PLAY AND CHILDREN WITH DISABILITIES

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PLAY AND CHILDREN WITH DISABILITIES

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PLAY AND CHILDREN WITH DISABILITIES

• Children with disabilities may engage in play
  differently than their peers without
  disabilities. Consequently quality of play
  depends on the following
• The disability or combination of disabling
  factors.
• The opportunity for play.
• The accessibility of toys.
• A modified play environment.
• The presence of peers and adults to facilitate
  and encourage play.
• Disabilities can be classified in terms of the
  following
• Intellectual impairment physical disabilities
  and emotional disorders (Rubin Fein
  Vanderberg 1983)
• Developmental and developmental delay.
• Children at risk for development (children who
  can become disabled without intervention).

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THE NATURE OF DISABLITIES

• PHYSICAL DISABILITIES
• Children with Physical Disabilities can have
• Hearing impairment. Depending on type of
  malfunction to the ear or nerves impairment may
  range from mild to severe temporary or
  permanent.
• Visual impairment. Variation in range of
  impairment due to premature birth injury or
  medical causes.
• Motor impairment. Variations range from physical
  restrictions of limbs hand trunk control
  mobility and strength. Generally caused by
• Spina Bifida
• Cerebral Palsy
• Muscular Dystrophy

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Spina Bifida

• Develops when spinal cord is not fully developed
  and has an opening that impedes protection of the
  cord.
• Significant impairment causes
• Loss of bowel and bladder control
• Bone Deformities
• Motor Impairment
• Paralysis
• Hydrocephalus.
• A condition in which spinal fluids collects in
  the brain. If left untreated can result in
  retardation and seizures. Condition commonly
  treated by surgically implanting a tube into
  brain which allows fluid to drain and blood to
  circulate properly.

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Cerebral Palsy

• Most common type of orthopedic impairment leading
  to a neuromuscular disability.
• Results from injury to brain before or during
  birth.
• Children (mild to moderate) are able to walk and
  use other motor movements with some awkwardness
  however children (severe) often have other
  disabilities (mental retardation and have little
  or no mobility).
• Muscular Dystrophy
• Results in progressive degeneration of the
  voluntary muscle of the arms and legs.
• Symptoms (can appear in children as young a 3
  years of age)
• Appearance of awkwardness
• Walking on tiptoes
• Severe curvature of the spine
• Other postural abnormalities
• Although there can be periods of remission
  gradually the child loses the ability to walk and
  early death is possible.

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AT- RISK CHILDREN

• At-risk Children. Childrens experience with
  Biological or Environmental factors that may
  result in developmental delays or disabilities.
• Biological Risk Factors
• Children have biological history that can result
  in later developmental problems
• Children at-risk include
• Premature babies.
• Children born to mothers who have German measles
  while pregnant or complications during labor.
• Low birth weight babies.
• Children who accidentally ingest toxic substance
  during infancy and toddlers years.
• Environmental Risk Factors
• Can be at risk because of the environment in
  which they lived before and after birth.
• These risk factors result from the mothers living
  in substandard or deprived environments.
• Early identification of at-risk child is
  essential so that intervention earlier on can be
  provided.

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DEVELOPEMNTAL DELAYS

• COGNITIVE DELAY
• Child with cognitive or mental retardation is
  unable to use thinking skills to the level that
  is characteristic of normal development.
• A child with Downs Syndrome experiences cognitive
  delays that result in mental retardation
• ADHD
• Language Delay
• Difficulty in articulating or expressing
  language. Speech deficit that limits
  verbalization such as stuttering or inability to
  utter sounds correctly.
• Immature use of language.
• Limited vocabulary.

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Emotional and Behavioral Disorders

• Exhibit deviation from age appropriate behavior
  that can cause them to be very aggressive or very
  withdrawn. Leading to behavioral problems such
  as
• Aggression.
• Academic disability.
• Anxiety.
• Depression.
• Behavioral deviation can be caused by
• Psychological causes Bereavement due to loss of
  a parent through divorce or death.
• Environmental causes Parenting methods of child
  management Teacher management strategies.
• Psychological causes Genetic factors.

