Community Reintegration and Spinal Cord Injury
Paige McCune, CTRS/L, ATRIC, ACSM
Sara Knowles, CTRS/L, CBIS
April 22, 2023
Course Objectives
At the conclusion of this session you will be able to:
1) Define Community Re-Integration
2) Identify 4 skills to focus on prior to completing an outing
3) Identify 4 benefits of CRE for persons with a spinal cord injuries
Objectives
What is Recreation Therapy?
What is Recreational Therapy?
"Recreational therapy, also known as therapeutic recreation, is a systematic process that utilizes recreation and other activity-based interventions to address the assessed needs of individuals with illnesses and/or disabling conditions, as a means to psychological and physical health, recovery and well-being."
National Council for Therapeutic Recreation Certification nctrc.org
Goal is to improve or maintain:
- physical
- cognitive
- social
- emotional
- spiritual functioning
to facilitate full participation in life.
Why RT after Spinal Cord Injury?
- To help answer questions on how to return to a healthy leisure lifestyle
- Through past or new interests
- Educate on all the possiblites of increasing quality of life through the 5 aspects of wellness
- Planning, implementing, and debriefing a CRE
- Learning about accessiblity and barriers
Why RT after
SCI?
Community Reintegration
Community
Reintegration
What is Community Reintegration?
Community Reintegration (CRE) is an individual or group session where a patients/client's abilities and independence are tested in real-life situations. (The Sheperd Center, Atlanta)
These outings are designed to help the individual adjust to the disability and re-enter society as quickly, as independently, and as easily as possible.
Where can a CRE occur?
Community outings can take place:
- Onsite facility
- At the persons place of work and/or school
- Any other public entity (within reason)
Why a Community
Reintegration Outing?
- Boost Confidence
- Decrease Anxiety
- Hone WC skills
- Assess accessibility
- Provide Recommendations
- Educate on ADA laws
- Educate family and/or friends
Why a CRE?
Preparation, Implementation, Debriefing
Preparation
Implementation
Debriefing
- What are the steps to making a CRE happen?
- What are the goals and objectives?
- How is an outing implemented?
- Why is it important to debrief with the patient afterwards?
Preparation
Preparation
- When does someone need a CRE?
- How do you refer a patient for a CRE?
- What topics should the therapy team be discussing?
- How does a RT prepare a patient for an outing?
- What skills should be worked on prior to leaving the facility?
- Communication skills
- Wheelchair or other AD navigation skills
- On and off hospital floor
- Time management skills
- Bathroom management
- Car transfers
- Pressure reliefs
- Identify goals and objectives from therapy team
Recreation Therapy Goals
RT goals:
- Pt will ID 1 CRE location to visit this week to increase chance of returning to location post discharge.
- Pt will set up meeting with disability office at school with min A prior to outing to complete accessiblity meeting prior to discharge.
- Member will ID 2 ways to advocate for self during outing with min prompts.
- Other goals
RT Goals
Assessment Options
Assessments
Implementation
- Have patient ID their personal goals prior to leaving facility
- Have patient ID therapy team goals prior to leaving facility
- Complete action plan
- Hospital or personal transportation
- Wheelchair skills
- Communicating emotions as needed
- Include family, friends, peers, coworkers, etc if possible
Implementation
Debriefing
- How does the patient feel about how the outing went?
- How does the family feel about it?
- What was a positive experience?
- What could have gone better?
- How can we advocate for ourselves?
- Is the patient confident for post discharge plans?
Debriefing
Benefits and Barriers
Benefits
and
Considerations
- Opportunity to meet goals in discharge setting
- Increased confidence in community setting
- Increased level of understanding for family and friends
- What happens if goals are not met?
Research
Community reintegration and self-efficacy Table 4 presents the results of the relationship between perceived community reintegration and self-efficacy that was examined by Pearson correlation coefficient.
There was a positive correlation between perceived community reintegration and general self-efficacy of the study sample (r =.647).
Although both factors of self-efficacy positively correlated with perceived community reintegration, the social functioning factor demonstrated the strongest correlation with community reintegration (r =.659) compared to the activity of daily living factor (r =.510), P<0.001
https://www.researchgate.net/publication/348663543_The_role_of_self-efficacy_in_community_reintegration_among_persons_with_traumatic_spinal_cord_injury_in_South_Africa
Outcomes
of Benefits
Contraindications for Participation
- Medical Issues (blood pressure, wounds, pain)
- Does not have appropriate equipment such as proper fitting wheelchair
- Declining/refusal of session
Contraindications
Questions?
Contacts
Paige McCune
The Center Tulsa
pmccune@thecentertulsa.org
Sara Knowles
Jim Thorpe Rehab
sara.teel@integrisok.com