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The Benefits of Play Based Therapy in the Rehabilitation of

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Madison Abela

on 8 May 2014

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Transcript of The Benefits of Play Based Therapy in the Rehabilitation of

Does incorporating play into therapy within the paediatric population show benefits in their function and development?
Clinical Question
Data bases used:
Number of Articles:
Search Terms:
Play based therapy
Child-centred therapy
Physiotherapy and play with children
Therapy for children
Inclusion Criteria:
Children 0-12 years with varying conditions
Children requiring occupational therapy or physiotherapy
Written in English
Published between 2000-2014
Incorporating play as a form of therapy
The National Health and Medical Research Council Hierarchy of Evidence
What is Play?
"Play is a particular type of rhythmic movement that connects the player with the play-environment and a playmate. Play has its roots in and is accomplished through movement. For play to exist, there must be movements. These movements are not only subjective 'means to an end. Play is movements between players and the play environment. Play is characterized by 'to-and-fro' movements which communicates a constant readiness and openness for change" - Buytendijk, 1993
By Madison Abela
The Benefits of Play Based Therapy in the Rehabilitation of Children
"Our habitus enables us to perceive and act based on more or less the conscious experiences of how we have done things before, and how they are usually structure. We improvise with help from our embodies practically directed competence: our habitus, our practical sense" - Bourdieu and Wacquant, 1992
"Play has a special relation to what is serious...play itself contains its own, even scared seriousness. Play fulfills its purpose only if the player loses himself in play"- Gadamer, 2004
Studies incorporated children with varying conditions
Both male and female subjects were used
Studies incorporated a combination of physio, OT , speech and social work interventions
Unspecified length and duration or treatment sessions
Unspecified play activities
All very different studies
Why Implement Play Based
Therapy in Everyday Practice?
Many studies were conducted incorporating play into therapy whether it was an interactive game (KVAP), in conjunction with constraint therapy or in the home or child care environment
Although five very different studies were reviewed, all the studies had the same outcome
Benefits were shown throughout all studies in the child's function and development
In essence, using play in therapy sessions is beneficial for children with upper and lower limbs affected, children with varying conditions, and varying levels of function (e.g. GMFCS 1-5)

Playful reflection: an investigation into the kindergarten project 'Play in physiotherapy with children'
Author- Foss, N. & Barsden, A.

Date published- 2013
Aim of study- Aimed to explore how a play-based intervention approach would affect professional collaboration and child development. Specific objectives were to explore if and how play can be used in physiotherapy in the kindergarten setting

Study design- cohort study

NHMRC ranking- 3-2

Sample size- two children with motor delay problems aged 3 & 5 years attending two different kindergartens

Study Findings-
Project period 16 weeks, 1-2 sessions for 60-90 min long
Video-reflection is an effective tool in action research processes
Concepts from Bourdieu's theory of practice illuminate why, and also contribute to the understanding of the experienced change
Theory on play can help action research practitioners to understand the mechanisms of engagement and involvement that are crucial in action research processes
Participation in physical play and leisure: developing a theory- and evidence-based intervention for children with motor impairments
Author- Kolehmainen, N., Francis, J., Ramsay, C., Owen, C., McKee, L., Ketelaar, M. & Rosenbaum, P.

Date Published- 2011
Aim of study: To develop a multifaceted theory- and evidence-based intervention to increase what children can do and what they actually do in terms of physical play and leisure

Study design- Cohort study

NHMRC ranking- 3-2

Sample Size- five children with motor impairments aged 4-9 years
had min of one body structure/function problems, mobilised independently and aged 6-8 years

Study Findings-
Developed an intervention to increase participation in physical play and leisure in children with motor impairments
Developing intervention had 5 main steps
1) identify biomechanical, personal and environmental factors proposed to predict children's participation in physical play and leisure
2) develop an explicit model of key predictors of participation
3) select therapeutic and behaviour change strategies to target the proposed predictors, and specify that pathways through which the strategies are hypothesised to change participation
4) operationalise the strategies in a feasible and acceptable interventions
5) model the intervention processes and outcomes within single cases
Intervention was effective, supporting children with motor difficulties to attain life-long well-being and participation in society
Intensive pediatic constraint-induced therapy for children with cerebral palsy: randomised controlled, crossover trial
Author- Deluca, S., Echols, K., Law, C. & Ramey, S.

Date- 2006
Aim of study- to determine if adult constraint-induced therapy can be applied to children with cerebral palsy upper limb hemiparesis

Study design- randomised controlled crossover trial

NHMRC ranking- 2

Sample size- 18 children from local early intervention programs referred from parents or health practitioners
Group one- 9 children received pediatric constraint induced therapy
Control group- continued to receive their traditional or ongoing therapy and were then crossed over to receive constraint-induced therapy
Study findings-
Constraint induced therapy (full arm cast on less effected arm) for 6 hrs per day for 21 days
OT/PT intervention included tasks such as weight bearing through arm, reaching, grasping, holding, manipulating, fine motor and ADL tasks
All interventions were provided through form of play in ways that provided immediate, frequent and repetitive rewards
A combination of OT/PT play based interventions in addition with upper with upper extremity constraint therapy showed significant changes in upper limb functioning
A meta-analysis of play therapy outcomes
Author- Oswego, S.

Date- 2001
Aim- to address the questions specific to play modalities including the overall effectiveness of play therapy and the variable related to effectiveness

Study design- meta analysis

NHMRC ranking-1

Sample size- 42 studies that were written in English and were dealing with children aged 0-12 years old
Study findings-
Children with social/emotional maladjustment, reaction to traumatic events, academic problems, family maladjustment and behavioural problems; benefitted from family based therapy (instructed by health professionals)
Overall play therapy was found to be as effective as non-play therapies
Research didn't highlight many of the important characteristics that differentiate therapies or therapy characteristics that lead to effective treatment
A gesture-based virtual art program for children with severe motor impairments- development and pilot study
Author- Diment, L. & Hobbs, D.

Date- 2014
Aim- to achieve physical engagement through a fun, leisure activity that encourages creativity and exploration

Study design- cohort study

NHMRC ranking- 3-2

Sample size- five female participants
4 cerebral palsy GMFCS 5
1 severe autism
Study findings-
The Kinect Virtual Art Program (KVAP) facilitates non-contact 'virtual' button activation that enables a child to more easily participate in art-making compare to traditional art methods
Provides a fun engaging activity for children with severe physical impairments
Was successful in encouraging physical activity and enabled children to create their own works of art, an activity that was previously inaccessible to them using traditional approaches
Future potential for KVAP- to help increase the ROM of an impaired limb, as well as being used to increase physical activity for wheelchair users
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