The Power of Activity in
Rehabilitation
Victoria Schindler, PhD, OTR, BCMH, FAOTA
Richard Stockton College of NJ
New Jersey Occupational Therapy Association
Annual Conference
October 1, 2011
Choose an activity to do for 15
minutes. It should be one that
is rewarding, relaxing and/or
would elevate your mood.
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Crossword Puzzle
Read a Newsletter
Drawing
Listen to Music
Go for a Walk
Talk with a Friend
Meditate
Take a Nap
Any other Activity of your Choice
Take a Handout
Use the Handout to Select
the words that describe the
way you are thinking and
feeling right NOW
Take a Handout
Select the words that
describe the way you
were thinking and feeling
during the activity
Handout
Compare the two lists and
note your findings
Power of Activity in
Rehabilitation - Agenda
• Neurological Underpinnings of
Engagement in Positive Activity
• Psychological Aspects of Activity
• FLOW
• Neuroplasticity of the Brain
• How to Develop Meaningful Activity
• Resistance to Treatment with Activity
Neurological Underpinnings of
Engagement in Positive Activity
• Imaging scans (e.g., PET Scans, MRI and
EEGs).
• Activities as REWARDING
• Activities promoting RELAXATION
• Activities that ELEVATE MOOD
The Brain’s Reward Center
• Mesocorticolimbic
system
– Cortex, Midbrain,
Limbic system
• Distinguishes
activities that are
pleasurable and
should be repeated
from those which
are harmful and
should be avoided
Neurological Basis of Activity
• Primary
Neurotransmitters in
the Brain’s reward
system
– Dopamine
– Glutamate
• The brain’s reward
system is activated
and dopamine and
glutamate are
increased during
times we are engaged
in positive activity
Activities activating the brain’s
reward system
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Music
Eating
Sex
Engaging in positive
conversation
• Fine arts
– Drawing, Painting, Sculpting
• Sports
– Stimulate reticular receptors
– Stimulate vestibular receptors
• Humor
– Physiological Responses
• Blood pressure, heart
rate, respiration
– Increased Immune
System Responses
– Neurological Responses
• Alpha, theta and delta
wave patterns
Neurological Basis - Relaxation
• Characteristics of Activity that Promote the
Relaxation Response – Herbert Benson
– Performed in quiet environment
– Enhances one’s ability to concentrate and
focus inwardly on the task at hand
– Enhances one’s ability to disregard everyday
thoughts and worries
– Requires focused attention on a repetitive
mental stimulus
– Progressive relaxation
– Visualization
– Guided imagery
– Crafts
– Yoga
– Meditation
– Art
– Music
• “the awareness that emerges by paying
attention on purpose, in the present
moment, and non-judgmentally, to the
unfolding of experience, moment-bymoment…with an affectionate,
compassionate quality within the
attending, a sense of openhearted, friendly
presence”
–http//www.psych.stanford.edu/pgoldin/Buddhism/MBSR2003_Kabat-Zinn.pdf
MINDFULNESS
• Mindfulness Training
– Meditation
– Become aware of one’s thoughts
• Negative, judgmental, self-destructive thoughts
• Catch these thoughts
• Challenge their validity
• Release them
Elevate Mood
• Neural activity in the left hemisphere
has been linked to positive mood,
feelings of well-being and emotional
stability
• PET Scans and MRIs have shown that
people with depression have a
marked decrease of activity and blood
flow in the left hemisphere
Elevate Mood
• Activities that
promote blood flow
and neural activity
in the left
hemisphere have
been shown to
alleviate feelings of
depression
Neurological Response – Elevate
Mood
• The left hemisphere is responsible for
language skills, math skills, categorization
skills, and sequencing skills
– Example of activities
• Word finding puzzles, crossword puzzles
• Jewelry making, cooking, crafts
• Cognitive Behavioral
Frame of Reference
“An
optimal experience in which
people feel intense pleasure and
satisfaction while deeply engaged
in desired activity”
-Csikszentmihalyi
FLOW
• A term that describes the positive feeling
we have when we are absorbed in a
pleasurable activity
• Totally immersed in the present moment
• Lose sense of time
• Lose sense of fear or anxiety; worries fade
• Participating in the activity is its own
reward
Csikszentmihalyi, M. (1997)
Research on FLOW
• Experience Sampling
Method
– Signal participants at random
times
– Doing, thinking, alone, or
with others
– Rate on various numeric
scales
• Happiness
• Concentration
• Motivation
• Self-esteem
– Can follow changes
in mood
Csikszentmihalyi, M. (1997)
Experiences with FLOW
• Female Dx’d with Chronic SCZ;
hospitalized for over 10 years
• Individuals diagnosed with Depression
• Quality of Life
• Increasing Flow
Activities that promote FLOW
• Sports and exercise
• Crafts - Knitting and
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needlepoint
Gardening
Hiking
Cooking
Play a musical instrument
Socializing
Active Leisure as opposed
to Passive Leisure
Csikszentmihalyi, M. (1997)
Developing Flow
• Develop curiosity and
interest
– In routine tasks
– In new tasks and
activities
• Reevaluate our present
tasks and routines
– Are they really
necessary?
– Control time carefully
• Control psychic energy
– Control concentration
– Control our thoughts
Neuroplasticity
• The brain’s ability to change – for better
or worse – throughout the life span
• Process involves forming neuronal
connections in response to information
derived from experiences in the
environment, sensory stimulation, and
normal development.
Dodge, 2007; McCormack, 2009; Merzenich, 2001; Nudo, 2008
Neuroplasticity
• The brain’s ability to grow and change into
old age as long as it is engaged in
meaningful occupations.
Christiansen and Baum, 2005; McCormack, 2009.
What are the characteristics of
activity that make it meaningful?
• Neurological
– Promote Reward
– Promote Relaxation
– Elevate Mood
• Psychological
– FLOW
How to Develop Meaningful Activity
• Requires both physical and mental involvement
• Defined according to each individual; cannot be
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defined by one individual for another individual
Elicits choice
Facilitates development
Must have meaning for the client
Must be related to the client’s goals
Must be of interest to the client
How do we Develop FLOW in
Activities?
• Include the client in the
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selection of activities
Help them to identify
activities they enjoy
Teach our clients to become
absorbed in activity
Teach our clients to control
their concentration thereby
decreasing distracting
thoughts
Use the flow experience to
manage anxiety, anger, and
depression
Resistance to Engagement in
Activity
• Create an environment in which choices
can be made
• Choices range from small to large
concerns
• Client will reject invitations to choose
• Staff must not despair and stop caring
• Staff should model hope and continue to
offer options
• Provide opportunity to fail and to try again
Select the words that describe
the way you were thinking and
feeling during the activity
• What about the activity led to your
thoughts and feelings during the activity?
• What about this is universal?
• What about this is unique to you?
Select the words that describe
the way you are thinking and
feeling right NOW
• What were the components of the activity
that produced this “after” effect
• How does this relate to the psychological
and neurological effects of activity on the
brain?
SUMMARY
• How can you use this
information to influence the
way you create and/or choose
activities in your practice?
Thank You very much for
your attention!
References – Psychological Aspects
of Activity
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