Adventure Therapy: Adaptive Ski Program

Semi-System

Nicole Bernard, RTStudent Mindy Burgess, RTStudent

November 14, 2017

Table of ContentsPROGRAM: Adaptive Skiing.........................................................................................................................................................................................2

Purpose............................................................................................................................................................................................................................ 2

Program Objectives......................................................................................................................................................................................................... 2

Implementation Description…………………………………………………………………………………………………………………………....3

Population………………………………………………………………………………………………………..……………………………………..3

Program Length and Duration.........................................................................................................................................................................................3

Staff................................................................................................................................................................................................................................. 3

Facility……………………………………………………………………………………………………………………………..………………...…4

Equipment………………………………………………………………………………………………………………………………………………4

Additional Information....................................................................................................................................................................................................5

Referral Criteria……………………………………………………………………………………………………………………..……………….5

Contraindicated Criteria…………………………………………………………………………………………………..………………………….5

Risk Management Considerations…………………………………………………………………………………………………………………...5

A Note on the Discussions…………………………………………………………………………………………………………………...……...5

Evaluation of the Performance Measures……………………………………………………………………………………………………………5

Objectives and Performance Measures……….……………………………………………………………………………………………………..…6

Content and Process Description……………………………………………………………………………………………………………………….7

Session Homework……………………………………………………………………………………………………………………………..…………………..…14

The Sequence Sheet………………………………………………………………………………………………………………….......................…16

The Performance Sheet………………………………………………………………………………………………………………………………..17

Client Descriptions…………………………………………………………………………………………………………………………...……….18

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PROGRAM: Adventure Therapy – Adaptive Skiing

PurposeClient will apply acquired knowledge and increased endurance, strength, and flexibility while learning to independently engage in adaptive skiing.

Program ObjectivesTPO 1. Participants will apply the acquired knowledge and skill to independently operate adaptive ski equipment (three-track, mono-ski, bi-ski) while skiing.

EO 1: Participants will be able to safely transfer from chair to adaptive ski equipment

EO 2. Participants will independently recover and resume skiing after a fall.

EO 3. Participants will have the required knowledge to safely ride the ski lift.

EO 4. Participants will independently navigate the mountain.

TPO 2. Participants will engage in ski outings with family and/or significant individuals to verbalize and direct care so family and/or other individuals will participate and assist the client as needed.

TPO 3. Participants will enhance independent functioning through increased cardiovascular endurance, upper body arm and core strength and overall flexibility.

EO 1. To demonstrate increased endurance through improved time of course completion by 50% by end of program.

EO 2. Increase upper body and core strength by 25%, by end of adaptive ski program. To independently recover and resume skiing after a fall.

EO 3 Increase flexibility by 25% by the end of program.

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EO 4. To demonstrate ability to independently navigate course.

Implementation Description

PopulationThis program is designed for adults 18 and above who has experienced an injury, accident, or disability that has resulted in limited physical functioning who is seeking leisure activities through adaptive recreation. Opportunities are available in both individual and group settings. To ensure safety and proper instruction, group settings are limited to eight participants per activity.

Program Length and DurationThis is an eight-week program, meeting one time a week. Session will vary in length and clients notified of session times. Lecture sessions are 50 minutes and adaptive activity time will me up to two hours. Each session has been designed to build off the previous session therefore, weekly attendance is recommended. The first four sessions will be focused on pre-ski season training. The remaining four sessions will take place at Snowbird Resort.

Program Context

Pre-ski season endurance, upper body and core strength, and flexibility training will take place at Wasatch Adaptive Sports. Adaptive ski program will be held at Snowbird Resort.

StaffEach session should have no more than eight participants. The ratio should be one participant to either one volunteer or one staff. The staff must be state licensed Therapeutic Recreation Specialists (TRS) and National Certified Therapeutic Recreation Specialists (CTRS). Staff members and volunteers must be First Aid and CPR certified, as well as a Level III Adaptive Ski Instructor (PSIA-Adaptive).

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FacilityPre-ski season endurance, upper body and core strength, and flexibility training will take place at Wasatch Adaptive Sports. Adaptive ski program will be held at Snowbird Resort. The latter part of the program at Snowbird Resort will take place on a ski school beginner slope to accommodate individual skill level of participants.

