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This is to certify that the
thesis entitled

THE EFFECT OF A PARENT EDUCATION PROGRAM
FOCUSING ON PLAY
ON THE DEVELOPMENT OF
PRESCHOOL NEUROLOGICALLY IMPAIRED CHILDREN
presented by

Dawn Marie We lch

has been accepted towards fulfillment
of the requirements for

Masters degreeinHealth’ Physical Education
and Recreation

 

 

ZNW

’xé’ V
ajor professor

Date .August_8,_;t918_

0-7639

THE EFFECT OF A PARENT EDUCATION PROGRAM
FOCUSING ON PLAY

ON THE DEVELOPMENT OF PRESCHOOL NEUROLOGICALLY IMPAIRED CHILDREN

By

Dawn Marie Welch

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Health, Physical Education and Recreation

1978

ABSTRACT

THE EFFECT OF A PARENT EDUCATION PROGRAM
FOCUSING ON PLAY
ON THE DEVELOPMENT OF PRESCHOOL NEUROLOGICALLY IMPAIRED CHILDREN

BY

Dawn Marie Welch

The purpose of this study was to determine the effect
of a parent education program on the development of preschool
neurologically impaired children. The experimental program
focused on parental attitudes toward play, the value of play,
the importance of play to physically impaired children, and
adaptations of play activities and modifications of play
equipment for physically impaired children.

The primary design was a quasi-experimental, pretest-
posttest model. Eighteen subjects were selected to participate
in the eight week program from three physical therapy programs
in southern Michigan. They were matched into pairs based on
developmental quotients from pretest data collected on a
comprehensive developmental exam. All subjects participated
in a therapeutic play group; parents of the experimental
subjects participated in the parent education program.

The Wilcoxon Sign Test for Matched Pairs demonstrated
a significant difference between the experimental and control
groups in gross motor and social-cognitive development. No
significant difference was noted in fine motor, expressive
language, and reflexive development.

ACKNOWLEDGMENTS

This study was carried out in conjunction with a
companion study on therapeutic play. Working with Joanne
FitzGerald made this project easier and more enjoyable.

I appreciate especially the encouragement and
assistance from my major advisor, Dr. Marcia Carter, and
from my committee members, Dr. Sharon Menkveld, and Dr. William
Heusner. Without Dr. Menkveld's enthusiasm about play oppor-
tunities for handicapped children and Dr. Heusner's statistical
assistance this thesis could not have been completed.

The Michigan Easter Seal Society deserves
special thanks for without their financial support this
project might never have been completed.

I would like also to express my appreciation to the
volunteers and to the staff of the facilities who so willingly
participated in the play and parent education group.

Many thanks also go to the families who so willingly
participated in this study and to my many friends who helped
me to remember how important play is to all of us.

TABLE OF CONTENTS
Page
LIST OF TABLES . . . . . . . . . . . . . . . . . . iv

LIST OF FfGUREs . . . . . . . . . . . . . . . . . v

CHAPTER I

The Problem. . . . . . . . . . 1
Need for the Study . . . . . . . . . . . . . . 3
Purpose of the Study . . . . . . . . . . . . . 5
Research Hypothesis. . . . . . . . . . . . 6
Antecedent Problems. . . . . . . . . . . . . . 6
Research Plan. . . . . . . . . . 6
Rationale for the Research Plan. . . 9
Assumptions Related to the Research Plan . . . 11
Limitations of the Research Plan . . . . . . . 12
Definitions. . . . . . . . . . . . . . . . . . 13

CHAPTER II
Review of Literature . . . . . . . . . . . . . 16
Definitions of Play. . . . . . . . . . . . . . 16
Theories of Play . . . . . . . . . . . . . . . 21

The value Of Play. 0 O O O O O O O O O O 0 25
The Value of Play to the Physically
Handicapped O O C O O O O O O C O O O O O O 27

Parental Influence on Child Development. . . . 29
Parent Education Programs. . . . . . . . . . . 32
Therapeutic Play Programs. . . . . . . . . . . 35
Program Design . . . . . . . . . .'. . . . . . 37
Summary. . . . . . . . . . . . . . . . . . . . 38

CHAPTER III

Methods and Procedures . . . . . . . . . . . . 39
Description of Population and Sample . . . . . 39
The Independent Variable . . . . . . . . . . 42
The Control and Evaluation of Extraneous

Factors . . . . . . . . . . . . . . . . . . 44
Test Procedures. . . . . . . . . . . . . . . . 45
Conduct of Treatments. . . . . . . . . . . . . 45
The Dependent Variables . . . . . . . . . . . 47
Instrumentation. . . . . . . . . . . . . . . . 47

The Pilot Study. . . . . . . . . . . . . . . . 50
Data Collection. . . . . . . . . . . . . . . . 51
Data Analysis. . . . . . . . . . . . . . . . . 52

Chapter IV Page

Analysis and Results . . . . . . . . . . . . 53
Introduction . . . . . . . . . . . . . . . . 53
Test Results for EPCDEC and DDST. . .
The Vulpe Play Assessment . . . . . . . . . . 60
Analysis and Results of Anecdotal Data . . . 61
Summary . . . . . . . . . . . . . . . 64

Chapter V
Summary . . . . . . . . . . . . . . . . . 65
Conclusions . . . . . . . . . . . . . . . . 66
Implications for Practice . . . . . . . . . . 68
Implications for Further Research . . . . . . 69
APPENDICES

Appendix A - Play Program Goals and Objectives 71
Appendix B - Parent Program-Goals and

Objectives . . . . . . . . . . 79
Appendix C - The Denver Developmental

Screening Test . . . . . . . . . 81

Appendix C - The El Paso Comprehensive
Developmental Evaluation Ct. . . 82
Appendix D - Objective Evaluation Form . . . 87
Appendix D - Pilot Project Evaluation Form. . 88
Appendix E - Demographic Data Form . . . . . 89
Appendix F - Parent Education Anecdotal
Data Form. . . . . . . . . . . . 90
Appendix G — Volunteer Training Program . . . 91
BIBLIOGRAPHY 93

iii

TABLE

LIST OF TABLES

Pretest, Posttest, Gain Scores for EPCDEC/
DDST for Five Developmental Categories
(in weeks)

Wilcoxon Sign Test for Matched Pairs on
Five Developmental Categories

Play Activities Attempted and Equipment
Modified by Parents at Home

iv

PAGE

55

S7

62

LIST OF FIGURES

FIGURE PAGE
3-1 Number of Subjects by Location and Group 40
3-2 Correlation Between Test Items 49

CHAPTER I

THE PROBLEM

The theoretical study of play in children with physically
handicapping conditions has been an area devoid of empirical
research. Developmental psychologists, early childhood
educators, and recreators contend that play is essential to
the social, emotional, cognitive, and physical development of
children (Piaget, 1954, Murphey, 1972, Ellis, 1973, and
Sponseller, 1974). Along with an increasing emphasis on
leisure in the world today, there is an increasing emphasis
on play as a subset of behaviors which are not separate from
other behaviors and therefore are subject to behavioral
methods of research (Herron, and Sutton-Smith, 1971). Most
of the behavioral research on play has been with normal
children as subjects. However, several empirical studies
have been devised to study play behavior of mentally retarded
children (Ross, 1970, Cleland, Swartz, and Chasey, 1971) and
therapeutic intervention has been initiated based on the
results of these studies. Michelman (1974) develops a case
for the inclusion of play agendas into the programs of
institutionalized multi-handicapped children based on
observational research.

Frequently the medical focus masks the daily living
needs of the physically handicapped child. Because of en-
forced immobility, sensory motor impairments, and time con-
straints of the primary caregiver, and because the child is
unable to function independently in play, basic play skills

1

2
often are not acquired (Michelman, 1974). Florey (1971)
stresses that the significance of the everyday play of the
child requires that professionals who work with children
regard it as a respectable area of concern. "When a child
cannot play, we should be as troubled as when he cannot eat
or sleep" (Florey, 1971).

Before play can take place, a child's basic needs for
comfort, security, sleep and food have to be met (Maslow, 1970,
Braga, 1974). The parents of a child who does not have dev-
elopmental problems are required to spend comparatively little
time in meeting those basic needs and thus may have time to
play with the child if they so desire. On the other hand, the
parents of a child with neurological impairment may have to
spend a considerable amount of time meeting basic needs. Often
spasticity, abnormal reflex activity, and muscle contractures
or bony deformities make it difficult to provide constant
comfort. Feeding difficulties due to pathological reflexes,
poor muscle tone, and coordination make mealtime a traumatic,
time consuming event. A large percentage of these children
have hyperirritability and hypersenstitivity to auditory
and tactile stimuli. These difficulties make bedtime and
sleeping difficult for the child, and time consuming for the
family. Time and energy for play are likely to be minimized.

Factors which are observed to affect the play behaviors
of physically impaired children include limited mobility to
explore and initiate play activities (Diamond, 1971), de-

creased sensory imput which decreases the childs ability to

3
learn about his environment through play (Marx, 1973), and
the increased amount of time spent on therapy and caring for
the physically handicapped child (Witengier, 1970).

Parental feelings of guilt about bearing a child with
a problem (Freeman, 1967) and their feelings of inadequacy re-
lated to handling and caring for the child frequently prevent
meaningful parent—child interaction. Parents often are observ-
ed by this author holding their child stiffly without cuddling
or rocking. It appears that they are reluctant to toss the
child around and tickle him as they would if he did not have
a physical problem. If the parents of the neurologically
impaired child are not aware of the need for play and/or are
apprehensive about engaging in play for fear it will cause
physical pain or increased spasticity, the time for play and
the quality of play can further be minimized.

The family has long been recognized as the dominant
factor in the socialization and education of the child
(LeMasters, 1970, Brazelton, 1969). Recent evidence suggests
that the first five years of life constitute the most critical
period for the total development of the child (Leach, 1977).
Because of the significance of the early years, parental know-
ledge about the physical, social, emotional, and intellectual
needs of children is important for the successful integration
of these little persons into society. Effective parenting re-
quires an understanding of childrens' needs at all stages of
their development. The ways in which these needs are met, or

are not met, influence a child's overall functioning (Braga, 1974).

4

The literature reveals that programs have been developed
for parents of preschool mentally retarded children (Ross,
1970, Gross and Gross, 1977) and for parents of preschool
disadvantaged children (Collard, 1972, Gross and Gross, 1977).
Most of these programs have had as their focus improvement of
the childs' intellectual functioning and preparation for school.
Play as program content has not been researched extensively
for neither parent nor play programs.

Play is vital to the social, emotional, physical, and
cognitive development of the preschool child (Norbeck, 1971,
Sutton-Smith and Sutton-Smith, 1974, and Buckland, 1971).
Because parental intervention can enhance the play process,
this writer contends that by providing an educational pro-
gram focusing on play for parents of neurologically impaired
children, the overall development of these children can be

enhanced.

NEED FOR THE STUDY

 

The value of play in the development of the preschool
neurologically impaired child is considered by this investiga-
tor to be significant. There existsa need to ascertain the
extent to which a parent education program focusing on play
alters the developmental progression of preschool children
with neurological impairments.

In reviewing the physical therapy literature, little
empirical or experiential research was located related to play
or to parent education. Physical therapy curriculum plans

routinely omit any discussion of play or a playful philosophy,

5
and the focus in pediatric therapy is on techniques of
orthopedic and neurodevelopmental treatment. Physical thera-
pists, as a consequence of this lack in their curriculums and
literature, rarely incorporate play in their treatment programs.

This writer has observed that parents of physically
impaired children do not play spontaneously and developmental-
ly with their children. Parents often depend on their child's
physical therapist for directions concerning how to manage
their child at home. Since most physical therapists are not
oriented to play or a playful approach, play is not regarded as
important. For these reasons, a parent education program which
focuses on the value of play to the neurologically impaired
child, play skills, and adaptations of play activities and
equipment appears warranted.

Literature on play in early childhood education,
recreation, and psychology (Sponseller, 1974, Diamond, 1971)
tends to be based on observation and not on research data.

This investigation attempted to document the effect of an
educational program, taught with play methods, about childs'
play on the developmental level of preschool neurologically
impaired children. Only through studies such as this, even
though there were significant limitations, can further research

be stimulated and the body of knowledge expanded.

PURPOSE OF THE sryprg

The purpose of this investigation was to determine the
effect of a parent education program on the developmental

progression of preschool, neurologically impaired children.

6
The parent education program focused on attitudes toward play,
knowledge about children's play, the significance of play to
development, and adaptations and modifications of play activi-

ties and equipment for neurologically impaired young children.

RESEARCH HYPOTHESIS
The review of the literature has led the investigator
to the following research hypothesis:
The physical, social, and cognitive develop-
ment of preschool neurologically impaired
children whose parents participate in a play
training program will be significantly
greater than the physical, social, and cog-
nitive development of the children whose
parents do not participate in a play training

ANTECEDENT PROBLEMS

The following problems were recognized and dealt
with before the study was initiated:

1. A scale was selected which yields an overall dev-
elopmental age in weeks as well as scores in each of
the pertinent areas (physical, social, and cognitive).

2. A specific play program which is appropriate for pre-
school neurologically impaired children was developed
and pilot tested. This task was undertaken in con-

junction with another investigator who was conducting

a companion study.

