.

Answer 121

Occult Spinal Dysraphism (OSD) Infants with this have a dimple in their lower back. Because most babies with dimples do not have OSD, a doctor has to check using special tools and tests to be sure. Other signs are red marks, hyperpigmented patches on the back, tufts of hair or small lumps. In OSD, the spinal cord may not grow the right way and can cause serious problems as a child grows up. Infants who might have OSD should be seen by a doctor, who will recommend tests. Spina Bifida Occulta- It is often called “hidden Spina Bifida” because about 15 percent of healthy people have it and do not know it. Spina Bifida Occulta usually does not cause harm, and has no visible signs. The spinal cord and nerves are usually fine. People find out they have it after having an X-ray of their back. It is considered an incidental finding because the X-Ray is normally done for other reasons. However, in a small group of people with SBO, pain and neurological symptoms may occur. Tethered cord can be an insidious complication that requires investigation by a neurosurgeon. Meningocele-A meningocele causes part of the spinal cord to come through the spine like a sac that is pushed out. Nerve fluid is in the sac, and there is usually no nerve damage. Individuals with this condition may have minor disabilities. Myelomeningocele (Meningomyelocele), also called Spina Bifida Cystica. This is the most severe form of Spina Bifida. It happens when parts of the spinal cord and nerves come through the open part of the spine. It causes nerve damage and other disabilities. Seventy to ninety percent of children with this condition also have too much fluid on their brains. This happens because fluid that protects the brain and spinal cord is unable to drain like it should. The fluid builds up, causing pressure and swelling. Without treatment, a person’s head grows too big, and may have brain damage. Children who do not have Spina Bifida can also have this problem, so parents need to check with a doctor. Children and young adults with Spina Bifida can have mental and social problems. They also can have problems with walking and getting around or going to the bathroom, latex allergy, obesity, skin breakdown, gastrointestinal disorders, learning disabilities, depression, tendonitis and sexual issues. People with Spina Bifida must learn how to get around on their own without help, by using things like crutches, braces or wheelchairs. With help, it also is possible for children to learn how to go to the bathroom on their own. Doctors, nurses, teachers and parents should know what a child can and cannot do so they can help the child (within the limits of safety and health) be independent, play with kids that are not disabled and to take care of him or herself. With help, children with Spina Bifida can lead full lives. Most do well in school, and many play in sports. Because of today’s medicine, about 90 percent of babies born with Spina Bifida now live to be adults, about 80 percent have normal intelligence and about 75 percent play sports and do other fun activities.

Answer 122

Wheelchair activities: utilize skills to promote independence, leisure education, community re-integration & exercises to strengthen muscles.

Answer 123

The central nervous system (CNS) consists of the brain and its various parts (cerebral cortex, medulla, cerebellum, pons, hypothalamus) and spine (spinal cord, vertebrae, and axial nerves radiating from the spinal cord to various parts of the body). Voluntary muscles of the body are linked to the CNS through the network of afferent and efferent nerve fibers that transmit impulses between the CNS and voluntary muscle groups. Proper working of the voluntary muscles and the CNS enable us to achieve mobility, maintain erect posture, and grasp objects. Voluntary muscles of the trunk (intercostal muscles of the rib cage and diaphragm) and of the mouth and throat (tongue, jaws, esophageal muscles) are needed for respiration and for swallowing, which are functions of the autonomic nervous system. These functions can become disturbed and in some cases disrupted entirely in persons with certain types of neuromuscular disorders. Neuromuscular disorders refers to any impairment in the structure or functioning of the voluntary muscles themselves and to any impairment of the structures and functioning of the CNS, which transmits nerve impulses to and from the voluntary muscles. Damage to any part of this highly integrated system due to malformation of structure, injury or degeneration results in impairment in mobility, and affects posture, balance and the ability to grasp objects. Degree of impairment of the affected functions will vary according to location of the damage and its extent. Muscular dystrophy is sometimes classified as a musculoskeletal impairment, since the movement disorder does not result from a defect or injury to the CNS. Includes Parkinson’s disease, MD, MS, CP, SCI, Spina Bifida.

Answer 124

Goal of treatment w/ persons who have neuromuscular disorders it to maximize independent leisure functioning in the least restrictive setting and to facilitate the individual’s development of an appropriate, satisfying leisure lifestyle. The specific objectives and treatment plans should reflect these goals. The principle of normalization should guide every decision made by the therapist and client regarding leisure experiences. More specific treatment objectives- Promote overall physical growth and development by providing opportunities for varied movement experiences using necessary adaptive equipment, instruction and movements. To encourage the individual to be as physically active as possible within the range of his/her abilities and to maximize independent movement. Facilitate the individual’s development of an appropriate social support network both for friendship, information and emotional support as well as for recreation. To provide leisure education in order to facilitate the learning of lifetime leisure skills and to help the individual increase his/her knowledge of available leisure resources. To facilitate the individual’s use of community recreation resources by helping him/her transfer leisure skills acquired to the more inclusive setting. Types of Interventions Used- Aquatics therapeutic benefits include possible increased range of motion, relaxed muscles, sensory stimulation and improved circulation, maintenance or improvement of strength and endurance, greater independence and increased sense of accomplishment. Wheel chair sports. Creative arts therapeutic benefits include reduce social isolation as the individual finds ways to communicate feelings and ideas, enhance self-esteem and feelings of accomplishment, improve and maintain physical, intellectual, and social skills which the individuals uses in creating and presenting work, dispel stereotypes about disabled people, provides an avenue for economic self-sufficiency through exhibition and sale of artistic work. Arts and Crafts, Social games.

Answer 125

Mostly institutional settings such as hospitals, long-term care facilities, rehabilitation centers, residential care settings. Also social and recreational groups- day programs in community settings and community and recreation programs and centers.

Answer 126

TRS may work w/ persons who are recovering from a myocardial infarction or have specific heart conditions that may impact their treatment. The American Heart Association has established functional ability limitations ranging from Class I (no limitations of physical activity) to Class IV (inability to carry on any physical activity without discomfort). The functional ability limitations places patients in one of four categories based on how much they are limited during physical activity. Class I- Patients with cardiac disease but resulting in no limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea or anginal pain. Class II- Patients with cardiac disease resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea or anginal pain. Class III- Patients with cardiac disease resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary activity causes fatigue, palpitation, dyspnea or anginal pain. Class IV- Patients with cardiac disease resulting in inability to carry on any physical activity without discomfort. Symptoms of heart failure or the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort increases. Objective Assessment classes- A,B,C,D. A- No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity. B- Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest. C- Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest. D- Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest. EX.- A patient with minimal or no symptoms but a large pressure gradient across the aortic valve or severe obstruction of the left main coronary artery is classified: Function Capacity I, Objective Assessment D. A patient with severe anginal syndrome but angiographically normal coronary arteries is classified: Functional Capacity IV, Objective Assessment A.

Answer 127

Includes persons learning to cope with diabetes mellitus. A person who is diagnosed w/ diabetes has large amounts of sugar in the blood and urine. Immune-mediated diabetes, type 1 is usually diagnosed before age 30. It is usually very difficult to regulate and then person is usually on insulin. Type 2 diabetes is more common and appears in adults older than 40. This form of diabetes can be managed by diet, but some may require insulin. Entry-level professionals may need to know how to assist people in coping with their diabetes and the impact of exercise on their on their insulin levels. Often diabetes is a secondary condition and the TRS needs to be aware of the impact of the disease on the person w/ the disability. Society today is seeing an influx of diabetes due to diets high in fats and sugar and poor exercise habits by a majority of Americans. TRS can have a huge impact on persons w/ diabetes by encouraging and teaching healthy lifestyles and nutrition.

Answer 128

Entry-level professionals need to have an understanding of a variety of cancers, their prognosis and treatment. Cancer includes a group of more than 100 diseases. A tumor may be benign or malignant. If it is malignant, a tumor is invasive, grows rapidly and can metastasize through the circulatory system or lymph system. Tumors can be graded (1-4) and staged using a TNM system: T refers to the size and extent of the primary tumor. N refers to the number of area lymph nodes involved and M refers to any metastasis of the primary tumor. There are many kinds of cancer, all cancers start because abnormal cells grow out of control. Untreated cancers can cause serious illness and death. Cancer starts when cells in a part of the body start to grow out of control. Cancer cell growth is different from normal cell growth. Instead of dying, cancer cells continue to grow and form new, abnormal cells. Cancer cells can also invade (grow into) other tissues, something that normal cells can’t do. Growing out of control and invading other tissues are what makes a cell a cancer cell. Cells become cancer cells because of DNA (deoxyribonucleic acid) damage. DNA is in every cell and it directs all its actions. In a normal cell, when DNA is damaged the cell either repairs the damage or dies. In cancer cells, the damaged DNA is not repaired, but the cell doesn’t die like it should. Instead, the cell goes on making new cells that the body doesn’t need. These new cells all have the same damaged DNA as the first abnormal cell does. People can inherit abnormal DNA (it’s passed on from their parents), but most often DNA damage is caused by mistakes that happen while the normal cell is reproducing or by something in the environment. Sometimes the cause of the DNA damage may be something obvious like cigarette smoking or sun exposure. But it’s rare to know exactly what caused any one person’s cancer. In most cases, the cancer cells form a tumor. Over time, the tumors can replace normal tissue, crowd it, or push it aside. Some cancers, like leukemia, rarely form tumors. Instead, these cancer cells involve the blood and blood-forming organs and circulate through other tissues where they grow. Cancer cells often travel to other parts of the body where they can grow and form new tumors. This happens when the cancer cells get into the body’s bloodstream or lymph vessels. The process of cancer spreading is called metastasis. No matter where a cancer may spread, it’s always named based on the place where it started. For example, colon cancer that has spread to the liver is called metastatic colon cancer, not liver cancer. In this case, cancer cells taken from the liver would be the same as those in the colon. They would be treated in the same ways too. In 2014, there will be an estimated 1,665,540 new cancer cases diagnosed and 585,720 cancer deaths in the US. Cancer remains the second most common cause of death in the US, accounting for nearly 1 of every 4 deaths.

Answer 129

The relationship between therapeutic recreation and palliation is examined as a treatment modality for the advanced cancer patient. Therapeutic recreation appears to contribute to palliation by providing the dying patient with an opportunity to maintain quality of life through an increased sense of control, social interaction, social supports, the accomplishment of task oriented goals, and by providing an appropriate medium for the expression of feelings as well as creativity. Palliation is a concept that has the potential to become a driving force in the treatment of all illnesses or disabilities in the healthcare profession from the time an initial diagnosis is made. the palliative approach to treatment includes control of pain and other symptoms while simultaneously addressing the individual patient’s psychological, social, and spiritual concerns in an effort to achieve the best possible quality of life for the dying patient as well as his or her family (Stjernsward & Colleau, 1996). The psycho-social impact of dying is monumental, involving the search for meaning, confronting fears, dealing with the loss of control, and issues of loss (Stjernsward & Colleau, 1996). The dying patient often experiences anger, guilt, disorganization, isolation, and depression (Rando, 1984). Therapeutic recreation contributes to the palliative treatment process by providing patients with an opportunity to gain a sense of control, develop new skills, facilitate feelings of self-satisfaction and enjoyment, as well as a means to appropriately express emotions. The primary role of therapeutic recreation is to assist patients in the development of their personal capacity to cope with the disease process and its subsequent affective symptoms such as psychological distress and depression (Willets & Sperling, 1983). Therefore, the role of TR in the treatment of advanced cancer patients is to support palliative goals. Given the above psycho-social issues, the following are four problem areas of dying patients can be addressed through therapeutic recreation: 1)Uncertainty: goals are written to increase the patient’s psychological comfort and to keep some dimension of hope alive until the end of life (Rando, 1984); (2)Negative feelings: goals are written to divert attention away from the stress and fears associated with the disease in an effort to reduce anxiety and depression and to address feelings of sorrow, shame and loneliness (Aaronsen & Beckman, 1987); (3)Control: goals are written to facilitate a restored sense of control and accomplishment (Rando, 1984); and (4)threats to self esteem: goals are written to foster participation in groups enhancing peer supports, and the opportunity to pursue new and old leisure interests.

