Therapeutic Recreation Program Design and Implementation Report

This report details a therapeutic recreation program designed for elderly individuals with dementia, focusing on the application of music therapy to improve their quality of life and manage symptoms. The report begins with an executive summary, outlining the context of the program at Abby Lee, a boutique lounge for seniors. It includes an introduction to dementia, its nature, and extent, emphasizing the cognitive and behavioral challenges faced by patients. The report then explores client assessment information, highlighting the use of leisure assessments to understand patient needs and preferences. It provides an overview of the therapeutic recreation model, explaining its goals and effectiveness. The core of the report centers on program implementation, specifically the use of music therapy, including session plans and evaluation. The program incorporates activities like music quizzes, karaoke, and reminiscence sessions. The report references relevant literature and includes session plans and evaluation methods. The conclusion summarizes the benefits of music therapy in reducing anxiety, enhancing emotional well-being, and promoting cognitive function in dementia patients. The report also includes program plan templates and discusses the role of recreational therapists in program implementation and evaluation. The program aims to minimize behavioural, social, cognitive, and emotional problems of elderly people with Alzheimer.

Running head: THERAPEUTIC RECREATION
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Name of the student:
Name of the university:
Author note:

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Executive summary:
Abby lee is a boutique lounge for seniors situated at Sydney’s south west Liverpool.
They range from 70 to 90 years old and have a variety of diagnoses, including falls risk due
to mental and cognitive impairment. The participants come from different social, economic,
and cultural background. The Abby lee provides therapeutic recreational activities such as
music therapy, half day bus trips, high teas, crafts, and more. These activities are tailored
made to suit the lives of clients and improve their quality of life and wellbeing. The Abby lee
service is open to seniors in the community, aged care facility and those in the retirement
village. They also welcome referrals from doctors, relatives and other services and operate
from Monday to Thursday.
Table of Content

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s
Introduction:...........................................................................................................................5
Nature and extent of the problem...........................................................................................5
Client (leisure assessment information):................................................................................6
Therapeutic Recreation Model Overview..............................................................................7
Program Implementation........................................................................................................8
Conclusion..............................................................................................................................9
Reference:................................................................................................................................10
Appendix:.................................................................................................................................14
Session Plans........................................................................................................................14
Memory programs............................................................................................................14
Evaluation:...........................................................................................................................16
Clients evaluation.................................................................................................................19

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Introduction:
Dementia is a type of health condition which is generally chronic or advanced in
nature. The health condition is found to cause deterioration in the individual’s cognitive
function such as the ability of the individual to process thought beyond which is normal
expected from an elder person who is ageing with no such difficulties (Livingston et al.,
2017). Dementia distresses the ability of an individual to understand, think, their ability to
remember, their learning capacity and judgement. Though their cognizance is not hampered
(Birks & Harvey, 2018). The impairment of the individual’s cognitive role proceeds further
by the deterioration of the control in their emotional, their social behaviour as well as their
motivation (Heppner, Ransohoff & Becher, 2015). Music therapy is recognized as one of the
techniques where the music is used in order to help in improving health of individual (Tyler,
2017). Various researches have described that music therapy is a mental therapy which
permits communication and collaboration between the patient and the therapist. It states that
music therapy is helpful for individuals of all age groups and capabilities (Stige, 2017). The
assignment will focus on the use of musical therapy in order to help the elderly patients
suffering from Alzheimer or Dementia and also develop a session plan for ensuring better
outcome (Alzheimer’s, 2015).
Nature and extent of the problem
Dementia is stated to be one of the most important causes of the impairment and
reliance within the elderly population throughout the worldwide (Bang, Spina & Miller,
2015). The condition affects not only the individual suffering but also the family members
and the individual’s career as well as social life (Jung, 2015). It has been observed that lack
of awareness, knowledge and understanding regarding the dementia condition often causes a
major disruption in the diagnosis, treatment and care process for the patient suffering (Forbes

