Day Ipcompletion

Intervention Protocol:
Exercise Activities for Physical

Improvement & Development of
Lifelong Health Habits in
Children with Cerebral Palsy
The Childrens Specialized Hospital

Recreational Therapy Program
Chelsea Day

Contents
Program Title ...1

General Program Purpose......1
Description of Program.1
Client Problems That May Be Addressed....1
Referral Criteria.....................................................................................................2
Contraindicated Criteria.....................................................................................2
Intervention Techniques......................................................................................2
Poppercise............................................................................................................3
Lets Make A Play List!..........................................................................................9
Balloon Dart Painting.........................................................................................15
Giant Bowling.....................................................................................................22
Obstacle Course................................................................................................28
Staff Training and Certification Requirements.........................................................35
Risk Management.......................................................................................................35
Outcomes Expected...................................................................................................35
Program Evaluation.....................................................................................................35

The Childrens Specialized Hospital
Recreational Therapy Program
Intervention Protocol
Activities for Physical Improvement & Development of Lifelong Health

Habits in Children with Cerebral Palsy
General Program Purpose

To improve an individuals physical state while also developing the individuals desire to live
a healthy lifestyle and therefore decrease depression. For individuals who are age 10 to 15
who have been diagnosed with cerebral palsy and at a Gross Motor Functioning Level 1 or
2.
Description of Program
An individual program that is created to uniquely address the clients personal goals and
interests. The program is implemented through two sessions per week over a significant
period of time. Exercise programs can involve anything from the individuals sport interests
such as soccer or baseball and/or outdoor leisure interests such as rock climbing or
swimming. The program may also involve general exercise such as walking, and exercise
routines (sit-ups, push-ups, etc.) or health/leisure education. The program is developed
specifically for the following outcomes:
to develop skills and habits to maintain a continued desire to exercise and have a
healthy lifestyle
to develop an understanding of how increased activity can be used to decrease and
cope with symptoms of cerebral palsy
to improve strength, flexibility and range of motion.
Client Problems That May Be Addressed

Physical
o muscle control, coordination and tone
o reflex
o posture
o balance
o fine and gross motor skills
Cognitive
o affected IQ
o difficulty communicating with others
Emotional
o difficulty processing emotional feelings
o anxiety and depression
o difficulty connecting emotionally with others
1

Social
o difficulty connecting emotionally with others
Referral Criteria
Team Referral
Physician Referral
Contraindicated Criteria
Individuals who have been rated above a Level 2 on the Gross Motor Functioning
Classification System
Individuals who are not between the ages of 5 and 12 years old
Intervention Techniques
Poppercise
Lets Make A Leisure List!
Balloon Dart Painting
Giant Bowling
Pool Noodle Obstacle Course
2

Poppercise
Population: Children who have cerebral palsy that have been rated at a level of 1 or 2 on
the Gross Motor Functioning Classification System
Age: Children between the ages of 7 and 12 years old
Group Size: 1-10 group members
Setting Considerations: This activity can be done in any open space with an even
ground surface; it may be completed in an outdoor or indoor setting.
Group Stage Considerations: Forming, Storming, Norming, Performing; this activity can
be utilized when a group is at any stage.
Purpose: The purpose of this activity is to engage children in active play that promotes
increased strength, balance, flexibility and range of motion. This intervention will also allow
the child to make the cognitive connection between the physical activity and healthy
lifestyle.
Goals:
Clients will have an increased understanding that exercise leads to a healthy lifestyle.
Clients will engage in physical activity that will lead to increased strength, balance,
flexibility and range of motion.
Supplies Needed:
An open area with an even ground surface
Tumbling pads
1 unit of 12x65 large bubble, packaging wrap
1 unit of 12x65 small bubble, packaging wrap
Upbeat Music and Bluetooth speaker or stereo
Intervention Description:
Ensure ahead of time that a space has been reserved and cleared of furniture
Before clients arrive, lay out tumbling pads, then roll out enough large and small
bubble wrap on top to fill the reserved space.
Have music and speaker or stereo ready prior to the clients arrival
When clients arrive, explain that this activity involves popping every single bubble on
the bubble wrap and that they need to try and use their bodies in creative ways to
pop the bubbles
Explain that the children need to find five different bubble popping techniques. For
example, they cannot just roll on all of the bubbles. They should try other techniques as
3

