Accessible Play for the Pediatric Therapist

Accessible play is a meaningful activity for children of all ages.

Accessible play provides the opportunity for self-directed enjoyment and allows children to acquire developmental skills such as problem-solving, socialization, motor skills, and sensory processing.

Dr. Temple Grandin, autistic author, speaker, and university professor, credits her leisure activities as a significant factor in finding friends. Outside of her leisure activities, she was bullied and teased because of her differences. She reaped the social benefits of play and gained problem-solving skills.

Recommended course: Providing Control of Devices in the Environment for Play, Independence, and Participation

Children with disabilities often have limited access to play and leisure activities, curtailing their ability to benefit from playing. Healthcare providers (HCPs) such as speech-language therapists (SLPs), occupational therapists (OTs), and physical therapists (PTs) can facilitate opportunities for play engagement by addressing the barriers to accessible play.

Accessible play modifications for children with disabilities

Play activities should be enjoyable and child-directed. After determining a child’s unique play interests and barriers to play, Therapists can make modifications and recommendations to improve the child’s ability to engage in desired play activities.

Some ways therapists and other healthcare professionals can facilitate successful child participation in desired play activities include:

• To modify toys to make toy manipulation more accessible
• Modifying play activities to make rules understandable and create opportunities for self-expression
• Modifying the physical environment where the child engages in play activities
• Consider the positioning needs of the child for engagement in play activities

Managing communication difficulties in pediatric patients

A child needs the ability to express their thoughts in a play atmosphere appropriately. Otherwise, they may express themselves in a maladaptive way, such as hitting or crying. Two ways to address communication difficulties during play time include:

• Provide means of communication using augmentative and alternative communication devices so children can request play items and engage in cooperative gameplay
• Make play activities physically accessible so the children can choose which play items they want

Therapy for children with sensory processing differences

Some children have difficulty processing sensory stimuli, causing them to avoid some types of sensory stimuli and seek other types of sensory stimuli. Epidemiological studies have found that the prevalence of sensory processing disorder (SPD) is 5-15% in Western populations.

A complete sensory evaluation must be administered to determine the child's sensory needs before making sensory recommendations. However, two suggestions that work universally for all children are:

• Providing skin barriers such as gloves activities that involve substances that are an adverse sensory experience for the child (water, glue, clay, etc.). This will allow the child to engage in an activity such as playing in the sandbox with friends without touching the sand.
• Facilitating play activities in sensory-rich environments such as the playground where the child can engage in sensory experiences that regulate their body systems while engaged in play activities.

Accessible play for children with physical disabilities

A 2021 research study with eleven typically developing children concluded that children are more likely to engage in associative and cooperative play on the school playground and solitary and parallel play on the community playground. This indicated that children were less likely to engage in play activities with children they did not know. A child with a physical disability can have difficulty seeking out playmates at the school and community playgrounds regardless of who they desire to play with.

Play structures can also prevent children with disabilities from fully engaging in play and accessing playmates at school and in the community. Children with mobility impairments may struggle to access play structures or navigate uneven surfaces.

Children with other physical disabilities may be unable to propel a swing, throw a ball, or safely climb on play structures. This can result in children missing out on motor, sensory, cognitive, and social experiences with play.

A few of ways to provide more equitable access to play activities on the playground include:

• Inclusion of swings with back and lateral supports and safety harnesses
• Positioning the child to play in the sandbox with other children
• Adding a walkway suitable for mobility using wheelchairs, walkers, or crutches

Age-appropriate accessible play opportunities

Playing video games is a leisure activity for some older children. Gaming for leisure can provide a social connection for them whether they are playing with someone in person or over the internet. Statistics show that 80% of video gamers credited gaming with helping them meet new people, and 84% percent said it helps them connect with other people with similar interests.

Teenage gamers with physical disabilities such as Cerebral Palsy (CP) can find it challenging to participate in video games due to decreased gross motor and fine motor coordination. However, adapted gaming devices can be provided to increase access to gaming activities. Examples of these devices are:

• A one-button mouse, which requires less dexterity than using a two-button mouse.
• A touchscreen monitor with enlarged icons, providing a larger target for button activation.
• Audio controls are a viable option if the child has the speech abilities to give clear enough verbal commands that the gaming system can recognize.
• A stylus pen to push buttons for the child who still uses a palmar grasp and struggles with finger isolation.
• Use of a gaming chair or recliner with back and side supports allowing for a change of position to prevent pressure sores from staying in one position for an extended amount of time.

Younger children with CP who are wheelchair users may benefit from repositioning to access floor, tabletop, and standing activities. Repositioning of the child can require:

• Removal of wheelchair armrests and leg rests so the child can be pushed to the table to engage in tabletop activities
• An assessment to determine if the seat cushion angle supports active tabletop activity engagement
• Use a towel roll to encourage a slight anterior weight shift of the pelvis so the child sits slightly forward in an active sitting position making it easier for the child to reach the table
• A standing frame that allows the child to play at eye level when their playmates are standing
• Sitting the child in a bean bag chair on the floor, which can provide back and lateral supports for the trunk so they can engage in floor play.
• Positioning the child on their side so they can prevent movements caused by retained primitive reflexes

Pediatric patients with cognitive barriers

Children with cognitive difficulties such as intellectual disabilities or acquired brain injury can become frustrated with play activities with rigid rules. When a child is frustrated and no longer enjoying an activity, the activity is no longer a play activity. Open-ended play activities allow a child to engage in play exploration without a right or wrong answer.

Examples of open-ended play activities include:

• Blocks
• Clay
• Finger paints
• Crayons and paper

Barriers to play in pediatric patients are barriers to learning

Play is essential to child development. Addressing the barriers that hinder a child’s ability to engage in play activities facilitates physical and socio-emotional growth. Therapists and other healthcare professionals play an important part in facilitating play for children with disabilities.