Occupational Therapists Make Playtime Accessible
April is Occupational Therapy Month
Assistive technology enhances one’s sense of autonomy. The possibilities with assistive technology are endless: they help with activities of daily living, mobility, driving, play, and academics. Assistive technology includes tools and devices that assist individuals to engage with people, environments, and activities. The creative and holistic nature of Occupational Therapy is what convinced me to go into this field. I currently work with children and young adults as an Occupational Therapist (OT) in New York City.
Occupational therapists bring out the best in people while accommodating their strengths and challenges in their daily lives. We work with individuals of all ages, from babies in the neonatal intensive care unit (NICU) to older adults living in assisted living homes or wanting to live independently in their own homes.
What Does An Occupational Therapist Do?
We work on regaining skills lost to injury or illness. We also work on developing new skills, as well as adapting activities and environments to fit individual strengths and interests. Strength, endurance, range of motion, sensory processing, and cognition are all addressed, and always in the context of occupations that are relevant and important to our clients.
During my nine years as an occupational therapist, I have worked with children as young as two, and older adults older than 90 years old. Currently, I work with children and young adults between the ages of four and 21. Many of the children and young adults I work with live with cerebral palsy, acquired brain injury, and seizure disorders. Despite the variations in age, settings, and diagnoses, every client I have worked with was similar in that they wanted to go about their lives with more independence and engagement.
I find the client-centered and holistic approach found in occupational therapy practice special. We work with our clients to determine our plan of care concerning activities they find significant to their lives. This could be independently getting dressed after an accident, learning how to play with mobility challenges, or making sure they maintain the skills necessary for driving.
Handwriting is a major skill that children learn in school; I worked with a six-year-old girl who was living with a brain injury that occurred at birth and she found handwriting challenging. Christmas was around the corner and it was important to her to handwrite her own letter to Santa. We worked on writing so that Santa could easily read her letter asking for a Wonder Woman costume. And it seemed Santa could read her handwriting because several weeks later, she received her Wonder Woman costume gift from Santa. It was exactly as she asked! I had the opportunity to watch her grow up in her preschool and early elementary school years and we worked on growing her skillset. We worked on independently dressing herself, learning to use stationery items like pencils and scissors, as well as playing fun board and card games.
My first attempt at switch adapting a toy, with the assistance of my peers and instructors took about an hour. Now, the process takes 10-15 minutes, with sewing being the most time-consuming process.
Like most kids, my students love to play, however, they have differences in their body movements, cognition, and sensory processing that make playtime more challenging to engage without support or adaptations.
Many of my students have varying ranges of motion, levels of coordination, and strength. I assist kids using their individual movements to play with toys that interest them. I adapt seats and their environment to provide support that more easily facilitates play and increases access to reaching, touching, seeing, and hearing toys. We work on ways we can interact with toys that produce sound or have tactile qualities for the students to use their hands for exploration and manipulation of the toy.
One Blind student I worked with loved listening to music, especially Beyonce and Justin Bieber. She found it challenging to move her body due to hemiparesis. So during her OT sessions, we found ways for her to access her favorite music using assistive technology that eliminated the requirements of vision and fine motor skills so that she could use her strengths with gross motor movement (using her hand to activate a large button connected to her music). With the use of assistive technology, she became the DJ of dance parties that ended every one of our sessions.
And This Is Where We Come In
We all have differences in the way we interact within our environments, through our movement and our senses. Most of my students do not use their hands to activate buttons regularly found on toys. The buttons may be too small, or they might require excessive force to activate. Instead, my students use adaptive switches: varying in size and activated by application of force, or touch.
Adaptive switches are input-output devices, commonly in the form of buttons in various shapes and sizes that can be used in place of the standard, smaller-sized buttons that are typically used on electronic devices, such as toys, appliances, and power wheelchairs.
They can be used with toys or devices that come with the adapted features like the input for a switch or were adapted by the consumer to include the insert in the form of a mono audio jack for the switch... Adaptive switches make volitional activation of these devices possible.
Everybody benefits from playing and accessible playing must be considered by designers and makers creating toys, in addition to therapists, teachers, and parents.
OTs are constantly hacking, adapting, and adjusting tools, clothing, spaces, and environments to maximize an individual’s participation in meaningful activities. We create additions to utensils to make grasping easier and the creation of art more accessible. We add larger pieces to zipper pulls to increase ease of use and increase independence or participation with dressing.
And though we are accustomed to hacking our environments, toys often appear to be a secondary thought in terms of accessibility. It is not uncommon to see older children with disabilities play with toys meant for infants and toddlers. More interest in toys for all ages should be supported. Adaptive gaming is a growing industry. Think Xbox with adaptive controllers. However, adaptive gaming is not the only option that kids or adults may want when engaging in play.
There are toys in the adaptive marketplace, such as singing and dancing toys, remote control cars, and light-up toys that accommodate adaptations including switches, however many of them are expensive and therefore less accessible economically for some of the families and individuals who may be interested in using them. A singing stuffed animal may cost approximately $25.00 at a big box store but will cost closer to $80 in its adapted form on a website specialized for adaptive devices.
Making Toys Accessible
OTs and other hackers and tinkerers adapt the toys by removing the original tiny switch of a simple battery-operated toy and adding a mono audio jack via soldering. In my OT program, I was briefly introduced to switches and adapted devices. It was not until a few years into my clinical career that I found a local workshop that introduced basic toy hacking. The workshop used simple battery-operated toys that were easily found in big box stores and the holiday section of chain drug stores.
These include those simple stuffed animals with hands or feet you can press to make sing and dance. You can open up the arm or leg of the toy, cut off the original switch, and solder on a 3.5-millimeter mono audio jack. That will be where you insert your adaptive switch. What was once an intimidating process, I quickly realized was quite simple for me!
My first attempt at switch adapting a toy, with the assistance of my peers and instructors took about an hour. Now, the process takes 10-15 minutes, with sewing being the most time-consuming process. Slightly more complex toys, such as remote control cars, can be adapted through the soldering of a mono jack, plus some additional wiring, to the circuit board inside. In turn, students can use their adapted switches to activate the toy of their own volition. They can now have agency over their playtime. No longer do they have to wait for a peer or adult to play! All children should have the opportunity to engage in self-directed play.
Everybody benefits from playing and accessible playing must be considered by designers and makers creating toys, in addition to therapists, teachers, and parents. Self-expression is developed and asserted through play. Playing helps build relationships between peers and between parent and child. It helps us learn from one another. I have observed many of my students learn to play with switches and share the experiences with their siblings, passing down the torch of toy knowledge. Closer relationships are formed when children develop more means to interact with one another through shared experiences.
Toys in the adaptive market create experiences and opportunities for all children to develop physically, cognitively, and emotionally. Toy hacks done by therapists and tinkerers are the initial steps in creating a more accessible and inclusive environment for kids to grow up in. We need to develop more toys that can be used by disabled and non-disabled children alike. Non-disabled and disabled peers having increased opportunities for shared experiences through play is beneficial to their well-being, social participation, and autonomy.
To observe my students develop play skills through OT and assistive technology has been an incredible experience. I have seen families form meaningful connections with their children through new interactions with play.