well like dancing, using their hands, jumping etc.
Play the prepared music and allow the children to pop all of their bubbles. Observe
and make note of all of the different ways that they are popping their bubbles.
After, ask each client to show the rest of the group the different ways that they had
popped their bubbles then proceed to ask discussion questions as appropriate to the
childrens ages.
Special Considerations or Risks:

This kind of activity may get chaotic, be aware of this and expect to calm things
down if needed.
Children may also get excited and want to pop all of their bubbles quickly in one way
rather than thinking of different techniques, remind them of the expectations along
the way.
Bubble wrap isnt necessarily a stable material to stand on, be aware of potential of
falls.
Possible Discussion Questions:

Remembering: What did we do for our activity today? What was everyones favorite
part of todays activity?
Understanding: Why do you think we did this activity today?
Applying: How do simple activities like today increase our physical health?
Analyzing: Who feels like they stretch their fingers? Who moved their shoulders? etc.
Evaluating: What can you do at home that would be fun and help you get stronger?
Creating: What activity are you going to now select and do every day until our next
group?
Possible Group or Individual Assignments:

Give clients their own square of bubble wrap to take home. Ask them to show their
family or friends the techniques they had come up with to pop the bubbles. Give them
additional bubble wrap if they express that they have siblings or friends they would
want to do the activity with.
Additionally, ask them to select a physical activity and do it every day until next group.
Modifications or Adaptations:
For clients with less balance/stability you may only use small bubble wrap and/or
provide a walker or cane to help with balance.
Aids/volunteers/interns can be available to help clients with balance and stability as
well.
Sources:
Hamilton, T. (2003, December 26). Poppercise. Retrieved February 17, 2017, from
https://www.recreationtherapy.com/tx/txex.htm

Lets Make A Play List!
Population: Children who have cerebral palsy that have been rated at any level on the
Gross Motor Functioning Classification System.
Setting Considerations: This activity should be completed in a quiet, indoor setting. There
should be space for children to sit together on the floor, in desks or chairs.
be utilized when a group is at any stage.
Purpose: The purpose of this activity is for clients to verbalize active play activities that they
already have in their lives, and come up with activities that they would like to try. This activity
also allows for clients to make cognitive connections between active play that they enjoy
and how it pertains to a healthy lifestyle. Additionally, this activity allows for the TRS to get to
know clients and their leisure interests even further.
Goals:
Clients will socialize with other group members
Clients will recognize that they not only already have play activities but they also have
the opportunity to try new active play activities as well
Clients will recognize why active play is associated with a healthy lifestyle
Clients will socialize and interact with other group members
Supplies Needed:
A large white board
Dry Erase Markers
After all of the clients arrive, seat them and direct their attention to you. Explain to the
clients what active play is.
Start off by having clients raise their hand and tell their favorite active play activities as
they are called. Write what they say on the board.
Then have group members raise their hands and tell you the active play that they
havent tried before, but would like to. Write these activities on the board.
Allow clients to describe why each activity they listed makes them happy or why they
think it would make them happy. Write what they say down.
Have an age appropriate discussion with the clients about why active play is
9

important and why it pertains to having a healthy lifestyle.
Some clients may feel shy and wont want to speak up in front of the group
Some clients may feel excited and may want to talk over others in the group, do your
best to maintain an inclusive environment

Remembering: What did we do for our activity today?
Understanding: What is active play?
Applying: How does active play help us to have a healthy lifestyle?
Analyzing: Who feels like they learned about new activities today? Who is excited to
try a new activity?
Evaluating: What are some play activities that you are going to try?
Creating: Can you make up your own play activity?

