LEI4724

Activity Portfolio # 3

Michelle Wilson

Facilitation Technique Category: Aquatic Therapy

Activity Title: Red Light, Green Light (To promote walking, running and balance)
Source: The Ultimate Guide to Aquatic Therapy. www.hydroworx.com
Equipment: pool shoes, neoprene vest, wet suit
Activity Description: Activities in the water provides experiences of fun and
challenge for many people. Aquatic therapy is a method of treatment that is
conducted in an inherently freeing environment, facilitates not only physical
benefits but psychological and leisure ones as well, while meeting the goals of
promotion of health and well-being (Datillio, 2016). Swimming can be adapted to
each participants needs and capabilities while facilitating normal patterns of
movement. Swimming can involve all the muscle groups and encourage social
integration. Although swimming promotes stretching, muscular strength, and
endurance, each participant must be assessed to ascertain the appropriateness of
each stroke (Datillio, 2016). The purpose of this activity is to promote functional
movement, proprioception, balance, the ability to walk and run. First, start with the
participants lined up along the starting line. Second, the CTRS will call out Green
Light the participants will move as fast as they can (run) towards the finish line.
Third, when the therapist calls out Yellow Light, the participants will walk slowly
toward the finish line. Fourth, when the therapist calls out Red Light the
participants must stop immediately. Fifth, if the therapist sees any of the
participants moving when Red Light is called out that participant must go back to
the starting line. Sixth, the first participant to make it to the finish line wins but a
new round is started when everyone crosses the finish line. Finish the session by
processing with the participants by reviewing the steps and safety of the activity,
benefits, expectations, difficulties, how they felt before and after the activity and
how they can compare this activity to their lives and discuss their goals.
Leadership Considerations: The CTRS functions as the instructor or therapist for
this activity and is in the pool with the participants. It is recommended that the
CTRS be CPR/first aid certified, have a certification in Water Safety Instructor,
certification in Aquatic Therapy and knowledge of the risk factors involved with
aquatic therapy. There is also another staff member present with experience and
the same qualifications as the CTRS - CPR/first aid certified, have a certification in
Water Safety Instructor, certification in Aquatic Therapy and knowledge of the risk
factors involved with aquatic therapy. There should also be at least one lifeguard
present especially during the time of the session. Depending on the severity of the
participant and their swimming capabilities the ratio should be 1:1 or 1:3. Prior to
the activity the CTRS should provide instruction and do a quick assessment on the
participants medical history to avoid contraindications/precautions of aquatic
activities. Before starting the session, the therapist must review water safety, rules,
expectations and provide any demonstrations or further explanation needed for the
participant.
Adaptations: Participants with Cerebral Palsy: Cerebral Palsy (CP) is a
neurological disorder that appears in infancy and early childhood. The neurological

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Michelle Wilson

problems are the result of non-progressive damage to areas of the brain that control
movement and coordination, such as the cerebellum and basal ganglia. Damage to
these areas also affects muscle tone, endurance, strength and speech. The effects
of CP vary in each person depending on the severity of the damage to the brain.
Some may have cognitive impairments and minimal physical problems, while others
may have a clear physical disability but not a cognitive one (Porter, 2015). For
participants with CP depending on the severity of CP they may need a need a lift
chair to enter/exit the pool safely. The use of a flotation belt to support the head
and upper body above water while preserving normal biomechanics
(www.hydroworx.com). Some participants may need to use an underwater treadmill
with support and to assist with ambulation or hand held support from the therapist
due to balance deficits. Adjustable water depth controls, whether standard or as an
optional therapy pool feature, benefit therapists by allowing for easy adjustments to
pool water levels. This allows for a therapist to determine what percentage of the
clients weight should be supported, creating a session that is tailored to the
individuals abilities. Underwater cameras are key features in effective aqua
therapy pools, as they allow for therapists to monitor the clients form and progress
from session to session or to make real-time adjustments. Clients can also use the
cameras to provide an additional level of visual feedback as they work through a
series of exercises (www.hydroworx.com). Adjusting the water temperature to
warmer water temperature (92F-93F) allows for less spasticity and improved
movement.
Adaptations: Participants with Duchenne Muscular Dystrophy: Duchenne
Muscular Dystrophy (DMD) is a genetic disorder characterized by progressive
muscle degeneration and weakness. DMD is the most common childhood form of
MD, mainly affecting boys, the onset of symptoms may be detecting from as early
as two years old, especially as the child begins walking. By the age of ten to twelve
the child may need braces to ambulation or are unable to ambulate. As stated
earlier muscle weakness begins around age three, first affecting the muscles of the
hips, pelvic area, thighs and shoulders, and later the skeletal (voluntary) muscles in
the arms, legs and trunk. The calves often are enlarged. By the early teens, the
heart and respiratory muscles also are affected (www.mda.org). For participants
with DMD depending on the severity of DMD they may need a need a lift chair to
enter/exit the pool safely. The use of a flotation belt to support the head and upper
body above water while preserving normal biomechanics (www.hydroworx.com).
Some participants may need to use an underwater treadmill with support and to
assist with ambulation or hand held support from the therapist due to balance
deficits. The therapist needs to know if the participant has difficulty with breathing,
if this is the case slow walking or floating to decrease energy expenditure and
decrease risk of shortness of breath. Adjustable water depth controls, whether
standard or as an optional therapy pool feature, benefit therapists by allowing for
easy adjustments to pool water levels. This allows for a therapist to determine what
percentage of the clients weight should be supported, creating a session that is
tailored to the individuals abilities. Underwater cameras are key features in
effective aqua therapy pools, as they allow for therapists to monitor the clients

