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Therapy can be made fun for patients
Patients occasionally need to be rewarded for their efforts, and throwing them a theme party is one way a rehabilitation facility can add a little excitement to the hard work of rehab therapy.
But in these days of tight financial constraints, rehab facilities have no time or money for fun events. The solution is to throw a party that incorporates therapy exercises and, therefore, is reimbursable. Delaware County Memorial Hospital in Drexel Hill, PA, has held several such parties, successfully combining work with play.
The parties were such a hit with patients and staff that hospital managers plan to hold one every other month, says Marijo Dougherty, OTR/L, rehab manager for the hospital, which is part of Crozer Keystone Health System, also in Drexel Hill, PA.
When recreational therapist Wendy Dargay first suggested the idea to the Delaware staff, they loved the way they could collaborate on the party, tying together various therapies and exercises. "We had a staff meeting with all the disciplines," Dargay says. "Then we reviewed what we thought was best for the patient."
They decided the parties would incorporate physical, occupational, speech, and recreational therapy, as well as input from the nursing and dietary staff. Because the parties would incorporate specific therapy goals and tasks, they would be billable and would be covered under the same consent forms patients signed when they were admitted to the hospital.
"It truly was a collaborative effort, and all of the therapists found a way to incorporate the party theme with their therapy," says Carol Heisner, OTRL/L, operations manager for rehab services.
The hospital’s first party, featuring a Hawaiian luau theme, was held at the end of last summer. The second was a Halloween party. (See party "welcome sheets," p. 25.) The parties included 18 to 20 patients, about 10 therapists or assistants, and two student interns. Nurses made sure the patients, all of whom were inpatients, were dressed and ready in time for the party.
Patients were divided into small groups that would visit each of the six stations where they would work with therapists. The staff decorated the facility’s gym with posters and paper decorations of goblins and pumpkins for the Halloween theme or beach items for the Hawaiian theme. Patients helped with the decorations as part of their therapy.
Each party had a welcome sheet that showed patients what the stations were and what therapy exercises were involved with each, says Ann Benner, PT, staff therapist.
The parties lasted all day and served as substitutes for each one-hour session of occupational therapy and physical therapy in the mornings and the additional hour of therapy in the afternoon after patients visited all of the activity stations. "Everything was billable because it incorporated occupational therapy, physical therapy, and speech therapy," Dougherty says.
"Some were challenging ones like climbing stairs and an obstacle course," Benner says, adding that the obstacle courses were designed for patients who had wheelchairs or assistive devices, as well.
The patients enjoyed the parties and were engaged in the activities, Heisner notes. "They just loved it," she says.
Here’s how the hospital incorporated therapy sessions into the party themes:
• Hawaiian party.
The staff wore Hawaiian-style shirts and leis. Six stations were named for Hawaiian islands or cities. The party began with patients descending a four-stair frame, imagining they were exiting an airplane that had brought them to Hawaii. At the bottom, they received leis, just as if they had stepped off an airplane at an Hawaiian airport.
One station had a plastic sandbox, simulating a beach. Patients walked on the sand to improve their balance, says Anne Waskiewicz, PT, senior physical therapist. "Those who couldn’t walk did some lower-extremity exercises in the sand," she says. "We also incorporated occupational therapy in the physical therapy component by having patients take their socks off and using an appropriate device to put the socks and shoes back on."
While the patients found the exercise to be fun, it served some important functions for both physical and occupational therapy, including knee extensions and flexion, ankle pump, and balance activities, Waskiewicz adds.
Another Hawaiian station simulated the experience of walking over hot coals but without the heat. Patients walked over a mat with bean bags underneath it, which adds to the challenge of walking over a lumpy surface. "The walk, depending on their level of experience, could be a few steps or they could walk through a couple of times," Benner explains. The hot coals obstacle course had three-foot-long bolsters that patients could use for support while walking in and out.
Patients played games at some of the stations. For example, the Hawaiian party featured a golf green with a cup at the bottom, as well as a lei toss, where patients tried to throw a lei over a cone as a practice in balance, Dougherty says.
Another station had a piñata shaped like a colorful fish hanging in the middle of the parallel bars. Patients would hold onto the bars to walk over to it and then hit it with a stick. The piñata contained paper scrolls with information about how patients could conserve their energy and about resources in the community they could use when they returned home, Dargay says.
