Therapeutic Play for the Severely Disabled Population: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:Robin Tacchetti|Robin Tacchetti]] based on the course by [https://members.physio-pedia.com/course_tutor/dana-mather/ Dana Mather]<br>
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
== Introduction ==
== Introduction ==
Children learn best in an environment which provides discovery, exploration and play.<ref name=":1" /> Playful interactions allow children to express their curiosity and creativity.<ref name=":0" /> Play facilitates independence and participation while fostering relationships with care-givers and peers. <ref name=":1" /> Playing facilitates gross and fine motor, language, social, pre-academic and psychosocial skills.<ref name=":0" />
Children learn best in an environment which provides discovery, exploration and play.<ref name=":1" /> Playful interactions allow children to express their curiosity and creativity.<ref name=":0" /> Play facilitates independence and participation while fostering relationships with care-givers and peers. <ref name=":1" /> Playing facilitates gross and fine motor, language, social, pre-academic and psychosocial skills and is  fundamental to support the multiple development domains: motor, social-emotional, language, cognition and adaptive behaviour.<ref>Fiss AL, Håkstad RB, Looper J, Pereira SA, Sargent B, Silveira J, Willett S, Dusing SC. [https://www.mdpi.com/2076-328X/13/6/440 Embedding Play to Enrich Physical Therapy]. Behavioral Sciences. 2023 May 24;13(6):440</ref><ref name=":0" />


Play should include the element of free choice by the child and being personally directed.  Intrinsic factors of play include flexibility, voluntary, spontaneity, and the use of the childs natural environment.<ref name=":1">Movahedazarhouligh S. [https://www.researchgate.net/publication/327567615_Teaching_Play_Skills_to_Children_with_Disabilities_Research-Based_Interventions_and_Practices Teaching play skills to children with disabilities: Research-based interventions and practices]. Early Childhood Education Journal. 2018 Nov;46(6):587-99.</ref>   
Play should include the element of free choice by the child and being personally directed.  Intrinsic factors of play include flexibility, voluntary, spontaneity, and the use of the childs natural environment.<ref name=":1">Movahedazarhouligh S. [https://www.researchgate.net/publication/327567615_Teaching_Play_Skills_to_Children_with_Disabilities_Research-Based_Interventions_and_Practices Teaching play skills to children with disabilities: Research-based interventions and practices]. Early Childhood Education Journal. 2018 Nov;46(6):587-99.</ref>   
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Children will naturally move through various stages of play based on their cognitive development.  The Takata Play Taxonomy divides play into 5 stages based on Paiget's stages of cognitive development.  The interactions and complexities in activities progressively increases as children move through the stages. <ref name=":0" />   
Children will naturally move through various stages of play based on their cognitive development.  The Takata Play Taxonomy divides play into 5 stages based on Paiget's stages of cognitive development.  The interactions and complexities in activities progressively increases as children move through the stages. <ref name=":0" />   


# Sensorimotor:
# Sensorimotor: (0-2 years)
#* cause-effect toys
#* cause-effect toys
#* takes considerable amount of practice
#* takes considerable amount of practice, repetition
#* high level of exploration
#* high level of exploration
# Symbolic:
# Symbolic: (2-4 years)
#* use of objects to represent actual objects (toy phone represent real phone)
#* use of objects to represent actual objects (toy phone represent real phone)
#* parallel play  
#* parallel play  
# Dramatic:
# Dramatic: (4-7 years)
#* role-playing
#* role-playing
#* cooperative play
#* cooperative play
# Game with Rules:
# Game with Rules: (7-12 years)
#* competition
#* competition
#* cooperative play
#* cooperative play
#* board games, puzzles, crafts, sport-related
#* board games, puzzles, crafts, sport-related
# Recreation:
# Recreation: (12-16 years)
#* team participation
#* team participation
#* sports, hobbies
#* sports, hobbies
#* dancing, team sports, music, tabletop games, books<ref name=":0">Hui S, Dimitropoulou K. iCan-Play: [https://scholarworks.wmich.edu/cgi/viewcontent.cgi?article=1696&context=ojot A practice guideline for assessment and intervention of play for children with severe multiple disabilities]. The Open Journal of Occupational Therapy. 2020;8(3):1-4.</ref>
#* dancing, team sports, music, tabletop games, books<ref name=":0">Hui S, Dimitropoulou K. iCan-Play: [https://scholarworks.wmich.edu/cgi/viewcontent.cgi?article=1696&context=ojot A practice guideline for assessment and intervention of play for children with severe multiple disabilities]. The Open Journal of Occupational Therapy. 2020;8(3):1-4.</ref><ref>Bulgarelli D, Bianquin N. 3 [https://core.ac.uk/download/pdf/302313787.pdf Conceptual Review of Play. Play development in children with disabilities.] 2017:58-70.</ref>


