The Power of Activity in The Power of Activity in RehabilitationRehabilitation

Victoria Schindler, PhD, OTR, BCMH, FAOTAVictoria Schindler, PhD, OTR, BCMH, FAOTARichard Stockton College of NJRichard Stockton College of NJ

New Jersey Occupational Therapy New Jersey Occupational Therapy Association Annual ConferenceAssociation Annual Conference

October 1, 2011October 1, 2011

Choose an activity to do for Choose an activity to do for 15 minutes. It should be 15 minutes. It should be one that is rewarding, one that is rewarding, relaxing and/or would relaxing and/or would elevate your mood.elevate your mood.• Crossword PuzzleCrossword Puzzle• Read a NewsletterRead a Newsletter• DrawingDrawing• Listen to MusicListen to Music• Go for a WalkGo for a Walk• Talk with a FriendTalk with a Friend• MeditateMeditate• Take a NapTake a Nap• Any other Activity of your ChoiceAny other Activity of your Choice

Take a HandoutTake a Handout

Use the Handout to Select Use the Handout to Select the words that describe the words that describe the way you are thinking the way you are thinking

and feeling right NOWand feeling right NOW

Take a HandoutTake a Handout

Select the words that Select the words that describe the way you describe the way you

were thinking and were thinking and feeling during the feeling during the

activityactivity

HandoutHandout

Compare the two lists and Compare the two lists and note your findingsnote your findings

Power of Activity in Power of Activity in Rehabilitation - AgendaRehabilitation - Agenda

• Neurological Underpinnings of Neurological Underpinnings of Engagement in Positive ActivityEngagement in Positive Activity

• Psychological Aspects of ActivityPsychological Aspects of Activity

• FLOWFLOW

• Neuroplasticity of the BrainNeuroplasticity of the Brain

• How to Develop Meaningful ActivityHow to Develop Meaningful Activity

• Resistance to Treatment with ActivityResistance to Treatment with Activity

Neurological Underpinnings of Neurological Underpinnings of Engagement in Positive Engagement in Positive ActivityActivity• Imaging scans (e.g., PET Scans, MRI Imaging scans (e.g., PET Scans, MRI

and EEGs).and EEGs).

• Activities as REWARDINGActivities as REWARDING

• Activities promoting RELAXATIONActivities promoting RELAXATION

• Activities that ELEVATE MOODActivities that ELEVATE MOOD

The Brain’s Reward CenterThe Brain’s Reward Center• Mesocorticolimbic Mesocorticolimbic

systemsystem– Cortex, Midbrain, Cortex, Midbrain,

Limbic systemLimbic system

• Distinguishes Distinguishes activities that are activities that are pleasurable and pleasurable and should be should be repeated from repeated from those which are those which are harmful and harmful and should be avoidedshould be avoided

Neurological Basis of Neurological Basis of ActivityActivity• Primary Primary

Neurotransmitters in Neurotransmitters in the Brain’s reward the Brain’s reward systemsystem– DopamineDopamine– GlutamateGlutamate

• The brain’s reward The brain’s reward system is activated system is activated and dopamine and and dopamine and glutamate are glutamate are increased during times increased during times we are engaged in we are engaged in positive activitypositive activity

Activities activating the brain’s Activities activating the brain’s reward systemreward system• MusicMusic• EatingEating• SexSex• Engaging in positive Engaging in positive

conversationconversation• Fine artsFine arts

– Drawing, Painting, SculptingDrawing, Painting, Sculpting

• SportsSports– Stimulate reticular Stimulate reticular

receptorsreceptors– Stimulate vestibular Stimulate vestibular

receptorsreceptors

• HumorHumor

– Physiological Physiological ResponsesResponses

• Blood pressure, Blood pressure, heart rate, heart rate, respirationrespiration

– Increased Immune Increased Immune System ResponsesSystem Responses

– Neurological Neurological ResponsesResponses

• Alpha, theta and Alpha, theta and delta wave patternsdelta wave patterns

Neurological Basis - Neurological Basis - RelaxationRelaxation• Characteristics of Activity that Promote the Characteristics of Activity that Promote the

