Therapeutic Recreation Talk Show Episode 4 Transcript

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hello and welcome to the TR talk-show therapeutic recreation recreation
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therapy neuroscience research psychology role-playing games and music therapy and
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other related topics too
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again the website is TR talk-show comm with all the resources that you'll need
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participate in the live chat email conversations etc and reminder we are
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looking for special guests and co-hosts for the show if you would like to be on
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the show as a guest or either a semi-regular or regular co-host we
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request that you have extensive background in TR preferably a CTRs though not required it you know
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especially if you're retired or something but we really value those with extensive experience and the
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certification etc to give the feedback I've been involved with therapeutic recreation since 2004 and also a
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Washington State Department of Health registered recreational therapists located here in Spokane Washington
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though I do provide services around the world through both remote and services
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and mobile facilities have the wheelchair accessible trailer and bus that we take around the continent and
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such today's topics for episode number four this October 8 2019 we are going to
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cover brain computer interfaces and their use in therapeutic recreation recreation therapy BCI games Jam event
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that's coming up I'll also related an electroencephalogram bio neurofeedback
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opensource EEG hardware and software BCI and
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recreation and games in general also role-playing games using EEG to validate observed immersion scale with other data
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the Wendy's role-playing game in the mainstreaming of role-playing games which again we use as a modality as part
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of our therapeutic recreation programs as well as music and other standard TR activities RPG is becoming more
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mainstream but also a little bit of the backlash against that which happens in many industries when you take a hobby
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and turn it into semi pro and professional and in an industry maturing
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industry which is relevant to TR with its struggles to become a respected and
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more well developed professional industry a converse some highlights from
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a wonderful conversation I had with Thomas Bochco the president of idle
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Arbor and we'll be talking related to that regarding a assessment tool
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development the observed the various tools that we're working on developing
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currently the observed immersion scale the OU is using EEG as we talked about
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to validate immersion and flow state experiences and recreation in games activity assessment tool development and
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and the problems with the current ones we've talked about that a little bit we'll go into a little bit more and give a latest update on our development
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efforts player style assessment tool development and any related topics now
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again we welcome audience members to join and post questions and answer
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real-time any topics you have or you can post after the show or email TR talk-show comm for topics you would like
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to see on the show and have discussed so today's episode is largely motivated
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because I also am on the RPG talk show and we have a couple of researcher
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meetings on Sundays and Tuesday mornings with a research staff over at the
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nonprofit RPG research and we have work with researchers and Saudi Arabia and
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several other continents around the world and one of our researchers actually here in Spokane is part of an
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effort to raise awareness about brain computer interfaces so there are many
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different types of brain computer interfaces and they really are a wonderful tool for
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improving accessibility in life in recreation and in daily life and one
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wonderful example of the use of BCI technology is the brain port some of you
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may already be familiar with this as part of your TR training and just being
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in the industry is all and what's interesting about the brain port it's
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also related to the wonderful features that we have learned in recent decades about the neural plasticity of the brain
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it's it's really quite remarkable and it's such a radical shift from older
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thinking about how the brain functions so it used to be believed that so if
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somebody had a brain injury the old way of handling it even just 30 50 years ago was put them in a quiet room don't
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disturb them don't agitate them keep the lights low and just let them be and let
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them recover and unfortunately it turns out that was almost the worst thing you
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could do I mean you know they still handle the medical immediate medical needs and such but as far as getting the
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brain to recover the most from a brain injury and having a better long-term prognosis that was it turns out to be
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very counterproductive it turns out in order to really engage the full effects
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of neuroplasticity theories about the ability of the brain to rewire itself
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and adapt to to changing stimuli and such you need to within the realm of
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their level of fatigue and functioning and such get them using as much of their brain as possible as soon as possible
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this is really critical to a better long-term functioning especially after
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that two to three year kind of plateau and both in the short term and in the long term so what you want to do is once
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they start coming out of weather it induced or otherwise coma and they start to orient
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even if they've still intubated and such that you start engaging their brain as
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much as possible they may not be able to do a lot of physical things at first if they're in intensive care
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initially you'll want to get them doing that as soon as you can but you can certainly start engaging their brain early on
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now there's the usual orientation quizzes use and then if they're intubated using eye blinks hand squeezes
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or other interfaces to figure out their responses to see where they're at oriented times three etc but you can
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also take it to another level and I've got a whole video about this in a 20-minute lecture on using for example
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role-playing games to help with the recovery of a TBI client it's an
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amalgamation of multiple clients experiences into into one hypothetical client and it gets them imagining as
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they are imagining and visualizing things and they're responding through binary question and response it's
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lighting up the brain it sorry it's rebooting parts that may have shut down out of protective mode and then the
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areas that have organic damage it'll start to try to reroute other areas for example I don't know if we're talking about in this show but in other shows
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the example for people who've lost their speech capabilities because damage to
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Broca's area so if if they can't understand things that's where Nikki's area and that's a different story but if
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it's broken there than having trouble with speech what they have found is that the singing a part of the brain is
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different than the normal speech part of the brain and they have found through the wonders of neuroplasticity that
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people can still sing when they can't speak so even there's organic damage they can sing and then through practice
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they bring the sing song I am speaking to you down to a little bit less
