Sensory Integration Education

Gina Evans, SensorNet Editor, summarises the keynote presentation by Dr Diane Parham at The International Sensory Integration Congress (ISIC) 2024 on behalf of Sensory Integration Education.

Dr Diane Parham opened day 3 of ISIC with her keynote address on Play Matters: How the biological, cognitive, sociocultural and spiritual aspects of play may inform sensory integration practice. 

Diane Parham is a Professor of Occupational Therapy at the graduate program University of New Mexico. Prior to joining the University of New Mexico in '07, she taught at USC for over 20 years. She is an OT with a master's from the University of Southern California. She taught SI certificate courses for over 25 years. Among her publications is the famous textbook on Play in Occupational Therapy for Children and the widely used assessment tool, the Sensory Processing Measure, now in its second iteration. This keynote explored play as therapy for adults.

Dr Parham spoke about the model of human systems that influences occupations and occupational engagement (Adapted from Clark et al. 1991) which she co-authored. There are 5 levels to this model – biological, cognitive, sociocultural and transcendental. These levels were used to take us through her keynote presentation. 

Biological Level

What counts as play? How can you tell when a person or animal is playing? 

We heard about the 5 minimal criteria for play across species (Graham & Burghardt, 2010). The behaviour is:

• Incompletely functional 
• Spontaneous, pleasurable, rewarding 
• Different from serious behaviours 
• Repeated 
• Initiated in the absence of severe stress, fatigue or illness 

Take-Home Points for Therapists 

You can't make a person play, but you can create a situation that makes play more likely to occur by:

• Making sure the situation is perceived as safe 
• Creating a relaxed atmosphere 
• Providing cues from the environment that support play 
• Reducing stress 
• Minimising fatigue 
• Grading the activity 

Neurobiology and Play

• It's been shown by the biologists who study play that you do not have to have a great cerebral cortex in order to play. But having a large cerebral cortex helps. Animals with the largest brains have the most play. 
• Neuroscience indicates that the midbrain structures are involved in the initiation of play activity. The nucleus accumbens is also thought to be involved. 

Play fighting and rough-and-tumble play are not the same as aggression. These provide a lot of deep pressure input and may have a calming effect at the end of a bout of play. Make sure it is not too overstimulating, which may lead to disorganised behaviours 

Cognitive Level 

Card games and board games (checkers, chess, monopoly) were included in the discussion on the cognitive aspects of play and involve cognitive planning. There are formal written rules with competition involved. These games contribute to the development of strategy and lifelong skills. There are elements of mind reading to imagine what your opponent might be planning or thinking.

Dr Parham spoke about the importance of break time in school. There is research completed by play scholar Dr Olga Jarrett which has shown that children with regular recess perform better academically than children in school without a recess. 

Take-Home Points for Therapists 

• Identify types of sensory motor or cognitive play that the person enjoys 
• Match games and activities to the cognitive level and interests of the person 
• Consider ways to grade the activity to present at the just right challenge 
• Expand the play activities of the person by introducing novel play and sensory activities 
• Find ways to include sensory play breaks into daily routines to support academic performance and self-regulation and advocate for these breaks to be embedded into daily routines 
• Advocate for recess (break times in school) and for safe, interesting playgrounds at schools and in communities 

Sociocultural Level 

This level considers influences on play that might be observed within your culture. Monopoly was used as an example, whereby it is designed to educate children into a capitalistic society where work and accruing money and objects is important. This is merely an observation. Constructional play involves building structures with blocks and sand, for example. Constructional play also involves commercial toy building such as Lego. These can support the development of constructional praxis and tactile perception. These may also contribute to the reduction of sensory defensiveness because of the handling of the materials and the individual is focused on the actual production of their construction.

Within this level, we are considering culture. This includes arts, crafts, music, dancing and friendships. 

Transcendental Level

Transcendence involves extending or lying beyond the limits of ordinary experience. It means the quality of being able to go beyond normal limitations or normal boundaries of experience. These definitions point to a state of consciousness that's not part of ordinary daily life experiences. Computer gaming could be considered a type of transcendental play because you're outside of the ordinary in terms of your perceptions. Spiritual practices that have play elements may also evoke transcendental experiences. Spiritual practices may include storytelling, humour, improvisation, games, religious rituals, reading and reflection, writing and reflection. Diane spoke about how there may be a different way to think about spirituality where there may be a play element to these practices. 

Do Adults Play? 

Dr Parham explained that this may be seen as a controversial topic. In the US, the term play has been reserved only to be applied to the activities of children. Diane recalled a debate she participated in with Anne Mosey at the AOTA conference (2000) where they debated on the topic of “Do Adults play”. Diane was advocating that adults do play. 

The Occupational Therapy Practice Framework (4th Edition 2020) of the AOTA was discussed. Under occupations, play is listed as a term used for children and leisure is listed as a term for adults. Is it play or is it leisure – or both? 

Diane explained that play is a verb and leisure is not. Leisure is a chunk of time in which many occupations could be completed. It’s a discretionary use of time where you might choose to play or not. This was highlighted as being the main difference. 

Current examples of adult play which may change your way of thinking about the concept that adults do play

• Card games 
• Music making/singing for fun 
• Playing with pets 
• Sports – informally 

Recommendations 

• Be respectful of the religious or spiritual practices of those who you are supporting 
• Collaboration is key 
• If you are struggling to engage a child or adult in play, encourage them to choose an activity they like or may want to try out 
• Think broadly about what play involves – baking a cake, finger painting etc. 
• Don’t put pressure on participation in play 

References

Blanche, E. I., Chang, M. C., & Parham, L. D. (2024). Experiences of Adult Play. The American Journal of Occupational Therapy, 78(4), 7804185040. https://doi.org/10.5014/ajot.2024.050436

Clark, F. A., Parham, D., Carlson, M. E., Frank, G., Jackson, J., Pierce, D., Wolfe, R. J., & Zemke, R. (1991). Occupational science: academic innovation in the service of occupational therapy's future. The American journal of occupational therapy : official publication of the American Occupational Therapy Association, 45(4), 300–310. https://doi.org/10.5014/ajot.45.4.300

Jarrett, O. S. (2013). A research-based case for recess. US Play Coalition, 1.

Jarrett, O. S. (2015). Recess and learning. The handbook of the study of play, Rowman & Littlefield, 299-318.

Parham, L. D., & Fazio, L. S. (2008). Play in occupational therapy for children.