EquipmentEquipment needed will vary depending on session. For the third session, these items will be needed:

7 Wheelchairs 8 Chairs 3 packages of scrap paper 1, 5-gallon bucket Stop watch Large room to accommodate indoor obstacle course 3 cones 2 ski poles 1 set of 3 pound weights Exercise handout Exercise Log

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Additional Information

Referral Criteria

Participants can be referred by medical team or voluntary by self-referral. All participants must submit an online Intake Registration Form prior to meeting with CTRS for adaptive equipment fitting. Online waiver must be submitted prior to session.

Contraindicated Criteria

Participants with higher level of injury may benefit from one-to-one training before entering the group program.

Risk Management Considerations

Participants must sign liability waiver prior to session one. Each group of no more than eight participants will have a ratio of one participant to one staff or volunteer. CTRS will instruct

and assist as necessary. Equipment will be inspected assessed by a certified technician for safety and need of repairs before and after each use. CTRS will instruct volunteers on proper spotting techniques for dumbbell curl portion of obstacle course.

A Note on the Discussions

Volunteers must receive training for First Aid and CPR. For volunteers taking part in the latter part of the program involving the ski program, they must have this in addition to being a Level III Adaptive Ski Instructor (PSIA-Adaptive).

Communicate with family and friends regarding the expectation to participate and assist in activities as needed.

Evaluation of the Performance Measures

Facilitators will complete the performance sheet and write individual SOAP notes following group.

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Objectives and Performance Measures

Program: Adventure Therapy- Adaptive Skiing Program

Terminal Performance Objective: Participants will enhance independent functioning through increased cardiovascular endurance, upper body arm and core strength, and overall flexibility.

Enabling Objectives Performance Measures

1. To demonstrate increased endurance through improved time of course completion by 50% by end of program.

2. Increase upper body and core strength by 25%, by end of adaptive ski program. To independently recover and resume skiing after a fall.

3. Increase flexibility by 25% by the end of program.

4. To demonstrate ability to independently navigate course.

1. The client will demonstrate the ability to complete obstacle course a minimum of one time in a 15-minute block as facilitated by recreational therapist.

2. The client will demonstrate the ability to perform a minimum of five alternating dumbbell curls on each arm using 3-lb weights as facilitated by the recreational therapist.

3. The client will demonstrate the ability to bend and reach to make a minimum of 10 paper snowballs in 30 seconds as facilitated by the recreational therapist.

Adaptive Obstacle Course : Content and Process Description

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TPO 3: Participants will enhance independent functioning through increased cardiovascular endurance, upper body arm and core strength and overall flexibility.

EO 1. To demonstrate increased endurance through improved time of course completion by 50% by end of program.

EO 2. Increase upper body and core strength by 25%, by end of adaptive ski program. To independently recover and resume skiing after a fall.

EO 3. Increase flexibility by 25% by the end of program.

EO 4. To demonstrate ability to independently navigate course.

EQUIPMENT: 7 Wheelchairs, 8 Chairs, 3 packages of scrap paper, 1, 5-gallon bucket, stop watch, Large room to accommodate indoor obstacle course, 3 cones, 4 ski poles, 1 set of 3 pound weights, exercise handout, exercise log

CONTENT PROCESS

1. Gathering of the Group:a. Clients and invited guests will gather in a circle to

complete introduction. It is important when guests are in group to not allow them to dominate group process.

b. Introduce purpose of group: Client will apply acquired knowledge and increased endurance, strength, and flexibility to work towards independent adaptive skiing

2. Group Guidelines a. Group Guidelines are in place to ensure safety for all

“Hello everyone! Welcome to group! Thank you all for coming to our third session. Since we meet once a week, we thought we could begin by reintroducing ourselves to the group and to our volunteers today. Let’s go around the circle and give your name, and one reason you are working towards independent, adaptive skiing.”

“Today we will be introducing everyone to an obstacle course that is designed to help increase your endurance, upper body and core strength, and flexibility. This activity will help prepare you to ski the slopes!”

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participants, staff, and volunteers. b. The group guidelines are:

Let staff or volunteers know if you are feeling unsafe. Perform activities as instructed to insure safety. Make sure to keep a mental and physical presence at all

times.

3. No Obstacle Will Ever Stop Me

a. Gather group at start point of the predesigned course

b. Explain course while other staff demonstrates.

c. Direct participants to create snowballs that will be used in obstacle course to address core strength and flexibility.

d. Participants move through cones continuously using ski poles to address endurance.

“Alright, before heading out to the course, let’s review our group guidelines. Can I have three volunteers read them out to the group?”

“Let staff or volunteers know if you are feeling unsafe.