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sing-songy and a little less sing-songy until finally they're speaking in what sounds like relatively like speaking
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they're speaking but they're using what was the singing part of the brain it's really amazing check out those studies
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it's it's wonderful example of the power of this so the brain port is another
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example of the amazing adaptive power of the brain where and and brain computer
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interfaces we're sensory information can be sent to the brain through an electrode array
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which sits atop the tongue it's actually on the tongue and it's kind of like a
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Braille type kind of interface on the tongue and at first it's just like wow
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that's a weird sensation and it doesn't do any good and this will even work for somebody you can learn to do it even without a brain
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injury just with practice just like you learn to read Braille without being
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visually impaired you can do so with this brain port okay so you learn to
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recognize you you slowly develop more and more sensitivity to figure out different configurations and signals
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that are being sent and eventually you start to recognize the patterns and as
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those become recognizable and then you're able to interpret with a meaning of it just like with Braille and such
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you're able to orient yourself in your environment so first it's gonna be very
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large features and then you can get more and more granular this is really amazing feature to give people who are who have
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visual impairments the ability to have a little more freedom and independence and and be able to move about and what's
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amazing is that the brain can start rewiring so that they can start having more of an imagery type effect that's
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not on a percent but it is really quite amazing how the brain will rewire this is assuming that the damage the organic
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damage has not affected the occipital lobe but even it has there's other workarounds and such but but if they
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don't have acceptable lobe damage what's more there their eye or nerve and in between and such was destroyed there's
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potential there it's quite remarkable really do check that out so that's called the brain port and there's some neat studies about that well so that's a
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type of brain brain computer interface others you might be familiar more familiar with would be in select row
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encephalo gram EEG type equipment you've got the all the little electrodes hooked up and you're reading different
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brainwave patterns and let's see and I had those links handy where did I just
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put that okay so with oh no I don't have
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the links on that page I'll have to add those I've got the topics but I haven't posted
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all of the links that I have associative this I will work on doing that while I'm
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juggling the show here if you don't mind me multitasking we're still getting the
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hang of this particular show because it's a little bit different format some of the others so there's a number of
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them so I wrote a paper some years ago just a simple a straightforward one about a fellow who was badly
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incapacitated and and not able to move and communicate pretty much at all limited eye movement and they were able
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to hook up a BCI brain computer interface in conjunction with virtual reality and overtime they were able to
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move around in this VR setting and increasingly do more and more granular activities including being able to
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basically type and this is someone who was a software developer who was able to start writing software development code
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again just using their thoughts it's amazing I've been involved with neuro
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and biofeedback actively since about 2004 2005 as a as a client even earlier
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back in the 90s in bio neurofeedback but as doing some experiments and such since
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since the early 2000s and one of the examples is I was working with a
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specialist and we experimented with use
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playing musical instruments and seeing how that would affect an EEG based
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neurofeedback video game whether it's a very primitive video game that gives you reinforcement for feedback and such on
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if you're meeting the objectives in your brainwaves so if you're having a focus
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or you've lower your anxiety we've raised your energy whatever the goals are you set the parameters of the brainwaves and then the game responds
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accordingly when you're closer and closer to the parameters that you need to be with between and then you know
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there's a lot of research out there about how music and such is supposed to help in a lot of areas this was an interesting way to experiment so there's
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playing guitar and playing flute I'm proficient fairly proficient in both I can play them with a fair amount of automaticity Amy
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playing the instrument while doing other things simultaneously and so experimenting we found that I while I
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was playing an instrument it actually was able to enhance my focus even though you would think that the distraction of
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multitasking because that is really multitasking I'm focusing on the game and this and or having a conversation or
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giving feedback which normally would interfere but with the plane the music
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and such which I do on a daily basis I literally use guitar to play guitar to
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fall asleep and such actually enhanced my efficacy with the neurofeedback game
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so lots of cool stuff led to that and we'll get it a little bit more detail in
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the future as well one really exciting thing that's coming up this is a wonderful way for you to learn more about this is the upcoming brain
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computer interface games Jam event you
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should definitely check this out the website it's a little long and again I'll have it here on TR talk-show comm
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shortly I'll get it post it even while we're doing the show here is this all
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under episode 4 so itch so like scratchy itchy ITC HIO ford slash jam j am ford
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slash BCI brain computer interface - game -
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Jam so again it's do forward slash Jam /bc I game jam and you can sign up to
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have some level of involvement in this so they're bringing together a bunch of BCI games and demonstrating and just
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trying to raise awareness about the wonderful capabilities of this with games and BCI so that is coming up on I
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think it's November 8th so November 8th it's several days so from number number
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8 at 10:59 p.m. I believe this is in Calgary or somewhere in Canada through
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November 10th 11 p.m. so November 8th 11
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p.m. basically - November 10th 11 p.m. so check that out there's that website
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to go to you can sign up and the goal of it I'll read it to you this game jam is
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motivated by the hundreds of children who until recently may never have been able to play a video game before as BCI
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technology grows and matures it will continue to enhance the lives of children and adults who have lost
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significant motor functions this game Jam aims to push the available experiences offered by BCI to new levels
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for these individuals we all cannot wait to enjoy the wide variety of gaming experiences you will create so people
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are going to be coming together pooling their resources to help grow this they're providing a unity asset which
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exploits the p300 BCI control scheme they've got an faq explains that and and
