by Maude Leroux | Aug 2, 2017 | Praxis
I had the occasion this past week to watch a BBC documentary that was really amazing and the story was for every parent out there that has a child with Sensory Processing Disorder. It is the story of an older gentleman who woke up one day to find that his total sense of proprioception was gone. He had no idea how to feel movement and literally felt completed disabled in his ability to use his body. All of his muscles were there, he had the joints, but the brain had lost all sense of “feeling” movement and therefore the body could not be commanded to move.
So many times I have found myself trying to explain to families what it really feels like for their child. I would say to them things like: If your child gets his arm in the sleeve, he has no idea how to produce the arm to get to the other side. As soon as his eyes could no longer see his arm, he would be unable to produce the movement forward. So many children come to us with the label of being a “visual learner” or the parent would say that before their child engages in a new and novel activity, they would first watch with their eyes before making a decision to join or not. When we do Interactive Metronome testing, it very frequently is the exercises with “both heels” that are the worst score because these are the only tasks on the test where the child cannot see where the trigger is located for them to reach.
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The main character in this documentary decided he was not going to give up on life and figured out how to use his vision to plan his movement forward. He re-taught himself to walk by using compensatory vision and went further to add gestures to his communication. It is an amazing story and one of great dedication and hard work. He finally got to scientists who wanted to figure out what this meant. With brain scans they found that when he engages in movement his right occipital lobe lit up very strongly, showing a lot of hard work in that area of the brain. I wish they had shown us the comparison of a person with an intact nervous system as a comparison, but I remember from multiple trainings that several areas in the brain are supposed to light up, crossing over into the parietal and temporal lobe.
Bottom line is that these children have to work much harder than their peers to accomplish anything with their body and they frequently get labeled as a “behavior” problem with no acknowledgement whatsoever to the strength and determination they are using to cope with every day activities.
The scientists were astounded by the amount of work that had to occur in the occipital lobe to achieve what this man had done. He had the intrinsic motivation and drive to get beyond his difficulty. The documentary never went into detail as to the origin of “how” he may have lost his proprioceptive sense and they assumed it fell under the domain of “acquired brain injury”, which really meant that they had no hope for this sense to return again.
In children with developmental delay, who struggle with sensory processing disorder, this particular sense impacts greatly on the development of praxis or “motor planning”. The profound impact of this can be more clearly understood in watching this documentary, but in essence it means that when one sense is not doing the job correctly, other senses have to step in and take over. And, as with this man, children have to work incredibly hard to do it. Some children develop stereotypical behavior, that we call “stimming” or “ticks” when they seemingly involuntarily start moving their body. These are nervous system responses to a non-integrated nervous system. Other children want to crash and bang into things, will squeeze you too hard, will bite, pinch and hit hard in an attempt to feel, and because of their limited understanding, would not even know if they are hurting you. Others would even go into self harm as they attempt to simply just “feel” something and the more frustrated they become, the more they lose any gainful compensation and the desperation fuels further self harmful behavior. Others are more “silent” and simply avoid participation in any new and novel activity that they have not figured out with their eyes as yet and even then, they may decide the effort is too great. And so we have the trajectory of developing a praxis difficulty, more specifically called a somatodyspraxia.
Bottom line is that these children have to work much harder than their peers to accomplish anything with their body and they frequently get labeled as a “behavior” problem with no acknowledgement whatsoever to the strength and determination they are using to cope with every day activities. Thankfully, as this is seen under the category of developmental delay, it is not a brain injury, and lack of development in this system can be woken up with therapy. My heart goes out to all those children who have no idea that their bodies are reacting differently to life than their peers, who are trying hard to keep up even at the cost of frustration and behavior and whose self esteem is being attacked every day due this enormous insecurity in their bodies.
I am including a link to my facebook page so you could view the documentary directly from the post I made just a couple of days ago. Please watch it.
by Maude Leroux | Jul 4, 2017 | Praxis
A critical developmental skill on so many levels
I just finished a round of workshops and training in Singapore and Australia and taking the opportunity of a few days break in Perth, Australia while visiting family. Every day here I get to observe two typical girls (2 and 4 years old) play and simply take from life whatever they can. It is refreshing and I am also realizing how much time I spend on observing human behavior!
What is so very clear; is how much active problem solving is enjoyed by kids developing typically. When I pose a problem for the 4 year old (we will call her Caren), she looks up, makes eye contact and searches my face to see if she could find a non-verbal cue to solving the problem. When I pose a problem to Tanya (2 year old), she stops dead still and stares, gives me her most engaging smile and hops on my lap to solve the problem for her, perfectly trusting me to be up to the job.
