Assistive technology to facilitate children's play: a scoping review

PURPOSE

Play is a fundamental human right and one of the most important occupations in children's lives. Fewer opportunities exist for children with physical disabilities (CWPD) to play. This study aimed to conduct a scoping review of published peer-reviewed literature on using AT to enable "play-for-the-sake-of-play" by CWPD.

METHOD

The review was conducted using a widely accepted scoping review methodology. Literature searches were conducted from January 2000 to March 2022 using MEDLINE, Central, CINAHL, ERIC, Scopus, and EMBASE. Pairs of reviewers used an online systematic review system to manage title, abstract, and full-text screening. Excel was used for data extraction and charting. Data was charted based on type of AT, play types according to LUDI definitions, and level of evidence.

RESULTS

The search yielded 5250 papers after the removal of duplicates. Title and abstract screening identified 58 studies for full-text screening. The final sample included 31 papers. Seven types of AT were identified in studies: power mobility, virtual reality, robots, adaptations for upper limb differences, switch-adapted games, augmentative and alternative communication devices, and mobility aids. Twenty-three papers addressed cognitive play, seven addressed social play, and one addressed both cognitive and social play. Most studies used case study, descriptive, or repeated measures designs.

CONCLUSION

There is limited evidence regarding the use of AT to support play-for-the-sake-of-play in CWPD. Given the importance of play, further research using rigorous methodologies and the development of assistive technology dedicated to promoting play-for-the-sake-of-play is warranted.

The Occupation of Play

The articles for the Special Section on Play highlight the complexity of play and the many ways occupational therapy practitioners study and promote play with children, families, and adults across individual, school, family, political, and cross-cultural settings. The authors of the articles in this issue view the importance of play across the lifespan and through multiple research lenses, including play preference, environmental supports for and barriers to play, the skills required to succeed in play, and the extent to which play is self-determined. The guest editors offer suggestions for how to enhance occupational therapy's voice in the study and promotion of play as a primary lifelong occupation.

Play as Occupation: The State of Our Science and a Research Agenda for the Profession

Occupational therapists view play through a unique lens. Considering play as a human occupation, and one to which all people have a right, places occupational therapists among a special group of professionals championing play. This State of the Science article seeks to increase awareness regarding the occupational therapy profession's contributions and to situate those contributions within the larger body of literature on play while also promoting further study of play as an occupation.

Using the Theory of Affordances to Understand Environment-Play Transactions: Environmental Taxonomy of Outdoor Play Space Features-A Scoping Review

IMPORTANCE

The transactions between the physical environment and children's play have not been well studied. The theory of affordances provides a way to better understand how environmental characteristics offer opportunities for play occupation.

OBJECTIVE

To investigate the relationship between environmental characteristics of outdoor play spaces and children's outdoor play and to develop an environmental taxonomy to support the analysis of play affordances in community play spaces.

DATA SOURCES

Peer-reviewed literature (1974-2023) was sourced from a previously published scoping review (Morgenthaler, Schulze, et al., 2023). The Academic Search Complete, Avery Index to Architectural Periodicals, CINAHL, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched using the keywords and synonyms of playground, environmental qualities, and children with and without disabilities.

STUDY SELECTION AND DATA COLLECTION

A secondary analysis of the previously published scoping review was conducted. Included studies were those that provided descriptions of physical environment-play activity transactions.

FINDINGS

A qualitative content analysis of 45 articles was conducted and used to form an environmental taxonomy. This taxonomy consisted of 14 space and object categories defined by their functional qualities and linked to play affordances. An array of 284 play occupations were identified in different forms. Play affordances of spaces and object categories and their functional environmental qualities were subsequently identified.

CONCLUSIONS AND RELEVANCE

This study provides evidence to support the understanding of how the physical environment shapes children's outdoor play occupations. Plain-Language Summary: The study authors developed the Environmental Taxonomy of Outdoor Play Space Features as a tool that occupational therapists can use to better understand and describe how the physical environment shapes opportunities for play. The tool could also be useful to justify environmental intervention in schools and public playgrounds to create spaces that support more play for a diversity of children.

'Finding the play' - exploring with occupational therapists practice possibilities in the context of Irish schoolyards

BACKGROUND

Research has identified diverse constraints to the adoption of school-based occupational therapy approaches and a lack of attention to addressing the barriers to children's play opportunities. Critical contextualised research is advocated to inform practice possibilities.