== Children with Disabilities ==
== Children with Disabilities ==
Children with disabilities have a clear disadvantage when it comes to play.  Mobility, visual and cognitive impairments can impose barriers to play.  It can be difficult for them to move, see and understand play.  This leads to children with disabilities participating in less complex play and playing less often than their typically developing peers.<ref name=":3">O’Connor D, Butler A, Lynch H. [https://journals.sagepub.com/doi/abs/10.1177/0308022620967293 Partners in play: Exploring ‘playing with’children living with severe physical and intellectual disabilities.] British Journal of Occupational Therapy. 2021 Nov;84(11):694-702.</ref><ref name=":1" /> Sensory development is likely impacted as well due to their limitation to physically interact with toys/objects.  <ref name=":2">Agostine S, Erickson K, D’Ardenne C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099238/ Sensory experiences and children with severe disabilities: Impacts on learning]. Frontiers in Psychology. 2022 Apr 29;13:875085.</ref>  
Children with disabilities have a clear disadvantage when it comes to play.  Mobility, visual and cognitive impairments can impose barriers to play.  It can be difficult for them to move, see and understand play.  This leads to children with disabilities participating in less complex play and playing less often than their typically developing peers.<ref name=":3">O’Connor D, Butler A, Lynch H. [https://journals.sagepub.com/doi/abs/10.1177/0308022620967293 Partners in play: Exploring ‘playing with’children living with severe physical and intellectual disabilities.] British Journal of Occupational Therapy. 2021 Nov;84(11):694-702.</ref><ref name=":1" /> Sensory development is likely impacted as well due to their limitation to physically interact with toys/objects.  <ref name=":2">Agostine S, Erickson K, D’Ardenne C. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099238/ Sensory experiences and children with severe disabilities: Impacts on learning]. Frontiers in Psychology. 2022 Apr 29;13:875085.</ref> Children with disabilities often require adaptive devices and toys to assist them with interactions and play.<ref name=":3" />
 
Children with disabilities often require adaptive devices and toys to assist them with interactions and play.<ref name=":3" />


Children with severe disabilities are typically dependent on their family or caregivers to play.  If they are not able to express their wants clearly, they will be presented with limited options of toys or activities to explore.  As a result, they will miss opportunities to expand their development. The decreased opportunity to self-direct play can further impact their interest in play and their self-esteem. <ref name=":0" />
Children with severe disabilities are typically dependent on their family or caregivers to play.  If they are not able to express their wants clearly, they will be presented with limited options of toys or activities to explore.  As a result, they will miss opportunities to expand their development. The decreased opportunity to self-direct play can further impact their interest in play and their self-esteem. <ref name=":0" />
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Research shows that children with severe disabilities have similar interests to typically developing children despite their medical needs and barriers.  They want to engage in physical play, read books, watch movies, socialise and play with electronics.  Understanding their developmental level can provide insight regarding activities of interest for them.  This in turn will promote a more positive play experience.<ref name=":0" />
Research shows that children with severe disabilities have similar interests to typically developing children despite their medical needs and barriers.  They want to engage in physical play, read books, watch movies, socialise and play with electronics.  Understanding their developmental level can provide insight regarding activities of interest for them.  This in turn will promote a more positive play experience.<ref name=":0" />


Positive social play experiences can be limited due to skill deficits and the physical and social environment. <ref>Danniels E, Pyle A. [https://link.springer.com/article/10.1007/s10643-022-01369-4 Inclusive play-based learning: Approaches from enacting kindergarten teachers.] Early Childhood Education Journal. 2022 Jun 22:1-1.</ref>. Children with severe disabilities can learn and master new skills with the right environment.  An optimal environment would include the following:
Positive social play experiences can be limited due to skill deficits along with the physical and social environment. <ref>Danniels E, Pyle A. [https://link.springer.com/article/10.1007/s10643-022-01369-4 Inclusive play-based learning: Approaches from enacting kindergarten teachers.] Early Childhood Education Journal. 2022 Jun 22:1-1.</ref> However, these children with severe disabilities can learn and master new skills given the right environment.  An optimal environment would include the following:


