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Play is one of the occupations of human beings (American Occupational Therapy Association 2014). While work and activities of daily living are defined and labeled by external social conventions, play is defined only by the player’s perception (Bundy 1993). This means that an activity is play if the individual’s feelings are related to pleasure, flexibility, spontaneity, intrinsic motivation, choice, challenge, internal control, and creativity (Blanche 2008; Skard and Bundy 2008). Parham (2008) reviewed the characteristics of play and proposed that plays activities (1) are intrinsically motivated; (2) are process oriented because play emphasizes the process rather than the product; (3) are related to free choice because the player is free to choose to play; (4) provide enjoyment and pleasure; (5) involve active engagement because the player is active; and (6) are noninstrumental, or are not “serious,” which is related to the pretend element of play. During play, children learn about the properties of objects and how to interact with objects and people (Reilly 1974). Play where the child interacts with people is called social play (Coplan, Rubin, and Findlay 2006), and play where the child interacts with objects is called object play (Gowen et al. 1992). Both types of play interactions have important benefits for children’s development, which occurs in a natural way.

Play follows three stages of development driven by cognitive development: functional play, pretend or symbolic play, and games with rules (Piaget 1951). Functional play is the type of play in which a child uses the objects according to the function designed for them and as they would be used in reality (e.g., a ball is used as a ball) (Barton 2010). Pretend play, or symbolic play, is a cognitive play skill of representing knowledge, experience, and objects symbolically (Stagnitti and Unsworth 2004). In pretend play, the child uses an object as if it were a different object (e.g., using a block as if it were a car) (Barton 2010). Games with rules involve more structured play, play activities having rules that need to be followed by each player. Thus, at this stage, play also takes on a social aspect (Piaget 1951).

Play is an ideal way for children to discover the world through practice with different objects and experiences (Ferland 2005). In fact, innovative problem solving occurs during play (Sutton-Smith 2001). However, children with motor limitations, such as children with CP, have difficulties engaging in play (Blanche 2008; Missiuna and Pollock 1991), especially play with objects. Due to their physical limitations, children with CP have constraints in engaging in pretend play (Pfeifer et al. 2011) and object play (Gowen et al. 1992) and expressing playfulness (Chang et al. 2014; Harkness and Bundy 2001). Children with CP and their families spend more time in activities related to self-care (including rehabilitation) than do typically developing children. This reduces time for family play routines (Brodin 2005; Hinojosa and Kramer 2008; Missiuna and Pollock 1991). With few opportunities for practicing and testing their skills, children can develop a learned helplessness; that is, children assume that they are unable to perform a task by themselves even though they have the required physical abilities (Harkness and Bundy 2001). All of these situations delay not only the child’s play and development but also future overall functioning (Missiuna and Pollock 1991).

The need for interventions focused on promoting play in children with motor impairments has been widely stated (Blanche 2008; Chang et al. 2014; Ferland 2005; Missiuna and Pollock 1991; Pfeifer et al. 2011; Rios- Rincon et al. 2016). Scholars agree that intervention should improve the play experience in a child’s life and involve the child’s family (Blanche 2008; Brodin 2005; Ferland 2005; Hinojosa and Kramer 2008; Rios- Rincon et al. 2016). Promoting engagement in free play in children with motor impairment may affect children’s overall functioning. Playfulness is an indicator of self-determined behaviors for children with CP with limited self-mobility. Children who are self-determined present behaviors oriented toward meeting personal life goals; these behaviors include identifying desires, actively pursuing interests, making decisions, and solving problems (Chang et al. 2014). This suggests that increasing playfulness may improve children’s ability to find creative strategies to make choices and to solve problems (Chang et al. 2014), which in turn can improve their future functioning in home, community, school, and work contexts.

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