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motivates the group and how they are motivated to be involved in recreation activities, to be
open to making changes as necessary to programs.
Adaptations:
Participants with Lou Gehrigs Disease/Amyotrophic Lateral Sclerosis:
Amyotrophic Lateral Sclerosis or Lou Gehrigs disease is a progressive,
neurodegenerative disease that affects nerve cells in the brain and the spinal cord ("What is
ALS?"). ALS is characterized by individuals having difficulty walking or doing normal daily
activities, weakness in the legs, feet or ankles, slurred speech or trouble swallowing, weakness in
the hands or clumsiness, muscle cramps and twitching in the arms, shoulders and tongue, as well
as difficulty holding his/her head up or keeping good posture. To adapt this activity to an
individual who has ALS, have larger gripped writing utensils. The CTRS can also adapt the pen
by taking a tennis ball and poking a hole through it, then getting a long pen and putting it
through, so the grip is larger and easier to use. As pinch strength and dexterity decrease,
handwriting may become more difficult. Enlarging the writing utensil with a triangular grip or
cylindrical foam will position the fingers, reduce strength needed, and make writing easier and
more legible. If the facilitator decides that this may still present a challenge to individuals,
instead of having participants initial by the box, the facilitator can provide each individual with
his/her own unique stickers that when they find something in common, they can provide their
unique sticker for the other person to stick onto the square. The CTRS can provide cushions for
support. Due to individuals presenting with the possibility of slurred speech, provide the
participant enough time to speak, resist the urge to finish his/her sentence or offer him/her words
and ask questions to clarify the message from the individual.
Participants who have Myasthenia Gravis:
Myasthenia Gravis is a chronic autoimmune neuromuscular disease characterized by
varying degrees of weakness of the skeletal muscles of the body. The muscle weakness can
increase during activity and improves after the individual rests. Muscles that control breathing
and neck and limb movements, control eye and eyelid movement, facial expression, chewing,
talking, and swallowing are often affected by the disorder. The degree of muscle weakness varies
throughout individuals. To adapt this activity to an individual who has Myasthenia Gravis, allow
participants the option to use a wheelchair to move around the room, if the individual does not
have one already. Instead of having participants initial by the box, the facilitator can provide
each individual with his/her own unique stickers that when they find something in common, they
can provide their unique sticker for the other person to stick onto the square. Due to fatigability,
it is important to allow for flexible scheduling with individuals, as some days may be better than
others. If practice schedules need to be shorter in time one day or if providing breaks throughout
the activity will be helpful, allow for this. Adapt the environment to allow for open
communication and an opportunity for the individual to feel comfortable to express his/her level
of fatigue. If 9 items are too many for each participant, provide less boxes.
Adaptation References:
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Myasthenia Gravis Fact Sheet. (n.d.). Retrieved November 03, 2016, from
http://www.ninds.nih.gov/disorders/myasthenia_gravis/detail_myasthenia_gravis.htm
A. (n.d.). What is ALS? Retrieved November 03, 2016, from http://www.alsa.org/aboutals/what-is-als.html
Everyday Life with ALS: A Practical Guide. (n.d.). Retrieved November 3, 2016, from
https://www.mda.org/sites/default/files/publications/Everyday_Life_with_ALS_P532.pdf