The predicaments of embedding play in pediatric physical therapy with infants and young children

In this study, we explored how pediatric physical therapists’ (PPTs) embed play in their therapeutic work with children aged 0-3. We seek answer to the research question: How do PPTs navigate the predicaments of embedding play into their therapeutic approaches? 

This is a qualitative study based on observations and interviews with 14 PPTs in Norway and the USA. Each PPT was observed in therapy sessions with two children from their caseload. This was followed by interviews with the PPTs that included video-elicited questioning based on clips from their two sessions. In the analysis, we explored the PPTs’ embedding of play during therapy sessions, supplemented by insights from the interviews. The methodological approach and data analysis were guided by enactive theory.

Addressing the predicaments of combining play and therapy necessitates a flexible therapeutic approach tailored to each child’s functional level and play interests. To achieve this, the PPTs patiently spend time to let play unfold and gradually explore therapeutic possibilities during this play. As a result, children’s play engagement increases and motor learning activities are extended. Finding balance between play and therapy is crucial. Excessive therapeutic demands during play can lead to children’s frustration and abandonment of play, unless the motor demand is a welcomed component of play. Similarly, when the PPTs prioritize specific exercises and therapeutic techniques, they risk losing sight of the ongoing play or deliberately terminates play that does not align with their therapeutic intent. Resolution is found in the PPTs’ respecting and pursuing of play itself in collaboration with the child. This facilitates a genuine embedding of play within therapy rather than merely using play as a means to achieve therapeutic goals. 

This study highlights the predicaments of embedding play in physical therapy sessions for children aged 0-3. The results underscore the importance of a patient, flexible approach that adapts to each child’s individual needs and interests. By allowing play to evolve as part of the therapeutic process, therapists can enhance children's engagement and extend motor learning activities. The successful embedding of play entails respecting children's autonomy and supporting their play explorations and achievements during therapy. Future work on the embedding of play for other age groups and across different cultural settings is warranted.

This study shows that PPTs need to recognize and foster children’s naturally occurring play within therapeutic sessions, ensuring that play is not merely a means to an end but becomes a vital therapeutic component. Physical therapy curricula and ongoing professional development should emphasize strategies for balancing therapeutic goals with play, teaching PPTs how to collaborate and modify their approaches based on the child's responses to the ongoing play and therapy.