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if you prefer to use another engine that's fine they don't wanna let me creativity is what you want but you need
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to design your game such that it can be played with a single button input preferably a key input you want to keep
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it nice and simple so requirements for the BCI game gem your game must either use the provided p3 under unity tool or
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have a single button control scheme the game gems focus on providing some great new experiences for children of all ages
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so please keep your games appropriate the games will be rated by a panel of children who routinely use BCI devices
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and our expert and their expert judges and they will be answering questions as best they can
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throughout the game jam so you built hoon into their live chat and stream of the event hosted at the University of
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Calgary Canada throughout that weekend so definitely check that out
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so I've been I've been experimenting with BCI stuff and an EEG a related
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stuff for about well 15 years plus and you can find a lot of that over because
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I've done it more through the RPG research side although now I do it in practice as well so you can learn more about that those experiments in the
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papers that I've been talking about over at RPG research comm and go to the research section and then you can go
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through the archives and read that I have used the BCI interfaces in
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different settings working with brain injury and other special needs populations but as far as experiments so
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far they've been limited to doing them upon myself with other certified professionals or on by myself just
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experimenting with open source EEG equipment yes there actually is open
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source hardware in addition to software so this is a very interesting thing that
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a lot of people don't know about and it's it also will tie in when we talk later about improving of the assessment
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tools that are out there in recreation therapy and trying to validate them better you know a lot of what we do is
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considered soft science and the hard sciences pupu are all of the theories
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and research that's done in the soft sciences but thanks to neuroscience and
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brain imaging and other objective measurable equipment we're able to start
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in validating validating and proving a lot of the theories and concepts and ideas so if you want to check out the
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open EEG equipment and software that's available there's a great website for that I've used them on and off for many
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years it's open EEG dot sourceforge.net and they have all sorts of wonderful
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info on both commercial and open software and commercial and open hardware so one of the products man I
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need to grab that for the show I'll try to do that next week if I can somewhere
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I'm still unpacking from the atra conference even this much later from the bus and the trailer somewhere I have I
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bought years and years and years ago well it's been almost 10 years I think from olam X modular open a EEG equipment
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and let me see if I can pull it up I'll pull it up on a browser here and then
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try to share the screen so that you can see what I am talking about and it's a 5
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channel EEG monitoring equipment it's it's made out of Europe well let's start
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it that's not what I wanted what the heck open the EEG oh it's a sight that taking
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advantage of typos not nice
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alright let me go ahead I'll move this over and I will give you a shared screen
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here yet I add it to this go in didn't have it set up in this particular
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profile there we go so now you can kind of see it when I show you the images and
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such by the way I'm broadcasting use an open broadcast server OBS and a lot of
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other hardware and equipment here in the studio so this is the site opening AG that's the new it's interesting the the
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logo that they have for that and so if you scroll down to hardware they talked
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about the different modular EEG passive electrodes versus active electrodes etc
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calibrators things like that are all very important you get a whole section down there for software so one of them
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if the manufacturers that you can buy from so that you don't have to build it yourself because a lot of this is building it yourself to create custom
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boards but you can go to the olmecs site and in there they have a whole open EEG
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section with these boards that you can buy these are in Euros and then one
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that's fully assembled for you so this is what I have I bought some years ago it's a five port Pete let's see so you
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can't see the mouse in there that's too bad so but it's a five port system that with a USB out you know okay here we go
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so you can see the guts of it inside etc so you can see on one side is the USB
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out port and then you have five in ports but you'll notice there's one port by
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itself so you have the four boat in a row and one by itself that one by itself is by default as passive all five other
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were passive excuse me second but that one can be set to active
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and that's where we get into transcranial stimulation transcranial
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induction etc you want to be very careful with the active settings so some
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of you have probably already familiar any of you work in the medical division of TR with tens and you know used for
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back injuries and and other products like that I have a whole slew of
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injuries I was in a wheelchair briefly in 2004 due to multiple knee and back injuries I went through five years of
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physical therapy and I had to pay a lot because they had very expensive equipment for tens which is the
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transcutaneous electrical nerve stimulation equipment and now you can
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buy it for sixty eighty bucks at local Walgreens or Rite Aid or their pharmacy or online and it's just little pads and
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their electrodes you attach and it's electrical stimulation Bruce Lee was famous for doing that not long before he
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died there were some people who hypothesized that may have contributed to his death of aneurysm all that that's
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questionable but I I think that's been to prove or disprove it I think that's in line with the other people have
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conspiracy theories about the Lee family and all anyway that's tangent but he used it he would really crank it up so
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it caused the muscle contractions so he thought it gave him a much faster workout and such then he can do normally
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and he was an incredible shape right generally you don't use tens in that way which you use tens for is to stimulate
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the nerve and blood flow and get everything going so it helps with speed up the healing process but it also kind
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of numbs the nerves in a non meta medical medication way so instead of
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having to medicate your whole body to get to one area that hurts it's a localized way to deal with pain
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and it can be pretty effective a number of uses in a day can relieve pain for
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hours and you know now I have chronic pain I live with pain all of my life because of my spinal cord and and knees
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and such cartilage damage etc you know so I'm never below on a scale of 0 through 10 I'm never below 2 or 3 for
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any length of time and with the tens I can have mostly I can
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get down to a one where there's still a little bit there but you know and and two or three just get get used to but in
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the days when it's a four or five six plus it really helps and I don't have to take a lot of medications on the
