TR Practice: Art, Science, or Magic?

Chapter 13 HPR 453

TR: Roots and Now

  Early Civilization – Play and recreation were healing to ill and injured Florence Nightingale – arts, music, humor, pets, writing, conversation in recovery of ill, injured, and dying soldiers  Recreation contributes to health and QoL  Art, Science or Magic????

TR Practice as Art

 “All Recreation is Therapeutic”   CTRS seeks to supplement, alter, or counteract effects of illness or injury Introduces media to supplement body’s healing and health capacity  Encourages individual to be autonomous and seek meaningful experiences  Results in improvement in health or condition

 Based on aesthetics of environment and value of self-expression and creativity to cause one to feel good (or at least better)  Arrange interventions in a way to effect sense of quality or goodness   The participant interprets the value Art for art’s sake or as recreation as a means unto itself

TR Practice as Science

 “TR as the Means to Outcomes or Ends”   More recent phenomenon due to internal and external forces Definition of science – The observation, identification, description, experimental investigation, and theoretical explanation of phenomena” American Heritage Dictionary (1994)  Through research phenomena and theories are tested and explained

 Scientific investigation of TR Practice and formal training programs began in 1950s  Which interventions were effective?

 What skills do practitioners need to be effective?

 Development of cause and effect and perspective on importance of constancy of purpose and consistency of approach

Important Developments

 Internally –     Body of knowledge professional organizations education and training programs definition of TR  observation and investigation of the practice of TR  accreditation process

Practice as a Science Milestones

 Autonomous credentialing program – NCTRC     Based on scientific analysis of TR job functions and knowledge needed to perform the functions Born of efforts to provide prof self-regulation Educational prerequisites, internship under qualified professional (CTRS), job knowledge test 1 st real measure of consistency of professional practice

 1991 National Consensus Conference on Benefits of TR in Rehabilitation    Temple University and National Institute of Disability Rehabilitation Research (NIDRR) Studied efficacy in TR in rehabilitation Consistent, uniform Tx outcomes of TR with specific populations

External Developments

  Standardization and accreditation of healthcare – JC, CARF Regulatory accountability – Healthcare Financing Administration (HCFA) now CMS  Concerns centered on quality delivered   Costs skyrocketing -> Insurance industry imposed restrictions on access to healthcare Evolution of technology/Consumers’ access to information

 People living longer, surviving catastrophic injuries and illnesses and better informed on options for healthcare  TR exists in scientific arena due to these factors

More recent developments…

 Development of evidence-based protocols or practice guidelines  2003 – ATRA Dementia Practice Guidelines for Recreational Therapy  Theoretical framework and scientific evidence to support efficacy of treatment approaches  Pending Guidelines  Pain, Obesity, Stroke or other neurological events

 Important to monitor trends in healthcare for direction of research and scientific inquiry  Worldwide health initiatives such as WHO ICF  Move away from disease to health and health related domains, how the individual is impacted by internal body functions and structures, activity participation, performance, and functioning in relation to social perspective and environment’s impact on functioning = Health and Health Promotion and role of TR

TR as Magic

  Holistic or Spiritual Perspective of TR Magic defined – “Possessing distinctive qualities that produce unaccountable or baffling effects” American Heritage Dictionary (1994)  Some practitioners practice more by doing what they know works – results through power of charisma, charm, persuasiveness of personality  Mysterious qualities connected to healing

   Mind-Body Connection such as acupuncture, chiropractic, naturopathic medicine, energy-based modalities such as yoga, Reiki or guided imagery, autogenics  Used for centuries yet lack scientific evidence so they are “magical” Enter “Mind and Behavior” – If you believe you can, can you?

Have we as practitioners affected the person by design, or was it really magic that caused the change?