RESEARCR‘PLAN
This study utilized a quasieexperimental, pretest

posttest research design with an available sample with subjects

7

assigned to control and experimental treatments. The inves-
tigation was conducted in conjunction with a companion study
whose purpose was to determine the effects of incorporating
therapeutic play into the physical therapy treatment program
of neurologically impaired preschool children. Twenty-seven
children were selected from three physical therapy programs
in Southern Michigan to be involved in the combined study.
Three comparison groups were establised at all three centers.

Group A: The control group for the companion study
was composed of nine (9) subjects; 3 from each location.
These subjects continued with their regularly scheduled physi—
cal therapy treatments twice a week for 1 hour.

Group B: This group was composed of nine (9) subjects;
3 from each location. They continued with their physical
therapy once a week for one hour and participated in the
experimental therapeutic play group once a week for one hour.
This is the experimental group for the companion study and
the control group for this study.

Group C: The control group for this study was com-
posed of the remaining, nine (9) subjects; three from each
location. These subjects received physical therapy for one
hour once a week, participated in the therapeutic play group
for one hour a week, and in addition their parents were in-
volved in a parent education program dealing with play and its
importance for the neurologically impaired child.

All subjects were pretested using the El Paso Com-

prehensive Developmental Evaulation Chart (EPCDEC) or the

8
Denver Developmental Screening Test, and the Vulpe Play Assess-
ment. Subjects were matched into pairs on the basis of their
overall developmental quotients from pretest scores. The
treatments were administered for eight weeks.

The subjects for this study were selected from
Roosevelt-McGrath School, Wayne, Michigan, Durant Tuuri Mott
School, Flint, Michigan and Ingham Medical Center, Lansing,
Michigan. All children were involved in physical therapy
programs for neurologically impaired children at the time of
the study. The Therapeutic Play and Parent Education programs
were implemented within these facilities and the pretesting
and posttesting were done during regularly scheduled physical
therapy sessions at the respective treatment sites.

Volunteers were selected from the Therapeutic
Recreation and Social Work programs at Michigan State Univer-
sity, East Lansing, Michigan to assist the principal investi-
gators with the therapeutic play and parent education programs.
They participated in a pretraining program for four hours prior
to beginning the program.

Employing a modified systems approach to program
planning, goals and objectives were determined related to the
value of play, the significance of play for the development of
normal and impaired children, parental attitudes about play,
and adaptations and modifications of play activities and
equipment for neurologically impaired children. Eight
learning sessions were designed utilizing an informal, playful

approach, to meet these objectives.

9

Following the eight week play and parent education
program, all children were posttested using the same comprehen—
sive developmental scale(s).

A pilot study was implemented to determine the
appropriateness of the goals and objectives, and the relation-
ship of the activities to the goals and objectives. Preschool
children and their parents from an existing physical therapy
program were used for the pilot study. Experts in therapeutic
recreation and pediatrics were enlisted to observe and evaluate
two play and two parent sessions. These experts also evaluated
the objectives and activities for all sessions. Evaluation
forms used are found in Appendix D. Goals, objectives, and
activities for the therapeutic play program can be found in

Appendix A, and for the parent education program in Appendix B.

RATIONALE FOR THE RESEARCH PLAN

 

A review of the literature on play shows that most
research on the topic is observational. A study of develop-
mental levels of impaired children following a play and parent
education program is adaptable to an experimental-control group
research design even though there are numerous limitations.
This investigation may stimulate further research in the area
using controlled methods of research.

The population for this study was chosen because children
with neurological impairments comprise a large segment of the
preschool age group that is commonly treated by physical thera-
pists. By limiting the subjects to those with neurological

impairments rather than including children with orthOpedic

10
and peripheral nerve problems, the physical therapy treatment
approach is somewhat circumscribed but will not be specifically
defined for each child and each therapist.

The eight week period for implementation of the play
and parent education programs was chosen because it seemed to be
a realistic period of time to maintain parental cooperation. A
longer program, and therefore more time between the pretest and
the posttest, might yield more definitive results.

The three locations selected were all within a reasonable
traveling distance for the principal investigators to administer
the pre-and post-tests and to implement the programs. The
physical therapists and administrators of these facilities were
willing to have their clientele participate in the study and were
willing to identify children who fulfilled the sample require-
ments.

The research design facilitated a comprehensive evalua-
tion of the child. The El Paso Comprehensive Developmental
Evaluation Chart (EPCDEC) was chosen as the primary scale to
measure motor (gross and manipulative), reflexive, social,
and cognitive development for subjects from one to three years.
The Denver Developmental Screening Test (DDST) was chosen
and items correlated within the same categories for subjects
from three to five years. In addition, the Vulpe Play Assess-
ment was administered to all children as it provided a more
detailed description of the social-cognitive areas using de-
velopmental play items. The data from the Vulpe Play Assessment

was used to supplement the developmental examinations and was

11
therefore not analyzed statistically. These combined scales
were found to give a comprehensive evalution of the childrens
development. These scales were chosen because they can be
given in a reasonable amount of time, are comprehensive, and
can be administered by a physical therapist. A11 evaluation

forms used for statistical analysis are found in Appendix C.

ASSUMPTIONS RELATED TO THE RESEARCH PLAN

 

The following assumptions were made in conjunction with
the implementation of the study:

1. Physical therapy treatment has a positive effect on
the development of preschool children with neurological
impairments.

2. The developmental scale selected accurately measured
the changes in motor, social, and cognitive development
of neurologically impaired children.

3. A representative group of neurologically impaired children
in the preschool age range will be available to the
researcher because of the early identification clause
of the Mandatory Special Education Act (Public Law 198,
1971).

4. Activities designed for the play and parent education
treatments were assumed to be appropriate to meet the
goals and objectives of the program.

5. The program activities in the therapeutic play and the
parent education program were presented in a "fun"
atmosphere, incorporating a playful approach by the

volunteers and the group leaders.

12
The program is of sufficient duration that there was no
pretest effect on the posttest. The items in the develop—
mental examinations are nonspecific and can be evaluated
in different ways through observation.
Parents developed skills and knowledge about playing with
their child from the training program.
Parents transfered their skills and knowledge about playing
to the act of playing with their child thereby increasing

the quality and quantity of play time.

LIMITATIONS OF THE RESEARCH PLAN

 

the

The following have been identified as limitations of
proposed research plan:

There was no way to prevent absence of children and/or
parents, due to illness, changes in parents' work schedules,
and other obligations.

Bias of the researchers, volunteer aides, and associated
facility personnel may have affected the results. The
developmental scales were as objective as possible to
decrease this bias.

The inability to regulate the physical therapy program
which was administered to the experimental and control
groups may have affected the results.

There was no way to control the amount and type of play
within the physical therapy treatment and within the home
environment. The amount and type of play in the home, the

playfulness of the parents and other family members, and

13
the playfulness of the physical therapist involved in
the child's treatment program are recognized as
important factors but were not considered in the data
collection or analysis.

5. Test reliability and validity of the developmental exam
to be used has not been completely researched though work
in this area has begun.

6. The relatively short duration of the play and parent
education programs may have affected the results.

7. The sample size was kept small in order that the principal
investigator and the principal investigator in a companion
study could evaluate all children in the pretest and post-
test and also implement the play and parent training
programs. This decreases tester bias, but severely limits
the generalizability of the study. The results are
applicable only to children in southern Michigan as this
is the area from which the available sample is drawn.

8. Cooperation of families, volunteers, and facility person-
nel might not have been consistent.

9. Socio-economic factors, which are known to affect play

behavior, cannot be controlled.

DEFINITIONS

Neurologically Impaired. Any central nervous system
defect manifesting a motor disability can be classified as a
neurological impairment. Examples of specific conditions

which were included in this study under this definition are:

14
Cerebral Palsy, post encephalitis, post meningitis, hydro-
cephalus, post traumatic head injuries and cerebral tumors.
Conditions not dealt with in this study were: Downs
Syndrome,peripheral nerve injuries, myelodysplasia, and benign
congenital hypotonias.

Preschool. Children between the ages of one year zero

 

months and four years eleven months were designated as
preschool for purposes of this study.

Therapeutic Play. Play activities for neurologically

 

impaired children, emphasizing self-initiated, pleasurable
(fun) experiences which are oriented toward therapeutic goals;
i.e. optimal positioning, use of involved extremities,
normalization of muscle tone, and motor patterns, and
facilitation of mobility constituted therapeutic play.

Therapeutic Play Program. An eight week planned program
of group play activities, which was designed to meet previously
determined therapeutic goals.

Play (for the neurologically impaired child). Behavioral
characteristics which are self initiated, pleasurable and
intrinsically motivated experiences, and which are receptive
and/or expressive, constituted the entity of play.

Playfulness. Lieberman defined playfulness as:"apersonal-

 

ity trait characterized by quantity and quality of physical,
social, and cognitive spontaneity, manifest joy, and sense of
humor (Lieberman, 1966)".

Physical Therapy (for the neurologically impaired child).

 

An individualized, goal-oriented session was conducted twice a

15

week emphasizing inhibition of abnormal reflexes and muscle
tone, facilitation of normal muscle tone, motor patterns,
and developmental sequence, maintenance of range of motion,
increase of strength and endurance, improvement of balance
and coordination, and improvement of ambulation and gait
pattern.

Parent Education Program. An eight week program for
parents focused on attitudes about play, knowledge about
the value of play for neurologically impaired children, and
adaptations and modifications of play activities and
equipment.

Physical Therapy for the Neurologically Impaired Child.
An individualized, goal-oriented session was conducted twice
a week, emphasizing inhibition of abnormal reflexes and muscle
tone, facilitation of normal muscle tone, motor patterns and
developmental sequence, maintenance of range of motion,
increase of strength and endurance, improvement of balance
and coordination, and improvement of ambulation and gait

pattern.

CHAPTER II

REVIEW OF LITERATURE

Two major areas of literature are considered relevant
for this review. Research on play and development is
reviewed to examine the appropriateness of the content in
planning an intervention program for young neurologically
impaired children and their families. Literature on
definitions, theories, and variables which constitute play,
the value of play and how play affects the social, emotional,
cognitive, and physical development of handicapped and non-
handicapped children will be reviewed. Parent education
literature is reviewed for effective methods of instruction
and for applicability to the topic of play.

Less extensively reviewed here but still of significance
to the study are parental influence on child development,
developmental problems associated with neurological impair-
ments and their influence on play abilities of children, play
in physical therapy, and literature that will support the

intended method of study and the instruments selected.

DEFINITIONS OF PLAY

 

In the past decade there has been an increasing concern
for play and leisure and a definite shift in attitudes away
from the puritan work ethic (Ellis, 1972). Researchers are
beginning to attack the basic questions of what play is, why
people play, of what value is play and playfulness, and what
constitutes the group of behaviors we call play.

16

17

Many psychologists, educators and, child development
Specialists have spent much time and effort trying to define
and delineate the exact nature of play. Huizinga (1949)
dealt with the tendency to split categories into exclusive
apposite sets by initially defining play as not-work. After
extensive study he concluded a more important complementary
pair would be play-earnest or play-seriousness; though he
felt that seriousness seeks to exclude play, whereas play
can very well include seriousness (Huizinga, 1949).

Some authors have defined play behavior in terms of
its cause or motive. Sapora and Mitchell (1961) defined
play as "the aimless expenditure of exuberant energy." Late
in the 19th century Groos defined play as "instructive
practice, without serious intent, of activities that will
later be essential to life" (Groos, 1898).

In searching for a satisfactory definition within the
literature, the question of whether play is intrinsically
motivated or learned behavior inevitably arises (White,
1959, Florey, 1971). Both sides of the issue appear to be
equally well documented. Play is thought to be innate
behavior for all mammals, though man is seen as the supreme
player (Ellis, 1972). Man exhibits a great variety of play
behavior as well as very complex play behaviors. Furthermore,
only man plays extensively beyond the juvenile period
(Norbeck, 1971, Dolhinow, 1971, Morris, 1969, Hunt, 1965).
On the opposite end of the continuum, play is viewed as a

learned behavior. Play can be explained as learned behavior,

18
made in response to stimuli in the environment, that is not
demonstrably critical for survival (Kimble, 1961, Ellis, 1973).

Play includes an emotional element of pleasure. Play
is spontaneous, is customarily regarded as nonutilitarian
and nonproductive, and is in its outward form species
Specific (Jackson and Angelino, 1974). Play allows for op-
timum exploration of the unknown and is unpredictable in that
each player is free to respond in his own way. Play implies
freedom from imposed constraints and encourages creativity
(Gunn, 1977). Sutton-Smith describes play as a very special
type of "knowing", unique in character and having the
characteristics of self-control, euphoric-tension, scale
reduction, and novelty (1972). He defines stages similar
to those explained by Piaget: sensory motor (infancy),
symbolic (toddlerhood), and imaginative (childhood). These
stages all deal with life in terms of models.

Attempts at defining play are numerous with the tendency
being to define play according to the particular purpose of
the research (Takata, 1969). Frequently researchers incor-
porate many definitions and theories or segments of theories
to derive an operational definition which will meet their
research needs.

