Lezlie Adler Power Point

15 Pages·2015·2.68 MB·English

Current Commentary on Play
Arizona Occupational Therapy Association
•  Childhood play is crucial for social, emotional

and cognitive development.
Linking Play to Function...
… Utilizing NDT and SI •  Imaginative and rambunctious “free play,” as
opposed to games or structured activities, is
Strategies to Facilitate Functional the most essential type.
Skills Through Play
•  Kids and animals that do not play when they
are young may grow into anxious, socially
maladjusted adults.
•  Participation (“children define as having fun,
feeling successful, doing things by
themselves, and doing and being with others”)
is essential to quality of life for children,
including those with disabilities.

•  Play” is being sneakily redefined. “Most of the
activities set up in ‘choice time’ or ‘center
time’ [in early-childhood classrooms] and
described as play by some teachers, are in
fact teacher-directed and involve little or no
free play, imagination, or creativity.”
•  Younger and older children ought to have the
chance to play together. Peter Gray, a
psychologist at Boston College, points out
that older kids are uniquely able to provide
support — often referred to as “scaffolding” —
Lez lie Adler, MA OTR/L C/NDT for younger kids in mixed-age play.
[email protected]
Current Commentary on Play
Attributes of Participation
•  Play is not just for children. The idea
of play is closely related to •  The child must take part in
imagination, inventiveness, and that
something or with someone
state of deep absorption that
Mihaly Csikszentmihalyi dubbed“flow.”
•  The child must feel included or
•  The point of play is that it has no point.
have a sense of inclusion in what
they are partaking
•  Play is essential for all children’s
healthy development and learning
across all ages, domains, and cultures.
•  The child must have a choice or
•  Play does the following:
control over what they are taking
–  Enables children to make sense of their
world part in
–  Develops social and cultural
understandings
–  Allows children to express their thoughts •  The child must work toward
and feelings
–  Fosters flexible and divergent thinking obtaining a personal or socially
–  Provides opportunities to meet and solve meaningful goal or enhancing the
real problems
quality of life
–  Develops language and literacy skills and
concepts
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Definition
Principles
of Playfulness
of Play

Under
Internal
Control

Sensory Suspend
Neuromuscular Reality/
Mental Purposeles s
All 3
Repetition Process Not
Exploration Product
Imitation Is the Reward

Interprets
Reality/Fantasy Intrinsically
Sequential Motivated
Developmental
Progression Active Rule Making
Engagement/ and
Voluntary Rule Breaking

Evolution of Play
Developmental
Se quence Types

of
Play for Exploration
•  Child imposes on object Play
•  Attentiveness based on responsiveness
•  Self, then use of objects based on
relationship to self
•  Conquering gravity expands environmental Practice Patterns of
exploration of Schemas Physical
Interaction
Symbolic Play Sensory -Motor
••     PTrraentesnfodr Pmlsa yR/Oeardlietyr i(ntigm Lei,f ep l(athcien.g pse &op plee,o ple) FPurnaccttiiocnea/ l Sys tems Caanuds e
objects) Effect
•   1st in relation to self 2nd outside of self
•   1 s t s o l i t a r y 2nd groups
Symbolic
Constructive Play
•  Involves physical properties of reality with
characteristics of play materials
•  Control over environment Constructive Dramatic Social
Interactions
Rules and Games Games With
Rules
•  Social skills
•  Independence

•  Role in Society
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Evolution of Play
Evolution of Play

The Development of
Emotional & Perceptual
Development of Capacities
Social Play

Regulation and Interest in the World
Engagement with Caretakers
Engaging and Relating
Onlooker Behavior
Intentionality and Two Way Communication

Solitary Play Social Problem Solvin g, Mood Regulation
and Formation of Sense of Self