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medication I used to take all the time for the injuries started causing trouble of kidneys there's all those side effects so you get four medication use
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now there are dangers with active induction you don't want to put any near the heart you don't want to put it
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around the brain because it can do all kinds of bad things so one of the things
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related to that it's not electrical but is related to the active type interfaces
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is I tend to because of my background in
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teaching automotive and electrical and computer science and such I use the term induction a lot but it's transcranial
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magnetic stimulation sometimes I accidentally say transcranial magnetic induction and also known as TMS also
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known as repetitive transcranial magnetic stimulation of different purposes and what's really fascinating about this is it lets represents you can
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control which parts of the brain start and stop and such through a three-dimensional targeting name you can
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wave a wand and do all kinds of math stuff but now they've got three-dimensional ones where you can instead of having to cut out a piece of
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brain or drill a hole and stick an electrode in to like stop a seizure or something like that they can temporarily
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stop a part of the brain through this magnetic stimulation and you experience
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blindness you experience all kinds of things you can experience euphoria it's very fascinating the different effects
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so it's great experimentally but it's also turning out to have some potential treatment uses so these are all related
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to just some really fascinating aspects of the brain that tie in in some way to tr and we're gonna focus mostly on the
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BCI and EEG aspect but you can see how it can go really far afield and I've got lots of blog postings essays and such on
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my other websites about that if you're interested in going deeper into the rabbit hole so back to the OL MX thing
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this five port one I've I have not used
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the active port I have not used this on clients or
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research subjects for research subjects it requires well to use the active port
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definitely is going to require an institutional review board oversight because at that point you are trying to
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change something and there may be the potential risk for harm in the passive mode I have used it with clients just as
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a monitoring mode and such but I haven't used it a neurofeedback I do I have been
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debating going and getting certified in neurofeedback equipment application
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there's a number of options out there and I am seriously considering that I get some other things I got to wrap up
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first so probably won't happen anytime real soon but I am thinking about adding that to my list of certifications and
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such but in an experimental setting we would need institution review or oversight oversight we have partnerships
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with different universities through the RPG research organization and I'm hoping that by next year or the year after but
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maybe next year it's looking promising we might have that IRB oversight to do some controlled studies with EEG
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equipment hooked up to to recreational participants specifically music and role-playing games because that's our
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focused modalities but then you can extrapolate for other activities and
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trying to find a more objective measure of immersion and flow state experiences
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so in our list here let me make sure I'm not skipping over yeah so that will tie
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in with our development to talk about assessment tool development are where our development of the observed
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immersion scale correlated to other data so I have over the years and trying to
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optimize whatever the recreational activity is trying to figure out how to do it the best way under the best
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environmental controls to get the greatest effect in the shortest amount of time so again I like to use
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role-playing games and music well we'll talk about role-playing games as an example but you can extrapolate these techniques to other modalities so back
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in 2010 to 2012 I had more than a hundred participants and more than a dozen groups on every other week basis
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coming in and participating in role-playing games and they were different games and and I experimented with a lot of variables and I wasn't
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trying to change anybody's health or mental health need that I was focusing
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on participant feedback forms on their level of enjoyment their reports of a
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depth of immersion and whether or not they think they had a flow state experience those are the three main
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things I was trying to establish what the the bits the variables were that I
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could make those numbers go up and down on their on their self-report at the end of each session and this has evolved
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into what I'm now calling the observed immersion scale it still has a long ways to go peer review more experiments and
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such to establish validity and reliability but we're working towards
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that because the problem is as far as I know there are plenty of subjective
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reported immersion and flow state scales out there many from me high-tech sent me
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I and such but as far as I know we haven't been able to find an observationally one that's outside of
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the subject that can let you predict what the person's experience subjective
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experiences so again we want to know more about me Heights accept me and flow if you're recreational therapists whether you're a student or professional
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I am hoping you know every lots and lots and lots about flow since it's such a
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key part of doing rec therapy and it is what I in practice you know use as a
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measure the more flow state experiences they have the usually because that's an
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optimal state of learning the more effective our educational and therapeutic programs tend to be but if
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you want to know a lot lot more about immersion and you know flow and the
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foundation of positive psychology the system's model creativity these are the collected works they're in two books you
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can get these on Amazon they're not too expensive by me high Csikszentmihalyi the spelling is very funky because it's
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Hungarian that's mi H al Y for me hi Csikszentmihalyi si si K s ze NT mi h al
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why I me I'd Csikszentmihalyi you can get these two books and there elected works of me I sent me I you know
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yeah they're great a great collection so you want to learn a lot more about flow state and his theories and such
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definitely check that out he's not the only person on it but he is one of the kind of founders of flow state theory
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and he has in here a number of the tools they use in the results of self-reported
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immersion and flow state experiences I really want to try to find something
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more objective than that it's great slow and correlate the two that's fine but we
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want something more objective this helps us as practitioners therapists educators
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be able to on-the-fly adapt more quickly to our clients needs so time out the
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study back in 2010 2012 I started noticing that I could start reading
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people's body language and interaction both group and individual and kind of get an idea of whether and we all do
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this instinctively to degree right we're all social human creatures except for those of you have some impairments can
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kind of read if somebody's having a good time or not and if a group is having a good time or not and his rec therapist that's what we do right so I'd be
