Community-Based Recreational Therapy for Veterans with Behavioral Health Disorders: Impacts on Quality of Life, Participation, and Happiness.

Identifying evidenced-based interventions that improve health outcomes for Veterans with behavioral health disorders is a national priority. Thus, this study examined the outcomes of a community-based recreational therapy (RT) program focused on health promotion for Veterans with behavioral health disorders. Fifty-five Veterans with disabilities completed pretest and posttest questionnaires that assessed Quality of Life (QOL), Participation, and Happiness. Significant improvements were found in Overall QOL, Environmental QOL, Psychological QOL, QOL Rated, Satisfaction with Health, Participation, and Happiness. Younger age and female gender were significantly associated with improved Overall QOL. Factors significantly associated with improved Environmental QOL included younger age and non-Caucasian race. Older age was significantly associated with improved Participation. Female gender was positively associated with improved Happiness, while being divorced/separated was negatively associated with Happiness. These results have important implications for the use and expansion of community-based RT health promotion programs for Veterans with behavioral health disorders.

Recreational Therapy to Promote Mobility in Long-Term Care: A Scoping Review.

The objective of this study was to explore and synthesize evidence on the effectiveness and implementation of recreational therapy programs to enhance mobility outcomes (e.g., balance, functional performance, fall incidence) for older adults in long-term care. The authors conducted a scoping review of 66 studies following the PRISMA guidelines. Two independent reviewers evaluated each article, and a third reviewer resolved discrepancies. Randomized controlled studies provided strong to moderate evidence that tai chi programs, walking, dancing, and ball games improve flexibility, functional mobility, and balance. Studies assessing program implementation highlighted that program delivery was facilitated by clear instruction, encouragement, attendance documentation, and minimal equipment. This review elucidated the benefit of recreational therapy programs on mobility. It also identified the need for customized programs based on individuals' interests and their physical and mental abilities. These findings and recommendations will assist practitioners in designing effective and feasible recreational therapy programs for long-term care.

Physical, occupational, and speech therapy for children with cerebral palsy.

AIM: To explore the relationship between rehabilitation therapies and development in children with cerebral palsy (CP). METHOD: We conducted a prospective, longitudinal study involving 656 children with CP (mean age [SD] 6y [2y 8mo] at study entry; 1y 6mo-11y 11mo; 287 females, 369 males), and their parents. Children were assessed two to five times over 2 years by therapists using standardized measures of balance and walking endurance. Parents completed questionnaires on demographics, rehabilitation therapies, and their children's performance in self-care and participation in recreation. Therapists and parents collaboratively classified children's Gross Motor Function Classification System (GMFCS) levels. We created longitudinal graphs for each GMFCS level, depicting change across time using centiles. Using multinomial models, we analyzed the relationship between therapies (amount, focus, family-centeredness, and the extent therapies met children's needs) and whether change in balance, walking endurance, and participation was 'more than' and 'less than' the reference of 'as expected'. RESULTS: Children were more likely to progress 'more than expected' when participating in recreation when therapies were family-centered, met children's needs, and focused on structured play/recreation. A focus on health and well-being was positively associated with participation and self-care. The amount of therapy did not predict outcomes. INTERPRETATION: Therapy services that are family-centered, consider the needs of the child, and focus on structured play/recreational activities and health/well-being may enhance the development of children with CP. WHAT THIS PAPER ADDS: Family-centered rehabilitation therapies were positively associated with greater participation in family/recreation activities and walking endurance. Parental perception that rehabilitation therapies met children's needs was associated with greater participation in family/recreation activities. Structured play, recreational activities, and health/well-being are important for self-care and participation when planning rehabilitation therapy. The amount of rehabilitation therapy was not related to developmental outcomes.

The experience of a recreational camp for families with a child or young person with acquired brain injury.

