Fun as an Important Element of Rehabilitation

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Helping People Without Making Them Helpless Fun,
Functional, and Other F Words
Tim Feeney, Ph.D. New York Neurobehavioral
Resource Project Schenectady, New York
USA tcskfeeney_at_aol.com
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FAQ CONTEXT-SENSITIVE REHABILITATION

• Q1 IF TX IS CONTEXTUALIZED, WILL TRANSFER NOT BE
  NARROW??
• A1 Possibly. But a CONSTRUCTIVE dilemma is
  associated with C-SR and transfer
• 1. With C-SR, either reasonable transfer occurs
  (with or without special effort) or it doesnt
  in individual cases
• 2. If it does, great
• 3. If it doesnt, at least the person has
  acquired useful knowledge or skill in some
  relevant context
• 4. Therefore, there is a positive outcome in
  either case
• A2 Compare Normal child development

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FAQ (contd)

• Q2 ISNT IT IMPOSSIBLE TO TRAIN A PERSON IN
  EVERY CONCEIVABLE CONTEXT??
• A1 Correct that is obviously impossible.
  However, see answer to Q1.
• A2 Professionals delivering C-SR create
  alliances with everyday support people in a
  variety of settings to ensure training and
  support are as widely distributed as possible

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FAQ (contd)

• Q3 IS IT NOT EXPENSIVE AND INEFFICIENT TO
  DELIVER SERVICES IN MULTIPLE CONTEXTS??
• A1 Yes! But context-sensitive services can be
  delivered in a clinic and/or via occasional
  consultation and/or via apprenticeship
  relationships with local support staff. The point
  is to somehow organize the everyday routines of
  the person with disability and the intervention
  and supports provided by everyday people. There
  are multiple ways to do this.
• A2 NYS DOH Medicaid Waiver Program
  Apprenticeship Program

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FAQ (contd)

• Q4 WONT CONTEXT SUPPORTS CREATE ONGOING
  DEPENDENCE AND HELPLESSNESS??
• A1 No, not if supports are well-conceived and
  reduced systematically
• A2 How to help without creating helplessness
  The Goldilocks Accordion Theory of Support
• - Not too much not too little just right
• - adjusted in an ongoing way to coincide with
  growing competence and with stressors, such as
  transitions, new responsibilities, increasing
  demands, etc

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Goldilocks playing her accordion
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FAQ (contd)

• Q5 ISNT C-SR HARD TO STUDY??
• A1 Yes. But it is unscientific and unethical to
  use an intervention simply because that
  intervention is easy to study. Tails Must Not
  Wag Dogs!!
• A2 A variety of research designs are possible
• A3 Designs MUST include (1) real-world measures
  of functioning, (2) long-term interventions, (3)
  attention to context, (4) engagement of
  individual and everyday people, (5)

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FAQ (contd)

• Q6 IS IT SCIENTIFIC TO SUPPORT OR REJECT AN
  INTERVENTION USING EVIDENCE DERIVED FROM STUDIES
  OF OTHER POPULATIONS??
• A1 In selected cases, yes. Cross-population
  inferences are valid if
• 1. The two populations are nominally different,
  but functionally and pathologically identical
• 2. The two populations are genuinely different,
  but the same with respect to all considerations
  relevant to the intervention
• 3. An intervention theme emerges across many
  (all) studied populations (e.g., sharply limited
  transfer)

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FAQ (contd)

• Q7 DOESNT THE SUCCESS OF COMPUTERIZED TRAINING
  PROGRAMS LIKE FAST FORWORD LEND SUPPORT TO
  COGNITIVE TRAINING EXERCISES?
• A1 No the goal of the program is acquisition of
  specific domains of linguistic knowledge
  (phonology, semantics). There is a fundamental
  difference between (1) teaching specific content
  skills and knowledge and (2) training purportedly
  content-less cognitive processes

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FAQ (contd)

• Q8 DOES C-SR INTERVENTION REQUIRE A CHANGE IN
  ASSESSMENT PRACTICES?
• A1 Yes! C-SR requires at least systematic
  exploration of context facilitators and
  stressors, and hypothesis-testing exploration of
  potential context-relative supports and
  teaching/interaction styles.