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observing this group in it and then I'd see what their scores were at the end I recorded all these sessions I have years
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and years and years of video and audio footage more than a decade's worth of
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game sessions and other activities drum circles and of course all these broadcasts have been doing for years and
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so I could go back through I could be in it while I'm running the game and facilitating and then I could go back and watch the videos outside of it so I
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wasn't having to juggle and really look at the details and started to be able to see patterns that started to better
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predict how high a score they would give and I was fiddling with the environment
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variables so some of the environment variables and all this is under RPG optimization on the RPG research comm
32:45
website included like room temperature right setting the room temperature to 78 or 62 versus the 68 to 72 typical range
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the lighting changing it from better lighting to softer lighting to harsh lighting to colorful lighting
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what-have-you noise you know ambient noise either the kind that can be tuned out easily or
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other more irritating noises or street noises going by all kinds of different
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stimuli and environment variables and was able to between all the different
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groups start being able to say okay this variable to this extreme typically across the group will lead to a
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one-point loss in participant enjoyment on their score and this will enhance so
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another area was size of the group so in role-playing gaming tabletop role-playing gaming the optimal size
33:34
which is generally what most role-playing gamers end up going to anyway most game masters are experienced end up settling with to about four or
33:41
five players in the game masters of the soul tater and then four or five players the table that's kind of the sweet spot
33:47
for a game that moves fast enough that the turn-taking isn't too long between each person's turn and we as rec
33:53
therapist you know we have that upper limit of eight or nine and for certain activities like that we don't want to get too large a group and as soon as you
33:59
start adding another participant so the sixth player the seventh player it's almost exponential increases in the
34:06
reduction of the satisfaction level of the players and their reports of their
34:12
immersion scale and their flow state experiences so you start getting up there and it gets harder and harder for them to have a deep immersion their
34:19
enjoyment is less and they're less like that flow state which means you're now having a less effective program if we're
34:24
trying to target your educational therapeutic and other goals and so you could repeat these techniques with any
34:31
modality so if with drum circles it's a different story we do drum circles with up to fifty people five zero people and
34:38
and it works fine right that's not the way drum circles work you don't have to
34:44
have the smaller group and in fact with drum circles I don't know what the infinite limit is I mean because we've
34:50
seen Evelyn Glennie do entire stadiums of drummers right
34:56
thousands of drummers is amazing and I have no idea what their flow state experiences are but but we do know a
35:02
drum circle of two or three you know it's a little harder to get into you can still get into a groove and such but
35:09
it's a little different you feel more on the spot special people who are new and you know aren't very advanced drummers
35:16
or it's their first time when you start to get a little bit larger group we start getting 4 5 6 7 8
35:21
10 12 people people aren't feeling like they stand out as much they can listen the others and they can experiment
35:27
without feeling as much embarrassment which means they can get to that point where they start dropping that
35:33
self-consciousness and worry and focus on the activity and enjoying it more focusing on the facility what we're kind
35:39
of the facilitator what activities are doing et cetera and then they have a
35:45
more enjoyable time so it's going to depend on the modality right the each one you're going to have different
35:50
numbers of participants that are going to affect efficacy so you can use these same techniques but it's really slow and
35:57
tedious and doesn't give you a response in that moment of I need to improve or
36:03
change something to make this better because I can see these clients are not having a good time now again most of us
36:09
can pick up people's overall cues body language facial expression etc although we work a lot with autism spectrum and
36:15
others Parkinson's etc where they have a very flat effect and you can't tell by
36:22
facial expression if they're enjoying themselves or not you might be able to tell a little bit by body language leaning forward where their eye contact
36:29
is they're responding to external stimuli but it is much harder to read
36:35
but the observed immersion scale tries to take all of these factors into account and try to more accurately
36:40
predict but even better would be the EEG type equipment that you could actually see if the when their brainwave patterns
36:46
are in a certain range now we don't have time to go over the five main brainwave
36:54
patterns that usually are tracked you
37:00
for these types of services for neuro feedback etc I do have as I add the
37:06
links there are links about five brain waves in its connection with flow state and such but the main ones are gamma
37:13
beta theta Alpha Delta there are different frequencies what they're
37:18
associated with etc you can check that out as I add those links you can go read a little bit more about that or you can
37:23
watch one of my researcher meetings that I just had a couple hours ago and I go into great depth in conversation with
37:29
that with some researchers and talk about it over on patreon.com forward slash RPG research that's behind a paywall
37:36
initially for donation because they're nonprofit but after a month or so that's made freely available to the general public mm-hmm
37:45
anyway with the observed immersion scale and assessment development you in order
37:50
to establish validity and reliability it's really helpful to have other tools that already have good numbers to see if
37:58
your new tool jives well with the other tools and especially if you're trying to
38:04
make something that's a little faster simpler easier you want to make sure you're not losing a lot of that validity and reliability so so having some so so
38:16
we already did in early development stages of the Oh is recording audio video of all the participants we have
38:23
the participant feedback forms and their scores and then we have the game master doing their observational notes etc both
38:31
during the session and then after watching the video but now with the oh is it starts asking very specific
38:37
questions to answer and rating it on a very specific scale and so now what's happening is we're now running it in
38:43
community settings weekly and I run the OS and then we see what their reports
38:48
are after and I'm trying to predict what their what their enjoyment levels are
38:53
going to be and it's getting pretty darn accurate in that if I say they had an OS
38:59
of seven then everybody's going to report a seven or higher on a scale of
39:05
well you know one through ten on their enjoyment level generally it's gonna be nines and tens and I'm still adjusting
39:12
the scale trying to figure out where it makes the most sense to have it initially we started with basically
39:19
about four or five kind of also a Likert type thing was the the general average enjoyment of a role-playing game but I'm
39:25
trying to better correlate it to the participant feedback forms for predictability so I might have to adjust
39:31
that scale further but it's it's a little bit tricky because I'm also trying to throw in the flow state and in
39:37
the community settings that we don't really have a flow state evaluation because it's too complex topic because some of our participants are young as
39:43
four or five years old who are using smiley faces frowny faces etc for their radium's so I guess little
39:48
bit trickier so right now generally an O is of seven for the group without
39:54
getting to individual asses generally predicts that all participants will
40:00
score a nine or ten on their enjoyment level an eight means everybody will
40:06
score a 10 or higher Isao higher because we've had participants from time to time especially we work with at-risk youth
40:13
knows you come from really rough environments who don't really have much experience with healthy leisure
40:19
lifestyle and recreational activities we'll say it's an 11 or 99 or a hundred
40:25
or a thousand but they'll often write best experience I've ever had in my life and edit and it's a tearjerker to hear
40:33
that from these kids who really struggle don't eat regularly abusive situations etc to be able to provide that to them
40:39
as wonderful and we've done this in school settings community settings and in private practice both with contracts
40:45
and and elsewhere and so whether or not
40:51
they those people have had a flow state experience we don't put them through the same questionnaires with our practice
40:57
side unless they're more mature more along the teenager and adult side and less with the at-risk youth we don't to
41:04
bog them down with with that kind of more research-oriented we where I just keep them moving forward with the programs and then seeing their their
41:11
productivity and how their behavior improves and all that on the research side we we do include questions to try
41:17
to determine if they had a flow state experiments when we're doing the more controlled research tip right now we're the OAS is that till
41:24
further adjustment a more peer review again seven if I observe and write I give a seven to the group that means
41:30
nobody rates it lower than a nine of their own experience if I give it an eight nobody rates it you know lower
41:36
than a tenth but where's the nine and ten on that scale right so I haven't that's why I'm talking about still
41:41
shifting it because nine is for when we do the research that everyone rates it