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Activity Portfolio # 3

Michelle Wilson

form and progress from session to session or to make real-time adjustments. Clients
can also use the cameras to provide an additional level of visual feedback as they
work through a series of exercises (www.hydroworx.com). Adjusting the water
temperature to warmer water temperature (92F-93F) allows for less spasticity and
improved movement.
Adaptations References
About Aquatic Exercise and MS. Retrieved September 20, 2016. From
http://aquatics.mymsaa.org/aquatic-exercise/.
Aquatic Therapy2. Retrieved September 20, 2016. From
http://www.nchpad.org/223/1456/Aquatic~Therapy2.
Dattilo, J., & McKenney, A. (2016) Facilitation Techniques in Therapeutic Recreation.
Third edition. State College, PA: Venture Publishing, Inc.
Duchenne Muscular Dystrophy. Retrieved September 20, 2016. From
https://www.mda.org/disease/duchenne-muscular-dystrophy.
Kisner, Carolyn & Colby, Lynn A. (2002) Therapeutic Exercise Foundations and
Techniques, Fourth Edition. Philadelphia, PA: F.A. Davis Company.
Muscular Dystrophy. Retrieved September 20, 2016. From
http://www.mayoclinic.org/diseases-conditions/musculardystrophy/basics/symptoms/con-20021240.
Porter, Heather. (2015). Recreational Therapy for Specific Diagnoses and Conditions.
Enumclaw, WA: Idyll Arbor, Inc.
The Ultimate Guide to Aquatic Therapy. Retrieved September 20, 2016. From
https://www.hydroworx.com/research-education/additional-resources/aquatictherapy-guide/.

LEI4724

Activity Portfolio # 3

Michelle Wilson

Facilitation Technique Category: Therapeutic Massage

Activity Title: The Massage worm via Swedish Massage
Source: The Massage Snake from http://kidsrelaxation.com/uncategorized/themassage-snake/
Equipment: Comfortable clothing, relaxing music, imagination for making up
stories
Activity Description: Touch is an important element of human behavior, and
when used in a positive manner can have a positive impact on peoples lives. One
of the most common outcomes targeted through massage is the reduction of stress.
Prolonged stress and associated tension can create anxiety and physical pain and
discomfort. Massage therapy is the scientific manipulation of the soft tissues of the
body, consisting primarily of manual techniques such as applying fixed or movable
pressure, holding and moving muscles and body tissues (Dattillo, 2016). This
activity involves the basic strokes of Swedish massage using effleurage, petrissage
and tapotement. It is mean to be performed through clothes in appropriate and
non-intrusive areas of the shoulder, back, arms and head. Emphasize that
importance of asking the participant if it is ok to touch them to perform the
massage and if it feels ok during the massage. The CTRS should always start with a
demonstration before instructing the group. First, instruct the participants to sit in a
curvy circular pattern on the floor like a worm and to place their hands on the
shoulder of the person in front of you. Second, have them slowly knead the
shoulder (petrissage) by squeezing and releasing the shoulder muscles like either
kneading breading or eating their favorite food. Third, instruct the participant to
walk their finger up and down (effleurage) the participants back that is in front of
them and very gently alongside of the spine, while doing this have them sing the
Itsy Bitsy Spider or with the palm of them slide their hand up and down the
participants back, like an elevator while singing up/down. Fourth, while telling the
participants a story have them instruct them to cup their hands and quickly tap on

