CHILDREN'S PLAY - WORLDS COLLIDING OR THERAPEUTIC TOOL?

Håkstad R1, Obstfelder A2, Øberg GK11UiT The Arctic University of Norway, Faculty of Health Sciences, Tromsø, Norway, 2NTNU Centre for Care Research, Faculty of Medicine and Health Sciences, Gjøvik, NorwayBackground: By definition, play is the engagement in activities for enjoyment and recreation rather than a serious or practical purpose. At the same time, play is considered fundamental to children's way of developing new skills and learning to make sense of themselves and their surroundings. Therefore, physical therapists (PT) are encouraged to provide therapeutic measures in a playful setting. In doing so, PTs combine children's joyful play with the serious process of setting and achieving goals that is essential for physical therapy practice. This raises the questions of if and how PTs can use play as a means to achieve therapeutic goals, and still maintain play as a joyous and meaningful activity for the child.Purpose: To investigate how PTs' use of play as a means to achieve therapeutic goals influence children's play initiatives and engagement during therapy sessions.Methods: In this qualitative study, we collected observational data from 20 physical therapy sessions with infants born preterm, aged 3-14 months. We conducted an interpretive content analysis and connected to phenomenological and enactive perspectives with regard to intentionality and cooperation.Results: The PTs made extensive use of play activities as a means to promote the children's rehearsal of motor skills. Overall, the children engaged in the activities with increased attention and a striving to complete activity tasks and goals. Crucial to this successful use of play was the PT's detection of the child's play intention and their fidelity to this intention throughout the play sequence. Contrary, when the PT's intention came into conflict with that of the child, disengagement arose and the child came to be a passive observer. Furthermore, the PT had to find the right level of striving for the individual child, and make continuous adjustments to improve the child's motor performance and accomplishment of tasks. When the PT failed at this, and the child thus repeatedly was unable to achieve the activity goal, engagement dropped and the child ceased to make new attempts at the given task.Conclusion(s): The use of play as a therapeutic tool relies on a sharing of play intentions and a cooperative relationship in which the PT scaffolds the child's ability to achieve play tasks and goals. Future work on the use of play in pediatric physical therapy should include a larger range of therapeutic settings, children's age and diagnosis.Implications: PTs should attend to the ways by which they use play during therapy sessions. While children's play can be used to provide meaningful learning events, it can also become a detrimental and discouraging experience for the child.Keywords: play, learning, preterm infantsFunding acknowledgements: We thank The Norwegian Fund for Post-Graduate Training in Physiotherapy for funding this study. Topic: PaediatricsEthics approval required: YesInstitution: UiT The Arctic University of NorwayEthics committee: Norwegian Social Science Data ServicesEthics number: 29259All authors, affiliations and abstracts have been published as submitted.