Creating Symbols and Using Words and

Ideas
Parallel Play

E motional Thinking, Logic, and a Sense
of Reality
Associ ative Play

Multicausal and Triangular Thinking

Cooper ative Play

THE PROBLEM
THE focus of THERAPY: WITH PLAY and
THE ACQUISITON OF SKILLS
THERAPY
THAT CAN Be measured
"   “In the therapeutic setting, play

often becomes a tool used to work
towards a goal, despite the fact that
Definition of Skills:
the goal – oriented, externally
sequences of organized actions, controlled aspects of the
which apply strategies proceeding therapeutic situation may conflict
with the essence of play itself.”
to future goals: expertness in
practiced activities showing
"  Inherent in therapy is the intention
dexterity, coordination and of a outcome including a change in
confidence in functional behavior or performance that can be
performances measured as a “new skill”.
"  Occasionally playing is the goal, as
a goal it becomes work.
Rhoda Erhart OTR
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Things to consider to make
therapy playful
Therapy
QUESTIONS
and Play
Does the child play/actively engage ?
cognitive & mastery Does the child have play preferences/self
perceptual over the directed ?
processing promotes environment
Is the child stuck on a particular scheme?
multi-
(joyfulness)
Entertain systemic
and Distract development How does the child use schemas, solve
difficulties, challenge self, use imagination?
Motivate How does the child interact with others,
Participation share, and gain attention ?
How does the child react to a
Social and variety of sensory input?
Emotional Does the child initiate creative play and
Development use it for problem solving?
Give Is the child motivated to play and make
Purpose to choices ?
Therapy
How does the child use his body, objects,
and others ?
Functional Skills for
What are functional
Hom e – School – Community
skills ?
Mobility: maintaining upright/weight shift
transitions on & off, in & out
•  Activities or actions that are
transitions through space
expected roles or occupations of
people Self Care: hygiene
clothing
•  Function implies “effectiveness” feeding
toileting
•  Task analysis is the process tool usage
used to determine each attribute
or component of function in a Communication: visual
oral
task gestures

Leisure Time: exploratory play
exercise
entertainment
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FUNCTIONAL AREA FUNCTIONAL AREA
Mobility: maintaining upright/weight shift Self Care: hygiene
transitions on & off, in & out
clothing
transitions through space
feeding

• Developmentally Playful Activities toileting
tool usage
– Supine Kicking/Hands to Hands/Hands
to Feet
•  Developmentally Playful Activities
– Prone propping
  Hand to Mouth
– Rolling   Body Exploration
– Pivoting/Bridging/Swimming   Object Reference:
– Transitions Sitting, Quadruped Hold/Move/Releasing/Bang, Shake, Transfer,
– Creeping/Crawling Hit, Tear, Place, Bilateral, Unilateral, Manipulate
– Bear crawling   Object Exploration
  Feel
– Up and Down Against Objects
  Taste
– Climb Stairs Steps   Look
– Cruising/Stands Alone   Move
– Walking Forward/Backward/Up   On and Off
Stairs/Down Stairs   Body Imitation
– Experiments With Movement   Facial, Extremity, Action
+Movement With Objects (pull,   Object Use
  Hand As Tool
push, throw…)
  Hand Over Adult
– Running   Hold and Manipulate Tool
– Jumping   Object Imitation
– Hopping   Pretend With Animate and Inanimate
– Galloping Objects…. Imitate Adult Use

– Skipping
FUNCTIONAL AREA
FUNCTION AREA
Communication: visual
ora l Leisure Time: play
gestures exercise
entertainment
•  Developmentally Playful Activities
– Feeding: sucking, munching, biting,
chewing •  Developmentally Playful Activities
– Manipulation
– Experimentation With Food:
texture. thickness, firmness/solid, – Body Action: with and without objects
crisp, sticky, combinations – Complex Object Manipulation:
– Sound Production: bilabial, construction, mechanical objects,
alveolar, labio – dental, lingual – combining objects to make a product
dental, palatal, back – velar – Complex Play: tool use and skilled
– Communicative intent: eye contact, movement (hop, skip, jump,
staring, reaching, cooing, facial summersaults…)
expressions, babbling, vocal – Games: with and without rules, fine and
imitation, smiling, laughing, gross motor
jabbers, real words, jargon – Team Games and Organized Sports,
– Physical Communicative Intent: Neighborhood Activities, Special
extraneous extremity activity, Interest Groups, and Hobbies
directive extremity posturing or – Social Entertainment: movies, dancing,
movement parties, camping……
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Multi Systemic
Contributions to Function

