Category Archives: Motor Skills and Planning

What is Dyspraxia?

What is Dyspraxia?

By Michaela Gordon, OTR/L

You most likely understand a therapist when they use the terms coordination, balance, and strength. However, do you understand the term praxis or dyspraxia?

 

Praxis can be broken down into three steps. Before a child can perform a motor action, two cognitive steps occur. The first cognitive step is ideation. Ideation is the ability to come up with new ideas for using your body and objects. In other words, is the child able to figure out what to do when they are presented with something new?

 

The second step is motor planning which involves planning out the sequence of motor steps to accomplish a task. Part of motor planning includes the timing of each step and getting the body into the various static and dynamic positions for each step moment by moment. In other words, now that the child has an idea of what they want to do, do they know how to put that idea into action in a timely and fluid way?

 

After these two cognitive steps have occurred there is then motor execution. Motor execution is the observable result of all these steps. In other words, was the child able to accomplish the task, and if so, was their performance within a range appropriate for their age?

 

The concept of praxis may be confusing for parents to understand if their child presents with high verbal skills or a vivid imagination but also presents with poor ideation in praxis. Ideation in praxis is specifically coming up with new ways to move or use the physical body in the physical world.

 

The other variable that may be difficult for parents to understand is the difference between praxis and motor patterns. The reason this can be hard to understand is because your child may be able to perform and even sometimes excel at one or more motor tasks i.e. riding a bike, or playing tennis, but then may not be able to perform a new motor task, even if that task is easier than the other tasks they excel at. Praxis requires focused attention in order to conceptualize and plan the novel task. The child’s level of praxis will not be revealed until the child engages in a novel task.

 

A motor skill (or a motor pattern) is a task that is familiar and has been repeated many times to the point that the motor pattern has become programmed into their muscle memory. When this happens, the child can perform those motor patterns automatically. For some children, if an element of a familiar task has been changed i.e. a longer rope, a smaller ball, someone else joins in, the task is done in a new environment etc., this may be enough novelty where praxis is needed and the child may have difficulty performing the task or may simply refuse to engage in the task. 

 

One important contributor to the development of praxis is body scheme, which is a sensory-cognitive map of the physical self. Body scheme is developed through multisensory information with tactile and proprioceptive processing (sometimes referred to as somatosensory) being the biggest contributor to body scheme. Body scheme provides the child with physical safety to explore their environment, the ability to connect with the social world, to learn and develop motor skills, to refine movement, and influence regulation.

 

Issues with praxis may be referred to as motor planning issues or dyspraxia. Dyspraxia means difficulty with praxis even in the presence of normal intelligence and environmental opportunities. Somatodyspraxia means praxis issues that originate from issues with body scheme due to inefficient tactile and proprioceptive processing.

 

If praxis issues are present, it may take regular practice over a period of time to learn simple tasks and the child may need to re-learn the task on some level each time. Dyspraxia is easier to determine as occupational therapy services and programs are implemented since you often see this issue when the child is engaging in a novel task or engaging in tasks within a novel environment.

 

Dyspraxia can be addressed through sensory integration treatment and other sensory-based modalities.

Environmental and task modifications may need to be made at home and school to support the child while they build up their praxis skills. The child may also benefit from using cognitive strategies so they can better manage challenging tasks on their own. Lastly, engaging in a daily home program that supports the development of their sensory-motor skills is both important and helpful for long-term results.

The Just-Right Challenge


 

    Occupational therapists are known for using the term, the just-right challenge. The term was originally coined by occupational therapist, Dr. Jean Ayres, and later used in other occupational therapy frameworks. The just-right challenge means the activity we are engaging in is not too easy and not too hard. We don’t want our daily activities to be too easy. This leads to boredom, impedes our ability to learn new skills, and doesn’t create enough stress to build our resilience. If activities are too hard, this causes too much stress and lead to avoidance of the activity.

 

As we know, life does not always provide us with just-right challenges, but in the therapeutic setting, the therapist is attempting to create an environment that allows for a healthy level of challenge, that leads to some level of success and encourages the child to come back and try again. The therapist will then teach you, the parent, how to create these just-right challenges at home. Over time, as the child masters these just-right challenges, it teaches them to be more adaptable in all sorts of uncontrolled life situations.

 

Sounds easy enough, right? Well, it can be easy for us adults to identify what a just-right challenge feels like, especially since we have had years of experience life experience to guide us. However, it can be challenging to determine that for our children. Regular meltdowns, battle of the wills to avoid tasks, and other creative ways to avoid non-preferred tasks can really leave us adults scratching our heads about whether we are providing the right opportunities for success.

