San Antonio Express News.  May 4, 2005

Fishing, Biking, and Sports Giving Way to Video Games –

By Dennis Cauchon

In October of 2002, Athena Oden, Ready Bodies, Learning Minds, and Dr. Denise Kern, Comal Independent School District, began a controlled research project into the effectiveness of the motor lab developed by Athena Oden, physical therapist.  The motor lab, nicknamed “Function Junction”, is a prescriptive motor development program that focuses on helping children to integrate tactile, proprioceptive, reflexive, and vestibular input.  The program hypothesis is centered on the idea that reflex and sensory integration are keys to academic success.  The basic question to be answered by this research was: Do specific experiences in the Ready Bodies motor lab affect reading performance in pre-first grade students?

Two different groups of children were included in the study: those from one elementary school who use Function Junction on a bi-weekly basis, and those from a control group of elementary school students who do not.  Each group was tested during October 2002, and re-tested under the same parameters in May of 2003.  The results were then tabulated and analyzed by Dr. Denise Kern.  Her conclusions were presented in a doctoral thesis for University of Texas at San Antonio.

Data was collected through the use of five different tests:
1) VMI ( Beery-Buktenica Developmental Test of Visual-Motor Integration); pre and post tests
2) Ready Bodies, Learning Minds Screening Report; pre and post tests
3) DRA  (Developmental Reading Inventories )  (Quarterly)
4) TPRI  (Texas Primary Reading Inventory)  (August and May)
5) Comal ISD Benchmark Reading tests (Quarterly)

While test results are too extensive to present in this forum, some conclusions can be described that show dramatic increase in reading performance.  Specifically, in a portion of the research project which included only pre-first students of both campuses, there was an average 70% increase in reading profiency in the research group when compared to the control group (according to the DRA test results) over the 7 month period.

The research group (with the motor lab) also exhibited marked improvement in reflex integration based upon the Ready Bodies, Learning Minds Screening Report.  Conversely, the pre-first students of the control group (without the motor lab) demonstrated , on average, a decline in reflex integration over the same 7 month period.

Ready Bodies, Learning Minds performed extensive studies involving more students and more grade levels than were analyzed in Dr. Kern’s thesis.  Overall, we see similar results: for example, phonemic awareness of the kindergarten children appears to have been improved by the presence of the motor lab. Still, further data analysis needs to made to document the correlation of improvement in academic and motor performance.  We hope to be able to do this in the near future. 

Motor Skills

Description

Common problems

Fine motor skills can become impaired in a variety of ways, including injury, illness, stroke, and congenital deformities. An infant or child up to age five who is not developing new fine motor skills for that age may have a developmental disability. These problems can include major health conditions including cerebral palsy, mental retardation, blindness, deafness, and diabetes. Children with delays in fine motor skills development have difficulty controlling their coordinated body movements, especially with the face, hands, and fingers. Signs of fine motor skills delays include a failure to develop midline orientation by four months, reaching by five months, transferring objects from hand to hand by six months, a raking grasp by eight months, a mature pincer grip by one year, and index finger isolation by one year.

Developmental coordination disorder is a disorder of motor skills. A person with this disorder has a hard time with things like riding a bike, holding a pencil, and throwing a ball. People with this disorder are often called clumsy. Their movements are slow and awkward. People with developmental coordination disorder may also have a hard time completing tasks that involve movement of muscle groups in sequence. For example, such a person might be unable to do the following in order: open a closet door, get out a jacket, and put it on. It is thought that up to 6 percent of children may have developmental coordination disorder, according to the 2002 issue of the annual journal Clinical Reference Systems. The symptoms usually go unnoticed until the early years of elementary school. It is usually diagnosed in children who are between five and 11 years old.

 

Fine motor skills

(Source: GGS Information Services.)

