Motor, locomotion and praxis difficulties

13. srpna 2014 v 14:01 | Prof.PhDr.Rudolf Kohoutek,CSc.
Motor, locomotion and praxis difficulties
The following symptoms are found in individuals with these problems:
• extremely untidy drawings and art work (0 - 1 - 2 - 3)
• difficulties in spatial orientation (0 - 1 - 2 - 3)
• cramped, excessively forced handwriting (0 - 1 - 2 - 3)
• clumsiness and lack of independence in self-service (0 - 1 - 2 - 3)
• lack of manual skills (0 - 1 - 2 - 3)
• difficulties in precision drawing (0 - 1 - 2 - 3)
• clumsiness in sports, awkwardness (0 - 1 - 2 - 3)
• uncoordinated walking(0 - 1 - 2 - 3)
• falls, accidents, injuries (0 - 1 - 2 - 3)
• partly paralyzed arm, leg, limping (0 - 1 - 2 - 3)
• retrained left hand because right hand cannot be used (0 - 1 - 2 - 3)
• crossed laterality (0 - 1 - 2 - 3)
• non-descript laterality (0 - 1 - 2 - 3)
• grimacing (0 - 1 - 2 - 3)
• tremors, tics (0 - 1 - 2 - 3)
• uncontrolled movements (0 - 1 - 2 - 3)
• defects in organization, fluency and coordination of active volitional movements (0 - 1 - 2 - 3)
• impaired self-perception of the body (0 - 1 - 2 - 3)

A material prerequisite for success in school is the attainment of a certain developmental level of motor skills. That is why the diagnostics of such motor development is important also with respect to various disorders of the central nervous system. Motorics is one of the basic behavioral aspects and as such needs to be monitored in behavioral assessment.
Ozereckij's scale is used to assess the adequacy of motor development. This methodwas designed by N. I. Ozereckij and its original version published in Russia in 1923. It is designed to assess the adequacy of motor development. The test was modified several times. The most recent version of the test is the modified American one from 1978.
Description of the test: N. I. Ozereckij viewed coordination, accuracy and fusionof various movements as important indicators of motor development. The test consists of 46 items of such orientation, divided into 8 subtests. For every age group, there are several tasks to be performed by a child of that age. The test makes it possible to assess the level of individual motor competencies: it helps measure both gross motor skills, i.e., the agility of the body and lower limbs, and fine motor skills, i.e., manual skills and agility of the hands, or rather fingers. An abbreviated version consisting of only 14 items is also available.
The scale can be used as part of the battery of tests in clinical and counseling practice for individual examination of children where motor skills development or overall retardation is suspected, e.g., as part of a more comprehensive disorders, such as mental retardation. It is also recommended for diagnostics of children with minimal brain dysfunction, or ADHD syndrome, and of children with specific learning difficulties.
The American psychologist Joy Paul Guilford (1897-1987) tried to create a 2D matrix of psychomotoric skills through which he observed parameters such as strength, impulse, speed, static accuracy, dynamic accuracy, coordination and agility, gradually observing the whole body: trunk, limbs, hands, fingers (Smékal, 2002).
Various tests have been designed for the assessment of the ability of motor coordination; for instance, the composite movement test (two levers are used simultaneously to control the movement of a spike which is to follow a curved line). Studies have shown that there is a close connection between success in these tests and the controlling of machinery (Sillamy, 2001).
The diagnostics or therapy of these children is addressed in detail for instance by the English pediatrician A. Kirby in her book Clumsy Child Syndrome (2000).
Motor, locomotion, praxis and laterality disorders needs to be distinguished from stereotyped movements disorders listed in the International Classification of Diseasesunder diagnosis code F98.4. This behavioral disorder is manifested by the child (juvenile) producing stereotyped movements to such extent that he/she causes physical injury to himself/herself or that normal activities are greatly impaired. The disorder must persist for at least one month and the sufferer does not suffer from any other mental or behavioral disorder.
Further, disorders with organic or somatic causes, e.g., consequences of infantile cerebral paralysis, must also be distinguished from the above.

