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RPG Handbook Wiki Original Source Document

by Hawke Robinson published Nov 09, 2016 01:10 PM, last modified Nov 12, 2016 03:15 PM
Here is the source document that is being converted to the wiki version of the RPG Handbook of Practice.

This is the source document from which I am creating the Wiki-fied version. As sections are converted to wiki pages, they will be removed from this master document, leaving just the section link to the new wiki page for that section.

You can contribute directly by editing this Wiki, you need to have a registered account on this website (free, no spam, etc.). Once registered and logged in, you can edit this page using typical Wiki tags. You are not required to use wiki tags, you can just edit using the built-in web-based word processor, but for those that like Wiki tags, this page supports both.

If you would rather not deal with creating an account and editing the wiki, then feel free to email rpgresearcher at gmail dot com, and I can enter your contributions for you. - W.A. Hawkes-Robinson

 

Here is more information on the Plone-ification of WIki tags:

 

########### BEGIN HANDBOOK MAIN TEXT ################

 

Role-playing Gaming

Handbook of Practice

(RPG-HoP)

(Hypothetical proposal draft and RFC)

Version: Alpha-2016-11-09-13:09:37

DRAFT H

 

By W.A. Hawkes-Robinson

RPG Research d.b.a.

http://www.rpgr.org

http://syntheticzen.com/discography/archives/2016-improvizention-3/iar

  

1.0 Preface

 

1.1 Foreword

 

1.1.1 About the Author(s)

 

 

1.1.1.1 William A. Hawkes-Robinson , “ Hawke Robinson ”, published as W.A. Hawkes-Robinson .

 

1.1.2 Roots of the RPG Research Project

 

1.2 Acknowledgements

  

  

1.3 Contributors and Feedback

 

 

Copyright and Disclaimers

 

 

Acknowledgements and Dedications

 

 

1.4 Recommended Experience, Skills, and Training

  

 2.0 Recreation Therapy Handbook of Practice (RTHP) Introduction

 

 

2.1 Specific RPG Program Plans

 

 

2.2 RPG as a Verb Instead of a Noun

 

2.3 Game Systems

  

2.4 Community Involvement

 

 

2.5 Research Methods and Related Information

 

 

 

3.0 Introduction to the ICF

 

 

3.1 Overview of the ICF

 

3.2 Clinical Terminology in the ICF

 

 

3.3 If You Are Not Yet Using ICF

 

 

3.4 ICF Coding

 

3.4.1 Finding the correct code

 

 

3.4.2 When to score the codes

 

3.4.3 Specific Code Forms

 

3.4.4 Scoring the Identified Code

 

4.0 RTHP Section 2: Diagnoses and Populations

 

4.1 Amputation and Prosthesis

 

4.2 Anxiety Disorders (GAD, Phobias, OCD, etc.)

 For details on this diagnosis, see the relevant section of the Recreation Therapy Handbook of Practice, the Diagnostic & Statistical Manual of the APA, and related sources.

 

 

4.2.1 GAD – Generalized Anxiety Disorders

 

  

OCD – Obsessive-Compulsive Disorder

 

 

Panic Disorder with and without Agoraphobia

 

 

  

PTSD – Posttraumatic Stress Disorder

  

Trauma from Military Service or related

 For details on this diagnosis, see the relevant section of the Recreation Therapy Handbook of Practice, the Diagnostic & Statistical Manual of the APA, and related sources.

 

 

Trauma from Abuse / Rape / Sexual Abuse  

For details on this diagnosis, see the relevant section of the Recreation Therapy Handbook of Practice, the Diagnostic & Statistical Manual of the APA, and related sources.

 

 

Social Phobia

 

 

Specific Phobia

 

 

Apraxia

For details on this diagnosis, see the relevant section of the Recreation Therapy Handbook of Practice, the Diagnostic & Statistical Manual of the APA, and related sources.

Noun: Inability to perform particular purposeful actions, as a result of brain damage.

 

   

ADD/ADHD - Attention-Deficit Disorder with and without Hyperactivity

 

ASD / PDD - Autism Spectrum Disorder / Pervasive Developmental Disorder

 

Program #1 Example: Prototype of Tabletop RPG as a Modality for Therapeutic / Educational Intervention for ASD Youth and Adults to Develop Civic Resources Knowledge & Skills[+]

 

Program #2 Example: Using Live-Action Role-Playing Adapted Activities for ASD Toddlers

 

 

Program #3 Example: A Recreation Therapy-related Program Plan Using Role-playing Gaming to Prepare

 

 

6.6 At-risk Youth

  

 

6.7 Back Disorders and Back Pain

 

Currently unknown if any programs have been created using any RPG format to address this population’s needs.

 

 

6.8 Brain Injury (Cerebrovascular Accident, Stroke, TBI, etc.) 

 

6.8.1 Brain Injury Recovery Using RPGs - Overview

 

 

6.8.2 RPGs for Brain Injury - Applicable Therapeutic Recreation Interventions

 

 

6.8.2.1 TBI Intervention 1 - Tabletop RPG Modification - Choose Your Own Adventure for Severe TBI-related impairments

 

 

6.8.2.1.1 RPG for TBI - CYOA - Example CYOA Process

 

 

6.8.2.1.2 RPG for TBI - CYOA - Needs addressed by intervention

 

  

6.8.2.1.3 CYOA for TBI - Common Settings

 

6.8.2.1.4 RPG for TBI - CYOA - Equipment Needed

 

 

6.8.2.1.5 RPG for TBI - CYOA - Program Adaptations

 

6.8.2.1.6 RPG for TBI - Similar Examples of Intervention

After spending hours searching, I was unable to find any existing programs using this exact form of intervention. This intervention meets the requirements for activities addressing the functional impairments listed, but so far I am unable to find any research information or current programs that have tried this approach.

The closest match I could find was an article about the Lincoln University (Snow, 2009) program requested by the Missouri National Guard using a “choose your own adventure” style interactive computer video (Hemmerly-Brown, 2010) for military personal suffering from suicide due to complications from PTSD and TBI. I was not able to find a second program that was even remotely relevant.

 

6.8.2.1.7 RPG for TBI - Similar Examples - Home Front Interactive Video

The Home Front interactive video.

 

6.8.2.1.8 RPG for TBI - Similar Examples - Home Front Interactive Video Location

Online: http://www.armyg1.army.mil/hr/suicide/videos/HomeFront_New/the-home-front/index.html

 

6.8.2.1.9 RPG for TBI - Similar Examples - Home Front Interactive Video Description of clients served

For at-risk military personnel to attempt to reduce the levels of depression and suicide from personnel recovering from PTSD , TBI, and other causes.

 

6.8.2.1.10 RPG for TBI - Similar Examples - Home Front Interactive Video Qualifications of program facilitator

Basic computer and online skills. Typical therapeutic background.

 

6.8.2.1.11 RPG for TBI - Similar Examples - Home Front Interactive Video - How I found this program

Lengthy search for any kind of “choose your own adventure” and “Traumatic brain injury” through many books and online resources.

 

 

6.8.2.2 Intervention 2 - Computer-based RPG Use and Modifications for Client With TBI[+]

Client is now at Rancho Rating IV+. Though client's cognitive functioning is now higher, the client's ability to communicate is still significantly limited. Based on client's current functioning, it is recommended to have the client try using a mouse (or Wii-mote) to participate in a computer-based RPG that is turn-based rather than real-time. The client is able to move and click both buttons on a mouse, can see the computer screen clearly, and has enough cognitive functioning to interact in the game at a much higher level than before.

As client slowly regains various levels of functioning, modified versions of RPG will be presented in which the client may participate.

Client will initially use a mouse with large buttons to interact with computer. This requires the functioning of at least one arm, hand, and finger, as well as usable visual capacity. The compute-based RPG should initially be turn-based, using the mouse and then using Wii-mote later as grasping improves.

Client with click on various options, direct the digital character to take certain actions, and solve various levels of simple to complex problems.

 

6.8.2.2.1 RPG for TBI - Intervention 2 - Needs addressed by intervention[+]

In addition to addressing some of the previous codes in intervention #1, this also addresses:

  • d1751 Solving moderately complex problems

  • d440 general fine hand use

  • d4401 grasping development.

 

 

 

6.8.2.2.2 Example CRPG Process

Client's functional arm (and hand/finger(s)) are placed upon the mouse (or later Wii-mote as grasping capacity develops). The client navigates on screen prompts to develop character, and than guides the character through the many challenging scenarios in the game.

 

6.8.2.2.3 Common Settings

In this scenario, ICU or long-term care facility, but potentially usable anywhere that has a computer.

 

6.8.2.2.4 Equipment Needed

A computer with screen, mouse, and installed software. Optional Internet connection.

 

6.8.2.2.5 Program Adaptations

Different means of interaction with the computer through different interfaces.

 

6.8.2.2.6 Examples of intervention

There are a number of programs using computer games as interventions for many needs, including TBI recovery, though I was not able to find specific mentioning of computer-based RPGs specifically, it is not a difficult stretch to extrapolate the benefits. The closest I found was an online game created by Jane McGonigal (2010) that experienced post-TBI depression and created the game to help herself recover. I had heard some of the NPR interview about this, and was able to track that down (Flato, 2011).

 

6.8.2.2.7 Program Name

Jane the Concussion Slayer by Jane McGonagal & Co.

 

6.8.2.2.8 Location

Online: https://www.superbetter.com/about

 

6.8.2.2.9 Description of clients served

Clients that enjoy computer games that will benefit from stimulus to help recovery from illness or injury, including traumatic brain injury. The program was created when the creator experienced a TBI, and was struggling to recover, creating games she found helped her, and other's, recovery process.

 

6.8.2.2.10 Qualifications of program facilitator

Some computer skills, recreation or other similar therapy background.

 

6.8.2.2.11 How I found this program

Web searches for any computer-based games aiding recovery of TBI patients.

 

6.8.2.3 References

Burlingame, J. & Blaschko, T.M. (2002). Assessment tools for recreational therapy and related fields (3rd edition). Ravensdale, WA: Idyll Arbor.

 

 

Flato, Ira. (2011, February 18). Talk of the Nation: Could gaming be good for you?. National Public Radio. Retrieved March 11th, 2013, from http://www.npr.org/2011/02/18/133870801/could- gaming-be-good-for-you

 

Hemmerly-Brown, A. (2010). Army creates new scenario-based suicide-prevention video. Retrieved March 11th, 2013, from http://myarmybenefits.us.army.mil/Home/News_Front/Army_creates_new_scenario- based_suicide-prevention_video.html

 

McGonigal, J. (2010). Achievements: Unlocked. Retrieved March 11th, 2013, from http://janemcgonigal.com/2010/12/23/achievements-unlocked/

 

Porter, H.R., & Burlingame, J. (2010). Recreational therapy handbook of practice: ICF-based diagnosis and treatment. Enumclaw, WA: Idyll Arbor.

 

Snow, T. (2009). Soldiers at risk: Mo. Guard responds to threat. Retrieved March 11th, 2013, from http://www.connectmidmissouri.com/news/news_story.aspx?id=287534

 

 

 

 

 

Cerebrovascular Accident[+]

 

See this chapter’s overview and example programs.

 

TBI - Traumatic Brain Injury[+]

See this chapter’s overview and example programs.

 

 

Burns[+]

Unknown if any RPG-based programs have been developed to help this population.

 

 

Cancer[+]

There is a computer-based role-playing game titled “That Dragon, Cancer” created by a family whose child suffered recurrent cancer bouts.

Other than that game, unknown if any RPG-based programs have been developed to help this population.

 

 

 

Cardiac Conditions[+]

Unknown if any RPG-based programs have been developed to help this population.

LARP would seem the most likely format, followed by CRPG with VR/AR in a mobile or treadmill setting.

There are the audio-book based, and smartphone linked adventures, that help set a pacing for the listener, for example being chased by zombies, etc. provided in a narrative format. Not exactly an RPG, but could be a baseline built upon.

 

 

COPD – Chronic Obstructive Pulmonary Disease[+]

 

Unknown if any RPG-based programs have been developed to help this population.

 

Cognitive Disorders[+]

 

 

 

 

Alzheimer's Disease[+]

Unknown if any RPG-based programs have been developed to help this population.

There have been some anecdotal stories in various RPG fora, blogs, websites, and mailing lists, about attempting to use RPGs to help. But not currently aware of any formal programs.

 

 

 

 

 

 

Other Dementia[+]

Unknown if any RPG-based programs have been developed to help this population.

There have been some anecdotal stories in various RPG fora, blogs, websites, and mailing lists, about attempting to use RPGs to help. But not currently aware of any formal programs.

 

 

 

 

Developmental Disorders[+]

 

W.A. Hawkes-Robinson has some programs developed for this population category, but they are not completed, nor have had any formal trials, though some informal programs have been implemented. Details pending.

 

 

 

Diabetes Mellitus[+]

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

Eating Disorders[+]

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

Fibromyalgia[+]

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

Guillain-Barré Syndrome[+]

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

 

Joint Replacement[+]

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

 

Mood Disorders[+]

(Bi-polar, Depression (Major Depression, Dysthymic, Reccurent, Suicidal Ideations, etc.))

 

 

 

Bipolar

Medication stability is of primary importance for this population. RPG-based programs will help address lifestyle and other cognitive-behavioral issues, but likely will only be potentially effective if client is having success with medication first.

 

W. A. Hawkes-Robinson has a number of programs outlined for this population, with some informal trials showing promising results. Details pending.

 

6.20.2 Depression

 

There is a considerable body of reasearch regarding the use of Role-Playing Games to address various forms and symptoms of Depression, from various disciplines including psychiatry, psychology, and others.

It is unknown if there are any TR based RPG programs or research articles at this time.

References:

Pending

See http://rpgresearch.com for a comprehensive list.

 

 

Dysthymia[+]

There are a number of research articles under depression indicating success in using role-playing games for treating clients with various forms of depression.

Information for this section pending... 

 

 

 

Suicidal Ideations[+]

 

There are a number of research articles under depression indicating success in using role-playing games for treating clients with various forms of depression, including those with suicidal ideations or attempted suicide in their case histories.

Information for this section pending...

 

 

 

 

<span>Muscular Dystrophy[+]

MD

As of November 2016, W.A. Hawkes-Robinson has begun development of RPG-based program plans for this population, focusing mostly on tabletop, live-action, and solo formats.

He has begun working with the Muscular Dystrophy Association HQ based in Spokane, Washington. The MDA at the location provides services to around 800 clients in Eastern Washington, Northern Idaho, and Eastern Oregon.

Hawkes-Robinson will be working with this population fairly regularly through the remainder of 2016, through 2017. It is expected the information from these programs will be added to this section some time in late 2017.

