Re-Creative Resources
By Kimberly Grandal, BA, CTRS, ACC, Executive Director
Kimberly Grandal,

Kimberly Grandal, Founder
and Executive Director of Re-
Creative Resources, Inc., is a
strong advocate for the field
of Therapeutic Recreation
and Activities, with over fifteen
years of experience working
with the elderly in numerous
management and consultant
positions.  She is an Activity
Consultant Certified and a
Certified Therapeutic
Recreation Specialist. Kim is
a member of the New Jersey
Activity Professionals
Association and the New
Jersey/Eastern Pennsylvania
Therapeutic Recreation

In 1990, Kim graduated from
William Paterson University
with a BA in Sociology and
later studied gerontology
courses at Union County
College and Therapeutic
Recreation courses at Kean
University. Throughout her
career, Kim has been the
Director of Therapeutic
Recreation for several long-
term care facilities, including
one of NJ’s largest.

In 2006, Kim founded Re-
Creative Resources Inc. She
is a speaker for various state
and local activity associations
such as NJAPA, MOCAP, and
NJACA, as well as the Society
of Licensed Nursing Home
Administrators of NJ. She
also offers lectures for Re-
Creative Resources Inc.,
local colleges, and
community groups, and
provides consultation and
support to numerous
facilities in the state.

Kim is the editor and writer
for the “The Rec-Room", a
monthly newsletter published
by her company. In addition,
she writes monthly articles
for the Activity Directors Office
newsletter, and has
contributed articles to
Creative Forecasting
Magazine, and The
Continuing Care Insite

Kim is a recipient of the
Kessler Institute of
Rehabilitation 1997 Triumph
of the Human Spirit Award.  
Her passion is to promote
the field of Therapeutic
Recreation and Activities and
to unite Recreation
Therapists and Activity
Professionals. Kim currently
serves on the NJAPA board
as the Chairperson for the
Legislation Committee.
Providing Internet Resources
for Activity Professionals
in Long Term Care Settings

Copyright 2004-Present
The Activity Director's Office
All Rights Reserved

Resources Inc.

Re-Creative Resources, Inc.
is committed to enhancing
the lives of long-term care
residents through the use of
Therapeutic Recreation. We
provide a variety of services
such as Therapeutic
Recreation seminars,
in-services, resources, form
development, program
analysis and development,
consultation, and support for
activity professionals and
recreational therapists. A
selection of downloadable
training materials and forms
are available for your
convenience as well as a free
job posting site.
Breaking Down the Barriers:  
Adapting Activities to Increase Active Leisure Participation

By Kimberly Grandal BA, CTRS, ACC
Executive Director, Re-Creative Resources Inc.
Changing Images Art Foundation

Identifying and reducing an individual’s barrier(s) to leisure pursuits is one of the most unique
responsibilities of activity professionals and recreational therapists and an area of great
importance in the revised CMS Activities Guidance to Surveyors. Often times, we have to
adapt/alter activities, the environment, or the situation to make the activities more available to
people who have limitations due to various social, cognitive or physical impairments.

Adapting activities proves to be very beneficial to individuals with various impairments and is an
essential part of the comprehensive care plan. Adapted techniques decrease the barriers that a
resident may have to numerous leisure pursuits, therefore increasing his/her participation in a
variety of activities. Adapting is a great technique for those who have a new disability and need
techniques or specialized equipment to actively participate in their favorite hobby or past time.
Adapting also increase quality of life, accommodates residents’ needs and interests, promotes
quality of life, maintains or even increases functional status, and decreases learned
helplessness. In many cases, residents may even learn new skills!

When adapting activities it is important to remember the following guidelines as
suggested by Schleien, Meyer, et al., 1995.

  1. Adapt only when necessary-consider whether or not the individual can participate actively
    without adapted equipment or techniques. It is important to thoroughly asses each
    individual and provide adaptive techniques only as needed.
  2. View adaptations as temporary-an individual’s abilities and skill levels may change
    therefore the need for adaptations should be assessed and re-assessed on a regular
  3. Adapt on an individual basis- not everyone requires adapted techniques or specialized
    equipment. For example: determine if all the participants in a bowling activity really need to
    use the bowling ramp. Some individuals may be capable of using a ball pusher, or a ball
    with a handle, while others may not require any assistance at all.
  4. Adapt for congruence-it is crucial to try to keep the activity as close as possible to the
    original activity. This is necessary so as to not change the activity so it no longer
    resembles the original activity and so that there is not heightened attention on the
    individual who requires the adaptation.
  5. Adapt for availability-it is important to offer adapted equipment and techniques that may be
    utilized in various settings, especially for those individuals that may be returning to the
    community. If you are utilizing specialized equipment that may not be available to the
    individual when they return home, consider alternate devices.

There are various ways in which a recreational therapist or activity professional may adapt
activities.  A common technique includes utilizing cues and prompts. An example of this includes
the use of props and pictures, verbal and/physical cues, hand over hand assistance, physical
guidance, verbal instructions, and so on. Another common technique is called task segmentation,
which is breaking down the activity into a series of steps and performing one step at a time. Task
segmentation is often used during a craft project or other activity that requires several steps for

The environment truly affects the way we feel and behave therefore, the facilitator should be
aware of room set-up, tables and chairs, glare, lighting, temperature, noise levels, distractions,
etc. and make any necessary changes to provide an environment that is conducive to the
activity. In addition, the facilitator may alter the activity, change the way the activity is normally
done, or even change the rules.