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FAQ (contd)

• Q9 IS C-SR APPLICABLE TO INPATIENT
  REHABILITATION??
• A1 Yes, in two ways
• 1. Inpatient staff should focus on
  post-discharge settings and activities with the
  goal of developing effective supports and well
  trained support individuals in those settings
• 2. Meaningful activities and projects can be
  included as an essential component of inpatient
  rehabilitation, from the perspective of
  cognition, communication, education, vocation,
  and executive self-regulation

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FUNCTIONAL does not equal Increased/Improved
performance on standardized tests
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Fun as an Important Element of Rehabilitation
Therapeutic Serving to sure or heal Fun
Lively, joyous, playful Do you ever ask
yourself Where is the fun? rather than Are
we having fun yet?
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FUNCTIONAL does not equal Bowling or the The
Friday Outing or the The really neat, really
expensive, simulated. . .
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FUNCTIONAL equals Creating stable routines of
life that enable me to do what I need to do when
I need to do it.
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FUN IS NOT

• ? Worrying about being politically correct
• ? Going to therapy
• ? Doing a workbook activity
• ? Working on fricatives in the speech closet
• Working to meet some fricking criterion on
• some fricking test before I can get out of
• this fricking place
• Being told to be realistic
• Being told to be realistic by some snot-
• nosed 24 year-old who hasnt lived life
• like I have

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FUN IS

• The 1st time ? Kids
• Play ? Joking
• Friends ? SpongeBob Squarepants
• Laughter ? Hope
• Feeling connected ? Feeling useful
• Viagara ? Being naughty
• Love ? Pure joy
• Doing something you really like with someone
• you really like
• ? Accomplishing something meaningful

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MINDSETS NOT CONDUCIVE TO FUN

• The Oprah Type - victim/tragedy/altruist
• Typical utterances
• Suffers from . . .
• Victim of . . .
• The Dr. Kildare Type - medical orientation
• Typical utterances
• The patient . . .
• The Dr. Phil Type - control/territorial
• Typical utterances
• You gotta . . .
• We tried that before, itll never work
• Because Im the expert
• This is my area, dont mess with me!

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MINDSETS CONDUCIVE TO FUN

• Flexible
• Typical utterances
• Yeah, we can do that.
• That looks interesting, different than I
  thought
• but its worth a try.
• Collaborative
• Typical utterances
• Whaddaya think?
• Geez, thats a good idea, lets give it a
  shot.
• Mature
• Typical utterances
• Youre right!
• Some things I cant change.

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MINDSETS CONDUCIVE TO FUN
Risk taking Typical utterances Well, I
dont know what might happen . . . Whats the
worst that could happen? Whats the
benefit? Sometimes its easier to ask for
forgiveness than for permission
Hopeful Typical utterances Hey, were onto
something here! Lets give it a
shot. Sure, we can do that. Self-Effacing
Typical utterances I dont think I could
think like that. I couldnt ever.
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• Friendly
• (adj.) 1 like, characteristic of, or suitable
  for a friend, friends, or friendship kindly 2
  not hostile amicable 3 supporting helping
  favorable

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• Fellowship
• (n.) 1 a mutual sharing, as of experience,
  activity, interest, etc. 2 a group of people
  with the same interests company brotherhood

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• Frequent
• (adj.) 1 occurring often happening repeatedly
  at brief intervals 2 constant habitual.

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• Faithful
• (adj.) marked by or showing a strong sense of
  duty or responsibility

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• Feeling
• (v.) to be moved by or very sensitive to

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• Fair
• (adj.) just and honest

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• Fabulous
• (adj.) very good wonderful

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• Fantastic
• (adj.) seemingly impossible incredible

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• Folly
• (n.) 1 a lack of understanding, sense, or
  rational conduct foolishness 2 any foolish
  action or belief 3 any foolish and useless but
  expensive undertaking.

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• Foolhardy
• (adj.) bold or daring in a foolish way rash
  reckless

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• Fiasco
• (n.) a complete failure.

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• Fail
• (v.) to be deficient or negligent in an
  obligation or duty

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• Fecal
• (adj.) of or consisting of feces

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Four Lessons to Live by
Hope is an essential part of any successful
plan of support. Form follows function.
Think about what the individual needs and then
create a way for that to happen in a flexible
manner. The more you try to force
something or someone to change, the more it (or
he or she) changes you. When all else fails, a
sense of joy and a sense of humor can get
you through a whole lot!
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• Finished
• (adj.) 1 ended concluded 2 completed 3
  highly skilled or polished perfected
  accomplished 4 given a certain kind of finish or
  surface, as of paint, wax, etc. 5 defeated,
  ruined, dying, etc. 6 no longer dealing with or
  concerned with.