Pediatrics: Motor Development

motor control

how one directs and regulates movement

motor learning

learning and refining motor skills over time

conditions with motor control deficits

• cerebral palsy

• DCD (Developmental Coordination Disorder)

• autism

• down syndrome

• sensory integration disorders

• acquired brain injuries

• intellectual disability

motor control difficulties:

• dysmetria

impaired ability to estimate distance

motor control difficulties:

• intention tremor

tremor with attempted voluntary movement

motor control difficulties:

• limited force control

limited strength or energy

motor control difficulties:

• dysdiadokokinesis

difficulty with rapid change of motion

motor control difficulties:

• poor bilateral motor coordination

inability to perform movements using both sides of the body

motor control difficulties:

• difficulty with FM and GM coordination

inability to complete movements in a smooth manner

motor control difficulties:

• associated reactions (synkinesis)

involuntary movement in 1 part when another part is moved (e.g., a child’s tongue moving around when they are focused on their handwriting)

interaction among systems:

• person

skills and abilities, client factors, motivation, goals can influence performance

• age

• cognition— attention, motivation, problem-solving

• musculoskeletal system— muscle tone, strength, posture

• sensory systems— visual, auditory, vestibular, kinesthesia, proprioception, and tactile

• perception + discrimination abilities— making sense of sensory stimuli

• social-emotional— positive feelings and positive thinking

interaction among systems:

• task

what type of actions are required— can influence performance

• nature of task

• simple or complex

• size, shape, weight, texture

interaction among systems:

• environment

contexts can influence performance

• physical

• social

• cultural

• temporal

• virtual

• personal

grading

task should be graded to meet the child; find the “just right challenge” (where tasks are challenging but possible and end in success)

practice and failure

challenge is critical and failure is part of the learning process; practice (and failure) makes perfect!); e.g.,

• whole vs part practice

• blocked practice

• distributed practice

• variable practice

• mental practice

intervention— whole learning

engaging clients in the whole activity

• play activities

  • crafts

  • dress-up

  • cooking

• games

• themed activities

intervention— variability

incorporating a variety of tasks with the same motor movement

• vary the objects or placement

• vary the requirements of the task

• vary the environmental context

intervention— problem solving

varying the different degrees of difficulty and waiting for the child to figure it out

• repeat movements so the child must figure it out

• similar to error-based learning, i.e., making errors or mistakes and self-correcting helps with learning

motor learning principles— meaningfulness

patient expresses interest in these activities

• purposeful

• shows pleasure

• wants to demonstrate

motor learning principles— transfer of learning

applying learning to new situations or generalizing to a natural context

• e.g., maneuvering a wheelchair through an obstacle course at the clinic vs through a school hallway

motor learning principles— grading and adapting

make tasks easier or harder to find the just-right challenge

• simple vs complex

  • place ball in bucket vs game of mini golf

• single step vs multi-step

  • write name vs draw + label a picture

• discrete vs continuous

  • pick up an object vs walk

• unimanual vs bimanual

  • grasp with 1 hand vs grasp with both hands

• stationary vs moving

  • hold toy vs catch ball

motor learning principles— modeling or demonstration

showing how to perform a skill or task:

• before practicing the skill

• after practicing, emphasizing critical cues

• throughout as needed

• model slowly

• with/without verbal feedback

motor learning principles— verbal instruction

used to teach motor skills

• brief, 1-3 words + clear, simple statements

• emphasize key aspects of movement

motor learning principles— whole vs part practice

whole: practicing the entire activity

• better for simple skills

part: practicing parts of the activity

• better for more complex skills

  • e.g., just chopping vegetables during a cooking activity

• natural units

motor learning principles— blocked practice

or “massed practice”, a child practices 1 skill by repeated a similar movement over and over

• e.g., having a child put pegs in a pegboard, rest briefly, and then do the same activity over again

• not best for novel or complex task

• less transfer of learning (generalization)

• not as motivating

motor learning principles— distributed practice

child practices a skill in a variety of ways by repetition of different but related skills

• e.g., art activity involving the child tearing small pieces of paper (neat pincer grasp), then gluing the pieces of paper (in-hand manipulation), and ending with coloring (tripod grasp)

motor learning principles— variable practice

i.e., “random practice”— a child practices actual task in natural context vs repeating 1 pattern of movement

• e.g., engaging the child in playing with marbles scattered on the floor, which requires the use of variety of movements and positions

• considered BEST for transfer of learning

motor learning principles— mental practice

thinking about what you’re going to do before you do it; can help the child to prepare to perform a task

• basic imagery ability is needed

• combine with physical practice works best

• short, not prolonged, images

order that you may implement motor control practice forms/protocols

“motor control deficits make Blocking Dis Very hard!”

• Blocked Practice —> Distributed Practice —> Variable Practice

• start ^ if skills are lacking/person is struggling —> progress through