Therapeutic Play: Difference between revisions

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3.3.1. Understanding a Family’s Play Culture
3.3.1. Understanding a Family’s Play Culture


Understanding family culture is important when incorporating play in the child's intervention.  Some families have a wide variety of materials and space for play while others do not.  Some families value play and physical activity while others do not.  The values and cultural beliefs can affect play for the child.  Many families of children with motor deficits underestimate their child's physical, developmental or play abilities.  <ref name=":1" />
Understanding family culture is important when incorporating play in the child's intervention.  Some families have a wide variety of materials and space for play while others do not.  Some families value play and physical activity while others do not.  The values and cultural beliefs can affect play for the child.  Many families of children with motor deficits underestimate their child's physical, developmental or play abilities.  <ref name=":1" />It is important to develop goals in partnership with the families.  This helps ensure more mastery of skills and carryover of skills. <ref name=":1" />


==== 3.3.2. Partnering with Families ====
Partnering is a multi-faceted, family-centered process that promotes family engagement in intervention programs [86,87]. It implies ‘co-construction’ of the therapeutic relationship: shared observation of child and family strengths/needs, shared development of therapy goals and outcomes, and shared conceptualization of the role of intervention in the child’s development [88,89]. It acknowledges that the primary agent for a child’s developmental change is the parent–child relationship [86,90,91]. A parent’s contingent responsiveness, or ability to read and respond to their child’s cues, is related to both secure relationships and the degree to which very young children explore their environments [91,92,93]. Responsive parents extend play and promote early learning through attentive but non-directive interactions [93]. These carefully nuanced interactions enhance the child’s mastery motivation, tolerance to frustration, and focused attention: all skills associated with stronger cognitive, communication, and self-regulatory/adaptive developmental outcomes [92,93]. Partnering between professionals and parents implies transparency, equality in decision making, and absolute ‘presence’ [87].


Presence may be considered physical proximity. Anecdotally, therapists and parents often comment that parental presence in the PT session is distracting to the young child. However, motor learning suggests that behaviors observed during therapist–child interactions are capacity-related and not true performance [94]. There is no guarantee of carry-over into daily routines if parents are not actively involved. Additionally, children rely on familiar caregivers to understand the context of any social interaction. When separated from their parents, they are not as likely to read the subtle shifts in gaze or to respond to the tactile cues that familiar caregivers use to direct, attenuate, and shift attention [92,93,95] needed for both social-emotional regulation and learning [93,96].
Presence may be considered attentional. In the therapeutic relationship, attentional demands are complex, dynamic and triadic (parent-child-therapist) [88,91]. Parents’ and therapists’ attention at any given moment is potentially fragmented by many things: other responsibilities, worries about the immediate and distant future, and constant technoference, defined as cell or smart-phone disruptions during social interactions [97]. In the parent–child relationship, these interruptions can lead to increased child distress, disrupted infant social-emotional regulation, lowered child inhibitory responses, and impaired contingency-related learning of both language and social cues [97,98,99]. Simply put, attentional disruptions interfere with the ability to recognize and respond to a child’s cues during play or any therapeutic interaction.
Engaged parents extend the reach and dose of any intervention, including play by embedding therapeutic activities into daily routines [89,90]. Parents who participate in play-based intervention programs report gaining an understanding of quality play time, spending more time with their child during play activities, and having a greater understanding of the developmental impact of play [100]. Multiple frameworks for engaging families exist. King et al. [87,88] propose four key principles for family engagement: (1) the personalizing principle, or ‘knowing the client’; (2) the individual variation principle, or knowing that clients differ in how they demonstrate engagement and what engages them; (3) the relationship principle, or that engagement is cultivated through interpersonal relationships; and (4) the monitoring principle, or staying attuned to the child’s and the parent’s level of engagement from moment-to-moment and from session-to-session. Practical strategies for family engagement as described by Marvin et al. include open communication, encouraging parent–child interaction during sessions, overtly linking play behaviors to developmental or motor outcomes and modeling, suggesting and practicing play behaviors in action and together. Therapists can invite parents to play, describe the purpose and learning opportunities embedded in play, and affirm parents in their parent–child play interactions. For children with motor impairments, this may include teaching parents to ‘wait’, to allow their child opportunities for trial and error and to support their child’s focused attention during play.
== 4. Conclusions ==
PT that embeds play has the potential to support acquisition of skills across the developmental continuum. In this framework, therapists work to engage the child in play, to facilitate optimal environmental set-up and toy selection, and to engage the family in play interactions with their child. Consideration of these components ensures the therapist is supporting play and development and is not disrupting or interfering with the play of children.
Currently, a gap exists in our understanding of PT that embeds play. Research suggests there may be differences in how physical therapists interpret and implement play in the design of PT sessions with children [11,15]. Additional information on if and how physical therapists intentionally incorporate play within their assessment and intervention sessions should be examined in greater depth. Educational guidelines for how physical therapists should be prepared to incorporate and support the play of children with or at high risk of motor delays are lacking, which may contribute to variation and a disconnect between effective strategies and clinical practice trends.
Future research should explore perceptions of both clinicians and of parents related to PT that embeds play. Greater understanding of therapist beliefs related to the importance of play in facilitating developmental skills, their own playfulness during therapy, and their comfort and skill in supporting the parent’s ability to play with their child is needed. Additionally, the perceptions of parents related to play and how best to facilitate their interactions with their children should be explored. Together, this information may inform additional guidelines or research to inform how best to support optimal play and overall development of infants and toddlers with or at risk of motor delays.