Ask clients to share the information they learned today with their family and friends.
Give each client the assignment of asking one other person outside of the group what
their favorite leisure activity is and why it makes them happy?
If clients have trouble verbalizing their ideas, the TRS may print out photos of common
leisure activities and clients may point to them
Sources:
D. (2015, June 19). Let's Make A Leisure List! Retrieved February 18, 2017, from
http://rectherapyideas.blogspot.com/?m=1
10

Balloon Dart Painting
Population: Children who have cerebral palsy that have been rated at a level of 1or 2 on
Setting Considerations: This activity can be done in any open space that has a wall,
fence or structure that a large amount of butcher paper can be hung on.
be utilized when the group is at any stage.
Purpose: The purpose of this activity is to engage children in active, creative play, and to
increase concentration, hand-eye coordination, balance and upper-extremity range of
motion, flexibility and strength. The activity will allow for children to express emotions and
cope with them in a healthy way.
Goals:
Clients will engage in active play that reinforces creative thinking
Clients will have an increased understanding that art and physical activity are both
positive ways to cope with frustration, stress, and other emotional difficulties.
Supplies Needed:
water balloons
washable paint
thumb tacks
balloon pump
butcher paper
scissors
large drop cloth or plastic sheet (if indoors)
plastic darts
aprons
Ensure ahead of time that a space has been reserved for the activity
Before clients arrive, cut out sections of butcher paper spanning about 5 feet for each
client
Hang drop cloth on wall/fence/structure and place on the floor below as well
15

Hang butcher paper in separate areas on top of the drop cloth
Partially fill balloons with different colors of paint, fill them the rest of the way up with air
using the balloon pump and tie them.
When clients arrive, clearly explain the rules of this activity
o Darts are only to be thrown if no one is in front of you
o Do not run in front of balloons
o Darts are only to be thrown at balloons
o Always hold darts with the point facing toward the ground
On your own, throw a dart and pop a balloon on your own butcher paper to show the
clients an example.
Allow the children to individually choose 10 balloons in the colors that they want and
let them show you where to tack the balloons onto each of their butcher papers
Allow the children to put on aprons and give them three darts each
Ask children to stand about 5-6 feet away from the balloons before throwing, allow
them to move closer if need be
Facilitate the activity with the children until everyones balloons are popped
Ask the children to take off their aprons and wash their hands in the nearest sink. If the
children are young, send an aid/assistant to help. While they do that, remove the
leftover balloons from the butcher paper and leave the paint to dry as is.
While the paint is drying talk to the children about their experience. Ask children
discussion questions as appropriate to their age.

While plastic darts are not highly dangerous, they can still be painful. Ensure that each
client understands the rules of the activity to avoid anyone being hit by a stray dart.
There is a possibility that clients may get frustrated if they are having trouble hitting
their balloons, allow them to stand as near or far away so that they may complete the
task
If the activity is performed outside, ensure that sunscreen (free of allergens) is worn
and water is available to stay hydrated

part of the activity? What were our rules today?
Applying: How do creative and active activities like what we did today help us cope
with our feelings?
Analyzing: What feelings did you feel before the activity? What feelings do you feel
now?
Evaluating: If your feelings changed, why do you think they changed?
Creating: What are other creative activities that you can do to help with your feelings?
16

After the paintings dry, let the children take them home and explain the activity to
their families.
Allow children as close to the balloons as they need to if they are having trouble
throwing or aiming.
Sources:
Chelsea Day TRS, CTRS (student), February 2017
17

Giant Bowling
Setting Considerations: This activity can be done in any open space, both indoor or
outdoor with an even ground surface.
be utilized during any stage.
lifestyle.
Goals:
Supplies Needed:
An open area with even ground surface
One giant, inflatable bowling set per three clients in group
Air Pump
Hose
One bowling score sheet per three clients in group
Clipboards
Pens/Pencils
Painters Tape
Ensure that a space has been reserved for the activity ahead of time
Ensure that aids, volunteers, interns etc. are available to help keep score and set-up
pins during the activity
Before the clients arrive set up the bowling ally. Use painters tape to create lanes
on the floor/ground.
Blow up all of the bowling balls and pins. Fill base of pins up with water and set them all
up.
22

