Peds ch 11/12

Play was the area for development of

- sensory

- integration

- physical abilities

- cognitive and language skills

- interpersonal relationships

Takatas (1974) taxonomy of play

- birth to 2 years: sensorimotor

- 2 to 4 years: symbolic and simple constructive

- 4 to 7 years: dramatic, complex constructive, and pregame

- 7 to 12 years: games

- 12 to 16 years: recreational

Impact of play deprivation

have occurred in children in orphanages or deprived environments which can result in self-stimulation, limited repertoire of activities and minimal social play.

low vision, hearing, or both

- use intact or residual senses, amplify sensory characteristics of objects such as color, size, tactile and auditory features.

- use tactile, verbal, visual or object cues, use gestures, decrease auditory and visual distractions.

Dislike of being touches (tactile over responsivity)

- prepare child for touch by giving deep pressure and applying organized, rhythmic touch.

- Give choice for tactile preferences (e.g, clothes, washcloths, brushes),

- let child preform touch him/herself with brushing teeth/washing face.

Inability to find clothes or understand to, front, or bottom:

- amplify characteristics, reduce distracters (only one item for grooming activity),

- use visual or gestural cues (mark medial border of shoes with happy faces to keep shoes on correct feet)

Inability to sit up or maintain balance

- provide support externally (use positioning devices on floor or chair)

- change position of child or activity.

Limited reach

reduce amount of reach needed, change position of activity

Difficulty grasping objects

- build up handles of objects with foam or wrapping tape,

- substitute assistive device so grasping isn't need (universal cuffs or straps)

Weakness, with little endurance

- eliminate gravity (prop elbow or dress in side-lying position)

- use light weight objects.

Difficulty controlling movement

- provide stable base of support (sit on floor with wide base)

- use weighted devices to give proprioceptive feedback.

Poor memory, inability to remember sequences or directions

- establish and practice set routines and sequences

- use partial participation, grading techniques

- backwards/forward chaining.

Tendency to become easily frustrated; outbursts

- identify purpose pf problem behavior (escape, avoid, attention, transition)

- limit exposure to context associated with misbehavior

- use preferred tasks and give choices.

Hygiene/Grooming 

- Promote grooming routines and habits with all family, groups, or classroom members (discussion, visual reminders, and typical routines for all)

- Establish or restore abilities to do the tasks (build strength, ROM, or sensory tolerance to perform grooming)

- Maintain the skills that are learned through routines, cues, expectations, and practice opportunities. (wash face in AM/PM with antiacne soap)

- Modify or adapt the environment, method, task, or tool used (turn lights down on dimmer, chair to sit during face washing/prop elbows on counter for hair brushing). Change the time when the task is done (take a bath at night instead of morning).

- Prevent social isolation by promoting socially acceptable hygiene and educate about grooming needs related to healthy living. (deodorant after bathing, clean clothes, brushing teeth)

Typical sexuality concepts discussed with children and adolescents with disabilities

- Birth to 2: touches genitals for sensory pleasure, experiences of affection and touch, questions about differences in bodies and body functions.  

- 3-5: shows interest in genitals of the opposite sex, learns proper names of genitals, questions where babies come from. 

- 6-8: understands gender roles and expected behaviors (girls wear dresses), knows differences between boys and girls, names body parts correctly. 

- 9-12: Shows interest in social relationships (may want a boy/girlfriend), desires privacy and more independence, discusses body image. 

- 13-18: is sensitive and private about body, compares body with other and may be critical, shows more interest in caring for body.