Perform activities as instructed to insure safety.

Make sure to keep a mental and physical presence at all times.”

“The name of today’s activity is No Obstacle Will Ever Stop Me. Let’s go out to the activities room where we have the obstacle course set up.”

“Before we line up, I will explain the course to you while Mindy demonstrates. At the start of the course, you will each have 30 seconds to make a minimum of ten snow balls. If you can do more, do more! As you complete a snowball, use your core to assist as you return to a fully erect seated position, place the snowball on your lap, reach down with the alternate arm, and repeat this process until I announce the designated time has elapsed. The bending and reaching for the paper snowball will address flexibility and returning to the erect seated position will assist in developing core strength.”

“You will then toss the snowballs in the bucket, if they do not make them all in, that’s okay. Once you have completed your last

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e. Participants will work on upper body and core strength as they bend to pick up and curl weights.

f. As each participant goes through course, provide encouragement and reminders about task as necessary.

g. The activity is completed when everyone has made it through the course.

4. Processing using Bloom’s Taxonomy

throw, a volunteer will place a pair of ski poles in each hand, and you will continue on the course. You will approach a series of three cones that you will have to maneuver around using the ski poles to propel you forward. As you do this, make proper precautions to avoid the cones. You will want to try and do this without stopping because this will work towards increasing endurance.”

“Once you have made it through the cones, the volunteer will take the ski poles, and you will reach down to pick up a pair of 3-lb hand weights. Using your core to assist you in this action will prevent injury. You will complete a minimum of five alternating curls on each arm as a volunteer spots you. Once you have completed your curls, place the weights back on the floor, and you have completed the course! Congratulations!”

“Once you have completed the course, please move to the side so the next participant can begin!”

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Remembering:

What were the three things we were working on today for our body?

Understanding:

What techniques were used in group today to:

Work on endurance? Work on strength? Work on flexibility?

Applying:

How did we use the obstacle course to build our strength? How does building strength assist in skiing

independently? How did the obstacle course build our endurance? How does building endurance help us ski independently? How did we use the obstacle course to build our

flexibility? How does building flexibility help us ski independently?

Analyzing:

Start a sequence:

How can building our endurance help us in our day to day life?

How can building our strength help us in our day to day

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6. Closing Group – Sum up key points of activity

a. This is done to sum up key points to the participants and to lead into the homework and closure activity.

life? How does building our flexibility help us in our day to

day life? How does this help you become more independent in

your day to day life?

Evaluating:

How can you work on your endurance, strength, and flexibility outside of the group?

What is one thing you like to do at home that requires increased strength, flexibility, or endurance?

Creating:

With limitations and needing adaptive equipment, what other resources might you seek outside of this facility?

What exercises could you do at home to help improve endurance, strength, and flexibility?

What are some ways you can create an independent ski experience for yourself?

“Before finishing up today, I would first like to thank you all for participating in this afternoon’s obstacle course activity. I hope each of you recognize that your hard work and dedication to overcome barriers made it possible for you to participate. Each of you have taken the skills learned throughout the past two weeks and applied them to independently and safely navigate the

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7. Homework

a. The homework used will allow the client to work on exercises that increase endurance, upper body and core strength, and flexibility before the next session.

b. These exercises include:

Side bends: Sit tall and let your arms hang down on both sides of your body. From here, gently bend to the right at your waist, extending your right hand as far towards the floor as comfortable. Return to starting position and repeat to opposite side. Continue alternating for five minutes in one minute intervals. (This exercise addresses both core strength and flexibility.) Complete this exercise two times daily. Throughout the week, try to increase time from five minutes to ten minutes. This will also address endurance.

Sit and Reach: With back tall and lifted, extend one arm straight up toward the ceiling. Stretch along your torso reaching as high as possible with one hand. Look at your hand for an added stretch through the neck and shoulders. Hold for 5-10 seconds, then switch to the other side. Grip

obstacles on the course. I encourage each of you to continue developing these skills throughout the remainder of the program as we work towards independent, adaptive skiing.”

“Before next week, I do have some homework to give you! We have created a handout that explains two different exercises which we would like you to perform throughout the week. After completing your exercises each day, please record what you have done on an exercise log, which we have also provided for you. We will have you return these sheets to us next week.”