Answer 130

low red blood cell counts (anemia) can result in pallor, dizziness, weakness, lack of energy, headache, and irritability; low platelet counts (thrombocytopenia) can result in easy bleeding and bruising; low white blood cell counts (including low neutrophil counts or neutropenia) reduce the body’s ability to fight infection. Low blood cell counts can be treated by transfusions or hematopoietic growth factors, and risk of infection may be reduced by prophylactic antibiotics. Gastrointestinal side effects are common among children receiving chemotherapy or radiation therapy, and can include oral mucositis (irritation and/or sores in the mouth), diarrhea or constipation, nausea, vomiting, and retching. Gastrointestinal side effects can result in poor nutritional intake, leading to weight loss and delayed growth. Medications, such as antiemetics given before chemotherapy, are available to reduce some of these side effects, and nutritional advice is available to help children and parents with these issues. Nutritional support, such as tube feedings, intravenous feedings, or appetite stimulants, may be recommended. Pain may arise from the tumor as it presses on bone, nerves, or body organs; it can also result from procedures, including surgeries and needle sticks. Pain can also be a side effect of some cancer treatment, such as neuropathic pain from some chemotherapy drugs. Pain is often treatable by medication and other integrative non-medicine therapies. Children whose pain cannot be well-controlled by available interventions should be seen by a specialist in pediatric pain management.

Answer 131

A viral infection associated with the human immunodeficiency virus (HIV). The virus is usually transmitted through sexual intercourse, but it can be transmitted by blood and blood products. AIDS produces a spectrum of symptoms. In some individuals, HIV progresses to AIDS. A – Acquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth. I – Immuno – Your body's immune system includes all the organs and cells that work to fight off infection or disease. D – Deficiency – You get AIDS when your immune system is "deficient," or isn't working the way it should. S – Syndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms. AIDS is the final stage of HIV infection, and not everyone who has HIV advances to this stage. People at this stage of HIV disease have badly damaged immune systems, which put them at risk for opportunistic infections (OIs). You are considered to have progressed to AIDS if you have one or more specific OIs, certain cancers, or a very low number of CD4 cells. If you have AIDS, you will need medical intervention and treatment to prevent death. “AIDS” refers to the late stage of HIV infection, when an HIV-infected person’s immune system is severely damaged and has difficulty fighting diseases and certain cancers. Before the development of certain medications, people with HIV could progress to AIDS in just a few years. But today, most people who are HIV-positive do not progress to AIDS. That’s because if you have HIV and you take antiretroviral therapy (ART) consistently, you can keep the level of HIV in your body low. This will help keep your body strong and healthy and reduce the likelihood that you will ever progress to AIDS. It will also help lower your risk of transmitting HIV to others.

Answer 132

More than 1.1 million people in the United States are living with HIV infection, and almost 1 in 6 (15.8%) are unaware of their infection. Gay, bisexual, and other men who have sex with men (MSMa), particularly young black/African American MSM, are most seriously affected by HIV. By race, blacks/African Americans face the most severe burden of HIV. Having HIV is not the same as being diagnosed with AIDS. HIV is a lot like other viruses, including those that cause the "flu" or the common cold. But there is an important difference – over time, your immune system can clear most viruses out of your body. That isn't the case with HIV – the human immune system can't seem to get rid of it. That means that once you have HIV, you have it for life.We know that HIV can hide for long periods of time in the cells of your body and that it attacks a key part of your immune system – your T-cells or CD4 cells. Your body has to have these cells to fight infections and disease, but HIV invades them, uses them to make more copies of itself, and then destroys them. Over time, HIV can destroy so many of your CD4 cells that your body can't fight infections and diseases anymore. When that happens, HIV infection can lead to AIDS, the final stage of HIV infection.However, not everyone who has HIV progresses to AIDS. With proper treatment, called “antiretroviral therapy” (ART), you can keep the level of HIV virus in your body low. ART is the use of HIV medicines to fight HIV infection. It involves taking a combination of HIV medicines every day. These HIV medicines can control the virus so that you can live a longer, healthier life and reduce the risk of transmitting HIV to others. Before the introduction of ART in the mid-1990s, people with HIV could progress to AIDS in just a few years. Today, a person who is diagnosed with HIV and treated before the disease is far advanced can have a nearly normal life expectancy. No safe and effective cure for HIV currently exists. Certain body fluids from an HIV-infected person can transmit HIV. These body fluids are: Blood, Semen, Pre-seminal fluid (pre-cum), Rectal fluids, Vaginal fluids and Breast milk. These body fluids must come into contact with a mucous membrane or damaged tissue or be directly injected into your bloodstream (by a needle or syringe) for transmission to possibly occur. Mucous membranes are the soft, moist areas just inside the openings to your body. They can be found inside the rectum, the vagina or the opening of the penis, and the mouth. Approximately 50,000 new HIV infections occur in the United States each year. In the U.S., HIV is spread mainly by:Having sex with someone who has HIV. In general: Anal sex (penis in the anus of a man or woman) is the highest-risk sexual behavior. Receptive anal sex (“bottoming”) is riskier than insertive anal sex (“topping”). Vaginal sex (penis in the vagina) is the second highest-risk sexual behavior. Having multiple sex partners or having sexually transmitted infections can increase the risk of HIV infection through sex. Sharing needles, syringes, rinse water, or other equipment (“works”) used to prepare injection drugs with someone who has HIV. Symptoms-The symptoms of HIV vary, depending on the individual and what stage of the disease you are in. Within 2-4 weeks after HIV infection, many, but not all, people experience flu-like symptoms, often described as the “worst flu ever.” This is called “acute retroviral syndrome” (ARS) or “primary HIV infection,” and it’s the body’s natural response to the HIV infection. Symptoms can include: Fever (this is the most common symptom), Swollen glands, Sore throat, Rash, Fatigue, Muscle and joint aches and pains and Headache. Each of these symptoms can be caused by other illnesses. Conversely, not everyone who is infected with HIV develops ARS. Many people who are infected with HIV do not have any symptoms at all for 10 years or more. You cannot rely on symptoms to know whether you have HIV. The only way to know for sure if you are infected with HIV is to get tested. After the early stage of HIV infection, the disease moves into a stage called the “clinical latency” stage. “Latency” means a period where a virus is living or developing in a person without producing symptoms. During the clinical latency stage, people who are infected with HIV experience no HIV-related symptoms, or only mild ones. (This stage is sometimes called “asymptomatic HIV infection” or “chronic HIV infection.”)During the clinical latency stage, the HIV virus reproduces at very low levels, although it is still active. If you take antiretroviral therapy (ART), you may live with clinical latency for several decades because treatment helps keep the virus in check. (Read more about HIV treatment.) For people who are not on ART, this clinical latency stage lasts an average of 10 years, but some people may progress through this phase faster. It is important to remember that people in this symptom-free period are still able to transmit HIV to others even if they are on ART, although ART greatly reduces the risk of transmission. If you have HIV and you are not taking HIV medication (antiretroviral therapy), eventually the HIV virus will weaken your body’s immune system. The onset of symptoms signals the transition from the clinical latency stage to AIDS (Acquired Immunodeficiency Syndrome).During this late stage of HIV infection, people infected with HIV may have the following symptoms: Rapid weight loss, Recurring fever or profuse night sweats, Extreme and unexplained tiredness, Prolonged swelling of the lymph glands in the armpits, groin, or neck, Diarrhea that lasts for more than a week, Sores of the mouth, anus, or genitals, Pneumonia, Red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids and Memory loss, depression, and other neurologic disorders. Each of these symptoms can be related to other illnesses.

Answer 133

To facilitate the development of an appropriate leisure lifestyle for the person who is diagnosed w/ HIV or AIDS. TRSs should provide services that enhance coping with the diagnosis of a communicable, sexually transmitted disease; focus on attitudes, knowledge and skills that facilitate a day-to-day behavioral expression in the ace of increasing OIs and physical and cognitive limitations and maintain functional dependence as the disease progresses.

Answer 134

Should include the following treatment objectives: Decrease cognitive and emotional stressors associated with HIV disease, Provide opportunities for day-to-day behavioral expression that lead to increased self-esteem, to provide recreational activities and experiences designed to reduce feelings of stigmatization, discrimination, isolation, alienation and learned helplessness. To assist patients in maintaining and enhancing personally satisfying leisure experiences as the disease progresses. To empower patients to take and active role in their treatment and recreational choices. To provide ongoing recreational opportunities for verbal and nonverbal expressions of positive feelings and emotions through diverse forms and mediums. Provide meaningful social and interpersonal experiences in a safe environment. Interventions should be selected to improve the overall function of the patient- boost immune system, decrease fatigue, improve stamina, prevent weight loss, promote relaxation.

Answer 135

stress reduction programs, exercise programs, creative arts programs, social activities, volunteer opportunities and leisure education and counseling. Assessment should include psychosocial status, stage in disease, cognitive/perceptual status, sensorimotor status, cultural background and leisure interest assessment.

Answer 136

A person who is classified as legally blind has a visual acuity of 20/200 or less in the better eye after correction or to a field of vision that is limited to an angle to 20 degrees or less out of the normal 180-degree field of vision. The TRS primarily works with persons who are blind in the community helping them meet their recreational needs through adaptive equipment, if necessary and sports. The etiology of the impairment, how people with visual impairments learn best and what equipment is necessary to help them enjoy a satisfying leisure lifestyle, are important topics to understand. An understanding of specific leadership techniques are important. 2-5 % Read Braille, 5% completely blind, others see shadows/movement. Purpose of TR: talking books, encourage other senses, orientation, environmental cues, movement, aquatics, dance, large print books, bright colors.

Answer 137

* Strabismus- where the eyes look in different directions and do not focus simultaneously on a single point. * Congenital cataracts- where the lens of the eye is cloudy. * Retinopathy of prematurity- may occur in premature babies when the light-sensitive retina hasn’t developed sufficiently before birth. * Retinitis Pigmentosa- a rare inherited disease that slowly destroys the retina. * Coloboma- where a portion of the structure of the eye is missing. * Optic nerve hypoplasia- caused by the underdeveloped fibers in the optic nerve, which affects depth perception, sensitivity to light and acuity of vision. * Cortical visual impairment (CVI)- caused by damage to the part of the brain related to vision, NOT to the eyes themselves.

Answer 138

Blurred vision (called refractive errors)- Nearsightedness (called myopia) is when you can see clearly up close but blurry in the distance. Farsightedness (called hyperopia) is when you can see clearly in the distance but blurry up close. If you are older than 40 and have trouble reading small print or focusing up close, this is usually due to a condition called presbyopia. One in every three people 40 years or older in the U.S. will need glasses to read smaller print. Astigmatism is another condition that causes blurred vision, but it is because of the shape of the cornea. These conditions affect the shape of the eye and, in turn, how the eye sees. They can be corrected by eyeglasses, contact lenses, and in some cases surgery. Age-related macular degeneration (AMD)- AMD is a disease that blurs the sharp, central vision needed to see straight-ahead. It affects the part of the eye called the macula that is found in the center of the retina. The macula lets a person see fine detail and is needed for things like reading and driving. The more common dry form of AMD can be treated in the early stages to delay vision loss and possibly prevent the disease from progressing to the advanced stage. Taking certain vitamins and minerals may reduce the risk of developing advanced AMD. The less common wet form of AMD may respond to treatment, if diagnosed and treated early. Glaucoma- There are different types of glaucoma, but all of them cause vision loss by damaging the optic nerve. Glaucoma is called the “sneak thief of sight” because people don’t usually notice a problem until some vision is lost. The most common type of glaucoma happens because of slowly increasing fluid pressure inside the eyes. Vision loss from glaucoma cannot be corrected. But if it is found early, vision loss can be slowed or stopped. A comprehensive eye exam is important so glaucoma can be found early. Cataract- A cataract is a clouding of the lens of the eye. It often leads to poor vision at night, especially while driving, due to glare from bright lights. Cataracts are most common in older people, but can also occur in young adults and children. Cataract treatment is very successful and widely available. Diabetic retinopathy (DR)- All people with diabetes, both type 1 and type 2, are at risk for DR. It is caused by damage to blood vessels in the back of the eye (retina). The longer someone has diabetes, the more likely he or she will get DR. People with this condition may not notice any changes to their vision until the damage to the eyes is severe. This is why it is so important for people with diabetes to have a comprehensive eye exam every year. There are four stages of DR. During the first three stages of DR, treatment is usually not needed. To prevent progression of diabetic retinopathy, people with diabetes should control their levels of blood sugar, blood pressure, and blood cholesterol. For the fourth stage of DR, called proliferative retinopathy, there are treatments that reduce vision loss, but are not a cure for DR. Warning signs of diabetic retinopathy includes blurred vision, gradual vision loss, floaters, shadows or missing areas of vision, and difficulty seeing at nighttime. People with diabetes are at greater risk for cataract and glaucoma as well.

