6/17/2014
Purpose
TO PLAY OR NOT TO PLAY
• Examine the role and value of play in Ayres Sensory
Integration intervention
• Identify strategies that support the child’s play experience
Sharing Power with Children During
Sensory Integration Intervention
during intervention
• Consider how sensory integration may be related to
pretend play, with emphasis on praxis
L. Diane Parham, PhD, OTR/L, FAOTA
Professor, University of New Mexico
[email protected]
Play in Ayres Sensory Integration (ASI)
Intervention
Play in the Fidelity Measure*
• Essential part of the process of therapy
• One of ten essential elements
• Mentioned by Ayres: building on child’s inner drive
• Five elements address development of sensory
integration, praxis, and arousal functions
• Five elements: dynamics of therapist-child relationship
* Parham,
L.D., Roley, S.S., May-Benson, T., Koomar, J., Brett-Green, B.,
Burke, J.P., Cohn, E.S., Mailloux, Z., Miller, L.J., & Schaaf, R.C. (2011).
Development of a fidelity measure for research on Ayres Sensory
Integration intervention. American Journal of Occupational Therapy, 65,133142. doi: 10.5014/ajot.2011.000745
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Ten Process Elements of ASI
• Ensures physical safety
• Collaborates with child in
activity choice
• Presents Sensory
Opportunities
Essential Ingredients of Play
• Tailors activity to present the
• Intrinsic motivation – the child does it because he
wants to do it
just-right challenge
• Supports sensory modulation
for attaining/maintaining a
regulated state
• Challenges postural, ocular,
oral, or bilateral motor control
• Challenges praxis and
organization of behavior
• Ensures activities are
successful
• Supports child’s intrinsic
motivation to play
• Internal control – the child perceives he has some
control over the activity
• It’s fun! The child enjoys it.
• Establishes therapeutic
alliance
Supporting Intrinsic Motivation to Play
• Therapist creates an atmosphere to communicate that
child’s interests are valued and ideas are encouraged
NOT FREE PLAY
• Therapist is constantly attuned to what the child wants to
do
• IMPROVISATION: Therapist does not completely control
Therapist does not simply follow the child around and
do whatever he wants.
the agenda or schedule of activities during the session
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Challenges Inserted Into Play
NOT DICTATED BY
THERAPIST
• The work of therapy is folded into the child’s play, without
compromising the child’s sense of self-competency and
need for control
• Therapist must discern when to present a challenge that
requires more effort from the child, and when to reduce
the challenge or give the child more control
• The agenda during a treatment session is not completely
set by the therapist
Sharing Power with the Child
Benefits of Sharing Power Through Play
• The child will be more highly invested in mastering the
• Negotiation process
• Amount of therapist structuring – and the timing and type
of structuring – varies depending on child characteristics
and goals of therapy
• Fidelity training video: What is happening that elicits the
child’s highest level of engagement?
challenges presented by the therapist  better
performance to meet therapy goals
• Provides child with opportunities to experience risk taking
and decision making  willingness to try new challenges
• Build’s child’s self-efficacy  critical for success in life
• Contributes to child’s developing view of self as a
competent person  essential for mental health
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Video clip acknowledgements*
Techniques for Sharing Control
• Therapist is Dr. Susan Spitzer, Pasadena, California
• Let the child choose an activity
• Free choice
• Choice among several therapist-presented options
• DVD is from a book referenced below:
Kuhaneck, H. M., Spitzer, S. L. & Miller, E. (2010). Activity analysis,
creativity, and playfulness in pediatric occupational therapy: Making
play just right. Sudbury, MA: Jones and Bartlett Publishers.
• Validating the child’s initiation of a change to the activity
• Go along with the child’s change
• Accept but modify or adapt the child’s change
• Suggest or direct the child toward a particular activity, but
allow child to adjust or modify the way it is done
What About Pretend Play?
How Does SI Contribute
to Pretend Play?
• Pretend play heavily draws upon cognition,
• Pretend play requires a number of SI
especially as related to symbolic representation,
memory, information sequencing, and social
cognition
functions to work well:
• Sensory modulation & arousal regulation
• Language also often involved
• Perception of affordances in the environment
• Praxis
• Ideation – new ideas for how to play
• Motor planning – sequencing of actions
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Definition of Praxis*
PRAXIS = the ability to conceptualize, organize, and
execute new motor tasks
Focus is on using the physical body to interact with the
physical world
* Ayres, A.J. (1985, 2011). Developmental dyspraxia and adult onset
apraxia. Reprinted as Ayres dyspraxia monograph. Torrance,
California: Pediatric Therapy Network.
Praxis is a Bridge Between
Cognition and Action
Key Components of Praxis
• IDEATION = ability to conceptualize a new activity or a
new way to perform an activity
• MOTOR PLANNING = ability to organize actions needed
to perform the activity, e.g., sequencing, spatial
awareness, and timing of action
• EXECUTION = observable motor performance, which
may be affected by issues other than praxis
Is Ideation the Same as Creativity?
• Ideation in praxis is creativity in coming up with
• Praxis requires use of highly organized sensory
information to create a program or plan for action
• PRIMARILY COGNITIVE
• Dyspraxia is not a motor disorder, but a disorder in
new ways to move or use the physical body in the
physical world
• Some children are very creative in language but
have poor ideation in praxis
processing sensory information to program actions
• So ideation involves creativity, but not all
creativity involves ideation in praxis
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Ayres’s Theory of Praxis Development
What is Concept Formation?
• Ayres viewed it as a complex process of integrating
Praxis
Language
multiple sources of sensory information into manageable
units that can be organized and sequenced with each
other
• Neural networks that overlap for praxis and language
functions
Concept
Formation
• Ayres proposed that overlapping neural networks involve
a “somatosensory-conceptual-planning” function
A suggested addition . . .
Questions About Praxis & Pretend Play
Social
Relatedness
Praxis
• Is ideation in praxis related to ideation in pretend play?
Language
• Is motor planning in praxis related to ability to sequence
actions in pretend play with dolls?
Concept
Formation &
Sequencing
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Pretend Play and ASI intervention
• Can be embedded in ASI
• Can be an adjunct to ASI
CAN SI INTERVENTION
SUPPORT DEVELOPMENT
OF PRETEND PLAY?
• Or can be a stand-alone intervention
Could improved pretend play be a
measurable outcome of ASI?
• Does improved ideation in praxis lead to better ideation in
pretend play?
• Does improved sequencing in praxis lead to better
sequencing of actions in pretend play?
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