Therapeutic Play for the Severely Disabled Population: Difference between revisions
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== Intro == | == Intro == | ||
The job of a child is to play. Through playful interactions, children are able to express their curiosity and creativity. Playing facilitates gross and fine motor, language, social, pre-academic and psychosocial skills. | The job of a child is to play. Through playful interactions, children are able to express their curiosity and creativity. Playing facilitates gross and fine motor, language, social, pre-academic and psychosocial skills. | ||
Play with or near peers is a primary form of | |||
engagement for young children and a major developmental | |||
indicator Children learn best in an environment which allows them to explore, discover, and play. Play promotes independent participation across settings (e.g., homes, classrooms, and communities) and allows children to become active members of their social contexts (Frey and Kaiser 2011). Play is related to better social and communication skills (Lifter et al. 2011), promotes improved physical and mental health and provides a critical context for developing and fostering relationships with care givers and peers. It is also closely tied to the development of cognitive, socioemotional, and physical behaviors Play also includes an element of being freely chosen by the child and personally directed in a process of trial and error in which the child learns new activities (Nelson et al. 2007; Wong and Kasari 2012). Play is intrinsically motivating, flexible, spontaneou.and voluntary, allowing children to use their natural environment to promote learning and socialization (Kasari et al. 2013). There are also two overarching types of play taxonomies: social playH<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> | |||
== Stages of Play == | == Stages of Play == | ||
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== Children with Disabilities == | == Children with Disabilities == | ||
Children with disabilities are at distinct disadvantage when it comes to play. Mobility problems make it difficult, if not impossible to play hide and seek, visual impairments impede a child’s ability to find and investigate toys, and cognitive disabilities limit the development of pretend play. In fact any disability (physical, cognitive, or sensory) poses a barrier to spontaneous engagement in play and playful activities (Barton and Wolery 2010). Children with disabilities engage in less complex and fewer play behaviors than their typically developing peers when given the same materials in the same settings (Barton 2015; Kasari et al. 2013). Children with disabilities including cognitive disabilities, intellectual disabilities, sensory disabilities, autism spectrum disorder (ASD), multiple disabilities, speech or language impairments, and emotional disturbance usually demonstrate social interaction difficulties, communication challenges, deficits in developing, maintaining, and understanding relationships, have a restricted range of interests that may be abnormal or unconventional and experience limited receptive and expressive communication skills (American Psychiatric Association 2013). They play less often and demonstrate fewer varied pretend play behaviors than children with typical development (Kasari et al. Without highly structured instructional cues, children with disabilities tend to use fewer novel play behaviors, use less variety and complexity in their play, display less variety in their choice of toys and use fewer actions on toys (Lifter et al. 2011). Although highly correlated with skills across other domains (e.g., communication, social, motor), the unique and idiosyncratic nature of play suggests that effective intervention approaches might need to be specifically adapted and tailored to effectively and efficiently increase the complexity and duration of a child’s play repertoire (Barton 2016). In the following section, a summary of researchbased interventions that can be used to teach play skills to children with disabilities a20<ref name=":1" /> | |||
oth skill deficits related to play and the surrounding physical and social environment have been noted to limit the positive social play experiences of children with disabilities <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 or multiple disabilities may have barriers to play due to their physical, language and/or cognitive impairments. Often times, play for these children is often neglected. 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 or multiple disabilities may have barriers to play due to their physical, language and/or cognitive impairments. Often times, play for these children is often neglected. 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" /> | ||
that play has different forms for children with severe disabilities given the limits in their ability to physical interact with objects (Wenger et al., 2021), move their own bodies (Graham et al., 2019), and talk or otherwise interact with others (Clarke and Wilkinson, 2009). This in turn is likely to impact the sensory development that is promoted by typical play.<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> | |||
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" /> | ||
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<nowiki>**</nowiki> When the task is too difficult or beyond their developmental level, they will not be able to learn<ref name=":0" /> | <nowiki>**</nowiki> When the task is too difficult or beyond their developmental level, they will not be able to learn<ref name=":0" /> | ||
== Environment == | |||
== 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" /> | |||
== Partner-Assisted Play == | == Partner-Assisted Play == | ||
| Line 46: | Line 63: | ||
''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'' | ''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 | |||
https:// | |||
Revision as of 15:30, 3 July 2023
Intro[edit | edit source]
The job of a child is to play. Through playful interactions, children are able to express their curiosity and creativity. Playing facilitates gross and fine motor, language, social, pre-academic and psychosocial skills.