The Heads Together organisation provides a weekend camping programme for children with an acquired brain injury (ABI) and their families. Utilising a qualitative approach, this study explored family experiences of the Heads Together Camp (HTC) from the perspective of parents. Semi-structured interviews were conducted with 11 parents who had attended the camp. Thematic analysis identified six themes: ABI and the family; Apprehension and discomfort; Connections and community; Hope and perspective; Fun, relaxation and respite; and Family functioning. Families experienced initial feelings of apprehension at camp, which attenuated as connections developed between camp attendees. These connections were grounded in shared experiences of ABI and enabled families to become part of an accepting community, feel less alone and share information. The camp environment also facilitated fun and relaxation, provided families with hope and perspective, and led to improvements in family relationships. Overall, recreational camps may mitigate some stressors experienced by families affected by ABI. Camps could be used to support families by providing them with connections, fun and relaxation, a sense of normality and hope for the future. Thus, recreational camps may represent an effective allied support service for this population.

Medical empirical research on forest bathing (Shinrin-yoku): a systematic review.

AIMS: This study focused on the newest evidence of the relationship between forest environmental exposure and human health and assessed the health efficacy of forest bathing on the human body as well as the methodological quality of a single study, aiming to provide scientific guidance for interdisciplinary integration of forestry and medicine. METHOD: Through PubMed, Embase, and Cochrane Library, 210 papers from January 1, 2015, to April 1, 2019, were retrieved, and the final 28 papers meeting the inclusion criteria were included in the study. RESULT: The methodological quality of papers included in the study was assessed quantitatively with the Downs and Black checklist. The methodological quality of papers using randomized controlled trials is significantly higher than that of papers using non-randomized controlled trials (p < 0.05). Papers included in the study were analyzed qualitatively. The results demonstrated that forest bathing activities might have the following merits: remarkably improving cardiovascular function, hemodynamic indexes, neuroendocrine indexes, metabolic indexes, immunity and inflammatory indexes, antioxidant indexes, and electrophysiological indexes; significantly enhancing people's emotional state, attitude, and feelings towards things, physical and psychological recovery, and adaptive behaviors; and obvious alleviation of anxiety and depression. CONCLUSION: Forest bathing activities may significantly improve people's physical and psychological health. In the future, medical empirical studies of forest bathing should reinforce basic studies and interdisciplinary exchange to enhance the methodological quality of papers while decreasing the risk of bias, thereby raising the grade of paper evidence.

[Health and well-being from forests - experience from Finnish research]. / Effets bénéfiques de la forêt sur la santé et le bien-être. L'expérience de la recherche finlandaise.

The role of forests in enhancing human health and well-being has been studied in Finland for more than a decade, and these benefits are increasingly recognized by the Finnish society. The national research has studied the associations of use and availability of nature with health using different research methods such as population surveys, on-site field experiments, and combining GIS-based data describing the provision of nature areas with use of the areas and health status of people. This article sums up research results from multidisciplinary research work in Finland. One of the main study areas has been restorative effects of nature areas using various psychological measures. These studies demonstrate that forests and other nature areas are important in reducing stress and add recovery from work. Moreover, field experiments have confirmed that visiting forests have beneficial psychological and physiological effects on human health. These effects can be explained by psychological stress relief with contribution from reduced air pollution and noise exposure during the visits. In addition, studies looking at long-term effects of nature exposure suggest that physical activity has a mediating role in perceived health benefits, particularly among suburban residents. Recent efforts include national policy-science discussions on how the research knowledge can be implemented within various sectors such as public health and land-use planning and forest management. This work has resulted a suggestion for a national program called Nature for Health and Well-Being in Finland consisting of an action plan and a multidisciplinary research program. More comprehensive research knowledge has contributed to and triggered series of practical experiments and pilots that are briefly discussed in the article.

[Effect of forest bathing (shinrin-yoku) on human health: A review of the literature]. / Effets des forêts et des bains de forêt (shinrin-yoku) sur la santé humaine : une revue de la littérature.

Humans have enjoyed forest environments for ages because of the quiet atmosphere, beautiful scenery, mild climate, pleasant aromas, and fresh, clean air. In Japan, since 2004, serial studies have been conducted to investigate the effects of forest environments on human health. We have established a new medical science called Forest Medicine. The Forest Medicine is a new interdisciplinary science, belonging to the categories of alternative medicine, environmental medicine and preventive medicine, which encompasses the effects of forest environments on human health. It has been reported that forest environments have the following beneficial effects on human health:1. Increase human natural killer (NK) activity, the number of NK cells, and the intracellular levels of anti-cancer proteins, suggesting a preventive effect on cancers.2. Reduce blood pressure, heart rate, and stress hormones, such as urinary adrenaline and noradrenaline and salivary cortisol.3. Increase the activity of parasympathetic nerves and reduce the activity of sympathetic nerves.4. Increase the levels of serum adiponectin and dehydroepiandrosterone sulfate.5. In the Profile of Mood States (POMS) test, reduce the scores for anxiety, depression, anger, fatigue, and confusion, and increase the score for vigor, showing psychological effects as well.These findings suggest that forest environments may have preventive effects on lifestyle-related diseases.

