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Childís play
Tuesday November 13, 2012


Maggie Reilly, PT, MBA, said she and her colleagues at All Childrenís Hospital in St. Petersburg, Fla., have pediatric clients with a broad spectrum of therapeutic goals. The therapists work on reaching those goals inside the clinic, as well as outside, on the hospitalís playground.

The playground is actually a therapeutic area, designed to accommodate kids with all kinds of disabilities and limitations. Reilly, who is director of physical and occupational therapy at All Childrenís, said physical and occupational therapists and speech-language pathologists work with patients on the playground, which features a variety of areas to meet the needs of different children based on age and diagnoses.

These playgrounds are not just for hospitals and hospital-affiliated clinics. The nonprofit Regional Rehab Center, Tupelo, Miss., also offers a therapeutic playground. While its playground is smaller than the one at All Childrenís, it, too, features a host of physical and sensory options for children of all ages and abilities.

A child uses the therapeutic playground at the Regional Rehab Center, Tupelo, Miss.
(Photo courtesy of Regional Rehab Center)
Combining the elements

All Childrenís offers versions of the therapeutic playground at satellite clinics. All have either trees or tarps for shade, Reilly said. "Thereís a toddler play area for children up to 5 years old; then a 5- to 12-year-old play area. Then we have an area with more sports-oriented equipment [as well as] a sensory garden with different sensory activities," she said.

PTs, Reilly said, use the playground often to work on upper- and lower-body strengthening and vestibular activities, ambulation and more. The equipment is much like what one would see on a traditional playground, but with adaptive twists. "We have a little log area that [patients] can crawl under, or cruise next to, or, if they are sensory overloaded, they can get under that log and have a little bit of quiet time," Reilly said.

The older childrenís area is more challenging, with rock and ladder climbing, and straight and circular slides aimed at challenging the vestibular system. "We have other vestibular equipment where the kids can work on standing and spinning. Things like that to work on whole-body muscle control, balance, gross motor skills, strength, etc. Itís very motivating for them," Reilly said.

Another area of the playground at All Childrenís is dedicated to sports rehab. "We have a regulation-height basketball hoop, which can be dropped down for a youngster who is just learning how to throw a basketball; a soccer goal; some body-weight resistance outdoor exercise equipment; a chin-up bar — things like that for kids who are not so neurologically or developmentally [impaired]," Reilly said. "Even our kids who do have some neurologic or developmental problems [play here], so they have some more typical age-appropriate things to help gross motor skills."

Regional Rehab Centerís 2,500-square-foot playground includes a sensory garden and trail around its perimeter, where children can ride bikes or tricycles. The playground is designed to allow children of different abilities to play together. The swing set, for example, includes a traditional swing alongside swings for children who donít have trunk control, according to Regional Rehabís Brandy Evans, RPT.

The playground is designed to include children who often avoid playgrounds, Evans said. "I have a cerebral palsy client — a 13-year-old in a wheelchair. Sheís able to pull herself through the monkey bars on her wheelchair, then roll over to use the sensory panels. ... She can follow the track to work on her mobility skills in the wheelchair," Evans said.

Mission: safety

Choosing a reputable company to design the playground and build the equipment is important, according to Reilly. All Childrenís worked with Longwood, Fla.-based GameTime playground equipment manufacturer (part of Dominica Recreation Products). "The company has a very good track record of safety," Reilly said.

Regional Rehab Center worked with Ellen Harrison, a registered landscape architect with Landscape Services, Inc., in Tupelo, Miss. Harrison said that designing and building therapeutic playgrounds should be a collaboration. "We work with the client, find out what it is they do with their clients, as far as mobility and tactile types of activities, and what they want for their playground. Then we evaluate the site — where the playground is going to go — and build as many of those activities into that site as possible," Harrison said.

Some of the equipment has to be custom-made to accommodate clientsí needs, according to Harrison.

Playground designers have to consider safety standards, including fall zones, which limit how much equipment can fit in an area. There are also safety standards for playground surfacing. "If a play structure is a certain number of feet high, the flooring below it has to have an impact rating of a certain number," Harrison said.

Both playgrounds have rubberized flooring. Regional Rehab also has rubberized mulch under the swing set.

Words of wisdom

Reilly recommends that PTs be involved in designing playgrounds at their facilities. All Childrenís went so far as to conduct focus groups with parents, patients and staff.

While these playgrounds are costly, All Childrenís and Regional Rehab Center secured sizable grants to cover the costs. Blue Cross & Blue Shield of Mississippi Foundation paid for Regional Rehabís playground, with a $101,000 grant. All Childrenís also benefited from grants, including $300,000 raised by the Southeastern Credit Union Foundation.

Because of the playground, the children make not only physical but also emotional progress, according to Kay Mathews, MS, CCC-SLP, Regional Rehabís executive director and a speech language pathologist. "[We have a patient] with balance issues, and his caregiver made the comment that itís so great that now he can go home and talk with his siblings about the fact that he has a playground," she said.

The investment is well worth it when you see the smiles on kidsí and parentsí faces, Reilly said. "The feedback from parents and kids has been very positive. They enjoy being there. Itís motivating to them," she said. And the therapists enjoy having another therapeutic space, she added.

"Itís really something to be proud of when youíre able to offer this to your clients," Evans said. "Any time you can make therapy more fun and enjoyable for these kids, thatís what weíre here to do." •

Lisette Hilton is a freelance writer.

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Tuesday November 13, 2012
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