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A. Autism

• Children with autism experience severe emotional
  disturbance. Noticeable as early as 2½ years of
  age.
• More common in boys than girls and is believed to
  be a biological problem that occurs during
  prenatal stages of development.
• Behavior exhibited includes
• Head banging.
• Extremely delayed expressive language.
• Echolalia speech.
• Stereotypical body movements.
• Children with Autism
• Can seem to be insensitive to sound and events
  around them.
• Have difficulty in socially interacting with
  others.
• Fail to recognize that outside world is different
  from self.
• Often experience mental retardation as well.

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(B) Abused Neglected Children

• Children can be abused emotionally physically
  sexually and through neglect. Frequently
  children who are abused experience more than one
  form of abuse.
• Abused children are aggressive and use
  inappropriate social behavior they are equally
  likely to be withdrawn and passive.
• Aggressive children can be
• Disruptive.
• Antisocial.
• Children who have been sexually abused might use
  inappropriate sexual behavior in social
  interaction with peers.
• Physically abused children might wear clothing
  that is seasonally inappropriate to cover signs
  of abuse.
• Neglected children might be dressed
  inappropriately or in dirty clothes. Generally
  because they have received minimal care and
  supervision.

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Children with Multiple disabilities

• Children with disabilities frequently have
  combination of conditions.
• Example. Children with visual impairments can
  also have hearing impairments mental retardation
  with unusual and hearing impairments.
• Cognitive delay or mental retardation can have
  language delay or communication disorder.
• Behavior disorder can also experience language
  abnormalities or cognitive delay.
• It is important to understand the nature of
  disabilities in order to understand how these
  conditions and variations from normal development
  affect how children play.
• Easier to understand the limitation of children
  with physical disability and how their play is
  affected than children with behavior or mental
  disabilities.
• Providing play opportunity is more challenging in
  case of multiple disabilities.

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DISABILITIES AND PLAY

• It is difficult to study the play of children
  with disabilities.
• Handicapping condition involves a wide range of
  disabilities therefore it can be difficult to
  determine the cause of play differences.
• Studies are flawed because they have failed to
  separate the developmental differences from
  differences caused by disabling condition.
• 3) Different researchers from different
  profession might be studying play for different
  purpose and with different results.
• 4) Some researches are conducted with individual
  children and do not consider the effect of peer
  relationship or behavior in a group setting.

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Children With Visual Impairments

• CHARACTERISTICS OF PLAY
• Troster and Bambring (1994) summarized
  significant difference between the play of
  sighted children and blind children. Blind
  children do the following
• Explore their surrounding and the objects in
  their surrounds less often.
• As infants and preschoolers frequently engage in
  solitary play that is repetitive and stereotyped.
• Exhibit less spontaneous play far more than
  sighted children they have to be taught how to
  play.
• Do not or only rarely imitate the routine
  activities of the caregiver.
• Play less frequently with stuffed animals and
  dolls and rarely engage in animism.
• Play less frequently with peers and usually
  direct their play towards adults.
• Exhibit clear delay in the development of
  symbolic play and role play.
• Engage in play that contains fewer aggressive
  elements.
• Children with visual impairments often have
  developmental delays in other domains of
  development that could easily affect their play
  skills.
• Overprotection or fear of danger might result in
  limited attempts to engage in play.

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• Tend to ask more questions of adults in an effort
  to further their understanding of the
  environment.
• Have obstacles interpreting nonverbal
  communication that can impede interacting with
  sighted children
• Differences in cognitive play i.e. use hands
  feet and other parts of the body in object kind
  of plays.
• Lack of interest in exploring toys in the
  environment might be due to lack of experience
  and tendency to be more interested in their
  bodies than the environment.
• Presiler Palmer (1989) found them to be more
  interested in environmental elements that opened
  and closed e.g. doors.

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• Adults should not only provide a variety of real
  objects for play but also assist children in the
  symbolic use of the objects.
• Toys should be selected to encourage symbolic
  representation e.g. dolls wooden trucks.
• Adults can provide experience with objects
  which sighted children can acquire automatically.
• Adults can support play by providing the
  opportunity to explore in a safe familiar
  environments.
• Partially sighted children need opportunities for
  motor play so that they can develop the same
  abilities as their sighted peers.
• Adults can assist children in becoming autonomous
  and independent in play. Assist them in
  developing social interaction with other
  children.
• Guide them to use more imagination and fantasy so
  their play can be enhanced with sighted peers.
• To encourage interaction with sighted peers to
  start with include one peer and then gradually
  increase to more.
• Teachers can help sighted children to understand
  the nature of visual impairments and encourage
  them to play with visually impaired children.