Answer 139

Blurred vision (refractive errors), crossed eyes (strabismus) and lazy eye (amblyopia).

Answer 140

Hearing losses are measured by the degree of speech heard per decibel level—the higher the number value, the more significant the loss. Knowing the etiology and teaching/learning techniques for persons who have hearing impairments or are deaf is important. The CTRS needs to be aware of the person’s residual hearing ability, use of hearing aids, whether the person can hear better in the left or right ear, and the type of communication method preferred by the individual. Hearing loss can be categorized by which part of the auditory system is damaged.

Answer 141

1) conductive hearing loss 2) sensorineural hearing loss 3) mixed hearing loss - Conductive hearing loss occurs when sound in not conducted efficiently through the outer ear canal to the eardrum and the tiny bones (ossicles) of the middle ear. Conductive hearing loss usually involves a reduction in sound level or the ability to hear faint sounds. It can often be corrected medically or surgically. Possible causes of conductive hearing loss are: fluid in the middle ear from colds, ear infection (otitis media), allergies, poor Eustachian tube function, perforated eardrum, benign tumors, impacted earwax, infection in ear canal, swimmer’s ear, presence of a foreign body and absence of malformation of the outer ear, ear canal or middle ear. - Sensorineural hearing loss (SNHL) occurs when there is damage to the inner ear (cochlea) or to the nerve pathways from the inner ear to the brain. Most of the time SNHL cannot be medically or surgically corrected. This is the most common type of permanent hearing loss. SNHL reduces the ability to hear faint sounds, even when speech is loud enough to hear, it may still be unclear or sound muffled. Possible causes of SNHL are: illnesses, drugs that are toxic to hearing, genetic/hereditary, aging, head trauma, malformation of inner ear and exposure to loud noise. - Mixed hearing loss- When conductive hearing loss occurs in combination with sensorineural hearing loss. There may be damage in the outer or middle ear and in the inner ear (cochlea) or auditory nerve.

Answer 142

have minimal noise, lighting is important, have them face you, close-up interactions, TR: use of other senses, emphasize lip movements & hand gestures; adaptive activities, encourage sign language.

Answer 143

Culture and language intertwine, with language reflecting characteristics of culture. Learning about the culture of Deaf people is also learning about their language. Deaf people use ASL to communicate with each other and with hearing people who know the language. ASL is a visual/gestural language that has no vocal component. ASL is a complete, grammatically complex language. It differs from a communication code designed to represent English directly. ASL is not a universal language, however. There are signed languages in other countries (e.g., Italian Sign Language, Chinese Sign Language, Swedish Sign Language). American Deaf culture centers on the use of ASL and identification and unity with other people who are Deaf. A Deaf sociolinguist, Dr. Barbara Kannapel, developed a definition of the American Deaf culture that includes a set of learned behaviors of a group of deaf people who have their own language (ASL), values, rules, and traditions. In 1913, George W. Veditz, president of the National Association of the Deaf, reflected in an old movie the sense of identity ASL gives Deaf individuals when he signed, "As long as we have deaf people on Earth, we will have signs, and as long as we have our films, we can preserve our beautiful sign language in its original purity. It is our hope that we all will love and guard our beautiful sign language as the noblest gift God has given to deaf people." The values, behaviors, and traditions of Deaf culture include: Promoting an environment that supports vision as the primary sense used for communication at school, in the home, and in the community, as vision offers deaf individuals access to information about the world and the independence to drive, travel, work, and participate in every aspect of society. Valuing deaf children as the future of deaf people and Deaf culture. Deaf culture therefore encourages the use of ASL, in addition to any other communication modalities the child may have. Support for bilingual ASL/English education of deaf children so they are competent in both languages. Inclusion of specific rules of behavior in communication in addition to the conventional rules of turn taking. For example, consistent eye contact and visual attention during a conversation is expected. In addition, a person using sign language has the floor during a conversation until he or she provides a visual indicator (pause, facial expression, etc.) that he or she is finished. Perpetuation of Deaf culture through a variety of traditions, including films, folklore, literature, athletics, poetry, celebrations, clubs, organizations, theaters, and school reunions. Deaf culture also includes some of its own "music" and poetry as well as dance. Inclusion of unique strategies for gaining a person's attention, such as, gently tapping a person on the shoulder if he or she is not within the line of sight, waving if the person is within the line of sight, or flicking a light switch a few times to gain the attention of a group of people in a room.

Answer 144

Like hearing and visual impairments, may be found in all populations. It is important to understand the different types of aphasia that may be a residual effect found with some persons who have had a CVA or another type of brain injury. Many persons with CP may also have problems with speech. Speech impairments may be present in different forms.

Answer 145

A symptom of several different speech disorders. They include: spasmodic dysphonia: identified by involuntary movements of the vocal cords when speaking. Your voice may be hoarse, airy, and tight; aphasia: expressive, cannot speak; the inability to express and comprehend language. Individuals with aphasia may find it difficult to think of words. They may also mispronounce words; dysarthria: weak vocal muscles. These weak muscles cause slurred and slow speech. The larynx (voice box) and vocal cords have difficulty coordinating to make a fluent sound, orofacial myofunctional disorders- with OMD, tongue moves forward in an exaggerated way during speech and/or swallowing, speech sound disorders- articulation and phonological process- most children make some mistakes as they learn to say new word, a speech sound disorder occurs when mistakes continue past a certain age. Every sound has a different range of ages when the child should make the sound correctly. Speech sound disorders include problems w/ articulation (making sounds) and phonological processes (sound patterns). Stuttering- affects the fluency of speech. Begins during childhood and in same cases, lasts throughout life. Characterized by disruptions in the production of speech sounds, called “disfluencies.” Most people produce brief disfluencies from time to time. Disfluencies are not a serious problem, but can impede communication when a person produces too many of them. Voice and vocal disturbances: any factor that changes the function or shape of your vocal cords can cause changes in the sound and ease of speech. Examples of voice/ vocal disturbances- vocal cord nodules of polyps, vocal cord paralysis, paradoxical vocal fold movement and spasmodic dysphonia. Speech impairment can occur suddenly or can gradually progress. Each speech impairment type has a different cause, which is what sets it apart. A TRS needs to demonstrate patience and listening skills when working with these individuals and also understand speech-facilitated technology. Global aphasia- cannot speak or understand.

Answer 146

Divert person away from pain.

Answer 147

Organic Brain Syndrome: Acute & chronic; physical changes to brain, memory loss, emotional instability, mood changes, poor judgment, confusion, & disorientation. TR- Sensory stimulation, positive reinforcement, reminiscence, pet therapy, cognitive games, walking/exercise, nutrition.

Answer 148

Sex offenders, murderers etc.- Purpose of TR: health, fitness, social skills, choice, limits.

Answer 149

Published by the American Psychiatric Association (APA) and is used by psychiatrists, other mental health providers and health care practitioners to diagnose and plan treatment for people with a variety of mental disorders. Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. The previous edition, DSM-IV-TR, has been used by professionals in a wide array of contexts, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors, as well as by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). DSM is used in both clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care) as well as with community populations. In addition to supplying detailed descriptions of diagnostic criteria, DSM is also a necessary tool for collecting and communicating accurate public health statistics about the diagnosis of psychiatric disorders. DSM-5 is eliminating what was a rather cumbersome five "axis” diagnostic system previously in use that required clinicians to rate each client according to criteria other than their main psychological disorder. Apart from the fact that no one truly could define the word “axis” (it was roughly a dimension), the previous DSM’s included a rather strange combination of personality disorders and “mental retardation” into one grouping. All other disorders were placed elsewhere. In addition, a collection of unrelated disorders that “originated in childhood” (but not “mental retardation”) were strung together in one section regardless of what the symptoms were. Eliminated the axes is probably a good thing as it will ease some of this confusion and messiness. This brings up another good change. “Mental retardation” is no longer being used as a diagnosis but is being replaced by “Intellectual Disability,” which makes DSM-5 consistent with established practices in the field. Several other diagnoses with possibly stigmatizing terminology were also changed, including hypochondriasis (now called “illness anxiety disorder”) and the paraphilias (now called “paraphilic disorders”). The DSM-5 authors felt that these changes were warranted not only for the sake of being politically correct, but because the terms are more accurate. A set of similar changes were made within each of the major disorder categories. Autistic disorder is now being eliminated as a diagnosis, and is replaced by “autistic spectrum disorder.” In the process of making this change, the DSM-5 authors also decided to eliminate the “Asperger’s Disorder” diagnosis. This has angered some groups, who feel that Asperger’s merits its own diagnosis. However, I’m including this change in the “good” (readers may disagree) because it’s been clear for a number of years that the “spectrum” concept is a useful one for the family of autistic disorders. In fact, many researchers believe that all categories should be eliminated entirely in favor of dimensional ratings, and though this didn’t happen, it might in future DSM’s. Another good set of changes involves reorganizing and eliminating some disorders that no longer made sense in the new framework. For example, obsessive-compulsive disorder now fits into its own grouping instead of being placed with anxiety disorders. The evidence didn’t support the notion that anxiety is at the root of this disorder. Similarly, PTSD is now part of a new grouping called “Trauma and Stressor-Related Disorders” which, again, highlights the underlying nature of these disorders and groups it with others that bear a substantive relationship. Guidelines for evaluating suicidality are also being included in DSM-5. This will provide clinicians with greater structure in assessing individuals who may present a risk to themselves. In the area of schizophrenia, the DSM-5 authors believed that the distinctions among the 5 subtypes (e.g. “disorganized,” “undifferentiated”) were not supported by research evidence, nor could clinicians always reliably distinguish among them. This is particularly good news for the legions of undergraduates who no longer have to memorize these somewhat confusing terms. More importantly, however, other changes made within the schizophrenia diagnosis will allow clinicians to rate the severity of a client’s symptoms in a way that does carry meaning.

Answer 150

Functional intervention, leisure education and recreation participation. Recreation participation component provides clients with the opportunity to participate in freely chosen activities that are similar to activities and opportunities outside the treatment setting. This experience duplicates all the beneficial outcomes of recreation participation for anyone: it is fun, enjoyable, makes people feel better about themselves and provides the opportunity to feel in control; that is the individuals choose whether to participate, w/ whom, when and how much. Benefits of a more therapeutic nature include, clients get to try out new behaviors or ways of interacting with others in a relatively safe environment and they get to be themselves in a setting where everything is not always clinically examined for its significance and meaning. Recreation participation has the potential to improve the client’s currently perceived quality of life, as well as help the client feel better about being in the treatment program and perhaps be more accepting of the clinical interventions of other areas of treatment. The leisure education component serves to address leisure-related skills, attitudes and knowledge. Both participation and education components are geared toward somewhat less tangible and observable outcomes. Attitudes and values are difficult to observe and measure directly. The nature of their benefits tends to be largely internal and very much under the control of the client. For this and other reasons, there is a great emphasis within the field of psychiatric treatment on the functional intervention or therapy component of TR service delivery. Clinical context- a situation where the client experiencing disturbed mental processes is recognized as an individual involved in a health crisis- a situation where clinical intervention are required. Clinical interventions are required to help the individual free himself/herself from the constraints that are limiting his/her personal growth and healthy choices of behavior. Health crisis is a result of an individual’s coping style being inadequate or inappropriate for the demands of a particular situation. Disorganization and disequilibrium results, w/ consequent increased stress placed on coping resources. This disorganization means the individual is now dealing with reality at a lower level of effectiveness than previously. For some individuals this cycle represents a continuing downward cycle until some sense of stability prevails. At the total extreme, stability may be maintained by a withdrawal from reality. Purpose of the therapy component is to work with the entire treatment team to disrupt the downward spiral, reinforce effective coping skills/behaviors that are working, develop new coping behaviors and help the individual become more effective in dealing with life crises. Treatment in TR may be individual or small-group oriented, depending on the needs of the clients and the resources of the agency. Most interventions tend to be group oriented. If these groups are to be effective as clinical interventions then it is necessary for them to meet certain requirements that include: group must be conceptualized to meet the specific needs of particular clients; specific referral criteria for admission to the group must be clearly identified, along with the purpose of the group, objectives and/or planned outcomes and a description of how the group will function; the functioning of the group is supported by the clinical milieu; that is, it is accepted by other therapies as a legitimate and important part of the treatment environment, clients are encouraged to attend and nonparticipation becomes a concern for all staff to explore with the client. This type of clinical group differs from the purely recreational group in that it allows for the principles of group process to evolve. The group through natural evolution (and TRS’s interventions) takes on a life and characteristics that reflect its members’ typical interactions with other elements of life. A recreation participation group depends on the interests of the group and there is little opportunity for intense group process to occur, little chance serving as a therapy group.

