Activity Title: Table Ball

Source: Pokorny, Natasha. "Activities for People with Dementia." Therapeutic Recreation
Directory. 31 Jan. 2000. Web. 8 Sept. 2015.
<http://www.recreationtherapy.com/tx/dementia.htm>.
Equipment: Inflatable beach ball (approximately 20 in diameter), a rectangular or 2-3 square
tables arranged side by side, chairs
Description of Activity:
The objective of the activity is to improve hand-eye coordination, reflex time, and motor control
while promoting social interaction. Have participants sit at a rectangular table with the therapist
occupying one of the seats. Place the beach ball in front of one of the participants and ask them
to push the ball so that it rolls or slides to another person. That person is to then push the ball to
another person and so on. Encourage participants to keep the ball moving on the table
throughout the activity.
Leadership considerations:
This activity is good for small groups of 6-8. This activity can be performed for up to one hour,
however, if a participant becomes tired or expresses a desire to leave, they should be allowed
to leave the table and have another person take their place. Playing upbeat music helps
maintain energy levels during the activity. It is important for the therapist to encourage
participants to keep the game going, encourage all efforts to participate, and call out individuals
names to refocus them as needed. The therapist should limit their own participation as much as
possible, allowing participants the opportunity to help each other keep the ball rolling.
Adaptations:
Participants with Dementia: Some participants with dementia may not be able to participate in
this activity as well as others depending on which stage of dementia they are in. Have
individuals who are more capable sit next to someone who is having difficulty with the activity
and encourage them to help in order to promote inclusion and enhance social interaction.

Activity Title: Adapted Golf

Source: Zoerink, D., & Carter, M. (2015). A Case Report of a Physical Activity Intervention for
Adults with Stroke: Enhancing Balance and Functional Fitness through Golf. Therapeutic
Recreation Journal, 49(3). Retrieved from http://js.sagamorepub.com/trj/article/view/6574/5173
Equipment: Golf Clubs, golf gloves with grip straps, Balls, Tees, Gait belts (if needed)
Description of Activity:
The objective of this activity is to improve physical functioning, particularly agility, balance,
strength, endurance, and coordination; decrease social isolation; and increase community
recreation participation. Activity sessions begin with a 15-20 minute warm-up period where
participants perform warm-up exercises, set fitness or technique goals for the day with the aid of
the therapist, and address any safety or risk concerns for the day. Then participants are allowed
30-45 minutes of playing time on a 3-hole course. Based on their fitness goals, participants may
play one, two, or three holes with the option of using the putting green and driving range.
Participants should be divided into groups with similar goals to maximize social interaction and
peer support. Therapists/facilitators must accompany each group and assist if needed. Finally, a
15-20 minutes debriefing and evaluation period is set aside to allow participants the chance to
log their own daily progress, acknowledge their accomplishments, and plan for next week. This
is done in an open discussion format facilitated by the lead therapist.
Leadership considerations:
This activity is ideal for small groups and requires a 3-hole short course with a practice putting
green and driving range. This activity is meant to take place once per week for up to 90 minutes.
The therapist acts as a facilitator, safety manager, and educator. Participants must be preassessed and cleared by their primary care physicians prior to participating in this activity. The
therapist must be aware of the adaptive equipment needed by each individual participant and be
prepared with the equipment on hand prior to every session. The therapist must make sure to
provide adequate hydration at 30-minute intervals unless otherwise specified by a physician. All
therapists and facilitators must be knowledgeable of proper exercise procedures and basic golf
technique.
Adaptations:
Individuals recovering from a Stroke: A recent study has found that a repetitive adapted golf
program significantly improved the coordination, strength, and socialization of individuals
recovering from stoke (Zoerink & Carter, 2015). When working with participants recovering from
stroke, especially older adults, it is important to consider temperature and humidity changes
during outdoor activities. Also, the therapist should be aware of problems with balance when
walking from even to uneven surfaces and while entering and exiting the golf carts. The
therapist could use gait belts to assist with this if necessary (Zoerink & Carter, 2015).
Individuals with Spinal Cord Injuries: Physical activity and exercise has been shown to decrease
some of the common secondary health conditions experienced by individuals with SCIs,
including osteoporosis, cardiovascular disease, pressure ulcers, urinary tract infections,
diabetes, and arthritis (Kehn & Kroll, 2009). Health promotion interventions which focus on
removing barriers and educating individuals about resources have been shown to increase
levels in physical activity and improve the quality of life of individuals with SCIs (Kehn & Kroll,
2009). For this population, the therapeutic focus should be more on leisure education.