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et al., 2015). The effect of dementia condition on an individual’s carers, family as well as
society at an extent can be physical, social, psychological, and economical.
Dementia is a one of the massively developing difficulties in the population of elderly people,
the total estimation states that the condition effects almost 25·3 million population throughout
the worldwide, with the occurrence of 5·2 million fresh cases per year (Satizabal et al., 2016).
There is an essential need for developing an effective systematic approach for the treatment
of the severe effects of dementia and the various difficulties faced while managing the
disorder (Wimo et al., 2017). Dementia occurs due to numerous numbers of diseases as well
as injuries which have a primarily and secondarily harmful effect on an individual’s brain
which includes Alzheimer's disease or brain stroke (McKeith et al., 2017).
Alzheimer's disease is a type of progressive disorder which is found to cause
degeneration of the brain cells and ultimately the cells die (Mattsson et al., 2016).
Alzheimer's disease is one of the most important as well as common causes of the dementia
condition which causes an uninterrupted decline in the thinking capability of an individual,
also disrupts the behavioural and social abilities of the person which leads to hamper the
ability of the individual to function freely (Van Cauwenberghe, Van Broeckhoven &
Sleegers, 2016). Loss of memory is one of the major symptom of the Alzheimer's syndrome.
the disease shows its early signs by making is it difficult for the individual to remember latest
incidents or any present conversations. memory impairments deteriorate with the increase of
the disease condition along with the development of other symptoms (Tramutola, Lanzillotta,
Perluigi & Butterfield, 2017).
Client (leisure assessment information):
The patients suffering from dementia and Alzheimer were selected on the basis of
voluntary session. People name were selected from the clinics in the locality, and their

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condition were first discussed by the local health care professional. Then they were informed
regarding the therapy plan, and those who were willing to participate were selected to
develop a group (Van Der Flier, 2016). The individual patient were asses on the basis of
personal interview sessions, where the discussion was done in order to know the needs,
requirements, linking, health conditions, their frequent complications and also the reason
behind these complications (Aisen, 2015). The agency has its objective focusing towards the
delivery of care and treatment using creative therapies such as music, art, craft, dance and
many other practices (West, 2017). They believe that happiness, relaxation and social
involvement helps to generate better development and recovery in patients suffering from
dementia and Alzheimer condition. participant who has an interest towards music were found
to be very interested in participating for the musical therapy (Aalbers et al., 2017).
Therapeutic Recreation Model Overview
Therapeutic Recreation Model has its aim towards promoting the capability and aptitude
of various assemblies and individuals in order to make them self-determined and accountable
in making choices and taking decisions, and also helps in developing an individual in to free
and independent personality, to discover their new perceptions and potentials (Tyler, 2017). It
also helps them realise the individual’s full potential (Carter & Van Andel, 2019).
Therapeutic recreation model is found to be the most effective process for individuals who
are suffering from mild to moderate Alzheimer and dementia disease (Hirshfeld, Gavendo &
Corey, 2016). The idea of conducting activity treatment is cases of Alzheimer’s care,
management and dementia treatment is found to the chief effective practice. One of the major
goals of the Dementia and Alzheimer’s care ensures that the patient suffering has the
uppermost quality of life. Therapeutic recreation model aims in accomplishing their goal by
accentuating the sense of worth of the suffering individual, by centring on the comforts, skills
and interests of the individual, by encouragement of the person’s recent as well as past