“Here is an explanation of the exercises on the handout:

Side bends: Sit tall and let your arms hang down on both sides of your body. From here, gently bend to the right at your waist, extending your right hand as far towards the floor as comfortable. Return to starting position and repeat to opposite side. Continue alternating for five minutes in one minute intervals. (This exercise addresses both core strength and flexibility.) Complete this exercise two times daily. Throughout the week, try to increase time from five minutes to ten minutes. This will also address endurance.

Sit and Reach: With back tall and lifted, extend one arm straight up toward the ceiling. Stretch along your torso reaching as high as possible with one hand. Look at your hand for an added stretch through the neck and shoulders.

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your chair for balance if necessary. Continue alternating for five minutes in one minute intervals. This exercise addresses both core strength and flexibility.) Complete this exercise two times daily. Throughout the week, try to increase time from one five minutes to ten minutes. This will also address endurance.

8. Closing Intervention

a. Take a few minutes to have the clients share in a group discussion one strength used to overcome an obstacle on the course and how they could apply that to everyday life. Have clients share in a circle. This is done to help clients recognize where they are in relation to their goals and prepare them for the next session.

Hold for 5-10 seconds, then switch to the other side. Grip your chair for balance if necessary. Continue alternating for five minutes in one minute intervals. This exercise addresses both core strength and flexibility.) Complete this exercise two times daily. Throughout the week, try to increase time from one five minutes to ten minutes. This will also address endurance.”

“As a final activity, we will take a few minutes to share with each other one strength used to overcome an obstacle on the course and how you could apply that to everyday life. Who would like to start first? We will go around the circle after that point.”

“Thank you everyone for sharing. Does anyone have any further questions before we end the group? Alright, please don’t forget to do your exercises and chart, we will see you next week!”

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My Physical Activity Diary Day _____________________________

Day of week Time of Day Description of Activity

(Type and Intensity Level) Duration

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SIDE BENDS

This exercise addresses both core strength and flexibility:

Sit tall and let your arms hang down on both sides of your body.

Gently bend to the right at your waist, extending your right hand as far towards the floor as comfortable.

Return to starting position and repeat to opposite side.

Continue alternating for five minutes in one minute intervals.

Complete this exercise two times daily.

Throughout the week, try to increase time from five minutes to ten minutes. This will also address endurance.

SIT & REACH

This exercise addresses both core strength and flexibility:

With back tall and lifted, extend one arm straight up toward the ceiling.

Stretch along your torso reaching as high as possible with one hand.

Look at your hand for an added stretch through the neck and shoulders.

Hold for 5-10 seconds, then switch to the other side. Grip your chair for balance if necessary.

Continue alternating for five minutes in one minute intervals.

Complete this exercise two times daily.

Throughout the week, try to increase time from one five minutes to ten minutes. This will also address endurance.

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The Sequence Sheet

TPO EO Description Session Time

3 1/2/3 Gathering of the Group 3 5

3 - Group Guidelines 3 2

3 1/2/3 No Obstacle Will Ever Stop Me 3 18

3 1/2/3 Processing Questions 3 15

3 - Group Closure 3 2

3 1/2/3 Homework 3 3

1/2/3 Closing Intervention 3 5

TOTAL: 50 minutes

Performance SheetPROGRAM: Adventure Therapy – Adaptive Skiing Staff: N. Bernard, M. Burgess Date: 11/14/2017 PROGRAM PERFORMANCE PERSONAL PERFORMANCE

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Client Name

TPO

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Pers

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Kathy (Mia) PM 3: The client will demonstrate the ability to bend and reach to make a minimum of 10 paper snowballs in 30 seconds.

Susan (Tara) PM 1: The client will demonstrate the ability to complete obstacle course a minimum of one time in a 15-minute block as facilitated by recreational therapist.

Lisa (Bergen) PM 2: The client will demonstrate the ability to perform a minimum of five alternating dumbbell curls on each arm using 3-lb weights.

Jane (Jacquelyn)

PM 3: The client will demonstrate the ability to bend and reach to make a minimum of 10 paper snowballs in 30 seconds.

Nick (Patrick) PM 1: The client will demonstrate the ability to complete obstacle course a minimum of one time in a 15-minute block as facilitated by recreational therapist.

John (Avery) PM 2: The client will demonstrate the ability to perform a minimum of five alternating dumbbell curls on each arm using 3-lb weights.