Interacting systems Musculoskeletal NEUROMOTOR
work together explaining how humans System SYSTEM

accomplish functional tasks
Coordination:
Posture/Movement
Skeletal
Alignment
Environmental Grading Muscle
System Tension & Force
ComSymsatenmdi ng Regulating Muscle Timing: initiate/
System Endurance sustain/terminate
Function- Jt. Range of Agonist/Antagonist
Comparing Skill Motion/ Relationship
System Sensorimotor Tissue
System Elasticity Type of Muscle
Contraction
Sufficient
Musculoskeletal Neuromuscular Strength Extraneous
System System Movements
Bernstein
Heroza
Thelen
Sensory Comparing
Commanding
Systems System
Regulating System
Systems
Visual
System Getting
Sensory Ready
Arousal
Vestibular
System
Having an
Cognitive Intention
State Proprioceptive
Regulation System
Emotional Feedback
Somatosensory Drive
System
Motor
Panning
Feed forward
Auditory
System
Executive Environmental
Function
Spatial Environmental System
Orientation Adaptation
Where & What
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Assessment of a Function
  Identify a Functional Goal

  Essential Posture and Movement Requirements

  Essential Sensations Generated and Integrated

  Essential Perceptual Strategies Accessed
 Regulating Mechanisms
 Commanding Mechanisms
 Comparing Systems

  Environmental Considerations

  Special Equipment/Playful Opportunities

  Intervention Plan
 Preparation
 Simulation
 Practice
 Carry Over
 Infused/Embedded (SCHOOL)

Therapy Focused On Function
How can play facilitate
TOP DOWN APPROACH
function in therapy?
Defined Outcome (Goal)

Play offers an opportunity to organize and
Identification of Interferes Identification of Strengths
orchestrate intervention episodes that
Strategies to engage children , facilitating practice and
Bypass Interference learning

Strategies to
PLAY
Improve Performance
Stages of Intervention:
INTERVENTION PLAN
AND OBJECTIVES
Preparation
Simulation
  The top down model focuses not on Practice
what the child cannot do or what the
Carry Over
child should be able to do, but focuses
Infusion/Embedded
on what the child can do and
intervention that emphasizes playful
interactions providing opportunities to
prepare for and practice functional skills
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Key Considerations The Is

  What function/skill is the focus of
therapy?
Engagement
 What are the essential multi-systemic
requirements to achieve this particular
•  Novelty: “newness”
function/skill?
•  Independent Responses:
 Compare the child’s current systemic
qualities of action the object/
strengths and barriers to the essential persons exhibits independent
requirements for performance? of any action by the child
  Over the lifetime of a child what are •  Responsivity: ease with which
a child’s action produces some
the typical playful activities children
reaction
engage in as part of gaining competence
•  Complexity: challenge to
in this function/skill
understanding what the object
  What are the features of the child’s or person offers the child
current play? •  Sensory Properties: constant or
interactive aspects of objects
  What are the child’s strengths and
and people
barriers to engaging in playful behaviors
that will facilitate acquiring new
functions
Theoretical Frameworks to achieve Motor Performance Principles
FUNCTIONAL OUTCOMES

Attention to Multi System
Typical Assessment of
Neuro- Developmental Development of Posture & Movement
Treatment
Posture & Movement Driving Hypothesis
Control of “WHY”