 

MD - Adaptive Devices[+]

 

Wheelchair accessibility is generally crucial by the teenage years.

Table with room for wheelchair to fit under. Consider ceiling mounted table options if possible.

Example of commercially available ceiling mounted table: http://uptable.com

The problem with the Uptable design is that it is not conducive to using RPGs that need a battlemat or other center-table area, but for other non-miniature-using RPGs, should be useful.

 

Dice Towers, to allow better “rolling” of dice, due to grip and fine motor skill challenges.

Larger, oversize dice.

Larger, oversize battlemat and counters/miniatures. 3d counters/miniatures much easy to grab than flat or small.

Counters/sliders instead of having to write on paper to track frequently changing stats on character sheet such as hit points, spell points/mana, etc.

Palmar adaptive grip for writing with pencil, on oversize character sheet, or a subsheet to keep track of frequently changing statistics.

Expensive option: Electronic tablets with oversize text, that can be changed to update hit points, treasure, mana, spell points, equipment, etc.

 

MD - Additional Considerations[+]

 

Keeping in mind many may tire quickly. That being able to response may be slowed due to the variant of impairment, so allow plenty of time to respond. Try to avoid count-downs, and allow for more patient fellow players to wait turns.

Keep group size smaller, due to these considerations of time and patience, do not recommend groups with more than 4 players (plus GM/DM = 5).

NOTE: This section will be updated in coming months as the above suggestions are tested. - W.A. Hawkes-Robinson 20161109.

 

6.22 Multiple Schlerosis

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

6.23 Obesity

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

6.24 Osteoporosis

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

 

6.25 Parkinson's Disease

Unknown if any RPG-based programs have been developed to help this population.

 

 

6.26 Personality Disorders

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

6.27 Psychotic Disorders (Schizophrenia and others)

 

There is actually some published research on using RPGs with this population for various Schizophrenia Spectrum clients. Though none of it is from the TR profession.

References:

Pending

See http://rpgresearch.com for a comprehensive list.

 

 

6.28 Rheumatoid Arthritis

Unknown if any RPG-based programs have been developed to help this population.

 

 

6.29 Sexual & Gender-Identity Disorders

Unknown if any RPG-based programs have been developed to help this population.

W.A. Hawkes-Robinson has reported some experiences with this population in tabletop RPG and LARP settings, though no indication of any specific program plans to address specific issues. However Hawkes-Robinson does have some case study information.

 

 

 

6.30 SCI - Spinal Cord Injury

 

See the example program plans from W.A. Hawkes-Robinson in the Brain Injury section, for some suggested program ideas also applicable to the SCI population.

 

 

6.31 Sickle Cell Anemia

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

 

 

 

 

 

6.32 Sleep Disorders

Unknown if any RPG-based programs have been developed to help this population.

 

 

6.33 Somatoform & Dissociative Disorders

Unknown if any RPG-based programs have been developed to help this population.

 

 

 

  Substance-Related Disorders[+]

W.A. Hawkes-Robinson has been involved with some program plans using RPGs as a part of a comprehensive transition plan from in-patient to outpatient for clients with substance-dependency issues. See the section under “At Risk Youth” for some example information.

 

 

 7.0 RTHP Section 3: Treatment and the ICF Model

 

TODO. For now reference RTHP Section 3

 

7.1 Body Functions[+]

TODO. For now reference RTHP Section 3: Body Functions

 

7.1.1 Scoring

See page 149 of TRHP for details on this section, detailing here would be redundant. However the Body Functions Qualifier Table is replicated here for your convenience.

 

7.1.1.1 General Coding Guidelines

TODO. For now reference RTHP Section 3: Body Functions

 

7.1.1.2 Body Functions Qualifier

Table 14: Body Functions Qualifier

Scoring for First Qualifier

 

 

% impairment

0

NO impairment

(none, absent, negligible...)

0-4%

1

MILD impairment

(slight, low...)

5-24%

2

MODERATE impairment

(medium, fair...)

25-49%

3

SEVERE impairment

(high, extreme...)

50-95%

4

COMPLETE impairment

(total)

96-100%

8

Not specified

 

 

9

Not applicable

 

 

Evaluating RPG TR Accommodations Ranking[+]

The therapists primary initial function will be to evaluate if the client's functioning is sufficient for participation in useful therapeutic recreational activities, and more specifically for this document, if sufficient client functionality exists for participation in one or more RPG format for therapeutic benefit. A Role-playing Gaming Therapeutic Recreation Accommodations Ranking (AR) should be evaluated to determine the level of modification to the RPG process needed to accommodate the client's needs allowing for maximal therapeutic benefit from participation in the role-playing gaming session(s). A comparison is noted in relationship to the ICF Body Functions Qualifier (See Table #__ for ICF Body Functions Qualifier Scoring).

RPG TR Accommodations Ranking (AR):

  • Client functioning meets requirements for participation in one or more RPG formats, with little or no accommodations necessary for therapeutic benefit from participation in RPG format(s). ICF Body Functions Qualifier range 0, 1, 2, or 3, but impairment does not require accommodations for RPG participation.

  • Client functioning meets minimum requirements for participation in one or more RPG formats, and only some accommodations are necessary for therapeutic benefit from participation in RPG format(s). ICF Body Functions Qualifier range 1 to 3.

  • Client functioning meets the minimum for some participation in at least one RPG format, but significant accommodations will be necessary for therapeutic benefit from participation in RPG format(s). ICF Body Functions Qualifier range 2 to 3.

  • Client functioning is below the threshold for useful therapeutic benefit from participation in any RPG format. Other therapeutic recreational activities should be considered. ICF Body Functions Qualifier range 3 to 4.

 

 

 

 

 

 

 

 

7.3 Mental Functions

 

7.3.1 Global Mental Functions (b110-b139)

 

7.3.1.1 (b110) Consciousness Functions

 

(b1100) State of Consciousness

 

 

(b1101) Continuity of Consciousness

 

 

(b1102) Quality of Consciousness

 

  <span>Treatment for Consciousness Functions[+]

 

 

Example

Therapist performs evaluation of level of impairment, for example one possible measure is the FOX or Activity Therapy Social Skills Baseline (earlier version). Based on the results of the client's functioning, the therapist should determine if the level of impairment is too significant for participation any of the RPG formats (TRPG, CRPG, CYOA, or LARP) by establishing the Accommodations Rating (AR) as per section 8.2 of this document, to determine if there is sufficient functioning to participate with modifications, or participation without modifications.

Initially it may seem impossible to apply RPG therapeutic treatment techniques to a level 3 or 4 patient with consciousness function impairment of such severity, but it might be possible with significant accommodation. Clients with severe levels of impairment in this category may not be candidates for application of role-playing gaming therapy, however it may still be possible with significant accommodations.

 

Hypothetical Scenario #1 (ICF b11003 or b11004)

The client is in the 3-4 level of impairment, barely responsive to stimuli. If not able to respond to at least simple yes/no questions with a squeeze, twitch, eye movement or other signal, the client is not candidate for any RPG accommodation. However, if the client can at least respond to simple yes/no questions by some means, or even slight numerical responses (for example 3 blinks for 3, and 1 blink for 1), then a highly accommodated version of RPG might be feasible. The client should already have been known to have an interest in RPG's and/or RPG-like activities prior to impairment. For example, the therapist may interview the client's friends and family and discover that the client previously enjoyed role-playing gaming in one form or another, so it might be a stimulus that the client would very much enjoy and have a positive response to.

In the case of the severely impaired, the therapist might take more of a “choose your own adventure” approach to engaging the client in RPG therapy. The therapist would provide a simple list (or a series of yes/no questions) of character archetypes for the client to chose as his/her Player Character (PC). Then the therapist would provide a narrative of the scenario, and at key points provide the client opportunities to make decisions on what to do next through either yes/no, or numerical selection. These scenerios could initially meet the RTHP suggestions of just small 10-15 minute increments initially, but slowly increase in duration and complexity over time (page 151, referencing the O'Sullivan and Schmitz (1998) list).

This adventure would initially just a be a solo, one-on-one, adventure with the therapist as narrator, and the client as the sole player. If the client's functioning improves, then longer sessions of greater complexity may be possible.

Additionally, other participants may later be able to join in the process, friends and family, to help with re-engaging socially and to train those in the client's support structure on the process.

 

7.3.1.2 (b114) Orientation Functions

 

7.3.1.2.1 Treatment for Orientation Functions

RPG may be helpful to work with improving General Mental Functions > Orientation.

 

 

  • Person

  • Place (especially use of maps)

  • Time

 

 

 

 

7.3.1.3 (b117) Intellectual Functions

 

7.3.1.3.1 Treatment for Intellectual Functions

 

7.3.1.4 (b122) Global Psychosocial Functions

 

7.3.1.4.1 Treatment for Global Psychosocial Functions

 

 

7.3.1.4.2 Treatment for Temperament and Personality Functions

 

Temperament & Personality functions may be addressable using RPGs.

 

 

  • Mood disorders

  • Personality disorders

  • Organic brain disorders

  • Childhood disorders

  • Learned behaviors

 

 

Not sure about the efficacy of using RPGs to help those with substance abuse or child abuse issues.

For the above listed Temperament & Personality functions, improvements could likely be seen from the applicable treatment list when using RPG to address:

 

 

  • Specially designed experiences

  • Journaling (adventure journals)

  • Behavior modification

  • Group work

  • Social skills

  • Opportunities for leadership

  • Challenges

  • Role-playing (of course)

 

 

The only item from this category list that RPGs would not have direct influence is the item "medication".

7.3.1.5 (b130) Energy and Drive Functions

 

 

 

 

7.3.1.5.1 Treatment for Energy and Drive Functions

From the energy and Drive functions list:

 

 

  • Energy Level

  • Motivation

  • Impulse control

 

 

Could possibly be treated with RPGs, however the Appetite and Craving items might not be effectively addressed using RPGs.

If the client likes RPGing, then motivation levels will likely be higher than more "mundane" activities. Also, tabletop RPGs can be performed even when at a low energy level (as can CRPGs), while LARP would require clients to have higher energy and motivation levels for sustained, regular, participation.

7.3.1.5.1.1 Energy Level

 

 

7.3.1.5.1.2 Motivation

 

7.3.1.5.1.3 Appetite

 

7.3.1.5.1.4 Craving

 

7.3.1.5.1.5 Impulse Control

 

7.3.1.6 (b134) Sleep Functions

 

7.3.1.6.1 Treatment for Sleep Functions

 

7.3.1.7 (b139) Global Mental Functions, Other Specified and Unspecified

 

7.3.2 Specific Mental Functions (b140-b189)

 

7.3.2.1 (b140) Attention Functions

 

7.3.2.1.1 Treatment for Attention Functions

RPGs, could be useful for improving attention functions including shifting, dividing, sharing, and sustaining attention.

RPG's can meet the following recommendations for treatment from this list:

 

 

  • Graduated tasks

  • Manipulate environment (most with LARP, and lesser degrees computer-based, but also tabletop when using dice, pencils, paper, miniatures, maps, etc.)

  • Progress from familiar to novel

  • Repetitive to complex

  • Treatment sessions appropriate length

  • Variety of interventions and medium

  • Positive feedback

  • Maintain eye contact

  • Structure or limit information

  • Break task into simple components.

 

 

RPGs definitely meet the needs for the above list quite well.

 

7.3.2.2 (b144) Memory Functions

 

7.3.2.2.1 Treatment for Memory Functions

RPGs can definitely address most, if not all, memory function treatment requirements:

 

 

  • Registering, storing, and retrieving information as needed.

  • Enhance memory functions through repetition, graduated tasks, and cueing

  • External aids (notes on paper, miniatures, dice, maps)

  • Training in active listening skills (key part of tabletop RPG)

  • “Chunking” or grouping

  • Mental retracing

  • Visual imagery

  • Story method

  • Association

  • Pegging (ex. APIE)

 

 

7.3.2.3 (b147) Psychomotor Functions

 

 

 

 

 

 

7.3.2.3.1 Treatment for Psychomotor Functions

Though likely LARP would be the most significant impact for these functions, both CRPGs and TRPGs could be used for those with

greater impairments. CRPGs generally require use of the keyboard and/or mouse, and/or game controller. TRPGs generally offer opportunities for

use of paper and pencil, tokens, moving miniatures on maps/boards, rolling dice, selecting cards, etc.

The following areas might be addressable through RPG treatment at various levels:

 

 

  • Psychomotor retardation

  • Excitement and agitation

  • Posturing (involuntary flexion or extension of the arms and legs)

  • Catatonia (Neurogenic motor immobility, and behavioral abnormality manifested by stupor) - Not sure that RPGs could effectively treat.

  • Catatonia - Negativism - client understands instructions, then does the opposite.

  • Catatonia - Ambitendency - a state of ambivalence with alternation of cooperation and opposition.

  • Echopraxia - involuntary imitation of the movements of another person

  • Echolalia - automatic repetition of vocalizations made by another person

 

 

RPGs would be unlikely to be effective for those with complete, and upper levels of severe impairments in this category, but those with lower levels of severe, and moderate to mild impairment, might be able to benefit from using various RPGs as treatment.

 

7.3.2.4 (b152) Emotional Functions

 

7.3.2.4.1 Treatment for Emotional Functions

RPGs, especially TRPG and LARP could help significantly in this area.  CRPG would have limited feedback and interaction benefits.

 

 

  • Appropriateness of emotion

  • Regulation of emotion

  • Range of emotion

  • Drama

  • Social skills training

  • Direct feedback

 

 

 

7.3.2.5 (b156) Perceptual Functions

 

 

 

 

 

7.3.2.5.1 Treatment for Perceptual Functions

Mental functions of recognizing and interpreting sensory stimuli.

Includes:

 

 

  • Auditory perception

  • Visual perception

  • Tactile perception

  • Visuaspatialperception

 

 

TRPGs and CRPGs would not normally address the other categories:

 

 

  • Olfactory perception

  • Gustatory perception

 

 

However, it is not unusual for LARP settings to potentially address these other functions, and it would not be impossible to integrate to some degree these functions with TRPG.

 

7.3.2.6 Form Discrimination

 

 

7.3.2.6.1 Visuospatial Perception

 

 

7.3.2.7 (b160) Thought Functions

 

 

 

7.3.2.7.1 Treatment for Thought Functions

Mental functions related to the ideational component of the mind.

Includes:

 

 

  • Pace of thought

  • Form of thought

  • Content of thought

  • Control of thought

 

 

While not very likely to be addressed with current CRPGs, it may be possible to address these in creative ways with TRPG and maybe some LARPs. Further research will be necessary to better determine the relevant efficacy.

