Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;I like to think that with the right adaptations, anything is possible for anyone. With weakness on one side of the body after a brain injury, I think if you think about it in the way of activity, it's a little easier to break down. If you think about an activity you'd enjoy, like playing cards, you definitely need two hands to play. Usually, you’d hold cards with one hand and play with another. However, you could try incorporating things like a cardholder, which are available at a lot of stores. Or, you can certainly buy them online and I think those can help do the trick. If you're thinking about things a little more active, say doing things like participating in yoga, it's always important to just tell people to participate as much as you can and modify exercises to enhance your participation. Instead of lifting both arms up, maybe use your stronger arm to help support your weaker arm or maybe keep things at shoulder height.&nbsp;&nbsp;There's a lot of different small adaptations that people can do. I think if people aren't able to see a recreational therapist in person, they could jot down the things that they want to do and bring them to their outpatient therapist if they are still seeing them. They could then get recommendations that are personalized to them and your level. If they give the outpatient therapists a little guidance, they can give them a little guidance to make sure that they’re successful. Then there's also things like cycling. If you're really into riding bikes, looking into adaptive cycles, and maybe getting controls all set up for your left side so that brakes are on the left, you’d still be using both legs together. The takeaway is that there are a lot of very individualized adaptations that you could go with, but there are also very simple things like a cardholder to help make participation successful.

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/12%3A-recreational-therapy-for-physical-symptoms-with-recreation-specialist-holly-auth" target="_blank">Brightway Answers interview with recreation therapist Holly Auth</a>: That's a really great question; I thought a lot about this one.&nbsp; Depending on your likes and dislikes, there are opportunities for you. For the physical aspect, there are a lot of different adapted sports programs. For example, I live in western Pennsylvania, and here we have a program called TRAS, which stands for Three Rivers Adapted Sports.&nbsp; They offer adaptive water skiing, biking, bowling, you name it - they offer it throughout the year. They also offer different programs in the winter time, like skiing. The people who run this are trained professionals and volunteers - they will assist you in making sure that you're successful in what you're doing.&nbsp; So if you have limited leg use, they have something called a hand cycle for biking where you power your bike with your hands. You're still biking but in an adapted way. Also in western Pennsylvania there's a horseback riding program and an aquatic program at Slippery Rock University. I know the horseback riding program is funded by the Council on Brain Injury (not sure about the aquatic program) but this is free to anyone who has a TBI. If you’re interested in non-physical activities, I always recommend music, word search, puzzles, reading, as well as social activities like support groups (like RediscoverU). There are a lot of really cool online programs on Facebook as well so you can connect with people there who have also had a brain injury.

CTRS

What recreational activities are offered for someone with a severe TBI with very limited right side arm and leg use?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;For those not familiar with meditation, it's really just a process of learning how to pay attention. This is paying attention to the present moment with a certain amount of curiosity and not necessarily just quieting the mind, which a lot of people think meditation is about. You should be allowing yourself to be more mindful: notice what's happening, what's going on, and practice being less reactive to what's going on. There's a lot of research out there that shows that meditation can help improve brain functioning. It can change some of the structures of the brain. For example, it could change the amygdala, which is our fight and flight response. It can also help change the prefrontal cortex, which is a lot of our executive functioning, so decision making, planning, and problem-solving. Additionally, it can help change the parts of the brain that play a role in learning, memory, and emotional regulation. Focus meditation can do so much for people. It can definitely help decrease stress and anxiety. The greatest thing about meditation is that it's free and you can do it anywhere with very little things, you can do it at any time.&nbsp;&nbsp;There are a lot of apps available such as Headspace, Calm, and Insight Timer. They all have guided meditations at lots of different lengths for people of any skill level. I also love that there's a lot of resources on Love Your Brain, and they're specifically tailored to individuals with brain injury. This comes at different lengths, where you’d be starting out short and working towards longer ones targeting specific areas like stress, anxiety, pain, and sleep. You can filter them in a lot of different ways. Those are some great resources for anyone with traumatic brain injury to engage in meditation. Specifically for someone with visual or hearing impairments, there are a lot of things like amplification devices. That might be helpful for some, but for others, this might not be the solution depending on the level of hearing impairment. For instance, some people engage in meditation by just using white noise, so finding that one noise that you might be able to hear or focusing on just your own breath. Something as simple as counting your breath, so inhaling to a count of one and exhaling to a count of one, or inhaling to a count of two and exhaling to a count of two and so on. There's a lot of really simple ways that you can engage in meditation. There are more complicated ways that you can engage depending on your level of readiness and your skill level, but I think it's important for everyone to remember that meditation is called a practice for a reason. There's no expert in meditation and there's really no way to do it wrong, it's just the act of trying that matters.

