'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.

The Representation of Children's Participation in Guidelines for Planning and Designing Public Playspaces: A Scoping Review with "Best Fit" Framework Synthesis.

For children, meaningful participation in community life includes being able to access places for play. Such community playspaces are potentially important for all children, including those with disabilities. Yet, children are rarely asked for their views on the design of playspaces, which can further contribute to exclusionary practices and undermine children's rights to share their views on matters that affect them. In this scoping review, we aim to analyze guidelines and identify strategies for supporting children's participation rights when planning public playspaces. Guidelines are practical tools used by local policymakers when creating community playspaces, which are important sites for children's outdoor play. In total, forty-two guidelines were identified that addressed children's participation rights, along with community involvement. Qualitative evidence synthesis with a "best fit" framework approach was used, informed by Lundy's model of children's participation. The findings revealed the importance of initial community involvement as a critical prerequisite. Strategies for children's participation mostly concerned "space and voice" (for children of diverse abilities), with little attention paid to giving their views due weight. This evidence shows that there is a significant gap in knowledge surrounding policy development and implementation to support adults and children to cooperate equally in designing playspaces. Future directions for research in children's participation require a focus on combined community-children participation approaches in public playspace design. Such work could strengthen and facilitate the role of adults as bearers of the duty to implement the rights of children. This review generated inclusive strategies in planning public playspaces, which could support local policymakers in this complex multi-layered process.

A pilot study of children and parents experiences of the use of a new assistive device, the electro suit Mollii.

Electrical stimulation has been used for many years to treat spasticity in children with cerebral palsy and some improvements have been noted. Building on the benefits of electrical stimulation, a new assistive device, a suit with imbedded electrodes designed to reduce spasticity through electrical stimulation of the antagonistic muscles, has been tested.Aim: The aim of this study was to describe experiences from children with cerebral palsy and their parents regarding the use of the suit. Methods: Individual interviews were conducted with six children 5 to 10 years of age and their parents. The interviews were transcribed and analyzed using a qualitative content analysis. Results: The analysis resulted in three themes: (1) the suit's impact on image, (2) changes that make a difference and (3) dealing with a desire for change. Each of the themes included subthemes. Conclusion: All children reported some impact on their body and self and/or in some activities after the use of the suit. The parents also saw improvements during the trial period. However, the results are inconclusive and a larger study is needed to determine if the suit is useful from a longer perspective and whether it can affect activity and participation in daily activities for children with spasticity.

Children's perceptions of playing on inclusive playgrounds: A qualitative study.

BACKGROUND: Inclusive playgrounds aim to enable all children to participate and be socially included on playgrounds through the way they are designed. However, knowledge is lacking about how children with and without disabilities perceive playing on inclusive playgrounds and whether these playgrounds lead to more social inclusion. AIMS/OBJECTIVES: The study explores the experiences of children, with and without disabilities, of playing on inclusive playgrounds. MATERIAL AND METHODS: Semi-structured interviews and observations were conducted on six inclusive playgrounds in Switzerland. Overall, 32 children aged 7-12 years participated; 14 children had a disability while 18 children did not. A qualitative content analysis was used for data analysis. RESULTS: The children's experiences of playing on an inclusive playground resulted in the creation of three categories describing: how children with and without disabilities experience play activities on inclusive playgrounds; invisible barriers on inclusive playgrounds; and the fact that children with disabilities have recommendations for the design of inclusive playgrounds. CONCLUSIONS AND SIGNIFICANCE: The results showed that achieving inclusion on a playground is complex and must be considered as a transaction among different environments. For occupational therapists, this could mean that, to support play as an activity on inclusive playgrounds, intervention is necessary at the community and political levels.

Health throughout the lifespan: The phenomenon of the inner child reflected in events during childhood experienced by older persons.

The aim of this study was to describe and gain more knowledge of the phenomenon of the inner child, reflected in events during childhood experienced by older persons. Thirteen older persons aged 70 to 91 years old were interviewed. A hermeneutical phenomenological analysis of the data revealed two main themes: the inner child becomes visible and the inner child's presence through life. The participants' narratives showed that their understanding of the experiences included both positive and negative feelings, as well as ways to be creative, in which the inner child became visible. The participants' experiences indicated that the inner child was present throughout the lifespan, was found in challenges that occurred in life, and could turn something bad into something good. However, the presence of the inner child could also be a source for development throughout life and could interfere with the person. The findings from this study point to older persons' need to be recognized, acknowledged, and understood as a unique person living his or her own life. In addition, dimensions of well-being such as feeling safe, loved, supported, and creating space for fantasy and possibilities can be compared to the physical, mental, social, and existential dimensions of well-being found in WHO surveys and definitions of health. This calls for a holistic approach when caring for older persons.

Interventions aimed at improving the ability to use everyday technology in work after brain injury.