# activities that are accessible  
# activities that are accessible  
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== Environment ==
== Environment ==
The environment for play involves both social and physical surroundings.chart p.5
=== Social and Physical Arrangements ===
=== Social and Physical Arrangements ===
The following are suggestions for setting up a positive social and physical environment for children with disabilities:
The following are suggestions for setting up a positive social and physical environment for children with disabilities:
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** arranging play materials<ref name=":1" />
** arranging play materials<ref name=":1" />


== Peer-implemented ==
== Partner-Assisted Play ==
Interventions that are peer implemented provide opportunities for social interactions between children with disabilities and their typically developing peers.  In addition, it allows for children with disabilities to engage in reciprocity, social referencing and initiation/responding. <ref name=":1" />  
Children with disabilities spend more time with caregivers or adults rather than peers despite their interest in being around peers.  Partnering a child with disabilities affords them the opportunity to learn from their peers.<ref name=":1" /> Interventions that are peer implemented provide opportunities for social interactions between children with disabilities and their typically developing peers.  In addition, it allows reciprocity, social referencing and initiation/responding. <ref name=":1" />The goal of the play partner is to facilitate interactions between the child and another child or the child and their environment.<ref name=":0" />
 
The choice of play partner should be made by the child with disabilities. Play should be centred around the child's needs and wants.    The child with disability should be included in the decision-making process regarding the activity, the toys used and how to play with it.  Multiple options should be offerred.<ref name=":3" />


Play partners typically do not see themselves as reciprocal playmates, but more as play enablers.  The play partner's role is to encourage and to create an environment where the child with disabilities plays the central role in the activity. <ref name=":3" />
== Playdates ==
== Playdates ==
Playdates can be both structured and unstructured time for children with disabilities to interact with another child.  During playdates children with disabilities have the opportunity to demonstrate learned skills from another environment.  Before initiating playdates, it is important that the child with the disability to be involved with their peers.  The child does not have to have independent play skills, but comfortable being in close proximity to others.  Another important skill to have prior to a playdate it learning how to transition from one activity to another.  This can be accomplished with appropriate prompts and reinforcement.<ref name=":1" />
Playdates can be both structured and unstructured time for children with disabilities to interact with another child.  During playdates children with disabilities have the opportunity to demonstrate learned skills from another environment.  Before initiating playdates, it is important that the child with the disability to be involved with their peers.  The child does not have to have independent play skills, but comfortable being in close proximity to others.  Another important skill to have prior to a playdate it learning how to transition from one activity to another.  This can be accomplished with appropriate prompts and reinforcement.<ref name=":1" />


=== Assistive Technology (AT) p.8 chart ===
== Assistive Technology ==
There are a variety of assistive services and devices that can be used to help improve the functional abilities of children with disabilities. Low-tech items are inexpensive, more readily available and easy to use.  Three common low-tech adaptions categories include:
There are a variety of assistive services and devices that can be used to improve function in children with disabilities. Using assistive technology can afford children with disabilities that ability to play more actively and participate in activities of their choosing.<ref name=":0" /> Adaptive devices can be categorised into the following:


# position and mobility items
# adapted toys:
# adaptive toys
#* assist with stabilising, attaching, extending or confining toys
# communication devices
#* shoelaces, elastic ribbon to bring a toy within reach
#* velcro, nonslip material to hold objects in place
#* box tops, hula hoops to help keep toys from getting out of the child’s reach or visual field
# positioning devices:
#* designed for those that have difficulty changing positions or need assistance in moving while playin devices
#* semi-reclined (sling seat)
#* side-lying (towels)
#* prone (wedges, towels)
#* kneeling (floor tables, stairs)
#* sitting (corner chairs)
#* standing positions
# speciality AT items
#* assist with manipulating play objects
#* develop and extend cause and effect relationships
#* cooperative play skills with siblings and peers
#* battery adapters
#* timers
#* latch devices
#* series adapters (turn a toy on and off with a movement of a body part against a switch)
# communication devices:
#* devices that help incorporate children with communicative deficits to express themselves
#* photos or line drawings to help children select what they want to say
#* tablet computers with touchscreens to help the child navigate through pages of icons
#* range from very easy to use through very complex<ref name=":1" />


