Meaningful Participation

Posted on May 24th, 2013 by Denise | No Comments

Meaningful Participation


Denise Koonce OTR

I had the honor and privilege of attending a particular session during the recent Neuro-Developmental Treatment Association’s National Conference that caused me, as well as others in the room, to dig a little deeper in regards to how we look at treatment.  There were many points the instructor presented that were thought-provoking and insightful but the one that keeps playing over and over in my mind is the concept of “participation.”  Participation can be defined in more than one way in regards to therapy and life.  However, the definition or application of the word “participation”, that she challenged us to think about was not just having a child follow thru with an activity during treatment, but instead understanding what the essence of participation is within a given activity, and is it meaningful to their life.  As a therapist we need to be considering what is important to them and how we can incorporate a specific movement pattern, multiple times a day/week, into the child’s world in order to move them towards true participation.  This particular presenter proudly acknowledged that she was yet a vessel in the delivery of this thought-provoking information in that she, with permission, was passing on information from those “who had come before” and was simply adding another layer.  One such source she cited was from an article written by Suzanne Davis Bombria PT, CI, C/NDT.  I read the article available on NDTA’s Website Network journal titled “Some Thoughts on Participation Versus Function.”  I enjoyed the article immensely and highly recommend reading it.   In the article, Suzanne speaks to both her professional and personal experience in determining her view-point of participation.  Suzanne has a unique perspective on participation because she is not only a physical therapist but also the mother of a young man with cerebral palsy.  Despite the fact that we must look at function developmentally and in detail, we also need to take our therapeutic mindset a step further to “participation.”  Mrs. Bombria states in the article “It is not enough to look at function in isolation.  Life is busy, complex, and interactive the majority of time.  We want the individuals we work with to be fully engaged in life.  As I explore goals with children and families I work with, I ask questions about the things they have in mind for goals and I also ask them what a typical day is like.  I ask what kind of activities the child enjoys and what he or she dislikes.  I ask about their child’s interactions with others.  It helps me to know the various environments and communities that the child lives in and where there might be some difficulty.  I want the goals to support the child in having a meaningful life.”

This fresh way of thinking made me stop and think about situations in my own life regarding my daughter and her participation in life.  When we needed to rebuild the muscle strength of one lower limb, we used activities to do so such as picking up marbles and scrunching a towel with her toes but then we also addressed her participation by having her use the weaker leg first every time she stepped up and into the car, getting into bed, going up stairs or climbing the playground ladder.  The later activities were at a participatory level instead of just a home program as they occurred during meaningful activity.    

Every morning while my daughter is eating her breakfast, her dad sits at the table and surfs the status of the world.  One morning this week there was something worth sharing with us and I believe worth sharing with you.  The event was a video of a young girl performing a ballet routine for what appears to be a school or community audience.  What is so uniquely special about this performance is her level of participation in reference to this blog subject.  You can view the video from our face book page but I want to describe to you what I saw.  The video captures a beautiful young girl performing a choreographed ballet piece to music including elegant flowing arm movements, pirouettes, and her gracefully gliding across the floor.  Did she have to work on developmental steps to achieve the level of function necessary to perform, yes, but this activity is set apart by her level of participation or by her act of participation.  What made her participation in this performance so special is what we can’t or didn’t see in the video.  However, I am quite sure that parents, therapists, and instructors embraced the concept of participation allowing this little girl with special needs an opportunity to engage in a beautiful example of meaningful life experiences.  If you watch the video you will see, she performed independently but required the assistance from a dynamic standing chair.  Did she have to work on developmental steps to achieve the level of function necessary to perform, yes, but this activity is set apart by her meaningful level of participation.    

I challenge you in the coming weeks to apply this concept to your patients and make sure you are incorporating the essence of participation into their everyday life.  Please share with us, as you look at your process, any thoughts or suggestions of what you have done. 



Adler, L.  Moving treatment from clinic to life:  Handling for daily routines in the home, school, and community.  NDTA Conference.  2013

Bombria, SD.  Some thoughts on participation versus function.  NDTA Network. 2012. Vol 19, Issue 1, 1 and 7.

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