Discussions about removing attitudinal and motivation barriers should be included, as well as
practical tutorials on how to acquire, use, and maintain adaptive equipment. There are several
devices on the market that can be used for adapted golf participation, including SoloRider,
GolfXpress, and ParaGolfer (Mobility Golf, 2013).
Kehn, M., & Kroll, T. (2009). Staying physically active after spinal cord injury: A qualitative
exploration of barriers and facilitators to exercise participation. BMC Public
Health, 9(1). doi:10.1186/1471-2458-9-168
Mobility Golf (2013). Retrieved October 14, 2015, from
http://mobilitygolf.com/equipment/index.html
Zoerink, D., & Carter, M. (2015). A Case Report of a Physical Activity Intervention for Adults
with Stroke: Enhancing Balance and Functional Fitness through Golf.
Therapeutic Recreation Journal, 49(3). Retrieved from
http://js.sagamorepub.com/trj/article/view/6574/5173

Activity Title: Kick It

Source: Elliott, J., & Elliott, J. (1999). Alive and Active. In Recreation for older adults: Individual
and group activities (pp. 15-16). State College, Pa.: Venture Pub.
Equipment: Soccer-sized Nerf ball, Small or medium cardboard box
Description of Activity:
The objective of the activity is to promote physical activity, motor control, coordination, and
socialization. The cardboard box is laid open on its side about 10 feet away from participants.
Participants are then instructed to take turns kicking the ball into the box. Participants may be
seated in a chair or standing while kicking. Points might be awarded for getting the ball into the
box with additional points added if the ball stayed in the box. If participants are fans of American
football, a broomstick could be held up by two chairs so that participants can attempt field goals
instead.
Leadership considerations:
This activity is recommended for small groups but can also be performed 1 on 1. This activity
was originally intended for older adults in long-term care settings. The therapist plays the role of
facilitator throughout the activity. Socialization might be increased by having participants divide
into teams to see who can get the most points. The therapist should encourage participation
and redirect participants as needed.
Adaptations:
Older adults with Dementia: Individuals with dementia vary greatly in physical and cognitive
functioning. For lower functioning individuals, the therapist might sit a few feet away facing the
participant. The therapist should then try to encourage the participant to kick the ball back and
forth with the therapist and encourage all efforts made to interact (Elliott & Elliott, 1999).
Older Adults with Parkinsons Disease: Parkinsons Disease is a progressive disorder that
occurs when neurons in the brain fail to produce sufficient amounts of dopamine. Symptoms of
Parkinsons disease involve trembling of hands, arms, legs, jaw and face; stiffness of the arms,
legs, and trunk; and slowness of movement; and poor balance and coordination (National
Institute of Neurological Disorders and Stroke, 2015). If participants prefer to stand while
kicking, they should be provided with a chair or table to hold for support in order to prevent
potential falls.
Elliott, J., & Elliott, J. (1999). Alive and Active. In Recreation for older adults: Individual and
group activities (pp. 15-16). State College, Pa.: Venture Pub.
National Institute of Neurological Disorders and Stroke (2015). NINDS Parkinson's Disease
Information Page. Retrieved from
http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm

