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Abstract
Key Words: Aims and Objectives: One in every 800 children suffer from Downs syndrome, who lack development of age
Downs syndrome, Play Behaviour, appropriate physical, mental, social andpsychological skills therebyaffecting childs play behaviour skills. Aim of
Revised knox preschool play scale, the study was to assess the play behaviour and effect of play based therapy in children diagnosed as Downs
Play based Occupational Therapy syndrome. Our hypothesis was that the childrens play behaviour improves significantly with play based
Occupational Therapy.
Materials and Methodology: Male and female children diagnosed with Downs syndrome in the age group of
2 - 6 years were randomlyobserved from an outpatient paediatric rehabilitation department of K. E. M Hospital,
Mumbai in this one arm cohort observational study. Each childs neuro-paediatric assessments and play behaviour
assessments on Revised Knox Preschool Play Scale (RKPPS) were done. Children were observed when they
were subjected to age appropriate play based Occupational Therapy intervention in an outpatient department,
for a period of 1 month and were re-assessed on RKPPS.
Results: 10 children were observed (6 males, 4 females). At the end of 1 month of therapy, each child showed
significant improvement in their play behaviour. The results were analysed using Pairedt test. The results
werestatistically significant at the level of P<0.001 and Confidence Interval of (at 99% Confidence interval).
However, factors affecting play behaviour in individual child were variable.
Conclusion: Play based Occupational Therapy was found to be effective in improving play behaviour in a
cohort of 10 children with Downs syndrome.
Abbreviations: RKPPS: Revised Knox Preschool Play Scale
* * Occupational Therapist
Student M.O.T.-III Introduction
** Ex-Assistant Professor 1.1 Background
*** Occupational Therapist
The first few years of a childs life seem spent almost exclusively in play. Nothing gives us more
Institution:
uneasiness than to see a child who does not play. We consider it a sign of sickness, either of
O.T. Training School & Centre,
body or mind. As a result of playing the child grows. Growth is the primary use of play and this
Seth GS Medical College & KEM
is as true of intellectual growth as of physical. [1-3]
Hospital, Mumbai-12
Period Of Study : Downs Syndrome is a chromosomal disorder, caused by the presence of an extra 21st
January 2013 - December 2013 chromosome, which is characterized by mild to moderate mental retardation, short stature, and
a flattened facial profile. It is also called as trisomy21. The incidence of Downs Syndrome is
Correspondence : estimated at one per 800 to one per 1000 births.[8-10]
Dr. Preetee Gokhale
Indraprastha, R-31, Dombivili Through play the child learns to explore, develop, and master physical and social skills. Children
(East) - 421203 with Downs Syndrome have tendency for more passive play and more repetitive play. Their
play skills are influenced by delayed motor skill development [4] pertaining to manipulation,
Phone No. : cognitive disabilities which implicate hampered capacities to direct and control ones attention
09819667230 and to regulate ones thinking and behaviour, and inadequate social development affecting
E- Mail : their pretend play and interaction with peers. Since play is such an integral part of a childs life,
preeteegokhale@gmail.com it seems only natural that it be used as a method for dealing with these childrens problems in
a therapy setting.
Childrens play is generally described as being spontaneous, purposeful, and involving roles
Paper was presented in
and relationships, and the use of body space and force in the spatial and material environment
OTICON ' 2014 : the 51st Annual
of the home. Such descriptions enable observers to identify and explain deviations from expected
National Conference of AIOTA at
patterns which may be attributable to a variety of environmental factors rather than the childs
Bhubaneshwar and was awarded own developmental status. [14,15, 21]
with KEMOT Youth Talent Trophy
for Best Paper. Some studies have util ised play categories and their definable developmental features to make
The social development and play behaviour of children with Revised Knox Preschool Play scale: The RKPPS is an
Downs Syndrome in the age group 1-2 years progresses in a observational measure [13] that allows therapists to evaluate the
manner similar to their same age typically developing play of children ages birth to72 months in their natural
counterparts. This is the reason that our study includes children environments[7] . The scale has 12 categories in 4 components
with Downs Syndrome in the age group 2-6 years, as the play namely Material management, Space management, Pretense-
skills acquired by them in these pre-school years lay an important Symbolic & Participation. Observed play behaviour that matches
foundation for further acquisition of school and adolescent life the age discriptors is recorded and each factor is scored at the
roles. upper age of age grouping. (For eg. 6 to 12 months is scored at
12 months). Each dimension is scored with the mean of factor
Therefore the purpose is to study the effectiveness of play based scores and overall play age is scored with the mean of the
therapy on the play behaviour of children with Downs Syndrome dimension scores.