Several authors have attempted to define and delimit
play by reviewing the literature only to conclude that play
is undefinable (Millar, 1968, Ellis, 1973). "The gallant
attempts to provide direct, comprehensive theories of play
are inamnuate partly because they attempt to define and treat

play as an activity with a common core and with characteris-

19
tics that distinguish it from all others" (Millar, 1968).
Millar proposed that play be used as an adverb to describe
how and under what conditions an action is performed.

Lieberman (1966) attempted to differentiate between
play and playfulness. Quantity and quality of physical,
social, and cognitive spontaneity, manifest joy and sense
of humor were rated, and Lieberman predicted that these
were in fact the expression of one personality trait--
playfulness.

Play is a universal human behavior. It is
therefore presumably vital to human existance.
Societies regard and handle play differently.
Some provide it a place of honor and put it

to social use. Other societies, notably our
own in recent centuries, have held play in
dishonor, a course of action that has borne
positive results in monumental economic
achievements, but at the same time has
presented us with a chain of social problems."
(Norbeck, 1971).

The preceding statement is only one of many examples
found in the literature on the history and philosophy of
play which indicate that our society has minimized the value
of play. Play is presented as trivial, worthless, and
something to be done only when all work is done. This
idealogy of play, described as "Scroogian" by Brian and
Shirley Sutton-Smith (1974), is explained by stating that
the industrial revolution which needed many workers had to
force a predominantly rural European culture from its
festive and seasonal way of life. The idea that work was
supreme and play was evil helped to provide the industrial

revolution with the human machinery it needed. The creati-

vity and individuality which is felt to be necessary in our

20
modern society (Buckland, 1971) were not needed and in fact
were discouraged during earlier eras. Several authors have
described the official suppression of play in western
cultures, particularly in Protestant countries followingthe
Reformation (Illick, 1974, Aries, 1962). In contrast non-
western societies, view play as "an outstanding, socially
approved feature of life which holds a position of honor in
religious observances (Norbeck, 1971).

Evidence of the puritan work ethic still is obvious
in our society today and tends to be transferred from one
generation to the next (Gunn, 1977). In spite of this,
however, people and animals continue to play from very
early in their lives (Smilansky, 1968, Sutton-Smith, 1972).
Play is first expressed in the mouth play of infants which
is apparent after needs of feeding are met. Unlike
exploratory activity, this play does not appear to be
controlled by immediate stimulus events (Sutton-Smith,
1972).

Neumann, in "The Elements of Play" (1971), analyzed
the literature on play and concluded that all activities can
be placed on a continuum from "work" to "play". Three
criteria are defined which distinguish play: control must

be internal, the player must suspend reality (to act "

as
if"), and the activity must be internally motivated

(Sponseller, 1974).

21

THEORIES OF PLAY,

 

At the 1970 White House Conference on Children,
participants recognized that play behavior cannot occur until
the basic needs such as food, health, warmth, and security
have been met (Jackson and Angelino, 1974). Maslow
formulated the "hierarchy of needs: as a construct through
which we can view the growth of human beings toward
psychological health and self-actualization (Maslow, 1970).
The basic needs can be classified into five groupings:

(1) physiological (2) safety (3) belongingness and love
(4) esteem and (5) self-actualization. The significance of
this formulation is not that it looks at human beings as
inherently growth oriented. In the literature on play,
nothing was found which attempted to place play into this
hierarchy of needs. Elements of what we call play can be
seen in all of the groupings beyond physiological and

safety needs (Braga and Braga, 1974). This basic need
concept has been expressed in terms of conditions

inhibiting or facilitating play (Florey, 1971). The
conditions which inhibit play (hunger, anxiety, and fear

of pain) are manifestations of physiological and safety
needs, which are lower on the hierarchy of basic needs.

The conditions which Florey delineates as facilitating play
(novelty, opportunity for exploration, imitation of competent
role models) are higher on the hierarchy of basic needs, to
be sought after physiological and safety needs have been met.

Gunn suggests that following the crisis period of an

illness or disability, after basic needs have been met,

22
the patient will be ready for play activites to meet the
need for optimal arousal (1975). In order for the individual
to meet his needs for optimal arousal the play activity
must meet certain characteristics: self-regulation,
increasingly complex skill acquisition, intrinsic rewards,
creative and imaginary responses, and free of external
constraints (Ellis, 1973).

Many theories have been advanced in the past which
attempt to explain why people play. The most common are
the classical theories of surplus energy, instinct,
recapitulation, preparation for life, and relaxation. The
surplus energy theory maintains that play is caused by excess
energy which must be expended. The instinctual theory
assumes genetic inheritance: play behavior of children is
natural and instinctive. The recapitulation theory states
that through play the player recapitulates the history of
the development of his own species. Groos's view of play as
preparation is based on behavior as instinctive. The
player is perfecting his instinctive skills so that when
they become critical they will be effective. The relaxa-
tion theory implies rest and recuperation from work (Ellis,
1973).

The more recent theories of play are concerned with
the actual form of the play behavior and attempt to explain
play in terms of cause and effect. The best known of these
are generalization (re-enactment of rewarding work
experiences), compensation (satisfaction of needs not met

through work), catharsis (expression of emotions in a

23

harmless way), psychoanalytic (repetition of unpleasant
experiences or tendencies), developmental (play as caused
by the growth of the childs intellect), and learning (the
normal process which produces learning) theories (Ellis,
1973).

Of these the developmental and learning theories
seem to be most applicable to the present study and will
therefore be discussed in greater detail. Developmentalists
view play as having various stages, each based on learned
behavior from the previous stage (Erikson, 1950, Piaget,
1962). Piagetian theory sees play as "the expression of
one of the phases of progressive differentiation occuring
when assimilation is dissociated from accommodation" (Piaget,
1962). Assimilation refers to the process by which the
living creature internalizes the information it receives
in terms of its previous habits and preferences as it makes
this information part of its already existing knowledge.
Accommodation refers to the adjustment the organism must
make to reality in order to assimilate properly any unique
or novel aspects which the environment may provide. Play
is the direct result of the "primacy of assimilation" (Piaget,
1962). Piaget sees play as closely tied to the growth of
intelligence and as a condition of pure assimilation
(Flavell, 1963). Piaget proposed three types of games:
practice games, symbolic games, and games with rules. These
types of games correspond closely to his three stages of

intellectual growth: the sensory-motor level, the preoperational

24
level and the operation level. Piaget also suggests
criteria which distinguish play from non—play activities:
Play as (1) an end in itself, (2) spontaneous, (3) pleasura-
ble, (4) relatively lacking in organization, (5) marked by
freedom from conflicts, and (6) as overmotivated (Flavell,
1963, Jackson and Angelino, 1974).

Information seeking as knowledge seeking (epistemic)
behavior also can have characteristics which are similar to
play. Play as a subset of behaviors can be reduced to stimulus-
response psychology, and play can be explained as merely
learned behavior. Schlosberg (1947) described play in terms
of stimulus response concepts of generalization, thresholds,
and learning. In the past decade, learning theorists have
begun to look at curiosity, arousal, and attention in learn-
ing (Smilansky, 1968). Moffitt attempts to show that play is
an important mode of sensory—motor, perceptual—motor, language
and cognitive development (1972). Much of what the author
describes as play would be called exploration or learning by
others.

In their recent book, The Power of Play, Caplan and

 

Caplan attempt to substantiate their premise that the power
of play is all pervasive. They view play as an entity which
can aid physical growth, strengthen personality, encourage
personal relations, further creativity and the joy of living,
and advance learning (Caplan and Caplan, 1974).

A recent integration of two existing theories appeared

most promising as a guide for the practitioner as well as

25

the researcher. The first theory contends that quiescence
is not the natural state of the organism, and for that
reason the organism interacts with the environment. It postu-
lates that an intermediate level of arousal is optimal. Play
seems to be the behavior that comes from a need for stimula-
tion and produces knowledge about the constantly changing
environment (Ellis, 1973).

For more than 100 years scholars have been formulating
theories to explain why people play. Basic to all of these
theories is the concept that play is valuable to animals and

humans and therefore is a legitimate area of concern.

THE VALUE OF PLAY

 

In reviewing the literature regarding the value of
play the following quotations are considered by this writer
to be of significance:

Through play that emerges in a normal, natural
pattern, children discover who they are, how
their bodies and minds work, and how they feel
about themselves and others. Play is childrens
response to life, if they are to be vital,
creative, healthy individuals. If we can be-
lieve that play is as necessary to our wholeness
as work and that the two can mesh with each
other, life will take on additional meaning and
joy" (Evans, 1974).

Play makes life more interesting. Play makes
us enjoy being with each other a lot more.
Playful people are more versatile. Versatile
people are flexible and creative." (Sutton-
Smith and Sutton-Smith, 1974)

Childs play is the infantile form of human
ability to deal with experience by creating
model situations and to master reality by
experiment and planning (Erikson, 1955)."

26

The sheer pleasure of playing is extremely
important to learning because it encourages
the child to explore. Here in play, we have
two essentials of intellectual growth--
interest and experimentation" (Hartley, 1971).
Play is the most dynamic childhood learning
method. The young child plays from early
morning until he goes to sleep at night. It
is the most natural way for a child to use
his capacities, to grow and learn skills"
(Caplan and Caplan, 1974).

Play habits of the young become a matter of
critical importance in their preparation for
adulthood. Those who play poorly when young
will have inept dreams for the social futures
in the societies in which they live"
(Erikson, 1973).

All of the above statements support the concept that
play is of value to man, though each view is supported by a
different body of knowledge.

Many professionals from various disciplines are
showing increased concern for the management of play to
achieve goals which they judge to be worthy (Sutton-Smith,
1971). Some authors argue that if the activity is managed
or manipulated by others it is no longer play (Gunn, 1977,
Neumann, 1974). Most who are concerned with children, how-
ever, agree with the following concepts: play is the main
mode of learning in children (Hartley, 1971, Garvey, 1977,
Arnold, 1955, Bruner, 1975); play can be successfully
employed as a technique with emotionally disturbed children
(Klein, 1960, Axline, 1947); play is the basis for creativity,
versatility, and imagination (Curry, 1975, Lieberman, 1965,
and Sutton-Smith, 1974); and play helps a person to perceive

the reality of the world (Hartley, 1971).

27

THE VALUE OF PLAY TO THE PHYSICALLY HANDICAPPED CHILD

The value of play to the physically handicapped child
is less well documented than the value of play to man in
general. Finnie devotes one chapter in her book Handling
the Young Cerebral Palsied Child at Home (1975) to play. In

it she states:

Play is equally important for the Cerebral
Palsy child. He, too, must become aware of
himself, explore, and get to know his hands,
feet, face, and so forth; learn about himself
in relation to others, and understand how the
world around him works. . . . Because of his
difficulties in moving and balancing, in eye-
hand coordination--and often with the addition-
al handicap of defects in seeing and hearing--
he needs lots of help. . . . His handicap
prevents him from learning through play in a
natural way, so unless he has help and encour—
agement, he will not be able to learn as he
plays, or to reach his potential" (Finnie, 1975).

In an article entitled "Play is Valid" (1968), Frank
says of play and learning:

With his sensory capacities, the child learns
not only to look but to see, not only to hear
but to listen, not only to touch but to feel

and grasp what he handles. He tastes whatever
he can get into his mouth. He begins to smell
what he encounters. He can and will--if not
handicapped, impaired, or blocked--master these
many experiences through continual play. . . the
most intensive and fruitful learning activity

in his whole life cycle" (Frank, 1968).

The deficits caused by play deprivation in children
are clearly recognized (Bruner, 1966, Schults, 1965, White
and Watts, 1973). Play deprivation has been studied in
laboratory animals (Suomi and Harlow, 1976) with results

showing that monkeys without playmates, to provide sensory

and motor stimulation, develop socially disturbed

28

characteristics and never learn to play as adults. Play
deprivation in handicapped persons has been described in
relationship to the blind (Frampton, Kerney, and Schattner,
1969, Morris, 1974), to the mentally retarded (Ross, 1970,
Cleland, Swartz, and Chasey, 1971, Horne and Philleo, 1976),
and to the physically handicapped (Cliff, Gray, and Nymann,
1977, Witengier, 1970, Gralewicz, 1973, and Michelman, 1974).

Through interviews with parents of multihandicapped
children, Takata found evidence that the handicapped child
lacks opportunity for successful play experiences (Takata,
1971). Lack of appropriate models for play is a major factor
in play deprivation. Since the physically impaired child
may be unable to function in play by himself, he fails to
acquire skills even at the lowest level of his ability
(Michelman, 1974).

The Education For All Handicapped Children Act of
1975 (Public Law 94-142) mandates that educational agencies
shall identify all unserved handicapped children and provide
a free appropriate public education, integrating the handi-
capped with the non-handicapped to the appropriate extent.
Related services which are required to help a child benefit
from special education are also mandated. Play, Michelman
proposes, is a neglected, overlooked factor which has an
important influence on learning and should be part of the
special treatment the child receives (Michelman, 1974).

Gralewicz completed a comparative study of multihandi-

capped and non-handicapped preschool children based on the

29
hypotheses that the multihandicapped child plays less, spends

more time playing alone, and has fewer play companions than
the non-handicapped child (Gralewicz, 1973). The results
supported all hypotheses except that the multihandicapped
child spends more time playing alone. The time spent playing
alone was found to be similar in both groups, but the multi-
handicapped child had less playtime with others because of
attendance in therapeutic programs and more time spent in

his physical care. The author contended that the develop—
mental gains from an effective therapy program may compensate
for decreased playtime and that compensatory play programs
can be developed once specific areas of deprivation are

identified.