AIMS/OBJECTIVES

This inquiry aimed to explore with occupational therapists their existing practices in Irish schoolyards to generate practice possibilities concerned with play, as an issue of occupational justice.

MATERIALS AND METHODS

Using the theory of practice architectures, six occupational therapists from diverse sites of practice participated in the first phase of a critical action research process using dialogical focus group and occupational mapping methods.

RESULTS

Three themes were generated (1) Existing practices as situated (2) (Re)mattering play and practices as occupations and (3) Practice possibilities - 'Finding the play' between responsiveness and responsibilities. A further interrelated dimension was how the research methods provided mechanisms of raising consciousness.

CONCLUSIONS, AND SIGNIFICANCE

Alongside constructing knowledges on existing practices in an Irish context, this inquiry contributes to understandings of practices as socially embedded generative processes of 'finding the play', highlighting ethical responsibilities to make visible inequities reproduced in habitual practices and engage in relationships of solidarity to (re)construct alternative shared practices.

Profile of paediatric occupational therapy practice in Eastern Mediterranean countries

BACKGROUND

Paediatric occupational therapy (OT) is considered the largest practice area in OT in several regions, including the Eastern Mediterranean (EM) countries.

AIMS/OBJECTIVES

This study aimed to establish a profile of paediatric occupational therapists in EM countries to identify theoretical models, assessments and interventions employed. It also investigated the therapists' usage of evidence-based practice in their practice.

MATERIAL AND METHODS

We conducted a cross-sectional survey using a questionnaire which was distributed electronically to occupational therapists working with children.

RESULTS

The participants included 118 therapists. Majority of the participants were working at rehabilitation centres. The primary client groups were pre- and school-age children with autism spectrum disorder and cerebral palsy. The most frequently used assessments were sensory-related tools. Activities of daily living and play were the most often targeted interventional area. Participants highlighted some of the challenges faced in implementing evidence in their practice.

CONCLUSION

Paediatric occupational therapists are usually exposed to specific age groups and conditions. However, a lack of knowledge practice in some areas and challenges in others exist.

SIGNIFICANCE

Within the EM region, knowledge regarding therapists' practices is lacking. Actions should be taken to improve current practice and meet the current needs of clients, and utilise evidence-based practices.

Children's Play-Work Occupation Continuum: Play-Based Occupational Therapy, Play Therapy and Playwork

Introduction: Occupational therapists often use play-based approaches to facilitate children's occupational development and promote participation, for example, play-based occupational therapy, play therapy and playwork. However, where does play occupation fit, within these adult-guided play-based approaches in occupational therapy? Purpose: To examine and discuss the play-work occupation continuum of children to inform occupational therapy practice. Key Issues: Children's play occupations are free-selected, unstructured, internally-controlled, spontaneous and intrinsically-motivated. Yet, occupational therapists often utilize play as a therapeutic modality to support occupational development for occupations other than play. This use of play represents play-based work occupations as they are structured, externally-controlled, adult-guided, goal-focused and extrinsically-motivated. Play occupations then move from being authentic free-play to adult-guided play-based work occupations for children. Implications: When working with children and families, occupational therapists need to balance the use of self-selected, unstructured play occupations with the application of adult-guided, structured, goal-focused play-based work occupations.

Spanish Cultural Adaptation and Inter-Rater Reliability of the Revised Knox Preschool Play Scale

BACKGROUND

The Revised Knox Preschool Play Scale (RKPPS) is a comprehensive assessment test that observes the level of play development; however, there is no culturally adapted version available with stable psychometric values that would allow its widespread use and provide objective information during clinical evaluations.

METHODS

Cross-cultural adaptation included direct and retrospective translations, along with cognitive interviews with pediatric occupational therapists to analyze the comprehensibility of the translation. In addition, a final phase of linguistic revision was carried out to determine the grammatical and semantic fit of the adapted version. Finally, inter-rater reliability was analyzed in a sample of typically developing children aged four to six years old.

RESULTS

The processes of translation and back-translation, cognitive interview, and linguistic review determined an adequate grammatical and semantic equivalence to the Spanish cultural context. Almost perfect agreement, with values between 0.82 and 0.94, was obtained for items and play dimensions, indicating that the precision of the measurements between both evaluators was excellent.