<nowiki>**</nowiki> Each child and family needs are unique whereby several categories or combinations of assistive technology can be used<ref name=":1" />  
<nowiki>**</nowiki> As each child and family needs are unique different combinations of assistive technology can be used<ref name=":1" />


=== Modeling and Prompting Interventions ===
== Modelling and Prompting Interventions ==
Research shows that the use of adult modeling has increased play behaviours in children with disabilities.  Modeling can be successfully performed in the following steps:
Research shows that the use of adult modeling has increased play behaviours in children with disabilities.  Modeling can be successfully performed in the following steps:


* adult follows child's lead  
# adult follows child's lead
* adult imitates the play
# adult imitates the play
* adults models and prompts a play behaviour
# adults models and prompts a play behaviour
** behaviour should be developmentally appropriate
#* behaviour should be developmentally appropriate
** behaviour should be geared towards child's attention and interests<ref name=":1" />
#* behaviour should be geared towards child's attention and interests<ref name=":1" />
 
=== Play Materials ===
Typically children with disabilities need more opportunities and time to interact with


Other environmental arrangement strategy involves arranging play materials. Children with disabilities need more time and opportunity to become familiar with toys, materials, and equipment in order to discover the different ways to interact with them. In particular, to teach children with disabilities, much repetition is required for them to learn from the materials. Therefore, toys, materials, and other equipment should not be changed or removed too often. Children with disabilities should be given the opportunity to interact with this equipment until they have had a chance to master it completely (Klein et al. 2001). Size, density, organization, and thematic arrangement are all considerations with play materials. A wide range of highly motivating sensory, motor, exploratory, constructive and socio-dramatic props with high potentials for interactive and imaginative play are suggested as play materials. The types of material should also vary in degree of structure and complexity to afford opportunities to support children who present diverse interest, learning styles and developmental levels. The important point is to identify play materials that are motivating, allowing for mutual enjoyment between typically developing peers and children with disabilit
== Play Materials ==
Typically children with disabilities need more time and opportunities to interact with equipment, materials and toys. In addition to time, they require repetition to master a new skill. Therefore, equipment and materials should strategically not be removed or changed often. Play materials can vary in size, theme, density, complexity, etc.  In order to increase interact and imaginative play, a variety of sensory, constructive, motor, exploratory and socio-dramatic toys should be used as play materials.   The best play material is one that is motivating and allows for mutual play between children with disabilities and their typically developing peers.  <ref name=":1" />


== Floortime Developmental, ==
== Floortime Development ==
individual differences, relationship-based model (DIR) or, in practice, “Floortime” emphasizes that success with any child is based on the ability of the play partner to meet the child on his/her developmental level, strengthens potential underlying neurological elements that may be impeding development and emphasizes the critical emotional connection between the impacted child and the play partner (Greenspan and Wieder 2009). The term “Floortime” refers to the actual process through which therapists, parents, and other caregivers make a special effort to tailor interactions to meet the child at his/her unique functional level and within the context of his/her processing difficulties. This model clarifies the basis of children’s behaviors, with Floortime sessions supporting the reciprocal relationship between child and caregiver (Davis et al. 2014; Greenspan and Wieder 2009). The technique involves having play partners get down on the floor and follow the child’s lead to encourage the child’s initiative and purposeful behavior, deepen engagement, lengthen mutual attention, and develop symbolic capacities. In Floortime, therapists and parents engage children through the activities each child enjoys. They enter the child’s games. They follow the child’s lead. Therapists teach parents how to direct their children into increasingly complex interactions, help the child maintain focus to sharpen interactions and abstract, logical thinking. For example, if the child is tapping a toy truck, the parent might tap a toy car in the same way. To encourage interaction, the parent might then put the car in front of the child’s truck or add language to the game. As children mature, therapists and parents tailor the strategies to match a child’s developing interests and higher levels of interaction. For example, instead of playing with toy trucks, parents can engage with model airplanes or even ideas and academic fields of special interest to their child (Greenspan and Wieder 2009). This process, called “opening and closing circles of communication,” remains central to the Floortime approach (Davis et al. 2014).
Floortime development refers to the ability of the play partner to meet the child at their developmental level. The elements of floortime involve:


=== Play Books and Play Scripts S ===
* having the play partner on the floor and follow the child's lead
cripts also have been used to teach young children with disabilities to engage in social and object play. Many children with ASD may find it challenging to play with toys appropriately or in the manner in which they were intended for use. Playbooks and play scripts are visual strategies that are used to support children with ASD increase play skills. Play scripts are visual prompts that help guide the play (Neville and Bachor 2002). For play scripts to be effective the child needs to be able to attend to others actions and imitate them in a sequence of multiple actions (for example, you’re able to say “copy me”, do several motor movements such as unzip coat, hang up hat and place shoes in closet, and the child copies your actions). Prepared script playbooks and play scripts are very similar tools for teaching play in that they show simple sequences of steps in a play routine (Petursdottir et al. 2007). For both strategies a book format may be used and each page of the book represents one step in a play sequence. In a playbook, only pictures are used to illustrate the sequence (for example, stacking Legos, or coloring a picture). However, in a play script both pictures and words are used to illustrate the sequence (e.g., playing with a doll house, driving toy trains). Play scripts can be short or long, based on a child’s current skills. Typically, the script starts out in a short form that the child can quickly learn. Once a child is successful with the interactions in the short script, additions are made to facilitate spontaneous and creative responses during the play (Neville and Bachor 2002; Petursdottir et al. 2007).<ref name=":1" />
* engage the child through activities they enjoy
* direct child to more complex interactions
* help the child to maintain focus<ref name=":1" />


== Sensory ==
== Sensory ==
evere disabilities have a ripple effect on the development of sensory processing and the ability to enact active patterns in response to sensory input. Limited gross motor movement restricts opportunity to explore the environment, which leads to limited sensorimotor experience needed to make sense of the objects. This then delays fine motor skill development and restricts play, which further restricts sensory development. These motor impairments further restrict access to the active strategies required by some of the sensory seeking and sensation avoiding patterns by Dunn (2007). Participatory sense making is one means of supporting purposeful sensory experience and patterns of sensory processing, but it is vital to also support children with severe disabilities in independent play and sense making. Interacting with toys in whatever way they independently can and exploring their environment by touch, sound, mouth, or vision should be combined with learning through the process of engaging with others to support their efforts to pursue desired outcomes or complete tasks. These are just as important and meaningful for children with severe disabilities as they are for any child.<ref name=":2" />
Children with disabilities who have limited gross motor development have restrictions on exploring their environment.  This can lead to decrease sensorimotor experiences.   This in turn can delay fine motor development further restricting sensory development. To support participatory sense making, children should interact with toys however they can independently and explore their environment by sound, touch and vision.<ref name=":2" />
 
== Partner-Assisted Play ==
''Partner-assisted play involves the child’s play partner, whether is it a self-chosen partner based on the assessment or an individual that is in the child’s day-to-day environment (i.e., parent, paraprofessional, teacher, therapist) that assists with facilitating play activities and opportunities. Partner-assisted play can be used to support autonomy and encourage voluntary action from the child (self-determination process). A play partner who is familiar with the child can help train new people on the team or facilitate interactions with new individuals. When possible, it is important for the child to have a decision about their play partner, play preferences, and desires. Partner-assisted play should always be focused on the child’s wants and needs and provide the child with options. The child should participate in the decision-making of the play activity, such as which toy to use, where they would like to put the toy, what they want to do with the toy, etc. The child’s play partner should facilitate interactions between the child and another child or adult, or the child and their environment. Children with SMD often spend more time with adults, such as paraprofessionals at school or caregivers at home, rather than with peers. However, many children with SMD relish the opportunity to be around peers to play with or observe their play. Vygotsky (1978) stated that children benefit from learning from their peers when pairing them with someone that has mastered an activity; it creates opportunities to provide scaffolding to master the activity. Moreover, providing children with a choice of a play partner can also differ between contexts. Based on the HAAT model, types of AT can differ across different contexts. In a new environment, a child with SMD may want a familiar adult to help set up toys and assistive devices or help positioning them in a way that will help them succeed. In a familiar environment, the same child may w''
 
Play partners viewed themselves as play enablers more than reciprocal playmates. Positive play experiences were more associated with the centrality of the child in the play partnership and less associated with equal exchange and negotiating play preferences. In one event the child enjoyed throwing a ball and the teacher, acting as play enabler, complemented and elaborated on the play-action by turning it into a target game. The perceived role of the play enabler was fundamentally ‘to encourage them’ (Teacher C). Encouragement was<ref name=":3" />
 