Relaxation Response – Herbert BensonRelaxation Response – Herbert Benson– Performed in quiet environmentPerformed in quiet environment– Enhances one’s ability to concentrate and Enhances one’s ability to concentrate and

focus inwardly on the task at handfocus inwardly on the task at hand– Enhances one’s ability to disregard everyday Enhances one’s ability to disregard everyday

thoughts and worriesthoughts and worries– Requires focused attention on a repetitive Requires focused attention on a repetitive

mental stimulusmental stimulus

– Progressive Progressive relaxationrelaxation

– VisualizationVisualization– Guided imageryGuided imagery– CraftsCrafts– YogaYoga– MeditationMeditation– ArtArt– MusicMusic

•““the awareness that emerges by paying the awareness that emerges by paying attention on purpose, in the present attention on purpose, in the present moment, and non-judgmentally, to the moment, and non-judgmentally, to the unfolding of experience, moment-by-unfolding of experience, moment-by-moment…with an affectionate, moment…with an affectionate, compassionate quality within the attending, compassionate quality within the attending, a sense of openhearted, friendly presence”a sense of openhearted, friendly presence”– http//www.psych.stanford.edu/-pgoldin/http//www.psych.stanford.edu/-pgoldin/

Buddhism/MBSR2003_Kabat-Zinn.pdfBuddhism/MBSR2003_Kabat-Zinn.pdf

MINDFULNESSMINDFULNESS

• Mindfulness TrainingMindfulness Training– MeditationMeditation– Become aware of one’s thoughtsBecome aware of one’s thoughts

•Negative, judgmental, self-destructive Negative, judgmental, self-destructive thoughtsthoughts

•Catch these thoughtsCatch these thoughts

•Challenge their validityChallenge their validity

•Release themRelease them

Elevate MoodElevate Mood

•Neural activity in the left Neural activity in the left hemisphere has been linked to hemisphere has been linked to positive mood, feelings of well-positive mood, feelings of well-being and emotional stabilitybeing and emotional stability

•PET Scans and MRIs have shown PET Scans and MRIs have shown that people with depression have that people with depression have a marked decrease of activity and a marked decrease of activity and blood flow in the left hemisphereblood flow in the left hemisphere

Elevate MoodElevate Mood

• Activities that Activities that promote blood promote blood flow and neural flow and neural activity in the left activity in the left hemisphere have hemisphere have been shown to been shown to alleviate feelings alleviate feelings of depressionof depression

Neurological Response – Neurological Response – Elevate MoodElevate Mood

• The left hemisphere is responsible for The left hemisphere is responsible for language skills, math skills, language skills, math skills, categorization skills, and sequencing categorization skills, and sequencing skillsskills– Example of activitiesExample of activities

•Word finding puzzles, crossword puzzlesWord finding puzzles, crossword puzzles• Jewelry making, cooking, craftsJewelry making, cooking, crafts

•Cognitive Behavioral Cognitive Behavioral Frame of ReferenceFrame of Reference

““An optimal experience in An optimal experience in which people feel intense which people feel intense pleasure and satisfaction pleasure and satisfaction while deeply engaged in while deeply engaged in desired activity”desired activity”

--CsikszentmihalyiCsikszentmihalyi

Csikszentmihalyi, M. (1997)Csikszentmihalyi, M. (1997)

FLOWFLOW

• A term that describes the positive feeling A term that describes the positive feeling we have when we are absorbed in a we have when we are absorbed in a pleasurable activitypleasurable activity

• Totally immersed in the present momentTotally immersed in the present moment

• Lose sense of timeLose sense of time

• Lose sense of fear or anxiety; worries fadeLose sense of fear or anxiety; worries fade

• Participating in the activity is its own Participating in the activity is its own rewardreward

Csikszentmihalyi, M. (1997)Csikszentmihalyi, M. (1997)

Research on FLOWResearch on FLOW• Experience Sampling Experience Sampling

MethodMethod– Signal participants at Signal participants at

random timesrandom times– Doing, thinking, alone, or Doing, thinking, alone, or

with otherswith others– Rate on various numeric Rate on various numeric

scalesscales• HappinessHappiness

• ConcentrationConcentration

• MotivationMotivation

• Self-esteemSelf-esteem

– Can follow changes in moodCan follow changes in mood

Experiences with FLOWExperiences with FLOW

• Female Dx’d with Chronic SCZ; Female Dx’d with Chronic SCZ; hospitalized for over 10 yearshospitalized for over 10 years

• Individuals diagnosed with Individuals diagnosed with DepressionDepression

• Quality of LifeQuality of Life

• Increasing FlowIncreasing Flow

Csikszentmihalyi, M. (1997)Csikszentmihalyi, M. (1997)

