It’s only Child’s Play or is it?

As an experienced Chartered Physiotherapist Jayne Hallford knows the importance in engaging patients in meaningful movement to enable them to achieve their goals. When working with children it is

Jayne Hallford important to understand how what and why movement is important to a child and to be able to integrate this into their rehabilitation goals

Movement teaches a child so much, it defines depth and perception, left and right, up and down, strong and light, fast and slow.

Play is a child’s work, their occupation, their interaction with the world and cannot be seen as separate from physiotherapy. Reaching for a brick or kicking a ball is more likely to engage a child in their rehabilitation than physio stretches that are abstract and meaningless to a child. Knowing how to incorporate movement into physiotherapy to achieve rehabilitation goals is a key skill but knowing how to engage a child in movement through play is the real skill.

ITS ONLY CHILD’S PLAY OR IS IT?

Is Play important? Why even consider it? How do children with a brain or spinal cord injury access play? Do they need to? Do physiotherapist’s working with children need to consider play as part of their rehabilitation goals? What role does play have within rehabilitation?

Play - When we think about play – what comes into our minds? Does anything come into your mind? Have you actually ever thought about why children play? Afterall isn’t it just what children do and what we as adults either expect them to occupy their time with or offer as a break from learning to blow off steam e.g. play times at school. Have you ever considered what if anything the child is learning during this time when they are playing?

The Oxford Dictionary defines play as – Engage in activity for enjoyment and recreation rather than a serious or practical purpose.

The above definition leads us to think that play is frivolous and has no real life benefit, but is this true?

Take a moment– what words/phrases come into your mind when you think about children playing?

So you’ve paused and thought, and some of those words in the cloud above you may have considered and thought about. Does this have any benefit?

Let’s break this down even further by looking at one activity. Take for example the play opportunity of making a white house from a selection of brightly coloured plastic bricks.

running, loud, happy, being with friends, falling out, sharing, throwing, catching, being imaginative, climbing, fun, loud, spontaneous, inquisitive, constructive, making friends, laughter, shouting, burning off energy, calm, physical.

Have you ever considered those coloured bricks may actually have value other than being the pesky toy that gets everywhere and really hurts when you stand on them!

Again, a person without clinical experience might think of skills such as creativity and problem solving, or maybe patience and concentration. This is all true - but there is so much more!

Below is a list of some of the skills and abilities a child needs, which can be developed just by playing with bricks.

A stable posture that allows them to take their hands away from their body Muscular strength to maintain the posture Head control to allow improved efficiency of eye control scanning for the white bricks Hand eye coordination – looking at the bricks and picking up the right ones Dexterity to manipulate the bricks Muscular strength to push the bricks together / pull them apart Handling the bricks gives experiences of different textures The ability to know what a house is and how to replicate the construction. The ability to know what ‘white’ is and be able to pick the white bricks out from the other colours; being able to scan with their eyes. Imagination- what do they want their house to look like? Perseverance, repetition, practice and motivation to keep trying so the project is successfully achieved. Concentration- not being distracted or bored. The ability to interact with other people and gain recognition and reward The list goes on.

Question - Why play with building bricks with a child with cognitive and physical difficulties? Does it matter if they can’t? And what role if any would playing with bricks bring to a child’s rehabilitation and therapy input?

Answer - The skills a child develops when playing with building bricks are often precisely the skills a child with a brain or spinal cord injury need to experience to ensure they are developing and reach their maximum potential.

A brain or spinal cord injured child may have significant areas of difficulty within their physical and cognitive skills – so as adults how do we ensure this child gains the benefit of building a house with bricks?

For example They may not be able to sit unaided. They may need to stabilise by propping with their hands. Their ability to scan and look for objects may be affected, or they might have a visual impairment. They may have poor head control. They may not understand what white is, or even what a house is.

SO, - How might a physiotherapist address some of these problems and still make the task of building a white brick house fun!

STARTING POSITION

Before we can consider actually playing with the toy, as the physiotherapist the first thing to consider is the physical capabilities a child needs just to be able to start the task.

In this case, the child must have the physical ability to get into and maintain a posture where they can access the bricks sitting, standing, on the floor. They then must have the stability within that posture to hold their head up and be able to take their arms away from their body to be able to see and pick up the bricks and manipulate them.

This is so important for the child to be able to explore movement. Giving a disabled child the opportunity to explore other positions for play introduces activities which support muscle stretching, strengthening and functional practice. Remember - Most young children play on the floor, not in sitting at a table!

If a child is a wheelchair user so often the toy is taken to the child and so the movement options are limited by the constraints of the wheelchair.

Being facilitated by a physiotherapist to roll to reach for a brick, is fun for the child, a learning opportunity and challenges the motor systems. Moving the brick further and further away with each roll increases the range of movement that is challenged and builds the core components for a child to be able to turn in bed.

Being supported for example by the physiotherapist to sit or stand in a way that allows the child to move within and outside of their base of support challenges their balance and postural control to reach for the brick.

If a child only plays in sitting then their movement experience will be limited to sitting in a wheelchair!

LEARNING THROUGH MOVEMENT

Once the child has the brick in their hands, they need to use their sensation recognise its shape and dimensions of the brick. Sensation and movement are integrally linked therefore supporting the child to manipulate the brick and learn from the experience rather than doing it for them is key.

Next the child needs the finger and hand dexterity alongside upper limb mobility and postural stability and head control to orientate the bricks into place. A physiotherapist will provide enough guidance and support, in the right places to the right muscle groups to enable this to be more successful, than if they did it on their own, providing errorless learning.

ACHIEVING THE GOAL

But how to make a house? The child needs to understand how to manipulate the bricks together how much pressure to apply to make the construction stable and know what shape they are trying to achieve and so they need to know what size and colour bricks they require. The child needs to be able to scan the pile of bricks and locate and separate the white ones out and ensure they have enough to complete the project, which then dictates how big is the house going to be.

Playing with building bricks - it might have surprised you what skills a child is using and developing in order to build that white brick house!

PLAY AS A MEASURABLE OUTCOME?

So, if play is so important to a child’s development why can it be overlooked as a part of their rehabilitation?

Despite the complex nature of working specifically with a child, in my experience and those of my colleagues here at SP Therapy Services, there is very little to no time on a physiotherapy course designated to specifically looking at how to engage children in the rehabilitation process. Specific conditions that affect children and alter the physical and cognitive presentation of a child may be on the curriculum, but the specific principles of how to use the power of play to engage children in meaningful therapy that they will adhere to is still an overlooked aspect of the training.

Added to that problem is that often as adults we ‘forget’ how to play with the children, getting frustrated with the repetitive nature how often children want to play, or feeling they should be doing ‘something more important’.

Hence, our focus as physiotherapists is on improving range of movement or preventing skeletal deformity, whilst the child’s focus is building a house! The skill is in manipulating the environment and the opportunities to achieve the physiotherapist’s goals whilst the child learns through the experience.

Play is the work of all children including those with a brain or spinal cord injury, that enriches their development as they grow and is not a frivolous activity that holds no real benefit. Teaching support staff and family members how to engage in play that is physically meaningful and functionally challenging benefits the whole family.

Understanding the benefits of play and its role in rehabilitation is central to our ethos at SP Therapy Services when treating children with a brain and spinal cord injury. We pride ourselves on having the high level of skills to problem solve how to involve and engage a child in play that achieves their rehabilitation goals.

If you wish to know more contact us on info@sptherapyservices.co.uk web: www.sptherapyservices.co.uk