Art therapy for people with dementia.

BACKGROUND: Art therapy is defined by the British Association of Art Therapists as: "a form of psychotherapy that uses art media as its primary mode of communication. Clients who are referred to an art therapist need not have experience or skill in art. The art therapist is not primarily concerned with making an aesthetic or diagnostic assessment of the client's image. The overall aim of its practitioners is to enable a client to change and grow on a personal level through the use of art materials in a safe and facilitating environment". Historically, drawings and paintings have been recognised as a useful part of therapeutic processes within psychiatric and psychological specialties, and this has been acknowledged within medical and neurology-based disciplines.Arts-based therapies are generally considered as interventions managing manifestations of dementia, as they may help to slow cognitive deterioration, address symptoms related to psychosocially challenging behaviours and improve quality of life. OBJECTIVES: To review the effects of art therapy as an adjunctive treatment for dementia compared with standard care and other non-pharmacological interventions. SEARCH METHODS: We identified trials from ALOIS - the Cochrane Dementia and Cognitive Improvement Group's Specialised Register - on 12 May 2014, 20 March 2015, 15 January 2016, 4 November 2016, and 4 October 2017. We also handsearched the grey literature and contacted specialists in the field and authors of relevant reviews or studies to enquire about other sources of relevant information. SELECTION CRITERIA: All randomised controlled trials examining art therapy as an intervention for dementia. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data. We examined scales measuring cognition, affect and emotional well-being, social functioning, behaviour and quality of life. MAIN RESULTS: We found two studies that met the inclusion criteria, incorporating data on a total of 60 participants (from 88 randomised), in experimental groups (n = 29) and active control groups (n = 31). One study compared group art therapy with simple calculation activities over 12 weeks. The other study compared group art therapy with recreational activities over 40 weeks. It was not possible to pool the data for analysis from the included studies, due to heterogeneity in terms of differences in the interventions, control treatments and choice of outcome measures.In both studies there were no clear changes reported between the intervention group and the control group in the important outcome measures. According to GRADE ratings, we judged the quality of evidence for these outcome measures to be 'very low'. AUTHORS' CONCLUSIONS: There is insufficient evidence about the efficacy of art therapy for people with dementia. More adequately-powered and high-quality studies using relevant outcome measures are needed.

Reflections on the development of a therapeutic recreation-based bereavement camp for families whose child has died from serious illness.

While bereavement camps serve as a support for children, this study examines a therapeutic recreation-based camp for families who have lost a child. The study triangulated documents, researcher reflection, and staff interviews to highlight the themes of Searching & Finding, Getting to Know, Finding the Balance, and Joining. Developing opportunistically through internal and external factors, the camp's evolution represents a closing of the loop, from supporting families of living children to also supporting the families of children who have died. Understanding the camp's evolution may facilitate other programs by highlighting the challenges in developing the program and the lessons learned.

Willingness to Interact After Therapeutic Recreation in a Patient With Schizophrenia.

The study aim was to describe how a patient with schizophrenia who had been in a psychiatric hospital for an extended period of time changed in his desire to interact with others after participating in the therapeutic recreation program, and to interpret his inner process based on symbolic interactionism theory. Data from a patient who showed marked changes in narratives of an interview held after the program and through observation during sessions were analyzed. The patient gained a sense of willingness, including the desire to interact with others and began to act accordingly.

Easily Administered Patient-Reported Outcome Measures: Adolescents' Perceived Functional Changes After Completing an Intensive Chronic Pain Rehabilitation Program.

