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The Nintendo Wii game system, which simulates tennis, bowling, baseball, skiing, fitness, yoga and aerobic exercises, has become a popular type of recreational therapy.
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Recreational therapy
By Ann Gorman

Shopping, baking, participating in sports or hobbies, playing with toys, going on outings, styling hair, visiting friends or taking a walk are simple tasks for most people. But such activities can present enormous hurdles for people with debilitating injuries, illnesses or conditions.  

Innovative recreational therapy techniques and equipment at Springfield's hospitals and outpatient facilities, however, are helping those individuals overcome obstacles and persevere.

Bob Wilson of Rochester thought his "life was done" after he was hospitalized because of a stroke. He discovered it wasn't at a fishing clinic organized by staff members from the Regional Rehabilitation Center at Memorial Medical Center and the Illinois Department of Natural Resources.

Using adaptive equipment - a harness that can hold a fishing pole - Wilson was able to cast out and reel in with his "good hand."

"It meant that I had some freedom," Wilson said of the event held at the pond in Conservation World at the Illinois State Fairgrounds. "I'm disabled; I'm not handicapped."

"It was a perfect day; everyone had a ball," said Dan Stephenson, a district fisheries fish biologist for IDNR. "(The event) turned out great.  Everyone caught a fish."

As a certified therapeutic recreational therapist at Memorial, Lisa Cline uses recreation as a tool to help people recover from spinal cord and head injuries, strokes, orthopedic traumas, joint replacements and other life-altering situations.  She also tries to alleviate any barriers that might prevent them from participating in leisure activities.

"What I do is totally individualized, because each person is different, (with regard to) their personality, attitude, interests and how they spend their leisure time," Cline said.

"A lot of therapeutic training, education and adaptation are required in a short span of time, in order to prepare the patient and family for going home," said Teresa Reiser, director of neuromuscular sciences at Memorial.

Cline initially does an assessment, talking with a patient and caregiver about what their lifestyle was like before the medical problem occurred.

"The goal is to return them to that lifestyle," Cline said. "We don't want patients to leave here thinking, 'OK, I had a stroke (or other health crisis), and now I have to stay home, and I can't go anywhere unless someone helps me.' We want to make sure their confidence is built up and they actually practice (skills) with us, so if there's any problem, we can address it then."

A unique feature of the Regional Rehabilitation Center at Memorial is Independence Square, where a variety of therapy modules replicate "the places people go every day," from a parked car, grocery store or pharmacy, front porch and restaurant to a city street, bus, golf course and bank.

"This space was an outcome of a lot of community support, through Festival of Trees," Reiser said of Independence Square, which opened in 1993. "The premise was to incorporate barriers, obstacles and challenges of every day home and community environments."

It's a great concept, said Dawn Lucasey, a physical therapist and clinical team leader at Memorial. 

Reiser pointed out that, in addition to traditional therapy sessions, there is a need for patients with functional impairments to "test their limits" in daily living skills.

"We want people to do it safely, under supervision and with appropriate awareness. We have the ability to simulate some of those activities here," Reiser said of the model bathroom and kitchen in the center.

She noted that a multidisciplinary team addresses both physical and cognitive limitations, helping patients recognize their abilities and where they need improvement, assistance and adaptation.

"There are lots of complex skills to try to manage.  We do role playing; we practice," Reiser said. "And it's not just the patient; the whole family unit is a part of the treatment and decision-making."

Tracy Green of Springfield knows from personal experience that a stroke "can turn your whole life upside down."

Green, 58, had a stroke Nov. 10, 2007, and was found alone in his apartment two days later after his friend and boss in St. Louis realized Green hadn't shown up for an appointment in Hannibal, Mo.

"I couldn't talk at all. I could not say my name," said Green, whose right side also was weakened.

As part of his treatment, Green boarded an Access Springfield transit bus with Cline.

"He had to do everything, but I was there alongside him to show him that he could do it independently and use that service when he was discharged," said Cline, who's accompanied patients and their family members to stores, restaurants and other businesses, showing them how to balance themselves with a grocery cart, use the restroom and other important tasks.

"Some people are self-conscious, but every time I achieved something, I was proud," said Barb Williams of Springfield. "I was ready to show the world that I could do anything."

Williams could "move nothing" on her body's left side following her stroke.

"I couldn't turn over in bed, lift an arm up, get out of bed, wiggle a toe - nothing," said the now-active 70-year-old.

Kate Steigerwald of Springfield said her stroke in 2004 "totally blew me out of the water. It caused my brain to swell so severely, (doctors) had to do a craniotomy," she said.

Among other things, Steigerwald now participates in an adapted swimming class each week at the local YMCA.

"I love it," said Steigerwald, who uses a wheelchair.  "I didn't think I'd be able to do it. It's really making a difference with my legs."

According to Cline, classes, workshops and camps give patients an opportunity to relearn or try a "scary" activity for the first time with people they know, who have similar diagnoses. 

In addition to the fishing and swimming clinics, Cline and others have helped organize salon, golf and cooking clinics, as well as a day camp at Lake Springfield, where attendees painted pictures; danced or did the hula; learned tai chi or how to fix a healthy meal; and talked to experts about assistive technology and adaptive equipment.