 

Age	Skill
SOURCE: Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, 5th ed. and Child Development Institute, http://www.childdevelopmentinfo.com.
One to three months	Reflexively grasps finger or toy placed in hand.
Three months	Grasping reflex gone. Briefly holds small toy voluntarily when it is placed in the hand.
Four months	Holds and shakes rattle. Brings hands together to play with them. Reaches for objects but frequently misses them.
Five months	Grasps objects deliberately. Splashes water. Crumples paper.
Six months	Holds bottle. Grasps at own feet. May bring toes to mouth.
Seven months	Transfers toy from hand to hand. Bangs objects on table. Puts everything into the mouth. Loves playing with paper.
Nine months	Able to grasp small objects between thumb and forefinger.
Ten months	Points at objects with index finger. Lets go of objects deliberately.
Eleven months	Places object into another's hand when requested, but does not release.
Twelve months	Places and releases object into another's hand when requested. Rolls ball on floor. Starts to hold crayon and mark paper with it.
Fifteen months	Builds tower of two blocks. Repeatedly throws objects on floor. Starts to be able to take off clothing, starting with shoes.
Eighteen months	Builds tower of three blocks. Starts to feed self well with spoon. Turns book pages two or three at a time. Scribbles on paper.
Two years	Builds tower of six or seven blocks. Turns book pages one at a time. Turns door knobs and unscrews jar lids. Washes and dries hands. Uses spoon and fork well.
Two and a half years	Builds tower of eight blocks. Holds pencil between fingers instead of grasping with fist.
Three years	Builds tower of nine or ten blocks. Puts on shoes and socks. Can button and unbutton. Carries containers with little spilling or dropping.
Four years	Dresses self except for tying. Cuts with scissors, but not well. Washes and dries face.
Five years	Dresses without help. Ties shoes. Prints simple letters.

 

A toddler demonstrates his fine motor skills by grasping and munipulating building blocks.

(© S. Villeger/Explorer/Photo Researchers, Inc.)

The tactile system or touch system refers to stimulation reaching the central nervous system from receptors in the skin. Since there are14 to 18 square feet of skin covering the adult body, it is obviously a large source of incoming information. Add the fact that there are dozens of each of three major types of receptors on every square inch of skin, and the possibilities for input are huge! The most primitive type of receptors register light touch, like a feather being brushed over the skin. Light touch is a primitive, but still powerful alarm system. There might be an insect crawling on me, or someone sneaking up on me; I need to look and see - I can't pay attention to anything else until I know what is touching me, or might touch me!

The second type of receptors are for pressure touch, known as discriminative touch. This is much more important for learning than we realize because we do not have to look at or think about what our fingers or feet are pressing against; we recognize the "feel" of things. Sustained, or pressure touch also has an important role in countering or subduing alarm and anxiety. When a baby is fretful or over-stimulated, wrapping in a light blanket, - applying pressure touch, in other words, - usually results in his falling asleep.

The third set of skin receptors register heat, cold, and pain. Obviously it is important for survival that these receptors work efficiently, and that their input is organized and processed quickly so that appropriate action can be taken.

When the nervous system is immature, when development is delayed, problems occur which can be directly related to immature registration and processing of input from the skin. The connection between the skin and the nervous system is not strange. The nervous system is formed from the same layer of embryonic tissue as the skin. The most common symptom of immaturity is excessive sensitivity to light touch. The individual may describe feeling as if the skin had been rubbed raw where he/she was touched. The infant avoids being touched, cries when picked up, avoids being washed or shampooed. Parents feel rejected, and the stage is set for emotional problems added to the original sensory difficulty. Feeding problems often result because extreme sensitivity in an around the mouth leads to rejection of the nipple, and later to rejection of many foods.

Unfortunately, hypersensitivity to light touch is often accompanied by lack of normal sensitivity to heat, cold, and pain. The child may refuse to wear a jacket in the winter, and refuse to take it off during the hot summer. He may not cry at injuries that would make another child scream.

The contribution of tactile defensiveness to attention deficit disorder is one of its most common manifestations. The child who is constantly on the alert because something might be moving toward him, - might touch him - cannot attend to what the teacher is saying. The tactile system's connections with hearing and vision means that hyper-alertness extends to other stimulations as well. The tactually defensive child often reacts reflexly by striking out in response to another child's well-meaning touch. This is labeled "aggressiveness", and one label leads to another.

The therapists' strategy in dealing with tactile defensiveness is two-fold. First, it is important to protect the child as much as possible from sudden and unwanted touch. Secondly, various kinds of activities utilizing sustained pressure can be used to dampen down the over-reactivity.

