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Condition
 

The root word is praxis which is Greek for an act, work, or deed.

"Dyspraxia is an impairment or immaturity of the organization of movement. Associated with this there may be problems of language, perception and thought." ( Dyspraxia Foundation , UK )

'Developmental Dyspraxia' or 'Developmental Co-ordination Disorder' is used to describe youngsters who have co-ordination difficulties and who also show significant perceptual problems.

Children with Dyspraxia may be able children with bright enquiring minds. However, listening to instructions and remembering them is very difficult, so children with dyspraxia may require a high level of verbal feedback to help with retaining the information. Dyspraxia can also affect language and speech development, as manipulation of the mouth requires fine motor coordination. As a child develops, language becomes increasingly more complex and the rapid sequencing of the tongue and jaw must also be coordinated with breathing. Dyspraxia compromises language skills, which in turn impacts on academic, social and emotional development. This often, but not always, occurs alongside general motor difficulties.

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The precise cause of dyspraxia is unknown. Research has it that the difficulty with planning, which is the primary symptom of dyspraxia, is owing to disruption in the neural pathways for the transmission of instructions from the brain to the limbs. The risk factors may include premature birth, difficult delivery, pre-natal issues and family history of dyspraxia or other developmental conditions.

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Some of the features seen in children with Dyspraxia are:

In the pre-school child:

  A history of lateness in reaching developmental milestones such as sitting, walking,    speaking, etc.
•  Physical co-ordination so poor that the child cannot run, hop, jump, play with a ball,etc. in    an age appropriate manner
•  Poor pencil grip
•  Significant difficulties with jigsaw puzzle, shape sorting games, construction toys, etc.
•  Very immature artwork
•  Difficulty understanding of positional concepts such as in/on/behind/in front of, etc.
•  Tendency to be anxious, excitable and easily distracted
   Difficulty in keeping friends or judging how to behave in company .

In the school-age child:

•  Poor attention span
•  Avoids or is poor at P.E.
•  Performs poorly in group but significantly better on a one-to-one basis
•  Difficulty in following/remembering verbal instructions, or in following more than one     instruction at a time
•  Reacts to stimuli (auditory, visual, tactile) without discrimination
•  Problems with math, spelling and reading
•  Handwriting is slow, laborious and immature
•  Severe difficulties in copying from the blackboard

Symptoms of neurological immaturity, delayed language development, poor social skills, and lack of co-ordination cause isolation within peer group. Also, sometimes 'mirror' movements are observed in the limbs not directly involved in a motor act e.g. unnecessary arm movements while jumping or hopping or the left arm might make similar gesture when the right arm is throwing a ball. All this in turn leads to frustration, discouragement and lack of confidence, the child becomes an outsider.

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There are several types of dyspraxia including:

  • inability to carry out a motor command, for example, "act as if you are brushing your teeth" or "salute" (Ideomotor)
    • when movements of the arms and legs are involved it is referred to as Limb apraxia
    • inability to carry out facial movements on command, e.g., lick, lips, whistle cough , or wink – this is referred to as Nonverbal-oral or buccofacial apraxia.
  • inability to create a plan for or idea of a specific movement (Ideational) , for example, "pick up this pen and write down your name",
  • inability to make fine, precise movements with a limb ( Limb-kinetic ),
  • difficulty planning the movements necessary for speech (Verbal ), also known as Apraxia of Speech
  • inability to draw or construct simple configurations (Constructional ),
  • difficulty moving the eyes (Oculomotor ).

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Assessing a child with apraxia or dyspraxia involves detailed interview with parents/care-givers along with directly testing the child's ability to execute actions. There are several standardized screening tools and assessments for identifying paediatric motor disorders. The results of a motor test together with a cognitive assessment and the developmental history of the child will form the basis of a diagnosis of dyspraxia. Clinical diagnosis is done by a paediatrician or physician after excluding underlying neurological or physiological causes. Teachers can provide important bits of information considering that many of the motor difficulties are not spotted until the child starts school.

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•  Neurologist
•  Physiotherapist
•  Speech-Language Pathologist
•  Occupational Therapist

Psychological testing by a Clinical and Educational Psychologist will provide an insight into the child's social-emotional status and intelligence quotient. Children with dyspraxia often present with average intelligence but when tested might present with lower scores in some sub-tests, in particular low spelling age (at least three years below their chronological or actual age) and poor handwriting skills. It hence becomes difficult to determine whether a child is actually one with low intelligence or is unable to perform owing to his/her difficulty with executing the response required.

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Early Intervention

Identifying dyspraxia/apraxia in the infant or pre-school stage is highly desirable for treatment to be more successful. The issues affecting the development of a child with dyspraxia will have an impact on his learning and adjustment in mainstream society. The problems a child with dyspraxia may have in motor coordination, planning and organizing information will have a direct and indirect influence on his academic skills of reading, writing, arithmetic, art and music etc. Children identified with dyspraxia at the infant stage will probably encounter less hostility from fellow pupils for appearing "different" or for receiving special treatment.

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Once a detailed profile of the child is obtained the treatment plan may involve Speech Therapy, Occupational Therapy or Neuro Developmental Therapy.

Speech Therapy

One of the common types of dyspraxia is the "Developmental Apraxia of Speech" (DAS). Here the child's ability to plan and sequence speech sounds for clear and intelligible speech is affected. Other terms used for the same are Articulatory Apraxia, Developmental Verbal Apraxia, and Verbal apraxia. The child will present with delayed speech-language development, multiple speech errors such as omissions of sounds, substitutions of one sound for another, inconsistent speech errors even on repetition of same word, poor intelligibility in speech.

Occupational Therapy

Neuro-developmental therapy

It is important to acknowledge that effective functioning cannot exist without normal development. The developmental milestones have their basis in the brain connections and hence the brain is an ideal focal point of intervention. Hence Neuro-developmental therapy

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Home activities that are supervised by parents are very essential to complement formal interventions. Therapist must design home programmes that will help "bridge the gap" between formal sessions and maintain improvements. Home activities should be as varied as possible, and are most effective when carried out "little and often".

  • Be patient
  • Be available for talking times
  • Be a good model
  • Be a good listener
  • Be open to playing with your child
  • Be willing to provide your child with many experiences
  • Be full of positive praise for your children when they do well
  • Encouraging the child to adopt a better sitting posture
  • Providing them easy to wear clothes e.g. Velcro on shoes instead of buckles or laces, elastic waist band in place of buttons or zips.
  • Use small notes or pictures on the fridge/mirror/cupboard etc as visual reminders
  • Break physical activities down into very simple movement components
  • Play games that emphasis control, e.g. where movements are slowed right down or stopped on command (e.g. "slow motion" and "statues" games)
  • A child with dyspraxia may benefit from individual attention in an unpressured environment before they can participate satisfactorily in group activities in the playground or gym
  • Encouraging problem-solving, e.g. "Do you need to bend/sit/stand to pick up something from the floor?" "Do you think your writing looks better when you hold the pencil more/less tightly?"
  • Pointing out to activities done well and praising improvements

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Children with dyspraxia might benefit from some assistance during their time in school. Teachers and fellow classmates can do their fair share by offering one of the following -

  • Individual attention
  • Extra help in problem subjects
  • Provision of computer for written work
  • Special physical exercises or P.E. routines
  • Make adaptations to games and break instructions into simpler steps
  • Help to complete school work
  • Provision of a sloping desk and/or easy-grip pencils for handwriting
  • Extra time for homework or exam revision
  • Social skills training
  • General encouragement and confidence building

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Useful websites

www.dyspraxiafoundation.org.uk

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