Teachers and school staff do their very best to support children across all 4 broad areas of need to achieve their potential. Conditions such as Spina Bifida and Hydrocephalus are less commonly found in UK classrooms in comparison to other well-known SEND conditions (like ASD, SLCN and SEMH). Teachers can be forgiven for feeling ill-prepared to safely support children with physical disabilities with outdoor and adventurous play.
For this article, Fawns has teamed up with Shine Charity (the experts in Spina Bifida and Hydrocephalus support) to share what inclusive play looks like for children with physical disabilities.
Shine Charity
For over 50 years, Shine Charity has provided specialist advice and support for Spina Bifida and Hydrocephalus across England, Wales and Northern Ireland. We spoke to Aimee Cave, the Education Officer for the charity, to get expert SEND advice for teachers wanting to learn more about the conditions and how to ensure inclusive play is achieved for all.
Contact the charity directly to organise free teacher training on Spina Bifida and Hydrocephalus and access a host of useful resources created by medical experts.
How to promote inclusive play for children with physical disabilities
Physical needs are one of the four areas found in the SEND Code of Practice. A child with a physical disability may experience reduced accessibility to the physical environment. Commonly paired with co-existing conditions, the physical disability is often not the only SEND need the child will experience.
Communication and interaction, cognition and learning and social, emotional mental health needs may also be present in children with physical disabilities. The complex needs of children can question the order in which the teacher meets the needs.
Active and social play are important aspects for all children during school time. As our understanding of what inclusive play is grows, there is the recognition that wheel-chair-friendly outdoor equipment is but one string to an inclusive bow. Aimee explains there is far more to offering an inclusive playground than accessibility for wheelchair users.
As with any inclusive practice, as a teacher, you must consider the child as an individual. Consulting with experts, and the family, is essential for being able to offer an inclusive (and enjoyable) provision for the child with Spina Bifida or Hydrocephalus.
You can measure how inclusive your playground is using our handy audit checklist.
What is Spina Bifida?
Spina Bifida means ‘split spine’. During the stages of development when the spinal cord and vertebrae are forming, a gap or split is left in the spine. There are different types of Spina Bifida: open Spina Bifida is often detected at the 20-week scan in pregnancy. The sonographer may notice a different appearance of the skull bones and the back part of the brain. The sonographer will then investigate further, looking for tiny abnormalities in the spine.
Closed Spina Bifida are types of Spina Bifida which are skin-covered at birth, and inc
lude lipomyelomeningocele. These can lead to changes in children’s mobility, and bladder and bowel function, through tethered cord, but learning is not affected by these conditions. Children would not usually develop Hydrocephalus either.
As with any disability, the effects of Spina Bifida vary for each individual. Depending on where on the spine the lesions are will often determine if a person will be a wheelchair user or may be able to walk.
Spina Bifida can cause:
- Bowel and bladder difficulties.
- Cognition and learning differences.
- Challenges when imagining the future.
- Rigidity of thinking.
- Difficulty with decision-making and motivation.
- Barriers when planning and organising tasks.
- Delays with processing and working memory retention.
- Social skill challenges.
What is Hydrocephalus?
Hydrocephalus can occur in isolation, with other needs, and with Spina Bifida. It is used to describe conditions where there is an excess of cerebrospinal fluid (CSF) in sections of the brain. As the brain cannot drain the CSF, it increases pressure inside the brain and requires help to drain to a suitable place in the body. 
Many free resources are available on Shine Charity’s website, including an easy-to-understand video explaining Hydrocephalus. The cause of Hydrocephalus can be varied; it can be from birth or acquired. It may be caused due to differences when the brain develops, where fluid absorption is not fully formed. Brain damage through head injury, haemorrhage or infection can also cause Hydrocephalus. The most common treatment usually involves surgery to fit a shunt; this helps to divert the CSF to a more suitable place in the body.
If a child in your class has Hydrocephalus, it is important to know the signs that a shunt may be malfunctioning, paired with a risk assessment and emergency procedure to act quickly.
Challenges pupils with Spina Bifida and Hydrocephalus have with play
All advice given in this article must be taken with the caveat that every child with these conditions will have different needs. As with all SEND needs, severity and complexity can vary. The families know their children best, and building positive working relationships will prove invaluable for improving your inclusive play provision.