OBJECTIVE: To determine whether patient-reported measures would be clinically sensitive and useful for identifying functional change within an intensive chronic pain program setting by examining 2 patient-reported measures administered as part of physical and occupational therapy for chronic pain. DESIGN: A retrospective data analysis of children and adolescents with chronic pain treated over a single calendar year. Paired t tests evaluated change in perceived function measures and pain over time. Standardized residual change scores were used in subsequent regression to assess associations between change scores. SETTING: An interdisciplinary pediatric pain rehabilitation program that supports children and adolescents with chronic pain by increasing strength, flexibility, and endurance; facilitating a return to daily life activities; and using appropriate self-directed coping and pain management skills. PARTICIPANTS: Children and adolescents (N=109; age range, 8-19y; 83% girls) with various chronic pain diagnoses who were admitted to a 3- to 4-week intensive pain rehabilitation program. INTERVENTIONS: Participants were involved in physical and occupational therapy for 3 hours daily, as well as recreation therapy, psychology, school, aquatics, art therapy, and music therapy for a total of 8 hours daily. Parents were involved in parent education with therapists from all disciplines in conjunction with their child's programming. MAIN OUTCOME MEASURES: Lower Extremity Functional Scale (LEFS), Upper Extremity Functional Index (UEFI), and self-reported pain severity rating on 0-to-10 numerical rating scale. RESULTS: Data demonstrated significant gains in LEFS and UEFI during the program. Improvement in perceived functioning was significantly correlated with a reduction in pain. CONCLUSIONS: The LEFS and UEFI provide a meaningful way to track progress in chronic pain rehabilitation. Using self-perceived measures, children and adolescents noted significant functional improvement, associated with less pain intensity. These findings increase our understanding of the rehabilitation process and point to goals for clinical improvement.

Factors that bring meaning to mementos created by elders.

OBJECTIVES: Reminiscing activity groups are commonly seen in various elder care settings This study addresses the impact of reminiscence activity groups, specifically a program where group members create their own mementos, on healthy Jewish elders' sense of satisfaction and meaning. In particular, this research focused on the specific factors involved in creating the mementos themselves. METHOD: In this mixed methods study, occupational therapy graduate students synthesized relevant aspects of commonly used activity analysis forms into a matrix to analyze the activities. From a pool of 30 activities, students chose seven representing many factors and levels of complexity. With a matrix composed of a Likert scale and open-ended questions, students and Jewish elders explored the elders' perceptions of factors significantly related to their experiences when creating the seven mementos. RESULTS: Memento-making was most satisfying when elders were replicated in some way, such as with hand casting. Least satisfying activities were those that could lead to talents being appraised, such as painted self-portraits. Unanticipated factors such as social participation and educating others appeared to be as important as making the mementos themselves. CONCLUSION: While the research questions were partially answered, factors such as meaning and creativity were difficult constructs to measure because they lacked clear definitions. However, this preliminary exploration supports the concept that the use of an activity analysis matrix can enable activities directors and occupational therapists to systematically ascertain which factors positively impact well-being and social participation to meet the unique needs of aging client populations.

Effectiveness of group music therapy versus recreational group singing for depressive symptoms of elderly nursing home residents: pragmatic trial.

OBJECTIVES: Several studies have suggested positive effects of music therapy in dementia, but research on age-related depression has been limited and of insufficient quality. The aim of this study was to examine the effect of interactive group music therapy versus recreational group singing on depressive symptoms in elderly nursing home residents. METHOD: Residents of two German nursing homes with sufficient length of stay who were not bedridden were invited to participate in a pragmatic trial. A total of 117 participants, grouped into four clusters (based on their wards), were randomised to interactive group music therapy (n = 62; 20 units of 40 minutes, 2×/week) or recreational group singing (n = 55; 10 units of 90 minutes, 1×/week). The level of depressive symptoms was assessed using the Montgomery-Åsberg Depression Rating Scale at baseline (47% with at least mild depression) and follow-up in the 6th and 12th weeks. There was no blinding of assessors. RESULTS: The level of depressive symptoms improved significantly more in those assigned to music therapy (n = 60) than in recreational singing (n = 53), both in 6th week (mean difference 3.0 scores, 95% CI 1.21 to 4.79, p = 0.001) and 12th week (mean difference 4.50 scores, 95% CI 2.51 to 6.50, p < 0.001). CONCLUSION: The results suggest that music therapy decreases depressive symptoms in elderly people in nursing homes more effectively than recreational singing.