OBJECTIVE: The aim of this study was to explore and describe how client-centred occupational therapy interventions may support and improve the ability to use everyday technology (ET) in work tasks in people with acquired brain injury (ABI). METHOD: A qualitative, descriptive multiple-case study was designed, and occupation-based interventions were provided to three working-age participants with ABI. Multiple sources were used to collect data throughout the three intervention processes, including assessments, field notes, and interviews. The Canadian Occupational Performance Measure and the Management of Everyday Technology Assessment were administered before the interventions, after the interventions and at a follow-up session 2-3 months subsequent to the interventions. RESULTS: The three intervention processes initially consisted of similar actions, but subsequently the actions took on a different focus and intensity for each case. All of the goals in each of the three case processes were achieved, and both perceived and observed abilities to use ET in work tasks improved. CONCLUSIONS: Client-centred occupational therapy interventions might have the potential to improve the ability to use ET in work tasks in people with ABI.

The challenges of everyday technology in the workplace for persons with acquired brain injury.

PURPOSE: To explore and describe how persons with an acquired brain injury (ABI) managed the everyday technology (ET) that they needed to use in their workplace and how this use influences their opportunities to work. METHODS: Nine persons with an ABI were interviewed and observed when managing ET in their workplace. The data were analysed qualitatively with a constant comparative method. RESULTS: The main category, "The challenge of managing ET in the workplace", consisted of three categories, all of which reflected different kinds of discrepancies between the participants' ability to manage ET and the demands that ET imposes on them in work: "Struggling with ET to be able to continue to work; "Depending on strategies to cope with ET to continue in a particular profession", and "Managing ET at work but concerned about keeping up with the changes". CONCLUSIONS: The result revealed discrepancies between the abilities of the persons with ABI to manage ET in relation to the demands that technology imposed on them in their work setting. This indicated that professionals need to consider the role of ET when designing interventions supporting a person's return to work after an ABI.

One woman's story about her everyday life after a spinal cord injury.

PURPOSE: The aim was to describe and offer an explanation for how one woman viewed her everyday life after a spinal cord injury (SCI). METHOD: Data were collected by conducting three interviews with one woman with a SCI. Open-ended questions were used with the intention of capturing the woman's own story. The narrative approach inspired by Polkinghorne was used to describe the woman's experiences of her everyday life after the SCI. RESULTS: The analysis revealed that, events influenced her everyday life after a SCI and these events influenced her identity, habits and participation in activities. Further, how she has gone from a state of hopelessness in the early days to a reconstructed identity, associated with a new insight during the 2 years after the accident through a complex and dynamic process of change. In our interpretation we have attempted to provide an explanation of why this outcome came about. CONCLUSIONS: When using narratives, professionals within health-care could focus on the individual instead of the diagnosis or disability. Further, according to a client-centred perspective it is important to attain the client's experiences and knowledge to gain a more complete picture in order to obtain a profound understanding of the client.

Participation in play activities: a single-case study focusing on a child with obesity experiences.

The purpose of this study was to describe how a child with obesity perceived participation in play activities. A single-case study design was chosen to optimize the understanding of the complexities of the research question. A 9-year-old boy diagnosed with obesity was studied. This is a typical case and is studied mainly to provide understanding to the issue. The data were collected from interviews with the boy, his mother and his teacher. Data were also collected through observations and a self-report assessment instrument called Kid Play Profile. The results showed that the boy was ridiculed by his peers and that at times he felt excluded from them, which prevented him from participating in play activities. The boy's experience came from different perceived problems such as lack of friends to play with, his inability to know how to perform in different play activities, and lack of proper support and encouragement from adults. Supporting children to overcome social skills deficits could prevent them from being teased and may have a positive effect on health. To optimize children's participation in play activities, it is important for adults to give them proper support and encouragement. The results were discussed with regard to earlier research, and topics for further research are suggested.

Usability of playgrounds for children with different abilities.

The aim of the present study was to better understand how children with different abilities use playgrounds to engage in creative play and interact socially with their peers. Twenty children aged between 7 and 12 years, with different abilities, participated in interviews. The findings showed that playgrounds served as a reference point for all the children, they challenged a child's physical abilities and provided opportunities for role-playing and social interactions. However, for children with disabilities, playgrounds had limited accessibility, usability and did not support interaction with peers. A methodological limitation of the study was that the interviewer only met the children once. Further research should be carried out to investigate if creating playgrounds according to universal design principles and adapting them to the needs of children with disabilities would improve social interactions and provide more opportunities for play.

How children with restricted mobility perceive the accessibility and usability of their home environment.

The purpose of this study was to describe how children with restricted mobility perceive accessibility and usability of their home environment. The investigation was carried through a descriptive questionnaire, mailed to children in northern Sweden with the diagnoses of cerebral palsy, spina bifida and muscular diseases. Eighty-two children completed the questionnaire. The results showed that the children perceived the accessibility of the physical environment in their homes as relatively good while outside the home the environment was less accessible. In the social environment, frequency of peer contacts varied. The present study underscores the challenges of ensuring that children with restricted mobility living in the parental home are able to have an accessible and usable environment in order to perform activities. Limitations of this study included the questionnaire design. Further research should be carried out with children with restricted mobility to obtain a better understanding of how to improve their mobility in their home environment.