5 – Objective Exceeded, 4 = Objective Met, 3 – Objective Somewhat Met, 2 – Objective Not Met, 1 – No Participation

Client Descriptions

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1.Client is a 40-year-old, white, male with paraplegia resulting from a car accident last year that left him with lumbar spinal cord damage. Client uses a wheelchair for full-time use. The client has full mobility of his upper body and displays functional independence in mobility and hygienic needs. John is very independent and lives alone. His mother and younger brother live close by and help with household tasks. Client has informed the therapist that he has some hand weights at home that he uses, but feels as if he is not getting the exercise he needs or wants. Before the accident, John was very physically active in the outdoors. His passions include rock climbing, hiking and skiing. Although John is getting back to his normal routine at work and home, he has expressed that he is finding it challenging and stressful to reengage in outdoor activities. John also expressed that in the past the mountains were a place to go where he felt a spiritual connection. He admits that hearing all of his friends talk about skiing this winter has left him feeling some depression. He expressed that he would like to be more independent in all areas of his life. He understands that in order to do this he will need to increase his overall core strength. Client also stated that he relies on his mother and younger brother to help him with shopping and household chores and expressed that would like to be more independent in that area as well. In the past, the client enjoyed spending time with his friends hiking, climbing, skiing and mountain biking. Although the client knows that he has a great support system through friends and family, he feels that is being left out of activities, because he is not able to do the things he used to. Client displays a very positive attitude and stated that he focuses primarily in the moment when feeling stress and anxiety. Client stated that the more difficult or challenging an activity, the more inspired and excited he becomes. Intervention Outcomes for Client: The client will demonstrate the ability to perform a minimum of five alternating dumbbell curls on each arm using 3-lb weights as facilitated by the recreational therapist.

2. Client is a 65- year old, white, female who had a stroke 2 years ago, resulting in Right Side Hemiparesis- client has reduced muscular strength and decreased control of the right side, resulting in limited movement specifically, right arm, right hand and fingers and right leg. Client reports tingling on right side and loss of feeling in right leg and has difficulty standing- MOD I; when standing from a seated position and uses cane for stability. Client experience loss of balance when walking and ambulates with cane when walking more than a few steps. Client also experiences right side tracking and at times, may not see objects to her right side and relies on verbal cues from others. Client’s speech is clear, but sometimes slowed; at times, she finds it difficult to find a word, when she is expressing herself. Client may experience some dizziness when there is a change in altitude (specifically when riding up the canyon). Client has been attending physical therapy two times a week for strength and flexibility training. Because, client is making great progress she has been recommended and cleared by her physician to participate in Wasatch Adaptive Sports ski program. Client’s past

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leisure interest included skiing, biking, hiking, dancing, reading and gardening. Client has always enjoyed the outdoors and expresses that she finds peace when she is outside engaging in physical activity. Client also expressed that she was happiest when she was skiing and biking with her children. Client is looking for increased activity to strengthen and increase independence. Intervention Outcome for Client: The client will demonstrate the ability to bend and reach to make a minimum of 10 paper snowballs in 30 seconds as facilitated by the recreational therapist.

3.

Client is a 37-year-old African American female, who moved to Utah 6 months ago from California. Client is a bilateral BK and uses a wheelchair for full time use. Leaving her family and friends behind, the client moved to Utah for work. Client is independent and lives alone. While living in California, the client enjoyed the outdoors and belonged to an adaptive swim group. Throughout the 3 years she was part of the swim group she developed a core group of individuals that she would often recreate with. The client expressed that since she moved to Utah, she is finding it difficult to make friends and misses the daily leisure activities she enjoyed back home in California, leaving her feeling alone and depressed at times. Opportunities through social leisure recreation at Wasatch Adaptive Sports will assist the client in building interpersonal relationships to increase the client’s satisfaction in personal feelings of recreation within community life. Establishing a support system through meaningful friendships with peers of all abilities, enabling the client to experience new activities; having a positive impact on social recreation and quality of life. Client’s leisure interest includes cycling, swimming, reading, gardening and live music. Client also expressed that since moving to Utah she has had a hard time finding organizations that offer adaptive sport classes. Client was recommended to Wasatch Adaptive Sports by a co-worker. Client states, that growing up on the coast of California, she has never had the opportunity to ski and would like to explore adaptive skiing. Client displays a very positive attitude and looks forward to the challenges that adaptive skiing has to offer. Intervention Outcome for Client: The client will demonstrate the ability to perform a minimum of five alternating dumbbell curls on each arm using 3-lb weights as facilitated by the recreational therapist.