Answer 151

Axis 1- Clinical disorders. Axis 2- Personality/developmental disorders Axis 3- relevant physical disorder Axis 4-psychosocial and environmental problems Axis 5- global assessment of functioning.

Answer 152

1 in 100 chance a birth the person will have disorder. To be diagnosed with schizophrenia a person must have 2 or more of the following characteristics during a 1-month period: “delusions, hallucinations, disorganized, grossly disorganized or catatonic behavior and negative symptoms. It is important to understand that with schizophrenia there is always a change in functioning level. Individual may show an inappropriate affect- display no emotion or even appear happy while describing a sad or unfortunate event. 1 of 2 symptoms: Need to have hallucinations or delusions of both. Types of hallucinations, auditory, visual, olfactory (smell). Delusions- flights from reality. Negative Symptoms- cognitive breakdown, often can't be reversed. Disorganized symptoms, usually have history of schizophrenia. Classic negative symptoms- 1) Alogia- incoherent speech. Person does not make sense, sentence de-rails. Neurologically damaged. Chances to returning to pre-morbid state is less likely. Neologism-make up words. Clang association- a mode of speech characterized by association of words based upon sound rather than concepts. Ex.- may include compulsive rhyming or alliteration without apparent logical connection between words. 2) Avolition- can't mobilize self to do basic things. Cannot act effectively. Neurological damage. General lack of drive, or motivation to pursue meaningful goals. A person may show little participation in work or have little interest in socializing. They may sit still for long periods of time. 3) Affective Flattening (DSM4)/ Diminished Emotional Expression (DSM5)- limited range of emotions, flat, over pronounce things, take loudly. Caused issues in DSM5 added Anhedonia. Give up on socializing, asocial. Schizophrenia is a severe form of mental illness affecting about 7 per thousand of the adult population, mostly in the age group 15-35 years. Though the incidence is low (3-10,000), the prevalence is high due to chronicity. Schizophrenia affects about 24 million people worldwide. Schizophrenia is a treatable disorder, treatment being more effective in its initial stages. Medications- Antipsychotic medications are used to treat schizophrenia and schizophrenia-related disorders. Some of these medications have been available since the mid-1950's. They are also called conventional "typical" antipsychotics. Some of the more commonly used medications include: Chlorpromazine (Thorazine), Haloperidol (Haldol), Perphenazine (generic only) and Fluphenazine (generic only). In the 1990's, new antipsychotic medications were developed. These new medications are called second generation, or "atypical" antipsychotics. One of these medications was clozapine (Clozaril). It is a very effective medication that treats psychotic symptoms, hallucinations, and breaks with reality, such as when a person believes he or she is the president. But clozapine can sometimes cause a serious problem called agranulocytosis, which is a loss of the white blood cells that help a person fight infection. Therefore, people who take clozapine must get their white blood cell counts checked every week or two. This problem and the cost of blood tests make treatment with clozapine difficult for many people. Still, clozapine is potentially helpful for people who do not respond to other antipsychotic medications. Other atypical antipsychotics were developed. All of them are effective. Agranulocytosis is less likely to occur with these medications than with clozapine, but it has been reported. These include: Risperidone (Risperdal), Olanzapine (Zyprexa), Quetiapine (Seroquel), Ziprasidone (Geodon), Aripiprazole (Abilify), Paliperidone (Invega) and Lurasidone (Latuda). The antipsychotics listed here are some of the medications used to treat symptoms of schizophrenia. Some people have side effects when they start taking these medications. Most side effects go away after a few days and often can be managed successfully. People who are taking antipsychotics should not drive until they adjust to their new medication. Side effects of many antipsychotics include: Drowsiness, Dizziness when changing positions, Blurred vision, Rapid heartbeat, Sensitivity to the sun, Skin rashes and Menstrual problems for women. Atypical antipsychotic medications can cause major weight gain and changes in a person's metabolism. This may increase a person's risk of getting diabetes and high cholesterol. A person's weight, glucose levels, and lipid levels should be monitored regularly by a doctor while taking an atypical antipsychotic medication. Typical antipsychotic medications can cause side effects related to physical movement, such as: Rigidity, Persistent muscle spasms, Tremors and Restlessness. Long-term use of typical antipsychotic medications may lead to a condition called tardive dyskinesia (TD). TD causes muscle movements a person can't control. The movements commonly happen around the mouth. TD can range from mild to severe, and in some people the problem cannot be cured. Sometimes people with TD recover partially or fully after they stop taking the medication. Every year, an estimated 5% of people taking typical antipsychotics get TD. The condition happens to fewer people who take the new, atypical antipsychotics, but some people may still get TD. People who think that they might have TD should check with their doctor before stopping their medication.

Answer 153

social skills training, stress management, coping skills.

Answer 154

Have a strong impact on emotions. These include bipolar and depression disorders. A person diagnosed with depression has a serious illness. To be diagnosed with depression, a person must have 5 or more of the following symptoms during the same 2-week period: depressed mood for most of the day, diminished interest in day-to-day activities, significant weight loss or weight gain, sleeplessness or sleeping all the time, psychomotor agitation, overall feeling of tiredness, feelings of worthlessness, inability to concentrate and thoughts of suicide. A person who is diagnosed with bipolar disorder not only has depression, but moods will swing from the lows of depression to mania. When in a manic mode, the person will have 3 or more of the following symptoms: inflated self-esteem, seems not to need sleep, very talkative, highly distractible, thoughts seem to be racing, increase in goal-directed activity (feel like they can accomplish anything) and overly involved in activities that have a possibility for a painful outcome. Mood disorders involve states where a stressful or maladaptive mood is present. Example: A person who is just depressed enough to have it affect a part of their life. Anxiety is also classified under mood disorders. Example: You are so anxious about a test that you have a panic attack and do not do well on it. Mood disorders can be neurotic. Example: you feel depressed and become highly self-critical. Mood disorders can also be Psychotic: You feel depressed and then hear voices telling you to jump off the BKLYN Bridge. Depression- Depression is one of the most common diagnoses; roughly 10% of the U S population has been on anti-depressant medication at some time in their lives. Depression is an extremely common diagnosis among college populations. About 1/3 of all college undergraduates have been borderline depressed or clinically depressed at some point in their college career. Freud was the first psychologist to address depression during the 19th century with his paper Mourning in Melancholia. In this paper, Freud tried to compare normal grief to feelings of depression. Freud felt that depression was the function of loss. He felt that a positive effect of grief was that there was something actually worth grieving over. Example: A widow would mourn over the loss of not only her husband, but also their wonderful relationship. Freud also felt that people have much more ambivalence toward loss when they are depressed. He felt that there was a narcissistic component to depression, like experiencing this loss made you less of a worthwhile person. With grief, we do not expect people to return to their normal selves for some time after a loss. Example: Loss of a spouse often takes a year or more to recover from; Loss of a child can take several years, especially for the mother. To Freud, it was important for people to undergo this grief reaction in order to come to terms with their loss. Grief becomes depression when the period of grief is sustained or does not end. When people experience a significant loss, it is important for them to have the support of both a professional and their social structure. The research literature suggests that significant loss results in premature death especially for men. Example: A widower is 100 times more likely to die in the same year that his wife died, than if she had stayed alive. Questions to Ask When Looking At Depression- Is there a precipitating event that led to the depression? Is the amount of sad feelings in proportion to the loss? What is the intensity and duration of the reaction? How maladaptive or destructive is this event on our lives? Has the reaction to this event been going on for too long? DSM IV Diagnostic Criteria for Depression – You must have at least four of these eight symptoms to be diagnosed with depression. Experience a change in appetite. Example: Overeating or under eating. Experience a change in sleep behavior. Example: Oversleeping or Insomnia. Experience a change is psychomotor functioning. Example: Agitated or blunted speech or thought patterns. Experience a loss of interest in pleasure or usually pleasurable activities. Experience a loss of energy. Expression of a lot of self-reproach or pathological self-images. Diminished ability to concentrate or think. Thoughts about death and / or suicide. Dysthimic Depression- Also called Dysthimic Disorder. Dysthimic depression is when a person is depressed almost all of the time. With Dysthimic depression, we usually see a fairly consistent lifelong pattern of depression; it seems to be part of one’s personality. A classic symptom of DD is called Anhedonia – the inability to experience pleasure. People with this disorder have a very narrow range of emotions. Example: They can go form “its OK” to “I’m worried”. DD people frequently worry about things and are prone to hypochondria. They often speak about themselves in very negative terms, are self critical, and highly critical of others. However, people with dysthimic depression tend to have fairly good psychological judgement. Example: They know who can harm them and who can help them. These people may also have underlying sleep disorders. They often come from families that are intrusive and have a history of depression. We usually see dysthimic conditions from adolescence on. Dysthimic people have a long history of being irritable and feeling inadequate. Example: Someone who complains all the time and is not any fun. Sometimes dysthimic people try to break out of their pattern by doing something reckless. Dysthimic people have a hard time reacting to antidepressant medication. Dysthimic depression tends to be a lifelong illness and usually gets worse with age. About 6-7% of the population is diagnosed with Dysthimic depression. Dysthymic people often benefit from Prozac, but they tend to also become dependent on it. Major Depressive Episode- Sometimes, people become severely depressed for a period of time and then go for an extended period of time not being depressed. A Major Depressive episode tends to be a more intense depression as compared to Dysthimic depression. With a MAJOR DEPRESSIVE EPISODE, the depression hits you like a train. With a major depressive episode, you can usually trace it back to some clear-cut identifiable stressor. Example: loosing your job. MAJOR DEPRESSIVE EPISODE people are depressed just about every day. It is also very easy for others to see that this person is depressed. Example: The MAJOR DEPRESSIVE EPISODE person always looks like they are about to cry. Some signs of a major depressive episode are slow speech, significant weight loss, loss of sleep, and frequent absence and poor performance at work. People experiencing a Major depressive episode have a hard time mobilizing themselves and do not accomplish much. Sometimes, their sense of guilt and self-reproach may border on delusional. People experiencing a major depressive episode are often preoccupied with death and thoughts of suicide. Example: The world would be better off without me. MAJOR DEPRESSIVE EPISODE people are at the highest risk for suicide when they start to show signs of getting better because severely depressed people often lack the energy to commit suicide. If a person experiencing a major depressive episode does not get into the deeper levels of sleep on a frequent basis, they may take longer to get better. MAJOR DEPRESSIVE EPISODE people often require some type of medical intervention. Example: Get on an antidepressant medication. Manic Depression / Bipolar Disorder- This disorder is classified by two elements: mania and depression. The moods of bipolar people are usually affected in profound opposite ways. Bipolar disorder is psychotic. It usually starts as neurotic and intensifies to the point of being psychotic. Bipolar disorder is a biochemical illness that is often associated with a chemical imbalance. Bipolar disorder can also be intensified by social stress. Bipolar Disorder affects roughly 1% of the population. Surprisingly, Bipolar people are often able to function in society because they tend to experience periods of normal behavior and ambition. Due to this fact, bipolar disorder can often be controlled for long periods of time. Lithium is a drug that has an 85-95% success rate in treating bipolar disorder. Bipolar people go through a process that is a mood disorder in itself. Bipolar people are also more prone to a major depressive episode. Bipolar people often turn to drugs as a way of regulating their mood. They are particularly prone to suicide and 10-15% of all bipolars eventually complete a suicide. Suicide usually occurs during the Manic Cycle. A classic bipolar method of committing suicide is to jump out of a window. Bipolars are often very ambivalent about taking their lithium because it has a tendency to reduce their “up cycles”. Bipolars are often very poor judges of when they need to take their medication. You only need to have one manic episode to be considered manic/depressive. However, some people have only manic episodes and are diagnosed as Hypomanic. Mania / Manic Episode- Mania is when a bipolar person starts to get extra energy, starts to sleep only 2-3 hours a night, becomes pushy, and has pressured speech. Bipolar people get a sense of euphoria from these manic episodes that quickens their descent into pathology. Two signs that a bipolar needs to see a doctor immediately are flight of ideas and pressured speech. Bipolars tend to do bizarre things. Example: They go out and buy 6 designer leather coats. These bizarre behaviors are often followed by excessive sex. Male bipolars can have intercourse with anywhere from 4-6 prostitutes in one night during a manic episode. Female bipolars usually have promiscuous sex with their acquaintances. People often develop grandiose ideations during manic episodes. Example: A person thinks that they are on a mission from God to save the president from aliens.Types of Depression- Retarded Depression – This is the stereotypical depression. Characterlogical Depression – This type of depression is characterized by people being depressed all the time. They have a persistent low-level depression. Dsythymic depression is a Characterlogical depression. Reactive Depression – This depression is when a specified event triggers a depressive episode. A Major Depressive episode is a reactive depression. Psychotic Depression – This is when depression is so intense that we are able to see delusional symptoms. Psychotic depression is common with Bipolar disorder and A major depressive episode. Sometimes people can experience what is called Manic Defense, where they overcompensate for feelings of depression by being overly active. Cyclothymia- Cyclothymia is characterized by sharp mood swings, without necessarily entering psychosis. Cyclothymic people do not usually experience psychotic depression or mania. Their moods can range from open and euphoric to closed and combative, and can switch rapidly within the course of a day.