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Children with Hearing Impairments

• Characteristics of Play
• Children with hearing impairments are less
  affected in their play than children with usual
  impairments.
• There is delay in language which results in less
  interest in make-believe play or fantasy play
  than hearing peers.
• Engage less often in socio-dramatic play.
• Use less symbolism of objects than children with
  normal hearing ability
• Social interaction with hearing children can be
  facilitated by using sign language or by lip
  reading.
• According to Parten(1932) parallel play can be
  observed more often in the self contained setting
  for hearing impaired children.
• Associative play more common in integrated
  setting in a study conducted by Esposito
  Koorland (1989).

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Children with Motor Impairments

• Characteristics of Play
• Complex because there are many kinds of motor
  impairments and severity varies from child to
  child.
• The most significant limitation is in play that
  involves physical activity.
• Indoor play is least affected because some of the
  activities do not require gross motor skills.
• By using wheel chairs and other physical
  assistance devices children with mobility
  problems can be included in games and other play
  activities with minimum adaptations.
• Unless other disabling conditions social
  interactions are affected only to extent that
  children without disabilities are guided in
  accepting the childs limitation and can modify
  their play to include the child.

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• Positioning Equipment Is equipment that can
  provide support and proper positioning that
  permits children to carry out daily self care
  activities and engage in play e.g. car seats
  prone standers stroller toilet seat.
• Equipment permits the child with weak muscle
  support to be placed in setting position and also
  provide mobility for some children or at a
  minimum makes it possible for children to use
  their hands to play with objects.
• Lack of mobility or limitations in mobility makes
  it difficult for the child to participate in
  outdoor play with peers who are not disabled.
• The environment should be made accessible to
  children with motor impairment.
• An issue in school settings is inclusion of
  children with motor impairments in sports and
  other physical activities with their peers who
  are not disabled.

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The Role of Adults

• The American with Disabilities Act ensures the
  rights of people with disabilities to be
  encompassed in all aspects of community life
  including participation in physical activities
  and integrated settings.
• Teachers physical education coaches and sports
  leaders must find ways to adapt and accommodate
  to provide support on an individual basis.
• Remove barriers to participation in physical
  activities.
• Burkour (1998) suggests the following to include
  children with disabilities in youth sports
• Skill assessment/task analysis clearly identify
  all of the physical sensory learning
  communication socialization skills needed to be
  successful.
• Focus on maximizing abilities utilize
  individual strengths.
• Ask everyone for accommodation ideas the child
  family teachers therapists and other children
  should be asked to come up with most unobtrusive
  adaptations.

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Characteristics of Play

• Play of at-risk children can be described in
  terms of sensor-motor practice play symbolic
  play and social play.
• The play of sensor-motor play of at-risk children
  develops similar to that of non-risk but if play
  indicates differences it can give early
  indications of a possible delay or handicapping
  condition
• Ex. Narrow range of sensorimotor activities might
  be found to be unusually impaired or autistic or
  have motor impairment.
• Level of symbolic play with play objects is
  affected in sensory impaired mentally retarded
  and autistic children who show less ability to
  use complex transformations in their play.
• Interactive adult-child social play routines can
  be impaired in children with reversal motor
  cognitive or emotional impairments.
• Children born to teenage mothers can have delays
  in social play because the mothers may have fewer
  social support systems and are less
  knowledgeable about parenting.
• Children who develop poor social interactions
  with adults may also experience delays and
  distortions in social play interactions with
  peers.

