Aldo+and+Judy

** Judy & Aldo ** 1. T7 paraplegia can have a significant impact on an individual’s occupational performance. Areas of occupation affected by T7 paraplegia can be; ADL’s, IADL’s, work and education. Work and education can be affected due to the decrease accessibility of the physical environment. The individual experiencing T7 paraplegia may encounter problems in completing daily routines in a timely manner due to functional mobility limitations. They may also need to plan ahead to compensate for the additional time needed to meet the demands of the occupations. According to a research study by Price, Stephenson, Krantz & Ward (2011), a participant described a situation where he was having difficulty entering a bar with his friends because there were no ramps. He also stated, “…that tells me that they probably don’t have a bathroom that I can use” (p. 84, 2011). The participant described the situation as uncomfortable and would need to do future planning before going out into the community. Individuals who experience T7 paraplegia may also become depressed due to the significant decrease in participation in activities they value. Our clients are individuals in the early adulthood stage of life (app. 20-25yrs) that have T-7 paraplegia and have been discharged from rehabilitative services. Spinal cord injury (SCI) is damage to the spinal cord either through compression, bruising or severing of the spinal cord, which can result in paralysis and loss of sensory and motor function (Crepeau, Cohn, Boyt Shell, 2009). Spinal cord injuries are primarily associated with trauma, like car accidents and gunshot wounds and can also be the result of tumors or acquired diseases. Porth and Matfin (2009), elaborate this is a disorder of young people, in which most injuries occur in the 16 to 30 year age group (p.1287). There are two classifications of injuries to the spinal cord; complete injury or incomplete injury. Complete injury can be described as having no sensory or motor function below the level of the injury. On the other hand when there is some remaining motor or sensory function below the level of the injury it is considered to be an incomplete injury. Further, SCI can be categorized as Tetraplegia, which is loss of function in both the upper and the lower extremities. A second category is Paraplegia and it only involves decrease function in the lower extremities that our clients exhibit. After experiencing spinal cord injuries our clients resided in an acute care setting, their length of stay varied based on the severity of the injury they acquired. Once our clients were medically stable they were transferred to an inpatient rehabilitation center for approximately a month and a half. Some of our clients remained in the rehabilitation center for a longer period of time, while most others continued therapy in an outpatient facility. All clients were discharged and were recommended to attend a community integration program. Most of the clients went home and didn’t consider attending our community integration program. That is only after friends and family members insisted they attend didn’t they agree to come check it out. A community integration program provides social and emotional support to individuals with disabilities. The ** goal in this setting is to encourage, teach and empower individuals to integrate into the community and form friendships with others ****. **This setting aims to involve people with all types of disabilities and of all ages in recreation and leisure activities that are available to the general public. The community integration program provides a support system that will enable individuals with T7 paraplegia to transition into the community by providing coping strategies to compensate for lost abilities. As occupational therapist we will predominantly focus on enhancing the client’s current level of functional skills. This will ultimately enable individuals to improve their quality of life.
 * The majority of the group paper was done collaboratively. However, we have added names to the corresponding sections **

** Judy & Aldo ** 2. The main focus of our group will be to increase social participation through leisure activities to enhance our client’s motivation, self-esteem and confidents. The group process will allow the member to acknowledge that being disabled does not mean they cannot participate in desired occupations, even though they face adversity. They can still function as a productive member within their community. Untimely, the group will help members increase self-awareness and enhance their self-confidence in order to function at their highest potential. The members will also be able to generalize the skills used within the group as they transition into the community. Moreover, once the adjourning stage is complete, the group members will be able to select and independently participate in desired meaningful occupations. This group will meet twice a week for eight weeks for the duration time of 45 minutes. Two therapeutic goals 1. The group members will participate in leisure activities that will allow them to increase their social participation as well as their motivation and self-confidence. 2. The group members will identify two activities they will like to engage in once they integrate back into the community. 3. Good afternoon everyone, and welcome to today’s group which will met Mondays and Thursday for a total of 8 weeks. Let’s go ahead and introduce ourselves since this is the first time we are meeting. My name is Judy Martinez and this is Aldo Martinez. Once all members have become acquainted with each other the group leader will explain the purpose of this group is to enable members to transitioning back into the community. We will then elaborate on one of the reasons why this group was established, “Many individuals who are experiencing this disability have received support in a rehabilitation program but when discharged home they find it difficult to interact in their natural environment without the support from the rehab center”. So let me start off by asking how many of you felt prepared to return home after leaving the rehabilitation center? If so, what did you find most difficult? Based on the feedback from the group members we may be able to generate a warm up discussion. If the previous questions do not generate a conversation the following questions will address: -How has your disability affected your social or leisure time?  -Do you find yourself avoiding specific situation in a given environment? If so, can you explain? (Stigma) -What kind of support system was available to you after discharge? The introduction section will conclude by providing the member with a brief outline of the session. Today’s session will take approximately 45 minutes. We will go over to the gymnasium to play a team sport. The sport that we will be playing is basketball. After a fifteen-minute game of basketball we will return to the classroom for a small group discussion. We will then head to the gym.