 

 

 

 

7.3.2.8 (b164) Higher-Level Cognitive Functions

 

7.3.2.8.1 Treatment for Higher-Level Cognitive Functions

RPGs are ideal for addressing this area of functioning.

 

 

  • Complex goal directed behaviors

  • Decision making

  • Abstract thinking

  • Planning

  • Plan implementation

  • Mental flexibility

  • Deciding which behaviors are appropriate under which circumstances (executive functions)

  • Hypothetical scenarios

 

 

 

All of the RPG media (tabletop, computer, live-action) can help in this area, but TRPG is most likely to have the strongest efficacy as treatment.

 

7.3.2.8.1.1 Abstraction

 

7.3.2.8.1.2 Organization and Planning

 

7.3.2.8.1.3 Time Management

 

7.3.2.8.1.4 Cognitive Flexibility

 

7.3.2.8.1.5 Insight

 

7.3.2.8.1.6 Judgment

 

7.3.2.8.1.7 Problem Solving

 

 

 

 

7.3.2.9 (b167) Mental Functions of Language

 

7.3.2.9.1 Treatment for Mental Functions of Language

 

7.3.2.9.1.1 Expressive Language Techniques

 

7.3.2.9.1.2 Receptive Language Techniques

 

7.3.2.10 (b172) Calculation Functions

 

7.3.2.10.1 Treatment for Calculation Functions

 

7.3.2.11 (b176) Mental Functions of Sequencing Complex Movements

 

 

7.3.2.11.1 Treatments for Mental Function of Sequencing Complex Movement

 

7.3.2.11.1.1 Buccofacial Apraxia

 

 

7.3.2.11.1.2 Conceptual Apraxia

 

7.3.2.11.1.3 Constructional Apraxia

 

7.3.2.11.1.4 Developmental Apraxia of Speech

 

7.3.2.11.1.5 Ideomotor Apraxia

 

7.3.2.11.1.6 Limb-Kinetic Apraxia

 

7.3.2.11.1.7 Oculomotor Apraxia

 

7.3.2.11.1.8 Verbal Apraxia

 

7.3.2.12 (b180) Experience of self and Time Functions

 

 

7.3.2.12.1 Treatment for Experience of Self and Time Functions

 

7.3.2.12.1.1 Experience of Self

 

7.3.2.12.1.2 Body Image

 

7.3.2.12.1.3 Experience of Time

 

 

7.3.2.13 (b189) Specific Mental Functions, Other Specified or Unspecified.

 

 

7.3.2.14 (b198) Mental Functions, Other Specified

 

 

7.3.2.15 (b199) Mental Functions, Unspecified

 

 

 

 

7.3.3 References

 

7.4 Chapter 2 Sensory Functions and Pain

 

7.4.1 Seeing and Related Functions (b210-b229)

 

7.4.1.1 (b210) Seeing Functions

 

 

If the client has significant visual impairment, the client will need braille versions of the rulebook for the game system, and some means of keeping track of the character's statistical information, and any notes the player/client may want to keep as the adventure progresses (maybe a voice recorder with a headphone so the client/player can play back verbal notes to self as needed, without disturbing the rest of the group to do so).

 

Use of electronic dice that have an auditory ability to indicate the result of a roll. Alternatively many apps on smart phones and PC's are available that can electronically represent random dice results, then the app just needs to have a text-to-voice component for the visually impaired participant. Failing that, the client is dependent on the other players and/or Game Master to verbally indicate the result from the client rolling the dice on the table.

 

Since the rest of the game play is primarily auditory, other modifications are not necessary for complete unimpaired performance in the game.

 

 

7.4.1.1.1 Treatment for Seeing Functions

 

7.4.1.1.1.1 Treatment for Visual Acuity Functions

 

7.4.1.1.1.2 Treatment for Visual Field Functions

 

7.4.1.1.1.3 Treatment for Quality of Vision

 

 

7.4.1.1.1.4 Treatment for Functions of Structures Adjoining the Eye

 

7.4.1.1.1.5 Treatment for Sensations Associated with the Eye and Adjoining Structures

 

7.4.1.2 (b229) Seeing and Related Functions, Other Specified and Unspecified

 

 

 

 

 

7.4.2 Hearing and Vestibular Functions (b230-b249)

 

 

7.4.2.1 (b230) Hearing Functions

 

7.4.2.1.1 Treatment for Hearing Functions

 

7.4.2.2 (b235) Vestibular Functions

 

7.4.2.2.1 Treatment for Vestibular Functions

 

 

7.4.2.3 (b240) Sensations Associated with Hearing and Vestibular Functions

 

 

 

7.4.2.3.1 Treatment for Sensations Associated with Hearing and Vestibular Functions

 

 

 

7.4.2.4 (b249)

 

 

 

7.4.2.5 (b250-b279) Additional Sensory Functions

 

 

7.4.2.6 (b250) Taste Function

 

 

7.4.2.6.1 Treatment for Taste Functions

 

 

7.4.2.7 (b255) Smell Function

 

 

7.4.2.7.1 Treatment for Smell Function

 

 

 

7.4.2.8 (b260) Proprioceptive Function

 

 

7.4.2.8.1 Treatment for Propreoceptive Function

 

 

 

7.4.2.9 (b265) Touch Function

 

 

7.4.2.9.1 Treatment for Touch Function

 

 

 

7.4.2.10 (b270) Sensory Functions Related to Temperature and Other Stimuli

 

 

7.4.2.10.1 Treatment for Sensory Functions Related to Temperature and Other Stimuli

 

 

 

7.4.2.10.1.1 Temperature

 

 

 

7.4.2.10.1.2 Other Stimuli

 

 

 

7.4.2.11 (b279) Additional Sensory Functions, Other Specified and Unspecified.

 

 

 

7.4.3 (b280-289) Pain

 

 

7.4.3.1 (b280) Sensation of Pain

 

 

 

7.4.3.1.1 Treatment

 

 

 

7.4.3.2 (b289) Sensation of Pain, Other Specified or Unspecified

 

7.4.3.3 (b298)

 

 

7.4.3.4 (b299)

 

 

 

 

 

7.4.4 References

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.5 Chapter 3 Voice and Speech Functions

 

 

 

 

7.5.1.1 (b310) Voice Functions

 

 

7.5.1.1.1 Treatment

 

 

 

 

 

7.5.1.2 (b320) Articulation Functions

 

 

 

7.5.1.2.1 Treatment

 

 

 

 

 

7.5.1.3 (b330) Fluency and Rhythm of Speech Functions

 

 

 

7.5.1.3.1 Treatment

 

 

 

 

 

 

 

7.5.1.4 (b340) Alternative Vocalization Functions

 

 

7.5.1.4.1 Treatment

 

 

 

7.5.1.5 (b398)

 

 

7.5.1.6 (b399)

 

 

 

 

7.5.2 Chapter 4 Functions of the Cardiovascular, Hematological, Immunological, and Respiratory Systems.

 

 

 

 

7.5.2.1 (b410-b429) Functions of the Cardiovascular System

 

 

7.5.2.1.1 Treatment

 

 

 

7.5.2.2 (b415) Blood Vessel Functions

 

 

7.5.2.2.1 Treatment

 

 

 

 

7.5.2.3 (b420) Blood Pressure Functions

 

 

7.5.2.3.1 Treatment

 

 

 

 

7.5.3 (b430-b439) Functions of the Hematological and Immunological Systems

 

 

7.5.3.1 (b430) Hematological System Functions

 

 

 

 

7.5.3.1.1 Treatment

 

 

 

7.5.3.2 (b435) Immunological System Functions

 

 

 

7.5.3.2.1 Treatment

 

 

 

7.5.3.3 (b439)

 

 

 

7.5.4 (b440-b449) Functions of the Respiratory System

 

 

 

7.5.4.1 (b440) Respiration Functions

 

 

7.5.4.1.1 Treatment

 

 

7.5.4.2 (b445) Respiratory Muscle Functions

 

 

 

 

7.5.4.2.1 Treatment

 

 

 

7.5.4.3 (b449)

 

 

7.5.4.4 (b450-b469)

 

 

7.5.4.5 (b450)

 

 

 

7.5.4.5.1 Treatment

 

 

 

 

7.5.4.6 (b455) Exercise Tolerance Functions

 

 

7.5.4.6.1 Treatment

 

 

 

7.5.4.7 (b460) Sensations Associated with Cardiovascular and Respiratory Functions

 

 

 

7.5.4.7.1 Treatment

 

 

 

 

 

7.5.4.8 (b469)

 

 

 

7.5.4.8.1 (b498)

 

 

7.5.4.9 (b499)

 

 

 

7.6 Chapter 5 – Functions of the Digestive, Metabolic, and Endocrine Systems

 

This is important to take into consideration during RPG Therapy sessions, since it is common to have drinks and food, and bathroom breaks as part of gaming sessions. The RPG Therapist will need to take these issues into account when planning the treatment sessions, allowing correct break frequency, correct “munchies” in line with the clients needs and restrictions, etc.

 

 

7.6.1 (b510-b539) Functions Related to the Digestive System

 

 

 

7.6.1.1 (b510) Ingestion functions

 

 

 

 

(b5100) Sucking

 

 

(b5101) Biting

 

 

 

(b5102) Chewing

 

 

 

 

(b5103) Manipulation of Food in the Mouth

 

 

 

 

(b5104) Salivation

 

 

 

 

(b5105) Swallowing

 

 

(b51050) Oral Swallowing

 

 

 

(b51051) Pharyngeal Swallowing

 

 

 

(b51052) Esophageal Swallowing

 

 

(b51058) Swallowing, Other Specified

 

 

 

 

(b51059) Swallowing, Unspecified

 

 

 

(b5106) Regurgitation and Vomiting

 

 

(b5108) Ingestion Functions, Other Specified

 

 

 

 

(b5109) Ingestion Functions, Unspecified

 

 

 

7.6.1.1.1 Treatment for Ingestion Functions

 

 

7.6.1.2 (b515) Digestive Functions

 

 

7.6.1.2.1 Treatment for Digestive Functions

 

 

 

7.6.1.3 (b520) Assimilation Functions

 

 

7.6.1.3.1 Treatment for Assimilation Functions

 

 

7.6.1.4 (b525) Defecation Functions

 

 

 

7.6.1.4.1 Treatment for Defecation Functions

 

 

 

7.6.1.5 (b530) Weight Management Functions

 

BMI

 

Inlusions:

 

Exclusions:

 

 

7.6.1.5.1 Treatment for Weight Management Functions

 

 

 

7.6.1.6 (b535) Sensations Associated with the Digestive System

 

 

(b5350) Sensation of Nausea

 

 

(b5351) Feeling Bloated

 

 

 

(b5352) Sensational of Abdominal Cramp

 

 

(b5358) Sensations Associated with the Digestive System, Other Specified

 

 

 

(b5359) Sensations Associated with the Digestive System, Unspecified

 

 

 

 

 

 

7.6.1.6.1 Treatment for Sensations Associated with the Digestive System

 

 

 

7.6.1.7 (b539) Functions Related to the Digestive System, Other Specified and Unspecified

 

 

 

 

 

 

 

7.6.2 (b540-b559) Functions Related to Metabolism and the Endocrine System

 

 

 

7.6.2.1 (b540) General Metabolic Functions

 

 

(b5400) Basal Metabolic Rate

 

 

(b5401) Carbohydrate Metabolism

 

 

 

 

(b5402) Protein Metabolism

 

 

 

(b5403) Fat Metabolism

 

 

 

(b5408) General Metabolic Functions, Other Specified

 

 

 

(b5409) General Metabolic Functions, Unspecified

 

 

 

 

7.6.2.1.1 Treatment for General Metabolic Functions

 

 

 

7.6.2.2 (b545) Water, Mineral, and Electrolyte Balance Functions.

 

 

(b5450) Water Balance

 

 

(b54500) Water Retention

 

 

(b54501) Maintenance of Water Balance

 

 

 

(54508) Water Balance Functions, Other Specified

 

 

(54509) Water Balance Functions, Unspecified

 

 

 

 

 

(b5451) Mineral Balance

 

 

(b5452) Electrolyte Balance

 

 

(b5458) Water, Mineral, and Electrolyte Balance Functions, Other Specified

 

 

 

(b5459) Water, Mineral, and Electrolyte Balance Functions, Unspecified

 

 

 

 

7.6.2.2.1 Treatment for Water, Mineral, and Electrolyte Balance Functions

 

 

 

 

  • Hypercalcemia

 

 

 

 

 

 

  • Hypocalcemia

 

 

 

 

 

 

 

 

 

 

 

 

 

7.6.2.3 (b550) Thermoregulatory Functions

 

 

Inclusions:

 

 

Exclusions:

 

 

 

(b5500) Body Temperature

 

 

(b5501) Maintenance of Body Temperature

 

 

(b5508) Thermoregulatory Functions, Other Specified

 

 

(b5509) Thermoregulatory Functions, Unspecified

 

 

 

 

 

7.6.2.3.1 Treatment

 

 

7.6.2.4 (b555) Endocrine Gland Functions

 

Inclusions:

 

 

 

Exclusions:

 

7.6.2.4.1 Treatment

 

 

 

 

  • Hyperthyroidism

 

 

 

 

 

 

 

  • Hypothyroidism

 

 

 

 

 

7.6.2.5 (b559) Functions Related to Metabolism and the Endocrine Systems, Other Specified and Unspecified

 

 

7.6.2.6 (b598) Functions of the Digestive, Metabolic, and Endocrine Systems, Other Specified

 

 

7.6.2.7 (b599) Functions of the Digestive, Metabolic, and Endocrine Systems, Unspecified

 

 

 

 

 

 

 

7.6.3 Chapter 6 – Genitourinary and Reproductive Functions

 

 

 

 

 

7.6.3.1 (b610-b639) Urinary Functions

 

TR is not generally going to have direct involvement, but will be expected to log, and make accommodations for clients with these issues.

Factors can also include UTI altering behavior from normal patterns, TR will need to keep notes on behavioral changes for any caretakers to be informed about.

If client has difficulty communicating the need to urinate, or difficulty getting to facility for urination, TR will need to be aware of these needs.

TR needs to know:

 

 

  • Specific urinary function impairments

  • Frequency of impairment

  • Activities affected by impairment

  • Adaptations and recommendations from caretakes

  • Treatments that have been initiated and the expected outcome of the treatments

  • What level of assistance does the client require

 

 

 

Treatments TR should be aware of:

 

 

  • Medication that client is taking and what side effects to watch for

  • Behavior modification – any observation of changes should be noted and communicated to caretakers.

  • Any changes in their toileting routine need to be considered.