Play with or near peers is a primary form of
engagement for young children and a major developmental
indicator Children learn best in an environment which allows them to explore, discover, and play. Play promotes independent participation across settings (e.g., homes, classrooms, and communities) and allows children to become active members of their social contexts (Frey and Kaiser 2011). Play is related to better social and communication skills (Lifter et al. 2011), promotes improved physical and mental health and provides a critical context for developing and fostering relationships with care givers and peers. It is also closely tied to the development of cognitive, socioemotional, and physical behaviors Play also includes an element of being freely chosen by the child and personally directed in a process of trial and error in which the child learns new activities (Nelson et al. 2007; Wong and Kasari 2012). Play is intrinsically motivating, flexible, spontaneou.and voluntary, allowing children to use their natural environment to promote learning and socialization (Kasari et al. 2013). There are also two overarching types of play taxonomies: social playH[1]
Stages of Play[edit | edit source]
Based on Paiget's stages of cognitive development, the Takata Play Taxonomy divides play into five stages. Each stage interactions and complexity in activities progressively increases.
- Sensorimotor:
- cause-effect toys
- considerable amount of practice
- high level of exploration
- Symbolic:
- use of objects to represent actual objects (toy phone represent real phone)
- parallel play is noted during this stage
- Dramatic:
- role-playing
- cooperative play
- Game with Rules:
- aspect of competition
- cooperative play
- board games, puzzles, crafts, sport-related
- Recreation:
- team participation
- sports, hobbies
- dancing, team sports, music, tabletop games, books[2]
Children with Disabilities[edit | edit source]
Children with disabilities are at distinct disadvantage when it comes to play. Mobility problems make it difficult, if not impossible to play hide and seek, visual impairments impede a child’s ability to find and investigate toys, and cognitive disabilities limit the development of pretend play. In fact any disability (physical, cognitive, or sensory) poses a barrier to spontaneous engagement in play and playful activities (Barton and Wolery 2010). Children with disabilities engage in less complex and fewer play behaviors than their typically developing peers when given the same materials in the same settings (Barton 2015; Kasari et al. 2013). Children with disabilities including cognitive disabilities, intellectual disabilities, sensory disabilities, autism spectrum disorder (ASD), multiple disabilities, speech or language impairments, and emotional disturbance usually demonstrate social interaction difficulties, communication challenges, deficits in developing, maintaining, and understanding relationships, have a restricted range of interests that may be abnormal or unconventional and experience limited receptive and expressive communication skills (American Psychiatric Association 2013). They play less often and demonstrate fewer varied pretend play behaviors than children with typical development (Kasari et al. Without highly structured instructional cues, children with disabilities tend to use fewer novel play behaviors, use less variety and complexity in their play, display less variety in their choice of toys and use fewer actions on toys (Lifter et al. 2011). Although highly correlated with skills across other domains (e.g., communication, social, motor), the unique and idiosyncratic nature of play suggests that effective intervention approaches might need to be specifically adapted and tailored to effectively and efficiently increase the complexity and duration of a child’s play repertoire (Barton 2016). In the following section, a summary of researchbased interventions that can be used to teach play skills to children with disabilities a20[1]
oth skill deficits related to play and the surrounding physical and social environment have been noted to limit the positive social play experiences of children with disabilities [3]
Children with severe or multiple disabilities may have barriers to play due to their physical, language and/or cognitive impairments. Often times, play for these children is often neglected. 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]
that play has different forms for children with severe disabilities given the limits in their ability to physical interact with objects (Wenger et al., 2021), move their own bodies (Graham et al., 2019), and talk or otherwise interact with others (Clarke and Wilkinson, 2009). This in turn is likely to impact the sensory development that is promoted by typical play.[4]
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]
Children with severe disabilities can learn and master new skills with the right environment:
- activities that are accessible to them
- assistance of a peer partner
- use of repetition and practice
- the use of assistive technology is needed
** When the task is too difficult or beyond their developmental level, they will not be able to learn[2]
Environment[edit | edit source]
Sensory[edit | edit source]
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.[4]
Partner-Assisted Play[edit | edit source]
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
Assistive Technology[edit | edit source]
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 https://scholarworks.wmich.edu/ojot/vol8/iss3/8 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:[edit | edit source]
https://raisingchildren.net.au/guides/activity-guides/children-with-diverse-abilities
Additional resources:
- ↑ 1.0 1.1 Movahedazarhouligh S. Teaching play skills to children with disabilities: Research-based interventions and practices. Early Childhood Education Journal. 2018 Nov;46(6):587-99.
- ↑ 2.0 2.1 2.2 2.3 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.
- ↑ Danniels E, Pyle A. Inclusive play-based learning: Approaches from enacting kindergarten teachers. Early Childhood Education Journal. 2022 Jun 22:1-1.
- ↑ 4.0 4.1 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.