 

When making decisions about what activities we want to expose our children to, we will naturally wonder if we should select activities based on preference. It is important to know your child’s strengths and really highlight those! We all have a purpose, talents, and gifts. Put them in just-right situations and let them shine!

 

However, it is equally important not to avoid all activities that they don’t like. I can’t tell you how many times I have had a parent or a child tell me that they “just aren’t really a sports person”. In reality, the child was lagging in the fundamental motor skills to participate in those sports. Once we worked on these skills in therapy, some of these children ended up finding a sport they loved and went on to be really great athletes! Even if this doesn’t happen, trying a variety of activities gives the child information about their activity preferences, gives them information about what types of challenges they respond best to, and teaches them to move outside their comfort zone.

 

Let’s go through some pointers to help us learn to create just-right challenges for our children:

1. One important thing to remember is that what seems easy to you, the adult, is not necessarily easy for your child. Whether you are playing a board game or riding bikes together, you have done these activities (or similar activities) many times before. For your child, these tasks are all relatively new, so you want to keep a beginners attitude when playing with them.

 

2. Your child may not have the same interests as you! Now, this doesn’t mean they shouldn’t try an activity, but it is ok if they don’t share the same enthusiasm you have for a particular activity. The more pressure you put on them, the less joy they will find in the task.

 

3. Make a list of child’s strengths and weaknesses. In what situations do they thrive and in what situations do they struggle?

 

4. Determine how your child likes to be helped. Do they like you to be direct? Do they want your physical help? Do they get mad and tell you they want to try it themselves? Do they need more space? Do they need a little push into new things or to keep trying? Do they complain a lot, but then feel proud or happy when they succeed? Would they rather someone else like a coach or teacher help them?

 

5. When approaching non-preferred or difficult tasks, it’s best to break down the task into easy, manageable steps. Let the child feel confident with one aspect of the task before adding on the next step.

 

Example #1: When learning to jump rope, first lay the rope down and just practice jumping over it. Once they have that down, have them pick up the handles and practice jumping over the rope. When they can do that step, teach them to touch the handles up at the top of their head. And for the last step, have them swing the rope over their head for one full cycle of jumping rope.

 

Example #2: Your child is afraid to ride their bike. You have been pushing them to ride out onto the street, telling them it is not scary, encouraging them that they can do it. You see they can sit on the bike and even pedal the bike, but looking down that long sidewalk seems daunting to them. This is telling you, the challenge is too hard, even if it doesn’t make sense to you. You would make the challenge easier by practicing pedaling in the driveway. Then the next challenge would be riding to a cone you put out or a certain crack in the pavement. With each mastery, the child goes a little further, and eventually they can ride their bike throughout the neighborhood.

 

Example #3: Your child despises handwriting. They may cry and scream, refusing to participate. Once you get them to the table, they scribble on their book or do everything but practice making the letters. You might not know if they find the task boring, meaningless, or maybe it is really hard for them. You decide to cut a strip of the top row of letters on the sheet so there are less letters to practice and less visual information. Perhaps you decide to make the challenge more fun by offering them a wiggle pen to give them some tactile input. You might also show them how to make the letter, followed by having them trace the letter, and then asking them to make the letter on their own.

 

6. Just-right challenges add up! It might seem at times what you are doing isn’t making a difference or that it’s taking a long time to master a skill. However, all children benefit from persisting and embracing challenges. Remind your children of how far they have come and how far they can go.

 

7. Allow frustration and failure. These are ok things to experience and they will not hurt your child! I am not talking about extreme frustration and failure because that’s not just-right. It can be so hard to watch a child struggle, but when you let them experience a healthy level of frustration, you are sending them the message that you trust them, you believe in them, and that you are there supporting them while they figure it out. It’s very empowering to the child!

 

“Nature does not hurry, yet everything is accomplished.” -Lao Tzu

Michaela E. Gordon, OTR/L

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    Handwriting Without Tears

    Handwriting Without Tears  


    By Michaela Gordon, OTR/L

     

     

    My first several jobs as a therapist were in the school setting. One of my responsibilities was to teach handwriting to the students. I exposed them to many choices of pencil grips, papers, curriculum, and other strategies to help students improve their handwriting skills.