Sensory Integration

Meaning of sensory integration

Sensory integration is the ability to take in information through the senses of touch, movement, smell, taste, vision, and hearing, and to combine the resulting perceptions with prior information, memories, and knowledge already stored in the brain, in order to derive coherent meaning from processing the stimuli. The mid-brain and brainstem regions of the central nervous system are early centers in the processing pathway for sensory integration. These brain regions are involved in processes including coordination, attention, arousal, and autonomic function. After sensory information passes through these centers, it is then routed to brain regions responsible for emotions, memory, and higher level cognitive functions.

Hyposensitivities and Hypersensitivities

Sensory integration disorders vary between individuals in their characteristics and intensity. Some people are so mildly afflicted the disorder is barely noticeable, while others are so impaired they have trouble with daily functioning.

Kids can be born hypersensitive or hyposensitive to varying degrees and may have trouble in one sensory modality, a few, or all of them. Hypersensitivity is also known as sensory defensiveness. Examples of hypersensitivity include feeling pain from clothing rubbing against skin or an inability to tolerate normal lighting in a room. This oversensitivity can cause people to prefer not to be touched or caressed, or to refrain from looking directly into the eyes of another person.

An example of a child or adult with hyposensitivity is one who throws themself into a wall in order to get a sense of their body.

Sensory integration and autism spectrum disorders

Sensory integration dysfunction is a common symptom of autism [4]. Often, autistic children receive too much sensory stimulation through one or more of their senses, and in order to turn down the volume, they tend to avoid people, noises and bright lights. Autistic children do not develop the neurotypical capacity to integrate and modulate information from the five senses.

In her book, Thinking in Pictures, Temple Grandin reports the results of a survey about sensory integration in a relatively small population with autism spectrum disorders from one center:

Alternative views

Not everybody agrees with the notion that hypersensitive senses is necesarily a disorder. Even if hypersensitivity is the most common in autism, insensitivity to pain is also common. Additionally, there is no proof for the idea that hypersensitivity would necesarily be a result of sensory integration issues.

It is possible that misdiagnosis is also a problem with the construct of Sensory Integration Dysfunction. Some experts claim that Occupational Therapists incorrectly apply this label to individuals with attention difficulties or who simply don't put forth any effort during assessments. For example, a student who fails to repeat what has been said in class (due to boredom or distraction) is referred for evaluation for sensory integration dysfunction. The student is asked to listen to signals coming from either side of a pair of headphones and combine them to form words. The student is still bored or distracted, and so does poorly on the test. The assessor concludes that the student has sensory integration dysfunction, while, in fact, he may have a disorder of auditory processing (also overdiagnosed), poor auditory attention, a mood problem, or may fail to put forth adequate effort on the task for other reasons. Diagnoses based on single tests are unreliable, and integrated assessment utilizing multiple sources of information is the preferred means of diagnosis, especially in children.

There is a large percentage of children who receive the diagnosis of sensory integration dysfunction who might be better understood as having anxiety problems or even behavioral disorders. These problems can make a child look reactive, "touchie", or unpredictable, and manifest in a manner similar to that characterized by occupatinal therapists as sensory integration dysfunction. And while this diagnosis is accepted widely among occupational therapists and also educators, these professionals have been criticized for overextending an already-poorly-supported model that attempts to explain emotional and behavioral problems that are better (and more simply) explained in other ways.

It should also be understood that there is general agreement that some children do have oversensitivity to many physical stimuli, the existence of this relatively small subset of children has lead to a general pattern of overdiagnosis in children who "look the same" but have other problems, and there are relatively few medical and psychological practictioners who agree that sensory integration dysfunction is the foundational problem in most children with this diagnosis.

While the physical methods employed by occupational therapists as treatment for SID are often paliative (they make the child feel better--much as a nice massage or physical contact would make anyone feel better), children misdiagnosed with sensory integration dysfunction will not receive appropriate psychological treatment (e.g., cognitive behavioral therapy) if they remain misdiagnosed.

Vestibular system

From Wikipedia, the free encyclopedia.