** Judy & Aldo ** 4. The group will engage in a five on five basketball game for approximately 15 minutes. Only four players from each team will be on the court at any given time. The fifth member from each team will be cheering on the sidelines. In order for the group leaders to control the amount of participation and communication between teams, we will rotate the fifth player when necessary. Before we begin the activity, several game rules will be established:  -Each player can dribble or place the ball in their lap while in motion, for no longer than five seconds. At this point the ball must be passed to another group member. We decided to add the 5 second holding rule to encourage the members to communicate with one another. This element will elicit social participation.  -We will only be using half of the court. Therefore, if the opposing team takes the rebound, the ball must be taken back to 3-point line.  -If the basketball is made, the referee (group leaders) will get the ball and reset the game back to the top of the 3-point line (similar to half court rules). -The referees (group Leaders) will determine the fouls.  We will also go over some safety rules/precautions involving the usage of wheelchairs during the game.  -Use caution when maneuvering around the court with the wheelchairs. Be careful with your hands, as they are exposed and injury may occur.  -No hard contact between wheelchairs will be allowed. A warning will be given when this occurs one time, you will be taken out of the game for 1min if it happens a second time. The game will end after the fifteen minutes have elapsed and the referee will sound a whistle. The team with the most points will win the game.

** Judy & Aldo ** 5. While running the group, one difficulty we may encounter will be the lack of participation from group members as a result of interpersonal factor. For instance, some members might show signs of depression; others might display low self-esteem or even decrease motivation. Although the design of this group is to increase social participation through leisure activities we do not expect all members to be physically active during the game to demonstrate participation. If a member is not participating and we notice the behavior, we will approach the individual and ask the member, “Joe, try and move closer to the basket so your teammates can pass the ball to you.” If the member ignores the advice and continues to demonstrate the same behavior, the group leaders will ask the individual to switch with the fifth member that is on the sideline. The group leaders’ actions will allow the individual to watch his teammates interact with each other and hopefully this can address multiple concerns within this person. For instance, if the member did not know how to play the game this will afford him the chance to learn vicariously. Further, the group member will observe from the sideline allowing him to see that people with the same disability are playing the entire game. Overall, we hope that the individual will rejoin his teammates once he has acknowledge that he has the same potential to engage in this activities and possibly others within the community. If the member decides not to engage in the game after a few minutes in the sideline, this will not be looked at negatively. The member will be encouraged to cheer his team on, which will also demonstrate participation on his behalf. We may also encounter a difficulty with the availability of the gymnasium. Therefore, we have developed a back-up plan to implement in case this happens. Our back-up plan will be a modified version of basketball and lacrosse. This activity will take place in the classroom setting.

** Judy & Aldo ** 6. One of the safety risks that can apply to our activity may be that the players may fall off their wheelchairs. A precaution to minimize this risk will be to let the members know that this can happen if they stop abruptly. We will advice them to use caution when grasping the wheels. Another risk can include wheelchairs clashing into each, which can cause members to hurt themselves (ex: crushing hands against chairs). Although the activity may become competitive, players will be advised not to crash into each other. At the start of the activity we will also state the rules and penalty (removed from the game for 1 minute). Moreover, we believe a psychological risk may surface during our activity. A possible psychological risk may be depression (sadness, decrease interest in activity). To address this risk we will provide positive verbal reinforcements during the game and praise teammates that score a point as well as those cheering. The group leader may state, “Good job, I like your sportsmanship.”

** ** Judy & Aldo ** **  7.    - So what did you guys think about playing basketball? - Do you feel that your teammates contributed to the game? - How did you feel about your teammates cheering you on? - Now that we have done this activity, what other activities do you feel you can do by yourself or with others? 8.