PARENTAL INFLUENCE ON CHILD DEVELOPMENT

Information sources which relate to the attempt to
understand the significant influence parents have upon their
children have varied widely. Supported by a heavy accumu-
lation of evidence suggesting that the first years of life
are instrumental in terms of cognitive development, Caldwell
(1967) calls for supplementing the family environment with
priming resources. Caldwell's discussion of priming resources
is primarily in the cognitive domain and directed toward
preparation of the child for formal education.

Gordon in "The Beginnings of the Self: The Problem
of the Nurturing Environment", stresses the importance of
children's early years on the establishment of a sense of

self that then serves as a filter for all future life

30

experiences (Braga and Braga, editors, 1974). The major
premise of this article is that feelings about the self are
influenced by the childs active experiences with the environ—
ment and by the attitudes and models of significant others.
Bayley (1964) indicated that the self-picture is fairly well
integrated by the third year of life. The results of her study
suggested that the mothers affectional‘ behavior toward her
child in the first three years of life was related to the
childs friendship, c00peration, and attentiveness at the time
of school age.

Concerning motor development, Seefeldt discusses
the importance of "critical periods" in relationship to
sensory stimulation. The author utilizes experiments on
animals and humans to support the theory that the reduction
of essential sensory stimulation results in delayed or
inappropriate motor responses. Seefeldt supports provision
of enriched environments by proposing that early movements,
if repeated often enough, are incorporated into cell and
phase assemblies within the central nervous system. This
process facilitates improved future learning of more complex
movements (Seefeldt, 1975).

Baumrind (1967) studied child rearing practices
associated with competence in the young child. A basic
assumption from which this and other similar studies proceed
is that physical, cognitive, and social development of young
children is largely a function of child rearing practices.

The child's energy level, his willingness to explore and

31

will to master his environment, and his self control,
sociability, and buoyancy are set not only by genetic
structure but by the stimulation and interaction provided
by his parents (Baumrind, 1967).

In developing Maternal Behavior Rating Scales,
play and social interaction were used as criteria to indicate
maternal awareness and quality of maternal interaction
(Ainsworth, 1971). The mother who responds apprOpriately
to her child does not overstimulate him by interacting in
too intense, too vigorous, too prolonged, or too exciting a
manner. She is also unlikely to understimulate because she
picks up and responds to the signals of boredom which the
baby gives. The quality of parent-child interaction was
emphasized and the author contends that children of highly
sensitive mothers follow more normal patterns of development
(Ainsworth, 1971, 1973).

Saunders and Keister (1973) found that very young
children placed in day care settings actually lost ground
in their physical and mental abilities. Children who had
previously walked or talked were no longer able to walk or
talk. This was related to the lack of stimulation provided
by the environment. Brophy (1970) assertsthat it is not the
amount of stimulation but the way the stimulation is organized
in the home that is important. The amount of stimulation
provided and therefore the childs achievement can be
influenced by the mothers impression of herself (Strom and

Greathouse, 1974) .

32

The three original Parent Child Development Centers
funded by the Administration for Children, Youth, and Families
(ACYF) have many unique features, but share the basic premise
that in order to help parents learn and change, the stresses
on the lives of parents must be alleviated (Gross and Gross,
1977). In these centers, information on growth and develop-
ment is offered to the parents in conjunction with supportive
and counseling services in a group setting.

Father participation in playing and learning is
emphasized by McDiarmid, Peterson, and Sutherland in their
book on parent participation in child development (1975).
They also stress making every learning situation enjoyable
for the parent and the child and offer suggestions on how to
do so.

Parent participation in the early education of
handicapped children is considered of such importance that
the Bureau for the Education of the Handicapped, United
StatesOffice of Education, requires that parent participation
be built into proposals for many of its federal grants
(Cohen, 1977). It is apparent from the literature search
that parents have significant influence on the development

of their children, both normal and handicapped.

PARENT EDUCATION PROGRAMS

 

The literature reveals that until recently educators
involved in preschool programming have virtually ignored the
critical influence of the home on child behavior and learning

(O'Connell, 1975, Gordon, 1975). O'Connell suggests that a

33
systematic procedure for relaying developmental information
to parents with children of all different ages and handicaps
is needed. Programs have been initiated which provide
developmental information to parents of children with develop-
mental disabilities (Diamond, 1971, Flint and Deloach, 1975,
and Morris, 1973) and disadvantaged families (Gross and Gross,
1977, Collard, 1972). Parent information and support groups
have been reported to have varying degrees of success with
parents of disabled children.

In a study which investigated the effect of play pro-
grams on preschool children with learning disabilities and
multihandicapping conditions, it was concluded that early
sensory and movement experiences are necessary to prepare
children for learning. The results of the study led to the
conclusion that parent/child sensory motor activities should
be initiated shortly after birth and should be done on a
continuing basis at home (Martin and Evans, 1972).

Once the need for assistance to parents is determined,
it is necessary to identify the most effective way that this
assistance can be provided. Parent education programs have
existed in the past with little research to objectively
evaluate the effectiveness of methods (Pickerts and Fargo,
1971). Program goals were rarely specified and programs
were continued if participants liked them and recommended
their continuation. Dinkmeyer described the "C" parent group;
the participants gollaborate, gonsult, glarify, gonfront,
show goncern, maintain gonfidentiality, and are gommitted

to ghange (Dinkmeyer, 1973).

34

The best known approaches to parent education are the
mental health and learning focused approaches. The former,
known also as the affective self—examination approach to
parent education was evaluated by Brim (1965). The focus
was on improving the mental health of parents and therefore
improving the mental health and learning abilities of
children. The results were inconclusive. The learning
focused approach was suggested by Pickerts and Fargo (1971)
as being adaptable to evaluation and successful because it
has clearly defined goals which can be translated into
specific behaviors or tasks that will indicate whether or not
the parent understands his role as parent and its significance
to the development of the child.

In research on methods of parent-education groups,
the question of discussion vs. lecture always arises.
Hereford (1963) compared semi-structured discussion groups,
with lecture control groups. The parents who attended the
discussion groups did show significantly (.05) greater
changes in their attitudes and behaviors than did the parents
in the lecture groups.

A comprehensive review of parent-education programs
for low income families is offered by Chilman (1973). Parent
education groups have not proven effective in making signifi-
cant changes in knowledge and attitudes of parents in the low
income populations. However, in studies of educational
intervention with mothers of disadvantaged infants it was

found that children made significant I.Q. gains in comparison

35

to a group whose mothers did not receive an education program.
The cost of the programs and the extent of intervention (i.e.
home training to allow for practice of skills, toy lending,
etc.) were found to be significant factors in the provision of

such programs.

THERAPEUTIC PLAY PROGRAMS

 

Results of a survey of therapeutic play services in
childrens general hospitals in the United States showed that
less than half of the hospitals surveyed provided any play
services to hospitalized children. The study concluded that
more emphasis is needed in the use of play to help children
work through anxieties associated with surgery and in play
sessions to promote physical therapy (Williams, 1970).

"Just as early infant movement comes as the natural
response to frequent physical handling by the mother and to
multisensory stimulation, so the young child uses his body
most vigorously in play with other children and in response
to toys and activities that he enjoys (Marx, 1973)". This
statement is the basis for a program implemented at the
United Cerebral Palsy Center of Manhattan which integrates
physical therapy into a preschool play/education program.
Parent instruction in physical therapy/play activities is
an integral part of this program. The approach utilized is
group activities, with learning experiences planned for each
individual based on objectives prepared for each child

during the multidisciplinary staff conferences. Positioning

children and stimulating movement are found to be effective

36

methods of incorporating physical therapy into the classroom.
Self-care and perceptual training are integrated into the pro-
gram and activities are carried out by the teachers. Compar-
ison studies of this method have not been reported in the
literature though the importance of such studies was stressed
by the author (Marx, 1973).

In England, play groups have become increasingly
popular in conjunction with physical therapy and speech therapy
(Leyland, 1976). The neurodevelopmental approach to treatment
of young cerebral palsy children (Bobath and Bobath, 1969)
originated in London, and is commonly used by therapists
throughout England. Because it is a dynamic method which is
incorporated into handling techniques with children, it is
very adaptable to a play setting providing the ratio of
therapists to children is high (Leyland, 1976). To date
research has not been reported of comparison of play groups
and individual treatment programs.

A play center for developmentally handicapped infants
and young children (three months to two and one half years)
was founded early in the 1970's in southern California. The
goals of ELic (Edward Levy Infant Center) were to provide a
play center with stimulation in a loving and playful atmos-
phere, and to provide emotional support for the parents, so
often denied them by their extended families and the
community (Diamond, 1971). Though this center serves as a
model for other programs which are being developed, no
controlled research methods are being used to determine

its effectiveness.

37

It is difficult to determine from reviewing the
literature whether there is a scarcity of preschool programs
for handicapped with a play approach, or only a scarcity of
authors who have chosen to report their findings. Nowhere
in the literature was there a model which one might follow

in the establishment of a play/physical therapy program.

PROGRAM DESIGN

 

Peterson (1971) seems to offer the most workable
program planning procedures using the systems approach. In
this model, the purpose of the program is defined and goals
and objectives are specified prior to implementation of the
program. These program goals are used as guidelines to
develop behavioral-learning objectives, which are descriptions
of the behavior expected after instruction. Procedures for
reaching the objectives are then designed. An ongoing,
formative evaluation plan is simultaneously developed
(Peterson, 1974). Initially stating the objective, provides
a workable rationale for selecting program activities to
meet the objective and furnishes direction when selecting
appropriate leadership techniques for conducting the activi-
ties (Witt and Witt, 1975).

Several developmental tests were reviewed during
the literature search. Those reviewed extensively were:
The Denver Developmental Screening Test, The Bayley Scales
of Infant Development, The Cattell Infant Intelligence Scales,
The Milani-Comparette Test for Motor and Reflex Development,

The Preschool Attainment Record, The El Paso Comprehensive

38

Developmental Evaluation Chart, The Vulpe Assessment Battery,
and the Wolanski Assessment (Frankenburg and Dodds, 1973,
Krajicik, 1977, Milani-Comparetti and Gideoni, 1967, Cliff,

et a1, 1975, Wolanski, 1973). Several play assessment scales
were also reviewed to determine feasibility of inclusions in
the study (Knox in Reilly, Ed., 1974, Sutton—Smith and Sutton-

Smith, 1974, and Vulpe, 1977).

SUMMARY

Literature on play and deve10pment, the value of play
to handicapped and non—handicapped children, and the importance
of play programs was reviewed. Though the material evidence is
minimal, an attempt was made to document the appropriateness
of play as content in planning an intervention program for
parents of neurologically impaired children. Parental
influence on child development is well supported by studies
in various disciplines; medicine, psychology and psychiatry,
and education. Parent education groups as a means to provide

information was explored to determine its effectiveness.

CHAPTER III

METHODS AND PROCEDURES

The purpose of this investigation was to determine the
effect of a parent education program on the developmental
progression of preschool neurologically impaired children.

The parent education program focused on attitudes toward

play, knowledge about child's play, the significance of play
to development, and adaptations and modifications of play
activities, toys, and equipment for physically impaired young
children. The program was administered to parents of children
participating in a physical therapy playgroup program as a

part of a companion study.

DESCRIPTION OF POPULATION AND SAMPLE

The study utilized a quasi-experimental, pretest-post-
test control-group design with an-available sample. Twenty-
seven preschool children, male and female, who were enrolled
in physical therapy programs for neurologically impaired child-
ren were pretested using a comprehensive developmental scale.
All children had chronological ages between one year zero
months and four years eleven months at the onset of the study.
They were living at home with their parents or foster parents
and were transported to a physical therapy department twice a
week for individual treatments. Eighteen (18) children were
participating in a companion study and were grouped as follows:
Nine (9) children received physical therapy twice a week for

one hour for the eight week duration of the study. Nine (9)

39

40
children received physical therapy once a week for one hour
and participated in a therapeutic play group once a week for
the eight weeks. Eighteen (18) children were participating
in this study and were grouped as follows: The control group
consisted of the nine (9) children receiving physical therapy
and the therapeutic play group once a week for the eight weeks.
The experimental group consisted of nine children who received
physical therapy once a week, the therapeutic play group
once a week, and in addition, their parents attended a
parent education program on play for the eight week period.
Three (3) children for each of the three groups were selected

from each of three (3) locations within southern Michigan.

 

 

 

Location Group Group Group
A B C
(Physical Therapy) (Physical Therapy (Physical Thera-
And Play) py, Play And
Parent Education)
1. 3 3 3
2. 3 3 3
3. 3 3 3
\fontrol experimentaL/
W
Therapeutic \control experimentaL/
Play *’ 4‘
Parent
Education

Figure gfl.f<Npgp r perubjects bvapcgtion and Group.

Following the programs, all children were posttested
using the same comprehensive developmental scale and gain
scores were calculated. In addition, anecdotal information

was collected following each play and parent training session.

41

Subjects were selected from the following preschool
programs: Roosevelt McGrath School, Wayne-Westland School
District, Wayne, Michigan, Durant Tuuri Mott School, Flint,
Michigan, and Ingham Medical Center, Lansing, Michigan.
Subjects were matched into pairs on the basis of their overall
developmental quotients from pretest scores and then assigned
to each of the three groups.