The vestibular system, or balance system, is the sensory system that provides the dominant input about our movement and orientation in space. Together with the cochlea, the auditory organ, it is situated in the vestibulum in the inner ear (Figure 1). As our movements consist of rotations and translations, the vestibular system comprises two components: the semicircular canals, which indicate rotational movements; and the Otoliths, which indicate linear translations. The vestibular system sends signals primarily to the neural structures that control our eye movements, and to the muscles that keep us upright. The projections to the former provide the anatomical basis of the vestibulo-ocular reflex, which is required for clear vision; and the projections to the muscles that control our posture are necessary to keep us upright.

Figure 1 Human Labyrinth, from the left ear. It contains i) the cochlea (yellow), which is the peripheral organ of our auditory system; ii) the semicircular canals (brown), which transduce rotational movements; and iii) the otoliths (in the blue/purple pouches), which transducer linear accelerations. The light blue pouch is the endolymphatic sac, and contains only fluid.

 

Semicircular canals

Our world has three spatial dimensions. Accordingly, our vestibular system contains three semicircular canals in each labyrinth. They are approximately orthogonal to each other, and are called horizontal, anterior, and posterior canal. (Alternatively, they may be referred to as lateral, superior, and inferior, respectively.)

 

Push-pull systems

The canals are cleverly arranged in such a way that each canal on the left side has an almost parallel counterpart on the right side. Each of these three pairs works in a push-pull fashion: when one canal is stimulated, its corresponding partner on the other side is inhibited, and vice versa.

Figure 2: Push-pull system of the semicircular canals, for a horizontal head movement to the right.

This push-pull system allows us to sense all directions of rotation: while the right horizontal canal gets stimulated during head rotations to the right (Fig 2), the left horizontal canal gets stimulated (and thus predominantly signals) by head rotations to the left.

 

Vestibulo-ocular reflex (VOR)

The vestibular system needs to be fast: if we want clear vision, head movements need to be compensated almost immediately. Otherwise our vision corresponds to a photograph taken with a shaky hand. To achieve clear vision, signals from the semicircular canals are sent as directly as possible to the eye muscles. This direct connection involves only three neurons, and is correspondingly called Three-neuron-arc (Fig 3). Using these direct connections, eye movements lag the head movements by less than 10 ms, one of the fastest reflexes in the human body. The automatic generation of eye movements from movements of the head is called vestibulo-ocular reflex, or short VOR.

Figure 3 Three-neuron arc, during a head movement to the right. 8th facial nerve, from the peripheral vestibular sensors to vn, the vestibular nuclei in the brainstem. VI abducens nucleus. The medial lateral fascicle (mlf) projects from the abducens nucleus to III, the oculomotor nucleus. The left lateral rectus muscle lr and the right medial rectus muscle mr get contracted, turning the eyes to the left. The blue objects are excited, the red ones inhibited. (From SensesWeb, by Tutis Vilis.)

This reflex, combined with the push-pull principle described above, forms the physiological basis of the Rapid head impulse test or Halmagyi-Curthoys-test: when the function of your right balance system is reduced by a disease or by an accident, quick head movements to the right cannot be sensed properly any more. As a consequence, no compensatory eye movements are generated, and the patient cannot fixate a point in space during this rapid head movement.

 

Mechanics

The mechanics of the semicircular canals can be described by a damped oscillator. If we designate the deflection of the cupula with θ, and the head velocity with , the cupula deflection is approximately

α is a proportionality factor, and s corresponds to the frequency. For humans, the time constants T₁ and T₂ are approximately 3 ms and 5 s, respectively. As a result, for typical head movements, which cover the frequency range of 0.1 Hz and 10 Hz, the deflection of the cupula is approximately proportional to the head-velocity (!). This is very useful, since the velocity of the eyes must be opposite to the velocity of the head in order to have clear vision.

 

Central Processing

Signals from the vestibular system also project to the Cerebellum (where they are used to keep the VOR working, a task usually referred to as Learning or Adaptation) and to different areas in the cortex. The projections to the cortex are spread out over different areas, and their implications are currently not clearly understood.

