As cities across America are beginning to reopen following the COVID-19 global pandemic, parents are being relieved of their duties as teachers and are safely returning to recreational play in their communities. In Florida, beaches have reopened and the park may be a place you are considering taking your child either for play or potentially for a community therapy session, as it could allow for social distancing. Through my work in the early intervention setting, I have gotten to take children to different places in their community to incorporate therapy into their daily lives. The playground has been one of the most rewarding places I have staged therapy sessions. Two of the most important jobs for a child are to play and learn, and the playground provides so many opportunities for these central pieces of a child’s life. Almost every part of a park or playground can be turned into a therapeutic environment when you put on your therapy goggles, and see it through the eyes of a physical therapist.
Swings - Balance and Motor Control
Swinging is a great way to challenge a child’s balance and motor control. Swings challenge a child's dynamic sitting balance, as it is a moving surface that a child must adjust to. The movement of swinging forward and backward in the air stimulates our vestibular system, and this is one of the three systems that influence our balance. Being able to maintain sitting while also integrating vestibular input of our body moving in space can be difficult if that input is startling or a new experience. Swinging challenges muscle control and leg coordination, with the initiation of bending and straightening legs while sitting to propel the swing. The quick movements of kicking out and bending legs on the swing require muscle flexibility and both sides of the brain working in coordination with each other to create motion. Swinging invites the repetitive active motion that allows for maintaining muscle length while also coordinating muscles together to swing forward and back.
Climbing - Global Coordination and Strengthening
Climbing is a way to combine whole-body coordination and strengthening. When climbing up a ladder or a rock wall, you are using your feet and arms together to allow for ascent and descent, which activates many areas of the brain to work together. Climbing also utilizes both left and right sides of the body, which can activate both the left and right sides of your brain and increase that communication between them, thus improving bilateral coordination of a child's body. When climbing, there is also a need for accuracy of movement to reach the next rung, and this helps children learn to practice grading their movements and improves motor accuracy. Inherently, climbing allows for global strengthening, as the arm, core and leg muscles help a child move along the obstacles, but climbing can also be helpful in targeting specific muscles that can help make movement more efficient. Specifically, climbing can help your child turn his feet facing out, versus his toes pointing towards each other, so it can help strengthen muscles that provide stability when walking.
Steps - Balance and Strengthening
Stair negotiation is an excellent combination of standing balance and the strength needed to go up and down steps. Stepping up requires balancing on one leg to place one foot on the next step and leg strengthening to get onto that step. Stepping up is equivalent to working on a single leg squat at the gym, which demonstrates just how much effort is needed to complete it without arm support. Stepping down requires leg strength of the leg still on the step to control the other foot stepping down, as the bottom leg has to maintain balance to get both feet onto one step. Stepping down can be harder to do, as the muscles that help a child do this are starting in a lengthened position, making it a more challenging motion to control. When children walk up and down stairs to play on the playground, they will be strengthening muscles and practicing one-foot balance during transitional play.
Slides - Balance and Strengthening
Slides are a motivational place to challenge postural control and provide strengthening. Every slide is an incline, so the inevitable motor task of getting to the top of the slide is how strengthening can be a part of slide play, either with climbing or stairs, as we have mentioned above. However, you can also walk up the slides to get back to the top, and walking up a ramp increases the challenge of walking, similar to adding an incline to your treadmill workout. Even with arm support, the child is engaging core and leg muscles to walk up the slide -- a fun place to overtrain for improved walking. Once the child is at the top of the slide, they must transition from standing into sitting and coordinate their body to scoot forward onto the slide before sliding down. Going down the slide is commonly the most exciting part of the experience, and this provides vestibular stimulation as the movement of a child's body down the slide will stimulate the inner ear. That stimulation gives the body information it will use for balance and will help the child maintain sitting balance when going down the slide. The muscles that assist in maintaining posture are needed to not fall over when going down a slide, and the slide is a fun place to practice this balance and postural activation, as the child can go down as fast or slow as they can handle.
Dynamic standing play - Balance and Motor Control
A playground has many changes of surfaces that a child will walk on, including the sidewalk, grass, mulch, and ramps. Being able to walk on hard and soft ground engages the body in different ways and can help to challenge standing balance. The mulch and grass can be a shifty surface and the unpredictable nature of those grounds can be a fun place to work on balance reactions. Specifically, staying in standing on wobbly surfaces challenges a child to maintain their balance. Stepping between those surfaces also allows for practice with small step ups and step downs between dynamic surfaces, thus increasing the balance challenges with stair negotiation. Ramps and inclines on the playground provide angled surfaces that bias specific muscles that help us maintain our balance in standing. When standing and walking up the ramp, it activates all the muscles on the front of the body to assist with staying upright, and when standing and walking down the ramp, it activates all the muscles on the back of the body. Those inclined surfaces can increase the demand in standing and improve motor activation and control during play.
Field Play - Gross Motor Development
Many parks have open fields and wide areas that are a great place to promote gross motor development. Fields can be a great place for ball play, including throwing, kicking and catching. Throwing a ball creates self-generated balance disturbances and catching a ball can promote bimanual play and hand-eye coordination. Kicking a ball requires a child to balance on foot and isolate the opposite leg muscles for dissociated jobs between legs. The wide, open field allows for practice with running, whether that be chasing after the ball or playing games like red light, green light. Squatting and jumping can be fun skills to include with scavenger hunts around the park, talking in the playground phones, and stomping leaves.
One of the most important parts of my job is making therapy fun. I always want the exercises and “work” that a child may be doing to be disguised in games, fun and play. The playground is this rich environment looking to be molded by us for creative and fun adventures with a child. It is a blank canvas waiting to be painted with our goals and to mask the challenges we may create for a child. Don’t let the list above limit your creativity, but let it inspire you at your local park or play gym to find ways to make physical challenges fun. Whether you have goals for a child who is attending PT now, or you want to continue to encourage your child along the developmental progression, I hope this has helped to share the many ways that a place you go every day or week could be used for so many therapeutic and developmental benefits. This list is not exhaustive and below I would love people to share other ideas, activities or games you have played at the park.
Caroline Ubben, PT, DPT, PCS