Therapeutic Play
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.
- Toys
- social games (peak-a-boo
- 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]
- ↑ 1.0 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.
- ↑ 2.00 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.