Psychomotor instability
Typical symptoms of psychomotor instability include for instance the following:
great liveliness, agility bordering on restlessness (0 - 1 - 2 - 3)
unable to sit still, fidgets, leaves his/her place (0 - 1 - 2 - 3)
talks without invitation, interrupts others (0 - 1 - 2 - 3)
acts rashly, on impulse, without thinking (0 - 1 - 2 - 3)
unable to cooperate satisfactorily (0 - 1 - 2 - 3)
moves rashly, bumps into objects, falls (0 - 1 - 2 - 3)
unable to focus on any game, activity, work for any length of time (0 - 1 - 2
- 3)
does not pay attention, is distracted, attention problems, unable to concentrate (0 - 1 - 2 - 3)
tires easily (0 - 1 - 2 - 3)
moodiness, disputes, conflicts (0 - 1 - 2 - 3)
conspicuous alternation of days when he/she is doing very well and days when he/she is completely out of control and does very badly at everything (0 - 1 - 2
- 3)
inappropriate exclamations (0 - 1 - 2 - 3)
does not observe the appropriate distance (0 - 1 - 2 - 3)
engages in other activities while working (0 - 1 - 2 - 3))
minor and more serious accidents (0 - 1 - 2 - 3).
Zelinková (2003) focuses on specific learning difficulties and disorders and their causes, dyslexia, dyspraxia and MBD, also in connection with motor skills.
Newly introduced terms are syndromes abbreviated as ADHD and ADD.
The ADHD diagnostic category is used for behavioral disorders characterized mainly by hyperactivity, impulsiveness and attention disorders. Disorders of fine motor development, including specific speech disorders, can be referred to as dyspraxia. The term ADHD refers to an attention deficit disorder combined with hyperactivity. ADD is an attention deficit disorder without hyperactivity, ODD is an oppositional defiant disorder. Further classification is ADHD without aggression and ADHD with aggression.
Minimal brain dysfunction (MBD) is used to refer to a number of manifestations in the child based on structural changes of the CNS which deviate from the norm. They thus appear to be unusual, conspicuous and strange (markedly uneven development of intellectual abilities, conspicuous manifestations and disorders in the dynamics of mental processes, hyperactivity or hypoactivity, attention deficit, insufficient perseverance, impulsiveness, rashness, mood and intellectual performance swings, physical clumsiness, perception disorders, etc. (Slowík, 2007).
Hyperkinesis is referred to as motoric restlessness. Certain hyperkinetic children (with ADHD) may also suffer from a specific developmental motor function disorder
manifested as marked dyspraxia, clumsiness and awkwardness (clumsy child syndrome); such children for instance find it difficult to hit a target with a ball, to tie their shoelaces, to string beads, to write or draw tidily. They tend to be reprimanded for breaking or damaging things often, they usually get bad grades in physical education and may become the source of mockery because of their clumsiness. They are fairly frequently left-handed.
About one half of children with tic disorders is afflicted with hyperkinetic symptoms at the same time. Tics are repetitive, involuntary and irregular muscle convulsions which most frequently affect mimic muscles (blinking, sniffing, mouth opening) but may affect other muscle groups as well. Tics may further be auditory and vocal: the child produces various disturbing sounds, exclaims certain words or fragments of sentences. a combination of muscle and vocal tics is typically found in a severe form of the tic disorder - Tourette's syndrome, which may also include a compulsive exclamation of vulgar expressions (Drtílková, 2007).
Education based on love and respect for a higher order is the most effective prevention of all mental and psychosomatic illnesses, and as such of restlessness in man and among people.
For gross motor skills - long walks, trips, mountain hikes (but not taking a cosyride on the funicular but making the hard climb on foot), cycling, rowing, jumping on the trampoline, jumping in a sack, dancing, jazz gymnastics, clearing of snow, sweeping, gardening - hoeing, weeding, etc.
For fine motor skills - all types of handiwork without using electrical appliances:filing, modeling, crocheting, knitting, fruit picking, cleaning of vegetables (potato or apple peeling), dough kneading, string spooling (Prekopová, Schweizerová, 2008).
Under certain circumstances, psychomotor instability can be referred to as hyperkinetic disorder in accordance with the International Classification of Diseases(10th edition), diagnosis code F90, which may be specific to home or to classroom.
The condition is for instance that the combination of certain selected symptoms must persist for at least 6 months and the symptoms have to be sufficiently severe to be maladaptive and in conflict with the child's developmental level. The disorder manifests itself before the 7th year of age, not later.
Monographs on children suffering from ADHD (Attention Deficit Hyperactivity Disorder) have been written for instance by Gordon Serfontain (1999), a child neurologist at the Sydney children's hospital. Serfontain claims that these disorders occur in as much as 20% of boys and 8% of girls.
In the Czech Republic, the LDE concept (Kučera, 1961) was applied in connection with this disorder.