Feasibility of the Participatory Experience Survey and the Setting Affordances Survey for use in evaluation of programmes serving youth with intellectual and developmental disabilities.

BACKGROUND: Participation by youth with disabilities in recreational activities has been shown to promote the development of important skills needed for transition to adulthood. The Participatory Experience Survey (PES) and the Setting Affordances Survey (SAS) were developed for use by recreational programmes serving youth with significant intellectual and developmental disabilities (SIDD) to assess participant experiences and ensure that participants are afforded optimal opportunities to develop these skills. This paper presents a feasibility evaluation to determine the appropriateness of the PES and the SAS for use in a programme evaluation context. METHOD: The PES and the SAS were used to evaluate a programme serving youth with SIDD in the greater northwest region of the United States. Three recreational activities were evaluated: an art project, trip to a zoo and a track practice. Programme volunteers used the SAS to assess opportunities and affordances offered within each activity. The PES was then given to 10 young people in each activity to capture their experiences. It was hypothesized that each setting would afford different experiences and developmental opportunities because of the differing nature of the activities. RESULTS: The PES and SAS were found to be feasible for conducting a programme evaluation. All three settings offered varying types of experiences and affordances. Notably, as measured by the SAS, opportunity for skill development was greater in more structured activities; the zoo had the fewest opportunities for skill development and the art project had the most skill development opportunities. Youth answered 'no' most often to 'asking for help' and 'helping a kid', suggesting changes to offer more opportunities to develop these skills would be beneficial in all three activities. CONCLUSION: These new instruments offer programmes a means to more fully include young people with disabilities during programme evaluations, leading to better-structured, more supportive programmes.

Innovative Mental Health Clinical Placement: Developing Nurses' Relationship Skills.

Engagement in clinical placements is mandatory for all pre-registration nursing programs. Although clinical placements can be valuable, recent literature illustrates that placements within a mental health setting can vary in their educational development. The aim of the current study was to examine the potential learning benefit of 20 pre-registration nursing students in an innovative, university-accredited mental health clinical placement called Recovery Camp. Recovery Camp is a 5-day immersive clinical placement, grounded in therapeutic recreation, which involves all participants engaging in a variety of activities focused on enhancing personal recovery. Qualitative data were collected using individual interviews, reflective journals, and researcher field notes. Analysis of data was conducted using an inductive thematic approach. Analysis of data revealed five themes: (a) Initial Anxiety/Nervousness, (b) Diffusion of Power, (c) Student Perceptions of Consumers, (d) Interaction and Communication, and (e) Resource Shift as a Result of Camp. Developing the professional learning of pre-registration nurses through immersion in effective clinical placements is paramount. Findings demonstrate that pre-registration nurses may benefit from clinical placements that provide immersive and collaborative experiences that allow for the development of relationship-oriented skills that can facilitate person-centered care. [Journal of Psychosocial Nursing and Mental Health Services, 55(2), 36-43.].

Efficacy of recreational football on bone health, body composition, and physical functioning in men with prostate cancer undergoing androgen deprivation therapy: 32-week follow-up of the FC prostate randomised controlled trial.

UNLABELLED: Androgen deprivation therapy (ADT) for prostate cancer (PCa) impairs musculoskeletal health. We evaluated the efficacy of 32-week football training on bone mineral density (BMD) and physical functioning in men undergoing ADT for PCa. Football training improved the femoral shaft and total hip BMD and physical functioning parameters compared to control. INTRODUCTION: ADT is a mainstay in PCa management. Side effects include decreased bone and muscle strength and increased fracture rates. The purpose of the present study was to evaluate the effects of 32 weeks of football training on BMD, bone turnover markers (BTMs), body composition, and physical functioning in men with PCa undergoing ADT. METHODS: Men receiving ADT >6 months (n = 57) were randomly allocated to a football training group (FTG) (n = 29) practising 2-3 times per week for 45-60 min or to a standard care control group (CON) (n = 28) for 32 weeks. Outcomes were total hip, femoral shaft, femoral neck and lumbar spine (L2-L4) BMD and systemic BTMs (procollagen type 1 amino-terminal propeptide, osteocalcin, C-terminal telopeptide of type 1 collagen). Additionally, physical functioning (postural balance, jump height, repeated chair rise, stair climbing) was evaluated. RESULTS: Thirty-two-week follow-up measures were obtained for FTG (n = 21) and for CON (n = 20), respectively. Analysis of mean changes from baseline to 32 weeks showed significant differences between FTG and CON in right (0.015 g/cm(2)) and left (0.017 g/cm(2)) total hip and in right (0.018 g/cm(2)) and left (0.024 g/cm(2)) femoral shaft BMD, jump height (1.7 cm) and stair climbing (-0.21 s) all in favour of FTG (p < 0.05). No other significant between-group differences were observed. CONCLUSIONS: Compared to standard care, 32 weeks of football training improved BMD at clinically important femoral sites and parameters of physical functioning in men undergoing ADT for PCa.