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/11%3A-recreational-therapy-for-cognition-with-clinical-specialist-marlene-rivera" target="_blank">Brightway Answers interview with clinical specialist Marlene Rivera</a>: I like this question because it really brings home what mindfulness is intended to do. When you learn to use meditation, it's the same way you learn to do anything: you get exposed to it, and you figure out which ones works best for you, because there's a lot of meditation practices out there. Regardless of what your barriers are, even though your hearing is impaired and you're legally blind, what mindfulness activities like meditation allow you to do is to help you pause and focus on the present using all of your senses. So even if some of your senses aren't functioning at their optimal level, you still can focus on all the other senses to help calm you and bring you back down to earth and ground you - this is the intention of these activities.&nbsp; This is especially helpful when you may be feeling overwhelmed or overstimulated. Brain fog is a factor of cognitive fatigue for some individuals, so engaging in meditation might help to calm them. However, keep in mind that for some individuals, it might actually cause increased anxiety. So it's very important to understand which ones work for you. But by participating in in a mindfulness meditation that best suits you, if you are forcing yourself to pause, that's a very powerful step when when you're trying to help your brain function better and to recover. It's the same concept of rest. When you're resting, you're pausing in your day to take the time to reset before you continue. So if you pause and you focus on what's going on around you with your other senses - what do you hear? what do you see? what do you taste? what do you feel? - that's meditation.&nbsp;&nbsp; You can find guided meditations online that help you go through some of these exercises that will help you focus on those different senses, but again, even if you can't access one, you can engage in meditation independently by pausing and focusing on the senses you have available and taking deep breaths when you're going through those exercises. There are so many resources out there for meditation that you can use. We have a couple that we share on our resource page for the RediscoveryU group that I help to run: <a rel="noopener noreferrer" href="https://www.councilonbraininjury.com/resource-page" target="_blank">https://www.councilonbraininjury.com/resource-page</a>

Clinical Specialist

I am hearing impaired, legally blind, and suffered a mild/moderate TBI 3 years ago 3/21/18. I do use art and poetry as therapeutic hobbies.&nbsp;

How can I learn and use meditation to help my brain to function and recover? 

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;&nbsp;I love this question. I see a lot of my patients in this, so there are so many games that already incorporate communication without even knowing it. There are a lot of games where you come up with a word in a category, games like Five Second Rule Topple that can be really fun, so coming up with a category name. Keep in mind that if your friend gets stuck during these games, maybe ask if they might want clues first and then give clues to words that can be supportive to them. Let's say your category is food. Tell them “I'm thinking of a red fruit” and maybe if that's not helping, offering up that it's something that starts with an “A” so we're giving the initial sound of the word.&nbsp; There are a lot of games like Catchphrase and Taboo, where you're describing a specific word, which is actually a strategy that a lot of speech therapists teach to help with word finding. You can incorporate speech into a lot more games than you think. I think even games you don't normally think of, for instance playing Uno and making a new rule that every time you play a card, you have to name the cards. You have to say what color it is and what number. Another really great game is Go Fish. The whole premise of Go Fish is that it's like structure, repetition, and matching. This can be really helpful and supportive to somebody with a brain injury and somebody that's got difficulties with communication. I think no matter what game you choose, trying to start out by removing any parts of the game that might cause extra pressure, like time constraints and buzzers, is always a big helpful tip. I never want to cause pressure in a situation where somebody's having difficulty with their communication. But again, I think you can incorporate it into anything that you want. Just focusing on that aspect of repetition can be really supportive.

Answer transcribed from the <a rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/10%3A-symptoms-%26-approaches-to-care-after-brain-injury-with-speech-language-pathologist-amber-kloess" target="_blank">Brightway Answers interview with speech-language pathologist Amber Kloess</a>: Here are a few suggestions based on how I work with my patients. The first thing to consider is what vocabulary would be most useful for your friend and to relate it to their hobbies, like food they like, music, past job, or experiences that you had together.&nbsp; Use that as a starting point to develop a list of words throughout the time spent with them.&nbsp; If it's on a zoom call you can use a whiteboard or a word document to write the words as you go so that this person can refer to them as needed for the rest of the conversation. You can always have google available - I use google a lot in each session to look up pictures to support the communication. Visuals can help with recall which is really nice. Some favorite games and activities that I use: Categories is a huge one - you can play it online for free.&nbsp; I use that a lot for virtual appointments for those who have to work on word finding. There's a game called Anomia, and then Catchphrase as well.&nbsp; Those are three that I really enjoy.