== References ==
== References ==


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Revision as of 20:08, 30 June 2023

Intri

Play is at the heart of childhood. It is a dynamic process that enables children to express themselves in their own ways, to get in touch with other children, to become socialized. In contrast to adults, is not an easy task for the children to express verbally their thoughts, their problems, their questions. They usually use play to express their concerns, their fears, their desires and to communicate with their environment (1, 2). Play as a free and effortless expression of life, is of vital importance for the children, because they can develop their imagination through it. They are also guided to new ways of viewing every day’s life. It is a way of exploring and getting to know both the interior and the outside world. It is a basic part of children development and it is as important as the maternal hug (3).[1]

Play is essential to support the development of multiple developmental domains: motor, language, cognition, social-emotional, and adaptive behavior [3,4,5]. Play allows children to learn about themselves and their environment [3,5,6]. Early reciprocal caregiver interactions such as eye contact, smiling, and mimicking sounds are some of the earliest forms of play, laying a foundation for future socialization and language development [7]. As the child ages, exploring the environment during play provides opportunities for children to learn what their body can do and to practice skills that support the development of new abilities [8,9]. For example, an infant may see an interesting toy out of reach, and through repeated attempts to obtain the toy, develop new motor skills such as rolling or crawling. As motor skills advance, new opportunities for exploration further facilitate cognitive growth.[2]

Therapy[edit | edit source]

Play therapy is a form of therapy that requires the therapist to come to the child’s level and speak in his own language. The most familiar mode of expression for a child is the play. In this therapy, therefore, toys are l[1]

Paediatric physiotherapists use play when assessing and providing treatment interventions for infants and children. The use of play increases the child's engagement and motivation in therapy.[2]

Infants and Toddlers[edit | edit source]

Children with motor delays require a supportive environment to fully engage in play. There may be differences in play for these children due to their underlying medical condition. When developing intervention programs it is important to understand the impact the child's condition may have on play. This environment involves parent and caregiver support and may also include adaptive equipment or toys.[2]

Respecting the Child’s Behavioral State and Cues[edit | edit source]

When working with children with developmental delays, it is important to give them time to process information, respond or make choices or take a break. Providing this increased time can help children that have difficulties with motor planning, attention and recognition. Multiple prompting can be overwhelming. Structured, rhythmic exchanges synchronised with the child's response will facilitate more participation.[2]

Sometimes it can be difficult to read the child's engagement or distress due to communication issues. It is necessary to observe communication signals such as gestures, eye movement, breathing patterns, vocalisations) in order to understand what message the child is relaying.[2]

Tactile stimulation play an important role in play and can either increase or decrease a child's attention. Understanding the child's sensory processing and how much stimuli cant be overwhelming is important for keeping the child engaged. [2]

3.1.2. Respecting the Child’s Autonomous Play Initiatives and Engagements[edit | edit source]

Providing simple and structured directions helps maintain the child's exploratory behaviour. Mutual play and allowing the child to direct play and time spent on a certain activity keeps the child engaged.[2]

3.1.3. Including Activities across Developmental Domains[edit | edit source]

Therapeutic play should include activities that cross multiple domains of motor-based and socioemotional. Performing motor-based skills can create and environment for that iniates language, social and cognitive skills. [2]

3.1.4. Supporting a Child’s Engagement in Play[edit | edit source]

The use of mirroring or mimicry allows for social connectiveness. This is an effective too for infants and young children.

Determining the right amount of challenge is important to keep the child engaged during the session. If the intervention is too challenging, the child may lose interest. If it is too easy, the therapeutic intention may not occur. The therapist needs to find the fine line where the child needs to focus their effort to master the skill but yet not too hard that they disengage. Once the skill has been attained, the therapist can increase the difficulty in small increments.[2]

3.1.5. Adapting Play to Individual Child Differences[edit | edit source]

When working in a thereaputic environment, it is important to use the strengths of the child versus their deficits. This allows for more positive interactions with the therapist and with the parent and child for the home setting.[2]

3.2.2. The Environmental Set-Up[edit | edit source]

The therapist should try as much as position to be face-to-face with the child to view visual cues and vice versa. Otten times, therapists or caregivers are behind the child giving external support. If there is an external support device that can be used to allow eye contact in a face-face interaction, the attention and intereaction can be increased.[2]

3.2.3. The Use of Toys[edit | edit source]

There are many ways to engage in play.

  1. Toys
  2. social games (peak-a-boo
  3. child actively exploring and interacting

When therapists try to use a toy to encourage movement without allowing child to fully explore the toy before the next request can lead to frustration and missed opportunities. Support the child with extended play and then request movement when they are ready. May need 4-5 toys to encourage movement and keep attention.[2]

3.3.1. Understanding a Family’s Play Culture

Understanding family culture is important when incorporating play in the child's intervention. Some families have a wide variety of materials and space for play while others do not. Some families value play and physical activity while others do not. The values and cultural beliefs can affect play for the child. Many families of children with motor deficits underestimate their child's physical, developmental or play abilities. [2]It is important to develop goals in partnership with the families. This helps ensure more mastery of skills and carryover of skills. [2]


References[edit | edit source]

  1. ↑ 1.0 1.1 Koukourikos K, Tsaloglidou A, Tzeha L, Iliadis C, Frantzana A, Katsimbeli A, Kourkouta L. An overview of play therapy. Materia socio-medica. 2021 Dec;33(4):293.
  2. ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 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.
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