Answer 155

Depression is commonly treated with antidepressant medications. Antidepressants work to balance some of the natural chemicals in our brains. These chemicals are called neurotransmitters, and they affect our mood and emotional responses. Antidepressants work on neurotransmitters such as serotonin, norepinephrine, and dopamine. The most popular types of antidepressants are called selective serotonin reuptake inhibitors (SSRIs). These include: Fluoxetine (Prozac), Citalopram (Celexa), Sertraline (Zoloft), Paroxetine (Paxil) and Escitalopram (Lexapro). Other types of antidepressants are serotonin and norepinephrine reuptake inhibitors (SNRIs). SNRIs are similar to SSRIs and include venlafaxine (Effexor) and duloxetine (Cymbalta). Another antidepressant that is commonly used is bupropion (Wellbutrin). Bupropion, which works on the neurotransmitter dopamine, is unique in that it does not fit into any specific drug type. SSRIs and SNRIs are popular because they do not cause as many side effects as older classes of antidepressants. Older antidepressant medications include tricyclics, tetracyclics, and monoamine oxidase inhibitors (MAOIs). For some people, tricyclics, tetracyclics, or MAOIs may be the best medications. Antidepressants may cause mild side effects that usually do not last long. Any unusual reactions or side effects should be reported to a doctor immediately. The most common side effects associated with SSRIs and SNRIs include: Headache, which usually goes away within a few days, Nausea (feeling sick to your stomach), which usually goes away within a few days, Sleeplessness or drowsiness, which may happen during the first few weeks but then goes away. Sometimes the medication dose needs to be reduced or the time of day it is taken needs to be adjusted to help lessen these side effects, Agitation (feeling jittery), and Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex. Tricyclic antidepressants can cause side effects, including: Dry mouth, Constipation, Bladder problems. It may be hard to empty the bladder, or the urine stream may not be as strong as usual. Older men with enlarged prostate conditions may be more affected, Sexual problems, which can affect both men and women and may include reduced sex drive, and problems having and enjoying sex, Blurred vision, which usually goes away quickly and Drowsiness. Usually, antidepressants that make you drowsy are taken at bedtime. People taking MAOIs need to be careful about the foods they eat and the medicines they take. Foods and medicines that contain high levels of a chemical called tyramine are dangerous for people taking MAOIs. Tyramine is found in some cheeses, wines, and pickles. The chemical is also in some medications, including decongestants and over-the-counter cold medicine. Mixing MAOIs and tyramine can cause a sharp increase in blood pressure, which can lead to stroke. People taking MAOIs should ask their doctors for a complete list of foods, medicines, and other substances to avoid. An MAOI skin patch has recently been developed and may help reduce some of these risks. A doctor can help a person figure out if a patch or a pill will work for him or her. Bipolar disorder, also called manic-depressive illness, is commonly treated with mood stabilizers. Sometimes, antipsychotics and antidepressants are used along with a mood stabilizer. People with bipolar disorder usually try mood stabilizers first. In general, people continue treatment with mood stabilizers for years. Lithium is a very effective mood stabilizer. It was the first mood stabilizer approved by the FDA in the 1970's for treating both manic and depressive episodes. Anticonvulsant medications also are used as mood stabilizers. They were originally developed to treat seizures, but they were found to help control moods as well. One anticonvulsant commonly used as a mood stabilizer is valproic acid, also called divalproex sodium (Depakote). For some people, it may work better than lithium.6 Other anticonvulsants used as mood stabilizers are carbamazepine (Tegretol), lamotrigine (Lamictal) and oxcarbazepine (Trileptal). Atypical antipsychotic medications are sometimes used to treat symptoms of bipolar disorder. Often, antipsychotics are used along with other medications. Antipsychotics used to treat people with bipolar disorder include: Olanzapine (Zyprexa), which helps people with severe or psychotic depression, which often is accompanied by a break with reality, hallucinations, or delusions, Aripiprazole (Abilify), which can be taken as a pill or as a shot, Risperidone (Risperdal), Ziprasidone (Geodon), Clozapine (Clorazil), which is often used for people who do not respond to lithium or anticonvulsants and Lurasidone (Latuda). Antidepressants are sometimes used to treat symptoms of depression in bipolar disorder. Fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft) are a few that are used. However, people with bipolar disorder should not take an antidepressant on its own. Doing so can cause the person to rapidly switch from depression to mania, which can be dangerous.To prevent this problem, doctors give patients a mood stabilizer or an antipsychotic along with an antidepressant. Treatments for bipolar disorder have improved over the last 10 years. But everyone responds differently to medications. If you have any side effects, tell your doctor right away. He or she may change the dose or prescribe a different medication. Different medications for treating bipolar disorder may cause different side effects. Some medications used for treating bipolar disorder have been linked to unique and serious symptoms, which are described below. Lithium can cause several side effects, and some of them may become serious. They include: Loss of coordination, Excessive thirst, Frequent urination, Blackouts, Seizures, Slurred speech, Fast, slow, irregular, or pounding heartbeat, Hallucinations (seeing things or hearing voices that do not exist), Changes in vision, Itching, rash and Swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs. If a person with bipolar disorder is being treated with lithium, he or she should visit the doctor regularly to check the levels of lithium in the blood, and make sure the kidneys and the thyroid are working normally. Some possible side effects linked with valproic acid/divalproex sodium include: Changes in weight, Nausea, Stomach pain, Vomiting, Anorexia and Loss of appetite. Valproic acid may cause damage to the liver or pancreas, so people taking it should see their doctors regularly. Lamotrigine can cause a rare but serious skin rash that needs to be treated in a hospital. In some cases, this rash can cause permanent disability or be life-threatening. In addition, valproic acid, lamotrigine, carbamazepine, oxcarbazepine and other anticonvulsant medications (listed in the chart at the end of this document) have an FDA warning. The warning states that their use may increase the risk of suicidal thoughts and behaviors. People taking anticonvulsant medications for bipolar or other illnesses should be closely monitored for new or worsening symptoms of depression, suicidal thoughts or behavior, or any unusual changes in mood or behavior. People taking these medications should not make any changes without talking to their health care professional. Other medications for bipolar disorder may also be linked with rare but serious side effects.

Answer 156

short term activities, success oriented.

Answer 157

set limits, provide structure.

Answer 158

American Psychiatric Association lists 10 different personality disorders, clustering them into 3 different categories based on descriptive similarities. Cluster A consists of paranoid, schizoid, and schizotypal personality disorders. In general, people with these personality disorders often appear odd or eccentric. Cluster B consists of the anti-social, borderline, histrionic and narcissistic personality disorders and these people have a commonality of being dramatic, emotional or erratic. Cluster C consists of avoidant, dependent and obsessive-compulsive personality disorders. The commonality between these personality disorders is anxiousness or fearfulness. Close to being psychotic but NOT. Involve some trait or characteristic that is inflexible which causes you distress or is maladaptive. This group of disorders includes mild diagnoses like Passive/aggressive personality disorder to more severe diagnoses like Antisocial Personality disorder (sociopath). Personality disorders are almost always neurotic, that is they involve a distortion of reality. The DSM IV groups personality disorders into three clusters; Odd/Eccentric, Dramatic/Erratic, and Anxious/Fearful. Odd/Eccentric Cluster – The symptoms of these disorders bear some similarity to the symptoms of schizophrenia, especially in its later phases.

Answer 159

A paranoid person is usually neurotic, not psychotic, they distort reality as opposed to creating their own. They often have very cold and unstable parents. They are very afraid and distrustful of other people’s motives and generally consider people to be malicious in nature. Paranoids are extremely hyper-vigilant about information. They are very aware of who has the power and have good awareness of power dynamics. They are also very good at reading peoples weaknesses, assessing other people’s ambitions, and can tell when others are lying. Paranoids tend to not believe people even when they are telling the truth. They start to see their pathology everywhere. They do not laugh. Paranoids are very secretive. This fact hides how crazy they really are from the outside world and makes them crazier because there is no one from the outside world to defy or falsify their paranoid judgments. At the core of their paranoia, they are angry and hostile. Paranoids feel slighted very easily, hold grudges for a long time, and often fantasize revenge plots. They also tend to be very jealous and are constantly questioning their partner’s fidelity. Paranoids are generally faithful themselves however. Paranoids tend to be very detached from their mates and do not give a lot of intimate communication or personal disclosure. But, the spouse is probably the only person in a paranoid’s life who they are close to. A paranoid’s spouse can have an effect on how bad their pathology becomes. If the marriage is supportive, the paranoid will tend to stay within the bounds of normalcy. If the marriage aggravates the person’s paranoia, they may become worse. Paranoids also project their undesirable (usually aggressive) feeling onto others. Paranoids have an especially hard time dealing with sexual feelings. Paranoids also project their homosexual feelings onto others. This can lead to the paranoid person joining a simple dogmatic group, but most paranoids are too antisocial to do this. About 2% of the population is clinically paranoid.

Answer 160

Schizoids are not schizophrenics. They range from indifferent to hostile about interest in close relationships with other people.

Answer 161

These people are bizarre, may often seem psychotic, and may even have a psychotic episode. Schizotypal people often resemble schizophrenics, but do not have psychotic beliefs. Schizotypal people seem to be walking the line between psychosis and extreme neurosis. They often have odd interpretations of casual events.

Answer 162

A person with avoidant personality disorder desires but avoids close personal relationships out of fear of rejection. They are unlikely to engage in any sort of relationship unless they are guaranteed that they won’t be rejected. They often live their lives trying to avoid failure.

Answer 163

A person with dependent personality disorder shows an excessive amount of dependence. They often seek the help of a psychologist.

Answer 164

OC personality disorder is a milder version of OC Anxiety disorder. An OC Anxiety disorder person does bizarre things that may lead one to question their grip on reality.

Answer 165

A person with antisocial personality disorder has consistently violated the rights of others and feels no guilt about it for their entire life.

Answer 166

Narcissism is a very hard disorder to treat. They have a grandiose sense of self-importance that is very out of proportion with their accomplishments. Narcissistic people are not usually very subtle.

Answer 167

Borderline personality disorder is characterized by a gross instability in cognitive and emotional areas. Borderlines are unstable in interpersonal relationships, are very moody, and tend to do bizarre and destructive behaviors.

Answer 168

Histrionic personality disorder deals with excessive emotions. Females are more likely to be diagnosed with this disorder because they are more likely to admit that emotional things are wrong during an interview session.

Answer 169

PA people have a hyper amount of ambivalence/uncertainty about everything. They don’t really like anything, but try to interact with others and to accomplish things. They often do things that send mixed messages.

Answer 170

Borderline personality disorder can be treated with psychotherapy, or "talk" therapy. In some cases, a mental health professional may also recommend medications to treat specific symptoms. When a person is under more than one professional's care, it is essential for the professionals to coordinate with one another on the treatment plan. No medications have been approved by the U.S. Food and Drug Administration to treat borderline personality disorder.

Answer 171

Help make decisions, challenging activities, modeling, contracts Recreation therapists plan and implement a range of verbal and task groups designed to improve and maintain social, cognitive, and coping skills. A Current Events discussion group can help build concentration and attention span. A Cooking Group can help with organization, decision making, and attention to detail. Photography and Creative Writing can offer outlets for creativity and expression. Exercise can help to elevate mood, as well as build muscle strength and energy levels. Competitive sports can improve impulse control and frustration tolerance. Animal Assisted Therapy can decrease isolation and withdrawal. Two areas that many CTRSs specialize in are leisure education and stress management. Leisure Education and Leisure Counseling allow people to explore their attitudes towards leisure and free time. Rather than conceptualizing leisure as free time or as a class of activities we engage in, recreation therapists tend to see it more as a state of mind or attitude. The construct of "perceived freedom" is central to this leisure state of mind, and can be viewed as being at the opposite end of a continuum that includes the concept of "learned helplessness." In a state of learned helplessness, we tend to give up, and feel that we have no control over situations and their outcomes. In a state of perceived freedom, we feel skilled and competent, feel free to exercise choice, and become totally absorbed in the activity or experience. Through Leisure Education, people can explore how they can select and pursue recreational interests that can help them achieve this state of perceived freedom.

