TR Practice: Art, Science, or Magic?

1
TR PracticeArt, Science, or Magic?

• Chapter 13
• HPR 453

2
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????

3
TR Practice as Art

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

4

• 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 arts sake or as recreation as a means
  unto itself

5
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

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• 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

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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

8
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
• 1st real measure of consistency of professional
  practice

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• 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

10
External Developments

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

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

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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

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• 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 environments impact on functioning Health
  and Health Promotion and role of TR

14
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

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• 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?