Praxis Emma Wijnberg Occupational Therapy and Speaker Introduction - PowerPoint PPT Presentation

Praxis Emma Wijnberg Occupational Therapy and Speaker

Introduction “In Sensory Integration theory, praxis refers to the ability to plan new movements” (Bundy, et al., 2002, p. 6). Three Processes (Ayres, 2005) - Ideation- Planning- Execution Dependant on Sensory Integration Motor Pathways Clumsy, Awkward and Accident Prone Struggle with novel tasks Avoidance, Anxiety and Frustration

Ideation Ideation is a cortical function of having an idea, and the ability to conceptualise a goal (Bundy, et al., 2002, p. 71)

Planning Motor planning is the ability to determine the sequential steps or the series of movements that need to occur in order for the action to happen. (Bundy, et al., 2002)

Execution Sensory information regarding the external environment, the position of the body, the degree of muscle contraction is all vital for the efficient adjustments and grading needed for the accurate execution of movement (Bundy, et al., 2002, p. 84).

Sensory Discrimination Discrimination is the ability to interpret information. It allows you to filter various sensory input, sorting relevant detail from irrelevant input. (Bialer & Miller., 2011)

Tactile Discrimination Tactile input is detected by receptors the skin. Dysfunction of the tactile system, therefore, affects a wide array of functional areas, including body scheme and awareness, motor planning abilities, visual perception, academic learning and social skills. Dorsal Column Medial Leminiscal Pathway

Proprioceptive Discrimination Information about where our body parts are in relation to one another and the external environment. Detected by receptors in the muscles, tendons and ligaments around joints. Dysfunction results in clumsiness, easily and frequently breaks things, exhibits low functional muscle tone, may fixate during movements, and present with mass movement patterns (Bundy, et al., 2002).

Somatopraxis “Somatodyspraxia is a type of sensory integration dyspraxia in which there is evidence of poor processing of at least somatosensory information. ” (Bundy, et al., 2002, pp. 71-72). Impaired tactile and proprioceptive discrimination

Vestibular Discrimination Vestibular input provides us with information regarding head position in relation to gravity. Motor responses play a role in balance, postural control, eye movements. Receptors: Semi-Circular Canals and Otolith Organs.

Bilateral Integration and Sequencing “Bilateral integration and sequencing disorder is a type of sensory integrative-based dyspraxia in which there is evidence of deficits in vestibular and proprioceptive processing” (Bundy, et al., 2002, p. 72). Coordination of both sides of the body and the ability to perform sequences of movements. (Bundy, et al., 2002, p. 81). Subtle, mild practic difficulty

Visual Discrimination Most important sense for our daily functioning (Bundy 2002). NB for learning new motor skills. Initially, vision guides the body’ s movements, until the skill is learnt, and becomes automatic.

Visuo Praxis “The relationship between visual perception and visually directed praxis” (Parham, 2010, p.350) Difficulties using vision to coordinate movement, copy drawings and find objects in a busy background (Schaaf 2010, p. 272).

Postural Control “Posture is that motor response which reflects an individual’ s relationship to the earth’ s surface and gravitational force. ” (Ayres, 2000, p. 75). Postural Control is the overall ability to regulate and control the quality of postural movements (Bundy, et al., 2002, p. 7).

Postural- Occular Control Postural-Occular Control is reliant on the integration of the proprioceptive, vestibular (specifically receptors on the semi- circular canals), and visual systems, to ensure smooth, coordinated eye movements and gaze stability during movement.

Auditory Discrimination Auditory discrimination is the ability to recognise differences between sounds.

Praxis on Verbal Command Praxis on verbal command refers to the child’ s ability to assume unfamiliar body positions, following a verbal command. Praxis on Verbal Command relies purely on verbal directions and not visual demonstration (Mailloux, 1990, p. 591). Consider postural and linguistic ability before diagnosis.