  • Collection devices used

  • Devices used to assist with releases

 

 

 

7.6.3.1.1 (b610) Urinary Excretory Functions

 

 

Exclusions:

 

 

Inclusions:

 

 

 

 

7.6.3.1.1.1 (b6100) Filtration of Urine

 

 

 

 

 

7.6.3.1.1.2 (b6101) Collection of Urine

 

 

7.6.3.1.1.3 (b6108) Urinary Excretory Functions, Other Specified

 

 

 

7.6.3.1.1.4 (b6109) Urinary Excretory Functions, Unspecified

 

 

 

 

 

 

 

 

7.6.3.1.2 Treatment for Urinary Excretory Functions

 

 

 

7.6.3.2 (b620) Urination Functions

 

 

7.6.3.2.1 (b6200) Urination

 

 

7.6.3.2.2 (b6201) Frequency of Urination

 

 

7.6.3.2.3 (b6203) Urinary Continence

 

 

7.6.3.2.4 (b6208) Urination Functions, Other Specified

 

 

7.6.3.2.5 (b6209) Urination Functions, Unspecified

 

 

 

 

 

7.6.3.2.6 Treatment for Urinary Functions

 

 

 

  • Neurological damage

  • Congenital malformations

  • Urinary tract infections

  • Bladder cancer.

  • Intoxication.

  • Seizures.

  • Extreme fear or anxiety.

  • Medication

  • Cognitive impairments:

  • Lack of mobility:

  • Communication impairments:

 

 

 

 

 

 

 

 

 

 

7.6.3.2.6.1 Indwelling Catheter

 

 

 

 

 

7.6.3.2.6.2 Straight Catheterizing

 

 

 

7.6.3.2.6.3 Texas Catheter

 

 

 

7.6.3.2.6.4 Urinal

 

 

 

7.6.3.2.6.5 Sanitary Pads for Urination

 

 

 

7.6.3.2.6.6 Importance of Urinary Continence

 

 

 

 

7.6.3.3 (b630) Sensations Associated with Urinary Functions

 

 

7.6.3.3.1 Treatment

 

 

 

7.6.3.4 (b639) Urinary Functions, Other Specified and Unspecified

 

 

 

7.6.3.5 (b640-b679) Genital and Reproductive Functions

 

 

7.6.3.6 (b640) Sexual Functions

 

 

 

 

 

 

7.6.3.6.1 Treatment for Sexual Functions

 

TR will may be informed by caretakers that the client may have some issues related to sexual functions, including personal relationships with other clients, and how sensitive the client is discussing these issues. And may need to modify the campaign appropriately for content related to relationships or even sex that might have been part of a plot or story line, may need to be modified for client sensitivity.

For example, youth gamers, sexual discussion or details of Player Character's actions may not be appropriate.

 

 

 

 

 

 

 

7.6.3.6.1.1 Male Issues

 

 

7.6.3.6.1.2 Female Issues

 

 

 

7.6.3.6.1.3 Both Male and Female Issues

 

 

7.6.3.7 (b650) Menstruation Functions

 

 

7.6.3.7.1 (b6500) Regularity of Menstrual Cycle

 

 

7.6.3.7.2 (b6501) Interval between Menstruation

 

 

 

7.6.3.7.3 (b6502) Extent of Menstrual Bleeding

 

 

 

7.6.3.7.4 (b6508) Menstruation Functions, Other Specified

 

 

 

7.6.3.7.5 (b6509) Menstruation Functions, Unspecified

 

 

 

 

7.6.3.7.6 Treatment of Menstruation Functions

 

 

 

 

 

 

 

 

7.6.3.8 (b660) Procreation Functions

 

 

7.6.3.8.1 (b6600) Functions Related to Fertility

 

 

7.6.3.8.2 (b6601) Functions Related to Pregnancy

 

 

7.6.3.8.3 (b6602) Functions Related to Childbirth

 

 

 

7.6.3.8.4 (b6603) Lactation

 

 

7.6.3.8.5 (b6608) Procreation Functions, Other Specified

 

 

7.6.3.8.6 (b6609) Procreation Functions, Unspecified

 

 

 

 

 

 

 

 

 

 

 

 

7.6.3.8.7 Treatment for Procreation Functions

 

 

 

7.6.3.9 (b670) Sensations Associated with Genital and Reproduction Functions

 

 

 

7.6.3.9.1 Treatment of Sensations Associated with Genital and Reproduction Functions

 

 

 

7.6.3.10 (b679)

 

 

 

7.6.3.11 (b698)

 

 

 

7.6.3.12 (b699)

 

 

 

7.6.4 References

 

 

 

 

7.7 Chapter 7 – Neuromusculoskeletal and Movement-Related Functions

 

This area will most significantly impact Live-action RPG. Significant impairment will limit capabilities for computer-based and tabletop, but moderate to light impairment should be easy to work with. In cases of significant impairment, some accommodations may be necessary, some example scenarios will be listed.

 

Assess muscle endurance functions.

 

7.7.1.1 (b710-b729) Functions of the Joints and Bones

 

 

7.7.1.1.1 (b710) Mobility of Joint Functions

 

 

7.7.1.1.1.1 (b7100) Mobility of a Single Joint

 

 

7.7.1.1.1.2 (b7101) Mobility of Several Joints

 

 

 

7.7.1.1.1.3 (b7102) Mobility of Joints Generalized

 

 

 

7.7.1.1.1.4 (b7108) Mobility of Joint Functions, Other Specified

 

 

7.7.1.1.1.5 (b7109) Mobility of Joint Functions, Unspecified

 

 

 

 

 

 

 

7.7.1.2 Treatment for Mobility of Joint Functions

 

 

 

7.7.1.2.1 (b715) Stability of Joint Functions

 

 

7.7.1.2.1.1 (b7150) Stability of s Single Joint

 

7.7.1.2.1.2 (b7151) Stability of Several Joints

 

 

 

(b7152)

 

(b7158)

 

(b7159)

 

 

 

 

Treatment for Stability of Joint Functions

 

 

 

 

(b720) Mobility of Bone Functions

 

 

 

 

 

(b7200)

 

 

(b7201)

 

 

 

(b7202)

 

 

 

(b7208)

 

 

 

(b7209)

 

 

 

 

 

Treatment for Mobility of Bone Functions

 

 

 

 

 

(b729) Functions of the Joints and Bones, Other Specified and Unspecified

 

 

 

 

(b730-b749) Muscle Functions

 

 

 

(b730) Muscle Power Functions

 

 

 

 

(b7300) Power of Isolated Muscles and Muscle Groups

 

 

(b7301) Power of Muscles or One Limb

 

 

 

(b7302) Power of Muscles of One Side of the Body

 

 

(b7303) Power of Muscles in Lower Half of the Body

 

 

(b7304) Power of Muscles of All Limbs

 

 

 

(b7305) Power of Muscles of the Trunk

 

 

 

(b7306) Power of All Muscles of the Body

 

 

 

(b7308) Muscle Power Functions, Other Specified

 

 

 

(b7309) Muscle Power Functions, Unspecified

 

 

 

Treatment for Muscle Power Functions

 

 

 

Table 15: Manual Muscle Evaluations – Strength

 

 

100%

5

N

Normal

Complete range of motion against gravity with full resistance

75%

4

G

Good

 

50%

3

F

Fair

 

25%

2

P

Poor

 

10%

1

T

Trace

 

0%

0

0

Zero

 

S

 

 

Spasm

 

C

 

 

Contracture

 

 

 

 

 

 

(b735) Muscle Tone Functions

 

 

(b7350) Tone of Isolated Muscles and Muscle Groups

 

 

(b7351) Tone of Muscles of One Limb-Kinetic

 

(b7352) Tone of Muscles of One Side of Body

 

 

(b7353) Tone of Muscles in Lower Half of Body

 

 

(b7354) Tone of Muscles in All Limbs

 

 

(b7355) Tone of Muscles of Trunk

 

 

(b7356) Tone of All Muscles of the Body

 

 

(b7358) Muscle Tone Functions, other Specified

 

 

(b7359) Muscle Tone Functions, Unspecified

 

 

 

Treatment for Muscle Tone Functions

 

 

 

 

  • Flaccidity (or hypotonia)

  • Rigidity (or hypertonia)

 

 

 

Warm water (or cooler water) can help loosen some.

 

 

 

(b740) Muscle Endurance Functions

 

 

(b7400) Endurance of Isolated Muscles

 

 

(b7401) Endurance of Muscle Groups

 

 

 

(b7402) Endurance of All Muscles of the Body

 

 

 

(b7408) Muscle Endurance Functions, Other Specified

 

 

(b7409) Muscle Endurance Functions, Unspecified

 

 

Treatment for Muscle Endurance Functions

 

 

(b749) Muscle Functions, Other Specified and Unspecified

 

 

(b750-b789) Movement Functions

 

 

(b750) Motor Reflex Functions

 

 

(b7500) Stretch Motor Reflex

 

 

(b7501) Reflexes Generated by Noxious Stimuli

 

 

(b7502) Reflexes Generated by Other Exteroceptive Stimuli

 

 

(b7508)

 

 

(b7509)

 

 

Treatment for Motor Reflect Functions

 

 

 

(b755) Involuntary Movement Reaction Functions

 

 

Treatment for Involuntary Movement Reaction Functions

 

 

 

 

Table 16: Rating System for deep Tendon Reflexes

Numeric Rating

Description of Function

4+

Brisk, hyperactive, clonus

3+

Is more than normal, but does not necessarilyindicate a pathologic process, gross functional ability not usually impaired.

2+

Normal

1+

Low normal, with slight diminution in response, havingminor impact on functionalability

0

No response

 

 

 

(b760) Control of Voluntary Movement Functions

 

 

(b7600) Control of Simple Voluntary Movements

 

 

(b7601) Control of Complex Voluntary Movements

 

 

(b7602) Coordination of Voluntary Movements

 

 

(b7603) Supportive Functions of Arm of Leg

 

 

(b7608)

 

 

(b7609)

 

 

Treatment for Control of Voluntary Movement Functions

 

 

 

Control of Simple and Complex Voluntary Movement

 

 

 

Coordination of Voluntary Movements

 

Asthenia

 

Ataxia

 

 

Dysdiadochokinesia

 

 

Dysmetria

 

 

 

Movement decomposition

 

 

 

Nystogmus

 

 

 

Supportive Functions of the Arm or Mleg

 

 

 

(b765) Involuntary Movement Functions

 

 

(b7650) involuntary contractions of Muscles

 

 

(b7651) Tremor

 

 

(b7652) Tics and Mannerisms

 

 

(b7653) Stereotypes and Motor Perseveration

 

 

(b7658)

 

 

(b7659)

 

 

Treatment for Involuntary Movement Functions

 

 

Atheotosis

 

 

Bradykinesia

 

 

Chorea

 

 

Choreothetosis

 

 

 

Dystonia

 

 

Hemiballismus

 

 

Tremors

 

 

 

Action Tremors

 

 

Coarse Tremor

 

 

Essential Tremor

 

 

Fine Tremor

 

 

Instension tremor

 

 

Intermittent Tremor

 

 

Motofacient tremor

 

 

 

Passive Tremor

 

 

 

Persistenttremor

 

 

 

Resting Tremor

 

 

 

Volitional tremor

 

 

 

(b770) Gait Pattern Functions

 

 

Treatment for Gait Pattern Functions

 

 

 

(B780) Sensations related to Muscles and Movement Functions

 

 

(b7800) sensation of Muscle Stiffness

 

 

(b7801) Sensation of Muscle Spasm

 

 

(b7808)

 

 

 

(7809)

 

 

 

(b789) Movement Functions, Other Specified and Unspecified

 

 

(b789) Neuromusculoskeletal and Movement-related Functions, Other Specified

 

 

(b799) Neuromusculoskeletal and Movement-Related Functions, Unspecified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.8 Chapter 8 – Functions of the Skin and Related Structures

 

 

 

7.8.1 (b810-b849) Functions of the Skin

 

 

 

7.8.1.1 (b810) Protective Functions of the Skin

 

 

 

7.8.1.2 Treatment for Protective Functions of the Skin

 

 

 

 

7.8.1.2.1 b820 Repair Functions of the Skin

 

 

 

 

7.8.1.2.2 Treatment for Repair Functions of the Skin

 

 

 

 

 

 

 

7.8.1.3 (b830) Other Functions of the Skin

 

 

7.8.1.3.1 Treatment for Other Functions of the Skin

 

 

 

 

 

 

 

 

7.8.1.4 b840 Sensation Related to the Skin

 

 

 

 

 

 

 

 

 

 

7.8.1.4.1 Treatment for Sensations Related to the Skin

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.8.1.5 b849 Functions of the Skin, other Specified and unspecified

 

 

 

7.8.2 b850-b869 Functions of the Hair and Nails

 

 

 

 

 

7.8.2.1 (b850) Functions of the Hair

 

 

 

 

 

 

7.8.2.1.1 Treatment for Functions of the Hair

 

 

 

 

 

7.8.2.2 (b860) Functions of the Nails

 

 

7.8.2.2.1 Treatment for Functions of the Nails

 

 

7.8.2.3 (b869) Functions of the Hair and Nails, Other Specified and Unspecified

 

 

7.8.2.4 (b898) Functions of the Skin and Related Structures, Other Specified

 

 

 

7.8.2.5 (b899) Functions of the Skin and Related Structures, Unspecified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.0Activities and Participation

 

 

 



Attendance - physically in the room, present/ not present, but no indicator as to level of participation.

Participation. Yes you were participating in the activity, you picked up the pencil at the right times, put it down at right times. Your eyes are open and looking up, you’re not sleeping,  But I really don’t know if you’re actively engaged in an activity.

Engaged - are they performing and actively engaged in the activity, or just going through the motions or the activities. Are they actually absorbing the material. Will they be able to use it when on their own.



Differentiate between the two terms as a field: recreation and leisure.
Recreation: lumped in with more structured activity. More structure and some sort of benefit. Aka Soccer League.
Leisure: state of mind, going to engage in leisure because I have free time, and whatever I dictate as leisure in my state of mind is what I define as leisure.
I can go home and organize and clean if in my mind that is a state of leisure, then that is leisure to me.

Purpose of ICF, recreation and leisure is activity focus. not much room for the gray area that the client may define as leisure. So ICF defines activity are recreation and leisure,



* CTRS must decide if its more appropriate to score an activity done for pleasure as a recreation and leisure code or use a code that more specifically reflects that specific activity.


If after school activity, associated with the school, it might be more appropriate to code as education.

if they are deriving more benefit in some other area of their life may be coded differently.