Children with Spina Bifida may have limited mobility, depending on where on the spine their lesions are. Wheelchair users may find accessibility to the physical environment challenging; seeing the accessibility from the child’s perspective is important to be proactive, when making adjustments for inclusion to occur.
There are a number of challenges children with Spina Bifida, Hydrocephalus and other physical disabilities may experience when playing:
- Limited mobility.
- Challenges with prospective memory (thinking ahead).
- Difficulty understanding the sequencing of games.
- Reduced working memory function (to hold the immediate information being used).
- Limited attention.
- An inflexibility of thinking (making social games challenging).
- Slower processing time.
- Difficulty with planning and organising games.
- Challenges with the concept of time (impacting their motivation to join in with games).
Challenges teachers may experience when planning an inclusive playground
When supporting children with SEND, teachers will be more likely to encounter more common disabilities like SLCN, SEMH and ASD. Spina Bifida and Hydrocephalus are less common, limiting teachers’ experience and knowledge about supporting the children.
Children with Spina Bifida and Hydrocephalus often experience cognition and learning challenges as well, making teachers unsure of which SEND need to support first. The condition’s physical aspects can often be considered the main barrier to joining in with play opportunities. This lack of knowledge can easily be remedied through whole-school training.
For children with a shunt, teachers can often be concerned with the increased risk associated with participating in play that involves outdoor play equipment. As Aimee explains, there are children who are supported by Shine Charity who are football-mad Limiting children due to an unknown risk can exclude them from joining in with their peers. Conversations and risk assessments from the whole support network around the child (including the neuro-team) can help to assess what measures must be in place for the child to join in, for example, with: trim trails, sensory swings and sports and fitness equipment.
When supporting children with well-researched conditions, like ASD, teachers can be signposted to a range of free resources to support the individual’s needs. Knowing where to find information on Spina Bifida and Hydrocephalus is not as well-known and can give teachers the confidence to implement inclusive practice during unstructured time.
How to promote inclusive play for children with Spina Bifida and Hydrocephalus
There are several steps you can take to audit how inclusive your playground already is. When thinking about inclusive play for children with Spina Bifida, Hydrocephalus and other physical disabilities, consider the following:
- Organise a play-related meeting with the child’s family and medical network.
- Know the child’s individual interests and hobbies; you can incorporate these into games. By asking the child about their ideal playground, you can build positive relationships and understand how to adapt your setting accordingly.
- Think about the different roles the children can take in a low-demand social setting. For example, developing speech, language and communication needs through leadership opportunities can help to build confidence and social skills.
- Understand the challenges the individual faces. Beyond the physical mobility, consider processing needs, memory barriers, rigidity of thinking and all other associated behaviours children with Spina Bifida may display.
- Motivation is key when supporting children with Spina Bifida; consider linking their interests with outdoor play equipment. For example, an interest in gardening may help to direct your plans when creating your own sensory garden.
- If a child has a teaching assistant or adult support, consider their role in facilitating inclusive play. Join several children in a game that will build social skills with peers and avoid a heavy adult presence during play, unless to physically support or initiate active play with others.
Think about the heights of your current activity boards. Are they suitable for wheelchair users? Contact expert playground designers to tailor the height of many playground activity boards for children.
Aimee reminds us we are aiming for equity, not always equality. Helping children to have the same access as their peers where possible.
How can Fawns help children with Spina Bifida and Hydrocephalus?
Playtime by Fawns is committed to supporting inclusive play through outdoor play equipment. Offering multi-use equipment that supports all 4 broad areas of need and helping SEND and mainstream leadership to design an inclusive playground to meet their needs.
Operating for over 30 years, Playtime by Fawns has assisted thousands of schools to design and install their dream inclusive playground. We have several SEND-specific pieces of equipment to support all 8 sensory systems.
Check out a selection of play equipment that can encourage children with Spina Bifida and Hydrocephalus to participate in play: 
- Musical instruments
- Sensory island
- Activity boards (like pinball)
- Water and sand play
- Trim trail- the Mu Fitness and Adventure Trail avoids time upside down (being mindful of children with shunts).
Looking for advice on supporting children with physical disabilities (current or future pupils)? Request a brochure or Get in touch with our expert team today.