CONCLUSIONS

The cross-culturally adapted version of the RKPPS meets the necessary adjustments for the sociocultural context and can be used in the clinical practice of occupational therapy.

Occupational therapists' practice with complex trauma: A profile

INTRODUCTION

Many children in Aotearoa (New Zealand) and Australia experience complex trauma and its developmental impacts. Internationally, occupational therapists work with complex trauma and use sensory-based, integrative, and functional approaches. The practices of occupational therapists in Aotearoa and Australia with children experiencing complex trauma have not previously been described.

METHODS

This article reports the quantitative results of a mixed-methods study which profiled occupational therapists' practice in Aotearoa and Australia with children aged 0 to 12 years old who experienced complex trauma. Twenty-five participants completed the survey. The average age of participants was 43 years (SD = 10.65), all were female (n = 25), and most identified as New Zealand European (n = 11) or Australian European (n = 9). A survey was distributed via Occupational Therapy New Zealand - Whakaora Ngangahau Aotearoa and Occupational Therapy Australia.

RESULTS

The majority of participants had a bachelor's degree (64%) and worked in community settings (76%). Fourteen participants (56%) used sensory approaches. The most common assessments used were those of sensory processing (n = 12, 48%) and observation (n = 12, 48%). The Sensory Profile was the most popular standardised assessment (n = 8, 32%). The most common interventions used with children experiencing complex trauma were sensory (n = 13, 52%) and play based (n = 13, 52%). Most participants reported not adapting their practices for Māori or Aboriginal children. Most participants felt somewhat prepared (n = 15) for working with complex trauma, with most reporting a lack of experience in this area (n = 10). Supervision was suggested by 92% (n = 23) of the participants.

CONCLUSION

Sensory-based practices were most common among occupational therapists in Aotearoa and Australia who worked with children experiencing complex trauma. The participants suggested supervision, social support, and practical training when working with complex trauma. Advocacy and research are required within this subspecialty, and further professional engagement in the application of culturally safe practice.

Perceived barriers to implementing occupation-based intervention

Abstract Introduction Occupation-based intervention (OBI) is defined as an intervention using a clients’ occupation and purposeful activities as a treatment medium to achieve the client’s goals. Several barriers to practising OBI have been reported in previous studies. However, limited research has been done to identify these perceived barriers to applying OBI in Malaysia’s various occupational therapy practice areas. Objective This study aimed to identify perceived barriers to applying OBI in Malaysia’s three main occupational therapy practice areas including physical, psychiatry and paediatric. Method A cross-sectional study design was employed, and participants were recruited using a purposive sampling strategy. Data was collected using an online survey from a Delphi study. Results Two hundred ninety-eight Malaysian occupational therapists aged between 22 and 56 years old participated in this study. The study identified several perceived barriers from the client factors, the contextual factors, occupation as treatment modalities and logistical issues. A statistically significant difference was found in the perceived barriers of applying OBI between different areas of occupational therapy practice (p=.013), working experience (p=.003), and position of occupational therapists (p=.001). Conclusion This study suggests that perceived barriers to applying OBI were influenced by the area of practice, working experience and position of the occupational therapists. The results highlight the need to identify potential solutions to applying OBI through research and education.

Spanish Cultural Adaptation and Inter-Rater Reliability of the Test of Playfulness

AIM

To adapt the Test of Playfulness (ToP) to the Spanish context (culturally and linguistically) and analyze the inter-rater reliability of the translated version.

METHODS

Following a specific methodology for cultural adaptation, direct and back translations were carried out, together with cognitive interviews with pediatric occupational therapists, to analyze the comprehensibility of the translated version. The resulting version was analyzed by a linguistic expert to determine its grammatical and linguistic adequacy. Finally, inter-rater reliability was analyzed in a sample of typically developing children aged between 4 years old and 6 years and 11 months (n = 12).

RESULTS

Direct and back translation phases showed a good conceptual equivalence with the original version. The cognitive interviews enabled the identification of difficulties surrounding the understanding and the terminology used in several items. The linguistic expert and the research team revision ensured that final grammatical and conceptual improvements were made. Inter-rater reliability analysis showed an almost perfect degree of agreement (0.82 ≤ κ ≤ 1.00; p < 0.001), as well as stability and a strong positive linear correlation (0.81; p < 0.001).