Social, educational and cultural neglect
Individuals with this difficulty manifest for instance the following symptoms:
poor preparation for school (0 - 1 - 2 - 3)
educational problems, although the child's intellectual gifts are within the norm (0 - 1 - 2 - 3)
poor understanding of information newly presented at school due to large gaps in knowledge (0 - 1 - 2 - 3)
primitive and vulgar forms of social communication (0 - 1 - 2 - 3)
small vocabulary (0 - 1 - 2 - 3)
developmental problems in speech and written language (0 - 1 - 2 - 3)
poor grooming (0 - 1 - 2 - 3)
disorder in private things (0 - 1 - 2 - 3)
lack of interest in reading magazines and books (0 - 1 - 2 - 3)
lack of interest in cultural matters (0 - 1 - 2 - 3)
lack of interest in theatre plays and serious cinema (0 - 1 - 2 - 3)
retarded somatic development, stunted growth, low weight etc. (0 - 1 - 2 - 3)
poor hygienic routines (0 - 1 - 2 - 3)
unpleasant bodily odor (0 - 1 - 2 - 3)
dirty aids (0 - 1 - 2 - 3)
Families of socially neglected children often tend to be primitive (simple), providing few psychosocial and cultural incentives, or even defective (alcoholism, drug abuse, criminal activity, mental illness), and generally insufficient in terms of upbringing.
A disturbed family (incomplete, defective, in crisis) creates worse prerequisitesfor the formation of its children's development than a complete and undisturbed family. a broken family, especially due to divorce, correlates positively with anxiety symptoms, for example.
Manifestations of psychosocial neglect are frequently accompanied by further problems and disorders: increased mental tension or even neurosis, antisocial behavior, etc.
The hostile relationship between the parents and the child often leads to childmistreatment, abuse (e.g., sexual), sometime even to the child's physical liquidation.
Socially neglected children have to be distinguished from children with a socio-cultural handicap. The latter may for instance concern children of immigrants who findadaptation to the new environment difficult because of national customs or language barrier.

Problems in school performance
Individuals with problems in school performance:
suffer from learning difficulties (0 - 1 - 2 - 3)
have results below average despite significant effort (0 - 1 - 2 - 3)
do not learn logically and rationally (0 - 1 - 2 - 3)
have a negative attitude to school and learning (0 - 1 - 2 - 3)
fail to comprehend (á) (0 - 1 - 2 - 3)
tend toward mechanical memorizing (0 - 1 - 2 - 3)
are slow to understand new information (0 - 1 - 2 - 3)
seem to be overworked, mentally exhausted (0 - 1 - 2 - 3)
tend to suffer from low self-confidence (0 - 1 - 2 - 3)
feel inadequate or even inferior (0 - 1 - 2 - 3)
are passive aggressive, refuse social communication (0 - 1 - 2 - 3)
have a poorly developed ability to abstract (0 - 1 - 2 - 3)
find it difficult to apply rules in practice (0 - 1 - 2 - 3)
have poor understanding even of common notions and ideas (0 - 1 - 2 - 3)
tend to be intellectually passive (0 - 1 - 2 - 3)
Where grades are very bad and lack of success at school marked, it first needs to be established what type of failure is involved, whether it is a more permanent and general, absolute school failure (i.e., learning insufficiency stemming from insufficiently developed intellectual abilities), or whether it is an occasional or partial, relative school failure (the pupil has poor results for reasons unrelated to his/her intellect), which can usually be rectified. Where relative school failure is concerned, the pupil's performance is poorer than his/her intellectual (mental) abilities and qualifications. This may be due to a crisis, increased tendency to fatigue, neurotic reactions, temporarily reduced motivation, etc.
Absolute and relative school failure both reflects and is the consequence of individual differences between pupils which we find not only in the pupils' personalities (e.g., the level and structure of gifts, nature, interest in learning, emotivity, motivation, harmonious or disharmonious personality development), but also in the different conditions of their upbringing in their families. Low grades and school failure are usually not caused by a single cause but rather by multiple causes. All the cases of poor results are caused by an individual combination of causes and conditions, and display their own individual developments and dynamics.
Relative school failure may be caused by socio-psychological, biological-psychological and intrapsychic factors. a single isolated handicap (e.g., worse conditions in the family) does not automatically have to have a determining impact on the pupil's success at school. School failure is usually due to a combination of several conditions and causes.
 

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