A pediatric occupational therapist works with dyspraxic students in different environment; at home, in-clinic and in-school. During in-school therapy, occupational therapists work on strategies that would enable the students to effectively function In-Class and out of class activities. The occupational therapist will observe how the student goes through everyday functions in school and even at home with the aim to help the student develop the skills lacking.
What is Dyspraxia?
The term Dsypraxia was gotten from the word Praxis which means “the ability to perform intentional movements or simple gestures”. Hence Dyspraxia is the difficulty in imagining, planning and execution of movement to achieve a desired output. Think of catching a ball, it definitely appears easy; however it involves a number of cognitive, perceptual and motor processes. A Dyspraxic student may have challenges with processing of movement required to catch a ball (ideation/Imagining), or forming the motor plan in order to place themselves in an appropriate position to catch the ball (planning) or they might have difficulty carrying out a sequence of movements to catch the ball (execution)
With Dyspraxia, the difficulty is in the impairment of conceptualizing, planning and or/ execution which affects or interferes with motor coordination. So, if we go back to the catching exercise, the dyspraxic student will miss the ball or the ball will hit their face/body. They might also fall while trying to catch the ball due to the lack of coordination in their hands and feet movement.
According to published reports, 5.3 percent of the global student population suffers from the problems of coordination and do not achieve their academic potential (Maeland, 1992; Gubbay, 1975; Henderson and Hall, 1982). It can, therefore, be assumed that at least 1 child in a class of 30 will have motor coordination difficulties but the figure may rise to as many as 3.
How can one identify a child with Dyspraxia?
A diagnosis of Dyspraxia can be made by an occupational therapist or a child developmental pediatrician.
At different stages of a student’s school life, Dyspraxia can present in differently. The stages we can focus on are:
- In kindergarten. ( 3 – 4 years)
- In Grade 1 and 2. (7 – 9 years)
- In Grade 4, 5 and above. (9 – 14 years)
Identifying Dyspraxia in Kindergarten. (3–4 years)
When the student is in kindergarten they are usually able to play well in the playground and maneuver their way through various play items in the fields. They are able to dance with a gentle rhythm and they attempt to catch big balls. They can put on T-shirts, trousers, and underwear independently. However, this is not so for a Dyspraxic student.
Here below is a list of probable signs of Dyspraxia to a kindergarten student:
- They might appear clumsy; they will bump into objects and people.
- Constant falls. This might be due to the difficulties in balance.
- Lack of rhythm in movement (e.g. in Catching and kicking)
- Difficulty in constructive play that require manipulation like Building Blocks.
- Untidy appearance due to poor body image and an inability to co-ordinate dressing and undressing.
- In ability to use a knife and a fork, hence the student prefers eating with his hands.
Identifying Dyspraxia in Grade 1 and 2 (7–9 years)
In grade 1 and 2, a student should display great levels of coordination and be able to do most of the activities of daily living such as dressing independently. As much as handwriting will vary for different students, good arrangement and consistent spacing of letters and words will remain constant.
A grade 1 and Grade 2 Dyspraxic student will present with the following symptoms:
- Difficulty in dressing due to challenges with buttoning and tying of the show laces.
- Constant falls. This might be due to the difficulties in balance.
- Avoiding playing in the playground.
- Poor drawing and construction skills.
- Fine motor challenges especially during Pen and Paper tasks.
- Confusion between left and right.
- Poor spacing of words on a page.
Identifying Dyspraxia in Grade 4, 5 and above (9-14 years)
When a student is in Grade 4 and above they are now expected to have the coping skills to be able to organize themselves with very little supervision. In some schools, they get a “Pen License” since it is believed or proved that they have much less errors during writing. They form great friendships at this age and their self-esteem is linked to what they can do well and how their friends perceive them.
A Dyspraxic student at this age will have the following signs:
- Poor organizational skills.
- Difficulty with Physical Education lessons.
