Motor Control and Motor Learning

Adam ambulates independently and transitions from floor to stand independently. He prefers to push up from the floor with his hands or attempts to hold onto something or someone else, indicating poor postural stability. He can run but isn't able to skip or gallop. He does not jump with 2 feet from the floor. He presents with impairments in motor planning evidenced by his tendency to have difficulty initiating a task, which leads to frustration. He has marked difficulty and anxiety with new tasks. Adam uses a palmer grasp when holding a marker and a spoon. When he engages in writing he likes to have tactile prompts when initiating copying letters but can finish on his own. Overall, he could be described as uncoordinated.

The first new concept I will incorporate from this module is a motor control concept of random trials. The Mass article identifies random order as more effective than using a block order. Specifically, this uses variable training of skills versus rote practice of the same skill. I am going to try to have Adam write letters in a random fashion and then increase to writing words. First, I will start with flashcards of letters and then change to verbal instruction to recall letters. They will not be in the same sequence as I usually use, "a,b,c...". Also, Adam enjoys various climbing activities such as climbing onto our mattress pad with assistance. Another concept that will be incorporated is decreased feedback. The Mass article reveals low-frequency feedback schedules facilitated better retention of skills. I will decrease physical assistance and feedback and then give him new challenges with climbing. For example, Adam will climb onto a large wooden box and then mattress pad or climb through tires, barrels and over other real-life obstacles such as pillows. The treatment strategies would incorporate motor control concepts of random trials and reduced feedback in a complex environment, tapping into intrinsic motivators in order to transfer skills to other environments.

Cognition, Perception, and Action

My initial evaluation was completed 6 years ago. I gave Adam the Peabody Developmental Motor Skills Test, used observation, and an interview with Mom. My comments indicate that he did not want to participate in some tasks on the Peabody. He received a score of poor for visual-motor and below average for fine motor, and was functioning at the 14-15 month level. It was recorded that he was ambulating, had not established hand dominance, used a palmer grasp for marking. Adam did not creep and used a wide base of support. He was following 1 step directions inconsistently.

His mother's biggest concerns were regarding his particular diet and sensory defensiveness. Noah was often in the high arousal mode. His mother's chief complaints now are eating vegetables, drinking from an open cup, and writing.

Perceptual: The treatments that I use to address these issues are writing tasks with concepts from Handwriting Without Tears. I need to break down the task as he copies alphabet letters. He often requires tactile prompts to initiate.

Movement: Adam works on climbing on different surfaces, creeping, and getting into various swings in order to address motor planning, coordination, and body awareness through proprioceptive activities. He enjoys this.

Cognitive: I work on incorporating cognitive skills into tasks. I encourage Noah to communicate his needs, recall previous information, and follow directions. I work on preparing him for the next activity such as drinking or eating. Since this class I have used the token system to complete drinking. Family is also using this system at home. He is now drinking 4 sips from an open cup at home, which is a huge success for him.

3rd post-enviornmental complexity

Adam has challenges managing environmental complexity. He becomes easily overwhelmed with noise, change in schedule, emotional responses, challenging tasks, and unpredictable situations and variables. He is accustomed to a fairly routine schedule with limited outside events due to home schooling. Adam manges novelty by self-stimulation such as hand-flapping, running away from the stimulation, or tuning into the TV. Adam's ability to process and respond to environmental complexity depends on his state of modulation. If he is attending to the situation and not in high arousal state he is better able to deal with changes in the environment. According to Miller-Kuhaneck(177) it was reported that children with executive functioning impairments have a great deal of difficulty with combination of activities, new activities, and changing activities. Looking at Adam, it appears relevant and explains why he may use his self-stimulation techniques. Due to his inability to predict, analyze, and adapt he resorts to comfort measures. Adam responds well with priming, which I have recently utilized to a higher level, so he knows what is expected and functions the best in a predictable routine world.

2nd post-behavioral strengths & challenges and communication strengths

Adam's behavioral strengths are that he responds well to reinforcement, the token system, prompting, and peer mediated intervention from his brother. He displays good perseverance when he engages in an activity he is interested in. He is able to follow simple 2-3 step directions depending on the request, displaying functional receptive language, has a good attention span, and cooperates approximately 75% of the time. He follows the rules unless over stimulated by therapy requests. In addition, Adam's verbal behavior from an OT perspective is that he has basic motor imitation, can mand for essential needs, intact echoic ability, able to tact, and has intraverbal skills on a concrete level of function. His behavioral challenges include inability to regulate between bothered and highly irate. He tends to become irritated and is unable to find the middle ground, resulting in a melt down. Adam is challenged by transitions and changes. These verbal behavior terms are from the the classroom lecture April 21, 2009.

Adam's communications strengths are that he is verbal, fluent, and articulate. He can express his basic needs. Adam often repeats phrases from the TV or video games even if they don't pertain to the current conversation. He does not require PECS or sign language to communicate his desires. He varies his intonation only when he is frustrated or really excited.