== Assistive Technology ==
''The “I CAN” part of the intervention should focus on grading the activities with the use of AT and creating as many successful play opportunities as possible. The grading of activities and providing the just right challenge aligns with Vygotsky’s (1978) theory of learning and development of starting with the child’s abilities and scaffolding more advanced activities to further learning. When starting with a child’s strength (i.e., one access method), the therapist can provide various play opportunities (different games, same access method) and repetition until they have mastered the skill. From there, the therapist can expand on a particular physical movement to incorporate various adaptations. Principles of the HAAT model place emphasis on participation and not on the device itself and on-going need for assessment is crucial to this stage of intervention (Cook & Hussey, 2002). The use of AT can be a range from low-technology adaptations, mid-technology adaptations, and high-technology adaptations. Lowtechnology adaptations are simple adaptations that do not require electronics; this can be a built-up holder, PVC pipe, or stylus. Mid-tech adaptations are items such as a switch, Powerlink, switch interface, and accessible toys; and high-tech adaptations are computers and gaze-based devices. With the help of AT and grading of activities, children with all physical abilities should be able to engage in play more actively and become an active participant in choosing their activities to interacting with materials despite their physical limitations. Thus, eliminating or decreasing the use of hand assistance during play 10 THE OPEN JOURNAL OF OCCUPATIONAL THERAPY – OJOT.ORG <nowiki>https://scholarworks.wmich.edu/ojot/vol8/iss3/8</nowiki> DOI: 10.15453/2168-6408.1696 and increasing self-efficacy and confidence. The physical interaction and exploration between the child and a toy or an activity should be emphasized during the intervention. Development and Learning Through Play Takata’s Play Taxonomy serves as a developmental guide through the iCan-Play assessment and the iCan-Play profile for intervention. The taxonomy guides the therapist by providing possible task modifications, grading of activities, or future activities to work toward. A crucial aspect of intervention of play in children with SMD is engaging them with developmentally appropriate activities. Results from the iCan-Play assessment will provide information about the developmental level of play that the child is in or would like to expand on further. When children are presented with activities that are not developmentally appropriate, there is a risk of disengagement from the activity. Meeting the child at his or her developmental level can have many benefits, such as increased comprehension of the activity sequence and feelings of success and mastery. The iCan-Play profile will encourage therapists to create a list of toys and games that are selected by the child or are in the same developmental level and can be accessed by the child during their leisure time''
 
== Ideas of games: ==
https://raisingchildren.net.au/guides/activity-guides/children-with-diverse-abilities
 
 
 
therapists
 
rents and professionals state that providing therapy on the level of participation in real-world situations is crucial but is not at present embedded in regular therapy: ''“Yes … we were always here in the practice'' [setting] ''… But I’d rather that the therapist tells me there (in the playground) … what I can do with my daughter, or that what I do is good”'' [parent 5]''.'' Some professionals feel fostering play as part of the everyday life of children with PD should be the aim of long-term therapy. However, therapists also experience a financial barrier when treating childrenSolutions mentioned were: home-based therapy in the playground, coaching and empowering parents to overcome social/emotional barriers, early-age intervention focusing on outside play starting around the age of 2 years, teaching children their own capabilities and boundaries and increasing self-esteem. These elements coincide with implications Palis<ref>Van Engelen L, Ebbers M, Boonzaaijer M, Bolster EA, Van Der Put EA, Bloemen MA. [https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02827-5 Barriers, facilitators and solutions for active inclusive play for children with a physical disability in the Netherlands: a qualitative study.] BMC pediatrics. 2021 Aug 28;21(1):369.</ref>
 
 
 
 
 
 
 
 


Additional resources:
== Resources: ==
* [[Therapeutic Play]]
* [[Children with medical complexities|Children with Medical Complexities]]
* [[Cerebral Palsy Aetiology and Pathology]]


https://iris.unito.it/retrieve/handle/2318/1746530/631583/Bulgarelli_2020_Perspectives%20and%20research%20on%20play%20for%20children%20with%20disabilities.pdf
== References: ==
<references />
[[Category:Paediatrics]]
[[Category:Rehabilitation]]
[[Category:ReLAB-HS Course Page]]
[[Category:Course Pages]]

Latest revision as of 00:13, 8 November 2023

Original Editor - Robin Tacchetti based on the course by Dana Mather
Top Contributors - Robin Tacchetti and Jess Bell


Introduction[edit | edit source]