Activity Title: Facilitated Strength Training

Source: Tapps, T., Passmore, T., Lindenmeier, D., & Bishop, A. (2013). An Investigation into
the Effects of Resistance Based Physical Activity Participation on Depression of Older Adults in
a Long-term Care Facility. Annual in Therapeutic Recreation, 21, 63-72. Retrieved from
http://galenet.galegroup.com.ezproxy.fiu.edu/servlet/HWRC/pdf?docNum=A350165133&locID=
miam11506
Equipment: Resistance bands or dumbbells, and/or free weights, adjustable exercise benches,
weight training gloves (optional)
Description of Activity:
The objective of this activity is to improve functional fitness (balance, coordination, mobility)
and/or to improve mood and socialization in older adults. The session should begin with a
warm-up and stretching session led by the therapist. Following the warm-up period, the
therapist will explain and demonstrate a series of exercises for the participants to execute for a
fixed number of repetitions and sets or until failure, depending on the population and individual
fitness levels of participants. After exercise, a cool down period for additional stretching and
relaxation should take place prior to ending the session.
Leadership considerations:
This is activity can be performed with small groups in a gym or properly equipped activity room.
Sessions should be up to 30-45 minutes in length. The therapist plays the role of facilitator,
educator, and safety manager. The therapist leading and supervising the activity should be
trained in facilitating strength training for older adults or have a certified trainer present
throughout the session to ensure participants are safely executing exercises using proper form.
All exercises should be explained and demonstrated for the participants. Participants should be
cleared by a physician prior to participating in strength training activities. The therapist should
provide water unless there is a water fountain available at the location. The therapist should
encourage participants throughout the session. Music may be played in the background to keep
the energy level up.
Adaptations:
Older Adults with Sarcopenia: Falls are a significant health problem for older adults as they are
the leading cause of accidental injury and death among the older adult population. While some
fall risk factors may not be modified, sarcopenia (non-pathological deconditioning associated
with old age) is one of those factors that can often be easily reduced (Mobily, Mobily, Walter,
and Rubenstein, 2004). Sessions for this population may last up to 45 minute. Dumbbells and/or
free weights may be used with the option of gloves. Lighter weights should be used at first,
increasing the amount of reps before the amount of weight. Progressive balance exercises
should also be incorporated into the cool down period (Mobily et al., 2004).
Older Adults with Depression: According to Banduras social cognitive theory, changes in
behavior or environment have the potential to bring about changes in cognitive processes
(Tapps, Passmore, Lindenmeier, and Bishop, 2013). A recent study based on this theory has
found that resistance-based physical activity may decrease the levels of perceived depression
among older adults residing in long term care facilities (Tapps, et al., 2013). For this population,
it is important to encourage self-efficacy and make clients feel secure and safe at all times.
Loop-tied resistance bands should be used instead of weights and exercises selected to target

key muscle groups should be performed for a fixed number of repetitions and sets (Tapps, et
al., 2013).
Mobily, K., Mobily, P., Raimondi, R., Walter, K., & Rubenstein, L. (2004). Strength training and
falls among older adults: A community-based TR intervention. Annual in
Therapeutic Recreation, 13, 1-11.
Tapps, T., Passmore, T., Lindenmeier, D., & Bishop, A. (2013). An Investigation into the Effects
of Resistance Based Physical Activity Participation on Depression of Older
Adults in a Long-term Care Facility. Annual in Therapeutic Recreation, 21, 63-72.
Retrieved from
http://galenet.galegroup.com.ezproxy.fiu.edu/servlet/HWRC/pdf?docNum=A3501
65133&locID=miam11506