Lastly, due to technology, there is a variety of adapted equipment available for individuals with
impairments. The CMS revised F248 Activities Guidance to Surveyors, has placed strong
emphasis on adapted equipment that is utilized across all disciplines.  Recreation equipment
often utilized in long term care  include: books on tape, closed-caption TV, magnifying glasses, c-
clamps, dycem, large print materials, adapted physical games, adapted craft projects, cooking
and sewing items, wheelchair gardens, adapted computers, and much more. For a list of vendors
who sell adapted equipment, visit

There are many creative adapted techniques that activity professionals utilize to
increase active participation of their residents. The following is a list of sample

Arts and Crafts
  • Assembly line approach- have the least able person complete the easiest task
  • Use masking tape to hold down pictures
  • Clipboards to hold paper or projects down
  • Silly putty or clay on the end of a pencil or toothpick can be used to pick up small objects
    such as buttons.
  • Use non-skid materials such as dycem
  • Use larger letters, outline guides
  • For poor grasp, larger handles, fatter pens etc.
  • Focus on one step at a time
  • Utilize task segmentation
  • Post a chart of steps
  • Have a finished project on display

Physical Activities
  • Bounce a ball, instead of throwing it
  • Slow down the action  (use a balloon or slow motion ball rather than a regular ball)
  • Use larger or smaller playing objects
  • Use contrasting colors for games
  • Move target closer or further away
  • During exercise, give clues- right, left, straight ahead, up, down
  • Provide hand over hand assistance
  • Provide passive range of motion
  • Have residents become scorekeepers or cheerleaders
  • Change the rules (i.e.) give 3 chances for bowling instead of 2
  • Utilize props such as colorful scarves, rhythm instruments, etc. during exercise programs
  • Have a sports competition (bowling, basketball, any toss game, etc. amongst those who
    either prefer to stay in their rooms or have to for medical reasons)

Word Games/Trivia/Discussion Groups/Table Games
  • For individuals who are non-verbal, provide paper and pen, pictures, communication board
  • Utilize multiple choices. (narrow down between 2 or 3)
  • Use phrases like, “it sounds like” or it begins with the letter __”
  • Use gestures, verbal/physical cues
  • Utilize pictures and objects to promote participation
  • Encourage a resident with severe physical limitations to call bingo
  • Have a trivia contest amongst those who either prefer to stay in their rooms or have to for
    medical reasons

Individuals with a visual impairment
  • Sit near the person within the range of his/her vision
  • Use bright colored inks in bold letters on a contrasting background (black on white is
    easiest to see)
  • Position individuals with poor vision nearest objects or persons to be seen
  • Provide good lighting (natural daylight is best)
  • Provide physical guidance
  • Provide descriptive verbal instructions
  • Utilize large print items, magnifying glass, audio books, magnified TV screen, etc.
  • When applicable, make sure glasses are being worn and are clean
  • Be cautious of glare from windows and floors
  • Approach from the front rather than the side

Individuals with a hearing impairment
  • Sit close to the person
  • Do not yell.  Speak normally.
  • First attract the person’s attention and establish eye contact
  • Face the person
  • Speak slowly and distinctly
  • Wait patiently for a response.
  • Ask only one question at a time
  • Use body movements and gestures often
  • Repeat yourself or re-phrase the question
  • Include in small group activities
  • Minimize background noises and distractions
  • Utilize closed caption TV and/or earphones
  • Utilize a microphone
  • When applicable, make sure hearing aid is in place and working
  • Utilize sign language
  • Utilize visual aides
  • Write down what you are trying to say
  • Sit person near the source sound

Individuals with a physical impairment
  • Utilize a variety of adapted equipment such as card holders, card shuffler, adapted
    scissors, adapted handles on paint brushes, gardening tools, cooking tools, sewing, etc.,
    bowling ramp, ball pusher, simple musical instruments i.e. egg shakers, wrist bells, dycem,
    clamps, book holders, etc.
  • Provide hand over hand assistance
  • Provide passive range of motion
  • Put supplies and materials in reach
  • Talk with PT/OT about adapted equipment options
  • Encourage resident to provide passive range of motion to self by using good hand/arm

Individuals with a cognitive impairment
  • Provide task segmentation
  • Involve in small group programs that are shorter in length
  • Provide validation and reassurance
  • Utilize extensive cues and prompts
  • Focus on long-term recollection
  • Utilize familiar movement during exercise programs i.e. swimming, climbing a ladder, mixing
    batter, etc.
  • Provide task-oriented activities based on interests and previous lifestyle
  • Provide 1x1 assistance as needed
  • Provide hand over hand assistance
  • Utilize pictures and props
  • Utilize simple, direct communication
  • Allow time for response
  • Provide a therapeutic environment
  • Provide spontaneous programming

In summary, the use of adapted techniques and equipment is instrumental to the quality of life
and functional status of the elderly in long term care, short-term rehabilitation centers, assisted
living, and adult day care centers. Some equipment can be expensive; however, we must make
all attempts to provide specialized equipment and services. Often times, we can be very creative
in our approaches for recreational therapists and activity professionals are very innovative and


Schleien, S., Meyer, L., et al. (1995) Lifelong leisure skills and lifestyles for persons with
developmental disabilities. Baltimore, Maryland: Paul H. Brooks.

Copyright Kimberly Grandal, 2007. All rights reserved.  -  END
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