Children learn best in an environment which provides discovery, exploration and play.[1] Playful interactions allow children to express their curiosity and creativity.[2] Play facilitates independence and participation while fostering relationships with care-givers and peers. [1] Playing facilitates gross and fine motor, language, social, pre-academic and psychosocial skills and is fundamental to support the multiple development domains: motor, social-emotional, language, cognition and adaptive behaviour.[3][2]

Play should include the element of free choice by the child and being personally directed. Intrinsic factors of play include flexibility, voluntary, spontaneity, and the use of the childs natural environment.[1]

Stages of Play[edit | edit source]

Children will naturally move through various stages of play based on their cognitive development. The Takata Play Taxonomy divides play into 5 stages based on Paiget's stages of cognitive development. The interactions and complexities in activities progressively increases as children move through the stages. [2]

  1. Sensorimotor: (0-2 years)
    • cause-effect toys
    • takes considerable amount of practice, repetition
    • high level of exploration
  2. Symbolic: (2-4 years)
    • use of objects to represent actual objects (toy phone represent real phone)
    • parallel play
  3. Dramatic: (4-7 years)
    • role-playing
    • cooperative play
  4. Game with Rules: (7-12 years)
    • competition
    • cooperative play
    • board games, puzzles, crafts, sport-related
  5. Recreation: (12-16 years)
    • team participation
    • sports, hobbies
    • dancing, team sports, music, tabletop games, books[2][4]

Children with Disabilities[edit | edit source]

Children with disabilities have a clear disadvantage when it comes to play. Mobility, visual and cognitive impairments can impose barriers to play. It can be difficult for them to move, see and understand play. This leads to children with disabilities participating in less complex play and playing less often than their typically developing peers.[5][1] Sensory development is likely impacted as well due to their limitation to physically interact with toys/objects. [6] Children with disabilities often require adaptive devices and toys to assist them with interactions and play.[5]

Children with severe disabilities are typically dependent on their family or caregivers to play. If they are not able to express their wants clearly, they will be presented with limited options of toys or activities to explore. As a result, they will miss opportunities to expand their development. The decreased opportunity to self-direct play can further impact their interest in play and their self-esteem. [2]

Research shows that children with severe disabilities have similar interests to typically developing children despite their medical needs and barriers. They want to engage in physical play, read books, watch movies, socialise and play with electronics. Understanding their developmental level can provide insight regarding activities of interest for them. This in turn will promote a more positive play experience.[2]

Positive social play experiences can be limited due to skill deficits along with the physical and social environment. [7] However, these children with severe disabilities can learn and master new skills given the right environment. An optimal environment would include the following:

  1. activities that are accessible
  2. assistance of a peer partner
  3. use of repetition and practice
  4. use of assistive technology if needed

** When the task is too difficult or beyond their developmental level, they will not be able to learn[2]

Environment[edit | edit source]

Social and Physical Arrangements[edit | edit source]

The following are suggestions for setting up a positive social and physical environment for children with disabilities:

  • effective groupings of children
    • providing children with disabilities the guided assistance they require to socially engage
  • appropriate play materials
    • toys encouraging shared and cooperative play
  • adult facilitation
    • interactive activities
      • with a peer
    • arranging play materials[1]

Partner-Assisted Play[edit | edit source]

Children with disabilities spend more time with caregivers or adults rather than peers despite their interest in being around peers. Partnering a child with disabilities affords them the opportunity to learn from their peers.[1] Interventions that are peer implemented provide opportunities for social interactions between children with disabilities and their typically developing peers. In addition, it allows reciprocity, social referencing and initiation/responding. [1]The goal of the play partner is to facilitate interactions between the child and another child or the child and their environment.[2]

The choice of play partner should be made by the child with disabilities. Play should be centred around the child's needs and wants. The child with disability should be included in the decision-making process regarding the activity, the toys used and how to play with it. Multiple options should be offerred.[5]

Play partners typically do not see themselves as reciprocal playmates, but more as play enablers. The play partner's role is to encourage and to create an environment where the child with disabilities plays the central role in the activity. [5]

Playdates[edit | edit source]

Playdates can be both structured and unstructured time for children with disabilities to interact with another child. During playdates children with disabilities have the opportunity to demonstrate learned skills from another environment. Before initiating playdates, it is important that the child with the disability to be involved with their peers. The child does not have to have independent play skills, but comfortable being in close proximity to others. Another important skill to have prior to a playdate it learning how to transition from one activity to another. This can be accomplished with appropriate prompts and reinforcement.[1]