CONCLUSIONS

The translated version of the ToP fits the Spanish context and can be used in the clinical setting of pediatric occupational therapy in Spain.

Can universal design support outdoor play, social participation, and inclusion in public playgrounds? A scoping review

PURPOSE

To synthesize evidence regarding the physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion; identify design recommendations; and explore the current discourses and concepts around designing for outdoor play, social participation, and inclusion in public playgrounds in the context of Universal Design (UD).

METHODS

Published studies addressing public playgrounds, inclusion, and design, were identified via a systematic search of eleven databases from health, science, education, and humanities.

RESULTS

Fifteen documents met the inclusion criteria. Three main themes were identified concerning physical design features and non-physical aspects of public playgrounds that facilitate/hinder outdoor play, social participation, and inclusion, with associated design recommendations. Although UD is recognized to have the potential to support the design of public playgrounds, no studies examined UD solutions for playgrounds or tested them for effectiveness.

CONCLUSION

We cannot yet determine whether UD can support outdoor play, social participation, and inclusion in public playgrounds. Research to date has mostly focused on understanding users' perspectives; future research should continue to be informed by diverse users' perspectives to address gaps in knowledge concerning children's voice from migrants, lower socioeconomic communities, and intergenerational users with disabilities alongside researching design solutions for play.Implications for rehabilitationChildren, particularly children with disabilities and their families, continue to experience marginalization and exclusion in public playgrounds, despite a commitment to inclusion in international treaties.Universal design is recognized to have the potential to support the design of public playgrounds, however, the evidence is currently very sparse.While accessibility is an important consideration for playground design, it does not ensure that play occupations can take place.Extending knowledge on universal design as it applies explicitly to playgrounds and play occupation requires multi- and trans-disciplinary collaboration that includes a play-centered perspective.

Construct validity of the Child-Initiated Pretend Play Assessment-For 3-year-old Brazilian children

INTRODUCTION

Play is an indication of children's development and how they function. In occupational therapy it is regarded as an important occupation of childhood. Assessment of a child's play should be included in the test batteries of occupational therapists, who understand the construct validity of the assessment they have chosen. Our aim was to provide evidence of reliability, internal consistency and hypotheses testing of the construct validity of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment.

METHODS

Two hundred typically developing Brazilian children aged 3 years were evaluated individually using the Child-Initiated Pretend Play Assessment.

RESULTS

The internal consistency showed a Cronbach's alpha coefficient to Percentage of Pretend Play Actions (PEPA) of 0.86 and NOS of 0.81. There were significant differences between the younger children (aged 36-41 months) and the older children (aged 42-47 months) for elaborate play across both conventional-imaginative play (p = .002), symbolic play (p = .012), and the combined score (p = .005). There were significant differences between younger and older girls for elaborate play with symbolic play materials (p = .009) and elaborate play overall (p = .039). There were significant differences between young and older boys for elaborate play with conventional toys (p = .006) and elaborate play overall (p = .025). There were no significant differences for object substitution or imitated actions.

CONCLUSION

The measurement properties of the cross-culturally adapted version of the Child-Initiated Pretend Play Assessment for 3-year-old Brazilian children identified evidence for response processes, internal structure, with discussion of consequences of testing for 3-year-old Brazilian children.

Occupational therapy practice with children with developmental coordination disorder: An online qualitative vignette survey

Introduction

Children and young people with developmental coordination disorder experience multiple occupational performance and participation challenges across environments. Research to date has not fully explored occupational therapy practice with children with developmental coordination disorder and their families. This study aims to describe current occupational therapy practice with children with developmental coordination disorder.

Method

This study used a cross-sectional, online qualitative vignette survey methodology. International occupational therapists who were working with or had worked with children with developmental coordination disorder within the previous 5 years were invited to participate. Following a case vignette, clinicians were asked questions prompting them to describe their practice based upon the vignette. The data were analysed thematically. The Consolidated Criteria for Reporting Qualitative Research and Checklist for Reporting Results of Internet E-Surveys reporting guidelines were adhered to.