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Both Caren and Tanya embrace the problem solving opportunities on different levels. Frustration is quick, but perseverance prevails. Even when we are not able to get to solve the problem before the “meltdown”, the turn around from being upset is fairly quick. It is also amazing to see how much longer they will stay with the problem solving if the adult remains engaged and supportive emotionally, even though not really doing anything physically. They will really keep trying and only get upset if the adult withdraws the attention.
They also create their own problems to solve and truly, anything goes! From wearing packaging bubbles on their heads, to figuring out how to really get at each other; and pushing each others buttons. As they go about their play, they literally are solving a new issue every 5 minutes. Each problem is yet another opportunity to answer a question, to engage in sequence, to figure out the steps, going from initiation to task completion.
And they do not need any rewards from anyone. Just attention, thank you very much, is all they seem to want. They look for validation, but they are not looking for extrinsic rewards. They want to intrinsically please themselves in playing or doing something. Just this morning they were engaged in making banana bread with their mother. Both cuties lined up at kitchen table, each with spoon in hand trying to figure out how to mash the bananas and of course each has to have their own ‘job”. Their inner drive is a sense of ownership which would be their own particular accomplishment. Even though our validation is reaffirming, they smile about what they have achieved before the adult has even said a word. This inner drive leads to the next explorative activity and then, the next.
It is also amazing to see how much longer they will stay with the problem solving if the adult remains engaged and supportive emotionally, even though not really doing anything physically. They will really keep trying and only get upset if the adult withdraws the attention.
It is also the simplicity that counts. I sat at the kitchen table and both had to squeeze into the tiniest corner at the side of my chair. I created a pretend idea of a “jail”. For Tanya it was a physical exercise of figuring how to get out. For Caren, it truly was the idea of a jail and being unlocked that grabbed her. Both were problem solving on their respective levels of development. What am I confirming?
- Children’s play is rife with opportunity of developing sequencing and imagination important for academic and social prowess later.
- Think before you do something for your child. They may really enjoy doing parts of tasks themselves, engaging their own self esteem and inner drive.
- They want us to be available and emotionally supportive, but not necessarily doing things for them.
Thank you Caren and Tanya!
Maude
by Maude Leroux | Oct 18, 2016 | Praxis
How do we know what children hear? How are they listening to our language? How do we know they are not responding due to not being able to sequence and use language in the right order, or not being able to plan a motor sequence? These are interesting questions, are they not? To answer them requires a certain amount of self-reflection, especially to ponder the multi-facets of children in all their wonderful ways, including the challenges.
Let’s first understand praxis and be sure we all carry the same understanding. Praxis entails multiple different components, built on several building blocks of foundation, which has to be accomplished in order to acquire the skill of praxis. As a definition, praxis contains the ability of the nervous system to ensure a timed, coordinated response from the motor system of the body, while also contemplating how the limbic system (emotions) feels about it. Without this function, we potentially feel helpless, as if we have no power, no way to enact upon this world and many times, the only recourse we have is the Amygdala in fight, flight, or freeze, because it does not require sequencing, simply a reflexive response. In fact, praxis is what gives us planful, executive behavior.
The real story is that it is all interconnected. With what we know as therapists today, we simply cannot intervene in a child’s life in isolation any longer.
Praxis is built on the foundation of having the ability to regulate (modulate) our different senses. If our nervous system is disorganized, it is very difficult to build planful behavior, as praxis requires a calm state in the nervous system. It also relies very heavily on our ability to discriminate with our different senses, so we know how hard to push a cart, how to feel what we hold in our hand, how we see the object in the distance we see it, and how we hear the instruction given to us. The ability to register information and process it to the brain to be analyzed, is the cornerstone upon which we can build constructive play that would contain purpose and meaning, and result in planful behavior. Without these building blocks, we will struggle to achieve the multiple forms in which praxis occurs. We need praxis to play!
The totality of praxis relies on first having a motor idea, initiating this idea, sequencing through the idea, and to culminate in completing this idea within the same timing and rhythm as our peer. As we complete the activity, our body also registers feedback that supports us to repeat that action. Feedback is important for self-motivated (intrinsic) repetition, such as you see the new toddler do when they pull themselves together after taking the first step to attempt the second step. An amazing process to watch unfolding in front of our eyes and no parent is more proud of witnessing this moment.
Which brings us to the thinking around language and praxis and their co-influence on each other. It is essential that we first consider non-verbal communication as therein lies much of the difficulty with our kids that also exhibit praxis difficulties. It is the primary job of the infant to cultivate increasingly complex non-verbal gesturing to support the meaning and context of what is to develop in verbal skill later. If the child is experiencing poverty in their ability to plan their movements, we have to consider the impact this would have on their ability to use gestures. It is a well-known fact that communicating a clear message depends 80% on your non-verbal communication to each other. It is what supports the meaning of context and without it, you become no more than a “talking head”. These children develop into kids who rely so much on facts and what they can grasp in black and white, that the underlying meaning, the different social nuances become lost on them. It becomes a sad world in which it becomes increasingly difficult to connect with others and no amount of social skills classes can replace the exquisite automaticity that this requires from our system.