** Aldo ** - What do you think will be the most difficult issue to adapt to when reintegrating back into the community? And what can you do to prevent this from happening? This question will allow the group members to start thinking of solutions to possible problems they may encounter as they transition into the community. - What will you do to work towards our group goal as we continue to meet each week? And how will you implement this outside this group? This question will get the members to think of ways to implement the new information and apply it outside the group. - Do you find it difficult to engage in leisure activities? If so, what makes it difficult? This question will enable the group members to think of barriers that cause them to neglect leisure activities. Many times these individual are unable to identify a problem until an external source brings it to their attention. - You have heard different ways group members have coped or changed to adapt to T7 paraplegia. What modifications or changes do you think you can use to accommodate your own needs? This question will allow group members to use information discussed within the group and apply it to their daily lives. A group member is more likely to implement advice or suggests from individuals who are experiencing the same concern or problem.

** Judy ** 9. To conclude, we will focus on emphasizing the goals of today’s group. Although we want to reiterate the main focus of our group, we don’t want to dictate the goals to the members again. Therefore, we will take a different approach. We will involve our group members by asking them, “What do you think the main purpose of the group was?” We want the members to be able to identify (or remember) and verbalize the goals independently. Imparting information is a crucial process. We feel that learning can be reinforced if our members can state what they each learned from the activity and how they can apply it to their daily lives. A sign that this group was a positive experience will be a change in the mood of members that were depressed/sad or uninterested. We will conclude by saying, “Now that that we have participated in this leisure activity, we hope this will encourage you to engage in activities that you enjoy”. “There are no limits to want you can do”. We hope we have enough time to display short YouTube videos of individuals engaging in many sport activities that also have a spinal cord injury.

** Judy ** 10. Since our group will met for a total of eight weeks, on our second or third week we will follow up with members in regards to the first group activity. We will interview our members by asking them, “What do you remember about our first group?” and what activities are you participation in?” We understand that some of the members might not like playing basketball, to address this issue we plan to introduce a suggestion box. Members can suggest activities they would like to do in the upcoming groups. We will take the suggestions and create a group that centers on an activity most members express interest in. This will encourage participation in leisure activities and social participation in the upcoming groups. Further, we will also be able to evaluate the members’ success by observing the amount of engagement in weeks 2 and 3.

** Aldo ** 11. Irvin Yalom developed eleven therapeutic factors (curative factors), which could create positive behavioral change within a group setting (Schwartzberg, Howe & Barnes, 2008). We designed our group to allow members to experience the following curative factors: universality, catharsis, imparting information and instilling hope. The first curative factor is universality. This factor allows group members to understand that they are not the only member experiencing the current condition or disability (Schwartzberg at. el., 2008). One of the main focuses of our group was to create an environment that could support the universality curative factor. Therefore, we decided to introduce an activity that could increase social participation. Our basketball activity will enable the group members to participate in a leisure activity with individuals who have the same disability. Further, the activity may increase member’s self-esteem and or confidence as they begin to understand that they are not alone. Another curative factor is Catharsis, which will allow group members to freely express their true emotions. Group members will be able to express catharsis after our basketball activity where a brief discussion will take place. Group members will be given an opportunity to release their feelings about past or present experiences. This discussion will also guide the group to utilize imparting of information. As group members verbally express their thoughts, the group leaders will direct the discussion to allow members to provide advice or suggestions to each other. Through imparting of information the group members will learn how others cope with similar problems and experiences. When designing our group we felt that it was important for the members to understand their abilities and true potential to function within the community. Therefore, we felt that instilling hope could be a significant curative factor to consider. We will introduce this curative factor in a different way for our first group session. Usually, instilling hope occurs within the group however, for the first session we will demonstrate the curative factor by show a couple of YouTube videos. The videos will include individuals with the same disability actively participating in a wide range of leisure activities. Hopefully, these videos will create an optimistic environment that will motivate and increase the member’s confidence throughout the 8 weeks.

** Aldo ** 12. Individuals will learn to cope with T7 paraplegia in a variety of ways. Some individuals have a harder time accepting the disability than others. As group leaders we must take this information into consideration when designing our intervention plan. A possible solution is to utilize the group members who have accepted the disability and who demonstrate higher motivational aspiration to continue forward. These individuals could be utilized during the group process to instill hope to those who are having a difficult time accepting who they are. Another strength that could be utilized is the group member’s level of function. We must be able to apply the cognitive behavioral frame of reference to change the member’s thoughts or beliefs of their current level of function. Moreover, our intervention activity will enable the group member to gain self-confidence in their abilities and possibly lead to vicarious learning of other.