Have all score sheets/clipboards/pens ready to use
When clients arrive, clearly explain the rules of bowling. Knock the pins over with the
bowling ball yourself to show an example to the clients. Make it clear to clients that
bowling balls are only to be rolled toward the pins and not toward other group
members to avoid
Allow clients to compete against each other in groups of 2 or 3 per lane, have an
aid/volunteer/intern at each lane keeping score and helping set pins back up
Play enough games to use the allotted amount of time for the activity leaving time at
the end for group discussion

If this activity is performed outside, ensure that sunscreen (free of allergens) is worn and
water is available to stay hydrated
This activity can become chaotic, ensure that a calm environment is maintained.

Applying: How do activities like today increase our physical health?
Analyzing: Who feels like they stretched their arms? Who moved their shoulders? Who
stretched their legs today? etc.
group?

A lane can be made as long or as short as needed to accommodate different skill
levels.
Lanes can be made shorter or longer depending on difficult or easy the activity is for
clients due to physical strength
Sources:
Chelsea Day TRS, CTRS (student)
February 2017
23

Pool Noodle Obstacle Course
Group Size:1-10 group members
Setting Considerations: This activity must be completed in a large, open, grassy setting.
The grass must be thick enough and soft enough to allow for safe and comfortable crawling
and falling.
Group Stage Considerations: Forming, Norming, Storming, Performing; this activity can
be utilized at any stage.
lifestyle. This activity is also meant to be a challenge for clients, allowing them to face the
challenge in an open, safe environment.
Goals:
Clients will be challenged, and learn the fun in accepting challenges
Supplies Needed:
40 pool noodles
3 rolls of duct tape
20 yard stakes
2 sponge footballs
2 soccer balls
a stopwatch
Build the obstacle course ahead of time
o Make 19 circular pool noodles by bending the pool
noodle until both ends come together and duct
taping them.
o Ground Crawling Section: Ground Crawling: Stick a yard stake in the ground
and push 1 end of a pool noodle on it (pool noodles have a hollow middle with
28

holes at both ends). Bend your pool noodle over to
make a semi circle and push another yard stake in the
ground where the pool noodle ends. Push the other
end of the noodle on the stake. Repeat this process
until you have the desired number of arcs, placing
each pool noodle about 1 foot apart from the next.
The purpose of this section is for clients to crawl
underneath the loops.
o Agility Ring Section: Agility Rings: Place 1 straight pool

noodle horizontally on the ground. Going upwards,
put 10 circular pool noodles on the ground, 2 at a
time. At the end, place another straight pool noodle.
The object of this section is to bounce from ring to ring
without disturbing them.
o Football Toss Section: Football Toss: Place 1 yard stake

in the ground. Push a straight pool noodle onto the
yard stake. Grab 2 pool noodle rings and tape them
to the top of the straight pool noodle with 1
underneath the other. Repeat with 4 more circular
pool noodles. Where the circular pool noodles end,
place another yard stake in the ground and push a
straight pool noodle onto the yard stake. Tape the
circular noodles onto the straight noodle. If youre
having difficulty keeping this obstacle straight, you
can also push long sticks into the ground for
reinforcement. Tape the sticks to the long and straight
pool noodles.
o Running Section: Stick some yard stakes in the ground

in a straight row, each stake about 1 foot apart. Push
a pool noodle onto each stake so they are sticking
straight up in the air. The clients will zig-zag around the
pool noodles.
o Ring Toss Section: Push a yard stake into the ground and push a pool noodle
onto the yard stake so the pool noodle is standing straight up in the air. Have
your kids try and throw a pool noodle ring onto the pole.
Have a pre-determined amount of cycles that you would like each client to go
through the course
Allow clients to take turns going through the obstacle course.
Use a stopwatch to time clients as they complete the course; encourage group
members to cheer each other on while others are participating. Challenge the clients
29

to beat their times and make a personal best time
Have aids/volunteers/interns assist clients through the course as needed
After everyone has had the pre-determined amount of turns have a discussion with
the children about the experience as appropriate to the childrens ages.