"There's a comfort zone, so it makes it easier," Cline said, noting that business owners and other community members have been supportive of such events.

The occasions also are a source of enjoyment and interaction with the public.

"Having a disability or an altered life doesn't mean you can't have fun anymore," Lucasey said.

"We have a great time," agreed Steigerwald, who suggested a sewing camp be developed.

There also are support groups and "peer resource programs," where individuals talk about their progress and encourage new patients with related health concerns.

"We try to link people with their true peers - they're good role models and provide that mentorship," Lucasey said. "They cheer each other on."

Able to talk again, Green is eager to share his story with others going through similar predicaments.

"I'm blessed," he said at a small gathering of stroke survivors at Memorial.

"It's our way of giving back," Wilson concurred.

"There is always someone better or worse off than you," Williams added.

Physical therapists in the Pediatric Rehabilitation Department at St. John's Hospital use the Lite Gait, a "partial-weight-bearing gait therapy device," with some children who have cerebral palsy, traumatic brain injury, brain-stem tumors or other conditions.

Unlike a freestanding treadmill, the Lite Gate helps control weight bearing and allows a therapist to manipulate a child's hip, knee or ankle position, according to Meghan McFarland, a pediatric physical therapist at St. John's Hospital.

"We put a harness on (the patient) and suspend them over the treadmill (or ground), and then we're able to facilitate their walking pattern," McFarland said.  "It can be used for anyone - from those with severe spinal cord injury, who can't walk, to somebody who is just fine-tuning their knee position."

The device also helps adults who are getting used to a walker or cane, she said.

"It gives the therapist a lot more accessibility to the patient's legs, (without the) worry of the patient falling over or losing his or her balance," McFarland said. "It's much more efficient, and it's a lot safer."

When appropriate, kid-friendly activities are integrated into a child's therapy treatment at St. John's. 

"It's about finding out what's important to that child and focusing the therapy around that," McFarland said.

For instance, a child - sometimes supported by a walker or sitting down - might practice kicking a soccer ball into a goal.

"Whereas he's playing soccer, to us he's working on balance, endurance and leg strength," McFarland said.

Pediatric physical therapist Brenda Vail has used Pilates exercises, kickboxing and "Dance Dance Revolution," an interactive musical video game, to get patients moving.

"I use the dance pad for the older kids who need to work on shifting their weight, to do the 'boring exercises' of stepping forward and backward," Vail said.

She also sets up obstacle courses and has children pretend to be Nintendo video game character Super Mario.

"We're using 'old-school' therapy techniques, but we're making kids use their imagination, as if they're reenacting the video game," Vail said. "Kids will stick with the activity longer."

Youngsters also might shoot baskets, play dress up, drive a child-size, foot-powered car, push a miniature grocery cart or pedal an adapted tricycle as part of their therapy session.

"Whatever motivates the child," Vail said.

McFarland and Vail noted that their department offers a "collaborative" approach to treatment, which includes doctors, other therapists, family members, school personnel and outside resources.

"We want families to come here, get a plan, get an education on how to live with the body you have and continue to grow and enjoy life in the community," Vail said. 

At St. John's Rehab South, physical therapists primarily see patients with orthopedic or sports injuries, although they also care for those with neuromuscular problems, according Brenda Reiling, PT.

A partnership with the adjacent FitClub gives St. John's access to the club's equipment and pools.

"The buoyancy of the water takes weight off of joints. People who are non-weight-bearing and can't do things on land can do more in the water," said physical therapy assistant Sarah Bailey.

St. John's Pediatric Rehabilitation Department utilizes the pools for aquatic therapy, too.

"It's not swimming lessons; it's actually doing exercises in the water," Vail said.

Jeff Koester, also a physical therapist for St. John's, uses "motion analysis" or high-speed digital photography to evaluate a person's movements, identifying any weaknesses or limitations.

"We can do measurements and analysis on the computer system immediately," Koester said.

While therapy treatments have evolved and improved over time, and equipment has become more advanced, "the goal still is function - to get (the patient) back to what they want to do," Reiling said.

"We have electronic games that make (treatment) more entertaining, and there are high-level balance systems and weight machines," she said.

Some of Reiling's patients have tried the Nintendo Wii game system, which simulates such sports as tennis, bowling, baseball, skiing and more, as well as fitness, yoga and aerobic exercises.

"It's something patients enjoy doing; you don't have to force them to participate in rehab or home-exercise programs," said Benjamin McClain, manager of St. John's South Sixth Street facility.

"It's fun," agreed Reiling. "I think people find it a lot more challenging than they anticipated."

The Wii also is popular at Memorial.

"It helped my hand-eye coordination and my balance as far as walking," said Bob Wilson, who mimicked hunting and bowling, via the Wii.

Wilson, who once wanted to "stay in bed and be left alone," is no longer letting a stroke keep him from living a full life.

"You can still do stuff that you used to do, just in a different way," he said.



Story published Friday, December 5, 2008 ( Volume 3, Number 7 )

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