Dyspraxia Assessment Treatment & Therapy Service For Children With Special Needs Dyspraxia, Autism, Asperger Syndrome, Sensory Integration, ADHD, ADD
What is DYSPRAXIA? Dyspraxia is an impairment or immaturity of the organisation of movement.
Dyspraxia is an inability to carry out non-habitual interaction with the environment. e.g. new tasks.
Dyspraxia affects every aspect of life, i.e. behaviour, language, daily living skills, learning and movement.
What is meant by the term Specific Sensory & Motor-Learning Difficulties, [SpMLD]? A term used to refer to a heterogeneous group of dysfunctions manifested by significant difficulties in the development of motor planning & coordination, & in the acquisition & used of skills of listening, speaking, writing, reasoning & mathematical abilities.
These dysfunctions are intrinsic to the individual & are presumed to be due to minimal deficits in the CNS, [Central Nervous System].
Although a specific motor-learning difficulty can occur concomitantly with other disabling conditions, for example, sensory impairment, social & emotional disturbances, etc., or environmental influences, [cultural influences, insufficient or inappropriate instruction, psychogenic factors], it is not the direct result of these conditions or influences.
Children with specific motor-learning difficulties [Sp MLD] are normally of average or above average intelligence. They do not,
usually, respond to conventional teaching methods. They need to have specific interventions to develop / enhance basic skills & learning activities.
What is Praxis? Praxis is a uniquely human cognitive process.
Praxis is to the physical world what speech is to the social world. Praxis is the basis for organisation of behaviour. Praxis is the ability to think about, prepare and execute a response which is environmentally appropriate.
The ability to produce a new motor response
The ability to conceive, organise and carry out a response on command
To organise multi-adaptive responses.
Every action has a consequence and the preparation for this must be taken into account. Forward thinking, planning the sequence of movements and preparing oneself for the result ensure that movement can be coordinated in time and space. The body must be prepared to respond to the next stimuli.
Research has shown that the body makes a postural change 300 m.secs before an action takes place in preparation for the execution of that action.
When the stimuli is received, the brain activates CORTEX, RETICULAR NUCLEI, THALAMUS & CEREBELLUM [plus other nuclei as appropriate] to respond to that particular input.
Feed-forward / feedback mechanisms have to coordinate action with perfect timing & accurate sequencing.
They organise the visual fields & the visual control mechanisms.
The whole sequence is coordinated with appropriate feedback received from the PROPRIOCEPTIVE / KINAESTHETIC information.
PRAXIS IS THE END PRODUCT OF A GOOD SENSORY-MOTOR SYSTEM
Praxis enables us to put together the components of the physical world and of ourselves in order to act purposefully on that world.
It is the ability, by which we figure out how to uses our hands and body in skilled tasks, e.g. using tools, pencil, knife and fork, playing with toys, building a structure.
Practical ability includes three components:-
IDEATION - forming idea and knowing what to do.
MOTOR PLANNING - organising the sequence of movements.
EXECUTION - carrying out movement in smooth sequence.
Praxis enables us ‘to do’ in the world.
Practic ability develops from experience and increases in skill as the child matures.
Practic models are stored in the memory
Praxis is not dependent on good motor skills – it uses the motor system for execution of praxis.
For example : Difficulty using body in space (clumsy)
Poor fine motor skills, e.g. handwriting
Slow in dressing
Daydreaming – often late and forgetful
Temper tantrums – may cry fairly easily
Low self esteem
Avoids new situation
Vulnerable to distractions
THE SCREENING OF DEVELOPMENTAL COORDINATION DISORDER 'DYSPRAXIA'
A. DEFINITION Developmental - indicates that the problem begins early in the child's life & affects his development as he grows & not the result of a specific insult or injury
Dyspraxia - defined as difficulty in planning & carrying out skilled, non-habitual motor acts in the correct sequence [Fisher et al, 1991]
B. DIAGNOSTIC PROCEDURES
 Criteria for Diagnosis *Average or above average intelligence
*Not due to other handicapped conditions [e.g.. sensory impairment, etc.], social & emotional disturbances or environmental influences, [e.g. cultural differences, insufficient / inappropriate instruction, psychogenic factors]
*These dysfunctions are intrinsic to the individual & presumed to be due to minimal deficits in the central nervous system
 Other Related Terms Clumsy child
Minimal brain dysfunction
Sensory integrative dysfunction
Emotional & behavioural difficulties
Attention deficit [ADD] & hyperactivity disorders [ADHD]
Specific motor-learning difficulties
 What Test to Use ? The ICD-10 recommends an "individually administered standardised test of fine and gross coordination" [WHO, 1992]
WISC holds the standard for reliability in the cognitive domain.