Answer 172

Anxiety disorders include: Obsessive-compulsive disorder (OCD), Post-traumatic stress disorder (PTSD), Generalized anxiety disorder (GAD), Panic disorder and Social phobia. Antidepressants, anti-anxiety medications, and beta-blockers are the most common medications used for anxiety disorders.

Answer 173

Bizarre irrational compulsion. Ex- wash hands 100x. The obsession is invasive thoughts, rumination, inappropriate thoughts and inappropriate implications.

Answer 174

DELAYED OR MORE THAN 6 WEEKS AFTER THE TRAUMATIC EVENT. Disassociate in crisis and helps get through crisis, early on it is adaptive. Displace anxiety in crisis. Can be part of event or witness event to trigger PTSD. Usually probability of people directly involved more likely to have and is a debate about #s that come from wars. Can be part of environment w/ a family member having cancer. If treated can be successful 1-3 can be greatly reversed, untreated symptoms can go on forever. Can change you for a long time w/ out symptoms. Anyone can get PTSD at any age. This includes war veterans and survivors of physical and sexual assault, abuse, accidents, disasters, and many other serious events. Not everyone with PTSD has been through a dangerous event. Some people get PTSD after a friend or family member experiences danger or is harmed. The sudden, unexpected death of a loved one can also cause PTSD. Re-experiencing symptoms: Flashbacks—reliving the trauma over and over, including physical symptoms like a racing heart or sweating Bad dreams, Frightening thoughts. Avoidance symptoms: Staying away from places, events, or objects that are reminders of the experience, Feeling emotionally numb, Feeling strong guilt, depression, or worry, Losing interest in activities that were enjoyable in the past and Having trouble remembering the dangerous event. Hyperarousal symptoms: Being easily startled, Feeling tense or “on edge” and Having difficulty sleeping, and/or having angry outbursts.

Answer 175

All of us worry about things like health, money, or family problems. But people with generalized anxiety disorder (GAD) are extremely worried about these and many other things, even when there is little or no reason to worry about them. They are very anxious about just getting through the day. They think things will always go badly. At times, worrying keeps people with GAD from doing everyday tasks. People with GAD can’t seem to get rid of their concerns, even though they usually realize that their anxiety is more intense than the situation warrants. They can’t relax, startle easily, and have difficulty concentrating. Often they have trouble falling asleep or staying asleep. Physical symptoms that often accompany the anxiety include fatigue, headaches, muscle tension, muscle aches, difficulty swallowing, trembling, twitching, irritability, sweating, nausea, lightheadedness, having to go to the bathroom frequently, feeling out of breath, and hot flashes. GAD develops slowly. It often starts during the teen years or young adulthood. Symptoms may get better or worse at different times, and often are worse during times of stress. When their anxiety level is mild, people with GAD can function socially and hold down a job. Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying out the simplest daily activities if their anxiety is severe.

Answer 176

1 or 2x/month have a panic attack. DSM-5, Panic attack interferes w/ basic functioning in life. Ex.- can't drive to work b/c had a panic attack in car. Scared something will trigger their panic attack, CUED PANIC ATTACK. UNCUED- our daydreams, way our thoughts travel.

Answer 177

social situation is avoided at considerable costs. Frequently reinforces an existing social structure that feeds their dependence for 3-6 months. Dangerous b/c it becomes other things. Harder to treat, takes longer. Sometimes allows them to live marginal lives. Idea of public speaking is a source of anxiety and can't do it or do it poorly. High chance of relapse.

Answer 178

Antidepressants were developed to treat depression, but they also help people with anxiety disorders. SSRIs such as fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) are commonly prescribed for panic disorder, OCD, PTSD, and social phobia. The SNRI venlafaxine (Effexor) is commonly used to treat GAD. The antidepressant bupropion (Wellbutrin) is also sometimes used. When treating anxiety disorders, antidepressants generally are started at low doses and increased over time. Some tricyclic antidepressants work well for anxiety. For example, imipramine (Tofranil) is prescribed for panic disorder and GAD. Clomipramine (Anafranil) is used to treat OCD. Tricyclics are also started at low doses and increased over time. MAOIs are also used for anxiety disorders. Doctors sometimes prescribe phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan). People who take MAOIs must avoid certain food and medicines that can interact with their medicine and cause dangerous increases in blood pressure. The anti-anxiety medications called benzodiazepines can start working more quickly than antidepressants. The ones used to treat anxiety disorders include: Clonazepam (Klonopin), which is used for social phobia and GAD, Lorazepam (Ativan), which is used for panic disorder and Alprazolam (Xanax), which is used for panic disorder and GAD. Buspirone (Buspar) is an anti-anxiety medication used to treat GAD. Unlike benzodiazepines, however, it takes at least two weeks for buspirone to begin working.Clonazepam, listed above, is an anticonvulsant medication. Beta-blockers control some of the physical symptoms of anxiety, such as trembling and sweating. Propranolol (Inderal) is a beta-blocker usually used to treat heart conditions and high blood pressure. The medicine also helps people who have physical problems related to anxiety. For example, when a person with social phobia must face a stressful situation, such as giving a speech, or attending an important meeting, a doctor may prescribe a beta-blocker. Taking the medicine for a short period of time can help the person keep physical symptoms under control. The most common side effects for benzodiazepines are drowsiness and dizziness. Other possible side effects include: Upset stomach, Blurred vision, Headache, Confusion, Grogginess, and Nightmares. Possible side effects from buspirone (BuSpar) include: Dizziness, Headaches, Nausea, Nervousness, Lightheadedness, Excitement, and Trouble sleeping. Common side effects from beta-blockers include: Fatigue, Cold hands, Dizziness, and Weakness. In addition, beta-blockers generally are not recommended for people with asthma or diabetes because they may worsen symptoms.

Answer 179

stress management, expressive activities, exercise.

Answer 180

Occurs in both children and adults. ADHD is commonly treated with stimulants, such as: Methylphenidate (Ritalin, Metadate, Concerta, Daytrana), Amphetamine (Adderall) and Dextroamphetamine (Dexedrine, Dextrostat). Most side effects are minor and disappear when dosage levels are lowered. The most common side effects include: Decreased appetite. Children seem to be less hungry during the middle of the day, but they are often hungry by dinnertime as the medication wears off. Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose. The doctor might also suggest that parents give the medication to their child earlier in the day, or stop the afternoon or evening dose. To help ease sleeping problems, a doctor may add a prescription for a low dose of an antidepressant or a medication called clonidine. Stomachaches and headaches. Less common side effects. A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may appear to have a personality change, such as appearing "flat" or without emotion. Talk with your child's doctor if you see any of these side effects.

Answer 181

Anorexia nervosa & Bulimia nervosa

Answer 182

may be diagnosed when a person place himself/herself on a diet and exercise program that eventually causes starvation. Anorexia Nervosa is an eating disorder characterized by self-induced starvation and excessive weight loss. DSM 5 diagnostic criteria- 1.Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. 2. Intense fear of gaining weight or becoming fat, even though underweight. 3. Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight. Warning signs include: Significant weight loss, Distorted body image, Intense fear/anxiety about gaining weight, Preoccupation with weight, calories, food, etc., Feelings of guilt after eating, Denial of low weight, High levels of anxiety and/or depression, Low self-esteem, Self-injury, Withdrawal from friends and activities, Excuses for not eating/denial of hunger, Food rituals Intense, dramatic mood swings, Pale appearance/yellowish skin-tone, Thin, dull, and dry hair, skin, and nails, Cold intolerance/hypothermia, Fatigue/fainting, Abuse of laxatives, diet pills, or diuretics and Excessive and compulsive exercise. Health Complications May Include: Amenorrhea (cessation of menstrual cycle), Abnormally slow and/or irregular heartbeat Low blood pressure, Anemia, Poor circulation in hands and feet, Muscle loss and weakness (including the heart), Dehydration/kidney failure, Edema/swelling, Memory loss/disorientation, Chronic constipation, Growth of lanugo hair and Bone density loss/Osteoporosis.

Answer 183

person goes through a cycle of overeating and then vomiting or using laxatives (binge-purge). Bulimia Nervosa is an eating disorder characterized as bingeing (excessive or compulsive consumption of food) and purging (getting rid of food). Symptoms may include repeated episodes of bingeing and purging, eating beyond the point of fullness, feeling out of control during a binge, inappropriate compensatory behaviors following a binge, frequent dieting, and extreme concern with body weight and shape. DSM 5 diagnostic criteria- Recurrent episodes of binge eating characterized by BOTH of the following: Eating in a discrete amount of time (within a 2 hour period) large amounts of food and sense of lack of control over eating during an episode. Recurrent inappropriate compensatory behavior in order to prevent weight gain (purging). The binge eating and compensatory behaviors both occur, on average, at least once a week for three months. Self-evaluation is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of anorexia nervosa. Warning Signs May Include: Bingeing and purging, Secretive eating and/or missing food, Visits to the bathroom after meals, Preoccupation with food, Weight fluctuations, Self-injury, Excessive and compulsive exercise regimes — despite fatigue, illness, or injury, Abuse of laxatives, diet pills, and/or diuretics, Swollen parotid glands in cheeks and neck, Discoloration and/or staining of the teeth, Broken blood vessels in eyes and/or face, Calluses on the back of the hands/knuckles from self-induced vomiting, Sore throat, Heartburn/reflux, Feelings of shame and guilt, Self-criticism and low self-esteem and High levels of anxiety and/or depression. Health Complications May Include: Electrolyte imbalances that can lead to irregular heartbeat and seizures, Edema/swelling, Dehydration, Vitamin and mineral deficiencies, Gastrointestinal problems, Chronic irregular bowel movements and constipation, Inflammation and possible rupture of the esophagus, Tears in the lining of the stomach, Chronic kidney problems/failure and Tooth decay.

Answer 184

early diagnosis and intervention may enhance recovery. Eating disorders can become chronic, debilitating and even life threatening conditions.

Answer 185

Most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or psychological counseling, coupled with careful attention to medical and nutritional needs. Ideally, this treatment should be tailored to the individual and will vary according to both the severities of the disorder and the patient’s particular problems, needs and strengths. Psychological counseling must address both the eating disorder symptoms and the underlying psychological, interpersonal and culture forces that are contributing to the eating disorder. The individual needs to learn how to live peacefully and healthfully with food and with her or himself. Typically care is provided by a licensed health professional, including but not limited to a psychologist, psychiatrist, social worker, nutritionist, and/or medical doctor. Care should be coordinated and provided by a health professional with expertise and experience in dealing with eating disorders. Many people with eating disorders respond to outpatient therapy, including individual, group, or family therapy and medical management by their primary care provider. Support groups, nutritional counseling, and psychiatric medications under careful medical supervision have also proven helpful for some individuals. Hospital-based care (including inpatient, partial hospitalization, intensive outpatient and/or residential care in an eating disorders specialty unit or facility) is necessary when an eating disorder has led to physical problems that may be life threatening, or when it is associated with severe psychological or behavioral problems. The most effective and long-lasting treatment for an eating disorder is some form of psychotherapy or counseling, coupled with careful attention to medical and nutritional needs. Some medications have been shown to be helpful. In the United States, 20 million women and 10 million men suffer from a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified (EDNOS). For various reasons, many cases are likely not to be reported.

Answer 186

Leisure Education, social skills, express feelings, values clarification, family groups, meal planning, No physical work. Using the specific recreational therapy intervention for eating disordered clients, exercise prescription, this intervention will assist in the role modeling of healthy levels of exercise, balance of lifestyle choices, and improve the client's physical and psychological health. The distinctive feature of recreational therapy, that makes it different from other therapies, is the use of recreation activities as a mode of treatment. The recreational therapist has a unique perspective regarding the leisure and social needs of a client with an eating disorder. Recreational therapy can assist eating disordered clients in assuming greater control over their leisure lifestyle, and is a useful and effective addition to the treatment of the eating disordered client. The Recreational Therapist working closely with persons having an eating disorder will also be able to assist them in encouraging that their exercise activities are properly motivated. Throughout our exercise sessions, we process how patients can be working on high self-esteem, body image, social skills, coping skills, and stress management. Need to understand their functional characteristics, focusing on emotional issues and self-image. The disorder is thought to have a direct relationship with the family system, it is important to understand family interactions.