 

 

 

 

 

Relationship between Activities and Participation and Other ICF Sections

 

 

 

 

 

 

 

Scoring

 

 

 

General Coding Guidelines

 

 

 

 

 

Qualifier Scoring Descriptions

 

 

 

 

First Qualifier (required)

 

 

 

Meaning of the Score

 

 

 

Key Points

 

 

 

 

 

Second Qualifier (required)

 

 

 

Meaning of the Score

 

 

Key Points

 

 

 

Third Qualifier (optional)

 

 

Meaning of the Score

 

 

Key Points

 

 

 

Fourth Qualifier (optional but highly recommended by the authors)

 

 

 

 

 

Meaning of the Score

 

 

 

Key Points

 

 

 

Fifth Qualifier

 

 

 

Blended scores

 

 

 

Addition of a Participation Score

 

 

 

 

 

 

 

 

 

 

 

 

 

8.1 Chapter 1 – Learning and Applying Knowledge

 

 

 

8.1.1 (d110-d129) Purposeful Sensory Experiences

 

 

8.1.1.1 (d110) Watching

 

 

 

Treatment for Watching

 

 

 

8.1.1.2 (d115) Listening

 

 

Treatment for Listening

 

 

 

8.1.1.3 (d120) Other Purposeful Sensing

 

 

 

 

Treatment for Other Purposeful Sensing

 

 

8.1.1.4 (d129) Purposeful Sensory Experiences, Other Specified and Unspecified

 

 

 

 

8.1.2 (d130-d159) Basic Learning

 

 

8.1.2.1 (d130) Copying

 

Treatment for Copying

 

 

8.1.2.2 (d135) Rehearsing

 

 

Treatment for Rehearsing

 

 

8.1.2.3 (d140) Learning to Read

 

 

Treatment for Learning to Read

 

 

 

8.1.2.4 (d145) Learning to Write

 

 

Treatment for Learning to Write

 

 

 

8.1.2.5 (d150) Learning to Calculate

 

 

Treatment for Learning to Calculate

 

 

8.1.2.6 (d155) Acquiring Skills

 

Acquiring Skills
Developing basic and complex competencies in integrated sets of actions or tasks so as to initiate and follow through with the acquisition of a skill



Therapists should be careful not to use the d920 recreation and leisure code set for leisure skill development because the d920 Recreation and Leisure code set reflects participation in a specific activity rather than acquiring activity skills

 

 

 

 

8.1.2.7 (d1550) Acquiring Basic Skills

 

Learning elementary, purposeful actions
such as learning to manipulate eating utensils, a pencil, or simple tool

 

8.1.2.8 (d1551) Acquiring Complex Skills

 

Learning integrated sets of actions so as to follow rules, and to sequence and coordinate one’s movements
such as learning to play games like football, or use a building too.

 

8.1.2.9 (d1558) Acquiring Skills, Other Specified

 

 

8.1.2.10 (d1559) Acquiring Skills, Unspecified

 

 

Treatment for Acquiring Skills

 

 

8.1.2.11 (d159) Basic Learning Skills, Other specified and Unspecified

 

 

 

 

8.1.3 (d160-d179) Applying Knowledge

 

 

8.1.3.1 (d160) Focusing Attention

 

 

 

Treatment for Focusing Attention

 

 

8.1.3.2 (d163) Thinking

 

 

Treatment for Thinking

 

 

8.1.3.3 (d166) Reading

 

 

Treatment for Reading

 

 

8.1.3.4 (d170) Writing

 

 

Treatment for Writing

 

 

8.1.3.5 (d172) Calculating

 

 

Treatment for Calculating

 

 

8.1.3.6 (d175) Solving Problems

 

 

8.1.3.7 (d1750) Solving Simple Problems

 

 

8.1.3.8 (d1751) Solving Complex Problems

 

 

8.1.3.9 (d1758) Solving Problems, Other Specified

 

 

8.1.3.10 (d1759) Solving Problems, Unspecified

 

 

Treatment for Solving Problems

 

 

8.1.3.11 (d177) Making Decisions

 

 

 

Treatment for Making Decisions

 

 

 

8.1.3.12 (d179) Applying Knowledge, Other Specified and Unspecified

 

 

 

 

8.1.3.13 (d198) Learning and Applying Knowledge, Other Specified

 

 

8.1.3.14 (d199) Learning and Applying Knowledge, Unspecified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.2 Chapter 2 – General Tasks and Demands

 

 

 

Introduction

 

 

 

 

 

Therapeutic Interventions Used for Tasks

 

 

8.2.1 (d210) Undertaking a Single Task

 

Those areas that require step by step thinking process

 

8.2.1.1 (d2100) Undertaking a Simple Task

 

 

 

8.2.1.2 (d2101) Undertaking a Complex Task

 

 

8.2.1.3 (d2102) Undertaking a Single Task Independently

 

 

8.2.1.4 (d2103) Undertaking a Single Task in a Group

 

 

8.2.1.5 (d2108) Undertaking Single Tasks, Other Specified

 

 

8.2.1.6 (d2109) Undertaking Single Tasks, Unspecified

 

 

Treatment for Undertaking a Single Task

 

 

 

 

8.2.2 (d220) Undertaking Multiple Tasks

 

 

8.2.2.1 (d2200) Carrying Out Multiple Tasks

 

 

8.2.2.2 (d2201) Completing Multiple Tasks

 

 

8.2.2.3 (d2202) Undertaking Multiple Tasks Independently

 

 

8.2.2.4 (d2203) Undertaking Multiple Tasks in a Group

 

 

8.2.2.5 (d2208) Undertaking Multple Tasks, Other Specified

 

 

8.2.2.6 (d2209) Undertaking Multiple Tasks, Unspecified

 

 

Treatment for Undertaking Multiple Tasks

 

 

8.2.3 (d230) Carrying Out Daily Routine

 

 

8.2.3.1 (d2301) Managing Daily Routine

 

 

8.2.3.2 (d2302) Completing the Daily Routine

 

 

8.2.3.3 (d2303) Managing One's Own Activity Level

 

 

 

8.2.3.4 (d2308) Carrying Out Daily Routine, Other Specified

 

 

8.2.3.5 (d2309) Carrying Out Daily Routine, Unspecified

 

 

Treatment for Carrying Out Daily Routine

 

 

 

8.2.4 (d240) Handling Stress and Other Psychological Demands

 

 

 

 

 

 

8.2.4.1 (d2400) Handling Responsibilities

 

 

8.2.4.2 (d2401) Handling Stress

 

 

8.2.4.3 (d2402) Handling Crisis

 

 

8.2.4.4 (d2408) handling stress and Other Psychological Demands, Other Specified

 

 

8.2.4.5 (d2409) Handling Stress and Other Psychological Demands, Unspecified

 

 

Treatment for Handling Stress and Other Psychological Demands

 

 

 

Acute Stress

 

 

 

 

Chronic Stress

 

 

Reactions to Stress

 

 

Assessments

 

 

Areas of Stress

 

 

 

Contributors to Stress

 

 

Clinical Treatment of Stress

 

 

Program Ideas

 

 

 

 

 

 

8.2.5 (d298) General Tasks and Demands, Other Specified

 

 

8.2.6 (d299) General Tasks and Demands, Unspecified

 

 

 

 

 Chapter 3 – Communication

 

Note any deficits. If non-verbal, how is their eyesight? means of communication? levels of impairment in communication. where is the deficit coming from? What is contributing to their inability to receive spoken messages. There are a number of different codes that could create a deficit in

 

 

8.3.1 (d310-d329) Communicating - Receiving

 

 

8.3.1.1 (d310) Communicating with – Receiving – Spoken Messages

 

Receiving spoken messages - analysis of what is necessary to receive: hearing ability, functional issues? structural? attention span? codes?

 

Treatment for Communicating with – Receiving – Spoken Messages

 

 

8.3.1.2 (d315) Communicating with – Receiving – Nonverbal Messages

 

 

 

8.3.1.2.1 (d3150) Communicating with – Receiving – Body Gestures

 

 

8.3.1.2.2 (d3151) Communicating with – Receiving – General Signs and Symbols

 

 

8.3.1.2.3 (d3152) Communicating with – Receiving – Drawings and Photographs

 

 

8.3.1.2.4 (d3158) Communicating with – Receiving – Nonverbal Messages, Other Specified

 

 

8.3.1.2.5 (d3159) Communicating with – Receiving – Nonverbal Messages, Unspecified

 

 

Treatment of Communicating with – Receiving – Nonverbal Messages

 

 

8.3.1.3 (d320) Communicating with – Receiving – Formal Sign Language Messages

 

 

Treatment for Communicating with – Receiving – Formal Sign Language Messages

 

 

 

8.3.1.4 (d325) Communicating with – Receiving – Written Messages

 

 

Treatment for Communicating with – Receiving – Written Messages

 

 

8.3.1.5 (d329) Communicating – Receiving, Other Specified or Unspecified

 

 

8.3.2 (d330-d349) Communicating – Producing

 

 

8.3.2.1 (d330) Speaking

 

 

Treatment for Speaking

 

 

 

8.3.2.2 (d335) Producing Nonverbal Messages

 

 

8.3.2.2.1 (d3350) Producing Body Language

 

 

8.3.2.2.2 (d3351) Producing Signs and Symbols

 

 

8.3.2.2.3 (d3352) Producing Drawings and Photographs

 

 

8.3.2.2.4 (d3358) Producing Nonverbal Messages, Other Specified

 

 

8.3.2.2.5 (d3359) Producing Nonverbal Messages, Unspecified

 

 

Treatment for Producing Nonverbal Messages

 

 

8.3.3 (d340) Producing Messages in Formal Sign Language

 

 

Treatment for Producing Messages in Formal Sign Language

 

 

8.3.4 (d345) Writing Messages

 

 

Treatment for Writing Messages

 

 

 

8.3.5 (d349) Communication – Producing, Other Specified and Unspecified

 

 

8.3.6 (d350-d369) Conversation and Use of Communication Devices and Techniques

 

 

8.3.6.1 (d350) Conversation

 

 

8.3.6.1.1 (d3500) Starting a Conversation

 

 

8.3.6.1.2 (d3501) Sustaining a Conversation

 

 

8.3.6.1.3 (d3502) Ending a Conversation

 

 

8.3.6.1.4 (d3503) Conversing with One Person

 

 

8.3.6.1.5 (d3504) Conversing with Many People

 

 

8.3.6.1.6 (d3508) Conversation, Other Specified

 

 

8.3.6.1.7 (d3509) Conversation, Unspecified

 

 

 

Treatment for Conversation

 

 

8.3.6.2 (d355) Discussion

 

 

8.3.6.2.1 (d3550) Discussion with One Person

 

 

8.3.6.2.2 (d3551) Discussion with Many People

 

 

8.3.6.2.3 (d3558) Other Specified

 

 

8.3.6.2.4 (d3559) Unspecified

 

 

 

Treatment for Discussion

 

 

8.3.6.3 (d360) Using Communication Devices and Techniques

 

 

8.3.6.3.1 (d3600) Using Telecommunication Devices

 

 

8.3.6.3.2 (d3601) Using Writing Machines

 

 

8.3.6.3.3 (d3602) Using Communication Techniques

 

 

8.3.6.3.4 (d3608) Using Communication devices and Techniques, Other Specified

 

 

8.3.6.3.5 (d3609) Using Communication Devices and Techniques, Unspecified

 

 

 

Treatment for Using Communication Devices and Techniques

 

 

8.3.6.4 (d369) Conversation and Use of Communication Devices and Techniques, Other Specified and Unspecified

 

 

8.3.7 (d398) Communication, Other Specified

 

 

8.3.8 (d399) Communication, Unspecified

 

 

 

 

8.4 Chapter 4 – Mobility

 

 

8.4.1 (d410-d429) Changing and Maintaining Body Position

 

 

 

 

8.4.1.1 (d410) Changing Basic Body Position

 

 

8.4.1.1.1 (d4100) Lying Down

 

 

8.4.1.1.2 (d4101) Squatting

 

 

8.4.1.1.3 (d4102) Kneeling

 

 

8.4.1.1.4 (d4103) Sitting

 

 

8.4.1.1.5 (d4104) Standing

 

 

8.4.1.1.6 (d4105) Bending

 

 

 

8.4.1.1.7 (d4106) Shifting the Body's Center of Gravity

 

 

8.4.1.1.8 (d4108) Changing Basic Body Position, Other Specified

 

 

8.4.1.1.9 (d4109) Changing Basic Body Position, Unspecified

 

 

Treatment for Changing Basic Body Position

 

 

8.4.1.2 (d415) Maintaining a Body Position

 

 

8.4.1.2.1 (d4150) Maintaining a Lying Position

 

 

8.4.1.2.2 (d4151) Maintaining a Squatting Position

 

 

8.4.1.2.3 (d4152) Maintaining a Kneeling Position

 

 

8.4.1.2.4 (d4153) Maintaining a Sitting Position

 

 

8.4.1.2.5 (d4154) Maintaining a Standing Position

 

 

8.4.1.2.6 (d4158) Maintaining a Body Position, Other Specified

 

 

8.4.1.2.7 (d4159) Maintaining a Body Position, Unspecified

 

 

Treatment for Maintaining a Body Position

 

 

8.4.1.3 (d420) Transferring Oneself

 

 

8.4.1.3.1 (d4200) Transferring Oneself While Sitting

 

 

8.4.1.3.2 (d4201) Transferring Oneself While Lying

 

 

8.4.1.3.3 (d4208) Transferring Oneself, Other Specified

 

 

8.4.1.3.4 (d4209) Transferring Oneself, Unspecified

 

 

Treatment for Transferring Oneself

 

 

 

8.4.1.4 (d429) Changing and Maingtaining Body Position, Other Specified or Unspecified

 

 

 

 

 

 

 

8.4.2 (d430-449) Carrying, Moving, and Handling Objects

 

 

8.4.2.1 (d430) Lifting and Carrying Objects

 

 

8.4.2.1.1 (d4300) Lifting

 

 

8.4.2.1.2 (d4301) Carrying in the Hands

 

 

8.4.2.1.3 (d4302) Carrying in the Arms

 

 

8.4.2.1.4 (d4303) Carrying on Shoulders, Hip, and Back

 

 

8.4.2.1.5 (d4304) Carrying on the Head

 

 

8.4.2.1.6 (d4305) Putting Down Objects

 

 

 

8.4.2.1.7 (d4308) Lifting and Carrying, Other Specified

 

 

8.4.2.1.8 (d4309) Lifting and Carrying, Unspecified

 

 

 

Treatment for Lifting and Carrying Objects

 

 

 

8.4.2.2 (d435) Moving Objects with Lower Extremities

 

 

8.4.2.2.1 (d4350) Pushing with Lower Extremities

 

 

8.4.2.2.2 (d4351) Kicking

 

 

8.4.2.2.3 (d4358) Moving Objects with Lower Extremities

 

 

8.4.2.2.4 (d4359) Moving Objects with Lower Extremities, Unspecified

 

 

 

 

Treatment for Moving Objects with Lower Extremities

 

 

8.4.2.3 (d440) Fine Hand Use

 

 

8.4.2.3.1 (d4400) Picking Up

 

 

8.4.2.3.2 (d4401) Grasping

 

 

8.4.2.3.3 (d4402) Manipulating

 

 

8.4.2.3.4 (d4403) Releasing

 

 

8.4.2.3.5 (d4408) Fine Hand Use, Other Specified

 

 

8.4.2.3.6 (d4409) Fine Hand Use, Unspecified

 

 

 

Treatment for Fine Hand Use

 

 

 

 

 

 

 

 

 

8.4.3 Chapter 5 – Self-Care

 

 

 

8.4.4 Chapter 6 – Domestic Life

 

 

 

 

 

 

 

8.4.5 Chapter 7 – Interpersonal Interactions and Relationships

 

 

8.4.5.1 (d710-d729) General Interpersonal Interactions

 

 

8.4.5.1.1 (d710) Basic Interpersonal Interactions

 

 

8.4.5.1.1.1 (d7100) Respect and Warmth in Relationships

 

 

8.4.5.1.1.2 (d7101) Appreciation in Relationships

 

 

8.4.5.1.1.3 (d7102) Tolerance in Relationships

 

 

8.4.5.1.1.4 (d7103) Criticism in Relationships

 

 

 

8.4.5.1.1.5 (d7104) Social Cues in Relationships

 

 

8.4.5.1.1.6 (d7105) Physical Contact in Relationships

 

 

8.4.5.1.1.7 (d7108) Basic Interpersonal Interactions, Other Specified

 

 (d7109) Basic Interpersonal Interactions, Unspecified

 

 

 

Treatment for Basic Interpersonal Interactions

 

(d720) Complex Interpersonal Interactions

 

 

 

(d7200) Forming Relationships

Need to find others with the same interests. For example other Role-playing gamers interested in tabletop RPG.