Movement ABC [Henderson & Sugden, 1992]
Bruininks-Oseretsky Test of Motor Proficiency [Bruininks, 1978]
~ Together probably comprise the most frequently used standardised tests,
~ None enjoys the status of the WISC with its supportive data base, accumulated from very extensive usage
~ Not all validated to UK norms !
 How to differentiate between normal & impaired performance?
The ICD-10 recommends: " The score on a standardised test of fine or gross motor coordination is at least 2 standard deviations below the level expected for the child's chronological age" APA 
The absence of full scale epidemiological surveys which provide reliable incidence figures means that there is not real consensus on the way that test scores are distributed across the community and what cutoff points are most valid.
However, even when the same tests are employed, different levels have been used to differentiate between normal and impaired performance.
In the medical profession the 10th centile is often used as a cutoff point, below which children are designated as "impaired".
[Psychologists & Educators often opt for the higher value of 15%]
 What Tasks to Include in Assessment? Performance on many movement tasks can be easily measured and age norms are available.
Other tasks capture performance well but are extremely difficult to measure, e.g. tying laces, button fastening, etc.
So decision needs to be made as to whether require it is important to :
* Measure of outcome [speed, accuracy of performance]
* Consider quality of performance
The Role of Therapy in Praxis Limited for a Child with Dyspraxia / Sp MLD
The Therapist is trained to deal with different disability conditions of different age ranges.
Therapy in Praxis Limited plays an important role in helping a child with SpMLD to develop optimal motor coordination, perceptual function, learning abilities, organisation of behaviour, emotion and behaviour & independence in basic skills for independence, by tacking the basic dysfunctions & developing specific strategies.
The Therapy in Praxis Limited assessment process includes a comprehensive assessment & specific programme planning for effective treatment intervention.
Therapy in Praxis Limited will use different evaluation procedures including standardised assessments in order to identify a child’s major underlying dysfunctions :
Handwriting & Graphomotor Skills
Emotional Development, Confidence Behaviour
Behavioural Organisation for Learning
-feeding & drinking
- washing & bathing
-community management & skills
Play & Learning
All aspects of Speech & Language Development
The accurate interpretation of the assessment result is the most important prerequisite for the effective planning of any therapeutic intervention [therapy].
Therapy in Praxis Limited will adopt a variety of treatment approaches in order to provide a comprehensive service for the child with specific motor-and-learning difficulties—Sp MLD, ‘dyspraxia’, ‘DCD’ - Developmental Coordination Disorder.
Typically the Therapist may use a sensory motor approach, perceptual motor training and sensory integrative therapy, a highly specialised treatment approach used specifically by a postgraduate trained Therapist in sensory integrative evaluation and analysis.
Sensory Integration is a neural process whereby information from one or more sensory sources is sorted, organised and altered in such a way that an adaptive response is produced for motor, cognitive and emotional growth.
The Therapist facilitates sensory integration by applying neurophysiological and developmental principles through purposeful activities. This is based on the research and theoretical principles of A. Jean Ayres and other specialists in the field.
The philosophy and methodologies particularly of Occupational therapy support the therapeutic uses of ‘activities’ to facilitate and carry over the effect of Therapy.
A therapy session is carried out on an individual basis and a home / school programme integrated into classroom / PE activities, where appropriate and as prescribed during the assessment in order to carry over the effect of therapy.
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Registered Office: Therapy in Praxis Limited. PO Box 90, York, North Yorkshire, YO62 6YE. Registered in England 3841429