Certified therapeutic recreation specialists, CTRSs for short, work in hospitals, assisted-living centers, nursing homes, schools, camps, residential programs, city parks and recreation departments and even prisons. Within a hospital, they may work with patients in physical rehabilitation, pediatrics, substance abuse, eating disorders and psychiatric units.

No matter what the setting, the goal is to improve the daily lives of their patients. According to the American Therapeutic Recreation Association, CTRSs provide treatment and recreation activities for individuals with disabilities and illnesses to improve patient functioning and independence as well as reduce or eliminate the effects of illness or disability.

"We assess patients to get information on their leisure history and lifestyle prior to whatever brought them to whatever setting they're in," explains Twyla Misselhorn, a CTRS who has worked in several settings since completing graduate school at the University of Iowa in the 1970s. "We plan and implement programs in a wide variety of program areas: music, dance, drama, arts and crafts, aquatics, horticulture, sports, table games, cooking, and nature or outdoor settings."

Now at North Memorial Medical Center in Robbinsdale, she works primarily with patients who have had strokes, spinal cord or head injuries. There's no typical day. "You just kind of juggle," she says. "It can be anything from phone calls and one-to-ones with patients to doing assessments and writing that material up."

She has also worked with developmentally-disabled children, teens and adults in community settings; worked in public relations; organized workshops; and currently runs a spinal cord injury support group for the Twin Cities metropolitan area.

"You have to be very flexible, pretty creative and willing to adapt on a moment's notice," Misselhorn says. "Your best laid plans can go down the tubes in three seconds."

Most CTRSs have bachelor's degrees. Those with master's degrees may go into management, and a Ph.D. may lead to research or education. The median annual salary nationwide was $34,990 in May 2006. "There are $10 and $12 (per hour) positions to start," she says. "You don't find a lot of positions greater than $25 an hour."

Despite the wages, positions aren't easy to find, particularly as hospitals focus on outpatient care and insurance companies look to trim costs. (HMOs generally do not cover therapeutic recreation services, according to Misselhorn.) However, with more veterans returning home with traumatic brain injuries, demand for CTRSs at Veterans Administration hospitals should increase.

"You don't get rich in this field," she adds. "You do it because you love what you do. I can't imagine loving anything more after all these years."

Nancy Crotti is a freelance writer who lives in St. Paul.