Physical Challenges in Child Care:

Let the Children Lead

by Sister Ginger Patchen

His mother came to tell us
about Matthew's new friend.
Not a particularly noteworthy happening
or so any of us might think.
Four-year-old Matthew is, after all,
going to nursery school now.
Making new friends is a large part
of the expectation there.
But, please understand, Matt says,
they played in the water table, worked
on some puzzles,
listened to a story and sang "Come
Together."

Trying to place, as parents are wont
to do,
just who this new friend was,
Matthew's mother made any number
of suggestions,
all to no avail.
Finally Matthew stated that Keri-Ann
always brought her own chair...
"You know, Mom, the one with the big
wheels."
Matthew didn't say that Keri-Ann is
strapped to a board to play in the water,
that she cannot hold a puzzle piece and
so "eye-gazes" it to the right spot,
that she listens but can't tell us how,
that the teachers clap her hands together.

What Matthew said was...
he had a new friend.

This scenario may seem an unusual way to begin an article intended to address the issues of training, modifying and adapting program, accessing resource support and assuring quality care, but I believe the story of Keri-Ann and Matthew provides us with a snapshot of what is needed for real inclusion to happen. As Matthew and Keri-Ann were the leaders in this example, so too are children generally the leaders in settings where a developmental approach is used. With this technique, what is appropriate for the individual child determines the process employed rather than the child being expected to change to meet the demands of the process. Facilitating inclusion takes many forms.

In today's teaching environment, the question is not whether we facilitate learning, but rather how best to do that. Child care facilities operate most effectively when their primary goal is to meet the developmental needs of the child, thereby enhancing the individual quality of that child's life. Building positive relationships supports entry into each and every field of endeavour. The components for accommodating children who are physically challenged are already included in the blueprints and practices most of us are using. Keri-Ann and Matthew used the same learning centres other children used. They led each other through a variety of learning experiences. It was how those experiences became individually accessible that was changed.

We all understand the need for ramps, handrails, walkers, wheelchairs, hearing aids and (eye)glasses. What we often don't think or hear about is how simple adaptations might reduce the exclusionary feelings and sometimes very real barriers that affect all who are involved. For instance, standard wheelchairs are designed more for the people who push them than they are for the people who sit in them. Seat height is convenient for the adult who sits in a standard adult chair to "help" the child. Problems arise when that height excludes the child in the chair from interacting with other children who are sitting on chairs and at tables that are child-sized and developmentally appropriate.

Searching out workable alternatives requires that we assess each goal and determine how that goal might best be accomplished in a fashion that is as unobtrusive as possible. The combination of sitting on an adult lap, using standard, adapted children's chairs or a lowered-seat wheelchair are all effective for children involved in table-top activities. As well, the combinations allow the child who is challenged some needed postural changes.

As an example, for many years the "best practice" understanding of what children with cerebral palsy needed in order to be supported appropriately was a made-to-order seat secured into a standard wheelchair. Finding that wheelchairs limited our goal of enhanced interactions and wondering how anyone would feel sitting in the same position for hours at a time pushed us to re-examine our thinking and possibly invalidate this "best practice." Granted, sitting on an adult lap may not "work" for all ages of children. But in a centre where other children find lap seating to be appropriate, why should/would we exclude the child who is physically challenged from this nurturing experience? When the goal is the inclusion of the child who has physical challenges, additional equipment challenges may undermine the goal.

If this sounds like a juggling act, it is. In fact, it is a daily round of balancing, equalizing and stabilizing. But rest assured, if you are presently an early childhood educator, you probably have all the skills you need to be an expert juggler. Developmental issues, safety concerns, individual needs and desires -- all these are relevant to enabling the whole child, any child, every child. Certainly there are occasions when specialized equipment is needed or helpful. You will remember that Keri-Ann used a standing frame to play at the water-table. Although she might not always use the frame, when she did, Keri-Ann was afforded a degree of independence from staff that no other method of care could or would have provided.

Over the years, we have been surprised to learn that having a child who moves through the day on a tricycle (even in a small classroom) is not as awkward as might have been anticipated and actually works well. It works as a means of locomotion for the child as well as an integrative, inclusive, normalizing activity. So too does having everyone taking turns on the large therapy ball or the Toddler-Bobbler (basically a modified trampoline). Singing, signing, swinging -- all these are effective means of inclusion and integration. Certainly it is true that, as the years pass, therapy equipment begins to become part of your general inventory, but primarily what you need is to use a little imagination with a wide variety of standard equipment.

