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Motor planning is often referred to as praxis, but a more accurate definition of praxis is the organization of the self. This definition encompasses motor skills but also extends to cognitive tasks. Insofar as it relates to motor function, praxis allows us to appreciate and carry out the step-by-step nature of many motor activities, as well as make inferences about new tasks based on similar ones already experienced. Most young children demonstrate this ability from an early age, organizing their actions with a purpose in mind.
Although blocks may be scattered on the floor and people may be moving around, most children would be able to physically negotiate a busy room without any difficulty. The reason they are able to do this is because they have a motor planning ability. At a certain age they recognize when to tiptoe carefully and can generally maintain such control over their body. Dyspraxia describes what happens when a child does not possess praxis and lacks the coordination and physical organization necessary to perform basic motor tasks as easily or successfully as others of the same age.
Praxis is possible through a three-step process: ideation (understanding the task), organization (planning how to perform the task) and execution (carrying out the task). People who have dyspraxia may have problems with ideation or organization, both of which are dependent on effective neural (brain) processing. Ideal motor development involves learning through motor planning, then automating movements so that new ones can be learnt. Individuals with dyspraxia expend so much energy planning their motor tasks that it takes a long time to learn them well enough to make subsequent tasks easier.
People with dyspraxia often find it very difficult to learn physical movements and adapt them to different situations – even when the movements are learnt, they are often executed without confidence or coordination. The motor difficulties experienced by individuals with dyspraxia are not a result of physical deficits. Dyspraxia, like many developmental disorders, is neurological in origin – that is, it has its basis in the brain. The brain is a network of neural connections that allow us to process the information we receive. Dyspraxia is a result of weak or disorganized connections in the brain, which then translates to difficulties with motor coordination.
Movements are performed because the brain sends messages to the area requiring action. The more often certain movements are performed, the better developed the neural pathways become, and pretty soon the most common applications of this system (such as moving the mouth to produce speech) become almost automatic. Dyspraxia is a result of weak or poorly structured neural pathways to the mouth (oral and verbal dyspraxia) or other moving parts of the body (motor dyspraxia).3 Some children only have verbal dyspraxia, while others only have motor dyspraxia. It is not uncommon for both types to be present in the same person.
While dyspraxia describes physical coordination difficulties, the associated problems are not limited to this sphere. Dyspraxic people also tend to have poor organization of thoughts and an inability to integrate sensory information to form an appropriate physical response. For example, most children at a Wiggles concert will be able to copy the actions of the people on the stage and dance along to the music. A child with dyspraxia would not know how to move his or her own body in imitation, even though the actions are very simple.
Dyspraxia can also affect language and speech development, as manipulation of the mouth requires fine motor coordination. As a child develops, language becomes increasingly more complex and the rapid sequencing of the tongue and jaw must also be coordinated with breathing. Dyspraxia compromises language skills, which in turn impacts on academic, social and emotional development. This often, but not always, occurs alongside general motor difficulties.
One of the most common symptoms of children with dyspraxia is messy handwriting which is a result of poor fine motor coordination. Similarly, the clumsiness and tendency to fall down are a matter of poor balance and gross motor coordination. People with dyspraxia also tend to have an overly sensitive tactile system that causes them to perceive the most benign touch as unpleasant. They may have a very low pain-threshold or have an automatic reaction of fear – tactile defensiveness – when touched. This is a result of a sensory integrative dysfunction which describes a problem in the way the brain interprets information received from the senses. This problem, like that of coordination, originates in the vestibule – an organ located in the inner ear. All sensory information is transmitted to the vestibule before being sent to the cerebellum, the part of the brain associated with movement.
Dyspraxia produces a variety of symptoms, many of which seem unrelated or untreatable from the same point. Research has shown however that many of the difficulties experienced by children with this disorder can be traced to the workings of the inner ear and the auditory system.
Dyspraxia is characterized most obviously by its effect on motor skills. As it happens, balance and coordination are governed by the vestibule, one of two organs that comprise the inner ear. The vestibule uses information transmitted by the muscles and knowledge of the gravitational forces acting on the body to maintain physical equilibrium and balance. The vestibule is located beside another organ called the cochlea which acts as a sound receptor.
Although they attend to different information, the proximity of the vestibular and cochlear systems allows them to complement each other. The other consequence of their relationship is that if one system is weak, the other may be concurrently affected. This may explain why children with dyspraxia often have difficulties with auditory processing and sound reception and why their language skills tend to be below average.
All sensory systems develop with reference to the vestibular system. The vestibular system is functional by 16 weeks in utero, and sends its messages directly to the cerebellum (the part of the brain concerned with movement). Once the auditory system is fully functional, the other undeveloped sensory systems send their input to the vestibule for analysis and it is here that sensory integration (or sensory organization) takes place. It is through movement that a child develops postural control as every movement stimulates specific neural connections. The more often a specific neural pathway is activated, the stronger and more automatic it becomes11 but this cannot happen unless the vestibule is operating normally.
There seems to be universal recognition that dyspraxia requires a multifaceted approach for effective management. No one explanation or therapeutic approach will address all the problems associated with developmental conditions, and holistic interventions are highly recommended.
Developmental Movement Exercises addresses the shortcomings of the vestibular system by encouraging the development of mature reflexes, while the Auditory Integration Listening Program delivers specially modified music designed to stimulate the auditory system and pathways and strengthen neural connections from the auditory system to the brain.
The systems targeted in Developmental Movement Exercises are those involved in learning through motion. Motion or movement is detected by the tactile system, the auditory system, the visual system, the vestibular system (balance) and the propioceptive system (body position). DME usually involves following a sequence of sensorimotor activities centred on these sensory systems. Most commonly the program involves energizing tactile stimulation, vestibular or auditory activity and propioceptive stimulation which is followed by fine and gross motor activity. Developmental Movement Exercises can be thought of as a movement program that guides the child through the earliest stages of developmental reflexes.8 It is, in a sense, the reliving of the experience of sensory development so that the primitive reflexes are revisited and overtaken as they ideally would have been during the child’s infancy.
A perfectly functioning ear does not guarantee a perfectly functioning auditory system. Sensory systems should not be purely thought of as abilities to hear, see, feel, smell or taste in isolation of each other. Our senses are only useful when the connections from the organ to the brain are operating normally.
The rationale for using the Auditory Training Program in conjunction with Developmental Movement Exercises draws on the assumption that all types of dyspraxia stem from the same source. Instead of addressing each area of impaired functioning as unrelated, the Auditory Training Program aims to strengthen auditory pathways while the exercises in DME revisit motor development as it ideally should have been experienced and as both regain a more effective level of operation, language skills and motor coordination advance together. These two forms of therapy strengthen neural connections essential for motor skills and auditory processing, both of which contribute to an improved level of functioning.
In order to recommend the most appropriate intervention it is necessary to attend an assessment at the centre.