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The Role of Adults

• Children found to be at risk for development or a
  disability are generally served through
  interventions to enhance development and minimize
  the risk of handicapping conditions.
• Services might be provided directly with the
  child indirectly through parents and other adult
  caregivers or both.
• In case of child who has an early diagnosis of a
  disabling condition both the child and care
  giving adults receive intervention services.
  Parent also receives help in how to enhance the
  childs development and to compensate for
  limiting physical or mental conditions
• In case of children who are at risk for
  environmental causes such as those whose mothers
  exposed them to drugs or alcohol during prenatal
  stage decisions have to be made about
  appropriate environment for the child whether
  the mother can provide a healthy environment.
• Children might be served in a foster home or
  placed with a relative.
• Care giver at risk for environmental causes also
  needs intervention service and support if they
  are to engage in appropriate adult-child
  interaction to meet the childs needs.
• Play has a significant role for development in at
  risk children.
• Provider of intervention services needs to
  include play in the curriculum for children at
  risk for delay as well as children with diagnosed
  disabilities.
• Parents and other care givers at home need to
  know how to use play with children and how to
  enhance the childs ability to play.
• Childs need to play and purpose for play should
  be the major focus for play activities.

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Developmental Delay

• Children with Cognitive Delay Mental
  Retardation
• Characteristics of play
• Literature on play of children with cognitive
  delay is limited when compared to other types of
  disabilities
• Reasons
• Research has been done with individual children
  and limited to the study of their play with
  objects.
• Most of the research done is medical in nature.
• Research results have been inaccurate in that the
  researchers seemed to be unaware of the nature of
  the early development that includes individual
  differences in rate of development in children
  without developmental delays.

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Findings

• Play of children with cognitive delay is less
  sophisticated and more functional than play of
  children with cognitive delay and requires more
  structure (Beckman Kohl 1987 Mindes 1982
  Weiner Tilton Ottinger 1969).
• Play of children with cognitive delay is similar
  to that of children without cognitive delay and
  is developmentally appropriate (Switzky Ludwig
  Haywood 1979 Weiner Weiner 1974).
• Differences in findings might be because of lack
  of control for toy familiarity in some studies
  and the differences in context for the studies
  (Malone Stoneman 1990 Rubin Quinn 1984).
• When equated with mental age children with
  cognitive disabilities do not differ from normal
  children in some characteristics of play.
• Nor do they differ in their preference from
  unstructured activities vs. structured
  activities.
• Prefer child centered or child initiated
  activities to adult-directed activities.

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The Role of Adults

• Adults use play with intervention with children
  with cognitive delay as an assessment tool to
  identify specific delays that need intervention.
• As a strategy that can be used in intervention
  programs.
• The Value of social play between adults and
  infants and toddles is also valuable for children
  with cognitive delay or mental retardation.
• Techniques used with children with cognitive
  delay are adapted to use a range from very
  directive to playful strategies.
• Strategies are both taught to parents and used by
  care givers in intervention programs and they are
  taught to be playful and responsive to their
  children.
• Modeling by adults is used to demonstrate
  symbolic play roles with more structured
  coaching used for children who are severely
  impaired.

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• It is natural for adults to be more directive in
  play with children with cognitive delay than with
  non-delayed peers.
• Integration of skills teaching into play
  sometimes can improve play and development.
• Free play can also facilitate development
  especially when adapted toys and play
  environments facilitate social interaction
  between children.
• The challenge for adult provider of intervention
  for children with cognitive delay or mental
  retardation is to affirm the childs ability and
  interest in engaging in play.

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CHILDREN WITH LANGUAGE DELAY AND COMMUNICATION
DISORDERS

• CHARATERISTICS OF PLAY
• Children with speech impairments did engage in
  make-believe play but occurred less often and
  was of less mature level of play than play of
  children without speech delays.
• Children with language impairments are capable of
  engaging in object substitutions and object
  transformations.
• They exhibit symbolic play less frequently than
  their peers with typical language development.
• Language- impaired children use less complexity
  in their play activities as they grow older.
• Children with communication disorder in group
  settings interact more with adults than peers
  are less likely to respond to peer initiation for
  play and tend to ignored more often by peers.

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• THE ROLE OF ADULTS
• Children with language impairments benefit from
  playing in integrated settings.
• They can be taught how to communicate and
  interact with other children.
• Adults working with children with language delays
  and disorders need to be skilled in ho to provide
  language intervention within play.
• Adults can serve as a facilitator of
  communication between children at play without
  directing the play activities.
• Can encourage the child with language delay to
  use verbalization and model appropriate language.
• Modeling of language in socio-dramatic play can
  also guide the child with language delay in how
  to engage in more sophisticated play.