The Hawaiian party also featured a crafts table where patients made fan-like accordians out of six pieces of tissue paper and then tied them together in the middle and turned them it into flowers. "They have to use sequencing follow-through with bi-manual skills with that task," Dargay says.
A speech therapist worked with Dargay at the crafts table, helping patients who have cognitive impairment or communications problems. "The speech therapist would have the patient talk through the directions because sometimes patients with cognitive impairment have trouble following directions and understanding what step comes next," Heisner says.
The Hawaiian party’s lunch included Hawaiian chicken with pineapple sauce, rice, salad, a fresh fruit bowl, and a pineapple cake.
• Halloween party.
The Halloween party also incorporated the staircase by having patients climb it to knock on a door, as though they were trick-or-treaters. They received trinkets instead of candy for their treats.
The staff turned the sandbox into "the creepy crawly walk" by putting plastic bugs in it. There also were stations to bob for apples, which used adaptive equipment called "reachers," says Helene Bailine, OTR/L, staff therapist.
"What that did was stimulate how they could reach for things off the floor or high shelves," Bailine says. "They had to reach for the apple in a bucket of water, and once they were successful, they were able to eat the apple and dip it in caramel, diet permitting."
The reachers could grab onto the apples, but the task was difficult because of the water, and that made it more of a challenge for patients. Most of the patients were successful, and the therapists helped those who weren’t able to grab the apple on their own, Bailine adds.
"We also incorporated cutting the apple for meal preparation, which helped patients with their fine-motor coordination, and they used assistive devices for cutting," she says.
The Halloween party had a pumpkin piñata and a haunted zone in which patients walked in and out of the bolsters. Another station was devoted to creating Halloween-type crafts. The craft tables used sequencing, following directions, upper extremities exercises, and bi-manual skills, Dargay says.
Another craft involved making spiders out of a Tootsie Pops, pipe cleaners, and toy eyeballs. Patients also made spooky hands out of plastic gloves they stuffed with popcorn; they glued candy corn to the ends of the gloves’ fingers to simulate fingernails. Patients were told that making the crafts was part of their therapy, but just as they always have the option to decline to participate in a therapy task, they had the option of sitting out any activities they didn’t feel like doing, Heisner says.
"For the most part, patients enjoy the opportunity to do something silly and fun during time when they don’t feel so great," Heisner says. Plus, patients were encouraged to share their crafts with their grandchildren or other small children they knew.
"They could take their crafts home, and they were given a copy of the directions so they could make the craft with their grandchildren when they were discharged," Dargay says.
Occupational therapists and recreational therapist asked the higher-level patients to help them set up the lunch tables in the facility’s dining room. For example, patients helped make ghosts out of string, markers, and tissue paper and hung them around the dining area.
Patients also worked with the occupational therapist in the kitchen, doing prep work, such as making a witch’s brew of sherbet and juice, Dargay says. The Halloween meal consisted of hoagie sandwiches, chips, pizza, sodas, and the witch’s brew. Plus, there was a large "Happy Halloween" cake.
Heisner says the main course was done with cooperation from the hospital’s dietary department. "We talked with them to see if they could go along with our theme that day, and they thought it was a good idea to provide this lunch in place of a regular meal," she says. "So they prepared it, and it didn’t cost us anything extra."
The theme parties could work any time of the year, tied to holidays or a particular season, Dargay says. For example, a hospital could hold a "winter wonderland" party that makes therapy sessions out of a snow walk, tree decorating, holiday crafts, a ski lift staircase, and a ramp that doubles as a skiing slope.
"You can make any variation on the theme," Dougherty says. "You just need to make sure the therapeutic input is there and disguise it in a fun way to fit the theme."
Helene Bailine, OTR/L, Staff Therapist; Ann Benner, PT, Staff Therapist; Wendy Dargay, Recreational Therapist; Marijo Dougherty, OTR/L, Rehab Program Manager; Carol Heisner, OTR/L, Operations Manager for Rehab Services; Anne Waskiewicz, PT, Senior Physical Therapist, Delaware County Memorial Hospital, 501 N. Lands down Ave., Drexel Hill, PA 19026. Telephone: (610) 284-8798.