Can be helpful for clients that enjoy role-playing gaming, and client needs to improve some of their social interaction skills. Through the game hoping to develop skills to self-regulate when around others.

The participants also may need to be interested in the same game systems, and often the same game settings, genres like Sci Fi versus Fantasy, Mystery versus Horror, etc. as well as sometimes specific campaign settings, Arthurian versus Star Wars, Mystery! versus Call of Cthulhu or Supernatural.

Though not required to be identical interests, the more similarities, the better chance for a stronger connection with the others, and more likely to be tolerant of the others in the interest of continuing the game sessions. You probably do not want several players that love Sci-fi but hate fantasy, and then a few other players that feel the inverse. In such a case, might want to go with a more neutral setting, lets say they all have some enjoyment of Westerns, so use that as the common ground for the setting instead.

The participants need to overcome the initial awkwardness of properly greeting initially complete strangers, but that fortunately have at least the common interest of the game.

(d7201) Terminating Relationships

Every group has participants come and go over time. Some times there is a pre-planned end determined in advance for everyone, or specific individuals, sometimes other reasons lead to the need for participants to leave. Or if the group is completley voluntary, a participant may decide that this particulat activity or group just isn’t their “cup of tea”. They need to know how to considerately express their desire to leave, or their reasons why they are considering leaving. If they decide to leave, doing so in a congenial fashion, and not in a “flaming out” way by making a scene, or sending mass flame mail, etc.

 

(d7202) Regulating Behaviors withing Interactions

Over time as they get to know each other at game sessions, even at the beginning, in a group of participants there can be VERY strong personality differences that need to be worked with. Some will have more overbearing or argumentative interests, while others will have more reserved or passive approaches. Each participant will have to work out what is the correct way to approach the other participants in a way that will be conducive to the glow of the activity, rather than interrupt and detract from the flow.

Understanding about the others being in a different place emotionally or otherwise, and being tolerant and patient with the others in waiting for decisions and responses. Or if one is being impulsive at the risk of the imaginary adventuring group, the other group members knowing how to help dissuade that player/character from acting on the impulse, and listening to the others, in a way that doesn’t make the player defensive.

 

 

 

 

 

8.4.5.1.2.4 (d7203) Interacting According to Social Rules

 

 

8.4.5.1.2.5 (d7204) Maintaining Social Space

 

 

8.4.5.1.2.6 (d7208) Complex Interpersonal Interactions, Other Specified

 

 

8.4.5.1.2.7 (d7209) Complex Interpersonal Interactions, Unspecified

 

 

 

Treatment for Complex Interpersonal Interactions

 

 

 

8.4.5.1.3 (d729) General Interpesonal Interactions, Other Specified and Unspecified

 

 

8.4.5.2 (d730-d779) Particular Interpersonal Relationships

 

 

8.4.5.2.1 (d730) Relating with Strangers

 

 

Treatment for Relating with Strangers

 

 

8.4.5.2.2 (d740) Formal Relationships

 

 

8.4.5.2.2.1 (d7400) Relating with Persons in Authority

 

 

8.4.5.2.2.2 (d7401) Relating to Subordinates

 

 

 

8.4.5.2.2.3 (d7402) Relating to Equals

 

 

8.4.5.2.2.4 (d7408) Formal Relationships, Other Specified

 

 

8.4.5.2.2.5 (d7409) Formal Relationships, Other Unspecified

 

 

 

Treatment for Formal Relationships

 

 

 

8.4.5.2.3 (d750) Informal Social Relationships

 

 

 

8.4.5.2.3.1 (d7500) Informal Relationships with Friends

 

 

 

8.4.5.2.3.2 (d7501) Informal Relationships with Neighbors

 

 

 

8.4.5.2.3.3 (d7502) Informal Relationships with Acquaintances

 

 

8.4.5.2.3.4 (d7503) informal Relationships with Co-inhabitants

 

 

8.4.5.2.3.5 (d7504) Informal Relationships with Peers

 

 

8.4.5.2.3.6 (d7508) Informal Social Relationships, Other Specified

 

 

 

8.4.5.2.3.7 (d7509) Informal Social Relationships, Unspecified

 

 

Treatment for Informal Social Relationships

 

 

 

8.4.5.2.4 (d760) Family Relationships

 

 

 

 

8.4.5.2.4.1 (d7600) Parent-Child Relationships

 

 

 

8.4.5.2.4.2 (d7601) Child-Parent Relationships

 

 

 

8.4.5.2.4.3 (d7602) Sibling Relationships

 

 

 

8.4.5.2.4.4 (d7603) Extended Family Relationships

 

 

8.4.5.2.4.5 (d7608) Family Relationships, Other Specified

 

 

 

8.4.5.2.4.6 (d7609) Family Relationships, Unspecified

 

 

 

Treatment for Family Relationships

 

 

 

8.4.5.2.5 (d770) Intimate Relationships

 

 

 

8.4.5.2.5.1 (d7700) Romantic Relationships

 

 

 

8.4.5.2.5.2 (d7701) Spousal Relationships

 

 

 

8.4.5.2.5.3 (d7702) Sexual Relationships

 

 

 

8.4.5.2.5.4 (d7708) Intimate Relationships, Other Specified

 

 

 

8.4.5.2.5.5 (d7709) Intimate Relationships, Unspecified

 

 

 

Treatment for Intimate Relationships

 

 

8.4.5.2.6 (d779) Particular Interpersonal Relationships, Other Specified and Unspecified

 

 

8.4.5.2.7 (d798) Interpersonal Interactions and Relationships, Other Specified

 

 

8.4.5.2.8 (d799) Interpersonal Interactions and Relationships, Unspecified

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 8 – Major Life Areas

 

 

 

 

 

 

Chapter 9 – Community, Social, and Civic Life

 

Defining the Term “Engaging”

 

8.4.7.1 (d910) Community Life

 

 

8.4.7.1.1 (d9100) Informal Associations

 

 

8.4.7.1.2 (d9101) Formal Associations

 

 

8.4.7.1.3 (d9102) Ceremonies

 

 

8.4.7.1.4 (d9108) Community Life, Other Specified

 

 

 

8.4.7.1.5 (d9109) Community Life, Unspecified

 

 

Treatment for Community Life

 

 

8.4.7.2 (d920) Recreation and Leisure

 

 

8.4.7.2.1 (d9200) Play

 

Participation in a tabletop role-playing gaming group as a player for recreation rather than specific therapy: D920 Recreation & Leisure - d9200 Play - “Engaging in games with rules.... such as playing chess or cards...”

While RPG could also be placed under Community Life because there are many formalized RPG clubs, meetings, and conventions, the most common, and more casual form is a group of players that regularly meet, typically once per week for several hours at a participants home for a tabletop role-playing game session. This is structured play.

 

 

8.4.7.2.2 (d9201) Sports

 

 

 

8.4.7.2.3 (d9202) Arts and Culture

 

 

8.4.7.2.4 (d9203) Crafts

 

 

8.4.7.2.5 (d9204) Hobbies

 

 

8.4.7.2.6 (d9205) Socializing

 

 

8.4.7.2.7 (d9208) Recreation and Leisure, Other Specified

 

 

8.4.7.2.8 (d9209) Recreation and Leisure, Unspecified

 

 

Treatment for Recreation and Leisure

 

 

8.4.7.3 (d930) Religion and Spirituality

 

8.4.7.3.1 (d9300) Organized Religion

 

8.4.7.3.2 (d9301) Spirituality

 

8.4.7.3.3 (d9308) Religion and Spirituality, Other Specified

 

8.4.7.3.4 (d9309) Religion and Spirituality, Unspecified

 

Treatment for Religion and Spirituality

 

Components of Spiritual Growth

 

Benefits and Interventions

 

Summary

 

8.4.7.4 (d940) Human Rights

 

Treatment for Human Rights

 

8.4.7.5 (d950) Political Life and Citizenship

 

Treatment for Political Life and Citizenship

 

8.4.7.6 (d998) Community, Social, an Civic Life, Other Specified

 

8.4.7.7 (d999) Community, Social, and Civic Life, Unspecified

 

 

9.0 Environmental Factors

 

9.1 Chapter 1 – Products and Technology

 

9.1.1.1.1 Chapter 2 – Natural Environmental and Human Made Changes to Environment

 

9.1.1.1.2 Chapter 3 – Support and Relationship

 

9.1.1.1.3 Chapter 4 – Attitudes

 

9.1.1.1.4 Chapter 5 – Services, Systems, and Policies

 

10.0 Section 4: Recreational Therapy Issues

 

10.1 Equipment

 

10.1.1 Role-playing Gaming Equipment

 

10.1.1.1 CRPG - Computer-based Role-playing Gaming Equipment

 

10.1.1.2 LARP - Live-action Role-Playing Gaming Equipment

 

10.1.1.3 RPG – Tabletop Role-playing Gaming Equipment

 

10.2 Concepts

 

10.2.1 Basic Awareness of Self as Part of Socialization

 

10.2.2 Consequences of Inactivity

 

10.2.3 Gait

 

10.2.4 Maslow's Hierarchy of Needs

 

10.2.5 Metabolic Equivalents

 

10.2.6 Nervous System

 

10.2.7 Participation

 

10.2.8 Precautions

 

 

 

10.2.9 Psychoneuroimmunology

 

 

 

10.2.10 Social Skills Development

 

 

 

 

 

 

 

10.3 Techniques

 

10.3.1 Acclimatizing Clients to a Communal Living Arrangement

 

 

 

10.3.2 Activity and Task Analysis

 

 

 

10.3.3 Activity Pattern Development

 

 

 

 

10.3.4 Adjustment in Disability

 

 

 

10.3.5 Americans with Disabilities Act Education

 

 

 

10.3.6 Anger Management

 

 

 

 

10.3.7 Balance

 

 

 

10.3.8 Behavior Manipulation

 

 

 

10.3.9 Body Mechanics and Ergonomics

 

 

 

10.3.10 Boundaries

 

 

 

10.3.11 Community Accessibility Training

 

 

10.3.12 Community Leisure Resource Awareness

 

 

 

10.3.13 Community Problem Solving

 

 

 

10.3.14 Coping with Stress

 

 

 

10.3.15 Education and Counseling

 

 

 

10.3.16 Emergency Response

 

 

 

10.3.17 Energy Conservation Training

 

 

 

10.3.18 Exercise Basics

 

 

 

 

10.3.19 Fine Hand Use Ergonomics

 

 

 

10.3.20 Integration

 

 

 

10.3.21 Interpersonal Relationship Activities

 

 

 

10.3.22 Lifestyle Alteration Education

 

 

 

10.3.23 Motor Learning and Training Strategies

 

 

 

10.3.24 Neuroplasticity

 

 

 

10.3.25 Oxygen

 

 

 

10.3.26 Personal Leisure Resource Awareness

 

 

 

10.3.27 Pie of Life

 

 

 

10.3.28 Proverbs

 

 

 

10.3.29 Relaxation and Stress Reduction

 

 

 

10.3.30 Self-Esteem

 

 

 

10.3.31 Sensory Stimulation

 

 

 

10.3.32 Skin Breakdown

 

10.3.33 Social Skills Training

 

10.3.34 Transitioning a Client from Inpatient Rehabilitation to a Communal Environment

 

10.3.35 Transfers

 

10.3.36 Vital Signs

 

10.3.37 Walking Techniques

 

10.3.38 Wheelchair Mobility

 

10.4 Assessments

 

11.0 Appendices 

 

11.1 Appendix A: The ICF Model

 

11.2 Appendix B: Common Therapy Abbreviations

 

11.3 Appendix C: Anatomical Orientation/Positioning

 

11.4 Appendix D: Common Role-playing Gaming Terms, Abbreviations, and Examples

 

11.5 Appendix E: Example Specific RPG (& other) Program Plans

 

11.5.1 Population: Autism Spectrum Disorders (ASD/PDD) / Pervasive Developmental Disorders

 

11.5.1.1 Tabletop RPG as a Modality for Therapeutic / Educational Intervention for ASD Youth and Adults to Develop Civic Resources Knowledge &amp; Skills[+]

 http://rpgr.org/blog/first-prototype-of-tabletop-rpg-for-therapeutic-intervention

This prototype was reviewed and play-tested by Professor Emily Messina, Director of the Therapeutic Recreation for Eastern Washington University.

A 1940s Gumshoe Detective-style mystery set in urban Chicago.

The ASD guardians would like Hawke Robinson to come to Tacoma to implement this program plan, but due to the logistics (he resides in Spokane Washington on the other side of the state), has not yet been able to implement this program. The PAVE group does not have a formal facility, they utilize churches and other ASD guardians' homes for some activities, but generally arrange to meet at facilities for activities periodically. This is one of the reasons why The RPG Research Trailer would be very useful in helping to actually implement programs such as this. 

