Facilitation Technique Category: Stress Management Techniques

Activity Title: Get moving: Physically active with regular exercise

Source: HG. (n.d.). Retrieved from http://www.helpguide.org/articles/stress/stressmanagement.htm
Equipment: Comfortable clothes and shoes.
Activity description: Stress management techniques can really promote better
health such as improving immune function, preventing illnesses, decreasing
physical discomfort, increasing energy, and promoting relaxation, among others.
Physical movement plays a key role in reducing and inhibiting the effects of stress.
The activity Get Moving is based on endurance training while keeping clients
physically active with regular exercise. The purpose of this activity is to improve
endurance, energy, and optimism in order to decrease stress levels. First, the
instructor will explain step by step all instructions (physical demonstration) to
participants. Second, instructor will proceed to the following command Keep an
upright posture and lift your feet off the ground when start walking. Third,
participants will engage in ambulation training on level and uneven surfaces.
Fourth, participants will perform breathing excs throughout the activity while being
in standing including static/dynamic positions to promote energy. Fifth, participants
will be able to take rest periods between sets in order to increase endurance. Sixth,
instructor will review all steps and provide feedback to participants.
Leadership considerations: CTRS will be the instructor in this activity. Also,
staff /volunteers, recreational therapist students can support/guide participants
during the activities. The staff to participants ratio should be1:1, 1:2, 1:3, and 1:4
depending on the clients physical abilities. Instructions/education regarding all
safety issues include: fall precautions during ambulation on uneven surfaces,
energy conservation techniques, breathing excs (belly breathing) to promote
endurance, transfers techniques from sit-stand using the appropriate assistive
device for gait, postural awareness, etc. Some precautions should be taken into
consideration including: weather status, bottle of waters, etc. The ambulation
activity will last 45 min. All participants are allowed to ask questions at any time of
the activity in order to complete proper sequence of tasks.
Adaptations: Participants with Amyotrophic Lateral Sclerosis (ALS).
According to ALS Association, Amyotrophic Lateral Sclerosis is an advanced
neurodegenerative disease that disturbs nerve cells in the brain and the spinal cord.
With voluntary muscle action gradually affected, this population may lose different
skills such as speak, eat, breath, etc. Some adaptations could be applied to promote
participation in this activity including the use of an assistive device (such as a footangle brace or splint or hand immobilizers). When clients with this condition are in a
terminal stage it would be appropriate to provide a wheelchair in order to facilitate
participation. Also, while ambulating the instructor can be behind the client with a

wheelchair in case the client needs to take a rest period between set due to low
endurance. Provide a board with images/commands in front of the clients where
they can point to what they want to express since they have difficulties with speech
(Giles, 2014).
Adaptations: Participants with Post-Traumatic Stress Disorder: PTSD is a
condition that develops in certain individuals who have experienced a shocking,
terrifying, or hazardous event (National Institute of Mental Health). Some of the
symptoms include: flashbacksreliving the shock more than one time (repetitively),
others signs such as physical symptoms like an increase in heart rate or sweating,
nightmares, etc. Some good adaptations could be restricting the use of any object,
word, or situation that reminds them the tragedy. Providing a calm environment for
the ambulation training activity in order to promote relaxation/enjoyment. Avoiding
thoughts or moods related to the traumatic episode to prevent re-experiencing
symptoms. The use of different relaxation skills (.e.g. conversations) while walking
will keep client concentrated in a new topic to prevent distraction regarding the
event.

Adaptations References
A Life Story Foundation. (n.d.). Retrieved from
https://www.alifestoryfoundation.org/learn/
ALS Association . (n.d.). Retrieved from http://www.alsa.org/about-als/what-isals.html
Benefits of Stress Management . (n.d.). Retrieved from
http://www.successfulaging.ca/programs/stress/11.html
HG. (n.d.). Retrieved from http://www.helpguide.org/articles/stress/stressmanagement.htm
National Institute of Mental Health. (n.d.). Retrieved from
https://www.nimh.nih.gov/health/topics/post-traumatic-stress-disorderptsd/index.shtml#part_145375
WebMD. (n.d.). Retrieved from http://www.webmd.com/balance/stressmanagement/stress-management-relieving-stress

