Members Article – Recreation and Leisure: a Motivator for Life’

Renee Rizzo (Senior Diversional Therapist) Liverpool Brain Injury Rehabilitation Unit

Working in a speciality clinical area brings about many challenges and rewards both professionally and personally. Being recognised by your peers as an expert and leader in your field gives one a great sense of accomplishment. Earlier this year I was invited to be one of 4 keynote speakers at the 2017 NSW Transitional Living Program Forum.

The theme of the forum “Working with Clients with Challenging Behaviour: Learning – Sharing – Doing” enabled me to share my expertise as a Diversional Therapist and demonstrate the contribution leisure and recreation has towards supporting clients with challenging behaviour or behaviours of concern.

The NSW Brain Injury Rehabilitation program provides a continuum of specialist clinical services for children, young people and adults of working age with a hospital admission for a significant traumatic brain injury (TBI). There are 15 BIRPs located in NSW Local Health Districts (LHDs) for the population of NSW and ACT. Seven are within metropolitan Sydney and Newcastle and eight are located in regional NSW. The transitional living programs (TLPs) are a short term live-in service that offers an intensive rehabilitation program for clients requiring further intervention to achieve identified goals with a focus on increasing independent living skills; community participation and facilitating adjustment to TBI. There are 8 TLPs across NSW operating Monday to Friday with weekend leave that encourages time with family and friends. Therapy and services are provided as close to home as possible, transition is a discrete step in the recovery and rehabilitation continuum when moving from inpatient to non-inpatient services and home. The TLP enables clients:
– to practice skills required to live as safely and independently as possible through individual and group therapy,
– additional time to understand changes that occur following a brain injury and
– an opportunity to mix with people with similar experiences.

My presentation was geared towards the Living Skills Educators (LSEs) that work within the TLPs. There are no Diversional Therapy positions in any of the regional services however the LSEs may be responsible for implementing some leisure and recreation based activities as part of the client’s rehabilitation goals. Amongst the audience were other allied health professionals, service coordinators and representatives from the NSW Agency for Clinical Innovation and icare lifetime care (Lifetime Care and Support Scheme) which gave a great platform to highlight the importance of Diversional Therapy. The event was held in Goulburn hosted by Southern Area Health Service, where one of the TLPs is located.

The focus of the presentation was to describe and increase participants understanding of:
– Leisure and recreation and its relationship to the WHOs International Classification of Functioning
– Benefits of leisure
– Barriers to independent leisure involvement
– Leisure partners
– Functional Intervention Programs
– Leisure Education Programs
– Recreation Participation Programs
– Leisure behaviour
– Client autonomy and control
– Activity analysis, selection, modification, implementation and evaluation
– Leisure resources available for use by LSEs

From a Diversional Therapy perspective, some strategies employed to minimise behaviours of concern include:
– Know the clients limits/triggers
– Be aware of client characteristics
– Allow the client to try the activity unassisted
– Modify the environment where able
– Introduce rest breaks
– Offer desirable choices
– Implement opportunity for success
– Provide positive feedback
– Allowing extra time to complete the step or activity
– Limit activity duration based on the person’s mood or cognitive ability
– Allow personal space when safe to do so
– Choose activities that are less demanding

Consequently, I was able to confirm the role leisure and recreation plays in supporting clients outcomes related to social inclusion, adjustment to injury, identity and independence (also modified independence).

In the afternoon, each of the speakers facilitated a ‘knowledge cafe’ with small groups of delegates to discuss a case study. This allowed a more intimate opportunity to demonstrate the specific skill set and knowledge base of Diversional Therapists. During this time I was also able give advice to individual delegates regarding the goals of current clients and encourage ongoing PD to up skill workers in the provision of leisure and recreation programs.

More information on the Brain Injury Rehabilitation Network and the types of programs delivered are available at

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