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Play or Pay: The Case for Having Fun in PT

June 9, 2017 • Other • Jessie Podolak

Summer’s here! The kids are out of school, the sun is shining brightly, and nature beckons us to come outside and PLAY! Lest we fill our summer schedules with too much working in the clinic, mowing lawns, watering flowers, grocery shopping, hauling kids to practices, reading work-related blogs, and buying the perfect graduation or wedding gifts for our nieces and nephews, it would behoove us all to take a step back and make sure we have intentionally carved out plenty of time to PLAY!

Have you ever thought of play through a neuroscience lens?

If you work with pediatric patients, you are likely thinking, “Well, duh, play is crucial to development. It’s the cornerstone of how we do therapy with kiddos too!” But for those of us who may be a little out of touch with pediatrics, neurodevelopment, etc. consider it: During our years of greatest neuroplasticity, what do humans spend the majority of our time doing? We play!

Play helps brain development on many levels, and it’s not just important for kids. According to Dr. David Whitebread of Cambridge University, “Play in all its rich variety is one of the highest achievements of the human species, alongside language, culture and technology. Indeed, without play, none of these other achievements would be possible. The value of play is increasingly recognised, by researchers and within the policy arena, for adults as well as children, as the evidence mounts of its relationship with intellectual achievement and emotional well-being.” Dr. Whitebread’s report, The Importance of Play, highlights much of this fascinating research and also describes the negative consequences of play deprivation, including criminal violence, decreased social competence, emotional deficits, and deficient growth and functioning in a number of key brain regions.

Play is important not only in humans, but has been demonstrated in animals as well. Whitebread shares the work of researchers Pellis and Pellis (2009), noting “playful rats have been shown to have significantly elevated levels of brain-derived neurotrophic factor (BDNF), which is recognised to have a central role in developing and maintaining neural plasticity (or, the ability to learn). They have also demonstrated that play supports novel neural connections and changes the architectural structure of significant brain regions. Play deprived rats became more aggressive to other rats, were less able to mate successfully, and showed heightened levels of fear and uncertainty in novel environments.”

While it’s quite clear that play is essential for normal growth and development, work by Michael Merzenich and other neuroscientists promotes the application of play for sustained mental acuity throughout the aging process. In his book, Soft Wired, Merzenich advocates lifelong learning of new skills, rather than simply mastering skills we already have acquired. This creates new neural pathways, promoting neurogenesis and sustaining problem-solving skills despite age-related changes. He notes that learning to play a new musical instrument, for example, yields many benefits: “Focus on accurate listening and performance precision as you play. Musical performance exercises reading, listening, fine and high-speed manual control, and often, other special oral skills. If you play with spirit, and why wouldn’t you?, you’re engaging emotion control brain hardware as well” (p. 204).

Merzenich goes on to advocate physical play, stating “Tennis or other games with the same ball-in-motion challenges (badminton, ping pong, catch, certain Wii games, basketball and volleyball among many others) put your visual reception machinery and action-control machinery in motion simultaneously. Games that require fast visual tracking, that drive your brain to rapidly move your eyes, and that lead to fast and highly flexible motor responses are very beneficial for both the brain and body! The exercise they provide for your neurological control of balance and posture is an important second benefit. One way to slowly progress inability at a new game like these examples is to find a matched, competitive partner to learn with” (p. 206). As PTs, we know this stuff, but do you ever just step back and appreciate the complexity and wonder of what we get to do when we help patients engage (or re-engage) with play?

Soft Wired is one of my all-time favorite books on neuroplasticity, because it reminds me that the aging process doesn’t have to be one of inevitable decline.

As I’ve watched my sweet and spunky grandmother slowly grow dim with Alzheimer’s disease, I will admit I can get a little nervous about my own future, but the fact that we are genetically coded and environmentally sculpted offers so much hope! A little intentional action now and throughout the rest of my life can yield tremendous rewards. And what great homework to combat neurologic decline: play!

I am forever thankful for the privilege of seeing a wide variety of patients in all stages of life. Like you, I see “old-old” patients and “young-old” patients, who inspire me to journey well. One of the most inspirational characters I have come across as I’ve explored neuroplasticity through the aging process is Stephen Jepson, who gives me great hope for not only myself, but my patients as well. I’ve shared his video, Never Leave the Playground, with many seniors, along with strong encouragement to get out learn pickle ball! If you want to see a champion for play, his video is eight minutes of must-watch, energetic fun.

So this brings me to the point of my little “U-rah-rah, Go! Play!” cheer-blog. Let’s not ever get too busy or too serious to forget to play. Seasons of play-deprivation can easily turn us into big rat-like critters, with heightened aggression, fear, and heaven-forbid, impaired mating ability! Play is such a fundamental need for us, and it has protective and restorative power.

Let’s also see what we can do to remind our patients to play. I know many of them are knee-deep in a world of pain: physical, emotional, and mental. But maybe a little levity can spark something new, shifting their attention off of the well-worn pathways of their pain-neuro-matrix and onto fledgling “fun neuro-pathways” that trigger positive emotions and stir up a bit of serotonin or dopamine. A little play may go a long way!

I’d love to hear our readers’ suggestions for therapeutic play in the clinic. Also, what kind of play do you plan on engaging in this summer? Let’s encourage one another to keep ourselves balanced, sharp, and playful!


Jessie Podolak

Jessie is a physical therapist with 21 years of experience and a passion for changing how pain is treated in the U.S., particularly when it comes to children. Current Roles: Clinician, Phileo Health LLC Program Director, EIM Fellowship in Pain Sciences Research: The clinical application of pain neuroscience, graded motor imagery, and graded activity with...

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