Children with neuromuscular impairments resulting
from meningitis, encephalitis, traumatic brain injuries or
other head injuries which cause damage to the central nervous
system were included in the study if they met the age and
physical therapy program requirements. Children with primary
muscle diseases, peripheral nerve injuries, and mental retarda-
tion without physical disability were excluded from this
investigation.

Nine sets of parents (three from each facility) were
selected to participate in the parent education program. These
parents attended eight, hour-long sessions with activities
designed to meet the goals and objectives of the program. See
Appendix B. Parents who agreed to bring their children for
the play group but did not participate in the parent education
program were provided with audiovisual materials, written
information on physical disabilities, refreshments, and a com-
fortable place to socialize while their children were in the
play sessions.

Parents in all three groups who agreed to participate
in the study were provided with information on therapeutic

Play following the collection of data. They were informed

42
prior to the study that all results and program information
would be made available to them and the facility staff
following the study.

Demographic data was collected on the age of parents,
ages and sex of siblings, position of the physically handi-
capped child within the family, educational level of parents,
and additional programs in which the child or parents are
participating. A sample form is included in Appendix E. No
attempt was made to match subjects based on these character-

istics or to formally analyze any of these variables.

THE INDEPENDENT VARIABLE

 

This section will include a brief discussion of the
therapeutic play program which is the independent variable for
the companion study as well as a more comprehensive discussion
of the parent education program.

The intent of the therapeutic play program is to
provide play activities within a physical therapy setting,
once weekly to children with neurological impairments in order
to encourage their progress in physical, social, and cognitive
development. Each developmental objective was divided into
sub-objectives and therapeutic play activities were designed
to meet these objectives.

The therapeutic play group utilized optimal positioning
for function, integration of all extremities, facilitation of
normal motor patterns, balance and equilibrium responses, and
concern for the normal developmental sequence. A description

of all activities may be found in Appendix A.

43

The independent variable for this study was the parent
education program. The intent of the parent program was to
establish an educational program for parents of preschool
children with neurological impairments in order to encourage
parents to play with their children at home in a developmental
yet playful manner. No attempt was made to measure their
playfulness in a pretest or to follow up with measurement of
the amount that they play with their children at home. It is
this investigator's hypothesis that if the program was effeca
'dyc in teaching parents the value of play and how to play
effectively with their child, the developmental progress of
the child would have been enhanced in the posttest.

The principal investigator in the companion study with
the assistance of four or five volunteer aides led all play
group sessions. This investigator with one volunteer aide
simultaneously led the parent group sessions.

An important factor in the program is the informal,
playful atmosphere with which the program was presented.
Volunteers were selected to assist with both the play and the
parent education programs through the Michigan State University
Recreation Program and from other people who expressed an
interest in childrens play. Criteria for selection was their
ability to facilitate playfulness in the children and parents.
The pre—program training for volunteers emphasized flexibility,
versatility, and creativity, which are traits thought to be
characteristics of playfulness (Lieberman, 1965). It is this

playful approach which is thought'to separate this program

44

from the typical group therapy programs sometimes found in
preschools for physically handicapped children that are taught
in a more conventional, educational manner (Leyland, 1976,
Sponseller, 1974). The volunteer training program schedule

may be found in Appendix G.

THE CONTROL AND EVALUATION OF EXTRANEOUS FACTORS
Provisions were made to control the following con—
founding factors:

1. A significant issue to be considered in this investigation
Was attendance of the children and their parents. Illness
within the family, transportation difficulties, changes in
parents' work schedules, and other obligations on a
particular evening are some of the factors which affected
attendance. Additional volunteers were provided to baby-
sit with siblings of parents participating in the parent
education program. Transportation was provided on a
prearranged basis when families were known to have a problem.

2. The physical therapy program and the therapeutic play program
was held in the setting familiar to the children in order to
demonstrate a minimal environmental effect. During pretest,
the physical therapist who works with each child was present
in order to minimize the effect of a stranger on the test
results.

3. The subjects in the study were matched according to their
oVerall developmental scores as measured during the pretest.
Children were placed in the experimental and control groups

from each of the three locations based on these pretest scores.

45

TEST PROCEDURES

The subjects in this study were pretested by the
principal investigators one week prior to the institution of
the program. The developmental testing took place within the
child's regularly scheduled physical therapy treatment in the
department where he routinely received treatment. The evalua-
tors spent a short time observing and interacting with the
child prior to beginning the testing so that the presence of
a stranger did not adversely affect the pretest. The childs'
physical therapist was present to discuss the results of the
pre- and post-testing in order to insure reliability and
validity of the testing.

Developmental scores for selected areas (gross motor,
cognitive-social, manipulative, expressive language, and
reflexive) were determined in the pretest and recorded for
each child. Posttesting occurred during the week following
the completion of the program under similar conditions as in the

pretest.

CONDUCT OF TREATMENTS

Literature was reviewed to determine the appropriateness
of the goals and objectives for the treatment programs
(Moffitt, 1972, Morgenstern, 1968, Griswold, 1972, Marx, 1973,
Braga, 1974). Positioning the children in order to facilitate
movement and participation in activities (Bobath and Bobath,
1975, Finnie, 1975, Marx, 1973) is an important part of the
play program. Following the developmental motor sequence and

stimulating proper postural alignment are treatment techniques

46
which will be incorporated into the objectives and activities
for the play program (Gesell, 1940, Bobath and Bobath, 1975,
Finnie, 1975). Activity selections for both programs will be
selected from related literature (Braga, 1974, Griswold, 1972,
Aston, 1971, Gordon, 1970, Madaras, 1977).

Facilities were selected based on their ability to
assist with the selection of families and to provide places
for the play group, the parent education group, and the parents
of the play group children to socialize. Large equipment, such
as Bobath balls, large wedges, bolsters, tunnels, etc. were
provided by the respective facilities. Smaller equipment,
consumable supplies, and refreshments were provided by the
investigators.

A proposal for funding of the therapeutic play program
and the parent education program was approved by the Michigan
Easter Seal Society. A total of six hundred eighty-five dollars
was used to cover the cost of equipment, supplies, and travel
to the experimental sites.

The programs were implemented once a week for eight
weeks in each of the three facilities chosen to participate.
The principal investigators implemented the play groups and the
parent education groups with the assistance of pretrained vol—
unteer aides to assure consistency of approach. Sessions #7
and #8 of the parent education program required involvement of
the parents and the children together.

The format for the parent education program was as

follows: an initial fun activity to develop a playful,

47
relaxed atmosphere, an information period designed to meet a
specific objective, and an informal discussion period
simultaneously with refreshments. Children from the play
group participated in the seventh and eighth sessions only.
The parent education group leader attempted to facilitate
discussion following the informational period, rather than

serve a leader function.

THE DEPENDENT VARIABLES

 

The dependent variables in this study all reflect
developmental status and were used to measure progress in
the subjects during the ten-week period between the pretest
and the posttest. The areas of development which were
selected are those felt to be most directly related to physical
therapy goals and objectives: gross motor, reflexive,
manipulation, expressive language, cognitive-social, and play.

Instrumentation. A comprehensive developmental test

 

(which is appropriate for the age group used in this study)
was chosen. The El Paso Comprehensive DevelOpmental Evalua-
tion Chart (EPCDEC) was chosen from several others reviewed
because: it could be given by a physical therapist or teacher
rather than a clinical psychologist, the testable categories
were not too broad, the test items were all observable so that
parental reports were not relied upon, and for the first year
the results are recorded in two-week intervals. Because the
EPCDEC covers developmental progress only through 36 months of
age, the Denver Developmental Screening Test (DDST) was se-

lected to cover the areas of development other than reflexive

48
for the developmental ages three to five years. Reflexive
development was recorded on the EPCDEC for all children as
all reflexes are assumed to be mature by the developmental
age of three years. Due to the severity of disability in
most of the children who are in preschool treatment programs
the assumption was made that most of the children would score
within the EPCDEC limits. This chart also evaluates the
locomotor prognosis for the child with cerebral palsy, a
syndrome manifesting sensory and motor impairments. Head
circumference, body growth, and presence of seizure activity
were also recorded on the EPCDEC. Research is presently
being conducted to determine the reliability and validity
of this test.

The results are recorded on the EPCDEC in bimonthly
intervals for the first year, every three months for the second
year, and every six months for the third year. Results are
recorded on the DDST at six month intervals from two to six
years. If the child scored in the two-and—one-half to six
year range, results were recorded on both tests to insure
reliability of the test items. Figure 3-2 demonstrates the
correlation between the test items on the EPCDEC and the DDST.
Items which show a positive correlation within a six month
period are marked with an asterisk (*). Two examples of this
correlation are: In the 2 1/2 year age range one DDST item
is "throws ball overhand"and the corresponding item in the
EPCDEC is "throws ball 4 feet". "Copies circle" was found

in both tests at the 3 year level.

49

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manual
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omnomm swan omnomm amen omaomm amen ounomm swan med
swan oz< umaumm "mXMHH Emmy zmmzamm onH<Ammmou .Num shaman

50

A play assessment taken from the Activities of Daily
Living Section of the Vulpe Assessment Battery for the
Atypical Child (Vulpe, 1977) was given to all of the children
at the same time as the developmental pretest. The play
assessment is scored in monthly intervals and employs the
stages of play development as its basis. This was compared
in the same manner as the developmental test and was used as
the basis for formative evaluation of play and parent activities.

Both physical therapists who evaluated the subjects
(the principal investigators in this and the companion study)
have had considerable experience doing developmental testing.
For this reason all of the testing was done by these two
individuals, and the results were discussed with the physical
therapist treating the child to insure reliability and validity
of the testing. At least ten children were tested prior to the
pretesting by the investigators to insure familiarity with the
form and recording methods of the EPCDEC, the DDST, and the
Vulpe Play Assessment.

The Pilot Study. A pilot study was conducted to

 

determine the appropriateness of the activities in meeting the
goals and objectives of the play and the parent education
program. Two activity modules were incorporated into an
existing physical therapy/play program with preschool physical-
ly impaired children. Implementation of the two sessions was
similar to those planned for the conduct of the actual study.
Observers with pediatric and therapeutic recreation experience
were present to evaluate the activities, leadership techniques,

and selection of activities in relationship to the goals and

51

objectives of the play program. Observers with expertise in
family counseling and therapeutic recreation evaluated the
parent education program in the same manner. See Appendix D
for evaluation forms utilized.

All of the goals and objectives were evaluated by
these observers and by additional experts in pediatrics, play,
family counseling, and systems approach to program planning.
Changes were made in the program objectives and activities
prior to the beginning of the study based on the observations
and written evaluations of the experts. The pilot study was

conducted as an attempt to increase the validity of the program.

DATA COLLECTION

Pretest and posttest data was collected on the EPCDEC,
the DDST, and the Vulpe Play Assessment by the principal
investigators. Gain scores in gross motor, fine motor, reflex-
ive, expressive-language, and social-cognitive development
were calculated.

During each weekly program session, a volunteer was
assigned to each parent and collected anecdotal data on parent
interaction, parent-child interaction, playfulness, and
incorporation of program materials and ideas into daily life
reported by parents. Parent-child interaction was observed
and recorded prior to the sessions when parents were bringing
their child to the play group and at the end of the sessions
when the parents returned to pick up their child. Observations
were also recorded following the seventh and eighth sessions

when parents and children played together. A form was designed

52
for the purpose of recording this data and may be found in
Appendix F. At the end of the eight week period a compilation
of the anecdotal observations was done, and the findings were
categorized and percentages of responses to three of the items

were calculated.

DATA ANALYSIS

 

Nonparametric statistics were used to analyze the results
of the study because of the small sample size and the
assymetry of the curve, as determined by Chi square test results.
The Wilcoxon matched-pairs signed—ranks test was used to
determine if a significant difference between the experimental
and the control groups existed. This test was used because
it considers the relative magnitude as well as the direction
of the differences between the pairs.

Each category of development was evaluated for the six
matched pairs (N=6) to determine whether or not the parent
education program had a significant effect on the child.

Alpha was set at .1. Setting alpha at this value takes into
consideration the many limitations inherent in this study
and enables the researcher to determine the feasibility of
further research in this area.

No attempt was made to analyze the anecdotal or demo-
graphic data statistically. Instead, it was looked at sub—
jectively to see if any differences could be noted in behavior
of parents of children after information about play and the
opportunity to play was provided. Inferences which would be
drawn from this subjective data are presented along with the

statistical data in Chapter IV.

CHAPTER IV

ANALYSIS AND RESULTS

The accumulated data of the El Paso Comprehensive
Developmental Evaluation Chart and the Denver Developmental
Screening Test are analyzed, discussed and interpreted in
this chapter which is divided into four major parts:

1. The analysis and results of five developmental

categories on the EPCDEC and the DDST: gross
motor, fine motor, expressive language, social-
cognitive, and reflexive.