Speech-Language Pathologist

My friend had a bad accident a couple of years ago. I talk to her a few times a week, but she doesn't remember many words.

Is there a way I can help to enrich a survivor’s vocabulary in a fun way?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;&nbsp;&nbsp;Recreation therapy is not typically covered by insurance. The good news is that a lot of our programs are free or low cost. Hospitals typically employ recreational therapists as part of their package deal. When you get a hospital bill, you might get services billed or there are things that are packaged deals and rec therapy would be included in that, so there's no extra charge. As far as our community programs go, a lot of ours are at no cost to our participants. A lot of them are free or low cost or on a sliding scale.&nbsp;&nbsp;At Medstar NRH, our programming is free. We do a lot of fundraising by applying for different grants to help support our programs throughout the year. For our biggest fundraiser, we do a big annual 5k called the super h5k runway wheel, which is always a really big hit. Our adaptive cyclists come out and ride in it. We've also got people running and it's great. There are people with strollers, dogs, and everything you name it, they're racing the same. Last year was a virtual race, which was a lot of fun. That's just a really good way for people of all levels to come out. They support each other and we help raise money to keep all of our programming accessible to everyone in our area. The takeaway is that a lot of programs are available free. I think the greatest thing about us not being paid for by insurance is that they are still available and accessible, and that's something that our field really strives for.

Is recreational therapy paid for by insurance? Are there free programs?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>: After a severe TBI, it's really important to continue engaging in activities that the survivor enjoyed prior to their injury but also noting that being a caregiver can be very stressful on its own. Taking into account the situation, I recommend a family-centered approach, which is trying things like scheduling a family game night. On this day of the week, you’re gonna all play a game together and have that be a planned event. Take into consideration what you need to support your family member in doing this, so maybe consider pairing up teams to provide your loved one with some support in whatever game you choose. Then, with the decreased attention, make sure that participation is shorter and allowing for breaks throughout can be helpful.&nbsp;&nbsp;I always think that setting goals and expectations together before you start is very helpful. This could be things like “we're gonna do this activity together for 15 minutes and then take a break”. Also, make sure that you're setting up your environment for success. That includes small things like removing any distractions so that you’re playing a game on a cleared-off table and there's nothing else in the way to take away from our attention. Make sure you’re turning off the TV, muting phones, and putting phones away. Things like that can be really helpful and supportive, it's a family-centered approach where everyone participates in something together. Of course, there are also all those online recommendations for things like adaptive fitness that both survivors can engage in on their own once set up, or family can also participate in.

I care for my mother who suffered a severe TBI in 2018 and is trying to take a rehabilitative approach to her care but she does have a very short attention span.

What is a good way to engage someone after severe TBI especially during Covid with less access to regular therapies?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;Recreation therapy can definitely help enhance the social life of participants. A lot of community programs offer group activities. which can help facilitate building those relationships with others with TBIs, people that have had shared experiences. A lot of those programs might be on hold currently, but there's still a lot of other opportunities where people can participate in outdoor recreation and leisure in a safe way. I'd encourage people to get involved in support groups, a lot of which are happening virtually right now. Make connections with others through that but also check into some outdoor opportunities that you can engage in. This includes things like a cycling program or there might be outdoor fitness classes.

Can recreational therapy help to improve my social life? Are there group activities?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;&nbsp;&nbsp;Being that I provide consulting service, I don't typically see patients like the day they're admitted. I pick patients up as soon as I can on my caseload. Once I get orders, depending on the patient and their need, that might be within a day or two of them being admitted and sometimes maybe they're not at the level where they're ready for extra therapy. Maybe they're not even tolerating what they've got at that point, so I might see them a few weeks into their admission. I typically see patients after a brain injury until the point when they're discharged, so that might be just a few days or it might just be enough time for me to get in there to do some education and make sure they go home with some resources. I've seen people for a little over a year before. it really depends, and I think a lot of people know that insurance can drive some of that. I see them as long as I possibly can and I very often keep in contact with patients and families after they go home.&nbsp;The duration of the time that I work with families is dependent on a mix of both insurance and the severity of the injury, as well as the trajectory of their progress while they're in rehab. There's a lot of factors at play. Severe injuries typically take longer to rehab, and less severe injuries typically take less time to rehab. By “to rehab”, I mean people go home when they're safe to go home. That’s ultimately our goal as a team, where we're all working on our separate pieces together to get patients and families to the point where it's safe to go home and they can continue rehab from that point. I work with people in all different kinds of phases of their recovery for a few days to almost a year as frequently as they will tolerate. So if they tolerate therapy five days a week and I've got time to do it, I'm going to see that patient five days a week. If they're not, then I might see them less at the beginning stages of rehab. When they're tolerating more therapy and more time out of bed, so when they're able to do a little bit more, we might ramp it up and see them a little more frequently.

