Naomi E. Graham, Juliette Truman, Heather Holgate; Parents’ Understanding of Play for Children With Cerebral Palsy. Am J Occup Ther 2015;69(3):6903220050. https://doi.org/10.5014/ajot.2015.015263
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© 2020 American Occupational Therapy Association
OBJECTIVE. To present the findings of an exploratory study regarding the experience of play as an everyday occupation for children with severe cerebral palsy from their parents’ perspective.
METHOD. We took a qualitative methodology and interpretive descriptive approach. After ethical approval, 7 participants were recruited and completed an interview and contextual information sheet.
RESULTS. The interview data led to the exploration of four themes: typical play, burden of play, expanding the concept of play, and therapy and play. These components were interlinked and contributed to parents’ understanding of play.
CONCLUSION. Occupational therapy practitioners can aim to further understand the importance of affirming typical play, recognizing the burden of play, explaining expanded play, and explaining the importance of play for play’s sake.
To explore parents’ understandings of how their child with severe CP plays
To explore parents’ understandings of how play is used as a therapeutic tool within therapy and home programs.
Children with severe CP, or Gross Motor Function Classification System (GMFCS) Level 4 or 5 as assessed by Bobath Centre therapists. (The GMFCS is used to measure the level of physical functioning a child has. Levels range from 1 to 5; children at Level 1 are able to walk and run, and children at Level 5 need support for sitting; Knox, 2008 .)
Children between ages 3 mo and 9 yr
Parents living in Buckinghamshire, Hampshire, Hertfordshire, Greater London, Oxfordshire, Surrey, or Sussex (enabling the researcher to travel for interviews).
At the moment, whatever age he’s at, the only thing on his mind is playing, in each and every sense. . . . Even if it’s studying, even if I ask him to write something, first he’ll be doing drawings. (Sanna)
It isn’t the easiest thing in the world to do, having a social situation, you know, sort of “mums' coffee mornings,” because you don’t feel that you can leave him to play on his own, really. . . . I feel that if he’s in his bouncy chair and I’m talking to people, then that’s at the expense of his playing. So it tends to be more that I would sit on the floor with him and engage with him and then go back to chatting. (Emma)
That wondering, Is she really quite content, or bored just sitting there? The idea of just leaving her and knowing that she can't instigate, pick up a toy, or amuse herself. (Anna)
They don’t tend to interact and play, the three of them, but she loves watching them play and will be encouraging them by saying, “Oh, look what they’re doing” or “[Cousin] is being naughty and doing this” or “Everybody jump in the tent.” . . . So she can comment on the activity and at the moment doesn’t seem to have a problem with the fact that she’s not physically participating. It seems to me that she thinks she’s fully joining in by commenting and watching. (Sarah)
The first thing that comes into your head would be his posture. Whatever you’re trying to do, you would just be thinking, what posture should he be in, not be in? Now, if you're trying to play something, you're going to be thinking how you should be doing it, how you should not being doing it. And then third thing you’d be moving onto, you would be thinking, What am I going to achieve out of it, what can I do more so he’s getting that good stretch, good posture, good in the moment in every way in his body? Then once that’s settled, then you think, OK, so he should be getting more out of it; how can I make it more fun, exciting for him? So it’s a step-by-step process that happens automatically with each and every thing. (Sanna)
I have to play with him, and I don’t want to, which is a terrible thing to say, but I don’t, I don’t want to, and I get very, very envious when I see my friends’ kids. I went round to somebody’s house for lunch the other day, and we were in the garden for 2 hours, and I think the kids came up maybe twice to just ask for something—“Can I have an ice lolly?” or something. And they just spent that on the trampoline and just running around the garden and talking to each other and playing. I just thought, Wow, it’s so, so different, you know. I would have been there, he would have wanted to be on the trampoline, and I would have been there on the trampoline with him. . . .
So when [friend] came round—that's his best friend from school—and we did, we were building the marble run, so Jack really likes the marble run. And that was kind of me and [friend] building it and Jack kind of watching and telling him where bits were and thinking, Jack is quite good at thinking through, you know, “try and turn that round” or something, and he can communicate that. I think he can see what's happening, so he does that. (Jane)
A multifaceted understanding of play is needed for children with severe CP.
Play is an everyday occupation that often needs to be facilitated for children with severe disabilities. Helping parents with play facilitation may be an important role for occupational therapy.
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