SUPPORTING A DYSPRAXIC CHILD



                                                



Our body’s ability to conceptualise (think), plan and execute a movement in the correct sequence is called as praxis. Learning a new task and following all its sequential steps happens due to our motor planning ability. It requires person’s attention to highest level.In simple the terms, Praxis is "Doing".


We can frequently see infants doing motor planning to achieve developmental milestones. A child perceives, holds, and explores a rattle at 7 months, mouths it at 8 months and bangs it on different surfaces (table, floor) to hear various sounds after achieving successful grasping skills. 
Here brain first learns to hold the spoon then to put it in to the mouth and later banging. All these tasks need attention. More child learns to move his or her body in different directions, better is the motor planning which all happens during foundation years.
Consider, when we try a new recipe for the first time, how much attention is needed to follow all steps. We are conscious about ingredients, water, salt, baking duration and all the other aspects to make the perfect dish. 
The way we react towards above process is called as praxis. Our brain is learning a new task, therefore, we need to pay more attention as compared to doing it for a second or third time.

Planning involves conscious attention, therefore, praxis is connected to analytical and logical functions.

Different daily chores that we perform without thinking much demand

a lot of attention during childhood learning phase. Putting on clothes, holding knife or spoon, making a cup of coffee, doing laces or ties, time-telling are some of the examples of tasks which a person learns in early years with much focus, concentration and practice, however, once understood and practiced it becomes a neural memory for future times. On repeated practice, this task becomes Motor Skill.

However, a child with poor praxis will have difficulties in processing information, formulating ideas to planning, and execute any task on his own. A child with consistent poor praxis may be diagnosed as be Dyspraxic.
Features like clumsiness, avoidance of motor activities, lethargic behaviour, difficulties in learning new tasks, poor balance and postural control are prominent in children with Dyspraxia. 

An occupational therapist plays a vital role in completing the full assessment and planning direct intervention strategies for the child to overcome functional difficulties in day to day activities such as self-care, handwriting, dressing, PE). Encouragement, supervision, and consistent practice are key to teach any tasks, such as tooth brushing. Following all the steps in a sequential manner is important for the child to learn this task.

Children with dyspraxia often display difficulties in figuring out and remembering how to carry out a task physically. They may face challenges while performing an activity having a number of steps. Putting together steps is tough for them. Often children with sensory issues involving proprioception, vestibular, tactile and visual sense display praxis inabilities. Proprioception sense contributes in balancing, postural control, motor planning, motor skills. Children with sensory modulation issues face challenges in performing simple and complex tasks.

Let’s contemplate an example of poor motor planning, during one of my OT sessions, I asked a pupil to take off his shoes and sit on the mat. 

I got engaged in other tasks and observed him from another corner of a room. He untied the laces with hit and trial method and then stopped. 

I asked, “you okay Andrew?”

He politely responded, “what do I need to do now?”

The poor little lad did not have had the idea, to how to take off his shoe from the foot. His brain couldn’t do the planning, sequencing and execution of actions at all. The "doing part" needed for untying laces, pulling off the shoe from feet, and standing was missing.

Climbing and descending stairs needs complex motor planning and children with poor skill show anxiety to use staircase or escalators. Fear of falling or tripping makes them avoid stairway. Doing practice on climber frames is one of the ways to reduce anxiety. Making staircase of different size mattresses can be safe, appropriate and fun ways.


RELATIONSHIP BETWEEN MOTOR PLANNING AND BRAIN'S FUNCTIONING


Our brain has body “maps” which carry information about every body part
and its relationship to each other.

These maps help’s person to feel how his own body feels like when vision is blocked. It also tells what it is doing without looking at different body parts. For example, scratching our back when it itches or wiping face when it has dirt on it. Our proprioception receptors update these body “maps” (precepts) which helps the brain in sending messages to needed body part for further actions.
In above, face wiping example, the brain sends messages to elbow so that specific muscles can contract and relax to bend elbow joint and hand can go up to face to clean the dirt. Related hand muscles also contract and relax.