** Judy ** 13. We decided we would use Mary Law’s person-environment-occupation (PEO) model to guide our intervention planning. This model will help use identify which factors that are affecting our members performance. The main focus of the PEO model is to identify environmental factors (cultural, physical, social demands, socioeconomic), which change frequently and has an effect/influence on individual’s performance (Crepeau, Cohn, Schell, 2009). By identifying such factors we will be able to determine whether they enable of constrain performance. We selected a model that emphasizes what’s meaningful to our members (client-centered). The transaction between person and environment is one of the elements that attracted us to this model. Knowing the environment is always changing and that the person is always in the environment, informs us that the person will change to meet the environmental demands alike our members. Overall, we want to create maximum fit between person, environment, and occupation.

** Aldo ** 14. We will need to change the group member’s beliefs about their capabilities and willingness to initiate change, in order for our group to be successful (Cole, 2005). By changing the member’s thoughts and beliefs, it will alter the maladaptive behavior and enhance their occupational performance as they transition into the community. Therefore, we believe the cognitive behavioral frame of reference will assist our intervention planning and implementation process. Moreover, we will use Bandura’s vicarious learning theory during our activity (intervention). As stated in our activity description, if a teammate is not participating in the basketball game we will move the player to the sidelines. This individual will then be able to observe the group and hopefully model the groups’ behavior. Further, we (the group leaders) will praise those playing the game by providing positive verbal reinforcements. Providing verbal reinforcements will allow the individual observing from the sidelines to be motivated and adapt his/her behavior. The “initial reinforces” will be observed as we cheer for both team in order to keep the energy levels at an optimal level. The developmental frame of reference will also be taken into consideration in order to identity the current stage of development. Understand the stage of development will assist us by determining how the disability will impact their current and future lifestyles. This frame of reference will assist us more during the discussion part of our session as we can anticipate what the group members will express related to changes in their daily lives. For instance, at the beginning stages of their disability the members may experience occupational imbalance due to the loss or decrease of roles and occupations. This may lead them toward the isolation part of their current stage. However, the group will try to create intimate relationships in order for the group members to proceed to the next stage of psychosocial development. One way they will be able to create intimate relationship is through universality and group cohesiveness. Throughout the group session the members will be able to form relationships with each other and possibly take their friendships into the community. However, we (group leaders) must take precaution and explicitly state appropriate and inappropriate behavior at the beginning of the group session. If these precautions are not taken, some group members may gradual become isolated from the group and will cause the group dynamic to change.

** Judy ** 15. One group leadership skill we anticipate using will be listening, responding and giving and receiving feedback. We think it’s crucial to be able to listen and respond to people because it helps build a trusting relationship. We structured our group to have certain parts were discussion will be elicited. Given the diagnosis of our members we anticipate two situations occurring. One that some members will not be ready to openly discuss some barriers they are experiencing. On the other hand there might be some members that will be ready to talk and express their feelings. Therefore, we will need to be extremely careful that we listen to our members and respond to their needs appropriately. If we hear what is being said but don’t address it, the member will most likely feel his input is not valued. If this is the case, members will stop talking and we will have a hard time eliciting a conversation. Secondly, the manner in which we respond to our members will also have an effect on participation in either discussion or in the activity. For instance, when playing basketball a member constantly passed the ball to the opposing team. We need to use caution when addressing this issue and not say, “You’re doing that WRONG”, because the member might feel guilty if their team losses and cause him or her not to participate. We will need to remember that we are not evaluating how well they play basketball. We are looking at their participation and how they communicate with their team members in order to increase self-esteem, and motivation. Lastly, when giving feedback to members we will be careful not to single any one person. We will address certain things in terms of the groups as a whole. For instance, if no one talks we can say it seem everyone one is having difficulty expressing their thoughts and or feeling. When giving feedback we will also take into consideration time and location. The members might become too involved in the game and might react to feedback in a negative way if giving during the basketball game. To address this we might wait until we get back to the classroom to discuss any observations we made. All in all, having the skill of communicating is extremely important when running our group. It helps build a trusting relationship with our members.