Signs of Praxis Difficulties Developmental Delay Poor gross motor skills, avoidant Social difficulties Poor spatial awareness Slow and hesitant in most actions Appears not to be able to learn anything instinctively but must be taught skills Falls over frequently Poor pencil grip Cannot do jigsaws or shape sorting games Often anxious and easily distracted Does badly in class but significantly better on a one-to -one basis Reacts to all stimuli without discrimination and attention span is poor • May have trouble with written expression Experiences great difficulty in copying from the blackboard Writes laboriously and immaturely Difficulty remembering and /or following instructions Disorganised

Behavioral Difficulties Low Self-Esteem Compensation Avoidance Delays Anxiety Disorganised

Assessment History Taking (Parent Interview) Classroom Observation Clinical Observations (structured and unstructured) Sensory Integration and Praxis Tests (SIPT), Ayres 1989 Bruininks-Oseretsky Test of Motor Proficiency, 1978 Miller Assessment for Preschoolers, Miller 1988 Movement Assessment Battery for children (Henderson & Sugden) Developmental Test of visual-motor integration (Beery) Test of Visual Perceptual Skills (Gardner) Sensory Profile (Winnie Dunn) Sensory Processing Measure (Lucy Miller)

Diagnosis and Classification American Psychiatric Association Diagnostic and Statistical Manual V classifies dyspraxia under umbrella term of Developmental Co- ordination Delay Billable Diagnostic Code: R27.8 (Other lack of coordination) OR F82 (DCD)

Treatment Ayres Sensory Integration Perceptual Motor Approach Sensorimotor Approach A cognitive goal directed approach (Older children) Teach Coping Skills Family support and education Concessions

References Ayres, A., 2007. Sensory Integration and Praxis Tests (SIPT) Manual. Updated ed. Torrance, CA: Western Psychological Services. Ayres, A., 1972, 1978. Sensory Integration and Learning DIsorders. California: Western Psychological Services. Ayres, A., 2005. Sensory Integration and the Child: Understanding Hidden Sensory Challenges. Los Angeles: Western Psychological Services. Ayres, A., 2014. Sensory Integration and Praxis Tests (SIPT) Manual. Updated ed. Torrance CA: Western Psychological Services. Dunn, W ., 2014. The Sensory Profile 2. s.l.:Pearson. Ayres, A., 1979. Sensory Integration and the Child. Los Angeles: Western Psychological Services.. Valentin, D., 1997. Neurscience Online: Visual Processing: Cortical Pathways. [Online] 
 Available at: https:/ /nba.uth.tmc.edu/neuroscience/m/s2/chapter14.html 
 [Accessed 27 January 2020]. Smith-Roley, 2002. s.l.: s.n. Silverthorn, D. U., 2010. Human Physiology: An Integrated Approach. 5 ed. San Fransisco: Pearson Education inc. Fox, S., 2006. Human Physiology. 9 ed. New York: McGraw Hill. Ayres, A., 2000. Sensory Integration and Learning Disorders. 11 ed. Los Angeles: Western Psychological Services. SAISI Research Commitee, 2005. Clinical Observations Adapted from J. Ayres: Administration and Interpretation. Revised ed. Johannesburg : South African Institute of Sensory Integration. Case-Smith, J., 2005. Occupational Therapy for Children. 5 ed. Missouri: Elsevier Mosby. Mailloux, Z., 1990. An overview of the Sensory Integration and Praxis Tests. American Journal of Occupational Therapy, 44(7), pp. 589-594. Mulligan, S., 1998. Patterns of Sensory Integration Dysfunction: A Confirmatory Factor Analiysis. The American Journal Of Occupational Therapy, 52(10), pp. 819-827. Martin, N., 2006. Test of Visual Perceptual Skills. 3 ed. California: Academic Therapy Publications. Ranna Parekh, M. M., 2017. American Psychiatric Association. [Online] 
 Available at: https:/ /www.psychiatry.org/patients-families/adhd/what-is-adhd 
 [Accessed 20 February 2019]. Beery, K., N., B. & Buktenica, N., 2010. Beery VMI. 1 ed. s.l.:Pearson Clinical. Bear, M., Connors BW . & Paradiso, M., 2006. Neuroscience: Exploring the Brain. 3 ed. s.l.:Lippincott Williams & Wilkins. Beil, L. & Peske, N., 2009. Raising a Sensory Smart Child: The definitive Handbook for Raising a Sensory Smart Child. 2 ed. London: Penguin.