by Kristen A. Johnson MS, CTRS and Sara J. Klaas, MSW, C-ASWCM

As Americans are flocking in larger numbers to the great outdoors, hospitals and rehabilitation centers are taking heed and creating a paradigm shift in the way treatment is being delivered. Therapists are implementing goal-oriented programs such as kayaking, sailing, rock climbing, and scuba diving, which enable patients to work on therapeutic skill development in an exciting and enjoyable environment. These experiences serve to broaden the range of traditional trips to malls, movie theaters, and restaurants, and take aim at the greater quest for generalized ability training, increased independence, and expanded opportunities for active recreation participation. In this process, rehabilitation professionals are discovering that removing individuals from traditional treatment areas such as therapy rooms and hospital beds, not only optimizes recovery, but also aids in the transition from clinical to community services.

This new philosophical foundation may be of significant importance for individuals with pediatric spinal cord injury (SCI). Involvement in outdoor recreation may directly impact issues related to this population, such as:

• the significant increase in homebound sedentary activities
• the upsurge in social isolation
• the development of secondary medical complications

To further support recreation’s impact, research has also found a positive correlation between recreation participation and life satisfaction, specifically with the pediatric SCI population.

Taking Kids Outdoors

One hospital making headway in this arena is Shriners Hospitals for Children in Chicago, Illinois. Over the last several years, the Recreation Therapy Department has implemented a number of high impact/high profile outdoor programs aimed at changing the way traditional treatment has been delivered. These programs have markedly increased positive patient outcomes in almost all areas of rehabilitation as they have solicited significant involvement from team members. The programs have included 1-dayweekend ski trips and overnight cycling and camping trips, along with a number of 1-day workshops aimed at exposing patients to a variety of active outdoor leisure opportunities they may utilize in their communities. Included in these activities, although not a hospital-sponsored program, is a weeklong scuba adventure trip with a not for profit organization called Diveheart.

The goals of these outdoor recreation programs are similar. The foundational premise is to promote a positive “I can” attitude among participants. This is accomplished by creating an extensive leisure education program that promotes kinesthetic or “hands on” experiences. Following the successful completion of the challenging activities, participants are encouraged to share their feelings thus promoting social interaction and the development of self-esteem. During this time, the importance of an active leisure lifestyle is also addressed and further community resources are discussed.

The participants are selected for the various programs by an interdisciplinary team based on specific criteria. All participants must be independent in activities of daily living, free of pressure ulcers, and also identified as specifically benefiting from the program. The exceptions to these criteria are in the 1-day workshops. Here participants independently register for various programs through the recreation therapy outpatient mailing list.

Evaluations are conducted post activity and have included both formal and informal surveys and interviews. The outcomes of these programs have been noteworthy. Both participants and their families have indicated an impact on their quality of life through enhanced leisure skills education and improved social opportunities. Patients have also reported a feeling of greater self-esteem due to the successful completion in a challenging activity. Other associated outcomes have included increased activity levels post-program experience, improved self-confidence, as well as programs providing a motivation for independence with activities of daily living including bowel and bladder programs.

Keys to Success

The reasons for the many successes of the outdoor recreation programs at Shriners Hospital in Chicago lie in several key components. To begin with, the philosophy and programs are fully supported by the hospital. This support is evident from administration giving the “go ahead” for program development and implementation, to actual professional volunteers working the programs. The strong interdisciplinary focus helps to create a holistic rehabilitation program benefiting the patient in numerous and comprehensive realms. Social workers, physical and occupational therapists, nurses, and volunteers help to create the strong sense of community and connectedness.

Another positive attribute is that activities are partnered with community organizations for support. For example, Creative Mobility in St. Charles, Illinois, provides the handcycles for the cycling and camping trip. Chestnut Mountain in Galena, Illinois, provides the instructors for the downhill ski program, and Diveheart in Downers Grove, Illinois, provides the equipment, instruction, and volunteers necessary to run the scuba adventure program. This not only develops goodwill between the hospital and the community organization, but it decreases the internal resources the hospital needs to run a successful program.

These successful programs are also population-specific. They focus primarily on adolescents with SCIs and similar orthopedic impairments. This allows for a base-level understanding and comfort level between participants. Experiences are more likely to be shared, and feelings more likely to be expressed if the group is more homogeneous. The cafeteria-style programming that is popular, where everyone, despite immensely different needs and goals feeds into similar programs with similar goals, is not as effective with the treatment modality at this stage of rehabilitation.

Limiting the size of participants in the programs has also contributed to the success. Groups are small in number (6–8 participants per program), allowing goals to be specifically tailored to meet participant needs, and also permitting therapists to have more control over participant outcomes. Programs are usually staff intensive due to the concentration of the program. Typically, there is a 1:2 staff to participant ratio with slight modifications in either direction.

Finally, the events are high impact and high profile, meaning they ask participants to step outside their comfort zone to find growth and meaning in their life. It also benefits the participants, the staff, and the hospital as these activities promote good public relations.

The paradigm shift of offering treatment outside the traditional realm, offers a new and innovative means to regain quality of life. Upon completion of an outdoor recreation program at Shriners Hospital in Chicago, it is the intention that the participants will be able to see their world in terms of possibilities and opening avenues. If rehabilitation professionals truly believe in the power of experiential education, they must seek and embrace new avenues.

Kristen A. Johnson, MS, CTRS, is assistant professor of Recreation Administration at Aurora University in Aurora, Illinois. Sara J. Klaas, MSW, C-ASWCM, is director of Care Coordination at Shriners Hospitals for Children in Chicago.