4.Patient (Jane) is a 46-year old, white, female who has recently recovered from a total hip replacement. Client was in need of a total hip replacement in her right hip due to localized avascular necrosis, which is the death of bone tissue due to a lack of blood supply. Her avascular necrosis was caused by cancer treatments involving radiation that weakened the bone and caused blood vessel damage. Fortunately, she is currently in remission (cancer free) and has been working with an interdisciplinary team of therapists to help her return to an independent and strong level of functioning. She was recommended to and cleared to participate in Wasatch Adapted

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Sports by her physician, and her husband and teenage son (with whom she lives and receives support from), encouraged her to become involved with the program as well. Client is currently experiencing limited physical functioning, low endurance, and balance issues. At this point in time, client cannot independently walk and ambulates using a wheelchair. Client’s leisure interests include a variety of different things. She loved reading, history, and spending time with her family. She enjoyed outdoor, independent leisure, and considered the outdoors a spiritual domain. She enjoyed being in nature and physical activity because it made her feel centered and connected to something bigger than herself. Among her favorite outdoor activities was kayaking, hiking, and skiing. She is excited to be introduced to the programs available at the Wasatch Adaptive Sports. She is willing to work in teams/with other people, but ultimately strives to participate independently again. Intervention Outcome for Client: The client will demonstrate the ability to bend and reach to make a minimum of 10 paper snowballs in 30 seconds as facilitated by the recreational therapist.

5. Patient (Susan) is a 64-year-old, white, female who has recently recovered from a total hip replacement (THR) on left side and is now seeking to become a participant with Wasatch Adaptive Sports. Before her stay at a rehabilitation facility, client had been bedridden for ten and a half months due to recovery complications from a prior THR. Surgery was needed due to rheumatoid arthritis. Her husband of 30 years died 2 years prior to her second hip replacement. After this happened client moved two hours away from her home to live with her 34-year-old son. Her son is a single father raising two young girls. They live in a home in a small, rural community. Because of their financial situation and the pre-existing medical bills from the first joint replacement she did not feel like she had the resource to address the problems that caused her to be bedridden. However, she recently found out that she qualifies for Medicare services and an additional supplemental plan and could get the surgery and the aftercare she needed. After spending two weeks at a rehabilitation center, she is seeking to re-submerge herself into the community and in leisure activities. The symptoms she is currently experiencing include social isolation and depression. While the acute pain physical has resolved, she still experiences limited physical functioning, low endurance, and balance issues. Client is still experiencing limited lower limb functioning, and ambulates using a walker. The client does not currently feel confident using traditional ski equipment, and would like to explore adapted ski alternatives. Client enjoys many things. Though she only received a high school education, she had a love for learning and trying new things. She does not identify with any religious group, but considered herself to be a spiritual person. She has enjoyed most being outdoors and doing activities such as skiing and gardening. She considered herself to be a physically fit person. She also enjoyed activities such as baking and sewing. Intervention Outcome for Client: The client will demonstrate the ability to complete obstacle course a minimum of one time in a 15-minute block as facilitated by recreational therapist.

6.

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Patient (Nick) is a 56-year old, African American male who has recently recovered from a double total knee replacement (TNR) and is now seeking to become a participant with Wasatch Adaptive Sports. Client has been living independently at home with his wife and three teenage children after a two week stay in a rehabilitation facility. He worked his entire adult life as a roofer, and spent much time on his knees. Consistently working on his knees caused bursitis and eventually wore away the cartilage in his knees. This injury and surgery has introduced a transition period in he and his family’s life. Client is no longer able to return to his job as a roofer; however, he is fortunate enough to work for a company that has provided him clerical work. Though he is grateful for the work, he is missing the outdoor work environment and the consistent source of physical activity. He is anxious to re-obtain these things, but is seeking an adaptive alternative to accommodate for his recovering knees. Client is currently experienced limited physical functioning, low strength, and balance issues. While he can walk, he has found it to be painful to be on his feet for too long and prefers to use a wheelchair if he is traveling long distances. He is still participating in physical therapy as he recovers from his double total knee replacement. Client’s leisure interests include the outdoors, physical activity such as football, golfing, and hiking. He really values the idea of being on a team, and is competitive by nature. For this reason, he also enjoys watching sports of all kinds. Another past time that he enjoys is spending time with his family. While he has never skied before, he is interested in learning more about it and the options that are available to him with his current abilities. Intervention Outcome for Client: The client will demonstrate the ability to complete obstacle course a minimum of one time in a 15-minute block as facilitated by recreational therapist.

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