This activity requires a lot of contact with the ground. Be sure that there arent any
hard rocks, sticks or other debris that could injure a client while completing the course.
Ensure that there arent any clients allergic to grass.
This activity requires a high amount of endurance. Check in often with clients to ensure
that they are feeling well.
This is an outside, warm weather activity. Ensure that sunscreen (free of allergens) is
worn and water is available to stay hydrated.
This activity involves a high chance of falls, be sure that aids/volunteers/interns are
assisting the clients to avoid dangerous falls.
There is a chance that clients can become frustrated during some of the tasks, be
aware of this and be there to support them

Applying: How do activities like today increase our physical health?
Analyzing: Who feels like they stretched their arms? Who moved their shoulders? Who
stretched their legs today? etc.
group?

Ask the clients to go home and tell their families all about their experience during the
obstacle course. Ask the clients to explain their favorite parts and their least favorite
parts and the feelings that they had during the activity.
The heights and distances of each of the obstacle course sections can be adjusted to
accommodate the physical needs of clients
Sources:
Dubian, J. (n.d.). Pool Noodle Obstacle Course. Retrieved February 20, 2017, from
http://www.pbs.org/parents/crafts-for-kids/pool-noodle-obstacle-course/
30

Staff Training & Certification Requirements
Utah State Licensure as a TRS or MTRS
National Certification by NCTRC as a CTRS
Basic Life Support Certification
First Aid Certification
Risk Management
Awareness of surroundings at all times. Reducing likelihood of falls by clearing any non-
relevant or non-natural materials around the client
Water available at all times to prevent dehydration of anyone involved
Additional aid or therapist near at all times to predict and prevent injuries from
accessibility or exercise equipment
Proper maintenance and cleaning of all exercise and accessibility equipment at all
times
The use of belts and straps as needed on mobility devices to prevent falls
Outcomes Expected
Client will show improved strength, flexibility and range of motion through pre and post
testing.
Client will develop lifelong exercise habits
Client will develop a desire to continue to exercise after intervention
Client will develop an increased ability to cope with depression, stress and/or anxiety
Client will have increased knowledge of leisure opportunities and physical abilities
Program Evaluation
Formative evaluation completed after each session
o observation of clients improvement ability of coping with anxiety and
depression
o observation of clients improved strength, flexibility and range of motion
o listing of tasks completed or not completed according to plan
o observation of clients improvement in completing tasks since previous session
Summative Evaluation
o Review of all formative evaluation
o Survey completed by all involved in the intervention including all therapists, aids,
parents/guardians, clients, etc.
o Testing of client physical outcomes and comparison to results of any testing
done prior to intervention
C. Day TRS, CTRS (student)

22 February 2017
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Intervention Protocol:

Exercise Activities for Physical

The Childrens Specialized Hospital

Program Title ...1

Activities for Physical Improvement & Development of Lifelong Health

General Program Purpose

Client Problems That May Be Addressed

Age: Children between the ages of 7 and 12 years old

Group Size: 1-10 group members

Special Considerations or Risks:

Possible Discussion Questions:

Possible Group or Individual Assignments:

Age: Children between the ages of 9 and 12 years old

Group Size: 1-10 group members

Possible Discussion Questions:

Possible Group or Individual Assignments:

Age: Children between the ages of 8 and 12 years old

Group Size: 1-10 group members

Special Considerations or Risks:

Possible Discussion Questions:

Age: Children between the ages of 7 and 12 years old

Group Size: 1-6 group members

Special Considerations or Risks:

Possible Discussion Questions:

Possible Group or Individual Assignments:

Age: Children between the ages of 7 and 9 years old

Group Size:1-10 group members

o Agility Ring Section: Agility Rings: Place 1 straight pool

o Football Toss Section: Football Toss: Place 1 yard stake

o Running Section: Stick some yard stakes in the ground

Special Considerations or Risks:

Possible Discussion Questions:

Possible Group or Individual Assignments:

C. Day TRS, CTRS (student)

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