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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?

What does it look like?

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?

  • Who do we advocate to?

  • 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

  • Knowledge is power

  • 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)

  • Poor activity tolerance

  • Does not have appropriate equipment such as proper fitting wheelchair

  • Declining/refusal of session

Contraindications

Conclusion

Questions?

Contacts

Paige McCune

The Center Tulsa

pmccune@thecentertulsa.org

Sara Knowles

Jim Thorpe Rehab

sara.teel@integrisok.com

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