.......Tomatis Topics

M otor planning or Praxis is the next level of sensory integration that is imposed on a foundation of sensory registration and regulation, and sensory integration and body schema. Praxis is the ability to self-organize. It is the ability of the brain to conceive, organize, and carry out a sequence of unfamiliar actions. Dyspraxia means a reduced ability to carry out non-learned movements, despite adequate motor and conceptual capacity. Praxis is believed to be a single function involving several basic processes. The first is ideation or generating an idea of how one might interact with the environment. Next is the organization of a program of action that includes the correct sequence and timing of the steps involved. This is the process most accurately referred to as motor planning. The final process is the execution or the actual performance of a motor act.

We need praxis in order to develop higher-level skills. It is after the infant moves beyond the 'hard wired' functions of sitting, standing, walking and babbling that praxis is called upon. These innate functions occur without praxis. Once the baby moves from sensory motor play (banging the rattle) to more purposeful play (putting the rattle into a cup), he starts to rely more on praxis. He needs to have and idea (ideation) of what he wants to do; he needs to have a plan (organization) of how he will sequence and time his movements; and finally he needs to perform (execute) the action. When we have adequate praxis for successful behavior, we can adapt effectively to our environment. The better the baby is able to do this, the more successful, or adaptive, his interactions will be. It is through successful sensory motor interactions that we develop responses that lead to further and more advanced interactions with our environment. All of this, of course, is dependent upon good sensory integration and a good body schema.

Testing

T hus, motor planning or praxis is the ability of the brain to conceive, organize, and carry out a sequence of unfamiliar actions. In dyspraxic syndrome there is a reduced ability to carry out non-learned movements, even though there is adequate motor and conceptual capacity to do so. Difficulty with imitative behavior is a key indicator of dyspraxia necessitating that children organize themselves cognitively, rather than perform tasks automatically. This often becomes a source of frustration for them.

Motor planning difficulties can manifest on a larger scale in the child's difficulty in organizing their environment and themselves in that environment. Learning routine and how one fits into the routine may take longer. Children with difficulties may perform slowly, or not be able to perform at all, when asked to follow multi-stepped directions. They may require a longer exposure to a new activity in order to learn it. They may initially use trail and error approaches to a task until they can generate a motor plan about how to approach the activity. This can also carry on to higher levels of reasoning. They can have difficulty organizing their thoughts and language to express themselves.

Understanding the particular sensitivities of a child not only helps explain some of the child's behaviors, but also helps caregivers and professionals determine better ways of interacting with the child. For example, a child who stringently avoids eye contact may need to use all his energy to concentrate on what is being said to him. Instead of insisting on eye contact, a caregiver may find better results from bending down and speaking gently into the child's ear.

Participation

P atterns of Early Sensory Integration Disorder: While no two children display exactly the same sensory issues, it is often helpful to you as parents to know that there are other children demonstrating patterns of behavior similar to that of your child. In other words, if you have a child with sensory integration difficulties, you are not alone. Here are some of the ways in which Sensory Integration Disordder manifests itself:

Example Patterns of Early Sensory Integration Disorder Early gross and fine motor skills develop as expected. Difficulties tend to appear later with the introduction of more complex motor behavior such as climbing a jungle gym or nesting cubes. Use of utensils may present a problem, and manipulating things such as buttons and zippers may prove impossible. There are, however, children who display advanced motor skills. These are the children who climb everywhere without apparent judgment (though they never get hurt). They are also the children who figure out how to work the VCR or computer at age two. Certain areas of development may excel while others lag way behind (such as language).

Children may also be over or under sensitive to tactile stimulation. Some children are so sensitive to light touch that routine self-care becomes an overwhelming proposition. They fight having their hair cut or washed as though it caused them significant pain, yet the same child may fall down, scrape a knee and get up without skipping a beat. For this child the band-aid is worse than the cut. Children may also be under reactive (sometimes the same child), and crave certain types of touch that provide deep firm pressure. Often the children hate "yucky" textures and want their hands cleaned immediately after touching textures such as finger paints. Children may also be over and under reactive to vestibular input. Some children may crave lots of intense spinning, jumping, or running back and forth. Other children may fear movement, clinging to their parents whenever their balance is challenged. Both extremes indicate some inadequacy in vestibular processing.

Benefits

O ver and under reactivity can also been seen in the visual system. Too much visual stimulation may be overwhelming to the child. On the other hand, some children may be fascinated with certain visual stimuli such as watching spinning objects or vertical/horizontal lines. Some children have very advanced visual memories such as learning a complex puzzle after only seeing it once. They may rely on a strong visual system to compensate for a weaker auditory system.

The auditory system may present with the same mixed reactivity. Commonly, one of the first things parents reports to us is that their child, 'tunes them out when his name is called from right behind him, yet comes running when his favorite video is playing three floors below.' Though it is hard to believe, this selectivity of response is not really under the child's control. Another common symptom is sound sensitivity. Certain machine sounds such as the vacuum cleaner or the blender may be very distressing to one child, while another child may crave these sounds, placing his ear to the vacuum cleaner.

The auditory stimulation and sensory integration techniques can help individuals with Sensory Integration Disorders by making it easier for them to process and integrate sensory information. By helping these children reach a more regulated state of calm alertness they become more available for learning. Children whose systems have been striving to shut out sensory stimulation become more relaxed and better able to connect to those around them. Most children with Sensory Integration Disorder are working much harder than their peers to accomplish the same things. There is a tremendous experience of relief as things become easier, leading to an improved sense of self-esteem. Their bodies are now able to keep up with the things their brains are able to conceptualize.

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