 

Otoliths

Figure 4 Otoliths, left side. A) the utricle, and B) the saccule. C) Cross-section through the utricle: the Mesh Layer is fairly stiff, while the underlying Gel Layer is more viscous. When the Hair cells are bent in the directions indicated by the arrows in A) and B) they get excited, while a deflection in the opposite direction inhibits them. (From Rudi Jaeger)

While the semicircular canals respond to rotations, the otoliths sense linear accelerations. We have two on each side, one called Utricle, the other Saccule. Figure 4C shows a cross section through an otolith: the otoconia crystals in the Otoconia Layer (Fig. 4, top layer) rest on a viscous gel layer, and are heavier than their surroundings. Therefore they get displaced during linear acceleration, which in turn deflects the Hair cells (Fig. 4, bottom layer) and thus produces a sensory signal. Most of the utricular signals elicit eye movements, while the majority of the saccular signals projects to muscles that control our posture. While the interpretation of the rotation signals from the semicircular canals is straightforward, the interpretation of otolith signals is more difficult: since gravity is equivalent to a constant linear acceleration, we somehow have to distinguish otolith signals that are caused by linear movements from such that are caused by gravity. We can do that quite well, but the neural mechanisms underlying this separation are not yet fully understood.

 

Pathologies

Diseases of the vestibular system can take different forms, and usually induce vertigo and instability, often accompanied by nausea. The most common ones are vestibular neuritis, also called Labyrinthitis, and BPPV. In addition, the function of the vestibular system can be affected by tumors on the cochleo-vestibular nerve, an infarct in the brain stem or in cortical regions related to the processing of vestibular signals, and cerebellar atrophy. Less severe, but often also with large consequences, is vertigo caused by the intake of large amounts of alcohol.

 

BPPV

BPPV, which is short for Benign Paroxysmal Positional Vertigo, is probably caused by pieces that have broken off from the Otoliths, and have slipped into one of the semicircular canals. In most cases it is the posterior canal that is affected. In certain head positions, these particles push on the cupula of the canal affected, which leads to dizziness and vertigo. This problem occurs rather frequently, often after hits to the head or after long bed rest. The tell-tale sign of BPPV are vertigo attacks which repeatably appear when the head is brought into a specific orientation. In most cases BPPV can be eliminated (for the patient in an almost miraculous way) by lying down, bringing the head in the right orientation, and sitting up quickly.

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Ready Bodies Motor Labs:

• Are designed as a classroom center or campus-wide curriculum that can be easily administered
• Are time-tested and powerful, and deliver results quickly
• Do not require specific referrals
• Can be used for ALL students - special education, at-risk, and regular education

The aim of the Ready Bodies Motor Lab is to be campus-wide. Each student on site attends regularly during the week. Some classes are in a rotation with art and music, some run for 20 minutes daily. We all know adding a new program is often difficult for schools. ANY time spent with the children doing this program will be beneficial, and the RBLM program is designed for easy adaptability for your situation and budget.

If the first 5 minutes of library time or computer class time is set aside to lead them in only two activities, their responsiveness to the teacher will be greatly enhanced. If the teacher must keep "bouncer" students in from recess to complete their work, it is likely that these same students would benefit from 5-10 minutes of Ready Bodies activities. These activities are designed to stimulate and develop the reflex, tactile, proprioceptive, vestibular, visual and auditory systems. Jumping as he spells the words he missed, crawling or creeping to the reading center, or doing tornadoes at the whiteboard prior to his writing assingment will help his systems operate.

Goals of the Ready Bodies Motor Lab

Our goal has always been to help children develop the skills necessary for learning readiness and mastery of the environment.

Many of these skills are motor based. Handwriting, sitting still, paying attention, speaking, and behavior are all performances based on a child's ability to maneuver and function in his environment. The more aware he is of his environment and the more he learns about the sensations of his own movement, the better he can control himself and accomplish tasks.

This is not intended to be a replacement for Physical Education, but instead is intended as a base for the skill building of Physical Education, as well as building a structure for the acquisition of acedemic skills. The aim of the activities outlined in the the Activity Guide are to stimulate the child's sensory systems.

If you would like to discuss how the RBLM team can help you quickly and easily setup an RBLM Motor Lab in your school, please contact Athena Oden, PT by clicking here!  

