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Pain Management


Pain Management/PROM/Relaxation Techniques co-treatment with Physical and Occupational Therapy
submitted by Anna Martin,CTRS of Magee Rehabilitation on August 6, 2006

Size of Group: Ideally 1:1 within group. No more than 2:1 ratio in group

Equipment: Relaxation script,
Music (classical/jazz/earth sounds)

Objective: Program goals:
1. Decrease pain 1-3 points on 10point scale. (0=no pain and 10=extreme pain).
2. To increase patients awareness of relaxation techniques 3. To have patients id episodes for relaxation techniques

Description/Procedure:
Instruct PT/OT’s prior to session that they will be starting PROM upon your cue during session as you will continue to do relaxation techniques throughout session.
Setting patients up in semi-circle explain purpose of session. Tally pain levels of patients (level and location of pain). Have patients ID when they may need to use pain management or times they are in pain and sources of stress. Explain benefits of pain and stress management.

Having patients close eyes and begin music. Let patients listen to music for a minute of so. Give them a chance to relax, themselves.

Relaxation Script:
(to be spoken calmly, softly, and slowly) I have written as it works for our specific group. I suggest going at the pace that is best for your group.

Now close you eyes. “I’m going to count to 10 and as I count, you are going to become more and more relaxed. 1...2..your mind is clear of all thought and stress. 3..4. Get comfortable in your seat (or bed) sinking deeper, relaxing your shoulders, becoming more and more relaxed. 5..6..imagine that you body is hollow and weightless, relaxing your arms. 7..8.. You feel as though you are floating freely in midair. 9...10..you are now completely relaxed. “

Pause…. checking to assure patient’s eyes are closed.

“Get comfortable in your chair (or bed). Keeping your eyes closed. Pay attention to you breathing. Pay attention to the rise and fall of your chest as you breathe in and out. Pay attention to the rhythm. If you are breathing rapidly, focus on decreasing the pace of your breathing to a slow deep, rhythm, feeling your chest rise and fall slowly. As you inhale, image you are breathing in clean, relaxing air, replacing stress and tension. As you exhale, imagine you are blowing out your stress and tension-erase all distraction from your mind”

Pause.

“Keeping your eyes closed, pay attention to the colors and shapes you see on the back of you eyelids. Imagine that all the colors and shapes have disappeared and now you see nothing. Now, start to imagine your favorite place to go when you want to relax. It may be a place outdoors like the beach or the mountains. It may be a special room, or a place you used to visit. Allow you mind’s eye to take you to that place. Imagine that colors of your surroundings. It may be an assortment of colors from a sunset or sunrise green landscapes of a forest or the colors of the walls and furniture of what special room you like to go to. You see the colors of your surrounding. Imagine the textures of your surrounding. It may be a soft cotton cushion or blanket in your favorite room; wind blowing through your hair from an ocean breeze, the warmth of the sand on your feet from a walk on the beach or the warmth from a camp fire burning in the night. You feel the textures of your surrounding.

Now, imagine the scents of your surroundings. It may be the familiar scent of that room, the smell of the morning dew on the trees and grass of a forest, the smell of ocean water by the shore. You smell the scents of your surrounds.

Now, try to exclude the noises you hear in this room and listen to the noises of your surroundings. Hear the leaves blowing in the wind, ocean water breaking on the shore, maybe relaxing music you enjoy playing, or you may prefer complete silence. You hear the noises of your surroundings. Take a few moments gadget completely relaxed, hearing, seeing, feeling, smelling, your place of relaxation”

Pause…Motion of PT/OT to begin PROM

Pay attention to you breathing. Pay attention to the rise and fall of you chest as you breathe in and out. Pay attention to the rhythm. If you are breathing rapidly, focus on decreasing the pace of your breathing to a slow deep, rhythm, feeling your chest rise and fall slowly. As you inhale, image you are breathing in clean, relaxing air, replacing stress and tension.

Progressive muscle relaxation (may need some extra cueing to participate with task)
“Feel the muscles in your face. Feel your eyebrows. Tighten your eye brows as tight as you can. Hold (pause)….and release. Feel your eyelids. Tighten your eyelids as tight as you can. Hold. (pause)…and release. Feel your lips. Pierce your lips as tight as you can. Hold. (pause)…and release. Feel your jaw. Tighten your jaw. Hold. (pause)…and release. Feel your shoulders. Shrug them up, as high as you can. Hold. (pause)….release.

Pause.

Pay attention to your breathing. Pay attention to the rise and fall of your chest as you breathe in and out. Pay attention to the rhythm. If you are breathing rapidly, focus on decreasing the pace of your breathing to a slow deep, rhythm, feeling you chest rise and fall slowly. As you inhale, image you are breathing in clean, relaxing air, replacing stress and tension.

Pause.

“Remain relaxed and still. Keeping your eyes closed, you are going to slowly return to this room. In a few moments I’ll count to 10, slowly. 1...2..you start to feel the temperature of the room. 3...4..you’re beginning to hear the noises in the room. 5...6.. Feel the texture of you chair, (or bed). 7...8..you’re becoming more aware of your surroundings. 9...you’re relaxed. 10...open your eyes and return to the room”.

Give everyone a minute to become more alert.
Tally Pain levels.
PT/OT continue PROM as needed.

Group processing:
1. Can someone ID source of stress or pain that we discussed?
2. What did you learn that was new?
3. Where was your place of relaxation? (shared if they wish) 4. How do you feel now, as compared to how you felt prior to the relaxation exercise?
5. What techniques will you use when you are in pain or in a stressful situation?

Contributor:
“ How You React to Stress”, The Relaxation & Stress Reduction Workbook

 

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