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These therapists involve patients on an inpatient unit in group games, crafts, cooking, playing with pet animals, and other activities to help them socialize, regain some control, and enjoy the physical and emotional value of recreation despite their new disabilities. This therapy sets the tone for outpatient fitness and recreational activities that also foster socialization. In addition, the recreational therapist joins with the physical and occupational therapists to teach patients how to reintegrate into the home and into the community. The first demanding trip to a supermarket or restaurant in a wheelchair is often remembered by newly disabled people. The therapists pave the way for solving problems that range from fatigue to opening the doors of a store, and to facing other imposing physical and psychological challenges.

An increase in physical activity, whether by a fitness program, recreation or competitive sports, seems likely to improve the disabled person's quality of life.176 Many opportunities are available to people with physical disabilities. For example, advances in equipment design for wheelchairs makes racing, basketball, and tennis possible. The same holds for snow skiing.177,178 Over 200 local, national and international organizations have developed rules and equipment for at least 75 sports and recreational activities that take into account a range of functional abilities.21 The United States Adaptive Recreation Center in Bear Lake, CA (www.usarc.org) is one of many services to provide information and training in sports activities. Self-esteem and problem-solving skills may grow as a disabled person learns a martial art or engages in outdoor experiential educational pursuits such as traversing a ropes course 30 feet above the ground.

More research is needed to design exercise and recreational programs for younger and older people with neurologic diseases. These studies should assess both useful and possibly injurious effects. Outcome measures may include medical morbidity such as pressure sores, blood pressure, and lipid levels, endurance for instrumental ADLs, leisure-time physical activity, and quality of life, with follow up through mid and late life. Sports and exercise activities could easily be incorporated into subacute and chronic neurologic rehabilitation programs to enhance and maintain functional recovery and to build self-esteem.

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