When we provide physical or occupational therapy to kids, we are often asking parents about their child’s participation in life. Are there areas that they aren’t able to participate in fully or things that are really important to the child or family? For instance, if they go to a playground, will they readily play or will they sit on the sidelines? At dinner, are they able to eat with the family or do they need help for all or part of it? Can they communicate with their friends and family? Can they play with their siblings? All of these are areas that may come up for participation.
Now, in order to participate, they may have to perform certain activities. For instance, in order to feed themself, they may need to be able to grip a utensil, or scoop with a spoon. In order to get dressed, they may need to be able to stand on one foot to put their pants on, or use both hands to button a shirt, or reach their foot to pull on a sock. To play at the playground, they may need to be able to climb a ladder, or run on uneven surfaces, or walk across a wobbly bridge. These are the areas that help them to better participate in their life. By either improving their skill at these activities or by coming up with strategies and accommodations to help them be more successful, they will improve their ability to participate in the different areas of their life.
If we want to break it down even further, what are the areas that help them to complete these activities? This is where their strength, endurance, balance, coordination, ability to attend to a task, sensory processing, visual processing, etc come into play. These are the building blocks that will help them improve at various activities.
We think its important to look at the big picture because the goal is for children to be able to more independently participate in all areas of their life. Our goal is to break it down into the parts that will help them be successful, and occasionally recommend equipment or modifications that will help with success. For instance, if a child is having trouble feeding themselves because they have trouble keeping their body stable while using the utensil, maybe we will look at how to change their seating to improve their success, while we continue to work on improving their core strength and stability. Or, maybe we look at getting velcro shoes to increase independence while we continue to work on fine motor coordination and shoe tying. Do you see how we are always keeping how to maximize independence with participation at the forefront.
I could go on forever with examples but I’m hoping this explanation of the big picture makes sense.
The picture above is from an expo we were at and I thought it was a great example of how to support participation. It allows kids in wheelchairs to play soccer with their siblings or peers!