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memories and by developing an understanding and effective therapeutic relationship with
them (Hanlon, Guerin & Kiernan, 2018).
Program Implementation
Various research has been conducted on the Alzheimer and dementia suffering
patients which commonly highlights on the reactions and behavioural assistances for the idea
of using music interventions (Hirshfeld, Gavendo & Corey, 2016). It has been found that the
physiological benefits of the regular music therapy involvements show a better outcome and
improvement in the dementia and Alzheimer suffering patient and it can be measured by the
assessment of the systolic blood pressure and evaluating the person’s intelligence (Hood &
Carruthers, 2016). The studies also stated that individuals suffering with modest to massive
dementia condition when practicing music therapy sessions for regular or weekly basis had
showed significantly decreased rate of systolic blood pressure and witnessed better improved
intelligence marks when compared to individuals with no such music therapy involvement
(Wise, 2016). The gained outcomes and results provided a better knowledge and
encouragement to the researchers as it known that systolic blood pressure gradually increases
with the increasing age and the psychological function of an individual declines with the
growing age for people with Alzheimer and dementia (Stumbo, Wolfe & Pegg, 2017). One of
the researchers found that the melatonin levels gets positively exaggerated in cases of male
patients, those who have been participating in 40-60 minutes early morning periods of the
music therapy 6 times every week for a continuous period of 4 weeks (Russell, Widmer,
Lundberg & Ward, 2015). The concentration of Melatonin in the serum progressively
increases after every music therapy session and it was observed to develop further after 6
weeks of continuous practice. the increased level of melatonin explains the individual’s
peaceful and calm state of mind for the patients suffering from Alzheimer and dementia
condition (Long & Robertson, 2019).

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Conclusion
In order to conclude, it can be stated that, people suffering from dementia often have a
feeling of getting isolated due to the loss of speaking abilities and monotonous behaviour.
Music therapy has been observed to be an effective measure in order to reduce the feeling of
anxiety and stress in an individual. The practice also enhances an individual’s emotional
welfare by the means of verbal as well as non-verbal term, it is found to develop social
interaction in the individual and cognitive encouragement. It is often observed to support the
usefulness of education and knowledge and different capabilities which are stored in an
individual’s memory such as the lyrics from any favourite or unknown songs, promote
listening, enhance singing, development movement and music generating capabilities. The
music therapy is found to keep the state of mind of the individual in a steady and clam
condition, which is important for the dementia suffering condition as their brain loses the
capability to operate in a normal manner. It can be stated that recreation therapy has a major
role in developing improvement and better health condition in individuals suffering from
Alzheimer and dementia. Therapeutic recreation model aims in accomplishing their goal by
accentuating the sense of worth of the suffering individual, by centring on the comforts, skills
and interests of the individual, by encouragement of the person’s recent as well as past
memories and by developing an understanding and effective therapeutic relationship with
them. It uses creative sessions such as music therapy, art and craft as the music therapy and
creative practices synchronises the unstable condition of the individual’s brain, and restores
the monotonous and repetitive behaviours of the individual.

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Reference:
Aalbers, S., Fusar‐Poli, L., Freeman, R. E., Spreen, M., Ket, J. C., Vink, A. C., ... & Gold, C.
(2017). Music therapy for depression. Cochrane Database of Systematic Reviews,
(11).
Alzheimer’s, A. (2015). 2015 Alzheimer's disease facts and figures. Alzheimer's & dementia:
the journal of the Alzheimer's Association, 11(3), 332.
Bang, J., Spina, S., & Miller, B. L. (2015). Frontotemporal dementia. The Lancet,
386(10004), 1672-1682.
Birks, J. S., & Harvey, R. J. (2018). Donepezil for dementia due to Alzheimer's disease.
Cochrane Database of systematic reviews, (6).
Carter, M. J., & Van Andel, G. E. (2019). Therapeutic recreation: A practical approach.
Waveland Press.
Forbes, D., Forbes, S. C., Blake, C. M., Thiessen, E. J., & Forbes, S. (2015). Exercise
programs for people with dementia. Cochrane Database of Systematic Reviews, (4).
Hanlon, P., Guerin, S., & Kiernan, G. (2018). Reflections on the development of a
therapeutic recreation-based bereavement camp for families whose child has died
from serious illness. Death studies, 42(9), 593-603.
Heppner, F. L., Ransohoff, R. M., & Becher, B. (2015). Immune attack: the role of
inflammation in Alzheimer disease. Nature Reviews Neuroscience, 16(6), 358.
Hirshfeld, K., Gavendo, R., & Corey, E. (2016). Activity-in-a-box for engaging persons with
dementia in groups: implications for therapeutic recreation practice. American
Journal of Recreation Therapy, 15(3), 8-18.

