Therapeutic Play for the Severely Disabled Population

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

Introduction

Children learn best in an environment which provides discovery, exploration and play. Playful interactions allow children to express their curiosity and creativity. Play facilitates independence and participation while fostering relationships with care-givers and peers. Playing facilitates gross and fine motor, language, social, pre-academic and psychosocial skills.

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.

Stages of Play

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.

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

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. Sensory development is likely impacted as well due to their limitation to physically interact with toys/objects.

Children with disabilities often require adaptive devices and toys to assist them with interactions and play.

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.

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.

Positive social play experiences can be limited due to skill deficits and the physical and social environment. . Children with severe disabilities can learn and master new skills with 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

Environment

The environment for play involves both social and physical surroundings

Social and Physical Arrangements

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

Partner-Assisted Play

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. Interventions that are peer implemented provide opportunities for social interactions between children with disabilities and their typically developing peers. In addition, it provides engagement in allows reciprocity, social referencing and initiation/responding. The goal of the play partner is to facilitate interactions between the child and another child or the child and their environment.

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.

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.

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.

Assistive Technology

There are a variety of assistive services and devices that can be used to improve function in children with disabilities. Adaptive devices can be in the form of low-technology, mid-technology to high-technology.

1. Low-tech item
   • inexpensive
   • more readily available
   • easy to use
   • do not require electronics
   • position and mobility items
2. mid-tech:
   • adaptive toys
3. high-tech:
   • computers
   • gaze-based devices

** Each child and family needs are unique whereby combinations of assistive technology can be used

Using assistive technology can afford children with disabilities that ability to play more actively and participate in activities of their choosing.

Modeling 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:

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

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.

Floortime Development

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

Sensory

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.

Ideas of games:

https://raisingchildren.net.au/guides/activity-guides/children-with-diverse-abilitieshttps://iris.unito.it/retrieve/handle/2318/1746530/631583/Bulgarelli_2020_Perspectives%20and%20research%20on%20play%20for%20children%20with%20disabilities.pdf

Resources:

• Therapeutic Play
• Children with Medical Complexities
• Cerebral Palsy Aetiology and Pathology