Camp NERF: methods of a theory-based nutrition education recreation and fitness program aimed at preventing unhealthy weight gain in underserved elementary children during summer months.

BACKGROUND: The number of obese children in the US remains high, which is problematic due to the mental, physical, and academic effects of obesity on child health. Data indicate that school-age children, particularly underserved children, experience unhealthy gains in BMI at a rate nearly twice as fast during the summer months. Few efforts have been directed at implementing evidence-based programming to prevent excess weight gain during the summer recess. METHODS: Camp NERF is an 8-week, multi-component (nutrition, physical activity, and mental health), theory-based program for underserved school-age children in grades Kindergarten - 5th coupled with the USDA Summer Food Service Program. Twelve eligible elementary school sites will be randomized to one of the three programming groups: 1) Active Control (non-nutrition, physical activity, or mental health); 2) Standard Care (nutrition and physical activity); or 3) Enhanced Care (nutrition, physical activity, and mental health) programming. Anthropometric, behavioral, and psychosocial data will be collected from child-caregiver dyads pre- and post-intervention. Site-specific characteristics and process evaluation measures will also be collected. DISCUSSION: This is the first, evidence-based intervention to address the issue of weight gain during the summer months among underserved, school-aged children. Results from this study will provide researchers, practitioners, and public health professionals with insight on evidence-based programming to aid in childhood obesity prevention during this particular window of risk. TRIAL REGISTRATION: NCT02908230/09-19-2016.

Perceived Control among People with Severe Mental Illness: A Comparative Study.

BACKGROUND: Given the importance of perceived control to mental health and recovery, research is needed to determine strategies to increase perceived control for people with a mental illness. AIM: Investigate the implications of a therapeutic recreation program on the perceived control of people with a mental illness. METHOD: Participants of an intervention group (n=27) and comparison group (n=18) completed the Perceived Control Across Domains Scale at three time intervals. Subscale and total scores were analysed. RESULTS AND DISCUSSION: Significant variation occurred in the perceived control areas of substance use, personal cognition and personal empowerment. IMPLICATIONS: A unique nurse led therapeutic recreation initiative, such as Recovery Camp, can improve and maintain facets of perceived control among people with mental illness.

Camps and Their Benefit to Pediatric Nephrology Patients.

Children with end stage renal disease (ESRD) frequently miss great amounts of school due to hospitalizations and three-times-a week hemodialysis (if that is their modality); thus, they miss opportunities to be with their peers and learn normal social interactions with other students. Because of this lack of normal socialization, many children with ESRD are behind in development in contrast to their peers and need opportunities to enhance their growth and development. One way this can occur for children with ESRD is by providing them opportunities to attend age-appropriate and disease-appropriate camps.

Complementary and alternative medicine approaches in the treatment of PTSD.

Complementary and alternative medicine is a diverse set of practices and treatments that has seen a significant increase among Americans over the past decade. These approaches have been applied to a myriad of medical and mental health disorders with varying levels of efficacy. Recent years have seen an increased interest in the use of complementary and alternative medicine to address the growing numbers of individuals suffering from post-traumatic stress disorder and other trauma-related disorders. These approaches include pharmacologic and non-pharmacologic modalities. This article will review some of the most widely used non-pharmacologic complementary and alternative medicine practices used to treat post-traumatic stress disorder such as recreational therapy, animal-assisted therapy, yoga, and acupuncture as well as alternative delivery methods for psychotherapy.