Answer 187

Also considered to a psychological impairment. Within this category are victims and/or perpetrators of violence, abuses or neglect. Child abuse and neglect have become a nationwide concern. Categories of abuse a TRS specialist needs to be aware of: 1) physical abuse 2) sexual abuse 3) emotional abuse. The act of having to watch a parent be abused by another parent may also be classified as abuse. Most symptoms of abused or neglected children are nonspecific, but the children may be classified as developmentally delayed due to emotional problems, passivity, overly aggressiveness or other problems. TRS can help these children gain coping skills and self-awareness. The children can gain the ability to express their emotions appropriately.

Answer 188

Ex.- bullying. These are also behavioral impairments. Persons who display “bullying” behavior may need help w/ self-esteem and the family may need professional assistance. Delinquency and criminal behavior can also fall under this category. These individuals usually display patterns of behavior that are not socially acceptable. Most of these individuals can be found in schools or institutions or prisons. Antisocial behaviors are disruptive acts characterized by covert and overt hostility and intentional aggression toward others. Antisocial behaviors exist along a severity continuum and include repeated violations of social rules, defiance of authority and of the rights of others, deceitfulness, theft, and reckless disregard for self and others. Antisocial behavior can be identified in children as young as three or four years of age. If left unchecked these coercive behavior patterns will persist and escalate in severity over time, becoming a chronic behavioral disorder. Antisocial behavior may be overt, involving aggressive actions against siblings, peers, parents, teachers, or other adults, such as verbal abuse, bullying and hitting; or covert, involving aggressive actions against property, such as theft, vandalism, and fire-setting. Covert antisocial behaviors in early childhood may include noncompliance, sneaking, lying , or secretly destroying another's property. Antisocial behaviors also include drug and alcohol abuse and high-risk activities involving self and others. Antisocial behavior develops and is shaped in the context of coercive social interactions within the family , community, and educational environment. It is also influenced by the child's temperament and irritability, cognitive ability, the level of involvement with deviant peers, exposure to violence, and deficit of cooperative problem-solving skills. Antisocial behavior is frequently accompanied by other behavioral and developmental problems such as hyperactivity, depression, learning disabilities, and impulsivity.

Answer 189

Many addictions start out as harmless pastimes, such as gambling or Internet use. Polysubstance and alcohol dependence are both within this subtopic. 11 classes of substances make up this category: alcohol, amphetamines, caffeine, cannabis, cocaine, hallucinogens, inhalants, opioids, phencyclidine and sedatives, hypnotics or anxiolytics. Prescribed and over-the-counter medications can also be addictive. Substance abuse occurs when an individual repeatedly uses a substance to the point it causes serious problems in life, whether its problems on the job, in role obligations, legal problems, health, etc. Chemical dependency involves developing a reliance on one or a combination of drugs. Addiction is continued use of a drug to the point of a compulsion. At some point, addiction can become so serious that getting and using drugs is the focus of the person’s life.

Answer 190

Although a substance dependent person is not physiologically addicted to a substance, it provides some physical or psychological need and you adjust your life to have that need met. With substance abuse, the use of a substance is not as maladaptive and the person probably is not addicted to the substance. This diagnosis is useful from a pragmatic viewpoint; insurance companies will often pay for treatment of substance dependence. Criteria for Substance Dependence – you need at least three of these symptoms to be prevalent over a 12-month period- Develop an increased tolerance for a given substance. Experience of withdrawal symptoms when you do not use a given substance. You use a given substance with increased frequency. You are not able to cut down the use of a given substance. You spend a great amount of time planning to or trying to obtain a given substance. You experience changes in social, recreational, and/or occupational activities in order to use a given substance. You experience physiological problems that are due to the use of a given substance.

Answer 191

With substance abuse, the substance has a more destructive effect on your life. Criteria for Substance Abuse – You really only need one of these symptoms to be prevalent over a 12-month period: The use of a substance puts you in physically hazardous situations. Example: drinking and driving. You incur legal problems because of the use of a given substance. The use of a given substance interferes with fulfilling some major life obligations such as school or interpersonal relationships. The use of a substance aggravates earlier problems.

Answer 192

Alcohol dependence/abuse are by far the most common pathologies in today'’ society along the lines of substance use. The American Psychiatric Association states that the borderline for alcoholism is 3 drinks 3-4 days a week; roughly 9-11 drinks per week. Any binge drinking, 4 or more drinks a day is considered alcoholism. People in the 18-24-age range are the most likely to have an alcohol problem. Alcohol problems typically tend to emerge around these ages because people have more leisure time and most social activities at these ages center around alcohol consumption. People who drink heavily in college tend to drink heavily throughout their entire lives. People who fall into the alcohol dependence category have an easier time quitting and around 65% do so on their own. Alcohol dependent people often quit after successive scares. Example: They do crazy things while intoxicated that affect their social or occupational lives. The 1st and 2nd drinks tend to relieve anxiety and often bring on a euphoric state. The 3rd drink usually affects judgment and often leads to reckless behavior. There is a strong correlation between alcohol consumption and rape. About 2/3 of all auto related fatalities are attributed to drinking.

Answer 193

Binge Drinking – These people only drink once or twice a week, but drink excessive amounts during these times. Consistent Drinking - These people have several drinks every day. Reactive Drinking – These people begin to show alcoholic patterns because of a traumatic event. Example: A guy gets dumped and starts to drink heavily.

Answer 194

Some components of alcoholism have been found by the research literature to be genetic. Although alcoholism is not totally genetic, genetics might make you more vulnerable to an alcohol-related disorder. Alcoholics Anonymous (AA) seems to be very successful in treating people who acutely use alcohol over a long period of time. For acute alcoholics, AA is usually the only thing that works. Partial drinking programs are not usually successful with people who abuse alcohol. With alcohol abuse, it is all or nothing. However, these programs do tend to be more successful with alcohol dependent people. Have an understanding of the different types of drugs found in each category, symptoms of drug abuse, and the effects of leisure education on the recovery of persons who are dependent on polysubtances and alcohol. The family system is impacted greatly by persons who are addicted to polysubstances and/or alcohol.

Answer 195

Leisure Education, fitness, social skills, provide choice, set limits, have rules, values clarification. Entry level professional is expected to have an understanding of the impact on family, co-dependent behavior and potential family treatment. People are not just addicted to drugs and alcohol, people can be addicted to gambling, exercise, work, etc. ALL persons who are addicted could use goal-oriented treatment, leisure education and an understanding of their behavior and how it affects others, especially the family.

Answer 196

Persons w/ disabilities have the same needs and desires as persons who do not have disabilities. In regard to recreation and leisure service, normalization would imply that persons w/ disabilities should have the same opportunities that anyone without a disability in the community has. Their lives should be as typical as possible: going to school or work, participating in recreation activities, etc., with the same life cycle of activities, expectations and opportunities (attending dances, getting married, etc.).

Answer 197

looks at the whole person & their needs. Recognizes & integrates multiple factors. Developed from a broad base of information. Integrated from an interdisciplinary frame of reference.

Answer 198

Everyone has a Right to recreate. Recreation as an end to itself.

Answer 199

used as a treatment tool to cure> to use Recreation to meet other needs/goals.

Answer 200

Non-clinical approach for disabled in the community (community model): Recreation as an end to itself.

Answer 201

A process that enables an individual to be part of his/her environment by making choices, being supported in what he/she does on a daily basis, having friends and being valued. The recreation profession has accepted the idea and now tries to present community activities as inclusive recreation. Community recreation programs are hiring TRSs to enable persons with disabilities to participate in any community recreation program. The TRS may provide assistance through recommendations of leadership needs, activity, or equipment adaptation or by providing support to assist everyone in accepting the person with a disability in the program. TRS may not be needed after making the necessary program, equipment or leadership adjustments.

Answer 202

An educational term that was first used in the Education of All Handicapped Children Act of 1975 (PL 94-142) and is part of the replacement Individual with Disabilities Education Act (IDEA). It refers to placing a child in an environment where he/she can have the greatest success. Not all children are alike, and that is also true of children with disabilities. Least restrictive environments are situations in which adaptations would be made only when evidence indicates that a person with a disability needs changes to function. Previously, recreation programs may have created “segregated programming” for children with disabilities thinking this would serve those persons best; but it is now recognized that children need a program that fits best for their needs. For some individuals it may be segregated programming at first and then, when appropriate skills have been developed, move into inclusive programming but some individuals may always require segregated programming.

Answer 203

Spontaneous, joyful, suspenseful of reality. Spirit of leisure. Unlike leisure, play has a more singular definition. Play is imaginative, intrinsically motivated, nonserious, freely chosen, and actively engaging. While most people see play as the domain of children, adults also play, although often their play is more entwined with rules and regulations, which calls into question how playful their play really is. On the other hand, children’s play is typified by spontaneity, joyfulness, and inhibition and is done not as a means to an end but for its inherent pleasure.

Answer 204

A freely chosen experience; voluntarily chosen; has a personal and social benefit.

Answer 205

self-determined; can be seen as a social instrument: seen as a means to and end; to make change: 1. freedom of choice; 2. intrinsic motivation; 3. sense of satisfaction

Answer 206

architectural accessibility, program accessibility and the skills required to access the resources now available to persons with disabilities.

Answer 207

Established in 1965. Recognized guidelines for architectural accessibility that were developed by the American National Standards Institute (ANSI). Currently, recreation facility planners must follow the standards issued by the American Transportation Barriers Compliance Board and those contained in the Uniform Federal Accessibility Standards and the Americans Disabilities Act Accessibility Guidelines. It is up to the therapeutic recreation specialist to be aware of the standards and to ensure that all recreation areas meet federal, state and local laws and guidelines.

Answer 208

Designing recreation programs and activities to people with disabilities can actively and socially participate in them. Program accessibility means providing supports and accommodations so people with disabilities can pursue their leisure choices, beyond making the space physically accessible. Approach and Enter are steps that relate primarily to physical accessibility, the next 2 steps, Use and Conveniences, relate more to program and service accessibility. Accommodations and supports can include changing the activity, the equipment or the staffing of the program. Focuses on the design and implementation of specific activities and other events. Just because a facility is accessible does not mean the program is. The TRS must make sure there is appropriate transportation or access to the program, that activities have a range of skill levels and appropriate adaptations, that the fee for the program does not keep people w/ a limited income from participating and that the program has been advertised to all people, including people who are deaf and may need interpreters or people who are blind and may need guides.

Answer 209

As an entry-level professional, need to understand society’s attitudes and what you can do to help educate and thus improve some of the more negative or misinformed attitudes. Attitude- - Attitude (and related behavior) is the number one challenge faced by people with disabilities. The treatment of people w/ disabilities over they years has perpetuated negative thoughts and behaviors.

Answer 210

Some people without disabilities feel that people w/ disabilities should be segregated from the rest of society; some people w/ out disabilities feel sympathy and pity toward people w/ disabilities that may results in a sense of helplessness, dependence, and/or humiliation among people w/ disabilities; some people w/out disabilities tend to belittle, ridicule or even joke about people w/ disabilities, which can result in people w/ disabilities feeling devalued by society; some people w/out disabilities ignore or avoid people w/ disabilities, treating them as if they do not exist or as if their disability is contagious and some people w/out disabilities have a patronizing attitude toward people w/ disabilities, talking to them and treating them like small children. A disposition to respond favorably or unfavorably to an object, person, institution or event. Attitudes can impact behavior. For years, society focused on individuals’ differences, thus causing people to be unaware of how alike we are. This focus on differences caused fear and negative attitudes. TRSs can educate people about how alike we are, thus helping to eliminate negative attitudes. One way is by using “person-first language”, focusing on the person rather than the disability (person with a disability, person who uses a wheelchair, etc.)

Answer 211

People with disabilities are also stereotyped and this is an issue. When we stereotype, we place everyone into a group and fail to treat them as individuals. When we program, we must keep in mind individual needs and differences.