NDT
Learning/Practice

CHILDREN

Sensory Impact on Individual
Integration Function
in Natural Environments

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The Neuro-Developmental Essential Handling Concepts
Treatment Definition
•  The NDT/Bobath (Neuro-Developmental Treatment/
Bobath) Approach
•  NDT is a holistic and interdisciplinary clinical practice Preparation Facilitation/ Simul ation Func tion
model informed by current and evolving research that Inhibition
emphasizes individualized therapeutic handling based
on movement analysis for habilitation and rehabilitation
of individuals with neurological pathophysiology. Using Preparation: Preparation addresses the critical
the ICF model, the therapist applies a problem-solving impairments in any system that must be
approach to assess activity and participation to identify specifically addressed before an individual is ready
and prioritize relevant integrities and impairments as a to move.
basis for the establishment of achievable outcomes
with clients and caregivers. An in-depth understanding Facilitation and Inhibition: Keeping undesired
of typical and atypical development, and expertise in responses and movements at bay while activating
analysis of postural control, movement, activity, and postural readiness, postural anticipation and
participation throughout the lifespan, form the basis for control, postural accompaniments, and efficient
examination, evaluation, and intervention. Therapeutic movement components for new motor patterns.
handling, used during evaluation and intervention,
consists of a dynamic reciprocal interaction between Simulation: Imitate functional goal in a variety of
the client and therapist for activation of optimal activities that are similar to the functional goal and
sensorimotor processing, task performance, and skill involve components gained, practice components.
acquisition for achievement of participation in
meaningful activities. Functional Goal: practice the function

Cayo C, Diamond M, Bovre T, et al. The NDT/Bobath (Neuro-Developmental Treatment/ 34
Bobath) Approach. NDTA Network. 2015;22(2):1.

Handling Basics
Handling Basics
What is the function, and what

are the essential posture and When should I take my hands off?
movement components?
What if the child moves a way I
Do I have body alignment ? don’t want, or doesn’t move?

What specific posture or How much should I repeat, or vary
movement is the focus, and am I what I am doing?
trying to facilitate?
Do I talk to the child…tell them
What are/is my key point(s) of what to do?
contact?
How should I position myself and
How should I hold? move?

How can I direct my pressure to Should I set up the environment to
gain an active postural help me….equipment, objects,
response? etc.?

How do I know I have gotten an When do I try to have the child try
active response? the actual function?
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Sensory Processing Principles SIGN
Sensory Integration Global Network
Understanding
Neurological Processes and Impact •  Sensory integration theory proposes
Registration of Vestibular that sensory integration is a
Modulation Proprioceptive
Intersensory Integration Pressure & Touch neurobiological process that
Discrimination Visual Sensory organizes sensation from one’s own
Praxis Systems
body and from the environment and

Sensory makes it possible to use the body

effectively within the environment.
Integration
The spatial and temporal aspects of
inputs from different sensory
modalities are interpreted,

Disorders of Sensory associated, and unified. Sensory
Processing: Impact on integration is information
Behavior &/or processing...Praxis and perception
Environmental
are both end products of sensory
Interaction
integration... Practic ability includes
knowing what to do as well as how
to do it.
SIGN
Sensory Integration
Sensory Integration Global Network Theory to Practice

•  Principles of Intervention include:
 Neuroscience literature presents material at the
•  Qualified professional …. family-centered ….. level of processes and neural mechanisms.
complete assessment and interpretation based on Therapy literature conveys information at the
the patterns of sensory integrative dysfunction…. level of experience or behavior.
•  Safe environment that includes equipment/activities
that rich in vestibular, proprioceptive and tactile  Processes vs. Behaviors:
sensations and opportunities for praxis…..promote  Processes are not observed because they
regulation of affect and alertness and provide the occur at the cellular or nervous system level
basis for attending.…  Behavioral manifestations of these
•  Activities that promote optimal postural control in processes are observed in sensory integration
the body, oral-motor, ocular motor areas and function and dysfunctional patterns
bilateral motor control …. maintaining control while
moving through space….  Functional and dysfunctional sensory
integration patterns are related to underlying
•  Activities that promote praxis including organization
neurophysiological processes (connectivity &
of activities and self in time and space… “just-right
excitability).
challenge”…. “Somato-motor adaptive

response”….
 There are both peripheral and central regulatory
•  Intrinsic motivation and drive to interact through
processes involved in sensory integration. SI
pleasurable activities … play….
focuses on remediating lower cortical brain
•  Therapist engenders an atmosphere of trust and functions (processing tactile, proprioceptive,
respect … activities are negotiated, not pre- and vestibular sensory information) ultimately
planned…. impacting behavior and function
•  The activities are their own reward and the
therapist ensures the child’s success….
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