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CHILDREN WITH AUTISM

• CHARACTERISTIC OF PLAY
• Autistic childrens pattern of development is
  distorted.
• Play patterns of these children are also
  different from children with other types of
  disabilities.
• Autistic children do not generally engage in
  symbolic play.
• They lack make- believe in their play because
  they lack basic representational skills.
• They lack in symbolic play because of
• Lack of motivation.
• Poor social context.
• Level of repetitive language skills.
• Lack peer interaction in play.
• Autistic children tend to engage in repetitive
  and stereotyped manipulation in toy and object
  play.
• They are less likely to use toys appropriately or
  engage in complex toy play.
• Few autistic children play similarly to children
  with cognitive delay and normal children.

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• THE ROLE OF ADULTS
• New intervention strategies are used which are
  more child oriented and focus in planned
  environments and opportunity to play wit peers in
  a group.
• According to Wolf-berg Schulers Integrated
  play Group Model The play opportunities should
  have eight components
• Natural Integrated Settings.
• Well- Designed Play Space.
• Selection of Play Materials.
• A consistent Schedule Routine.
• Balanced Play Group.
• Focus on Child Competence.
• Guided Participation.
• Full Immersion in Play.

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Abused Neglected Children

• Characteristics of Play
• There are some indicators that abused and
  neglected children play differently from their
  peers who are not experienced in abuse.
• Type of abuse can also affect play behavior
  differently.
• A study comparing abused children with control
  group found the following differences (Hughes
  1998)
• Abused children played in less mature ways both
  socially and cognitively.
• Engaged in less play overall.
• Involved in themselves and less often in group
  and parallel play.
• Used the play materials in less imaginative and
  more stereotyped ways.
• Fantasy themes are more imitative and less
  creative.
• They repeatedly played out domestic scenes.

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• Sexually abused children had an absence of
  fantasy play suggesting a need to occupy the
  present.
• Sexually abused children have been found to be
  more passive but they are not necessarily
  antisocial or negative.
• Sexually abused children are more focused on
  sexual features of anatomically correct dolls.
• Play themes of physically abused children were
  more action oriented to include fights wars and
  sudden disasters.
• Physically abused children tend to be disruptive
  and uncommunicative and are antisocial.
• Their play is characterized as fantasy
  aggressive and chaotic.

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Role of Adults

• Teachers role would seem to be to guide children
  in ways to play appropriately and expanding
  socio-dramatic play to include many types of
  themes.
• Teacher needs to be aware of the differences in
  play behavior and alert to the possibility that
  the child had been experiencing abuse.
• THE ROLE OF THE ENVIRONMENT
• Influences of Inclusion Classrooms in Childrens
  Play
• A major goad of intervention programs is to help
  children with disabilities develop social
  competence.
• Social interaction is seen as a way for children
  with disabilities to overcome long delay and to
  acquire developmental skills.
• Social play is also perceived to benefit children
  who involved themselves with less complex form of
  play as a result of a disability.

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• Children with disabilities are not as involved or
  accepted as children who are developing
  typically. Also they receive initial
  opportunities for social play less often and have
  fewer reciprocal friendships and less involved in
  higher levels of social play.
• Children with typical development have positive
  attitudes towards children with disabilities.
• Peer mediated activities in inclusion classrooms
  were found to
• Increase peer interaction.
• Children with disability benefited both
  academically and socially.
• Children with disabilities can benefit from
  inclusion in mixed age classroom. They achieved
  more sophistication in play with toys in mixed
  age classrooms.
• Teachers attitude in inclusion classroom can
  have an effect on successful social
  relationships. Teachers with positive attitudes
  have a positive effect on para-professional time
  and direct time with children with disabilities
  and the social competence of children without
  disabilities.
• Teachers training can be a factor as can be
  specific teaching behaviors that are supportive
  of play.