2. The analysis and results of the Vulpe Play Assessment.

3. The analsyis and results of the anecdotal data.

4. An overall summary.

The initial sample consisted of nine (9) pairs of
children selected from three locations in southern Michigan.
Three pair were from each of the following locations: Durant
Tuuri Mott School, Flint, Michigan, Ingham Medical Hospital,
Lansing, Michigan, and Roosevelt McGrath School, Wayne
Michigan. All subjects were participating in physical thera—
py programs at the time of the study. The majority of subjects
were also involved in at least two other treatment areas, i.e.
occupational therapy, speech and language therapy, recreational
therapy, etc. Only two subjects were involved in home exercise
programs on a routine basis. Sixty-six percent of the parents
involved had at least one year of education following high school.
Only two parents had not finished high school. Socianconomic
status of the families was unknown.

53

54
Four subjects dropped out of the study, leaving six

pairs available for analysis (n=6).

TEST RESULTS FOR EPCDEC AND DDST

 

The pretest, posttest data and gain scores are shown

for each of the five categories of development in Table 4.1

55

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e NN NN eN NoN Na NN eeN NNN en em on ON on as eN

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e we we sN eN Nm eN em NN e Nm es N Nm om eN

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0 we we NN es sN NN em NN o NA NN N we es mN

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o eN eN N eN NN N ON NN N oN NN N oN NN NN

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N NN ON N om me o om om N eN eN e NN s e

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Amxmmz sz mmHmOOWH¢U A<Hzm2moqm>mn H>Hm mom

.Hmmeemom

.emwemmm

H.¢ mgm¢H

56

The raw data found in Table 4.1 was subsequently subjected
to analysis using the Wilcoxon Sign Test for Matched Pairs.
Following the collection of all data, gain scores for all
subjects were calculated. Differences in gain scores were
computed and ranked without respect to sign, the smallest
difference being ranked as one. Signs were then reattached
from the original values. The sum of the ranks of positive
differences (T+) and the sum of the ranks of negative dif-
ferences (T-) were then computed. Referring to the Distribu-
tion of the Sign-Ranked Statistic T for alphaat .l determina-
tion of significance was made. Table 4.2 shows the applica-

tion of the Wilcoxon Sign Test for Matched Pairs to the data.

 

 

 

 

 

 

 

 

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58

A research sub-hypothesis can be stated for each
category of development:

The development of children whose parents received the
parent education program focusing on play is significantly
greater than the development of the children whose parents
did not receive the training program in the following categories:

H1.1 Gross motor deve10pment

H1.2 Fine motor development
1.3 Expressive language development

H1.4 Social-Cognitive development

H1.5 Reflexive development

Table 4.2 indicates that a significant difference in the
gain scores between the control and the experimental group was
noted in gross motor and social-cognitive development. Fine
motor, expressive language, and reflexive development did not
demonstrate a significant difference. However, members of
the treatment group moved in the desired direction in fine
motor and expressive language, while no change was noted in
either the control or the experimental group in reflexive
development.

In expressive language development all pairs showed
differences in direction but the magnitude of the differences
was not great enough to accept the research hypothesis. In
this category, one subject in the control group made a very
large improvement (48 weeks in the eight week period between
the pretest and the posttest). The magnitude and direction
of this subject was sufficient to cause rejection of the

research hypothesis.

59

One of the anticipated limitations of the study, the
effect of a stranger on the pretest results, was noted in two
subjects. One control group subject improved more than would
be feasible in the language area. It was felt by the
researchers that this large difference in the posttest results
was due to the subjects being comfortable with the evaluators.
In the fine motor area four of six pairs achieved some gain,
but due to one control subject making a very large gain,
presumably the effect of a stranger in the pretest, signifi-
cance was not shown.

In reflexive development, four pairs of subjects showed
no change in magnitude or direction. The sample size was
therefore reduced to two for purposes of analysis. The
research hypothesis was rejected at the .1 alpha level.

Alpha was chosen to be .1 for this study as it is
generally accepted in this type of educational research. At
this level if significance is detected, further research in
this area may be pursued. If the .2 alpha level had been
selected, significance would have been more likely in
additional developmental areas, but the validity of the
results would be decreased and would not justify further
research.

The individuals who dropped out may have affected the
statistical results of the study. The decreased n may have
affected the significance. The two subjects in the
experimental group whose partner in the control group dropped

out had shown change in magnitude and direction which may

60

have determined significance in fine motor or expressive
language development.

Observation of the raw data indicated improvement in
the desired direction in all developmental categories
except reflexive deve10pment. The mean gain score for each
developmental area for the experimental group was larger than
for the control group. With an n large enough to justify the
use of parametric statistics it is probable that significance

would be shown in the analysis of the data.

1
THE VULPE PLAY ASSESSMENT

 

The play assessment which is part of the Activities of
Daily Living section of the Vulpe Assessment Battery for
the Atypical Child (Vulpe, 1977) was used in an informal
attempt to determine if the items on the play scale compared
with the items on the social-cognitive section of the El Paso
CDEC and the personal-social section of the DDST. From the
literature review (Knox, 1974, Sutton—Smith and Sutton-Smith,
1974) it was apparent that criteria used to evaluate the play
development of children contained elements of all categories
of development but were most similar to the above named
sections. It was found that many items on the play scale
were difficult to observe in a testing situation, and required
significant amounts of reporting from parents or therapists
to score. In addition, some items which were scored as
requiring assistance or as unable to do were observed one week

later in the play group, and the child was found to be

61
independent. It was unlikely that this improvement was valid,
and was probably due to inadequate time for the testing.

In analyzing the data it was found that 9 out of 12 of
the subjects exhibited no change in the posttest. Two subjects
improved 18 months in the 8 week period between the pretest
and the posttest. The remaining subject actually showed re-
gression on the Vulpe Scale during that same period. When
observing the posttest scores of the two subjects who improved
in the Vulpe play scale with the same two subjects on the
EPCDEC no change in development on the Vulpe play scale was
noted. The subject who regressed on the Vulpe play scale
actually improved on the EPCDEC. Because of the observed
inconsistencies in results between the Vulpe play scale and
the two developmental exams it was felt that the Vulpe play
scale was not an appropriate test and therefore no statistical

analysis was conducted.

ANALYSIS AND RESULTS OF ANECDOTAL DATA

Table 4.3 shows the percentage of positive responses to
the items on the anecdotal data form about play activities
attempted and equipment modified at home in the previous weeks.
This information was recorded by the volunteers who were
assigned to each parent for the duration of the eight week
program. During the course of the program it appeared that
volunteers became more relaxed with the families and less
attentive to detail. This factor may have influenced some of
the trends noted in the anecdotal data. Multiple volunteer
raters and reliability checks between raters might have made

these observational results more valid.

62

TABLE 4.3 PLAY ACTIVITIES ATTEMPTED AND EQUIPMENT MODIFIED

BY PARENTS AT HOME

 

 

Location Subject Play Activities Equipment Modified
#/7 weeks Z #/7 weeks %
Flint 22 5 71 2 29
7 3 43 1 l4
8 2 29 3 43
Lansing 18 4 57 5 71
16 6 88 O 0
Wappe 25 3 43 O 0

 

Fifty—five percent of the parents reported activities
tried at home in the previous week. All of thaparents tried
some of the activities at least once during the eight week
program. Parents did not modify play equipment or toys as
frequently (25%) as they tried play activities. Two of the
subjects' parents did not modify any equipment during the
eight week period. Eighty percent of the parents responded
that they learned facts about play and child development
which were helpful to them in dealing with their children at
home. No specific information was recorded about what kind
of information was most helpful.

The following inferences were drawn from subjective
evaluation recorded on the anecdotal data forms:

1. After the third session both mothers and fathers
were described as being increasingly playful.
Volunteers recorded phrases such as: "mother
smiled at child constantly and winked at her",

"picked up child and twirled him around", "child

63
laughed out loud", and "mother ran and hid behind
the big wedge, encouraging child to hunt for her,
laughed together when found". These types of
descriptions increased in number and in the de-
scription of active playfulness as the program
progressed.
No apparent differences were noted between play-
fulness of mothers and fathers as a group. How—
ever, there was a recorded change in the play-
fulness of 2 of the fathers. One subject's father
requested a change in the order of two sessions so
that his family would be able to attend a session
which he felt would be especially fun. Another
father was described as physically tossing his child
around and tickling him, while making the following
comment: "I never thought I'd be having fun doing
this."
Some trends can be noted in the observational data
between the three experimental groups. The Wayne
group requested written information and asked
questions of the researcher about emotional adjust-
ment factors much more frequently than the other
two groups. Parents in this group brought books
and articles to share with each other. Members
of the Flint group frequently expressed anger and
frustration toward the medical and school systems

in relationship to services offered for their

64

children. The Lansing group appeared to establish
some friendships within the group as was exhibited
by all three set of parents attending a family
camping week-end together and planning additional
social activities. There was a noticeable difference
in the comraderie shown within this group.

4. No trends could be noted from the items on parent-
child interaction. Two parents were noted to
interact more spontaneously and easily with their

handicapped child after the fifth session.

SUMMARY

The literature review supports the importance of play
to child development and the influence of parents on the
development of their child. This study documents the positive
effect of a parent education program on the gross motor and
social cognitive development of preschool neurologically
impaired children. Anecdotal data shows that the majority of
parents utilized program information to assist their children
with play at home. Parents appeared to enjoy the program and
became increasingly playful as the eight week program progressed.
The Vulpe Play Assessment, demographic data and anecdotal data
was analyzed subjectively and inferences drawn in an attempt

to stimulate further research in this area.

CHAPTER V

SUMMARY

An accumulation of evidence suggests that parents in-
fluence the physical, social, and cognitive development of
their children. Play has been determined to be an important
medium for learning in preschool children. There is evidence
to suggest that play is of increasing importance to neurolog-
ically impaired children. This study was designed to determine
the effect of a parent education program focusing on play for
parents of neurologically impaired preschool children. The
gross motor, fine motor, expressive language, social-cognitive,
and reflexive development of two groups of children partici-
pating in physical therapy programs was compared in this study.

The design was a quasi-experimental pretest-posttest
control group model with an available sample. The control
group received physical therapy once a week and participated
in a play group once a week. The experimental group received
this same treatment and in addition their parents participated
in the parent education group once a week. Both groups of
children were pretested using the EPCDEC or the DDST (if they
tested above the developmental age of three years) and the
Vulpe Play Assessment prior to the eight week program. Sub-
jects were matched into pairs on the basis of their overall
developmental quotients from pretest data. All children were
posttested by the same examiners after the program and gain
scores were calculated. The families participating in this
and a companion study comparing physical therapy with

therapeutic play, were selected from three locations in

65

66

southern Michigan.

The one—tailed Wilcoxon Sign Test for Matched Pairs
was used to statistically analyze the results. The Vulpe Play
Assessment was analyzed subjectively as were the anecdotal and
demographic data. The experimental group improved significant-
ly over the control group in gross motor and social-cognitive
development. No significant differences were noted in fine
motor, expressive language, and reflexive development after

treatment.

CONCLUSIONS

 

The following conclusions are presented within the
confines of the limitations imposed by this investigation
following the statistical and subjective analysis of the data:

1. The parent education group which focused on the

value of play, the influence of play on child
development, the importance of play to the
neurologically impaired child, adaptations of
activities and modifications of play equipment
had a significant effect on the gross motor
and social-cognitive development of preschool
neurologically impaired children.

2. This parent education program which focused on play

did not have a significant effect on fine motor,
expressive language or reflex development.

3. The parent education program on play was beneficial

to parents and children as evidenced by the follow-

ing anecdotal results:

67

The majority of parents will utilize informa-

tion provided to them on play activities and

modifications of equipment to assist their
neurologically impaired child.

Parents reported positive feelings about the

information presented and about the opportunity

to become acquainted with other parents of
handicapped children. They felt that the
information provided needs to be practical and
explained in sufficient detail.

Parents appeared to enjoy the sessions as

demonstrated by:

1. They stayed after the formal sessions
ended to socialize.

2. One group requested continuation of the
sessions.

3. One group suggested making the program
available to other parents of handicapped
children.

Parents became increasingly playful with their

children and with each other in the parent

group as the program progressed.

Parents showed increasing ability to interact

spontaneously with each other and with their

children.

68

IMPLICATIONS FOR PRACTICE

The void in physical therapy literature which

related to play and to parent education suggests the need for

research in these areas. The publication of the results of

this and other related studies will enable the clinician to

re-evaluate present clinical practices. This investigation

suggests some important implications for the clinician:

1.

This investigation in combination with the companion study
demonstrates that play is a useful adjunct to physical
therapy. Play as a method for achieving many of the
objectives of physical therapy could be incorporated

into the individual programs of preschool children in
school and clinical settings.

The group approach to physical therapy with play as the
basis for treatment was shown to be effective for pre-
school children. It is feasible to incorporate this
group approach into treatment programs for neurologically
impaired children.

It is feasible for parents to be instructed in play
activities and adaptations of equipment to enable the
child to play at home as a routine part of the childs
physical therapy program.

An instructional manual for parents could be develOped
patterned from the play and parent programs designed for
this investigation.

Physical therapy curriculums could develop instructional

sessions for their students incorporating play into

69
physical therapy. Students could be assigned to clinical
settings which emphasize the playful approach to physical

therapy.

IMPLICATIONS FOR FURTHER RESEARCH

 

Although there are many limitations inherent in this

study it nonetheless provides a basis for further research in

the area of play and development of neurologically impaired

children. Some important implications for the researcher

are listed here:

1.