Findings

Fifty-three valid responses were analysed. Analysis identified three themes describing occupational therapy practice with children with developmental coordination disorder: (a) a collaborative approach to establish occupation-focused goals; (b) occupation-focused assessment to guide therapy and diagnose developmental coordination disorder; and (c) the use of occupation-based interventions incorporating multiple strategies to enhance occupational engagement.

Conclusion

This study suggests that current occupational therapy practice with children with developmental coordination disorder is collaborative, occupation-focused, and multi-component. Findings highlight a gap between the complexity of practice and the nature of interventions evaluated in research to date.

A Systematic Review on Clinimetric Properties of Play Instruments for Occupational Therapy Practice

Play is considered the main occupation for children. Pediatric occupational therapists utilize play either for evaluation or intervention purpose. However, play is not properly measured by occupational therapists, and the use of play instrument is limited. This systematic review was aimed at identifying play instruments relevant to occupational therapy practice and its clinimetric properties. A systematic search was conducted on six databases (Academic Search Complete, CINAHL, MEDLINE, Psychology and Behavioral Science Collection, Scopus, and ASEAN Citation Index) in January 2020. The quality of the included studies was evaluated using Law and MacDermid's Appraisal for Clinical Measurement Research Reports, and psychometric properties of play instruments were evaluated using Terwee's checklist while the clinical utility is extracted from each instrument. Initial search identifies 1,098 articles, and only 30 articles were included in the final analysis, extracting 8 play instruments. These instruments were predominantly practiced in the Western culture, which consists of several psychometric evidences. The Revised Knox Preschool Play Scale is considered the most extensive and comprehensive play instrument for extrinsic aspect, whereas the Test of Playfulness + Test of Environmental Supportiveness Unifying Measure is a promising play instrument for intrinsic aspect on play, where both instruments utilize observation. My Child's Play is a potential questionnaire-based play instrument. However, the current development of play instruments in the occupational therapy field is immature and constantly evolving, and occupational therapists should exercise good clinical reasoning when selecting a play instrument to use in practice.

Assessing the environmental quality of an adapted, play-based LEGO® robotics program to achieve optimal outcomes for children with disabilities

Purpose: This study assessed the environmental quality of an adapted, play-based LEGO^® robotics program for children and youth with disabilities to determine the degree to which the activity setting supports the therapeutic goals of the program.Materials and methods: We measured the environmental qualities of a robotics program held at a paediatric rehabilitation hospital. We observed and coded video-recordings of the robotics program, specifically one session from each of five different rooms where the program took place. Using the 32-item Measure of Environmental Qualities of Activity Settings (MEQAS), we described the place- and opportunity-related qualities of these settings.Results: Our observations revealed that, across all five settings, the environments support the therapeutic goals of the program, including providing opportunities for social interaction with peers and adults to a great extent. We also identified several environmental features of the robotics program that support optimal outcomes for children and youth with disabilities.Conclusions: Our findings lend support for the value of examining environmental opportunities and affordances of play-based therapy within rehabilitation.IMPLICATIONS FOR REHABILITATIONAssessing the environmental opportunities and affordances of play-based activities using the Measure of Environmental Qualities of Activity Settings (MEQAS) is valuable for supporting positive outcomes in rehabilitation.The settings of an adapted LEGO^® robotics program offer children with disabilities opportunities to engage in social interactions with peers and adults, to learn a new skill, and to develop a sense of self-identity.Optimal therapeutic outcomes of an adapted LEGO^® robotics program can be supported by environmental features, including: large tables with sufficient space for two youth and one or two adult volunteers to interact at eye-level, arranged separately with enough space to invite movement between tables, in such a way that children may also interact across tables.

Advancing play participation for all: The challenge of addressing play diversity and inclusion in community parks and playgrounds

Introduction

Outdoor parks and playgrounds are important sites of social inclusion in many urban communities. However, these playspaces are often inaccessible and unusable for many children with disabilities. This paper presents findings from a case study of one urban municipality in Ireland. The study aimed to understand play participation in five local playgrounds by exploring the perspectives of play providers and families with diverse abilities, through the lens of universal design.

Methods

Multiple qualitative methods were used, including playground audits, walk-and-talk observations, and semi-structured interviews. Four play providers, 12 children, and 10 adult users took part. Inductive analysis was conducted to understand the usability and accessibility of playgrounds from a universal design perspective.