 

11.5.1.2 Using Live-Action Role-Playing Adapted Activities for ASD Toddlers

http://rpgr.org/blog/creating-larp-program-for-autistic-toddlers

This program plan was implemented in a single trial with ASD toddlers and their neurologically normal peer group.

Program plan development and implementation previewed, monitored, and reviewed by program members, volunteers, classmates, and Professor Emily Messina, Director of the Therapeutic Recreation Department for Eastern Washington University. The LARP program run simultaneously in parallel to several other activity programs created by other groups, in a large gym/dance-hall. Participants rotated from group-to-group every 15 minutes. While participants lost focus/interest in all the non-LARP activities within an average of 5 minutes (indicated typical by the ASD program's representatives), when the participants engaged in the LARP-adapted activities other results were immediately observed and comment upon by the ASD program representatives.

Immediately observed results during program implementation:

 

  • Noted immediate reduction in presentation of significant stereotypical behaviours (hand-flapping, fixation, distraction, lack of response/interaction to/with others, etc.) during the activities using RPG-based activities compared to those activities without

  • Better positive experiences with cooperative engagement using RPG-based activities than those without

  • Better success rates at completing all tasks cooperatively with RPG approach compared to non-RPG activities (all but one participant completed all tasks successfully, and all maintained attention and focus for full duration of a 15 minute session rotation, compared to average of only 5 minutes for all the other groups running non-RPG-related activities.

  • Noted improvement in interaction and communication with other participants when using the RPG-related adapted activities than those without.

  • Better response and success rates in complying with instructions to correctly complete multi-staged activities.

 

 

11.5.1.3 Recreation Therapy-related Program Plan Using Role-playing Gaming to Prepare Autism Spectrum Disorder (ASD) Youth & Adults to Use the Metropolitan Bus 

http://rpgr.org/blog/using-role-playing-games-for-autism-spectrum-participants

Program plan utilizes tabletop and live-action role-playing game sessions to help Autism Spectrum Disorder (ASD) participants build up confidence and competence toward improved autonomy through use the public transit system.

This adventure activity begins by using tabletop RPG for phase I, and then Live-action role-playing (LARP) (actually using the buses) for the final phase II.

The original version of this program plan was reviewed by Professor Emily Messina, Director of the Therapeutic Recreation for Eastern Washington University.

It has also been reviewed by the Tacoma PAVE Group for addition to their programming schedule. The ASD guardians would like Hawke Robinson to come to Tacoma to implement the program plan, but due to the logistics (he resides in Spokane Washington on the other side of the state), has not yet been able to implement this program. The PAVE group does not have a formal facility, they utilize churches and other ASD guardians' homes for some activities, but generally arrange to meet at facilities for activities periodically. This is one of the reasons why The RPG Research Trailer would be very useful in helping to actually implement programs such as this.

If you know of other programs with similar approaches (using RPG for ASD), please let me know, and I will gladly add a link and/or add your information.

 

11.5.2 Population: Deaf and Hard of Hearing[+]

 

 

11.5.2.1 RPG for the Deaf & Hard of Hearing 

Details pending, online overview here:

http://rpgr.org/documents/rpg-research-project/rpg-adapted-for-the-deaf-using-asl

“Hands-On-Adventure” - (ASL signed role playing gaming) - Role-Playing Gaming Adapted for the Deaf Using - American Sign Language - by W.A. Hawkes-Robinson - (c) 2007 - Revised for Creative Commons 2012-10-01

“Hands-On-Adventure”

(ASL signed role playing gaming)

Role-Playing Gaming Adapted for the Deaf Using American Sign Language

by W.A. Hawkes-Robinson

RPG Research Project Document ID: #RPGR-A00007-20111212b-part-1.cc

(c) 2007

Revised for Creative Commons 2012-10-01 

Role-Playing Gaming Adapted for the Deaf Using American Sign Language by W.A. Hawkes-Robinson is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Based on a work at http://www.rpgresearch.com/documents/rpg-research-project/rpg-for-deaf-using-asl.
Permissions beyond the scope of this license may be available at http://www.rpgresearch.com/disclaimers.

11.5.2.1.1 Overview

Provide a social activity to deaf, hard of hearing, and any signing-capable (hearing) participants through a social recreational event to help reduce isolation and encourage interaction in a cooperative, fun, team/friendship-building series of activities using role-playing gaming with American Sign Language (ASL).

 

11.5.2.1.2 Appropriate Setting

Safe, quiet, comfortable, non-distracting room, or outdoor setting. Seating reasonably close enough and sufficient lighting for everyone to see each others' signing. Seating usually best in the shape of a circle or a square rather than a rectangle so signing can be seen by all fairly equally (compared to long rectangle making it a bit more difficult to see everyone).

 

11.5.2.1.3 Population

Deaf and hard of hearing, or anyone who can sign in ASL (or any signing language) with sufficient proficiency. Ages can range in groups from 8 to 13, 14 to 21, and 21 on up. Both male and female can equally participate.

 

11.5.2.1.4 Explanation of activity

 

  • Participants gather around a table for an interactive shared imaginary adventure(s) using just paper, pencil, dice, agreed-upon rules/game-system and their imaginations.

  • In this particular variation of the role playing gaming theme, an added difference is that participants will be using sign language to communicate rather than verbal communication.

  • Also for maximum therapeutic benefit the adventure setting must be cooperative not competitive, and all participants must play “good” aligned characters rather than “neutral” or “evil” alignment.

  • The game referee/narrator, commonly known as the Game Master meets with the players in a comfortable setting around a table, or anywhere they find comfortable, and begins with a description of the imaginary setting.

  • An example game start: "You and your friends have just walked into the courtyard of an ancient building. The courtyard is approximately forty feet square. The walls, built of a tan colored stone material apparently indigenous to the area, are built to the points of the compass. They are about thirty feet high. You entered from an opening in the south wall. You see the north wall has some stairs going up, and the east wall on your right has what appears to be a solid metal door hanging open on rusted hinges. The walls are crumbling in places, and much is overgrown with ivy and weeds. In the center is a large fountain about fifteen feet high in what appears to be the form of a series of three flower-like terraces. Surprisingly, the fountain is currently spouting clear and cool-looking water. Viewing the water, you're more acutely aware of how dry you mouths are after the long day's hike to arrive here, with no water previously in sight. The wind is picking up as a storm from the south, with lightning and dark clouds gathering, quickly approaches. It is getting colder by the minute. What do you do?"

  • At this point, those playing in the game each take turns telling the GM and the other players what actions they take. Some will have mundane results, others could have surprising consequences. Dice are used to simulate the random events that can occur in life. For example, someone may decide to climb the stairs, there are some loose steps, and depending on how agile the player's made-up "character" is, with a roll of the dice, that character may leap to the top unscathed, or may have a bit of a fall to deal with. Of course, there also could be trouble in the form of "ill-intentioned bandits" lurking within the entrance of the door to dispense with...

 

 

Activity costs

Entry/participation is free. Food and beverages will be provided by sponsors and/or participants in a “pot luck” style to share with other participants.

Leadership necessary

One person to play the role of referee/narrator, also known as Game Master or Dungeon Master (GM or DM). Typically a ratio of 1 GM per 1-8 “players”.

 

Equipment

Required equipment: 

 

  • Table(s)

  • Chairs (enough for GM and as many players participating)

  • Paper

  • Pencils

  • Polyhedron dice

  • Player and GM rulebooks

 

 

 

Optional additional equipment can include: 

 

  • Gridded and/or hexagonal “battle mats”

  • Miniature figurines.

 

 

11.5.2.1.7 Evaluation procedures

GM and participants fill out evaluation forms provided at the end of each gaming session covering mostly subjective information. Additionally event organizers fill out a form related to statistics and other measurable areas.

The questionnaire would include for example (see attached sample combined evaluation form):

 

 

  • Rating of fun factor

  • Level of interaction with others

  • Comfort level

  • Number of participants and type

  • Level of opportunity for involvement

  • Challenge level

  • Suggestions for improvements

  • Ratios of hearing, deaf, etc.

 

 

 

Suggested sponsors

 

EWDHHC (Eastern Washington Deaf and Hard of Hearing Center)

 

  • Could providing gaming facilities

  • Could provide ASL translators if non-hearing participants a little weak in ASL

 

 

Could generally promote the event(s)

 

Merlyn's Games & Hobbies

 

  • Provide gaming facilities

  • Could provide prizes

  • Provide gaming materials

 

 

Hobbytown

 

  • Could provide gaming facilities

  • Could provide prizes - such as a miniature used to represent their player character

  • Could provide gift certificate for discount on role playing gaming purchases.

 

 

11.5.2.1.9 CODES:

 

TODO

 

 

11.5.2.2 Other Activities for Deaf & Hard of Hearing

 

TODO

  

 

11.5.3 RPG For People with Visual Impairment / Blind[+]

 

 

RPG Adaptations for the Blind

 

 

If not already doing so, use/take a more narrative approach to the game play.

 

 

11.5.3.1 Action Resolution

Braille dice.

 

 

Talking dice.

 

 

Talk dice app for phone/mobile device.

 

 

 

Other (talking spinner?)

 

Not recommended to use select from bag technique, because cheating could be a problem through tactile selection.

 

 

 

 

11.5.3.2 Character Sheet creation

Braille Printer/Embosser (VERY EXPENSIVE!, $1,000+ USD)

?

 

 

11.5.3.3 Character changes tracking

Braille copies of character sheets are not as easily updated during game play. Gold, hit points, treasure, etc. often need frequent updates.

 

Braille counter/clicker?

Braille slider

 

 

 

 

11.5.3.4 Mapping/Battlemat/Situational Tracking

Wires also work. Having a major distinction between good guy tokens and bad guy tokens really helps the blind person keep the entire board in mind at once. Realize that even by touch, the blind person has to hold a lot of pieces of information in their brains all at once, so the more distinctively tactile the map features are, the easier it is for them to understand what’s going on, and to better strategize.

At the gaming table, use cork board for positioning. Elements of the map made tactile with simple cardboard cutouts, textured tape, and placing thumbtacks, pins, etc. with different meanings. It also helps hold all the items in position as blind player uses hands to figure out where everything is.

 

As a DM, make sure to provide accurate descriptions of position, and keep up the descriptions as the characters move around on the cork board, etc.

 

puff paint grids, Braille labeled monster tokens, metal-backed dry erase board with magnetic tokens

 

Braille Labeller: https://www.amazon.com/Reizen-RL-350-Braille-Labeler/dp/B00II08XH6/ref=sr_1_1_a_it?ie=UTF8&qid=1478632983&sr=8-1&keywords=braille+printer

 

 

11.5.3.5 Rulebook(s)

Any Braille Printed RPG Books?

Audio book not effective for referencing.

If have access to PDF that allows printing, can print sections as needed on a Braille printer/embosser.

 

 

NOTE: This section will be updated in coming months as the above suggestions are tested. - W.A. Hawkes-Robinson 20161109.

 

  

 

11.5.4 Population: Brain Injury[+]

 

Revision for this document pending, for now online example available:

http://rpgr.org/documents/rpg-research-project/rpg-for-tbi-using-rt

 

11.5.4.1 RPGR-A00011b Hypothetical Therapeutic Recreation Program Plan for Clients with Traumatic Brain Injury Using Role-Playing Games as Therapy - SHORT-VERSION-20130331m-cc

 

“Hypothetical Therapeutic Recreation Program Plan for Clients with Traumatic Brain Injury Using Role-Playing Games as Therapy” Essay (short version) - INTERVENTIONS. March 11th, 2013. The RPG Research Project. http://www.rpgresearch.com. by W.A. Hawkes-Robinson (c) 2013. Revised for Creative Commons License Release: March 31st, 2013.

“Hypothetical Therapeutic Recreation Program Plan for Clients with

Traumatic Brain Injury Using Role-Playing Games as Therapy”

Essay (short version)

INTERVENTIONS

March 11th, 2013

The RPG Research Project

http://www.rpgresearch.com

by W.A. Hawkes-Robinson (c) 2013

Revised for Creative Commons License Release: March 31st, 2013


Hypothetical Therapeutic Recreation Program for Clients with Traumatic Brain Injury Using Role-Playing Games as Therapy Essay (Short Version)

by W.A. Hawkes-Robinson is licensed under a

Creative Commons Attribution-ShareAlike 4.0 International License.
Based on a work at

http://www.rpgresearch.com/documents/rpg-research-project/RPG-for-TBI-short-essay.pdf.
Permissions beyond the scope of this license may be available at http://www.rpgresearch.com/disclaimers.

 

 

 

11.5.4.1.1 Overview

After consultation with the family and care-takers, it is determined that prior to injury, one of the client's favorite activities included various forms of role-playing games (RPGs). The client mostly preferred tabletop, but had dabbled with both computer-based and live-action forms. As the client slowly regains various levels of functioning, modified versions of RPGs can be presented in which the client may participate to stimulate neurological recovery.

While other therapies are assumed to be undertaken in parallel, this document will focus on the use of therapeutic recreational techniques in treating the client, specifically using variants of role-playing games, with various modifications as warranted to fit specific client needs, throughout different stages of impairment and recovery.

One of the major obstacles in writing this section is that role-playing games appear to have not yet been considered by many health professionals as a potential therapeutic intervention, let alone specifically the recreation therapy industry in the USA. I have had multiple dialogues in person and via websites, with various RT professionals, many with decades of experience, and in speaking with them, they never even considered, or ever heard of anyone considering, using any version of role-playing games for therapeutic intervention. The closest I have been able to find included drama therapy, and standard game therapy, but nothing in the full form of “role-playing game therapy”. There are a few possibilities outside of the United States, and there are a number of educational programs using RPG's, so this document is purely hypothetical in the proposed interventions for TBI clients, but is based on closely similar approaches, but using the structure of RPG forms. Hopefully some recreation therapists will attempt these in the future and report on the results and modifications necessary for maximal efficacy.

Not counting purely experimental research projects, after researching and searching worldwide now for several years, there appears to only be one actual ongoing RPG-related therapy program that I have found to date, and this is in Israel through the Romach group (http://www.lance.co.il/). (Update: Their program ended in the Spring of 2015, due to the store closing where they provided sessions.) Unfortunately the site is completely in Hebrew, though I have had some dialog with them in English through email.

There are however any number of educational programs using role-playing games for instructional purposes, including the Danish public high school (Østerskov Efterskole - http://rpgr.org/blog/osterskov-efterskole-danish-public-high-school-teaching-all-subjects-using-larp) with an entire curriculum taught using live-action role-playing (LARP). Because using RPG as a therapeutic intervention is not (yet) established for TBI, every effort was made in this document to extrapolate likely scenarios matching the use of related activities, expected implementations, and outcomes, using hypothetical suggestions based on the information to be gleaned from the aforementioned areas.

