Unit I - Dyspraxia

Question 1

apraxia

Answer 1

impairment in the ability to accomplish previously learned and performed complex motor actions

Question 2

developmental dyspraxia

Answer 2

failure to have ever acquired the ability to perform age appropriate complex motor actions

Question 3

disorders of praxis (older taxonomy)

Answer 3

dyspraxia
bilateral integration and sequencing
somatodyspraxia

Question 4

bilateral integration and sequencing (BIS)

Answer 4

a type of dyspraxia in which there is evidence of deficits in vestibular and proprioceptive processing.
o For deficits in BIS to be considered sensory integrative in nature, they must be accompanied by evidence of poor sensory processing (generally vestibular proprioceptive sensations)
o Mild form of praxis disorder
o Problems with coordinated use of 2 sides of the body
o Deficits in performing sequences of movement
o Daily tasks
 Confusion of right-left
 Poor lateralization of hand function (no hand dominance)
 Avoidance of midline crossing
 Poor ability to skip, do jumping jacks or stride jumps, or catch and throw a ball
 Handwriting deficits
 Difficulty using scissors

Question 5

somatodyspraxia

Answer 5

• more severe
  *evidence of poor tactile processing, and may have deficits in vestibular and proprioceptive processing
  o poor motor planning of both anticipatory, feed forward-dependent movements, and actions that depend of sensory feedback
  o child has difficulty with planning the same kind of tasks problematic for children with BIS deficits as well as some additional, generally easier tasks.
  o Daily tasks
   Delays in acquisition of self-care skills
   Poor organization
   Difficulty manipulating and assembling toys
   Poor social relationships with siblings or playmates

Question 6

clinical presentations of dyspraxia

Answer 6

behavioral issues, clumsiness, poor fine motor skills, delayed ADL skills, poor performance in timed tasks, poor self concept, decreased play repertoire, poor play skills

Question 7

3 areas defined in praxis activities

Answer 7

1. ideation
2. planning
3. execution

Question 8

ideation

Answer 8

conceptualizing an action
• Likely a cortical function
• The prefrontal cortex is involved in the process
• Plays a major role in setting goals for complex, goal-directed sequences of movement, especially in novel situations

Question 9

planning

Answer 9

• setting up the activity
  • The premotor and supplementary motor areas play key roles in planning of movement.
  • Involve translation of a movement strategy into action
  • Proprioceptive input plays a key role in motor planning – sensation of movement (ie. speed, rate, sequencing, timing, and force) and joint position. Provides a child with a “map” of where the body is in relation to objects in the environment

Question 10

execution

Answer 10

the ability to successfully complete and finish the task
• The primary motor cortex play a key role in motor execution and voluntary action
• Information from the primary motor cortex is transmitted to the muscles for execution via the corticospinal and corticobulbar pathways.
• The cerebellum also has a major role in execution of coordinated movement
• The basal ganglia is most important in completion of movement sequences

Question 11

Dyspraxia in the pre-school child

Answer 11

• May not be able to run, hop or jump.
• History of delay reaching milestones e.g. rolling over, sitting, walking and speaking.
• Appears not to be able to learn anything instinctively but must be taught skills.
• Poor at dressing.
• Slow and hesitant in most actions.
• Poor pencil grip.
• Cannot do jigsaw or shape-sorting games.
• Art work is very immature.
• Has no understanding of in / on / behind / in front of etc.
• Unable to catch or kick a ball.

Question 12

Dyspraxia in the school age child

Answer 12

• All the problems of the pre-school child may still be present with little or no improvement.
• PE is avoided. Coordination difficulties can be particularly problematic in physical education classes and other sports activities.
• Child does poorly in class (group) but significantly better on a one-to-one basis.
• Attention span is poor, and the child may react to stimuli without discrimination.
• May have trouble with math, copying from the blackboard.
• Writing is laborious and immature.
• Unable to remember and / or follow instruction.
• Generally, poorly organized.
• Commonly anxious and distractible.
• Child finds it difficult to keep friends or judge how to behave in play situations
• Difficulty doing fine-motor activities such as tying shoelaces or buttoning clothing
• Poor sense of direction

Question 13

Teenagers & Adults

Answer 13

The challenges presented to adults with dyspraxia can be seen in all aspects of everyday life. Difficulties can have an impact on:
• Driving
• Completing household chores
• Cooking
• Personal grooming and self-help activities
• Manual dexterity needed for writing and typing
• Speech control - volume, pitch and articulation
• Perception inconsistencies - over- or under-sensitivity to light, touch, space, taste, smell.

Question 14

Dyspraxia Goals:

Answer 14

 Improve registration and integration of sensory input as it relates to the praxis deficit
 Increase awareness and strength in muscle synergies, develop mature postural control
 Develop adequate body scheme
 Increase complexity of play
 Enhance ideational skills
 Improve constructional skills
 Improve organization of behavior
 Improve sequencing and timing

Question 15

Treatment Strategies May Include:

Answer 15

 Progress from activities that require simple, discrete movements to those that require more complex movement sequences (ie. play on 1 piece of equipment then play on multiple pieces of equipment, grade up play on 1 piece of equipment).
 Develop praxis in the context of play (tap into child’s inner drive)
 Help child remember strategies that were successful, talk through ineffective strategies
 Help child to slow down, think about plan before executing

Question 16

Key Words/ “Catch Phrases” of SI Intervention

Answer 16

 Modifying the sensory environment
 The context of play/ “buy in”
 Child-directed
 “Artful Vigilence” by the therapist – careful perception of the child’s state of being
 the “just right challenge”
 Eliciting adaptive responses
 Tapping the child’s “inner drive”
 “Scaffolding” – how a therapist adjusts and controls task elements that are beyond the child’s current skills

Question 17

core elements of SI intervention

Answer 17

1. Provide sensory opportunities
2. Provide just-right challenge
3. Collaborate on activity choice
4. Guide self-organization
5. Support optimal arousal
6. Create play context
7. Maximize child’s success
8. Ensure physical activity
9. Arrange room to engage child
10. Foster therapeutic alliance

Question 18

state of arousal during treatment

Answer 18

1. Womb – Full body physical contact. Child seeks containment, low lights and sounds, minimal motion, full body flexion. The child may escape to a “womb” space to regroup and “get it together”
2. Mother – Any task that gets or gives nurturing from another person, stuffed animal, pet, favorite toy. This is the child that brings favorite toy or blanket to therapy and has difficulty separating from it. Allow the child to keep the nurturing item or stay near mom until he/she is able to separate without distress.
3. Kid Power – Child displays some risk taking and physical competence. May need some physical assistance from the therapist for sequencing, planning, or physical completing of the activity.
4. Brain Power – Child displays problem solving and creativity. The child is able to participate in complex social interactions. Can plan and execute motor activities without assistance.