Findings

These playgrounds provided high play value for younger children, but low play value for older children and those with disabilities, due to lack of accessibility or usability. While local authorities aimed to provide inclusive playgrounds, they lacked knowledge on universal design for playspaces.

Conclusion

Children with disabilities continue to experience exclusion in community playspaces, despite a commitment to inclusion in local authorities. Play providers need support to tailor principles of universal design to playground design. Occupational therapists are ideally situated to collaborate with local authorities on universal design for enhancing children’s play participation in community settings.

The meaning of leisure to children and young people with significant physical disabilities: Implications for optimising participation

Introduction

The facilitation of meaningful leisure participation for children and young people requires an understanding of what leisure means to them. This study aimed to understand meaningful leisure from the perspective of children and young people with complex physical and communication disabilities.

Method

A hermeneutic phenomenological research design was used. Data was gathered through multiple interviews with six young people supported by photo elicitation, Talking Mats and direct observation. Individual case studies were analysed, together with six autobiographies of people with similar disabilities. Data analysis was iterative and multi-directional, alternating between segments and the whole throughout interpretation.

Results

Leisure experience meanings were uniquely constructed for each person, based on preferences, personality and circumstances. The tree of leisure emerged as a useful metaphor for three essential features (control, engrossing, enjoyment) and four key meanings (escape, exploration, exchange and expression) of leisure. Children and young people experienced five meaningful outcomes that lasted beyond the leisure activity (restoration, protection, construction, reflection and connection).

Conclusion

For children and young people with disabilities, a balanced array of diverse leisure experiences provides a powerful and accessible route to wellbeing. Implications for practice include understanding the individual, focusing on the social environment, supporting self-advocacy and promoting opportunities for free movement.

Occupational Therapy Practice in Mainstream Schools: Results from an Online Survey in Switzerland

The shift towards inclusive education in many European countries has led to structural changes that affect both schools and their related professionals aiming to support children's participation. While most European countries acknowledge inclusive education and its need, serious challenges exist to its implementation at a national and local community level. Interdisciplinary collaboration, including health and educational professionals, is seen as an imperative key principle for inclusive education services. To learn about the occupational therapist's contribution to inclusive education, the aim of this study was to describe the state of the art of occupational therapists' collaboration and services delivery in Swiss schools. Using an exploratory, cross-sectional study design, a web-based survey was sent to 509 occupational therapists in Switzerland resulting in 302 responses for data analysis using descriptive statistics. Findings show that nearly all participants (97%) collaborate with schools, and 49% of participants provided direct services within a mainstream school setting. These services were mainly funded by health insurance and focused on physical and social environmental adaptations. Despite reported collaboration between occupational therapists and schools, this study shows a need for changes in federal health and education legislation as well as innovative solutions for service delivery in schools.

What makes playgroups therapeutic? A scoping review to identify the active ingredients of therapeutic and supported playgroups

BACKGROUND

Supported and therapeutic playgroups aim to support and strengthen vulnerable children and families by increasing parenting capacity, parent-child interaction, enhancing child outcomes and promoting community networks. This review aimed to comprehensively scope the literature to identify the "active ingredients" of supported and therapeutic playgroups.

METHOD

A systematic search of grey and scholarly literature was conducted using Medline, PyschINFO, EMBASE, ERIC, CINAHL, MedNar, Informit, Scopus, Libraries of Australia and Trove. Articles were included if they: i) defined playgroup as a group of children and actively involved caregivers; ii) described a therapeutic playgroup or supported playgroup model; iii) targeted children prior to school age; and iv) measured the impact of playgroups. A total of 36 articles met the inclusion criteria. Qualitative data was synthesised using a meta-ethnography approach with findings charted against a conceptual model of engagement. Quantitative data was synthesised using descriptive statistics.

RESULTS

The findings identified that emotional, practical and informational components of playgroups strongly reflect family centred practice, self-efficacy theory and peer-support principles.

CONCLUSION

Therapeutic and supported playgroups are complex interventions, with numerous interacting components that make them beneficial for children and families. This review is the first to identify the "active ingredients" of playgroups with findings informing the design of future playgroups for vulnerable children and families.