How long do you work with a patient as a recreational therapist?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;&nbsp;&nbsp;Recreational therapy programs are sometimes difficult to come by in the community. I always recommend people to look into their local recreation centers, so what your city offers. They typically employ a recreational therapist. Definitely look into the nearest big rehabilitation hospital, they usually have plugs into the community. Also, check out your local brain injury association chapter. Those are three good starting points to finding things in the community. Rec therapists work in a lot of different settings, such as hospitals, schools, and in the community. There are also a lot of online programs offered now especially, which is something new and I think one of the silver linings of the pandemic is that there are a lot of online resources. People in rural areas that don't necessarily always have access to services now do.&nbsp;&nbsp;For instance, I teach an adapted yoga class and it's on Wednesdays. I've certainly had people participate in my class that are not from the DC metro area, which is great. I'm happy to have them and I hope that continues to be a thing. I definitely recommend people check out, as far as online resources go, Movie United. I think their website is movieunitedsport.org and they have a really robust program called “adapt at home”. They offer a lot of different adaptive fitness classes every day of the week, sometimes streamed live and some are recorded. There's a lot to check out there. People can also always go for Google search to check out things like adaptive fitness, adaptive sports, and recreation therapy near me. There's certainly a lot available and specifically for brain injury. Love Your Brain is another great program that's offering virtual options right now, and they can check that out at liveyourbrain.com.

Where do recreational therapists work? It would be great to hear about online or remote resources as well.

Where would I go to find recreational therapy programs?

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;&nbsp;&nbsp;When I first meet with somebody, I always go over the basic questions everyone asked in the hospital. This includes “who are you”, “what's today”, “when's your birthday”, “why are you here” to tease out what their perception is that they're working on. Then my next set of questions is a set of questions that they may or may not have been asked before. This includes “what do you enjoy doing”, “what are you like outside the hospital”, “what is your typical day like”. I ask them all of those questions and we go over what's important to them. Of course, I always incorporate “what do you want to be able to achieve when you leave here”, “what do you want to be able to do in your free time”, and “what do you find enjoyable”, so we always try and target those things.&nbsp;&nbsp;Sometimes we're not even at that step yet though. Sometimes communication, attention, or mobility might be a really big barrier to participating in anything. So really using my expertise as a therapist and picking what are the things that are important to them, what are the biggest barriers, and what are the biggest things that we have to work on, tackling those in one is a really important step in choosing what we work on while we're in the hospital. Then we make sure that when they go home, they as well as their families know how they can continue to work on that progress. I'm never gonna discharge someone and say like all of their goals are met and they're good to go. It's a lifelong process for most people. We figure out what goals can we achieve in the amount of time we have together, and then what can I arm them with to continue working on their goals once they don't have me as a therapist anymore.

How do you pick what to work on to help motivate your patients as a recreational therapist? 

Answer transcribed from<a style="color: rgb(34, 34, 34);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/7%3A-susan-little-pt%2C-ms%2C-cbis" target="_blank"> </a><a style="color: rgb(17, 85, 204);" rel="noopener noreferrer" href="https://www.brightwayhealth.org/podcast-episodes/4%3A-allison-huck%2C-ctrs%2C-rrt" target="_blank">Brightway's interview with recreational therapist Allison Huck</a>:&nbsp;&nbsp;&nbsp;Outpatient recreation therapy is not necessarily a thing, but there are community programs. With recreation therapy, it's not necessarily like physical occupational and speech therapy where you would see inpatient and then you move to outpatient. You would see a recreation therapist inpatient, and then branch out to community programs. There are a lot of recreation therapists that work at recreation centers and they're also school-based recreation therapists. So there are a lot of different settings that rec therapists can work in, but there's not typically a smooth transition from inpatient to community-based. At NRH, or the national rehab hospital, we did just hire a rec therapist to bridge that gap. That's something we're working on at our hospital, but that's not necessarily the norm everywhere. That's why as an inpatient therapist, it's really important for me to make sure that my patients and families go home with all the resources. I try to think of it as if they'll never meet a rec therapist again in their life and what can I possibly give them to arm them for the future.

TherapeuticRecAllison's Answers