- Slow and labored handwriting which results to unfinished work.
- Low self- esteem which affects their academic achievements.
The role of an Occupational Therapist in Managing Dyspraxia
Once a student is suspected to have Dyspraxia, an occupational therapist can be contacted. The occupational therapists will conduct an assessment that will check on the child’s perceptual, cognitive and motor skills. They will also review the child’s ability to participate in activities of daily living as well as their emotional wellbeing.
Teachers and the parents are integral in guiding the Occupational therapist on what the student is currently having difficulty with. The teachers conduct an informal assessment by observing and charting the student’s challenges
Once the assessment is complete, the results will be used as a compass to guide the therapy intervention plan. From experience, many a time after the assessment, the following may be the student’s difficulty.
- Handwriting challenges.
- Spatial awareness challenges.
- Visual perceptual difficulties especially visual closure and visual figure ground.
Occupational Therapy Strategies
Fine Motor/Handwriting Intervention
Students write a lot during their school life. Them having great handwriting matters a lot to them. The occupational therapist has very many activities they can implement to help a dyspraxic student improve the handwriting. A handwriting program is recommended and the Occupational therapist will be best suited to pick the best Handwriting program. Then after that, the OT will try out various grips and pick the most appropriate one. The therapist will then guide the student while they participate in the writing program. In addition to the writing program, age-appropriate Dot-to-Dot and mazes are recommended.
Adaptations: Provision of an angled/slant board is important for the students, this improves their writing position when writing.
Spatial Awareness strategies
Eye-hand coordination and Eye-foot coordination activities are important. Ball activities are great for this. Target practice is also recommended for all ages of children. Obstacle circuits can be added during the movement activities to encourage the students to plan and execute the various movements involved.
To make it even more interesting, the therapist can ask the student to copy his/her body position. Most students with Dyspraxia have a poor sense of position in space, this leads to distorted or primitive body awareness.
Visual perceptual Intervention
Visual perceptual skills involve the ability to organize and interpret the information that is seen and to give it meaning. Every second, our eyes send large amounts of information to our brains to process. If our eyes are sending us the proper information in a way that makes sense, the brain can then process it, thus allowing us to form thoughts, make decisions, and create action. Visual closure and Visual Figure-Ground are the two main visual skills the child with Dyspraxia might have difficulty with.
Visual closure is the ability to visualize a “complete whole” when given incomplete information or a partial picture. This skill helps students read and comprehend quickly; their eyes don’t have to individually process every letter in every word for them to quickly recognize the word by sight. They may also confuse similar objects or words, especially words with close beginning or endings. This skill can also help children recognize inferences and predict outcomes. To build this skill, encourage lots of construction tasks such as Legos and building blocks. Matching and completion of drawing are engaging activities for students.
Visual Figure ground is the ability to pick out an object within a busy background. Children with poor figure ground are easily overwhelmed on a page with a lot of words. They simply get lost in detail. I can Spy is an engaging game many students like. A great website that will offer many of these activities is Eye Can Learn.
Some Points to Note
It is important that each student’s needs are considered individually and it is important that the intervention takes place early. Preferably when the child is in Kindergarten. Perceptual responsiveness is best addressed between the ages of 4 and 8 years (Addy, 1995).
For teachers, parents and others who work with children with Dyspraxia, a clear understanding of how it presents and the various interventions is important to grasp. Knowledge of normal development of motor coordination and perception is the first step. Then after this one will be able to identify the gaps.
Dypraxia is not curable but the student can learn new skills or refine the skills already present or they can compensate for their difficulties. Students do not grow out of Dyspaxia, they learn to accommodate their difficulties and with early intervention progress is accelerated.(Losse et al., 1991)
Have you had an experience with a Dyspraxic student? What are the strategies that have worked for you as a parent, teacher or occupational therapist? Leave a comment below or let’s chat on WhatsApp. You can also get in touch with me if you have any questions regarding ADHD.