Activity Title: Aquatic Exercise

Source: Kargarfard M., Etemadifar M., Baker P., Mehrabi M., & Hayatbakhsh M. (2012), Effect
of Aquatic Exercise Training on Fatigue and Health-Related Quality of Life in Patients With
Multiple Sclerosis. Archives of physical medicine and rehabilitation. DOI:
10.1016/j.apmr.2012.05.006
Equipment: Pool noodles, assorted resistance equipment (if needed)
Description of Activity: The objective of this activity is to improve physical strength, flexibility,
and balance and to reduce pain and fatigue associated with illness. The buoyant nature and
viscosity of water facilitate physical activities for individuals with a physical weakness (Broach &
Datillo, 2012). Individual activity sessions are meant to be a part of a continuous aquatic
exercise program held 3 times per week for 60 minutes. Sessions are divided into 5-10 minutes
of warm-up activity, 30-40 minutes of exercise with breaks in between as needed, and 5-10
minutes of cool down exercises. Warm up and cool down periods are to take place in the water
and include low-intensity aerobic exercises such as breathing exercises, flexibility, walking, and
neck, arm, and leg movements. Depending on the population served and individual treatment
goals, the types of exercises used may vary. For examples, exercises may focus on increasing
strength using resistance equipment such as foam barbells, water mitts, or other pool-safe
weighted devices. Prior to in-water activity, time should be set aside for the therapist(s) to
discuss daily exercise goals with each participant and to allow participants enough time to enter
the water with the aid of pool lifts or ramps as needed and/or preferred by the client. At the end
of each session, after the cool down period, the therapist should engage participants in about 5
minutes of entertaining and playful activities to increase enjoyment and promote program
adherence.
Leadership considerations: This activity is meant to be performed in an indoor, temperature
controlled aquatic therapy pool at 24C 36C, equipped with lifts and no-slip mats. While it
may be performed 1 on 1, it is ideal for small groups of up to 6 participants at a time.
Participants should be cleared by their physician prior to engaging in an aquatic exercise
program. The lead therapist or facilitator should be a certified aquatic instructor or arrange to
have a certified aquatic instructor present to lead, demonstrate, and supervise exercises.
Lifeguards and pool safety equipment should be available during sessions for safety.
Adaptations:
Older Adults with Osteoarthritis: Osteoarthritis (OA) has been identified as the most prevalent
rheumatic disease affecting older adults, and involves joint degeneration which typically results
in chronic pain, decreased flexibility, and loss of mobility (Davis & Nelson, 2015). Physical
exercise is commonly recommended as a non-pharmacological treatment for symptoms of OA,
however, land-based exercises might place strain on affected joints, which can make symptoms
worse (Davis & Nelson, 2015). Aquatic exercise can help individuals with OA build strength,
flexibility, and reduce pain without putting additional strain on joints. For this population, strength
training using underwater resistance equipment is recommended (Davis &Nelson, 2015). Some
of this equipment may include foam dumbbells, medicine balls, and water-proof weighted mitts.
Aqua aerobic exercises including bouncing, jogging, kicking, twists, jumping jacks and side
steps are also recommended (Davis & Nelson, 2015).
Older Adults with Multiple Sclerosis: MS is a chronic and progressive neurological disease that
results in in loss of muscle control, vision, balance, and sensation (Kargarfard et al., 2012).
Fatigue is one of the most common disabling complaints in patients with MS and often leads to

feelings of depression and impaired social relationships (Kargarfard et al., 2012). For individuals
with MS, exercises included should focus on joint mobility, flexor and extensor muscle strength,
balance movements, posture, functional activities, and intermittent walking (Kargarfard et al.,
2012). Also, neutral spinal position should be encouraged and participants should be allowed to
hold onto a noodle or foam hand bars for safety while performing exercises (Kargarfard et al.,
2012).

Davis, J., & Nelson, R. (2015). Aquatic Exercise for Pain Management in Older Adults with
Osteoarthritis. Therapeutic Recreation Journal, 49(4). Retrieved from
http://js.sagamorepub.com/trj/article/view/6571
Kargarfard M., Etemadifar M., Baker P., Mehrabi M., & Hayatbakhsh M. (2012), Effect of
Aquatic Exercise Training on Fatigue and Health-Related Quality of Life in
Patients With Multiple Sclerosis. Archives of physical medicine and rehabilitation.
DOI: 10.1016/j.apmr.2012.05.006