in the age group 2-6years which has future use in the acquisition
of life roles. This therapy is based on the Occupational Study Procedure:
Behavioural Frame of Reference. 10 children with a diagnosis of Downs syndrome coming
1.3 : Hypothesis: to Occupational Therapy; paediatric OPD of KEM Hospital,
Mumbai were selected as per inclusion and exclusion
NULL HYPOTHESIS (H0 ): There is no statistically significant criteria. Parents of children selected were explained the
improvement in play behaviour of children with Downs purpose and nature of the study. Written consent was taken
syndrome with play based Occupational Therapy. from the parents in the language best understood by them.
ALTERNATE HYPOTHESIS (H ): Improvement in play behaviour Any queries regarding the study were explained to the
1
of children with Downs syndrome is statistically significant parents. Four week protocol was administered. Evaluations
with play based Occupational Therapy. were done on the 1st day and at 4th week of Protocol using
RKPPS.
Aims And Objectives: Treatment protocol
To assess the play behaviour of children with Downs Occupational Therapy and Play Based Therapy. Subjects
Syndrome. were called twice a week, each session lasting for one hour.
To study the effects of play based therapy on play behaviour 45 minutes of play based Occupational Therapy was given
of children with Downs Syndrome. followed by 15 minutes of Free play.
Data Analysis:
Statistical method used:
Table 6
Comparison of scores of RKPPS ( Dimension : Space
management)
The alternate hypothesis of the study Improvement in play 6. Teaching & Learning, Pamela Sharpe, vol.17(2),pg.87-92.
behaviour of children with Downs syndrome is statistically 7. American Journal Of Occupational Therapy,2009, vol.114, no.4,
significant with play based Occupational Therapy was accepted pg.274-278.
as all the subjects included in the study showed a statistically 8. National Down Syndrome Congress, www.ndsccenter.com
significant improvement in their play behaviour following a 9. Down Syndrome Educational Trust, ww w.downsed.org
month of Play based Occupational Therapy intervention.
10. Down Syndrome. Com, www.downsyndrome.com
The improvement in play behaviour was found to be statistically 11. Social development for individuals with Down syndrome - An overview,
significant as the data analysis showed significance at the level www.downssyndrome.org
of P < 0.001 .
12. Ancy Parry Bledsoe, A Study of reliability and Validity of a Preschool
Thus, Null hypothesis was rejected. Play Scale (pediatrics, developmental disabilities, play, research)
AJOT.36.12.783
Limitations: American Journal of Occupational Therapy, December 1982, vol. 36
Small sample size no. 12, 783-788
13. Hilda Harrison and Gary Kielhofner, Examining Reliability and Validity
Short studyduration of the Preschool Play Scale With Handicapped Children, American
Journal of Occupational Therapy March 1986, vol. 40 no. 3, 167-173
One arm Cohort Observational Study
14. Stagnitti, Karen; Unsworth, Carolyn, The Importance of Pretend Play
Further Recommendations: in Child Development: An Occupational Therapy Perspective, The
British Journal of Occupational Therapy, Volume 63, Number 3, March
Similar study can be carried out on a larger sample after 2000 , pp. 121-127(7)
sample size calculation. This study can be used for sample
15. Play based Occupational Therapy International Journal of Disability,
size calculation. Development and Education,Volume 46, Issue 3, 1999.
Duration of study protocol can be increased so that the 16. Development of play behavior in handicapped and normal infants,
long term effects of the therapy can be evaluated. Topics in Early Childhood Special Education, October 1982 ,vol. 2,
no. 3, 14-27
Similar study on an older age group can be carried out with
17. K. E. Wisniewski M.D., Ph.D.*,Down syndrome children often have
some different assessment tool so as to detect areas of
brain w ith maturation delay, retardation of growth, and cortical
development which are lacking. dysgenesis, American Journal of Medical Genetics, Supplement:
Trisomy 21 (Down Syndrome) ,Volume 37, pages 274281, 1990
A randomized controlled trial can be conducted to study
the efficacy of play based therapy in comparison to other 18. Barbara H Connolly and Beth T Michael, Performance of Retarded
Chi ldren, W ith and W i thout D ow n Syndrome, on the
therapies.
BruininksOseretsky Test of Motor Proficiency, Physical Therapy, March
References: 1986 ,vol. 66 ,no. 3 344-348
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