In children with poor motor planning skills the relationship between body actions and these “maps” do not work well. Due to poor functioning of body percept, a brain is not able to plan actions leading to poor motor planning.

This is the reason children with Dyspraxia are disorganised, forgetful and clumsy. Their brain is not able to do motor planning causing them not being able to judge speed, weight rate, the direction of any object or task. 

Moreover, these maps also contain memories related to environment such as gravity. For example, while sitting on swing we know our upper body is on swing however legs are swinging. Another common example is while swimming whether our body is in deep or shallow water. In both the situations, body maps help the brain to plan the movements according to the state of the body.

In conclusion, it is essential to understand child's difficulty zone, create child-friendly strategies and provide sensory, playful opportunities which involve her imagination abilities, creativity and motor planning skills.




INTERVENTION STRATEGIES FOR DYSPRAXIA:

A. HANDWRITING STRATEGIES: -

Handwriting is an important functional task for school-aged children and the primary way to express thoughts, ideas and knowledge, and emotions.
Here are some significant handwriting strategies with proprioceptive input.


Hand strengthening activities:

·        Use hole punch

·        Make orange juice using a hand juicer

·        Playdoh activities such as pinching pulling, hiding items in playdoh, kneading

·        Finger extension and finger spread exercises.

·        Hand Exerciser

·        Ask the child to write on a vertical surface followed with a horizontal surface.

·        Wax pencil

·        Games like bed bug,operation can be useful for young children

·        Use clipboard while writing for stability or clip the paper to a desk.

·        If the child moves the whole arm, shoulder, and elbows while writing than practice while lying on the stomach.

·        Propelling pencil can be used if children apply too much of force while writing. This may break the lead but wouldn’t create holes in paper.

·        Vibrating Pen

·        Use non-slip mat under the book to prevent slipping of paper.

·        Use reading ruler if child is dyslexic to reduce visual stress and as reading tracker

·        Thick (fat) pencils can be used as they make holding and writing easier

·        Sitting Alterations: If child has poor posture which is difficult to improve, try following options: -

·        Allow child to sit on floor

·        Wobble cushion


·        Bean bags

·        Workstations

·        T-stools: Should be prescribed by an OT as she knows how to make ergonomic changes and take measurements according to child's height and weight 


B. SELF-CARE STRATEGIES:

For the competent dressing skills at the age of 5-6 years onwards, a
reasonable sense of proprioception and body awareness are essential features along with an adequate sense of touch (tactile feedback).

It will be better to start with warm up exercises such as push- pull games, bouncing on the therapy ball, jumping on a trampoline, rolling on a mattress to increase sensory feedback.

Label child’s clothing drawer so that he can easily access clothes and garments.

Use large textured buttons for easier manipulations

Ask the child to see the mirror for visual feedback.

Place the clothes in a sequence night before school keeping garments on the top of other clothes.

Use bathroom checklists or visual checklists for ease.

Add a ring to zipper fastener so as to make it easier to grab hold of.


C. OT APPROVED GAMES FOR MOTOR PLANNING:




D. BALANCING ACTIVITES:

A child with Dyspraxia commonly display poor standing and walking balance as their sensory systems ae not supportive. Having inefficient proprioceptive, vestibular and visual systems can cause poor posture and balancing issues. Different activities such as walking, hopping, sidewalk, jumping, kicking a ball, running, dancing or riding a bike can be difficult tasks to carry out.

Activities:

  • Obstacle Courses.
  • Walking along a narrow beam or line marked on the ground – forwards, backward, sideways
  • Walking on different surfaces such as grass, concrete, foam, mattress.
  • Doing activities on balancing board or equilibrium board
  • Walking in a straight line.
  • Play hopscotch
  • Walking on toes and on heel
  • Follow a wriggly line – walk on the line or feet either side
  • Tunnel Games: Crawling in the tunnel is a fun activity.
  • Climbing Activities: Climbing frames, monkey bars, ladders, ropes or slopes.