41:47
as a ten experience and everybody checks off in one way or another that they had not just deep immersion that they
41:54
believed they had a full flow state experience that everybody on that group had that on a limited basis at least had
42:01
one everybody at some time had at least one flow state experience and then the
42:06
OIS of ten is that everybody reports that they had extended flow State experience either multiple flow State
42:13
experiences or extended flow State experiences and if they're able to estimate the time look for the overlaps
42:19
but that's also subjective I'm wondering
42:24
and I'm hoping as I buy more of this ee opening AG equipment and then we get permission through IRB and such I want
42:31
to see if when those self reports of those nines and tens happen and and self reports of flow State happen if we can
42:38
see that in the EEG reports so there's there's a web there's some websites on
42:43
this about brain waves and flow State and so using that as a guide for the
42:51
configuration settings that we want to set up and remember we use electronic activities you know video games etc we
42:57
use tabletop activities that are verbal we use live-action activities that are physical and we do a lot of hybrids
43:03
in-between and then of course we do music activities as well my hope is some
43:09
day and it may be as soon as next year if I can find funding and and keep training the resources up that I need is
43:15
next year that we will do a controlled study of people wearing a bunch of EEG equipment while doing the activities and
43:23
then over time as they get used to the equipment and start tuning that sensory stimulation which it takes them out of
43:28
it we start to get some real hard data until then we've got various other areas
43:34
but that'll really help us dial in the OIS and now oh is well I'm focusing on role playing games should be applicable
43:41
to any activity that you're trying to rate immersion and the potential for
43:47
flow State it doesn't measure flow state it tries to measure their observed immersion so here's part of how I tested
43:54
I think it talked about in a previous show though we do an activity and I think they're getting up around a six
44:00
I will go walk past the table and see if they look up at me if anybody looks up
44:06
starting to get up around a seven I'll go start opening closing doors kind of noisily make
44:11
noises see if people are distracted by that even for a flicker in a second the ultimate test that they're likely to be
44:18
there so immerse that they're likely being flow state is I'll literally take like a big heavy book textbook drop it
44:25
on the floor somewhere or the other carpet or tile or whatever piles louder do the little boom and there are
44:32
participants in these role-playing game activities who the entire group will not look up they will be so immersed in the
44:37
activity nobody jumps nobody looks not even a darting of the eyes occurs and again the community sayings we don't
44:43
have recording but others we do and they completely tune out that extra mule i
44:49
they are so in the group collective bubble of that activity so immersed so
44:55
engrossed that it seems very likely they're having a flow state experience
45:00
and in talking to them it does indeed sound like that subjectively they were having it at that time and so that's
45:06
putting putting the OIS up around a nine and an OS to ten is kind of a theoretical construct based on more
45:14
research we need to do I haven't been able to test in oh is of ten yet until
45:20
we can do more of these established control experiments with the EEG so it's kind of a placeholder everything might
45:26
shift a point or two one way or the other it's gone through a number of shifts over the years this is kind of where it's at right now so this is all
45:33
related to the discussion of assessment tools and I had a wonderful conversation
45:38
at the atra 2019 in Reno Nevada last month which we talked about a little bit with Thomas Blasco from Idol Arbor that
45:48
is one of the large publishers of TR books many of you will already be
45:54
familiar with if you've been through any of the formal training programs etc one
46:00
of the more common ones that I love to reference is the red book that's what we call it assessment tools for
46:07
recreational therapy related fields this is the latest edition fourth edition I'm not aware of a fifth edition yet by idle
46:13
Arbor that's ID yll space ARB Oh our and it's Joan Burlingame and Thomas M
46:20
Belasco so wonderful conversation with Thomas a Tatra he was very excited to hear that we were
46:26
trying to work on new scales and so we had a number of lengthy conversations and he hopes that in the future we'll
46:33
consider publishing through their resources well we'll see I do have my own publishing organization I've been
46:38
involved with publishing for a few decades on and off working in different fields but he had highly recommended in
46:44
our efforts to do this because I've been frustrated trying to find a number of scales that don't seem to be either
46:50
properly developed or to exist at all like the oh is he said in these efforts
46:56
I ran by him what we were doing and how we were doing it and he thought we were totally on the right track that that's
47:01
exactly the approach they would take to develop the same scale so that was wonderful to get that feedback from
47:07
somebody so knowledgeable about that kind of development very very thankful for that but he had a book there I
47:14
hadn't seen before and it's been around for a little while but I just somehow had never come across it and I posted
47:20
repeatedly on the atra Oklahoma State email list asking for more assessment
47:26
tools and such but looks like this is published in 2012 behind l'arbre so the Green Book now similar style by Mounier
47:35
G ragab I'm sorry for mispronouncing that MOU NIR G Raghib a RG h-e-b PhD
47:45
it's measurement for leisure services and leisure studies this has a few more scales in it but what it really has
47:53
that's useful so the red book talks about how to assess the reliability and
48:00
validity of assessment tools how to test that in a high level of how to develop
48:05
an assessment tool and then it just mostly goes into lots and lots of assessment tools and you can see this is
48:11
I have this highly bookmarked from the many assessment tools we've looked at and many of which we use some of which
48:18
we've had to reject because they've either had no they do not have good reliable and until Italy either from the
48:24
book saying so or from our own testing but there's a lot of great ones in that
48:29
book if you need a collection if you had to have a single collection of assessment tools for rec therapy as far
48:34
as I know this is as good as it gets but this is a nice kind of add-on to it because it has some additional tools but
48:41
but critically to what we're doing and talking about here and in our other research sessions is methods used to
48:48
construct measurements now I have I've only got this last week I'm juggling some other stuff I'm doing some social
48:54
gerontology work right now and everything some kind of I'm loaded so I don't know when I'm gonna have time to
49:00
read through this but I'm really excited looking forward to going through this so
49:06
there's a number of assessment tools we talked about this at a high level and it looks like we're already running up on
49:12
our time here about assessment tools which this is taught in a whole bunch of
49:18
textbooks the activity analysis step right it's part of a pie let's not get
49:25
into the API pay a pie discussion from last week you know so here's another client assessment book this is from
49:33
Norma J Stumbo we've got this series from Heather our Porter which is a an
49:40
expansion of what we call the blue book before but now it's a series of blueish green books recreational therapy in the
49:45
international classification of functioning disability and health court of the World Health Organization ICF ICD codes recreation therapy basics
49:54
techniques and interventions recreational therapy for specific conditions there's one other here that's
50:01
missing from the stack there does let me grab that luckily I went Wireless today mm-hmm
50:06
so these are all recommended and then of course the cookbook Siang else same
50:15
thing over here protocol development okay that's enough of the assessment
50:22
activity analysis related books so then we have eighth edition from David R
50:28
Austin this just came out recently he specifically reached out to me when I posted on the atra email list suggesting
50:35
a look at this so 2018 from Sagamore venture big heavy heavy book it's
50:41
softcover but it is heavy its 580 pages the read books SEP 7 under or so therapy
50:46
recreation processes and techniques evidence-based recreational therapy all right and then of course the
50:52
cookbook therapeutic recreation program design procedures principles and
50:58
procedures normal stumble care on Peterson so all of these in some way
51:03
reference part of a PI process and an assessment in a key part of a yoda part
51:09
of the CTRs the activity analysis phase then you have task analysis etc task
51:16
sounds pretty straightforward that's not a problem there's a real problem with activity analysis and therapeutic
51:22
recreation I would really want to get some of you professionals with more experience I've been in the industry for
51:27
about 15 years TR industry but there are many of you with far more experience and really want to get you on the show
51:33
commenting about this again I've had dialogue with a number of people through the at row Oklahoma State email
51:40
discussion list a number of people at the atra conference this fall and I've
51:45
talked to people over the years because as far as I can tell there is no good
51:52
activity analysis tool out there so there are what is taught to everybody so
52:01
let me start here I think it's in the cookbook here as part of the process I
52:07
forget which page I've had that pulled this out so many times okay tibialis is
52:12
chapter 7 176 in the cookbook and right this is part of what every rec therapist
52:18
is trained and you know and it's a critical part of doing recreation
52:24
therapy in theory if we're doing this wrong everything else we're doing is gonna be wrong and it's only gonna be up
52:30
to the individual to do it right if we're if our foundation is flawed that's
52:37
a problem and this is a key part of that foundation activities should be selected
52:42
carefully according to the behavioral requirements of participants and the activities ability to contribute to the
52:47
achievement of outcomes carefully selected now rec therapists are highly
52:54
intuitive for the most part I don't know what the union assessments in MMPR CI
