Posted on June 22nd, 2012 by Denise | No Comments

A Little Imagination Goes A Long Way


Denise Koonce OTR


I had been working as an occupational therapist for about 2 years in the adult population when I received my first pediatric patient.  She was a precious 4 year old and had a diagnosis of bilateral upper extremity amputee.  She had just received her first prosthesis and it was my job to engage her in play while using her new prosthesis.  I wanted to use pegs and blocks to work on coordination but not her, she wanted to play Barbies!  In an effort to build report and later engage her in my treatment plan, I agreed to play Barbies.  She jumped right in and started attempting to use her prosthesis while selecting her Barbie.  She then looked at me and said “Come on, you pick one.”  After I did so, she began an imaginative dialogue with reflective actions and said “Come on, play.”  I froze, I couldn’t remember how to play, and I couldn’t seem to engage my imagination.  I tried to find it on the spot but couldn’t.  I followed her lead and we were able to do some good work but I left the session with a feeling of bewilderment.  How could I have lost my imagination?

The situation reminded me of a scene from the movie Bedknobs and Broomsticks in which Angela Lansbury is playing the role of a kind witch intent on helping the British WWII effort through magic.  She has in her care three orphaned children with the oldest boy age 10.  She has bewitched a bed to fly but the oldest boy does not want to go because he doesn’t believe it will work.  His sister begs him to come but still he refuses.  Angela then states “Ah, I know the problem.  He has reached the age of not believing in the dreams that still can come true.”  I didn’t want this to be me.

The rest of the day I thought of that experience and what I was going to do during the next treatment session.  I had a couple of days before the next session and I knew I had to be prepared.  I contacted a friend who had young children and asked her if I could come over.  I thought having an opportunity to observe and play with children might help me remember how to play.  I arrived and decided to watch the kids play first.  I began to notice there were unsaid rules and structure that they used while they played.  The children would decide on a general theme and then the plot would evolve as their imagination led them.  Characters would be added or taken away as needed.  Imaginary items or other elements from the room would be used as necessary to set the scene and finish the story.  Good vs. evil generally with a beginning, a plot, a climax, and finally a happy ending.   I asked if I could join in and immediately I was offered a character role.  Little by little I began to add to the dialogue with their approval.  When it did not work I was immediately corrected or reminded of where we were or what we were playing.  My imaginative skills didn’t all come back immediately but I began to remember what it was like to play and use my imagination.  This gave me a starting point to work from and allowed me to be better prepared for the next treatment session with my patient.  The more I practiced the easier it became.  Not having to think about my imagination allowed me to then focus on being a step ahead of her during play in order to meet the treatment goals necessary to improve her quality of life.

I learned a powerful lesson from my patient as I learned once again how to use my imagination.  I further learned what could be accomplished during a treatment session without many toys and using the gift of imagination.  Please share with us some of your imaginative ideas you use to engage “that age of believing.”


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