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Hood, C. D., & Carruthers, C. P. (2016). Strengths-based TR program development using the
Leisure and Well-Being Model: Translating theory into practice. Therapeutic
Recreation Journal, 50(1).
Jack Jr, C. R., Knopman, D. S., Chételat, G., Dickson, D., Fagan, A. M., Frisoni, G. B., ... &
Van Der Flier, W. M. (2016). Suspected non-Alzheimer disease pathophysiology—
concept and controversy. Nature Reviews Neurology, 12(2), 117.
Jung, C. G. (2015). Psychology of dementia praecox (Vol. 1294). Princeton University Press.
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... &
Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet,
390(10113), 2673-2734.
Long, T., & Robertson, T. (2019). Foundations of therapeutic recreation. Human Kinetics,
Incorporated.
Mattsson, N., Zetterberg, H., Janelidze, S., Insel, P. S., Andreasson, U., Stomrud, E., ... &
Hanlon, D. (2016). Plasma tau in Alzheimer disease. Neurology, 87(17), 1827-1835.
McKeith, I. G., Boeve, B. F., Dickson, D. W., Halliday, G., Taylor, J. P., Weintraub, D., ... &
Bayston, A. (2017). Diagnosis and management of dementia with Lewy bodies:
Fourth consensus report of the DLB Consortium. Neurology, 89(1), 88-100.
Raglio, A., Bellandi, D., Baiardi, P., Gianotti, M., Ubezio, M. C., Zanacchi, E., ... & Stramba‐
Badiale, M. (2015). Effect of active music therapy and individualized listening to
music on dementia: a multicenter randomized controlled trial. Journal of the
American Geriatrics Society, 63(8), 1534-1539.

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Russell, M. S., Widmer, M. A., Lundberg, N., & Ward, P. (2015). Adaptation of an
adolescent coping assessment for therapeutic recreation and outdoor adventure
settings. Therapeutic Recreation Journal, 49(1), 18.
Satizabal, C. L., Beiser, A. S., Chouraki, V., Chêne, G., Dufouil, C., & Seshadri, S. (2016).
Incidence of dementia over three decades in the Framingham Heart Study. New
England Journal of Medicine, 374(6), 523-532.
Stige, B. (2017). Where music helps: Community music therapy in action and reflection.
Routledge.
Stumbo, N. J., Wolfe, B. D., & Pegg, S. (2017). Professional Issues in Therapeutic
Recreation. Urbana, IL: Sagamore Publishing.
Tramutola, A., Lanzillotta, C., Perluigi, M., & Butterfield, D. A. (2017). Oxidative stress,
protein modification and Alzheimer disease. Brain research bulletin, 133, 88-96.
Turner, R. S., Thomas, R. G., Craft, S., van Dyck, C. H., Mintzer, J., Reynolds, B. A., ... &
Aisen, P. S. (2015). A randomized, double-blind, placebo-controlled trial of
resveratrol for Alzheimer disease. Neurology, 85(16), 1383-1391.
Tyler, H. M. (2017). The music therapy profession in modern Britain. In Music as medicine
(pp. 375-394). Routledge.
Van Cauwenberghe, C., Van Broeckhoven, C., & Sleegers, K. (2016). The genetic landscape
of Alzheimer disease: clinical implications and perspectives. Genetics in Medicine,
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West, M. (2017). Music therapy in antiquity. In Music as medicine (pp. 51-68). Routledge.

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Wimo, A., Guerchet, M., Ali, G. C., Wu, Y. T., Prina, A. M., Winblad, B., ... & Prince, M.
(2017). The worldwide costs of dementia 2015 and comparisons with 2010.
Alzheimer's & Dementia, 13(1), 1-7.
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disability. Therapeutic Recreation Journal, 50(3).