52:59
and other assessments are for rec therapist but clearly there's a large part for the to go into his career of intuitive and
53:07
Pathak aspect and so we become for the most part better and better it is hoped
53:13
at seeing when a modality is working and not working for our clients so that's
53:20
kind of a gut feel thing and it's not that that's useless but it's not good for research in hard science and
53:27
publication and it means a lack of consistency of treatment for our clients
53:32
which as B to be respected as a good professional industry we've got to have
53:39
some way to have some level of consistent quality delivery of services I think it's a big part of why TR gets
53:47
beat up so much it's because we're we have some foundational stuff that's still in trouble
53:52
we still have and rest and again please yeah I'm bringing this up too for us to have a conversation as a community so
53:58
that we can hopefully all be more aware and hopefully improve this as a community so I had been using these
54:08
examples throughout these books of anak T there's an activity analysis process so activity analysis client assessment
54:15
then you decide the intervention programs so I would have a spreadsheet full of data from all the assessment
54:21
stuff from an intake client and and know where their functioning was where it wasn't and what our targeted goals were
54:27
and you know so part of the process is analyze the activity is normally engaged
54:33
in the general populace when completing the activity analysis rating form write the activities compared to all other
54:38
activities out there that requires a broad tool set of knowledge already man everybody's tool set is different
54:46
analyze the activity without regard for any specific disability group per se then analyze the activity with regard to
54:54
the minimal level of skills required for basic successful participation now doing this myself in private practice and
55:01
doing it elsewhere it was not a problem as an individual therapist there was I
55:06
didn't have to worry about inter-rater reliability issues this from what I can
55:12
tell completely breaks down on iterator reliability across the board and the more you get
55:18
away from CTRs level training the worse that gets that's to be expected but even those who all have the same training in
55:25
towards the sea TRS don't all have the same activity training so part of why I
55:30
went into TR when I went into retirement I was 33 because I did the whole tech thing into the silicone delegating and I
55:35
had that option of that luxury to look at a new career after my kids moved out you know grew up and moved out just this
55:41
year finally I have a very diverse tool
55:47
belt of recreational activities I've always been a very high-energy person
55:52
you know even now with all my injuries and ailments and such that have happened to me I'm still a lot higher energy
56:00
Everage person even with these things slowing me down and and and and putting on weight and all that from the
56:06
medication you know I do a lot and I have a low threshold for boorda that's
56:12
the ADHD part certainly so I've always want to be engaged in very active activities I don't like being passive I
56:18
like being actively engaged so I've developed a huge array of hobbies and interests throughout my lifespan so I
56:27
went to tr I wasn't thinking to role playing games initially my testing of all these other things I you know I do i do hiking and survivalism and all kinds
56:35
of crafts and hobbies and motorcycle rides and I'm an automotive background USB ASE certified you know all kinds of
56:43
Sciences music I played more than 20 instruments wide tool belt right so I
56:48
have a lot of experiences to compare and contrast when I do the rating on the activity analysis so when when I would
56:54
do an activity analysis by myself to figure out what activity was best and then looked at the variables between the
56:59
two spreadsheets and do a cross analysis matrix I could get a pretty good picture of this activity done this way for this
57:06
client is gonna get the ideal optimal goals met I've took the exact same
57:12
activity Alice's that other people have given me over the years from universities and other practices from
57:18
facilities as well as my own applied it to others who have been through the
57:25
training and such and where it holds up on a
57:30
per question basis these activities seem to do pretty well if just a checkbox is
57:36
required if you're not using a Likert or other variable scale type if it's binary
57:41
options for the most part the inter-rater reliability is pretty darn consistent so for example what body
57:48
parts are required that's pretty consistent what types of movement for the activities are required that's
57:54
pretty consistent what are the primary sense is required more junior therapists
58:00
kind of forget some of the other senses there once they've had a little bit experience they're usually pretty consistent about that social aspects of
58:09
looking at the Avedon interaction patterns which we've talked about before the minimum maximum number of people
58:16
that's a little bit more variable but these still are fairly close there are point eight or better coefficient in
58:22
inter-rater reliability and as far as our Peas Richards concerned as far as I'm concerned the gold standard that we
58:28
always want to try to be at a minimum at is point eight or higher and below point
58:34
eight still might be useful it's certainly a promising indicator point six two point eight is not useless that's still pretty good information but
58:41
it needs to be improved below point six you know point four two point six is well there needs to be more research
58:47
done but there's definitely something there and then point two two point four is well there's something but we got a
58:53
long ways to go before we understand and then below point two is basically random you might as a flip a coin and sadly you
58:59
see published all the time on PBS and YouTube and NPR and air and people all
59:05
excited because this research study shows a point three or point four correlation to this effect in this
59:10
effect you know this causality etc and this correlation and that is not strong
59:17
at all and we see a lot of people and and the beautiful thing about the red
59:22
book love this about the red book is it takes time to tell you and and tell you
59:28
how they did it and how much and what the sample sizes were the N size etc what the coefficients are so for example
59:36
one of the ones we like thinks the LR let's see get the right okay that's the
59:43
whole leisure battery there's the LMS let's look at the numbers I'm there yeah let's go through the LMS so leisure
59:49
motivation scale and has a nice summary page or two that you can just quickly jump to before going deeper so suggested
59:56
levels as far as level of functioning they need to have an IQ of a adapted IQ of 80 or above mental age 12 years above
1:00:02
Rancho Los Amigos level of 7 or above reality orientation level of mild snow orientation disability this lets us know
1:00:10
which clients are potentially appropriate Oh interestingly enough this is Jacob beard and Mona ragab the guy
1:00:17
who does the green book tells you the time needed to administer on average etc
1:00:23
how and how much to score at etc and then the reliability validity has a number of sub scales so under the
1:00:30
intellectual subscales and and cross-referenced 0.9 coefficient under
1:00:38
social and social 0.92 comp c mattis 3.9
1:00:43
one stimulus appointed 0.9 that's a strongly indicated a tool but we got a
1:00:51
look at the sample sizes things like that because some of the sample sizes in here say like 20 participants as opposed
1:00:57
to 120 participants or sometimes they've done it over years and testing and retesting and it's been consistent over
1:01:03
all those years and say have a huge aggregate so that's a better tool than one that has had one study of 20
1:01:08
participants it is wonderful that this book gives you that info see you can make an informed decision as a
1:01:14
professional on which tools you want to use in your practice well there is no
1:01:22
activity analysis as far as I can find I haven't gone through the let's take a look at the green book but I don't think
1:01:27
they're saying in the green book there's nothing in the red book and I've gone through all the other books who do have activity analysis templates but none of
1:01:34
them are complete they're all partials I've been emailed a few examples from people's professions that either they've
1:01:40
done themselves or their facility provides and they're all kind of partial
1:01:45
even the ones that are supposed to be complete really aren't very complete because for example we do modalities
1:01:50
like music and role-playing and the assessment tools don't include ways to determine which musical
1:01:57
instrument or musical activity would be appropriate for this person's functioning there's no questions in
1:02:03
their assessment tool that would address that to give us an idea of which would be best give us a general level from the
1:02:09
other questions but helping us differentiate with that modality it's kind of lacking and it's just a way of
1:02:15
phrasing the questions and making sure it's all-inclusive with role-playing gaming way off there's a lot of stuff
1:02:20
that's not asked that would help us determine which role-playing game would be the best one to use with the
1:02:25
population now we know from decades of experience I've been involved with role-playing games since 1977 that No
1:02:31
thank you evil was totally appropriate for ages five on up of all kinds of levels of functioning and that vampire
1:02:36
the masquerade would not be appropriate for five-year-olds pretty easy a lot of people could Intuit that pretty quickly
1:02:42
but there's no assessment tool that you could do an activity analysis on all the different role-playing games out there
1:02:48
or just between those two between oh thank you evil you could do the same you would do an activity assessment on both
1:02:54
and you'd get the exact same results and so according to your matrix if you were to put this in a computer program you
1:03:00
would be saying five-year-olds are okay to play vampire the masquerade girl I think the only it would show up is maybe
1:03:06
a reading level would be problematic but that's about it so please your involvement leader in
1:03:16
motivation you know I'm just doing a quick look here in the Green Book see if there's anything about activity analysis since again I haven't had time to read
1:03:23
this but this is a real hot-button topic because again this is so fundamental to
1:03:28
what we do nope nothing our activity analysis in the green book so where it is covered is