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Speech Language Pathologists frequently discuss the language model proposed by Bloom and Lahey, which explains three components of language: Form, content and use. The Form of language is the tangible part. It consists of the phonology (sound), morphology (different morphemes in words), and syntax. It starts with single words, develops into two word phrases, adding plurals, and then culminates in the formation of sentence structure. This process is very reliant on sequencing, though there are two forms of sequencing available to the speaker. The sequencing that involves the body and timed execution of gestures simultaneously with speech is one aspect. The other form of sequencing is understanding logical order through the cerebral cortex with intelligence and utilizing memory to support development in language. So it is possible to use language and become a fluent speaker while still experiencing praxis difficulties in the body. This type of speech development though often is very bound to intelligence and though the speaker can maintain fluid speech on a topic, the speech might lack the prosody and tonality of voice modulation, and the rhythm of a back and forth communicative effort. Such persons may also have difficulties in social skills as the speaker has not developed the integration of gestural and verbal communication causing a lack of understanding in hidden and abstract meaning.
This brings us to content part of their model, which includes meaning expressed through words. In terms of language development, it also contains the development of action words, location words, and descriptive words. Children struggling with praxis have difficulty figuring out the “how to” of things and pairing physical problem solving with action words is a frequent technique to use in sessions.
The use of language is the third component of the model. The child has to understand why she is communicating, which involves an abstract formation of having meaning to communicate. Frequently parents are so proud of the words and sentences their child can repeat back or use when prompted. This expression frequently does not come from the place of meaning. Using language is one aspect, communicating with language is the fuller aspect. The sense of purpose and goal directedness behind her language is reliant on the building block of abstract formation and ideation, which is formalized through the use of sequential order.
The real story is that it is all interconnected. With what we know as therapists today, we simply cannot intervene in a child’s life in isolation any longer. Families need evaluations from both occupational and speech language therapists that understand this overlap, can assess it and can formulate a plan to build this in an integrative way for each individual profile. We need to bring a team around each child that will consider the different goals of the child in a way that would respect the child’s entire profile in order for her to become intrinsically motivated to turn towards learning and simply… fly!!!
Maude Le Roux, OTR/L, SIPT
by Maude Leroux | Mar 20, 2016 | Autism Spectrum Disorder, Executive Functioning Skills, Parenting, Praxis, Programs, Reading, Social Skills
For many years now I wanted to create a space for parents, therapists, teachers and psychologists to come together and discuss functional difficulties in the light of development. In our world today, the focus has shifted to more and more productivity and though I also believe being productive is a good goal, I really want to support the process to get to that goal. What does this mean? Simply that if a child understands the sequence of how to accomplish something and can execute it, the product will always be there.
Too much emphasis is being placed on behavior, when in reality the child’s behavior is a communication to us. We have to try to understand why a child chooses a specific behavior in a certain circumstance. At my trainings, I usually repeat the following statement a number of times: “If a child could, he/she would”. Once any one of us feels successful at something, we wish to repeat it again because it feels so good. The only reason we avoid certain activities is because that “feeling good” is absent or elusive and we have to find a way out of the situation.
Too much emphasis is being placed on behavior, when in reality the child’s behavior is a communication to us.
In this blog, we can cover a multitude of discussions on a variety of different topics. We can discuss modalities such as DIR/Floortime or Sound Therapy, but we are also going to be practical and discuss different behaviors and what to do about them. We can discuss the brain and what does a child need in order to achieve academically. How do we read and write? How do I get my great ideas out on written expression? How do we pace ourselves through an activity and know how much we can accomplish in a certain time? How do we mobilize a child to the next level of functioning? I will welcome case discussions and discuss sensory processing development alongside emotional processing development. Diagnosis is necessary, but not considered the most important aspect of every child. We can discuss kids on the autism spectrum; though also discuss children with Down syndrome, Cerebral Palsy, and yet other categories such as reading and learning disorders. What I do not know, we can research together, but the importance would lie in that we tie in theory with practice and be helpful in providing everyone ideas to collaborate upon.
I travel a lot to train others; so do not despair if sometimes I do not respond immediately. I will be there most of the time quite quickly, unless travel causes a delay in my response time. I would also like to make this blog about you. Your questions, your suggestions are going to spearhead the next pieces of information, so please comment, ask your questions. Together we can create a forum that would support all of us as a collective group.
So welcome again and let the games begin!
Maude
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