A similar study could be designed with a larger sample
size to determine which categories of development are
influenced by play education for parents.

The duration of the study could be increased to see if
developmental change would be noted over a longer period
of time.

Other developmental categories such as receptive language,
emotional, perceptual-motor could be evaluated.

Other existing assessment tools could be used to see if
there are similar findings.

Developmental scales for preschool neurologically impaired
children could be developed and utilized in a similar
study. The EPCDEC could be standardized and norms
determined.

A play scale for neurologically impaired children could
be developed and tested.

Play and parent program approaches could be varied to see

if developmental progression is influenced.

10.

11.

12.

70

Children of different ages and physical disabilities
could be studied.
The assumption that increased parental knowledge about
play leads to changed parental behavior could be tested
in a controlled study.
Rating the playfulness of parents in a pretest-posttest
design could determine the effectiveness of parent
education programs.

Individual case studies, utilizing methods of observation
(videotaping, activity check lists, etc.) could be
developed for use as developmental evaluation tools.

A similar study could be designed attempting to eliminate

the effect of a stranger doing the pre—and posttesting.

APPENDICES

APPENDIX A

71

THERAPEUTIC PLAY PROGRAM

for

PRESCHOOL NEUROLOGICALLY IMPAIRED CHILDREN

GOALS STATEMENT: The intent of this program is to provide
recreational, play activities in a Physical Therapy setting
once weekly to children with neurological impairments,
between the ages of one to five years in order to encourage
their progress in physical, social, sensory, perceptual-
motor, cognitive and reflexive development.

Objective 1.0 To provide a relaxed, playful atmosphere with-
in a pre-school play group setting.

Sub~objective 1.1 To expose the participants to fun
experiences, through playful leadership techniques and
presentation of play activities.

Sub—objective 1.2 To decrease excessive sensory input
and facilitate normalization of muscle tone in order to
enable participation in play activities.

Sub-objective 1.3 To select playful volunteers, based
on their interest and previous experience in play or
recreational settings.

Objective 2.0 To improve physical development and physical
function.

Sub-objective 2.1 To improve gross motor skills.
Activities
2.1.1 Obstacle course: Rolling and crawling up and
down a large wedge, somersaults, creeping through the
tunnel, sliding down slide, jumping on the trampoline,
walking or crawling on various materials-textures,
climbing in and out of a large box, climbing on a
chair and jumping off, crawling under a bar, climbing
over a bar, stepping on flagstones, throwing balls
into a barrel, etc.

2.1.2 Ball Games: Nerf ball suspended from above on
a string, kick ball, catching and throwing, rolling
(balls of various shapes, sizes, textures), bat and
ball activities, pushing balls, barrels, etc.

2.1.3 Mobility Games: Belly boards, swinging in sheet
or hammock, tyke bikes, wheelbarrow races and other
relay races, sit-n—spin, see-saw games, tilt board
games, etc.

2.1.4 Beanbag and ring toss games

2.1.5 Angels—in—the-snow, rolling, and somersaults

72
2.1.6 Marching rhythm band

2.1.7 "Simon Says, and "Follow the Leader"

Sub-objective 2.2 To improve fine motor skills.
Activities
2.2.1 Marching rhythm band, making of instruments such
as box guitars, pie pan tambourines, coffee can drums,
tin can marracas, bells, xylophone, etc.

2.2.2 "WhaB—in-the-box activity; filling and emptying
containers with objects of various sizes, shapes, and
textures while positioned on large balls, wedges, and
barrels, etc.

2.2.3 Bottle sandwiches; fill clear glass or plastic
containers with layers of macaroni, peas, beans, rice,
cloves, popcorn, peppercorns, etc.

2.2.4 Tactile collages; cutting and pasting onto con-
struction paper, various objects such as macaroni, yarn,
cotton, popsicle sticks, fabrics, ribbon, construction
paper, etc.

2.2.5 Fun dough activities; using materials such as
silly putty, play dough, and flour and cornstarch dough.

2.2.6 Toy boats; making soap sailboats, wooden "motor"
boats with rubber band propulsion, for water play.

2.2.7 Body tracings; adult traces child's body, child
adds clothing and body parts.

2.2.8 Making cardboard box trains; painting outside,
adding windows (to fit various body parts), wheels,
smoke stack, etc.

Sub-objective 2.3 To improve range of motion.
Activities
2.3.1 Action songs and rhythm games; examples (to be
selected based on the children's abilities), "Head,
Shoulders, Knees and Toes", "I'm a Little Teapot", "The
Itsy Bitsy Spider", "Do Your Ears Hang Low?", "If You're
Happy and You Know It, Clap Your Hands", "The Hokey Pokey",
"Ring Around The Rosie", "London Bridges", "Row.Row,Row,
Your Boat".

2.3.2 Hula Hoop Activities; sitting while holding onto
the hula hoop, raise it overhead, changing position of
hands, moving it around from hand to hand, etc.

2.3.3 Angels—in-the—Snow

73

2.3.4 Finger Painting; with large sheets of paper on
the wall,

2.3.5 Bicycling of extremities; reciprocal movements
of legs and arms done to rhymes and songs by adults.

2.3.6 Water play; buoyancy, warmth of water incorpora-
ted to increase joint mobility, bilateral hand
activities, etc.

2.3.7 "Wham-in-the-Box"; positioning of child and
placement of box to facilitate joint mobility.

2.3.8 Ball play; throwing, catching, and kicking various
1 O

Sub-objective 2.4 To improve muscle strength.
Activities
2.4.1 Obstacle Course

2.4.2 Ball and Bolster Games; Throwing and pushing balls
and bolsters of increasing weight.

2.4.3 Fishing Game; pull weighted ropes to get prizes.

2.4.4 Pretend Animals; Be a duck, bunny, snake, cat,
frog, rocking horse, etc.

2.4.5 "What's-in-the-Box?"; To be done prone over balls,
bolsters, etc.

2.4.6 Mobility games; such as belly boards, wheelbarrows,
tyke bikes, crazy car, etc.

2.4.7 Water play; utilizing resistance of the water.
2.4.8 Bean Bag Toss; utilizing various weights.

2.4.9 Hula Hoop Activities; utilizing resistance to hoop
when raising up and down.

2.4.10 Cardboard Box Train; pushing and pulling each
other in train

Sub-objective 2.5 To improve balance and reinforce equilib-
rium reactions
Activities
2.5.1 Obstacle Course; rolling up and down wedge, creep-
ing over tilt board, jumping on trampoline, walking
through tires and hoops, teeter-totter, sit-n-spin, etc.

2.5.2 Equilibrium Board Boat; maintaining balance while
in various positions on the equilibrium board

74

2.5.3 Musical Beanbag Pass; children pass the beanbag
to music, sitting just far enough apart to have to use
balancing reactions.

2.5.4 Large ball and barrel activities

2.5.5 Ball Games; stressing reaching out and main-
taining balance

Sub-objective 2.6 To inhibit abnormal reflex activity
and muscle tone
Activities
2.6.1 Prone over large balls and bolsters; gentle
movement to inhibit spasticity

2.6.2 Swing; child positioned in sheet or hammock to
inhibit tone

2.6.3 Mirror play; head in midline to discourage tonic
reflexes

2.6.4 Bilateral hand and foot activities; finger and
foot painting, throwing and catching, stringing beads,
stacking cones or rings, etc.

Sub-objective 2.7 To facilitate oral-motor development
Activities
2.7.1 Tongue games; follow the leader with tongue
movements - in/out, to the sides, up/down, etc.;
licking off whipped cream, peanut butter, etc.
2.7.2 Mirror play; tongue and facial movements

2.7.3 Pretend Indians; learning war whoops, sounds, etc.

2.7.4 Snacktime; exposure to various textures of foods,
jello, whipped cream, pudding, cookies, cheese, etc.

2.7.5 Pudding Painting; encouraging hand to mouth
pattern, tongue movements, etc.

2.7.6 Action songs
2.7.7 Water play; using straws, blowing bubbles, etc.
2.7.8 Straw Painting

Objective 3.0 To facilitate sensory awareness.

Subnobjective 3.1 To differentiate between different
textures

75

Activities

3.1.1 Rubbing body with various tactile materials,
such as terry cloth, sheepskin, carpet, vinyl, bur-
lap, sandpaper, silk, suede, plastic packaging
material, corduroy, mud, hand cream, etc.

3.1.2 Feely ball; made from various textures. Push,
pass, and catch games

3.1.3 Sand play; use of various textured objects in
the sand, i.e. sponges, soft plastic animals, hard
plastic pails and shovels, add water to change tex-
ture of the sand.

3.1.4 Water play; varying temperatures, addition of
crazy foam and/or soap bubbles to change the consistency.

3.1.5 Finger and Body Painting; addition of sand,
coconut, cornmeal, rice, to change texture. Use of
pudding (plain or with rice or tapioca), gel, frosting,
or whipped cream.

3.1.6 Tactile collage

3.1.7 "What's-in-the-Box?"; using various textured
objects.

3.1.8 Fun dough

3.1.9 Bead Play; wooden beads, pop beads, hair rollers,
etc.

3.1.10 "Pass the Jar"; filled with rice, beans, yarn,
macaroni, styrofoam pieces, cotton balls, etc.

Sub-objective 3.2 To distinguidibetween various sounds.
Activities
3.2.1 Identify the sounds; use bell, spoons, tambou-
rine, drums, tin containers with various objects
inside, xylophone, blocks of wood, etc.
3.2.2 Rhythm band
3.2.3 Animal Sounds Game

3.2.4 Tearing, wrinkling, crumpling various materials,
paper, plastic, cellophane, tinfoils, etc.

3.2.5 Action songs and music
3.2.6 Pass the beanbag to music

3.2.7 Water play, emphasizing sounds such as drip,
Splash, plop, etc.

76

Sub-objective 3.3 To distinguish between smells.
Activities
3.3.1 Hand Cream Activities; rubbing on different
parts of body, discussing the process of smelling,
hand to nose, etc.
3.3.2 Snacktime, emphasizing various smells of foods.
3.3.3 Blowing bubbles; odor and sensation involved
3.3.4 Frosting cookies; use various flavors in
frostings, i.e. lemon, mint, chocolate, orange,
cinnamon, etc.

Sub-objective 3.4 To distinguish between tastes.
Activities
3.4.1 Foodstuffs; tasting various foods, such as
peanut butter, jelly, sugar, salt, lemon, spaghetti
(cooked and uncooked) carrots, cheese, apples, nuts,
granola, raisins, pudding, etc.
3.4.2 Pudding Painting

Sub-objective 3.5 To facilitate visual discrimination.
Activities
3.5.1 Mirror play
3.5.2 Ball play; emphasis on focus

3.5.3 Obstacle Course; emphasis on focus

3.5.4 Flashflight Games; focusing on moving light,
in a darkened room

Objective 4.0 To improve perceptual motor skills.
Sub-objective 4.1 To increase awareness of body parts.
Activities
4.1.1 Angels-in-the-Snow
4.1.2 "Simon Says", and "Follow the Leader"
4.1.3 Body Tracings
4.1.4 Mirror play
4.1.5 Hula Hoop Games
4.1.6 Finger and Body Painting

4.1.7 Hand Cream Activities

4.1.8 Action songs and rhythm games

77

4.1.9 Cardboard Box Train
Sub-objective 4.2 To improve awareness of spatial concepts.
Activities
4.2.1 Hula Hoop games
4.2.2 Obstacle Course
4.2.3 "Simon Says", and "Follow the Leader"
4.2.4 Mobility Games
Sub-objective 4.3 To improve motor planning.
Activities
4.3.1 Obstacle Course
4.3.2 Mobility games
4.3.3 Marching rhythm band
4.3.4 Angels—in-the-Snow
4.3.5 Action songs and rhythm games

4.3.6 Cardboard Box Train

4.3.7 Hula Hoop Games; children get in and out, over
and under hoop, etc.

Sub-objective 4.4 To improve figure-ground awareness.
Activities
4.4.1 Obstacle Course
4.4.2 Pegboard Games; copy pre-determined patterns
4.4.3 Suspended ball activities

Sub-objective 4.5 To improve directionality and

laterality.
Activities
4.5.1 Angels-in-the—Snow
4.5.2 Ball games
4.5.3 Chalk and felt board activities; acting out
stories with figures on the feltboard, making large
circles, scribbling on chalkboard.
4.5.4 Obstacle Course

Objective 5.0 To improve cognitive-social (play) skills.

Subaobjective 5.1 To improve the ability to maintain
attentiveness during a group activity.

78

Sub-objective 5.2 To improve the ability to follow basic
directions and commands.

Sub—objective 5.3 To improve an awareness of self.
Sub—objective 5.4 To increase awareness of others.

Subnobjective 5.5 To increase recognition of common
playthings and their function.

Sub-objective 5.6 To improve the ability to imitate
others.

Sub-objective 5.7 To improve the ability to explore
their immediate environment.

Sub—objective 5.8 To increase ability to show likes
and dislikes.

Sub-objective 5.9 To improve ability to take turns.

The activities for this objective are incorporated into
the total program.

APPENDIX

 

79

PARENT EDUCATION PROGRAM

GOAL STATEMENT: The intent is to establish an educational
program for parents of preschool neurologically impaired
children with an informal, playful atmosphere. The program
will focus on the significance of play in development, parental
attitudes toward play, information concerning neurological
impairment, and adaptations and modification of activities and
play equipment.