     

    I also was involved in educating teachers and other staff in these strategies so the students could use them on a regular basis. The challenge I found was that each classroom was using a different curriculum so the style being taught was not necessarily uniform. Children would report confusion with the styles being taught from one year to the next, including terminology that was being used to teach handwriting.

     

    The other issue that seemed to occur was their seating position. Some classrooms had children of different heights sitting at one table or children were provided with desks and chairs that did not meet their postural needs. This created less postural stability for children while trying to produce legible written work.

     

    Materials were also another issue as each classroom had different types of pencils, papers, and worksheets that did not meet every student’s needs and were not always age appropriate.

     

    After seeing all these challenges, I began to search for other avenues to teach handwriting. I had heard about Handwriting Without Tears and I decided to attend the Handwriting Without Tears conference. I thought the curriculum was excellent because it was developmentally based. The materials are user friendly and can be used with children with a variety of needs. I also like that the products are a reasonable price and the curriculum is easy for parents and teachers to learn.

     

    After getting trained in the HWT curriculum, I decided to also get trained in the Print Tool, which is a handwriting assessment. I feel this is a great assessment as it measures 8 components of the child’s handwriting and gives a clear picture of what aspects of handwriting need to be addressed. Once I completed both of these courses, I then decided to become a Level 1 Certified handwriting specialist. Handwriting Without Tears is the curriculum that I choose to use in combination with other therapeutic modalities.

     

    I am sure there are many parents as well as teachers out there that are wondering if technology will soon take the place of paper and pencils. Perhaps at some point this may happen. Electronics are becoming a means to provide children with information and to express themselves. However, the literature is indicating that there is still a need to learn and develop handwriting skills. According to a research review conducted by HWT in 2009, handwriting continues to be a primary tool for assessing children’s knowledge in the classroom (Feder and Majnemer, 2007). Another studied conducted by Marr, Cermak, Cohn, and Henderson (2003) indicated that children in kindergarten are now spending 42% of their fine motor time on paper and pencil activities during the school day. Handwriting skills are also important, as they are part of many state standardized assessments. In 2005, a handwritten essay was added to the College Board SAT. Graham and Harris (2005) did research that indicated that handwriting plays a major role in producing creative and well-written text.

     

    The review of literature done by HWT (2009) supports the structure of their curriculum. In 1996, the National Association for the Education of Young Children recommends that infants through eight-years of age learn best when the teaching methods are developmentally appropriate. The Handwriting Without Tears curriculum focuses on this with the variety of materials and activities i.e. making a person with wood pieces and other materials; drawing a person; coloring; pre-writing strokes; sensory-based materials (dough, chalk, sponges); and music. HWT curriculum also focuses on the biomechanical skills that are required for handwriting. Rosenblum, Goldstand, and Parush (2006) found that children that demonstrated insufficient posture, fine motor skills, and positioning were less proficient in handwriting than children that had sufficient biomechanics. A study done by Smith-Zuzovsky and Exner (2004) pointed out the connection between the quality of children’s hand skills and their seated position. The Handwriting Without Tears curriculum includes instruction in checking seating as well as activities to promote good posture, paper positioning, and writing utensil grip.

     

    The other question parents may have is how will their child develop good handwriting skills and who will teach them these skills? A 2007 national survey indicated that only 12% of teachers rated their formal preparation to teach children handwriting as sufficient. A study done by Graham et. al. (2007) suggests that professional development should be available to teachers in order to prepare them for handwriting instruction. Parents can seek out handwriting workshops in your area or seek out an occupational therapist to conduct group instruction with your child along with some of their peers. As cited in Medwell and Wray’s literature (2007), children that were enrolled in an 8-week handwriting intervention program produced more legible handwriting than their peers, with a 46% increase in the quality of written text. This literature indicates the importance of children receiving daily, supervised handwriting instruction.

     

    Parents can also seek out individual occupational therapy services to help their children develop age appropriate handwriting skills. The occupational therapy services can provide your child with a combination of treatments in conjunction with handwriting instruction. I have found when the child is responsive to treatment and the family has strong carryover of therapeutic activities, that not only does the child’s handwriting skills improve, but there are also improvements in their other sensory-motor and social-emotional skills. I have also found that teachers are able to provide suggested strategies and materials to the students with good success. I have seen many children have great success with the HWT program and I look forward to continuing to help children develop stronger handwriting skills.

     

    Reference:

    Handwriting Without Tears-Research Review: http://www.hwtears.com/hwt, (2009)