Therapeutic Play for the Severely Disabled Population
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.
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[1]
Children with Disabilities[edit | edit source]
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. [1]
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.[1]
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[1]
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
https://link.springer.com/article/10.1007/s10643-022-01369-4
https://scholarworks.wmich.edu/cgi/viewcontent.cgi?article=1696&context=ojot
https://journals.sagepub.com/doi/abs/10.1177/0308022620967293
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9099238/
https://raisingchildren.net.au/disability/school-play-work/play-friends/play-friendship-disability
https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-021-02827-5
https://jneuroengrehab.biomedcentral.com/articles/10.1186/s12984-018-0464-x
Additional resources:
- ↑ 1.0 1.1 1.2 1.3 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.