Facilitation Technique Category: Therapeutic Use of Tai Chi

Activity Title: Basic skills of Tai Chi: decreasing stress and anxiety
Source: Live Strong. (n.d.). Retrieved from
http://www.livestrong.com/article/431042-tai-chi-basic-steps-for-beginners/
Equipment: Loose fitting clothing
Activity description: Therapeutic use of Tai Chi promotes relaxation, decrease
stress and conscious mindfulness of the instance. Tai Chi may help reduce physical
complaints, depression and anxiety, improve balance, control and coordination of
trunk, stabilizes blood pressure values and improves sleep time, among many other
positive things. This technique is a gentle, low-impact workout and therefore is
generally appropriate for population of any level of physical fitness. Basic skills of
Tai Chi promote a peaceful attitude and inspire a state of well-being in general. The
purpose of this activity is to decrease stress and anxiety in order to promote quality
of life. First, the instructor will explain and demonstrate all different steps before the
activity will start. Second, proceed to the first basic skill of Tai Chi which is warm up
that is the abdomen loosening exercise. Third, the instructor will provide the
following command: Stand with feet equivalent and a little wider than hip-width
separation. Lessen the arms next to the body. Rotate the hips simultaneously
towards right and left side while letting the arms/hands to follow the swing of the
body. Allow the arms hang lightly and fold against lateral side of the trunk while
performing lateral bending. When the body has warmed up, integrate your neck
(cervical area), upper arms and spine in the turnings, performing each movement
smooth and continuous. Fourth, continue to the windmill exercise and the instructor
will give the following command: Place the hands in front of the body by the pubic
area, with the fingers indicating down toward the ground. Start breathing while
inhaling and lifting the arms up the middle of the body and over the head with
extremities pointing up. Flexibility excs toward the roof and arch the spine slightly
extended. Exhaling and gradually flex forward to the ground, moving the arms down
the middle of body. Flex forward at the hip level, allowing the arms to suspend

lightly in front of the body. Breathe deeply and return to the initial position. Fifth,
precede to the last position and the instructor will perform the following command:
Place the upper extremities on the knees with the fingers touching toward both.
Alternate bilateral knees in a circular movement, in the following order: left, back,
right and front like if we are doing a circle with both knees. The ideal movement is a
clockwise direction. Sixth, the instructor will conclude the activity by reviewing all
steps and providing feedback.
Leadership considerations: CTRS will be the instructor in this activity and at the
same time he/she has been approved to teach by the National Instruction
Coordination Committee (NICC). CTRS or staff /volunteers, recreational therapist
students must join regular training workshops and meet one time in a year for reaccreditation requirements to instruct Tai Chi. the staff to participants ratio should
be1:1, 1:2, 1:3, and 1:4 depending on the clients physical abilities.
Instructions/education regarding all safety issues include: fall precautions during
different positions, energy conservation techniques (rest periods between sets),
breathing techniques to promote relaxation, postural awareness, balance control,
etc. Some precautions should be taken into consideration including: appropriate
weather (preferably warm). The Tai Chi activity will last for 30 minutes. All
participants are allowed to ask questions at any time of the activity in order to
complete proper sequence of tasks.
Adaptations: Participants with Osteoporosis: According to National Institute of
Arthritis and Musculoskeletal and Skin Diseases, osteoporosis is a condition that
thins and deteriorates the bones. The bones become delicate and fracture easily,
particularly the bones in the hip, spine, and wrist. Some of the possible adaptations
include: provide some cuff weights or dumbbells in some of the positions to increase
weight bearing in order to improve bone density. Also, allow participants to perform
the activity early in the morning since they tend to fatiguing easily. Since they have
a high risk of fracture after any falls it is recommended to complete the activity on a
dry and level surface floor.
Adaptations: Participants who are Legally Deaf: According to Mayo Clinic,
deafness is generally the consequence of inner ear or nerve injury. It may be
affected by a congenital defect, damage, illness, certain pills, experience to loud
sound, or age-related process. Good adaptations that could help this population
include: the use of hearing device, having an interpreter in front of the group and
allowing these individuals in the first line of the activity. Provide a written or printed
text in a TV with the commands from the instructor about the different basic skills of
the activity, etc.

Adaptations References

Live Strong. (n.d.). Retrieved from http://www.livestrong.com/article/431042-tai-chibasic-steps-for-beginners/

Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.org/diseasesconditions/hearing-loss/basics/definition/con-20027684?
utm_source=Google&utm_medium=abstract&utm_content=Hearingloss&utm_campaign=Knowledge-panel
Medline Plus. (n.d.). Retrieved from
https://medlineplus.gov/osteoporosis.html#cat93
NIH Osteoporosis and related bone diseases national resources center . (n.d.).
Retrieved from
http://www.niams.nih.gov/Health_Info/Bone/Bone_Health/Exercise/default.asp
PTDirect. (n.d.). Retrieved from http://www.ptdirect.com/training-design/anatomyand-physiology/chronic-skeletal-adaptations-to-exercise
Taoist Tai Chi Society of the USA. (n.d.). Retrieved from
http://www.taoist.org/usa/beginner-introduction/?gclid=CjwKEAjwabABRDquOTJi8qdojwSJABt1S1OrjSIaOyKAUc2qIzhVI57KgX5C_TmQxvjFRd08E
PGmxoC4-Tw_wcB