Many individuals close to childhood apraxia of speech hear the words “motor planning” and think of speech. However, motor planning affects everything that requires movement; a child’s function at home, at school and in every extra-curricular or leisure activity that they are involved in. Motor planning is the ability to plan and carry out motor tasks. For children with deficits, physical activities are hard to learn, difficult to retain and generalize, and may look hesitant or awkward in performance.
When considering the effect of motor planning on a child’s performance in school, an immediate concern is typically hand writing. Hand writing is definitely affected by motor planning, but so are many other activities that children need to perform independently to be successful at school. It is important to remember that just as speech is so difficult for many children with apraxia of speech, other complex motor tasks may be difficult as well. A good example is the task of shoe tying.
When a child learns a new task, they usually learn it in steps:
- cross the laces
- wrap the top lace under and pull tight
- make a loop with one lace
- make a loop with the other lace
- cross the loops over each other
- push the top loop around through the hole underneath and pull tight
It is easy to see that when one breaks down the task into steps, there is a lot of room for error and confusion until the motor plan for the activity becomes set or automatic, and does not need constant cueing and reminders. It can become frustrating for the child and for the parent or teacher when there is difficulty learning basic tasks like dressing or gathering books to take home.
Occupational therapists are trained first and foremost in the analysis of everyday activities, and in a school setting- teaching their clients or students how to be independent for school activities. These activities are considered the “occupation” of the child and go well beyond just the academic performance. They can also include being able to sit in one’s seat, organize books and papers, attend to the teacher, and function in the classroom. The child also needs to be able to function outside the classroom to be successful at school. This includes being able to do the other things that happen during a school day, like going to the bathroom- managing the snaps or buttons on their pants, going through the cafeteria line without bumping into people, carrying a tray to a seat, opening containers, eating independently, packing up belongings at the end of the day and getting ready to go home.
When there is a breakdown in motor planning, children can appear clumsy, unorganized, and inattentive and not be able to complete tasks in a timely manner. It is important if any of these issues are noted, to speak to the occupational therapist and follow through with recommendations at home and at school. Children with motor planning deficits learn through demonstration, repetition and successful attempts. As with speech motor planning difficulties, appropriate therapeutic intervention usually is very helpful in managing motor planning problems, and should be addressed as early as possible.
[Ann Marie Feretti, OTR/L, CHT is the owner of Helping Hands Occupational Therapy PC. She earned her degree in Occupational Therapy at the University of Alberta in Western Canada, and is now pursuing an advanced Master’s degree at Boston University. In addition to being an occupational therapist, Ann Marie is also a certified hand therapist and has published articles and lectured in this specialty area, especially in the area of traumatic hand injuries and burns. Ann Marie has been able to link her expertise in hand therapy to the needs of the children in the Bronx/New York City school districts to provide occupational therapy services to local children and families.]
This article originally appeared in “Ask The Experts”, October 2005 Apraxia-KIDS Monthly Newsletter