TO PLAY OR NOT TO PLAY

Transcription

1 Purpose TO PLAY OR NOT TO PLAY Sharing Power with Children During Sensory Integration Intervention Examine the role and value of play in Ayres Sensory Integration intervention Identify strategies that support the child s play experience during intervention Consider how sensory integration may be related to pretend play, with emphasis on praxis L. Diane Parham, PhD, OTR/L, FAOTA Professor, University of New Mexico DiParham@salud.unm.edu Play in Ayres Sensory Integration (ASI) Intervention Essential part of the process of therapy Mentioned by Ayres: building on child s inner drive Play in the Fidelity Measure* One of ten essential elements Five elements address development of sensory integration, praxis, and arousal functions Five elements: dynamics of therapist-child relationship * Parham, L.D., Roley, S.S., May-Benson, T., Koomar, J., Brett-Green, B., Burke, J.P., Cohn, E.S., Mailloux, Z., Miller, L.J., & Schaaf, R.C. (2011). Development of a fidelity measure for research on Ayres Sensory Integration intervention. American Journal of Occupational Therapy, 65, doi: /ajot

2 Ten Process Elements of ASI Essential Ingredients of Play Ensures physical safety Presents Sensory Opportunities Supports sensory modulation for attaining/maintaining a regulated state Challenges postural, ocular, oral, or bilateral motor control Challenges praxis and organization of behavior Collaborates with child in activity choice Tailors activity to present the just-right challenge Ensures activities are successful Supports child s intrinsic motivation to play Establishes therapeutic alliance Intrinsic motivation the child does it because he wants to do it Internal control the child perceives he has some control over the activity It s fun! The child enjoys it. Supporting Intrinsic Motivation to Play Therapist creates an atmosphere to communicate that child s interests are valued and ideas are encouraged Therapist is constantly attuned to what the child wants to do IMPROVISATION: Therapist does not completely control the agenda or schedule of activities during the session NOT FREE PLAY Therapist does not simply follow the child around and do whatever he wants. 2

3 NOT DICTATED BY THERAPIST Challenges Inserted Into Play The work of therapy is folded into the child s play, without compromising the child s sense of self-competency and need for control Therapist must discern when to present a challenge that requires more effort from the child, and when to reduce the challenge or give the child more control The agenda during a treatment session is not completely set by the therapist Sharing Power with the Child Benefits of Sharing Power Through Play Negotiation process Amount of therapist structuring and the timing and type of structuring varies depending on child characteristics and goals of therapy Fidelity training video: What is happening that elicits the child s highest level of engagement? The child will be more highly invested in mastering the challenges presented by the therapist better performance to meet therapy goals Provides child with opportunities to experience risk taking and decision making willingness to try new challenges Build s child s self-efficacy critical for success in life Contributes to child s developing view of self as a competent person essential for mental health 3

4 Video clip acknowledgements* Techniques for Sharing Control Therapist is Dr. Susan Spitzer, Pasadena, California DVD is from a book referenced below: Kuhaneck, H. M., Spitzer, S. L. & Miller, E. (2010). Activity analysis, creativity, and playfulness in pediatric occupational therapy: Making play just right. Sudbury, MA: Jones and Bartlett Publishers. Let the child choose an activity Free choice Choice among several therapist-presented options Validating the child s initiation of a change to the activity Go along with the child s change Accept but modify or adapt the child s change Suggest or direct the child toward a particular activity, but allow child to adjust or modify the way it is done What About Pretend Play? Pretend play heavily draws upon cognition, especially as related to symbolic representation, memory, information sequencing, and social cognition Language also often involved How Does SI Contribute to Pretend Play? Pretend play requires a number of SI functions to work well: Sensory modulation & arousal regulation Perception of affordances in the environment Praxis Ideation new ideas for how to play Motor planning sequencing of actions 4

5 Definition of Praxis* Key Components of Praxis PRAXIS = the ability to conceptualize, organize, and execute new motor tasks IDEATION = ability to conceptualize a new activity or a new way to perform an activity Focus is on using the physical body to interact with the physical world MOTOR PLANNING = ability to organize actions needed to perform the activity, e.g., sequencing, spatial awareness, and timing of action * Ayres, A.J. (1985, 2011). Developmental dyspraxia and adult onset apraxia. Reprinted as Ayres dyspraxia monograph. Torrance, California: Pediatric Therapy Network. EXECUTION = observable motor performance, which may be affected by issues other than praxis Praxis is a Bridge Between Cognition and Action Praxis requires use of highly organized sensory information to create a program or plan for action PRIMARILY COGNITIVE Dyspraxia is not a motor disorder, but a disorder in processing sensory information to program actions Is Ideation the Same as Creativity? Ideation in praxis is creativity in coming up with new ways to move or use the physical body in the physical world Some children are very creative in language but have poor ideation in praxis So ideation involves creativity, but not all creativity involves ideation in praxis 5

6 Ayres s Theory of Praxis Development What is Concept Formation? Praxis Language Ayres viewed it as a complex process of integrating multiple sources of sensory information into manageable units that can be organized and sequenced with each other Concept Formation Neural networks that overlap for praxis and language functions Ayres proposed that overlapping neural networks involve a somatosensory-conceptual-planning function A suggested addition... Questions About Praxis & Pretend Play Praxis Social Relatedness Concept Formation & Sequencing Language Is ideation in praxis related to ideation in pretend play? Is motor planning in praxis related to ability to sequence actions in pretend play with dolls? 6

7 Pretend Play and ASI intervention Can be embedded in ASI Can be an adjunct to ASI CAN SI INTERVENTION SUPPORT DEVELOPMENT OF PRETEND PLAY? Or can be a stand-alone intervention Could improved pretend play be a measurable outcome of ASI? Does improved ideation in praxis lead to better ideation in pretend play? Does improved sequencing in praxis lead to better sequencing of actions in pretend play? Kiitos! Tack! Takk! Tak! Köszi! Grazie! Danke! Dankie! σας ευχαριστώ! Merci! Dank u! Дякую! Gracias! Obrigada! Go raibh maith agaibh! Cпасибо! Hvala! ありがとう! Ačiū! Tänan! Aitäh! 感謝 / 感谢! Thank you! 7