Objective 1. To improve parent's awareness and understanding
of their attitudes toward play and playfulness and of how
their attitudes influence the play attitudes and abilities of
their children.

Sub—objective 1.1. To increase parent's knowledge
about the significance of play.

Sub—objective 1.2. To increase parent's awareness of
their own playfulness and their attitudes toward play.

Sub-objective 1.3. To enable parents to participate in
play activities in a playful manner.

Sub-objective 1.4. To increase parent's knowledge of
the effect of a playful attitude on their children.

Objective 2. To increase parent's understanding of neurologi-
cal impairment.

Sub-objective 2.1. To increase parent's basic know-
ledge of neurological impairment.

Sub-objective 2.2. To increase parent's knowledge of
the varied sensory and motor deficits associated with
neurological impairment.

Sub—objective 2.3. To increase parent's knowledge
concerning handling and positioning.

Objective 3. To increase parent's understanding of the
significance of play in the development of their children.

Subb-objective 3.1 To increase parent's knowledge of
child development.

Subnobjective 3.2. To increase parent's knowledge of
the way children learn and develop through play.

Subeobjective 3.3. To increase parent's awareness of
the incorporation of play into physical therapy treat—
ment of children.

Sub—objective 3.4. To increase parent's awareness of
the importance of play for the growth and development of
neurologically impaired children.

80

Objective 4. To assist parents in adaptations and modifications
of play activities and play equipment.

Subeobjective 4.1. To increase parent's understanding
of the necessity of adapting and modifying toys and
play activities for their neurologically impaired child.

Sub-objective 4.2. To increase parent's resources
concerning play adaptation and modifications.

Sub-objective 4.3. To increase parent's ability to
adapt and modify play activities for their neurologically
impaired child.

Sub—objective 4.4. To increase the parent's ability to
adapt and modify play equipment for their neurologically
impaired child.

Sub-objective 4.5. To encourage parent's to pose problems
they encounter with play activities and equipment, to
the group for discussion and possible alternatives.

 

APPENDIX

81

COMPREHENSIVE DEVELOPMENTAL EVALUATION CHART

 

 

 

 

 

 

 

 

 

 

related dhorden—_. __ _..__- _._ __. -- -.

 

Child's Neme.____. Mother's Nun-
Iirthd-t- ' Father's Name
lnItIeI Evaluation Date- Md.
"In...
rv , ' Other family members with
Physician‘s)
Heelth Clinic

 

 

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Referrel Sewn

 

 

Summary of History:

Precautions:

 

Clinic Appointments:

 

 

 

 

 

 

 

 

 

 

Equipment:

SOURCE TYPE DATE ORDERED

RECEIVED RETURNED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Developed by the Early Childhood Development Team of the El Paso Rehabilitation Center
5. Clitt. D. Carr. J. Gray. C. Nymann. S. Redding.

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DENVER DEVELOPMENTAL SCREENING TEST

Nome

PERCENT OF CHILDREN PASSING

= STOMACH
SITTING

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90

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DATE

TUUHS
DIRECTIONS BIRTHDATE

IEOSP. NO.

 

 

Try to get child to smile by smiling, talking or waving to him. Do not touch him.
When child is playing with toy, pull it away from him. Pass if he resists.
Child does not have to be able to tie shoes or button in the back.
. Move yarn slowly in an are from one side to the other, about 6" above child's face.
Pass if eyes follow 90° to midline. (Past midline; 180°)
5. Pass if child grasps rattle when it is touched to the backs or tips of fingers.
6. Pass if child continues to look where yarn disappeared or tries to see where it went. Yarn
should be dropped quickly from sight from tester’s hand without arm movement.
7. Pass if child picks up raisin with any part of thumb and a finger.
8. Pass if child picks up raisin with the ends of thumb and index finger using an over hand

FUJNH
O

 

 

 

 

 

approach.

9. Pass any en- 10. Which line is longer? 11. Pass any 12. Have child copy
closed form. (Not bigger.) Turn crossing first. If failed,
Fail continuous paper upside down and lines. demonstrate
round motions. repeat. (3/3 or 5/6)

When giving items 9, 11 and 12, do not name the forms. Do not demonstrate 9 and 11.

13. When scoring, each pair (2 arms, 2 legs, etc.) counts as one part.
1h. Point to picture and have child name it. (No credit is given for sounds only.)

 

15. Tell child to: Give block to Mommie; put block on table; put block on floor. Pass 2 of 3.
(Do not help child by pointing, moving head or eyes.)

16. Ask child: What do you do when you are cold? ..hungry? ..tired? Pass 2 of 3.

17. Tell child to: Put block on table; under table; in front of chair, behind chair.

Pass 3 of A. (Do not help—Ehild by pointing, movihg head or eyes.)

18. Ask child: If fire is hot, ice is ?; Mother is a woman, Dad is a ?; a horse is big, a
mouse is 7. Pass 2 of 3.

19. Ask child: What is a ball? ..1ake? ..desk? ..house? ..banana? ..curtain? ..ceiling?
..hedge? ..pavement? Pass if defined in terms of use, shape, what it is made of or general
category (such as banana is fruit, not just yellow). Pass 6 of 9.

20. Ask child: What is a spoon made of? ..a shoe made of? ..a door made of? (No other objects
may be substituted.) Pass 3 of 3.

21. When placed on stomach, child lifts chest off table with support of forearms and/or hands.

22. When child is on back, grasp his hands and pull him to sitting. Pass if head does not hang

23. Child may use wall or rail only, not person. May not crawl.

2h. Child must throw ball overhand 3 feet to within arm's reach of tester.

25. Child must perform standing broad jump over width of test sheet. (8-1/2 inches)

26. Tell child to walk forward, macaw-«y heel within 1 inch of toe.

Tester may demonstrate. Child must walk A consecutive steps, 2 out of 3 trials.

27. Bounce ball to child who should stand 3 feet away from tester. Child must catch ball with
hands, not arms, 2 out of 3 trials.

28. Tell child to walk backward, «(DcQCOm toe within 1 inch of heel.

Tester may demonstrate. Child must walk A consecutive steps, 2 out of 3 trials.

 

 

DATE AND BEHAVIORAL OBSERVATIONS (how child feels at time of test, relation to tester, attention
span, verbal behavior, self-confidence, etc,):

 

157. 10-70 Distributed as a service by Mead Johnson Laboratories

back.

 

 

APPENDIX

 

87
EVALUATION

Please identify any objective(s) which are not stated
clearly. Comments

 

 

 

Please identify any objective(s) you feel does not relate
to the goal statement. Comments

 

 

Please identify any additional objective(s) which you feel
would be necessary to achieve the purpose of the study.

 

 

Please identify any sub-objective(s) which are not stated
clearly. Comments

 

 

 

Please identify any sub-objectflmis) you feel does not
relate to its respective objective.
Comments

 

 

 

Please identify any additional sub-objective(s) which you
feel would be necessary to meet its objective.
Comments

 

 

 

Please identify any activity(ies) you feel does not relate
to its respective objective(s).
Comments

 

 

 

 

Please identify any additional activity(ies) which you feel
would be necessary to meet its respective objective(s).

 

Comments

 

 

Are the sub-objectives and activities appropriate for
preschool Cerebral Palsy children?

 

 

 

88

PILOT PROJECT EVALUATION
THERAPEUTIC PLAY PROGRAM AND PARENT EDUCATION PROGRAM 0N PLAY
As you observe the play/parent education pilot session, please
comment on the following areas:

1. Organization (time structure, order of presentation, etc.)

 

 

 

2. Preparation

 

 

 

3. General Atmosphere

 

 

 

4. Leadership and Direction

 

 

 

5. Participant Interaction

 

 

 

6. Activities (therapeutic, fun, motivating, etc.)

 

 

 

7. Additional Comments

 

 

 

 

APPENDIX

E

89
Child's Name _fi

Birthdate

 

Siblings' Name

 

 

Siblings' Ages

 

Address

Mother's Name

 

Father's Name

 

Mother's Birthdate

Father's Birthdate

 

 

 

Educational Level:

Mother
K - 8th grade K 1 2 3 4 5 6 7 8
High School 1 2 3 4
College 1 2 3 4

Post-grad

 

Diagnosis of Child

K - 8th grade
High School
College
Post-grad

Phone

 

 

Treatment Services for Child (where and number of times per

week)

 

 

Additional programs your child participates in?

 

 

Additional programs you are involved in related to your child

 

Describe your child

 

 

APPENDIX

 

90
ANECDOTAL DATA FORM

PARENT EDUCATION ON PLAY

NAME SESSION #

 

DATE EVALUATOR

 

 

Answer the following questions with brief descriptions of inter-
actions observed during the parent group sessions. Use direct
quotations whenever appropriate.

Did parent(s) comment on any play activities tried or equip-
ment or activities modified during the past week?

 

 

 

Did they comment on anything learned in the past session(s)
and/or their response to any of the information presented?

 

Do parents appear comfortable (i.e. interact easily and
Spontaneously) with each other? Describe situation.

 

 

 

Do parents appear comfortable (i.e. interact easily and
spontaneously) with their child (children)?
Describe situation.

 

 

 

Describe childs' initial response when parents re—enter the
room after the play sessions.

 

 

Describe parents response upon returning to their child.

 

Comment on the playfulness of the mother

 

 

Comment on the playfulness of the father

 

 

Comment on the playfulness of the child in the play group,

 

in the presence of parents

 

Were there observable changes in the parents responses during
the session? Describe

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..... . .

 

 

 

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General Comments

 

 

Vw‘Vw v

 

APPENDIX

C

91

VOLUNTEER TRAINING PROGRAM

First Session

I.

II.

III.

Fingerpainting with Pudding

Half of the volunteers will each be given the description
of a child of preschool age, who has been diagnosed with
a neurological impairment. The description will include
the child's age, disability, personality characteristics,
mental status, etc. They will then be requested to role
play their assigned child. After a brief description of the
Therapeutic Play session the rest of the volunteers will
act as volunteers in a modified therapeutic play session.
Roles will be reversed after fifteen minutes. Following
the play session there will be a group discussion dealing
with the participants' feelings during the session, the
activity itself (pudding painting), and ways in which the
activities can be therapeutic yet fun. Time: One hour

Videotape on the therapeutic play program. Time: thirty
minutes

Policies and Procedures

A. Time, place and transportation discussion
B. Expectations of the volunteers
1. Versatility between parent and play group.
2. Assist group leaders in the preparation of the

area and equipment.

3. Assist with the dressing of the child.

4. Each volunteer will be assigned to specific
children.

5. Participate in free play with the children as
they arrive.

6. Observe children and parents' reactions for
recording after each session.

7. Encourage children to participate in the group.

8. Encourage children to interact, but do not
allow them to hurt each other.

9. Assist in cleaning program area.

Time: thirty minutes

Second Session

I.

Roleplay Parents of Handicapped Children

After a brief description of the parent education program
on play, half of the volunteers will be given the
description of a preschool neurologically impaired child,
including the same characteristics as those given for

II.

III.

92

the play program. They will then be requested to role play
the results of these children in a modified parent educa-
tion session on play. The rest of the volunteers will be
asked to act as volunteers in the session. Roles will be
reversed after fifteen minutes. A group discussion will
follow dealing with the participants' feelings and
reactions, handicaps such as neurological impairments and
parental attitudes towards these and play.

Time: One hour

Observation and Recording

A segment of the Therapeutic Play videotape will be shown
and the volunteers will be asked to record their
observations. Discussion will follow concerning observa-
tion and recording with emphasis on the problem of
interpretation. Another segment of the video will then
be shown and they will be asked to record their observa-
tions again. Comparisons will then be made.
Time: Forty-five
minutes

Handouts and Further Discussion and Questions

A. An opportunity for the volunteers to ask any further
questions or stimulate further discussion will be
provided.

B. Handouts
1. Schedule of both programs
. Chapter on "Play" by Finnie
. Development of Play
. "How To Play With Your Baby" (Asconi)
Time: Fifteen minutes

2
3
4

BIBLIOGRAPHY

10.

11.

12.

13.

14.

93

BIBLIOGRAPHY

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Aries, P. Centuries of Childhood, Social History of
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Arnold, A. Your Child's Play, New York, Essandess, 1955.

Auerbach, A. Parents Learn Through Discussion, Principles
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Axline, V. M. Play Therapy,_The Inner Dynamics of
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Braga, J. and Braga, L. Growing with Children, Englewood
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Brazelton, T. B., Infants and Mothers, New York, Dell
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Brim, 0. Education for Child Rearing (2nd. edition),
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Brophy, J. E. "Mothers as Teachers of their own preschool
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Cliff, 8., Gray, J. and Nymann, C. Mothers Can Help,
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Collard, R. R. "Exploration and Play in Human Infants?
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Courtney, J. Davis, J. M. and Solomon, P. "Sensory
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Curry, N. E. "Dramatic Play as a Curricular TooTL in

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National Association for the Education of Young Children,
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Qprry, N. E., Arnaud, S. Play; The_Child Strives Toward
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‘fo

 

Dolhinow, P. "At Play in the Fields, Natural Histogy

‘Magazine, Dec. 1971, pp. 66—71.

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