Activities that promote Activities that promote FLOWFLOW• Sports and exerciseSports and exercise

• Crafts - Knitting and Crafts - Knitting and needlepointneedlepoint

• GardeningGardening

• Hiking Hiking

• CookingCooking

• Play a musical instrumentPlay a musical instrument

• SocializingSocializing

• Active Leisure as opposed Active Leisure as opposed to Passive Leisureto Passive Leisure

Developing FlowDeveloping Flow• Develop curiosity and Develop curiosity and

interestinterest– In routine tasksIn routine tasks– In new tasks and In new tasks and

activitiesactivities

• Reevaluate our present Reevaluate our present tasks and routinestasks and routines– Are they really Are they really

necessary?necessary?– Control time carefullyControl time carefully

• Control psychic energyControl psychic energy– Control concentrationControl concentration– Control our thoughtsControl our thoughts

NeuroplasticityNeuroplasticity

• The brain’s ability to change – for better The brain’s ability to change – for better or worse – throughout the life spanor worse – throughout the life span

• Process involves forming neuronal Process involves forming neuronal connections in response to information connections in response to information derived from experiences in the derived from experiences in the environment, sensory stimulation, and environment, sensory stimulation, and normal development.normal development.

Dodge, 2007; McCormack, 2009; Merzenich, 2001; Nudo, 2008Dodge, 2007; McCormack, 2009; Merzenich, 2001; Nudo, 2008

NeuroplasticityNeuroplasticity

• The brain’s ability to grow and The brain’s ability to grow and change into old age as long as it is change into old age as long as it is engaged in meaningful occupations.engaged in meaningful occupations.

Christiansen and Baum, 2005; McCormack, 2009.Christiansen and Baum, 2005; McCormack, 2009.

What are the characteristics of What are the characteristics of activity that make it activity that make it meaningful?meaningful?• NeurologicalNeurological

– Promote RewardPromote Reward– Promote RelaxationPromote Relaxation– Elevate MoodElevate Mood

• PsychologicalPsychological– FLOWFLOW

How to Develop Meaningful How to Develop Meaningful ActivityActivity

• Requires both physical and mental involvementRequires both physical and mental involvement

• Defined according to each individual; cannot be Defined according to each individual; cannot be defined by one individual for another individualdefined by one individual for another individual

• Elicits choiceElicits choice

• Facilitates developmentFacilitates development

• Must have meaning for the clientMust have meaning for the client

• Must be related to the client’s goalsMust be related to the client’s goals

• Must be of interest to the clientMust be of interest to the client

How do we Develop FLOW in How do we Develop FLOW in Activities?Activities?

• Include the client in the Include the client in the selection of activitiesselection of activities

• Help them to identify Help them to identify activities they enjoyactivities they enjoy

• Teach our clients to Teach our clients to become absorbed in become absorbed in activityactivity

• Teach our clients to Teach our clients to control their control their concentration thereby concentration thereby decreasing distracting decreasing distracting thoughtsthoughts

• Use the flow experience Use the flow experience to manage anxiety, anger, to manage anxiety, anger, and depressionand depression

Resistance to Engagement in Resistance to Engagement in Activity Activity

• Create an environment in which choices Create an environment in which choices can be madecan be made

• Choices range from small to large Choices range from small to large concernsconcerns

• Client will reject invitations to chooseClient will reject invitations to choose• Staff must not despair and stop caringStaff must not despair and stop caring• Staff should model hope and continue to Staff should model hope and continue to

offer optionsoffer options• Provide opportunity to fail and to try againProvide opportunity to fail and to try again

Select the words that Select the words that describe the way you were describe the way you were thinking and feeling during thinking and feeling during

the activitythe activity• What about the activity led to your What about the activity led to your

thoughts and feelings during the thoughts and feelings during the activity?activity?

• What about this is universal?What about this is universal?

• What about this is unique to you?What about this is unique to you?

Select the words that Select the words that describe the way you are describe the way you are thinking and feeling right thinking and feeling right

NOWNOW• What were the components of the What were the components of the

activity that produced this “after” activity that produced this “after” effecteffect

• How does this relate to the How does this relate to the psychological and neurological psychological and neurological effects of activity on the brain?effects of activity on the brain?

SUMMARYSUMMARY

•How can you use this How can you use this information to influence information to influence the way you create and/or the way you create and/or choose activities in your choose activities in your practice?practice?

Thank You very much Thank You very much for your attentionfor your attention!!

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