Assistive Technology[edit | edit source]

There are a variety of assistive services and devices that can be used to improve function in children with disabilities. Using assistive technology can afford children with disabilities that ability to play more actively and participate in activities of their choosing.[2] Adaptive devices can be categorised into the following:

  1. adapted toys:
    • assist with stabilising, attaching, extending or confining toys
    • shoelaces, elastic ribbon to bring a toy within reach
    • velcro, nonslip material to hold objects in place
    • box tops, hula hoops to help keep toys from getting out of the child’s reach or visual field
  2. positioning devices:
    • designed for those that have difficulty changing positions or need assistance in moving while playin devices
    • semi-reclined (sling seat)
    • side-lying (towels)
    • prone (wedges, towels)
    • kneeling (floor tables, stairs)
    • sitting (corner chairs)
    • standing positions
  3. speciality AT items
    • assist with manipulating play objects
    • develop and extend cause and effect relationships
    • cooperative play skills with siblings and peers
    • battery adapters
    • timers
    • latch devices
    • series adapters (turn a toy on and off with a movement of a body part against a switch)
  4. communication devices:
    • devices that help incorporate children with communicative deficits to express themselves
    • photos or line drawings to help children select what they want to say
    • tablet computers with touchscreens to help the child navigate through pages of icons
    • range from very easy to use through very complex[1]

** As each child and family needs are unique different combinations of assistive technology can be used[1]

Modelling and Prompting Interventions[edit | edit source]

Research shows that the use of adult modeling has increased play behaviours in children with disabilities. Modeling can be successfully performed in the following steps:

  1. adult follows child's lead
  2. adult imitates the play
  3. adults models and prompts a play behaviour
    • behaviour should be developmentally appropriate
    • behaviour should be geared towards child's attention and interests[1]

Play Materials[edit | edit source]

Typically children with disabilities need more time and opportunities to interact with equipment, materials and toys. In addition to time, they require repetition to master a new skill. Therefore, equipment and materials should strategically not be removed or changed often. Play materials can vary in size, theme, density, complexity, etc. In order to increase interact and imaginative play, a variety of sensory, constructive, motor, exploratory and socio-dramatic toys should be used as play materials. The best play material is one that is motivating and allows for mutual play between children with disabilities and their typically developing peers. [1]

Floortime Development[edit | edit source]

Floortime development refers to the ability of the play partner to meet the child at their developmental level. The elements of floortime involve:

  • having the play partner on the floor and follow the child's lead
  • engage the child through activities they enjoy
  • direct child to more complex interactions
  • help the child to maintain focus[1]

Sensory[edit | edit source]

Children with disabilities who have limited gross motor development have restrictions on exploring their environment. This can lead to decrease sensorimotor experiences. This in turn can delay fine motor development further restricting sensory development. To support participatory sense making, children should interact with toys however they can independently and explore their environment by sound, touch and vision.[6]

Resources:[edit | edit source]

References:[edit | edit source]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 Movahedazarhouligh S. Teaching play skills to children with disabilities: Research-based interventions and practices. Early Childhood Education Journal. 2018 Nov;46(6):587-99.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 Hui S, Dimitropoulou K. iCan-Play: A practice guideline for assessment and intervention of play for children with severe multiple disabilities. The Open Journal of Occupational Therapy. 2020;8(3):1-4.
  3. ↑ Fiss AL, Håkstad RB, Looper J, Pereira SA, Sargent B, Silveira J, Willett S, Dusing SC. Embedding Play to Enrich Physical Therapy. Behavioral Sciences. 2023 May 24;13(6):440
  4. ↑ Bulgarelli D, Bianquin N. 3 Conceptual Review of Play. Play development in children with disabilities. 2017:58-70.
  5. ↑ 5.0 5.1 5.2 5.3 O’Connor D, Butler A, Lynch H. Partners in play: Exploring ‘playing with’children living with severe physical and intellectual disabilities. British Journal of Occupational Therapy. 2021 Nov;84(11):694-702.
  6. ↑ 6.0 6.1 Agostine S, Erickson K, D’Ardenne C. Sensory experiences and children with severe disabilities: Impacts on learning. Frontiers in Psychology. 2022 Apr 29;13:875085.
  7. ↑ Danniels E, Pyle A. Inclusive play-based learning: Approaches from enacting kindergarten teachers. Early Childhood Education Journal. 2022 Jun 22:1-1.
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