The Power of Play

We get told all the time that Play is the most important occupation for
children; play is how children learn, occupy their time, create and grow.  There is loads of research out there about what play is and how children play.  Reading all the information, I understood the complex theory, constructs and philosophy about play and embraced it with vengeance in my previous practice.  I think because play has always (well hopefully at least mostly) been part of my practice, I did not really understand or comprehended the power of play or how simple play can be until this week.

Case Study 1
Bong; a 5 year old with CP, GMFCS 4; MACS 2 (I think he previously may have been GMFCS 3, but his muscles have tightened, reducing function).  He attended therapy and the PT and I noted he had potential to stand and walk.  He was instructed to ‘tindog’ (stand) and he tried, as hard as he could; he is one internally motivated person with the most amazingly beautiful personality.  He would get to a crouched position with his knees in about 30 degree’s flexion.  I then had a small ephinpy, what is Bong’s motivator to stand? Why should he stand? We are just telling him too.

So I grabbed a simple toy for him to reach for; a target. I wish I had before and after photo footage!  All of a sudden he was able to stand at full length and sustained it for 3 times longer, especially when his twin brother was holding the toys and teasing him with it a little; turning a mundane reach activity into a simple game. Magic!  My mantra to myself and the colleagues became, “what is the child’s motivator to do this activity?”  ‘Motivator’ was a common term with mutual understanding of the definition, some colleagues are already rolling their eyes at me, because I am saying it all the time!

Case Study 2
Gwen is a 6 year old with a un-diagnosed condition, she presents with whole body low tone, limited head and trunk control, and very low endurance, or so we thought.  She has great cognitive skills and the most beautiful smile.  Again Gwen was instructed to try a bridge position to assist with building core body strength.  I watched as Gwen rushed though the movement with limited to no control, and was not able to hold the position for longer then a second.  Her face told an amazing story of effort, pain and discomfort; a little like some of those boys at the gym trying to break a record.

So I grabbed a doll and a car and turned her bridge into a real bridge, driving the car and walking the doll under the bridge.  Gwen’s control became much greater and she was able to hold her bridge for 10 seconds! The most important thing I observed was her facial expression, there was a smile and laughter as well as a colleagues comment of “wasn’t that improvement amazing!”

Case Study 3
Carla, a preschool honors graduate, recently diagnosed with TB meningitis arrived with a deeply traumatic fear of hospitals/clinics and anyone touching her, especially her left side which was now weak and had lost a lot of movement.  The first session was soul destroying for all involved; with a push to complete range of motion treatment sessions despite the distress, for fear of further loss of movement.  The plan was to try a graded approach to orientate her to the clinic and people involved as a safe and comfortable place to come.

We had a new clinician come to our next session, and it was amazing.  She approached Carla just like a sister, calm and friendly.  We started the session with Clara and the therapist reading stories; the only activity that Carla enjoyed and found calming in the previously session.  Again is was magic, watching the therapists natural play skills engage, relax and build confidence with Carla.  The most amazing thing was watching the therapist engage Clara with no toys!  The therapist turned all the activities into games by mirroring the movements Carla was doing, making fun and being silly.  To see Carla go from being completely distressed in one session to laughing in the next was mind-blowing; full credit goes to the social worker for this change and her natural ability to play.

For me, these sessions have really awakened the play element and power of play in me.  It has clarified that while research, questioning, and theorizing the complexities of play is essential; and I still strongly believe needs to be continued, explored and researched;  play can be very simple, very powerful and not only in learning and development. Play in action does not have to be complex, it is so simple, and it does not have to have ‘things’ to make it effective.  All Play  needs is someone who is a little creative, fun and willing to get on the floor and be a little bit silly :) Bring it on!

Disability...What Disability?

We recently celebrated Simon’s foundation day.  Foundation day is a community awareness activity,  while acknowledging and celebrating the beginning of Simon, over 28 years ago.  This year they chose to have a sports day with the theme, “Magkarawat Kita Gabos”, “Come lets all play”.  There were over 200 participants, from 3 years old to 40 + years old.  There were labels everywhere, “that ones CP, that one is limb deficient, oh and she is deaf, that one is intellectually disabled”. Every label was represented at least once.  We played tunnel ball, hacky sack (with a bunch of loose rubber bands tied together, worked a treat as it was a slower movement compared

to a ball), pin the tail on the water buffalo, sack races and a number of local games.

Interesting, the labels faded very quickly and soon were no where to to be seen.  Names, people and personalities not only emerged but were celebrated.  Everyone participated in everything; where had the disability gone?  There were tears of laughter, loads of smiles, participation, excitement and what I found most interesting, the abundance of confidence to just get in and have a go, no matter what and with absolutely no fear of failure.  It got me thinking, Nata?(why?)

Who, what and how is ‘disability’ created? Because from what I have just witnessed; these people may have looked different, walked different, may not have heard or saw the same as I did, but they were in no way disabled...at all! Who is creating the disability label and placing it on the person.  How did the disability just disappear like that? What were they doing that was so different?

Simon works very hard on first raising the confidence of the person.  They hold workshops that highlight the persons strengths, not focus on what they can’t do.  It made me reflect on the Australian health systems and question, do our systems really create empowerment for people or does it create a dependence, and more disability, due to its focus on ‘problems’.  While I can not answer these big picture question or change thing on a large scale quickly, I surely can and have asked myself these same questions.  Am I affording empowerment or and I affording disability though my ‘therapy’.  How can I ensure that I empower and build confidence not create more disability and dependence.

With OT I especially think its about utilising the abilities of a person and thinking outside the box for 'intervention' or 'rehabilitation'.   I feel that we loose this sometimes, with pressures of wait lists, high caseloads and a mentality of right, ‘how can I help?” It is through this that we loose sight of the persons true abilities as well as their own strengths to be creative and problem solve.  Today, I saw a 7 year old boy with bilateral upper limb deficiency (above elbow), and leg length discrepancy of 20 cm, walk the full street parade of 2 km, play every game, draw an amazingly detailed picture with his toes, and eat independently with his arms; no adaptive devises, fully independent going for it.

One child (12 yo) impression of the theme, He said every person in this picture has a disability, can you see them???

The creative genius of the person really shone today, and focused it for me, how often in the past did I underestimated it, sometimes allowing the professional v’s client power relationship to over take.  The person is the real expert in themselves and are so cleaver in figuring out how to modify activity and environment something ever so slightly to enable participation.  It was great to see the kids with vision impairment, play ‘soccer’ with a tin can with a rock taped inside the can, so that everyone can see the ‘ball’.  It really re-enforced my role as a sounding board and creative thinker to a person, and not the ‘professional’ or ‘expert’.  How important it is to empower, not to do. Today it really emphasized to me, being an OT is not necessarily about making things easier but possible.  The young boy was putting in a massive effort but was able and passionate about doing the things the way he was.

Some of the communities we go into we get stuck on the idea of 'rehabilitation' being to make someone normal - eg if someone is an amputee we may ask them what they need and they'll say - Money, for a prosthesis.  However this person may have had no leg for 10 years and gets around fine without a leg - works in the farm, feeds his family... performs all his occupational roles, however its the community that needs the rehabilitation (to their way of thinking and limiting someone with no leg) and actually all he needs is some adaptive techniques on how he can go about his ADLs to reduce the chance of secondary impairments. We need to look at the functional level of the individual and focus on improving function within context.

As OT’s should we really be looking at changing the person, maybe the person focus should be about building confidence, and our focus should be more on community education.  This may be old news for those who have been in the industry for longer then I have, however what I really would like people to think about is, no matter what you do... am I really empowering and making the disability disappear or am I adding to the disability?