The 1st of June marked the ‘Global Day of Parents’ as recognised by the United Nations. It is a day to appreciate the critical role parents have for nurturing and protecting children. This year, the theme was ‘the promise of playful parenting’, acknowledging the scientific foundations of play for children and recognising the increasing prevalence of online play. What relevant topics for anyone working in paediatrics, but also may be relevant for other users too. It is also worth considering how this child-parent relationship may look a little different when there are disabilities.
‘Play is the occupation of children’ is a phrase that resonated with me as an occupational therapy student in university. For a child, play is not just about ‘having fun’, but is how children learn, meet developmental milestones, and for social and psychological development1,2. There are many different types of play, and each provide different mediums for learning.
What happens though when a child has a disability, and perhaps isn’t able to play in the same way?
Foundations of play – Developmental needs
For young children, developmental milestones are focused on. Despite this, children with disabilities may not meet these milestones at the same pace as children without disabilities, resulting in a focus on therapies and/ or AT to assist. This is challenging, and can sometimes result in therapy and AT becoming the focus which can actually get in the way of a kid just being a kid, rather than facilitating play.
Being able to move towards (and away!) from objects as well as people facilitates intrinsic play and engagement. It is a worthwhile pursuit for therapists and family members to encourage! Therapists are important to support this, however parents will likely be spending the most time with the child, so empowering their involvement in facilitating self-initiated mobility and play is very invaluable.
We are increasingly understanding how interconnected the different areas of development are, and in particular how mobility (typically starting with rolling, crawling and then walking) supports development in other areas such as vision, cognitive skills, language development and social skills. When mobility is delayed, this can result in the delays of other milestones which incorporate aspects of mobilising, such as visual tracking, depth perception, proprioception and problem solving.
It is through movement that children first start to learn, and research is showing that includes movement in AT such as a power mobility device. When supporting development in a power mobility device it can be assumed the need to maximise postural support for function, as we typically do for older children and adults. However as mentioned, movement itself is key to support development, aided by receiving proprioceptive input and engaging in self-initiated mobility. This then encourages us to consider what the primary goal may be for a task – posture or play? If it is play, additional harnesses or pelvic supports may not aid this, with the freedom of movement and action of a power mobility device allowing our littlest uses to move for themselves, sometimes for the very first time.
Online play
Whether you yourself are a gamer or not, accessible gaming can open up a world of engagement and opportunities for people with and without disabilities to communicate and have fun.
A report from Digital Australia cited that 2/3 of Australians are connected with video games3, with ages reported from under 4 years to over 90 years of age. It is certainly not a paediatric specific area. There are suggestions that 20% of gamers have a disability, however this has not been officially determined.
Gaming may be a convenient activity choice for those who have difficulty getting out of the house or communicating, with devices easy to access and alternate ways off communicating being integrated in many games. The ways games may need to be adapted to facilitate accessibility can be described in three categories:
- Accessibility features within games
- Hardware solutions
- Software solutions
Accessibility features within games may be turning on subtitles, reallocating input controls to preferred keys or buttons, and changing sound preferences. There are increasing options which are readily available to use, and may be all that could be needed for a user to engage in a game.
Hardware solutions are physical devices which allow an alternate way for games to be accessed. This video has multiple users sharing their thoughts on a new PlayStation Access Controller. If a user isn’t physically able to use a standard keyboard and mouse, or controller, exploring alternate input devices may be beneficial. This could be something simple like a roller mouse, or more specific such as this controller.
Software solutions are changes to the ‘brains’ (software) of a program to improve accessibility. This could be using Bluetooth or infrared to program a PWC joystick to be the mouse, or a separate program on a computer which allows talk to text communication or eye-scanning inputs, for example.
It can be challenging to know whether a game has or allows for the innate accessibility needs a user may have, though there are increasing websites which offer information to support this. Media access offers multiple website which could be used to assist with deciphering this.
References
- Rosen, L., Plummer, T., Sabet, A., Lange, M. L., & Livingstone, R. (2023). RESNA position on the application of power mobility devices for pediatric users. Assistive Technology, 35(1), 14–22. https://doi.org/10.1080/10400435.2017.1415575
- Gray, P. (2011). The decline of play and the rise of psychopathology in children and adolescents. American Journal of Play, 3(4). https://files.eric.ed.gov/fulltext/EJ985541.pdf
- Brand, J. E., & Jervis, J. (2021). Digital Australia 2022. Eveleigh, IGEA.
Author
Roseanna TegelBHthSc/MOT
Clinical Services Specialist
Roseanna Tegel joined Permobil in May 2023 as a Clinical Services Specialist. She graduated from Western Sydney University in 2016 with a Bachelor of Health Science/Master of Occupational Therapy and received the Prize in Undergraduate Occupational Therapy for Overall Achievement and the Cerebral Palsy Alliance scholarship. Roseanna began working at residential aged care facilities where her understanding of the need for suitable, person-centred equipment commenced. From there, she transitioned to work in community disability and quickly developed an interest for complex seating and mobility outcomes to benefit both the end user and wider network. She then stepped into a Team Leader role due to her passion for learning and best practice; supporting the Occupational Therapists with their own clinical needs and outcomes, and progressed to also provide external supervision to Occupational Therapists. Roseanna is motivated to support clinicians with their confidence and clinical reasoning allowing them to provide the best outcome for each individual user. Outside of work, Roseanna enjoys time with her dog, playing the 'cello, horse riding and aerial sports.