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Spontaneous and independent use of commercially available toys is not possible for many children with cerebral palsy. The toys often require more coordination or strength than these youngsters have. Continuous inability to engage in physical activity and gain mastery over the environment may cause the child to lose motivation and become passive. Because playing is an integral part of intellectual, social, perceptual, and physical development, growth in these areas may be limited when the child cannot actively play.


How to Get Started

Fortunately, toys can be adapted to make them more accessible to children with physical disabilities. Six types of modifications are most effective in promoting active, independent use of play materials.


Stabilize the toy.

Stabilizing a toy enhances its functions in two ways. First, it prevents the child's uncontrolled movements and difficulty directing the hand to desired locations from moving objects out of reach or knocking them over. Second, many children with cerebral palsy have difficulty performing tasks that require holding an object with one hand while manipulating it in some way with the other hand, Toys with a base can be clamped to a table. Masking tape is an inexpensive and effective way to secure many toys. Velcro is another. The hook side of Velcro can be placed on the toy, while the loop side is mounted on a clean surface. Suction cups can also stabilize a toy for a short time on a clean, nonwood surface.


Create boundaries.

Restricting the movement of toys such as cars or trains makes it easier for some children to use and retrieve them if pushed out of reach. Boundaries can be created in various ways depending upon how the object is to be moved. For example, push toys can be placed in the top of a cardboard box or on a tray with edges to create a restricted area. Pull toys can be placed on a track, and items that require a banging motion, such as a tambourine, can be held in a wooden frame with springs.


Add a grasping aid.

The ability to hold objects independently can be facilitated in a variety of ways. A Velcro strap can be placed around the child's hand, with Velcro also placed on the materials to be held, thus creating a bond between the hand and the object. A universal cuff can be used for holding sticklike objects such as crayons or pointers. Simply enlarging an item by wrapping foam or tape around it may make it easier to hold.


Make the toy easier to manipulate.

Some toys require isolated finger movements, use of a pincer grasp, and controlled movement of the wrist, which are too difficult for a child with physical disabilities. Various adaptations can help compensate for deficits in these movements. Extending and widening pieces of the toys will make swiping and pushing easier. Flat extension, knobs, or dowels can be used to increase the surface area. A crossbar or a dowel, placed appropriately, can compensate for an inability to rotate the wrist.


Add a special activation switch.

Some children have such limited hand function that they can only operate toys that are activated by a switch. Commercially available, battery-operated toys can be modified to operate by adapted switches. Teachers can make and adapt their own switches and toys (Burhardt, 1981; Wright & Momari, 1985) or purchase them from a number of firms that serve persons with disabilities. After determining some physical action (such as moving a knee laterally, lifting a shoulder, or making a sound) that the child can perform consistently and with minimum effort, select the type of switch best suited to that movement. The switch is always positioned in the same place, which facilitates automatic switch activation and allows the child to give full attention to the play activity rater than concentrating on using the switch.


Consider the child's position needs.

An occupational or physical therapist should determine the special positioning needs of each child. Good positioning will maximize freedom of movement, improve the ability to look at a toy, and facilitate controlled, relaxed movement. Placement of the toy is crucial. It should be within easy reach and require a minimum of effort to manipulate. The child should not become easily fatigued or have to struggle. The child must be able to look at the toy while playing.


Other considerations.

Activities should be interesting and facilitate cognitive growth yet not be beyond the child's conceptual capabilities. Toys should be sturdy and durable. Avoid toys with sharp edges or small pieces that can be swallowed.

These principles for adapting toys can be applied to other devices such as communication aids, computers, environmental controls, and household items, to make them easier to use. Making an educational environment more accessible gives children with physical disabilities greater control of their surroundings and the opportunity to expand the scope of their learning experiences.


Definition: other health impairment is a disability category included in the Individuals with Disabilities Education Act (IDEA). Other health impairment means having a disability caused by diseases, condition, disorder, or injury that substantially affects strength, vitality, or alertness. To be identified with an other health impairment, the student’s condition must cause a substantial impact on his educational performance.


The category also includes a “heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment. A student with attention deficit disorder, for example, who is distracted by the every day classroom environment and who cannot pay attention may be diagnosed with an other health impairment if the problem is severe enough to affect his learning.


Other health impairments may be caused by:

  • Chronic or acute health problems such as asthma ;
  • Attention deficit disorder or attention deficit hyperactivity disorder;
  • diabetes, epilepsy, a heart condition, hemophilia, lead poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia, and Tourette syndrome.

 Success story of a person with ADHD

Olympic Gold Medalist Michael Phelps and ADHD


As a toddler, little Michael Phelps was constantly talking, asking questions, and needing attention from other people. His preschool teachers complained that he was noisy during quiet time, wouldn't sit during circle time and bothered the other children.During elementary school, Michael's teachers described him as "immature" and said he couldn't sit still, be quiet when required to, or stay focused on his class work. Although he did well with physically active subjects like PE and science experiments, he did not like to read. His report card had D's, C's and B's.


Both of Phelps' sisters were swimmers. His mother decided to get him swimming, too, as an outlet for all that excess energy.When Phelps was in 5th grade, his doctor (and fellow parent at Michael's sisters' swim meets) suggested he might have ADHD. He himself had witnessed Micheal running around at the meets "like a crazy person." Assessment forms were sent to the teachers and the results were no big surprise..."cant sit still, keep quiet or focus."At age 9, Micheal started taking Ritalin which helped a little bit. His grades improved slightly but he continued to do minimal work, never going above and beyond.


By age 10 Michael was doing great in swimming. He ranked nationally for his age group in competitions. Swim meets offered Michael a way to focus on something he loved. ADHD children are very good at focusing on something they have a passion for. He started setting records.After about 2 years of being on ADHD medication, Michael asked his mom if he could stop taking it because no one else took it and going to the school nurse for mid-days medication made him feel different than the other children. He promised his mother he could handle school without the medication.Phelps graduated from Towson High School in Maryland and studied at the University of Michigan in Ann Arbor.