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Michelle Wilson

the participants back that is in front of them, make sure the story relates to either
popcorn or a drum. Fifth, instruct the participants to spread their fingers slightly
(making their fingers into rakes) and move them in a downward motion down then
back from the shoulder to the bottom of the back. Start off with heavier pressure
and decreasing with each repetition (www.kidsrelaxation.com). Finish each session
by processing with the participants by reviewing the types of massages performed
effleurage, petrissage, and tapotement while discussing the steps, benefits, how
they feel currently, and difficulties of each massage.
Leadership Considerations: The CTRS is the instructor for this activity and they
are demonstrating prior to the session. It is recommended that the CTRS have a
certification in massage therapy, story massage or pediatric massage therapy. The
CTRS should be CPR/First Aid certified. Depending on the medical history,
precautions, contraindication and flexibility of the participant, the staff to
participants ratio should be 1:1, 1:2, 1:5 or 2:10. Prior to the session the therapist
should ensure that everyone is willing to participate. Safety topics should be
discussed regarding appropriate touching, rules, notifying the therapist if they do
not feel comfortable to continue and asking for permission. The therapist should
monitor the participants reaction to the massage and social interaction.
Demonstrate the massages if necessary.
Adaptations: Participants (children) with Anxiety Disorders: Anxiety
disorder is characterized by excessive and uncontrollable worry about everyday
things more days than not for at least six months. The intensity, duration, and
frequency of the worry are disproportionate to the issue and interfere with the
performance of tasks and ability to concentrate. The anxiety can also manifest in
physical symptoms, including muscle tension, sweating, nausea, gastrointestinal
problems, jumpiness, fidgeting, trembling, inability to relax, being easily startled,
trouble sleeping and feeling on edge (Porter, 2015). Swedish massage movements
are safe to be performed on participants and movements can be adapted to suit
varying personalities and temperaments. Positive touch through storytelling can
be especially beneficial for children with special/additional needs
(www.storymassage.co.uk). The therapist may want to gradually increase the time
of the massage once the trust between therapist and participant is established,
ensure there is open communication between the therapist and participant by
educating them about touch and what is doing to happen during the session.
Keeping a regular routine and have the family carryover the massage at home is
vital. Incorporate deep breathing to begin the relaxation process.
Adaptations: Participants with (children) Autism Spectrum Disorder:
Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is diagnosed
on behavioral and developmental characteristics rather than medical, anatomic or
specific genetic markers. It includes deficits in social communication and social
interaction, including social-emotional reciprocity; nonverbal communication
behaviors, and developing, maintaining and understanding relationships; and
restricted repetitive patterns of behavior, interests or activities, including
stereotyped or repetitive motor movements, use of objects, or speech; insistence on
sameness, inflexible adherence to routines, or ritualized patterns of behavior; highly

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Michelle Wilson

restricted or fixated interests of abnormal intensity and/or focus; or hyper/hypo

reactivity to sensory input (Porter, 2015). It is a collection of social, communication
and behavior impairments and not just one single behavior that create ASD. The
condition affects boys more frequently than girls. Since lighter touch tends to
overstimulate and aggravate a person with autism, a moderate to deep pressure
massage with joint compression has been more effective to calm down, relax and
ground hyperactivity and sensitivity (www.elementsmassage.com). At first it may
need to be a 1:1 ratio for the participant to gain the trust with the therapist. The
therapist may want to gradually increase the time of the massage once the trust
between therapist and participant is established, ensure there is open
communication between the therapist and participant by educating them about
touch and what is doing to happen during the session. Keeping a regular routine
and have the family carryover the massage at home is vital for regular sensory
integration. During the session lowering your voice to a whisper will assist with
redirection of behavior secondary to having to listen to what you are saying.
Another approach is to use the participants own hands to do the massage on the
arm until that trust is gained
Adaptation References
Autism and Treatment with Therapeutic Massage. Retrieved September 23, 2016.
From http://www.massagetoday.com/archives/2005/02/04.html.
Children and Massage. Retrieved September 23, 2016. From
http://www.massagetherapy.com/articles/index.php/article_id/470/Children-andMassage.
Dattilo, J., & McKenney, A. (2016) Facilitation Techniques in Therapeutic Recreation.
Third edition. State College, PA: Venture Publishing, Inc.
Massage Provides Mental, Physical Treatment Options for Children with Autism.
Retrieved September 23, 216. From http://elementsmassage.com/blog/massageprovides-mental-physical-treatment-options-for-children-with-autism
Massage Therapy for Anxiety and Depression. Retrieved September 23, 2016. From
http://www.balancenaturalhealthclinic.ca/articles/122-massage-therapy-for-anxietyand-depression.
Porter, Heather. (2015). Recreational Therapy for Specific Diagnoses and Conditions.
Enumclaw, WA: Idyll Arbor, Inc.
The Massage Snake. Retrieved September 22, 2016. From
http://kidsrelaxation.com/uncategorized/the-massage-snake/