1:03:35
again in the cookbook this is where lots of people are taught that David Austin
1:03:40
had recommended I take a look at his I need to put a post-it in there because he has a whole little section it's not a
1:03:48
lengthy section but he does go into it and provide some examples there it is
1:03:53
2:17 through to 20 and then 347 to 349
1:03:58
so 217 and I've got it folded over well
1:04:04
these are all great questions but it's not really an
1:04:09
activity analysis form it's it's it's the interview questions that you would want to ask and put into a form but it's
1:04:15
not complete right and it's some great questions and we take all that in account part of the process of
1:04:21
developing a tool is find all available resources and start huge and then narrow it down through redundancy and other
1:04:27
things and rephrasing the questions finding what works best on a question by question basis and then one or two of
1:04:34
these other books also has activity analysis in it but none of them are complete and this is everything and
1:04:41
talking to everybody on the ATRA list the at rekon forints asking all around now for about six months I've been
1:04:46
asking around this is all I can find and then the emails and it's sent to me this
1:04:52
is a core part of what TR is about and we don't have a standardized well tested
1:04:58
one or more tools with any kind of
1:05:03
established reliability even just tested anywhere what I can find is we go to
1:05:09
academia.edu and research gate net a number just in the last few years a number of people have done Studies on
1:05:15
recreation therapy activity analysis and how incredibly flawed they are and and I
1:05:21
you know and and I already found that again the binary question ones tend to have a good inter-rater reliability of
1:05:27
0.8 0.9 or better but everything else I had people rating on a scale of 1 to 5
1:05:33
so like simple to complex quiet to loud etc anyway from a 1 to a 5 I might as
1:05:41
well flipped a coin the the coefficient was effectively 0 for just a number of
1:05:51
different disciplines when we get to just CTRs trained it was still often
1:05:56
based on their age and experience and their tool set of activities still at
1:06:02
point 2 point 4 the best I've seen was 0.6 and that's it
1:06:08
that's not good that's not good at all so I have been having our researchers
1:06:13
and I work together we are trying to put together a decent activity analysis to
1:06:20
that's quite lengthy right now Oh we'll worry about shortening it when we've got it working properly and we've covered
1:06:25
all the bases and then we'll worry about trying to keep it above a point eight or about higher but by shortening the
1:06:31
duration and complexity of it if you know more please comment please reach
1:06:39
out to TR talk show at gmail.com comment on the video etc if you have resources
1:06:44
with links to point two that you think would be helpful please please please share that and we will gladly share that
1:06:50
with others through our Twitter and Facebook etc going over here a bit and I'm gonna keep bringing this up because
1:06:56
it's such a foundational issue there it'll Cu let me make sure I didn't miss
1:07:01
a topic completely so some of the things we all other assessment tools we're looking at our genre interest
1:07:06
assessments so let's say you won't interested in seeing people like to read well you need to know what genre is they're gonna like and you might want to
1:07:12
know what kind of story style they like so a genre interest assessment tool is
1:07:17
another tool we've been developing it's basically just a long list of different genres that are available out there and
1:07:23
it's a long one it's it it includes like biblical and all these other things we want it to be as inclusive as possible
1:07:29
right now it's too long we're hoping we can shorten it without hurting its efficacy but right now its efficacy is
1:07:35
high if people say they like this and they rate how much they like it you know
1:07:41
on a Likert scale then we know which books to recommend or not recommend to
1:07:46
them as far as from a genre perspective but then there is reading style or play style and there are some tools out there
1:07:54
for play style we've been trying to find better ones for role-playing game style
1:07:59
because that's a more complex activity than most role-playing games are such a
1:08:05
complex multivariate activity that's part of the challenge with doing research in that field but it's also I like that challenge so we've also been
1:08:13
working on there's three semi established fairly well-established play style assessment tools out there
1:08:18
they're all for video games we've been trying to expand and adjust that to
1:08:23
include video versions of role-playing games tabletop versions live-action versions of hybrids so we get an idea of
1:08:30
people's different play style making sure it's applicable across all of them we think that's gonna make a better tool and that play style
1:08:36
assessment well right now it's geared toward role-playing gaming should be able to tell you about other activities there are general play style assessment
1:08:45
tools out there there's a number of them and some are better than others but if you're trying to figure out what is the
1:08:51
right video game or the right role-playing game or the right live
1:08:56
action game for a participant as far as their individual styles so we already
1:09:01
talked about an activity analysis that tells us what's appropriate to the activity for their level of function
1:09:07
now we're going more individual right let's say we go from a broader social
1:09:13
phobia type thing to now we're going to a more specific that individuals personal tastes and preferences has
1:09:20
nothing to do with functional level it's just personal tastes and preferences well that's what the play style
1:09:26
assessment so some people if you use the Bartle taxonomy which is heavily flawed but as easy for people to understand you
1:09:32
would have people who are explorers people who are socializers people who are puzzle solvers and people who are
1:09:38
into combat they call killers but murder almost whatever if they really like the combat in the action
1:09:43
those are quadrants that can from the assessment questions you can kind of figure out where they're leaning more
1:09:48
towards and what they'll enjoy more because if you put somebody who loves to pulp solve puzzles into just a social
1:09:56
game they may and then there aren't really puzzles associated with that social interaction the sign language for
1:10:02
boring um they're not really gonna be that well engaged and you're gonna
1:10:08
you're you're you're gonna have to be more trial and error right we want to reduce the trial and error of TR
1:10:13
practice as much as possible here so if you have a place a good effective play style assessment tool now you know much
1:10:20
more specifically which game we could say whether Dungeons and Dragons versus Doctor Who between their genre interest
1:10:28
and their play style interest is going to be more appropriate when engaging them so these are other tools we're
1:10:34
working on among others there's there's some others out there but that that's some examples so I hope that this
1:10:39
conversation well right now monologue but I hope it will trigger a conversation you found helpful if you're
1:10:45
student I hope you find that you learned a lot of new things if you're experienced professional and in
1:10:52
the TR field or other fields that you found these thought-provoking just
1:10:59
things and if you have experiences that you either disagree please civilly wonderfully welcome
1:11:05
disagreement suggestions for improvement resources etc please post them to the
1:11:11
YouTube or contact ER doc show at gmail.com so that's it for episode 4 we had a pretty long episode today well
1:11:20
that's weird that okay so we're gonna go ahead and wrap it up this is episode 4
1:11:25
again October 8 2019 we'll be back again next Tuesday 1 to 2 p.m. Pacific time
1:11:31
again TR talk-show calm for the links to our YouTube channel until we get to a thousand views of our videos and such we
1:11:41
can't have a custom YouTube channel URL they change that whole process so do please like the video whether you
1:11:47
disagree or not that's okay but but if you at least like that we're doing this
1:11:52
talk show whether or not you agree with the subject matter or opinions expressed herein please like it and help spread
1:11:58
the word and let's get the views up then we'll be able to make it youtube.com /tr talk show or something like that that's
1:12:04
much easier to get to till then you got to go TR talk show com go to livestream and then there's a linking click there
1:12:10
to get to the channel because otherwise the channel is a really long random string so I welcome your feedback and
1:12:17
comments and again if you're interested in being a guest who wants to cover any of these topics or other topics you want
1:12:23
to talk about your upcoming book your upcoming research things in your own practice field since they're fewer there
1:12:30
aren't as many researchers and tiaras we'd like but there's lots of practitioners so if you have evidence-based practice things you want
1:12:36
to discuss wonderful we'd love to have you on the show we're all about
1:12:41
spreading the word about so we are happy to advocate and promote things that are related to TR and help spread the word
1:12:48
but we're also going to be critical write as much as I'm a fan of TR is you can hear I've also have my criticisms
1:12:54
and worries because I want to see the TR industry flourish and it looks like
1:13:00
watching 15 years it feels like the last few years it's been floundering it seemed like it was really really doing
1:13:06
well and now it feels like it's occupational therapy is eating our lunch I think there have been more organized
1:13:12
they I think they've been doing a better job on marketing and lobbying and I'm
1:13:17
really worried with the recent expansion into recreation as part of tea about the
1:13:22
harm that's happening to TR and that we're not getting our act together so you know all these things advocacy
1:13:29
research evidence and practice various practice problems social issues
1:13:34
biopsychosocial old spiritual etc all relevant topics would love to have you on the show either commenting or as a
1:13:41
guest and I am looking for one or more co-hosts so that we can not have a
1:13:46
monologue and have a more interesting do dialogue of multiple people experts in
1:13:52
the field from different aspects of TR industry so please do email TR talk show
1:13:58
at gmail.com if you're interested in that wherever you may be be well and happy therapeutic recreation
1:14:23
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