The First Important Stages of the Child’s Routine

The first few year of life are arguable some of the most important years of ones life. During the first few years children reach certain milestones such as walking and talking, such milestones build on top of one another and ultimately help the child socialize with others and help them interact with their environment. Unfortunately this is not the case with children who are born with spina bifida (SB). Depending on the location on the spine and the severity of their case children with SB can lag behind their peers in developing thier motor skills and develop their motor skills much later than their peers. Luckily there are surgical interventions and physically therapy that can help the child develop their motor skills to help them interact with their environment.

However, the approach that most therapist take often neglect some psychologic components that contribute to lifetime over all wellness which in turn can effect a person self-confidence and feelings of competence Campbell (1997). Physical therapist can change this and it can be done by changing the child’s perceptions of the rehabilitation setting by changing their current setting of one where the therapist is in control go promoting more of a motivational climate. The question that this paper explores is how does the perceived rehabilitation climate created by a physical therapist influence the physical and psychological behaviors of children with spina bifida? To Answer this question the self-determination theory (SDT) will be applied to explore this question.

In the article by Campbell (1997) she investigates the current approaches to Physical and occupational therapy to see if the current therapeutic approaches provided to children with disabilities, such as spina bifida, help develop skills can be carried with them throughout their lifetime. To do this she observes the children’s current treatment and ask them question that relate to their perceived control over personal health (autonomy), motivation through self-determination and through the development and perceived sense self-control and accomplishment. The researcher then interviews the of the children and ask them a simple question of what they were doing in therapy or what the goal of their rehab was. When prompted with this question most children had very little knowledge of what their goal was. Ultimately through her study she finds that that children in most traditional therapeutic setting do not have a sense of autonomy, lowered self-confidence and often do not understand their current treatment program. From this study conducted by Campbell (1997) it’s very clear to see that the traditional

The author also mention that in settings where there is more of a sense of choice or a better motivational climate children not only learn the motor skills necessary to function but also develop certain skills ,such as a sense autotomy, that are useful down the road. She goes on to mention that most PT’s and OT’s focus more on short term goals rather than on longer term goals or goals of lifelong productivity. She goes on to mention that provide the children more autonomy in the therapy sessions children may not only adhere to their therapy protocol, but the power of choice may lead to an increase of competence and relatedness. The author provides evidence that the current therapeutic climate structure needs to change in order to improve the lives of children for the better and she does so by using principles of SDT to explain how and why the therapy settings need to change. Ultimately by changing the motivational climate from one that focuses on an outcome goal to a climate that focuses on skill mastery these children will develop skills that will contribute their overall wellbeing and keep them physically active.

Keeping a child physically active can have a great positive affect on their physical and mental health and helps mold the way that they interact with the world. Children who experience sever forms of spina bifida often times than not are physically inactive and experience adverse effets on their health according to Kosma, Cardinal, & Rintala (2002). In a article by Kosma, Cardinal, & Rintala (2002) they stress the importance of getting people with disability, such as spinal cord injuries and people with certain types of spina bifida, to be physically active and what kind of barriers these people have to overcome. The authors offer several models and theories that professionals can use to get this patient population involved including the transtheoretical model, social cognitive models and achievement goal and competence motivation theories. In the achievement goal and competence motivational theories sections the authors mention the effects of motivational climate has on those with disabilities and relates it to components of the SDT.

In the article by Kosma, Cardinal, & Rintala (2002) mention that there is not a lot of research in the area of disability or movement difficulties and the type of climate (ego or mastery). The authors do mention one study that was conducted by Causgrove Dunn where she studied youths and how the type of environment affect their perception of competence. From her results she stated that children with movement difficulties preferred a motivational task focused climate over an ego performance climate according to Kosma, Cardinal, & Rintala (2002). Ultimately the researchers make the argument that people with movement difficulties respond better to activities that are task oriented and can be applied to physically therapy realm by changing the curt paradigm of one that is focused on the outcome of therapy to the process of treatment. One of the best way that a professional can promote a motivational climate is by using the TARGET approach to enhance the sense of competence and autonomy.

In this study the authors focus on children with motor skill development delays and the barriers that these kids face while trying to properly develop their skills. In the article the authors test the effects that motivational climates, ones of low and high autonomy, and the use of TARGET programs on the development of motor skills.

The researchers found that children that had motivational climates improved the most form pre to post intervention and also outperformed the other group postintervention. Their research shows that there is a need to provide motivational climates that emphasize high autonomy. By providing a climate of high autonomy children not only develop the necessary motor skills to be physically active, but also have a positive perspective of self and ability to be active.

The research that is provided by the annotated bibliography shows that the motivational climate that is created by a professional can play a role in the physical and psychological behaviors that are expressed by patients. By therapist making a change to the current therapeutic model of one where the therapist in control of the program to one that promotes a motional climate of high autonomy children can not only develop their motor skills, but can also work on psychological skills that contribute to the overall wellbeing of the child down the road.