Improving Functional Movement & Behavior

Addressing functional movement skills is important in children and adolescents with functional movement and behavioral challenges.  The FAB Goal-Plan-Review strategy promotes functional movement, behavioral, developmental, and learning skills.  Teaching children and adolescents to use adaptive strategies and equipment addressing dyspraxia (e.g., direction following, organizational, printing, cursive writing, keyboarding, and/or shoe tying difficulties) can improve behavior by reducing confusion and frustration.  Dyspraxia is now often referred to outside of the United States as DCD (“Developmental Coordination Disorder”).

The FAB Goal-Plan-Review strategy is adapted from the CO-OP (Cognitive Orientation to daily Occupational Performance), Ayres Sensory Integration, and Tools of the Mind approach.  These functional movement approaches span three decades and nations.  Research suggests that the CO-OP, Ayres Sensory Integration, and Tools of the Mind approach significantly improve functional skills but they appear most clinically effective when combined.  The FAB organizational strategies (see preceding Planning strategies improve behavior blog post) and FAB Goal-Plan-Review strategy integrate these three approaches to improve youngster’s functional movement and behavior.

The FAB Goal-Plan-Review strategy adapts the CO-OP (Cognitive Orientation to daily Occupational Performance) task-oriented approach by having clients develop a goal, plan a task, do the task, and review their performance.  The CO-OP approach is based on current motor learning research addressing dyspraxia by guiding clients in actively discovering adaptive techniques and generalizing them across functional motor tasks.  After doing the movement task clients review it with their therapist and revise strategies for improved performance.

The FAB Goal-Plan-Review strategy also adapts Ayres Sensory Integration by considering three components of functional movement (explained in parenthesis using the example of building with Playdoh).  The first component “IDEATION” is developing a physical movement goal (e.g., I want to build a snowman). The second component “MOTOR PLANNING” is developing a sequential movement plan (e.g., a. Make a large ball and place it on the bottom for a foundation, place a medium ball on top, then a small ball on the medium ball for the head; b. Make 3 tiny balls and place them vertically on the center ball for buttons; c. Finally on the head place two tiny balls horizontally on top for eyes, another tiny ball centered below for a nose, then several tiny balls in a concave circle below for a mouth).  The third component “EXECUTION” is the physical actions (e.g., building the snow man).

This ideation, motor planning, and execution framework enables therapists to observe whether a clients’ dyspraxia results from difficulties with ideation, motor planning, or both. To address ideation difficulties it is helpful to treat any related sensory discrimination and body image difficulties.  It is often also helpful to use touch prompts and/or massage strategies immediately before beginning motor tasks.  If the difficulty is in motor planning discussing, writing, and drawing the motor plan can be helpful.  The client can also try different motor plans and decide which works best.

Activities combining linear movement with deep pressure input can also promote motor planning and praxis skills.  Repetition of these movements in the functional environment is important for motor learning.  FAB Strategies involving slow linear movement and deep pressure that are embedded in regular school and home environments include: setting table, moving mats, moving tables, passing out books, and playground activities.

FAB Strategies also adapt the Tools of the Mind approach visual supports and modeling to teach self-regulation during functional movement tasks.  The Tools of the Mind approach, developed by a pediatric neuropsychologist to promote development of inhibitory control and planning skills, helped inspire the FAB: Goal-Plan-Review, List, Picture schedule, Praxis comic, 3 Comic, Schedule story, Rainbow goal, and Coping card strategies. The Tools of the Mind use of visual supports, self-talk, and modeling is particularly valuable for improving functional movement and behavior in children and adolescents with developmental challenges.

BEST Prax

Modern neurological and motor learning research suggests that repeated active practice in the natural environment as implemented in the FAB Goal-Plan-Review strategy is essential for learning.  A clinical example of the FAB Goal-Plan-Review strategy helps clarify its use with children and adolescents who have behavioral, praxis, and developmental challenges.  I worked with an adolescent girl who was low registration and had dyspraxia and Asperger’s Syndrome.  She repeatedly got injured while skate boarding and was upset that her parents would not let her go skate boarding by herself.  Her goal was to skateboard safely and independently.

While initially planning a skateboard obstacle course in the clinic, the adolescent seriously proposed skate boarding on the roof of the clinic.  I guided her with her parents assistance to ask and answer out loud the question “is that safe?” during ideation and motor planning of skate boarding and related movement tasks.  She was repeatedly reinforced for independently considering safety during her ideation and motor planning for skate boarding, and her parents eventually let her skate board independently without concern about her safety.  She gradually learned to transfer this questioning strategy “is that safe?” across her movement tasks.  In this way, the FAB Goal-Plan-Review and planning strategies help children and adolescents to improve their functional movement and behavioral skills.

References:

Ayres, A. J. (1985).  Developmental dyspraxia and adult-onset apraxia.  Torrance, CA: Sensory Integration International.

Dunn, W., Cox, J., Foster, L., Mische-Lawson, L. & Tanquary, J. (2012).  Impact of a contextual intervention on child participation and parent competence among children with autism spectrum disorders: A pretest-posttest repeated-measure design.  American Journal of Occupational Therapy, 66(5), 520-528.

Hillier, S. (2007).  Intervention for children with developmental coordination disorder: A systematic review.  The Internet Journal of Allied Health Sciences and Practice, 5(3).

Polatajko, H.J., & Cantin, N. (2006).  Developmental coordination disorder (dyspraxia): An overview of the state of the art.  Seminars in Pediatric Neurology,12(4), 250-258.

Rodger, S. & Brandenburg, J. (2009).  Cognitive orientation to (daily) occupational performance (CO-OP) with children with Asperger’s syndrome who have motor-based occupational performance goals.  Australian Occupational Therapy Journal, 56(1), 41-50.

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