Answer 212

Greatest impact on people with disabilities has come from the government in the form of legislation, which is another competency for CTRS. There are a variety of pieces of legislation that have impacted people with disabilities in the U.S. and made access to recreation and therapeutic recreation services mandatory. •PL 93-112—The Rehabilitation Act of 1973: Title II trained recreation workers to work with people with disabilities and provided research money for recreation projects. Section 304 made money available for demonstrating how to make recreation activities accessible. Section 502 established the Architectural and Transportation Barriers Compliance Board. Section 504-Nondiscrimination under Federal Grants. This is considered to be landmark legislation for individuals with disabilities and laid the groundwork for the Americans with Disabilities Act. It essentially said that a person with a disability could not be discriminated against in any program supported with federal monies. •PL 95-602—The Rehabilitation Act of 1978: Section 311 provided grants for operating and where necessary, removing or constructing facilities to demonstrate methods of making recreational activities accessible. Section 316 provided money to pay for the initiation of new recreation programs to provide activities to assist individuals w/ mobility and socialization. •PL 94-142—The Education of All Handicapped Children Act of 1975: Ensured children w/ disabilities a free and appropriate education. Included recreation as a “related service” defining it as including assessment of recreation and leisure functioning, leisure education, therapeutic recreation and recreation in school and community agencies. Required parents and teachers to write and Individualized Education Plan for all children w/ disabilities. •PL 101-476—Individuals with Disabilities Education Act of 1990 (amendments to The Education of All Handicapped Children Act-changing the name): Required more fully the inclusion of children w/ autism and traumatic brain injury. Included transition and assistive technology services. •PL 105-117—Individuals with Disabilities Education Act of 1997 (reauthorization with amendments): Behavioral plans must be developed. Transition services need to be included beginning at age 14. •PL 101-336—The Americans with Disabilities Act of 1990: Defines person with a disability as an individual who has a physical or mental impairment that substantially limits 1 or more major life activities, has a record of such an impairment and is regarded as having such an impairment. Disability has to result in a substantial limitation in 1 or more major life activities. Four Primary Titles under the ADA: Title I-Employment. Title IIA-Government Services. Title IIB- Public Transit. Title III- Public Accommodation. Title IV- Telecommunications. Need to understand the provisions of these important pieces of legislation because they have had and will continue to impact the lives of persons w/ disabilities and therapeutic recreation/recreation services.

Answer 213

When planning a program, the TRS must be aware of federal and state regulatory agencies and their guidelines and standards. All programs must be offered in barrier free facilities and be as accessible to all as possible. Facilities that receive Medicare funding must follow the regulations established by the Centers for Medicare & Medicaid Services (CMS).

Answer 214

- Joint Commission (originally called the Joint Commission on Accreditation of Healthcare Organizations or JCAHO) - Rehabilitation Accreditation Commission (CARF)

Answer 215

Sets standards for the following groups of healthcare agencies that might offer therapeutic recreation services: ambulatory care, assisted living, behavioral health care, health care networks, managed behavioral health care, preferred provider organizations, home care, hospitals and long-term care. In order to become accredited by the Joint Commission, the hospital or healthcare agency must meet established standards. These standards have a strong influence on programming. Recreation therapy is listed as rehabilitation therapy service. Primarily oversees organizations such as hospitals and long-term care facilities. Wants to see clients’ functional improvement, health status, performance outcomes. Private, not-for-profit agency, you invite them in. Accreditation is based on agencies receiving a passing score. If an agency has met JCAHO standards, the CMS waives it’s own accreditation process. JCAHO standards are higher than CMS.

Answer 216

Establishes the standards for hospitals and a variety of healthcare organizations that might offer TR services including: adult day services, aging services, child and youth services, durable medical equipment, opioid treatment programs, assisted living standards, behavioral health, blind rehabilitation, employment and community services and medical rehabilitation. The standards developed by CARF also address programming issues and the TR specialist must meet those standards. Recreation therapists are designated as treatment team members (based upon need) in the acute brain injury, post-acute brain injury and the inpatient rehabilitation. Mission is to “promote the quality, value and optimal outcomes of services through a consultative accreditation that centers on enhancing the lives of the persons served.” Voluntary, not-for-profit accrediting agency. Accreditation by CARF substitutes for a formal review by CMS.

Answer 217

Includes recreational therapy in the mix of treatment and rehabilitation services used to determine federal compliance in skilled nursing, rehabilitation (physical and psychiatric) and long-term care facilities. Reviews facilities that serve patients on Medicare and Medicaid. Federal government body that regularly reviews hospitals that bill Medicare and Medicaid recipients (long-term care/ skilled nursing facilities). Guidelines 483.10- provide an ongoing program of activities designed to meet, in accordance w/ the comprehensive assessment, the interests and physical, mental and psychosocial well-being of each resident and cannot charge residents for these services. Resident funds should not be charged for universal items such as bookmobile services or local newspaper subscriptions intended for use by more than one resident. Documentation requirements CMS- Minimum Data Sets (MDS)

Answer 218

assessment, plan of care, physician’s order, progress notes and discharge summary.

Answer 219

HIPAA went into effect in 2001. Essentially it states that health care personnel cannot release patient information unless given permission by the patient. Confidentiality is stressed.

Answer 220

Federal agency’s regulations that the entry-level TRS need to be aware of. OSHA provides regulations to reduce workplace hazards and dangerous conditions.

Answer 221

Leisure seen as Time: a block of time/ free time. Leisure seen as Activity: social-economic factors -education/money/income/age/ethnicity determines activity/interests. Leisure activities can be differentiated from other life activities, ignores our mental state. Leisure seen as Holistic: integration of leisure in all aspects of your life. Leisure as an anti-utilitarian concept- leisure does not need to serve any purpose and needs no justification. Believing in and doing what one wants to do rather than responding passively to outside pressures. Leisure as a state of mind- the leisure experience is a function of one’s own state of mind. Leisure is a subjective attitude and experience that is based on an individual’s own feelings, perspectives, values and past life experiences.

Answer 222

use of free time &/or skills to satisfy interests. Leisure awareness: understand the value & importance of leisure/play in one’s life. Motivation to participate: level of internal desire. Social skills: ability to socialize. Personal, financial & physical resources. Leisure interests: can describe & display a wide variety. Quality of past leisure involvement’s: reflected by attitudes & behaviors. Ability to learn play skills. Leisure commonly refers to the factors of “perceived freedom” and “intrinsic motivation” as central defining properties of leisure.

Answer 223

money, education, age, ethnicity, etc.

Answer 224

Csikszentmihaly: Flow: State of optimal, psychological arousal-when the challenge matches your skill.

Answer 225

Personal benefits of recreation and leisure is recreation contributes greatly to a full and meaningful life, regular physical activity it one of the best ways to assure good physical and mental health, leisure helps to manage stress in a busy world, leisure meaningful to us helps to increase self-esteem and to promote good feelings about ourselves and our lives; leisure helps us to lead balance and full lives, to achieve our full potential and to gain life satisfactions, leisure provides positive lifestyle choices and alternatives to self-destructive behavior, leisure and play are essential to the human development process, many skills necessary for successful participation in other parts of life are learned during leisure and people gain satisfaction and a higher quality of life when they can recreate in parks, open spaces, and other aesthetic and diverse environments. Intellectual stimulation, catharsis, hedonistic companionship, secure solitude, moderate security and expressive aestheticism. Needs commonly met through leisure- escape from routine, autonomy, relaxation, family activity, interaction w/ others, stimulation, skill development and utilization, esteem, challenge/competition, leadership/social power and health. Leisure offers freedom of choice to satisfy any number of intrinsically derived needs.

Answer 226

leisure provides opportunities to build stronger communities, recreation reduces alienation, loneliness and antisocial behaviors, community recreation promotes diversity and increased understanding of difference between people, recreation builds strong families, leisure provides opportunities for community involvement and friendship development and community pride is higher when quality recreation opportunities are available for all.

Answer 227

To meet your own leisure needs, benefits from good circumstances. You need a repertoire of skills to be self-capable. Meet own needs/goals.

Answer 228

The causal analysis of behavior. The process by which a person attributes or makes causal inferences. “To what I attribute my successes and failures”.

Answer 229

Maslow’s hierarchy of needs, to reach your potential: A peak experience. Physiological needs>safety/security>belonging>self-esteem>self-actualization Highest self-actualization

Answer 230

Implies that people think they have a choice and in this instance it is used in relation to leisure. Person’s ability to exercise choice or self-determination, over his/her own behavior. According to most leisure professionals, people do not really have leisure unless they at least believe they have the freedom to choose what they do during their leisure. When a person does not feel forced or constrained to participate & does not feel inhibited or limited by the environment. (LDB) The freedom to choose your activity; feel competent; “I can do this.”

Answer 231

Conceptualized as energizing behaviors that are internally (psychologically) rewarding. Intrinsically motivated behaviors are those engaged in for their own sake rather than as a means for an extrinsic reward. Intrinsic rewards that the individual pursues through leisure participation can be divided into personal and interpersonal. Personal rewards include, feelings of competence or mastery, challenge, learning, exploration, efforts and relaxation. Individual participates in those leisure activities at which he/she is good, that are challenging and allow him/her to use and develop personal talent and skills. People must be motivated from within to have a truly leisure experience; external factors (other people, money) CANNOT be the motivating reason. To do something for yourself. Internal desires to do something as a sense of satisfaction.

Answer 232

activities or experiences occurring within leisure. Recreation has also been perceived to be constructive, meeting socially accepted goals of the participant. Recreation has been linked with being restorative, offering refreshment or re-creation for the participant. It is this ability to restore or refresh both mind and body that perhaps is the property that the average person most attaches to recreation. Restoration is goal of both clinical practice and recreation. Recreation is considered to be a natural restorative phenomenon.

Answer 233

A perceived lack of control over events. -no matter how much energy is expended, the situation is futile & you are helpless to change things.-people learn to be helpless; people become dependent. -behaviors & outcomes are out of one’s control.

Answer 234

Relates to the amount of control a person feels he/she has over the events that occur in his/her life. If a person believes that for the most part he controls the outcome of events, he is said to have “internal locus of control.” Internal locus of control- You have the control/can change/good self esteem. If a person believes that the outcome of events is largely due to luck, the environment or others, then he is said to have “external locus of control.” External locus of control- Low self esteem, helpless; “he made me do it”.

Answer 235

Engaging in play to reduce anxiety. Ex.: play therapy-abused child uses doll to master situation. Catharsis Theory: Play to release repressed thoughts, feelings, and emotions. An outlet for aggression. Diversion Theory: To amuse ourselves. Compensation Theory: To play/recreate, to fulfill needs not met at work. Surplus Energy: To get rid of excess energy.

Answer 236

There are not specific activities that one must participate in during a specific life stage within her lifespan, one can identify general activities that one might participate in dependent upon her life stage. Ex.- a sing person in her 20s is more likely to go backpacking in the mountains along than a married person in her/his 40s. Understanding a person’s life stage will help the entry-level TRS develop a program that will meet patients’ interests and needs.

Answer 237

Leisure can influence lifestyle. The work of a leisure services professional, along w/ encouraging life satisfaction, should focus on facilitating both social (behavioral) and environmental (physical) conditions that help people achieve optimal lifestyles. Leisure can assist the individual in developing a healthy, satisfying lifestyle. Persons w/ disabilities may have limited experiences w/ leisure involvement due to imposed, real or perceived limitations and it’s the responsibility of TRS to assist in their leisure lifestyle development. Leisure Lifestyle- Day to day behavioral expression of one’s leisure values, attitudes, awareness & skills in their life experience.

Answer 238

By definition, adjuvant analgesics are drugs whose initial use was not for pain but rather for other conditions. They are a diverse group of drugs that includes antidepressants, anticonvulsants (antiseizure drugs), and others.

Answer 239

Medication is classified as an adjuvant. Anti-depressant. The best studied adjuvant analgesics are the tricyclic antidepressants (TCAs), such as amitriptyline (Elavil®), and desipramine. There is overwhelming evidence that this class of drugs can be effective for migraine headache, tension-type headache, postherpetic neuralgia, painful diabetic neuropathy, arthritis, low back pain, and other painful conditions. These drugs have been shown to relieve pain independent of their effects on depression; that is, patients who are not depressed may experience pain relief.

Answer 240

Treats pain. This medicine is a narcotic pain reliever. Drug classes- Analgesic, Opioid.

Answer 241

Percodan contains a combination of aspirin and oxycodone. Aspirin belongs to a group of drugs called salicylates. It works by reducing substances in the body that cause pain, fever, and inflammation. Oxycodone is an opioid pain medication. An opioid is sometimes called a narcotic. Drug classes: Non-steroidal anti-inflammatory drug, Opioid.

Answer 242

This medicine is an NSAID that treats pain, including arthritis pain. May treat: Inflammation, Rheumatoid arthritis, Osteoarthritis, Ankylosing spondylitis Drug class: Non-steroidal anti-inflammatory drug