11.5.4.1.2 Applicable Therapeutic Recreation Interventions

When the client is actually in the coma and at the Rancho Los Amigos Cognitive Level I, RT is not able to implement anything in the way of an interactive intervention. However, once the client is out of the coma, even at just Rancho Los Amigos Cognitive Levels II & III, the RT can begin to implement various modifications of role-playing games as a recreation therapy intervention.

Initially the client is too disoriented and has such significant cognitive and memory impairment that using the “Choose Your Own Adventure” CYOA form of RPG is probably contraindicated, but after just a few days, when the functioning is closer to b11428.2, and within a week around b11428.1. At this stage the client may be able to engage in “let's pretend” imaginary scenarios and differentiate from the real and imagined situations. Though the client has memory issues, and may not remember every detail from 30 seconds to a few minutes ago, the exercises could still be useful for stimulating
“neuro-plasticity” related recovery. The client may need repetition and occasional reminders, but is now potentially ready to begin the CYOA form of RPG TR treatment.

Though the client had previously enjoyed and participated in RPGs, he/she did not do so constantly, so it is not believed to be an “over-learned leisure skill”(Porter, p 144), so that it may still be a reasonable activity for monitoring and assessment of overall recovery.

 

11.5.4.1.3 Intervention #1 - Tabletop RPG Modification - Choose Your Own Adventure for Severe TBI-related impairments

Once the client is out of the coma, and rated at just Rancho Los Amigos Cognitive Levels II & III (able to open eyes in response to stimuli such as a spoken request or physical touch) (Burlingame, 2002), the RT can begin to implement various modifications of role-playing games as a recreation therapy intervention. At this stage, the RT could begin to implement the most rudimentary of RPGs, the Choose Your Own Adventure (CYOA) form. As long as the client can make a binary/Boolean responses indicating yes or no, whether verbally, by number of eye blinks, hand squeeze, or other method, the client potentially qualifies for participation in this therapeutic intervention.

 

11.5.4.1.4 Example CYOA Process

After establishing that the client meets sufficient cognitive functioning, and determining that client has a sufficient means of response and interaction with the recreation therapist, the RT asks the client, “Would you like to play a simple version of a role-playing game?”. “Squeeze/blink once for yes, two for no.” Client indicates yes...

“This adventure is set in Chicago during the 'Roaring '20's'. It is a mystery-style adventure.”

Of course any genre/setting will work.

“You will have three characters you can choose from. I will first list the three options, then I will ask you which one you prefer as I go through the list a second time. You will then indicate 'yes' when I mention the character you want.”

“You may choose to play: 1. A Police Detective, 2. A Private Eye, 3. An Investigative Reporter.”

“Would you like me to repeat that list again?” (yes/no)

“Have you decided which option to pick from those 3 choices?” (yes/no)

When the client indicates “yes” to being ready to choose, the RT states, “I will now repeat those three choices. Squeeze once for yes when you hear the option you want.”

Client squeezed yes for “Private Eye”.

“You selected 'private eye', is that correct?”. (yes/no).

The RT continues, “You have chosen Private Eye, is that correct?” Client confirms with single squeeze/blink.

The RT continues, “The story unfolds as follows. An old man has come to your office. A family heirloom has been stolen from his house. The police have no leads, but he says everyone knows that you, as the ace private detective that you are, can use alternate channels to find things the police can't or won't....”

If the client is continuing to be responsive to this form of modified RPG, and if it is deemed appropriate, as the client's functional level continues to improve, the client's family, friends, and caretakers may be able to engage the client in continuing the “adventure” when the RT is not around.

 

11.5.4.1.5 Needs addressed by intervention

This intervention addresses a number of the diagnosis A&P codes, some of which include:

 

 

 

  • d163 Thinking

  • d310 Communication with - receiving – spoken messages.

  • d1750 Solving simple problems

  • d177 Making decisions

  • d9200 Play

 

 

 

 

11.5.4.1.6 Common Settings

Any environment that is relatively quiet and distraction free, allowing the client to focus on listening to the storyteller's voice.

 

11.5.4.1.7 Equipment Needed

No special equipment required. TR might need a Choose Your Own Adventure Book, or else a prepared adventure outline or script.

 

11.5.4.1.8 Program Adaptations

Using hand-squeeze or eye-blink with Boolean-only (yes/no) questions for the client to answer (one squeeze/blink for yes, two squeezes/blinks for no). As client progresses, may be able to use simple multiple choice questions instead of only Boolean choices.

 

11.5.4.1.9 Examples of intervention

After spending hours searching, I was unable to find any existing programs using this exact form of intervention. This intervention meets the requirements for activities addressing the functional impairments listed, but so far I am unable to find any research information or current programs that have tried this approach.

The closest match I could find was an article about the Lincoln University (Snow, 2009) program requested by the Missouri National Guard using a “choose your own adventure” style interactive computer video (Hemmerly-Brown, 2010) for military personal suffering from suicide due to complications from PTSD and TBI. I was not able to find a second program that was even remotely relevant.

 

11.5.4.1.10 Program Name

The Home Front interactive video.

 

11.5.4.1.11 Location

Online: http://www.armyg1.army.mil/hr/suicide/videos/HomeFront_New/the-home-front/index.html

 

11.5.4.1.12 Description of clients served

For at-risk military personnel to attempt to reduce the levels of depression and suicide from personnel recovering from PTSD , TBI, and other causes.

 

11.5.4.1.13 Qualifications of program facilitator

Basic computer and online skills. Typical therapeutic background.

 

11.5.4.1.14 How I found this program

Lengthy search for any kind of “choose your own adventure” and “Traumatic brain injury” through many books and online resources.

 

11.5.4.1.15 Intervention #2 - Computer-based RPG Use and Modifications for Client With TBI

Client is now at Rancho Rating IV+. Though client's cognitive functioning is now higher, the client's ability to communicate is still significantly limited. Based on client's current functioning, it is recommended to have the client try using a mouse (or Wii-mote) to participate in a computer-based RPG that is turn-based rather than real-time. The client is able to move and click both buttons on a mouse, can see the computer screen clearly, and has enough cognitive functioning to interact in the game at a much higher level than before.

As client slowly regains various levels of functioning, modified versions of RPG will be presented in which the client may participate.

Client will initially use a mouse with large buttons to interact with computer. This requires the functioning of at least one arm, hand, and finger, as well as usable visual capacity. The compute-based RPG should initially be turn-based, using the mouse and then using Wii-mote later as grasping improves.

Client with click on various options, direct the digital character to take certain actions, and solve various levels of simple to complex problems.

 

11.5.4.1.16 Needs addressed by intervention

In addition to addressing some of the previous codes in intervention #1, this also addresses:

 

 

  • d1751 Solving moderately complex problems

  • d440 general fine hand use

  • d4401 grasping development.

 

 

 

11.5.4.1.17 Example CRPG Process

Client's functional arm (and hand/finger(s)) are placed upon the mouse (or later Wii-mote as grasping capacity develops). The client navigates on screen prompts to develop character, and than guides the character through the many challenging scenarios in the game.

 

11.5.4.1.18 Common Settings

In this scenario, ICU or long-term care facility, but potentially usable anywhere that has a computer.

 

11.5.4.1.19 Equipment Needed

A computer with screen, mouse, and installed software. Optional Internet connection.

 

11.5.4.1.20 Program Adaptations

Different means of interaction with the computer through different interfaces.

 

11.5.4.1.21 Examples of intervention

There are a number of programs using computer games as interventions for many needs, including TBI recovery, though I was not able to find specific mentioning of computer-based RPGs specifically, it is not a difficult stretch to extrapolate the benefits. The closest I found was an online game created by Jane McGonigal (2010) that experienced post-TBI depression and created the game to help herself recover. I had heard some of the NPR interview about this, and was able to track that down (Flato, 2011).

 

11.5.4.1.22 Program Name

Jane the Concussion Slayer by Jane McGonagal & Co.

 

11.5.4.1.23 Location

Online: https://www.superbetter.com/about

 

11.5.4.1.24 Description of clients served

Clients that enjoy computer games that will benefit from stimulus to help recovery from illness or injury, including traumatic brain injury. The program was created when the creator experienced a TBI, and was struggling to recover, creating games she found helped her, and other's, recovery process.

 

11.5.4.1.25 Qualifications of program facilitator

Some computer skills, recreation or other similar therapy background.

 

11.5.4.1.26 How I found this program

Web searches for any computer-based games aiding recovery of TBI patients.

 

11.5.4.1.27 References

Burlingame, J. & Blaschko, T.M. (2002). Assessment tools for recreational therapy and related fields (3rd edition). Ravensdale, WA: Idyll Arbor.

 

Flato, Ira. (2011, February 18). Talk of the Nation: Could gaming be good for you?. National Public Radio. Retrieved March 11th, 2013, from http://www.npr.org/2011/02/18/133870801/could- gaming-be-good-for-you

 

Hemmerly-Brown, A. (2010). Army creates new scenario-based suicide-prevention video. Retrieved March 11th, 2013, from http://myarmybenefits.us.army.mil/Home/News_Front/Army_creates_new_scenario- based_suicide-prevention_video.html

 

McGonigal, J. (2010). Achievements: Unlocked. Retrieved March 11th, 2013, from http://janemcgonigal.com/2010/12/23/achievements-unlocked/

 

Porter, H.R., & Burlingame, J. (2010). Recreational therapy handbook of practice: ICF-based diagnosis and treatment. Enumclaw, WA: Idyll Arbor.

 

Snow, T. (2009). Soldiers at risk: Mo. Guard responds to threat. Retrieved March 11th, 2013, from http://www.connectmidmissouri.com/news/news_story.aspx?id=287534

 

 

 

 

 

11.5.4.2 Other Brain Injury RPG Therapy Program Examples

 

 

Contributions from others are welcomed!

 

 

 

 

 

11.5.5 Population: At-Risk Youth[+]

 

 

 

11.5.5.1 Activity Program for At-Risk Youth, Includes LARP-related Activities - “Extreme Medieval Sports”[+]

 

 

 

Details Pending. Online overview available here: http://rpgr.org/documents/rpg-research-project/extreme-medieval-sport

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

11.6 Relevant Essays on Role-Playing Games, RPG for Education, RPG for Therapy[+]

 

 

 

 

 

11.6.1 RPGR-A00004 Role-playing Games Used as Educational and Therapeutic Tools for Youth and Adults

 

http://rpgr.org/documents/rpg-research-project/role-playing-games-used-as-educational-and-therapeutic-tools-for-youth-and-adults

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Glossary, Abbreviations, & Definitions of Terms

 

Online glossy of terms updated here: http://rpgresearch.com/documents/wiki/glossary

 

CRPG

Computer-based Role-Playing Game

Includes many types, ffline, online, group, and solo, various abbreviations including: CRPG, MMORPG, MUSH, MUD, etc.

….

 

CYOA (sub-form of SRPG)

Choose Your Own Adventure and interactive variants.

 

 

D, d, Die / Dice (and related abbreviations)

The type of die/dice indicated will typically be preceded by the letter “d” (usually lower-case), followed by a number indicating the number of faces on the die.

Example for a single six-side die: d6

If multiple dice are reference, a numerical indicator will precede the die type indicator.

Example for three 12-sided dice: 3d12

While dice and randomizers are available in unlimited variants, the most commonly used in TRPG are:

d2 – two side die, typically a coin flip, or d6 divided as 1 to 3 = 1, 4 to 6 = 2.

D3 – typically either a d6 divided as 1 to 2 = 1, 3 to 4 = 2, 5 to 6 =3, or a thirty sided die with the +, -, and no-sign. - PHOTO HERE.

D4 – typically a pyramid shaped die with 4 sides. - PHOTO HERE.

D6 – the typical cube-shaped six-sided die found in most common household board games. - PHOTO HERE.

D8 – eight sided octahedron die. - PHOTO HERE.

D10 – ten-sided die. Often used in pairs to represent percentile dice. - PHOTO HERE.

D12 – twelve-sided die. - PHOTO HERE.

D20 – twenty-sided die. The standard die for Dungeons & Dragons and many other “d20” based games. - PHOTO HERE.

D30 – thirty-sided die. Less common now, was more popular in the 1980s. - PHOTO HERE.

D100 – either a (rather round) large die with one hundred sides, or more commonly two ten-sided dice, with one indicating the “tens” place, and the other the “ones” place. Some of these 2d10 pairs are specially marked with only the tens and ones. - PHOTO HERE.

 

…..

 

 

 

 

DM

Dungeon Master.

Typically specific to GM's running Dungeons & Dragons games.

The referee, narrator, storyteller, …..

…..

 

 

GM

Game Master

The referee, narrator, storyteller, …..

…..

 

 

 

LARP (sub-form of live-action)

Live-Action Role-Playing

….

 

 

MMO (sub-form of CRPG)

Massive Multi-player Online

 

MMORPG (sub-form of CRPG)

Massive Multi-player Online Role-Playing Game

 

 

MUD (sub-form of CRPG)

Multi-User Dungeon

 

 

MUSH (sub-form of CRPG)

Multi-User Shared Hallucination

 

NPC

Non-Player Character

….

 

 

 

PC

Player Character

…..

 

 

 

RPG, also TRPG

Role-Playing Game. In this document, unless otherwise indicated, specifically Tabletop Role-Playing Game (TRPG).

….

 

 

RPG forms

This indicates what form the RPG manifest through: tabletop, live-action, computer-based, solo.

This can include sub-types, such as solo-computer-based-RPG, or solo-Choose Your Own Adventure, or CRPG-MMORPG (Computer-based Massive Multi-Player Online Role-Playing Game), etc.

 

 

 

 

SRPG

Solo Role-Playing Game (includes some interactive variants).

….

 

TRPG, see “RPG”

 

 

 

 

….

…..

 

 

 

…..

….

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Bibliography

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Alphabetical Index

 

CRPG 22, 24p., 27, 43, 47, 137

CYOA 22, 27

D10 23

D100 23

D12 23

d2 23

d20 23

D20 23

D3 23

D30 23

D4 23

d6 23

D6 23

D8 23

DM 23

GM 23p.

LARP 24, 27p., 43, 45pp., 137

MMO 24

MMORPG 22, 24p., 27

MUD 22, 24, 27

MUSH 22, 24, 27

NPC 24

PC 24, 43, 52

RPG 2p., 25, 27pp., 41pp., 46p., 49, 62, 80, 124, 132, 137

SRPG 22, 25, 27

TRPG 25, 27, 43, 47pp.

 

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