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Appendix:
Session Plans
Monday
Time : 10 -11am
Tuesday
Time : 10 -11 am
Wednesday
Time : 10 – 11 am
Thursday
Time : 10 – 11 am
Match songs with
artists quiz
music karaoke :
song choice 50s ,
60s, 70, &80s
Reminiscence –
child hood nursery
rhymes
Match songs with
movies
Time: 01-02pm Time: 01-02pm Time: 01-02pm Time: 01-02pm
Afternoon session :
Musical instrument
quiz
Afternoon session:
Story writing after
listening to music.
Afternoon session:
Auditory
identification of the
music or sounds.
Afternoon session:
Vibro-Acoustic
Therapy
Music activity for clients with Dementia
Memory programs
Program title: music studio
Size of group: 4
Target group: 70-90
Location: Day Abby lounge
Musical instruments & equipment: recorder, karaoke, piano, music player, harmonica and

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Program objective: using music therapy to minimise behavioural, social, cognitive, and
emotional problems of elderly people with Alzheimer.
Program description: the music studio runs musical activities that are clients centred for
older people who are suffering from, Alzheimer’s and other form of dementia disease. Lists
of songs from the 50s, 60s, 70s and 80s will be played. Participants will be asking to name
the songs, band or artists that performed the song. During this session a fun Reminiscing
activities will be also to bring back memory. Such activities are quizzes, match songs with
artist, karaoke and more. During this session the musical activities or programs that will be
used are musical instruments quizzes, games, songs quizzes, and DVD and television.
Program Plan
Program: Music Studio
Aim: Music therapy to reduce agitation in case of elderly population suffering from dementia
and Alzheimer.
Primary Diagnosis: cognitive impairment, stroke, dysphasia, aphasia, fall risk and memory
loss.
Secondary Diagnosis: Dementia and Alzheimer condition
Identified Problem/Need: sun downing syndrome, agitation, fall risk, repetitive behaviour,
memory loss, hoarding, difficulty in recognition and wandering
Exclusion Criteria: people below the age group of 70 and above the age of 90, people with
severe health complications and have a delicate health condition, impairment, any other
health complications apart from dementia and Alzheimer.
Funding Source: Aged care package, adult day care centre, Elderly Pharmaceutical
Assistance Program (EPIC), other health care organization and government

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Overall Cost required for running the program: $ 310
Person responsible for program implementation- Recreational therapists associated with
the primary health care centres.
No of sessions to be delivered: 2 sessions every day for 6 weeks of continuation.
Objectives: the main objective of the programme is to promote better health in adults
suffering with Alzheimer and dementia conditions using music therapy, as it helps the patient
to restore the normal state of their mind.
Current Staffing: 3 staff members to conduct the therapy and address the musical activities
and a doctor to address any severe complications.
Program Delivery Method: the therapy will be delivered by the recreational therapist along
with the other staffs in the presence of a doctor. The patient will be reported in to a hall
consisting of all the musical instruments and comfortable arrangement as the targeted
population are between the age group of 70-90. The will be provided with the appropriate
therapy according to the plan. Groups will be conducted in order to develop a better
understanding among each other.
Detailed Costing of Program:
Item Cost Numbers of people
Salary 35.50 3
Non Salary Items volunteer 1
Evaluation:
The basement of the elderly population after the musical therapy session provided a
better outcome for the Alzheimer and dementia condition (Tyler, 2017). The recreational

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therapist assessed that the health condition of the elderly population was improving
gradually. The music therapy synchronises the unstable condition of the individual’s brain,
and restores the monotonous and repetitive behaviours of the individual (Raglio et al., 2015).
The patients were able to better interact with others and were found to enjoy the session. The
occurrence of the health complication was also witnessed to be decreasing, the patient was
now able to sleep at night and they did not forget things that often. The concentration of
Melatonin in the serum progressively increases after every music therapy session and it was
observed to develop further. They were taking their medications and meals on time as
involvement in the therapy session were keeping their mind busy and active thus they were
feeling the hunger and were understanding the need to take medication (Tyler, 2017).

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Clients evaluation
Mary has completed 6/6 sessions of music therapy she has showed a decrease in agitation and
related behaviour.
The program was suitable length (1 hour per day) to achieve the client’s outcomes. Five out
of six sessions were conducted in the morning. Resulting in a reduction in agitation
behaviours, session five was delayed because of negative result john and Joan displayed
increase agitation throughout the morning.