Realizing that children with physical challenges would be members of our centre, we planned our outdoor play space carefully. For example, we have a large sandbox with multiple levels. Children can sit in, stand beside or slide a wheelchair under parts of the box. Our swing collection includes the following types: standard belt, hammock, Exerglide, airplane and limited-rotation horizontal tire. Although the hammock was designed to give swingability to those who cannot sit up and/or hold on, it has become the favourite of all the children, hands down. The Exerglide enables arm pumping for those with limited leg power and the added social advantage of safely accommodating two folks at a time. The climber has wheelchair access to the lowest level and a double-wide slide for companionship (or assistance). Much of the playground surface is Tuff-Turf or Elastocrete to provide cushioning against falls while allowing for easy walking or wheelchair mobility. This picture of our "park" (as the children call it), is complete with trees, grass, shrubs, garden boxes, picnic tables, tricycle paths, hand rings and variety of mobile toys. It is equipment that all can enjoy and share.

Letting the children lead is the key to opening many learning and experiential doors. Allowing this to happen is not always easy. For example, last Christmas one of our children, J.J., was using a standing frame on wheels quite regularly. One day, some of her friends asked for the use of some bungee cords. Somewhat hesitantly I met their request and watched as a series of intricate wrappings and tyings took place. The bungee cords were then hooked to the standing frame. I stood holding my breath (a most common occurrence, I assure you) while J.J., already chortling to herself, was given a hat and they were off...to the North Pole. I heard them exclaim as they roared from my sight that jolly J.J. was Santa and the bungee kids, her reindeer!

Ways to Enable the Children

Enlist the help of other children. They benefit from being involved, from helping and from the relationships they are building. You benefit from their unique visions of how something/anything might be done. The child who is challenged benefits from your combined efforts and from knowing that if it were not for their unique challenges, this wonderful, atypical thinking might not be taking place.
Use mirrors. Both standing and tabletop are excellent motivational tools for: developing an appropriate sense of self; building self-esteem; encouraging self-care; the remediation of speech and articulation; the strengthening of head, neck and chest muscles; as well as face-painting, dress-up and the naming of body parts.
Deck your halls. Regularly change the pictures, charts, murals and drawings that adorn your walls, windows and hallways. Any child who has poor trunk control will be encouraged to look up to see what is there, thus strengthening those muscle groups. Additional stimulation is also positive for almost all children.
Provide a firm foundation. For children whose feet do not reach the floor, footrests will promote stability and focus for sitting activities (taping phone books together works well). This, by the way, applies to anyone. Everything from using a toilet to puzzle solving to writing essays is easier when you are "grounded" this way.
Sing and sign. When typical ways of speaking and communicating are not having the desired effect, you might want to try singing instructions and/or adding some basic signs to your speech. Combinations are often more effective than any single method of operation. To assist children in making choices or to allow children who are not able to speak to have turns picking songs, make a chart of one-picture illustrations representing individual songs (spider for Eensy-Weensy Spider, bridge for London Bridge is Falling Down).
Therapy for one is therapy for all. Incorporate as much "therapy" as possible into everyone's daily routine. Some children may need the movements involved, but all will enjoy the action. Stretching, flexing, reaching, rolling, balancing, pushing, swinging and crawling are present in many songs and movement routines for children (This is a Song About Sammy; Open, Shut them; Growing Song).
Different is "do-riffic." Remember that learning to do things in different ways is a positive living experience. Although we work hard at "teaching" this concept to our children, the practicality of it remains difficult for us throughout most of our lives. If it hasn't been done this way before, the inclination is to think it probably won't work. Don't be fooled by this passing thought -- go with your intuition and make a possibility a reality.

Sister Ginger Patchen has been the Director of Epiphany Children's Centre in Winnipeg, Manitoba for 16 years.

References

Esbensen, Steen (1987). An Outdoor Classroom. Ypsilanti, Michigan: High/Scope Press.

Kramer, Paula and Hinojosa, Jim (1993). Pediatric Occupational Therapy. Baltimore, Maryland: Williams and Wilkins.

Miller, Susan (1988). Games, Giggles and Giant Steps. Cleveland, Ohio: Edgell Communications.

Recommended Books for Children

Cairo, Shelley (1985). Our Brother Has Down's Syndrome. Toronto, Ontario: Annick Press, Ltd.

Dwight, Laura (1992). We can Do It! New York: Checkerboard Press.

Merrifield, Margaret (1990). Come Sit By Me. Toronto, Ontario: Women's Press.

Rabe, Bernice (1988). Where's Chimpy? Toronto, Ontario: General Publishing, Ltd.

Smith Sally L. (1994). Different Is Not Bad -- Different Is The World. Longmont, Colorado: Sopris West.

For related articles on special needs, go to the Main Menu.

This article appeared in Interaction (Winter 1997), published by the Canadian Child Care Federation.

Posted by the Canadian Child Care Federation, July 1997.