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Adapted Play Environments

• Environments that serve a large number of
  children must include modifications for all types
  of disabilities.
• The environment needs to be predictable so that
  they can play with confidence
• The American with Disabilities Act (ADA) aims to
  ensure that people with disabilities have access
  to employment public accommodation commercial
  facilities government services transportation
  and telecommunications.
• Regulatory Negotiation Committee on Accessibility
  Guidelines for Play Facilities are as follows
• Be based on childrens anthropometric dimensions
  and other resource information.
• Be base on children with disabilities using a
  variety of assistive devices.
• Provide opportunity of use by children who have a
  variety of abilities.
• Support social interaction and encourage
  integration.
• Create challenges not barriers.
• Provide advisory information to assist designers
  operators and owners to effectively incorporate
  access into their designs. Information should be
  in an understandable format.

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Components of Play Environments

• Ground level Components
• Are different types of play components that can
  be entered and exited at ground level (e.g.
  swings climbers spring rockers).
• Recommendation suggests that children with
  disabilities have a choice of at least one of
  each different type of play components.
• Ground component should equal to 50 of total
  number of elevated play components.
• Elevated Play Components
• Are part of a composite play structure and are
  entered above or below grade e.g.s
  climbers and activity panel.
• At least 50 of all elevated play components be
  accessible to children with disabilities.
• Accessible Routes
• Guidelines require that pathways be constructed
  of a material that is suitable for wheelchair and
  other mobile aids.
• At least one Accessible route be provided within
  the boundary of the playground and connect
  accessible play components including entry and
  exit points.
• Ramps Decks Stationary Bridges
• Access to elevated play components is provided
  through use of ramps decks and stationary
  bridges.

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THE ROLE OF TECHNOLOGY

• ASSISTIVE TECHNOLOGY
• Technological advances in recent years have
  enhanced the possibilities for children with
  disabilities to be able to communicate
  participate and engage in play with their peers.
• These assistive devices are provided as the
  result of an evaluation of the technological
  needs of individual children and selection of the
  most appropriate devices that can be acquired or
  devised.
• ADAPTED TOYS
• Assistive technology can be used to adapt toys
  for children with disabilities.
• Specially designed switches control units
  battery devices adapters and mounting system can
  be used with available toys to make them
  interesting and accessible.
• Battery powered toys can be adapted for
  external switch control so the child can control
  the on and off operation of the toy.
• Switch control adaptation can be used for battery
  powered kitchen appliances and action toys.
• Games can also be adapted with a control switch.

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CREATIVITY PLAY

• Assistive technology makes it possible for
  children with some types of disabilities to
  engage in creative activities.
• Types of adaptation makes it possible for
  children with disability to enjoy creative play.
• With careful planning children with disabilities
  can be encouraged to engage in creative
  activities.
• PLAY - BASED ASSESMENT
• Understanding play variations resulting from
  disabling conditions can be helpful in
  understanding their needs for intervention.
• The appearance of or a delay in the play behavior
  can also be used to assess children.
• Earlier identification of children with delay or
  disabilities traditionally was done through
  standardized assessment.
• Recently play-based assessment with children with
  disabilities has gained popularity.

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• There are three approaches to play observations
  which are being currently used. These are
• Nonstructured Assessment
• Purpose is to identify all behaviors that
  occur during a play session.
• Spontaneous play is observed in
  nonstructured play assessment.
• Play may be initiated by either the child or
  the caregiver.
• Structured Assessment
• Focus on a previously designed set of play
  behavior.
• Procedure are established as are the toys
  to used.
• Techniques employed by adults to initiate
  the play activities.
• 3. Tran disciplinary Assessments
• Included a team of evaluators who observe
  the child at a play concurrently.
• Each member of the team observes a
  different domain of developmental or for a
  different purpose.
• Observation are generally structured.
• May include planned adult interaction.

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Suggested Videos

• Theyre Just Kids Excellent for anyone working
  with children with disabilities. Aquarius Health
  Care Videos. (Videotape E5641)
  (www.justkidsvideo.org). 26 minutes.
• Aquarius Health Care Videos
• 5 Powderhouse Lane
• Sherborn MA 01770
• 508-651-2963
• Bringing Out the Best. Research Press.
  (Videotape E2169). 24 minutes.
• Research Press
• 2612 N. Mattis Ave.
• Champaign IL 61821
• [phone]