• Simple but powerful understanding of the relationship between systems
• Practical advice and useful activities, demonstrated and discussed
• Hands-on and specific training that prepares you to act as soon as you get back home!
• Workshops can be designed to meet the needs of your student population
• Blind and visually impaired, AD(H)D, ODD, and other populations can be specifically addressed

Please click here for the current RBLM Seminar schedule

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Ready Bodies, Learning Minds - A Key To Academic Success

This 110+ page book provides the therapist, teacher and parent with all of the information they will need to understand the interrelationships between reflexes, the sensory systems, motor skills, learning and performance. Technical and medical jargon are explained concisely for the non-technical professional. Real examples and the appropriate treatments are explained in detail. A special focus on each of the sensory systems goes beyond the basics, and clearly illustrates how each system, and the interaction of systems, affect a child's ability to learn and perform. All of this is organized in an easy to understand structure, and you will find the book to be an invaluable ongoing reference.

Basic exercises are illustrated in the book, with specific reference to the sensory system and symptoms that the exercises address. For a comprehensive set of exercises aimed at the stimulation of learning readiness, please refer to the Ready Bodies, Learning Minds Activity Guide

Ready Bodies, Learning Minds - Activity Guide

The Ready Bodies Activity Guide is an important companion to the RBLM book. This 120+ page activity guide provides everything a therapist, teacher or parent needs to design, execute and administer the Ready Bodies Motor Lab and curriculum. From the general guidelines for use, complete materials lists, station design, and approaches to progress reporting to the specific and detailed activity descriptions, this book will become your reference guide to success. Each activity is clearly illustrated, using graphics that the children can understand as easily as their therapist, teacher or parent. Each exercise is rated for it's activity and difficulty level, allowing quick and easy adjustment for special needs.

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• A clear understanding of reflexes, sensory integration and kinesthetic awareness, and how they impact learning
• A clear understanding of how learning impacts performance through motor responses, patterns and skills
• Specific, easy-to-implement activities, exercises and in a motor lab format that focus on immature, faulty or disabled systems and deliver results

Do you know children who are "bouncers", "noodles", or "shirt chewers"? Does this behavior affect their ability to learn? Motor and sensory development provide the central nervous system with the ability to perform the many tasks necessary for academic achievement. If the reflexive-vestibular-proprioceptive-tactile systems are not functioning optimally, the student has a limited base of body knowledge and skills on which to build. Limited attention span, poor posture, difficulty sustaining equilibrium, poor coordination of sequential movements, restlessness, problems with spatial relationships, and slow academic progress are common signs of an immature neurological system.

Adults sometimes take for granted how our bodies operate, and how the experiences of our bodies teach us to understand the world around us. The energy spent constructing a world of objects, sights, sounds, colors, shapes, dimensions and directions is enormous. Without the incredible and finely-tuned machine called our body, our brain would be at a loss to describe the world. Our ability to see, touch, feel, hear, move and control ourselves in relationship to the environment is the slate that academic learning is etched on.

Ready Bodies, Learning Minds (RBLM) is a comprehensive approach to understanding how sensory integration and motor control drives learning, and therefore the performance, of our children. RBLM clarifies these powerful relationships, and then delivers powerful, hands-on tools for therapists, teachers and parents to assist children.

• With Ready Bodies, Learning Minds you'll understand the linkage between motor planning, learning and performance
• You will learn how children with immature sensory systems develop faulty and adaptive patterns
• Ready Bodies, Learning Minds is designed to preempt and correct these patterns and ready the child for learning

Reflexes, Sensory Systems, Learning and Performance

Learning occurs primarily via the interaction of the sensory systems. It is not something we can see happening, but is rather information our brain is gathering through these systems and sensations all the time. The reflex system contributes to our understanding of movement. The tactile, proprioceptive, and vestibular systems contribute to our kinesthetic awareness. The visual and auditory systems supply us with stimulation from the environment. The information gathered is our storehouse of knowledge and skills used to perform tasks.

Performance is the motor or movement response. We speak, gesture, and write to communicate our thoughts and ideas. These are all movement skills that are used to demonstrate what we have learned. We often mistakenly label the performance of these movement skills as learning.

Motor Planning

When learning a new task, we think through the new information our sensations give us and then perform; this creates a motor response. With practice, skills are refined by recalculating the information from the sensory systems and a motor pattern emerges. A motor skill is a highly refined pattern of movement performed automatically from previously developed plans.

Whatever activity a child does will require motor planning. If you are seeing a pattern of difficulty, the Ready Bodies program can help you back up and understand which systems are giving the child the biggest problem, and how to address them.