Disclaimer: Sensory Processing Disorders is a VERY specialized field. Information and suggestions on this website are to be used as guidelines, not treatment. This website CANNOT and SHOULD NOT replace medical advice. Do NOT attempt sensory strategies without first discussing the issue with your child's health care provider.
Praxis: A Motor Plan
Have you ever gone to close a door and ended up SLAMMING it shut because you pushed it WAY harder than you needed to? Based on an understanding of your body's strength and coordination, plus it's memory of previous door closing experiences, your brain made a plan to close that door.
Perhaps in past experiences, you needed to exert some force to close a heavy door, or push against resistance from a rug or carpet. Your brain pulled out that memory, and said, "hey, muscles - this is how much force to use!" The reality was that the door was not the same as the one in your memory, and the motor plan that was constructed had mistakes.
"Praxis" is the ability to create a successful motor plan, and it is a very complex task. We need a motor plan for almost everything we do - telling our fingers how to move to write a letter, telling our arm how far to reach to get a glass, knowing how an when to shift our weight to climb stairs, even determining what muscles to activate to sit up straight in a chair.
In order to create a motor plan, the brain must:
1. Have a good understanding of OUR BODY PARTS in relation to OUR BODY, or body scheme.
2. Have a good understanding of OUR BODY in relation to OUR ENVIRONMENT, or body awareness, sometimes called position in space.
Perhaps in past experiences, you needed to exert some force to close a heavy door, or push against resistance from a rug or carpet. Your brain pulled out that memory, and said, "hey, muscles - this is how much force to use!" The reality was that the door was not the same as the one in your memory, and the motor plan that was constructed had mistakes.
"Praxis" is the ability to create a successful motor plan, and it is a very complex task. We need a motor plan for almost everything we do - telling our fingers how to move to write a letter, telling our arm how far to reach to get a glass, knowing how an when to shift our weight to climb stairs, even determining what muscles to activate to sit up straight in a chair.
In order to create a motor plan, the brain must:
1. Have a good understanding of OUR BODY PARTS in relation to OUR BODY, or body scheme.
2. Have a good understanding of OUR BODY in relation to OUR ENVIRONMENT, or body awareness, sometimes called position in space.
Baby Talk
Luckily, we didn't come out of the womb a blank slate. Our brains were already pre-wired with some incredibly important motor plans, in the form of reflexes. Motor plans serve a purpose, and although we were not in voluntary control of our reflexes, they certainly served a purpose during our infantile development. As our brains developed, we become more in tuned to our bodies and our surroundings. By moving our head through space (vestibular input), we get an understanding of right side up, upside down, and where we are in space. By using our muscles against gravity (proprioceptive input), we get an understanding where our limbs are position, and how to move them. We begin to understand what muscle to activate, what force to use and what direction to ,move them in order to achieve a goal. As our controlled movements take over, our "primitive reflexes" typically fade out. But, we always have some reminiscent of them - just think of how you startle when there is suddenly a loud noise.
However, there are circumstances where reflexes are more prominent that they should be. There are a variety of reasons this happens - some that can be predicted - such as a child is diagnosed with a neurological impairment. Sometimes the reasons why the reflexes aren't integrated aren't so clear. In my opinion, reflexes stick around because the child has not had enough opportunity to learn about their body and their surroundings to understand how to move purposefully. As a result, the brain resorts to the only plan they know - reflexes.
Let me be clear - the presence of reflexes doesn't mean the child was neglected, or deprieved, from motor experiences. The needs of the brain vary so much from individual to individual. One of the most common situations I see reflex presence is in children that were "early walkers". No medical issues; supportive family life.....the child just needed more time crawling to get that sensory input to develop an accurate "body scheme" and "body awareness". Without it, the child cannot develop a "new" motor plan, and so the old one still lingers.
However, there are circumstances where reflexes are more prominent that they should be. There are a variety of reasons this happens - some that can be predicted - such as a child is diagnosed with a neurological impairment. Sometimes the reasons why the reflexes aren't integrated aren't so clear. In my opinion, reflexes stick around because the child has not had enough opportunity to learn about their body and their surroundings to understand how to move purposefully. As a result, the brain resorts to the only plan they know - reflexes.
Let me be clear - the presence of reflexes doesn't mean the child was neglected, or deprieved, from motor experiences. The needs of the brain vary so much from individual to individual. One of the most common situations I see reflex presence is in children that were "early walkers". No medical issues; supportive family life.....the child just needed more time crawling to get that sensory input to develop an accurate "body scheme" and "body awareness". Without it, the child cannot develop a "new" motor plan, and so the old one still lingers.
The Praxis Puzzle
1. Primitive Reflexes
There's a good number of reflexes that we are born with, all which serve purpose. However, I am just going to touch on two of the most common residual reflexes that I see impacting functional movement. A great resource for learning how primitive reflexes impact development is Ready Bodies, Learning Minds by Athena Oden.
The first step in functional movement is for these reflexes to fade out, or become integrated, and for voluntary movement to take over. With voluntarily movement occurring we begin to understand our bodies position in space. Using this information, we build a stable base of support (stability) and then move our limbs as desired using this base of support (mobility). When reflexes are still present, the child will still learn to move. However, there are glitches in understanding their body in space, and therefore there are glitches in how the stabilize and move. As a result, movement WILL be awkward, inaccurate and clumsy.
The first step in functional movement is for these reflexes to fade out, or become integrated, and for voluntary movement to take over. With voluntarily movement occurring we begin to understand our bodies position in space. Using this information, we build a stable base of support (stability) and then move our limbs as desired using this base of support (mobility). When reflexes are still present, the child will still learn to move. However, there are glitches in understanding their body in space, and therefore there are glitches in how the stabilize and move. As a result, movement WILL be awkward, inaccurate and clumsy.
Asymmetrical Tonic Neck Reflex (ATNR)
A residual ATNR is often seen in children I work with. It's usually very, very subtle - you would never notice it, unless you were intentionally looking for it. The ATNR is seen in newborns, and is usually integrated by 4-6 months. It is often called the "fencing" reflex, because it looks like a person extending their sword into battle. Here you see my youngest son, Rohnan, showcasing the ATNR at its best.
The ATNR is "activated" by turning your head to the right or left. The reflex is extension (reaching outward) of the arm and leg of the side you are turning to, and flexion (bending inward) of the opposite arm and leg. Its purpose is starting the brain to "blueprint" functional rolling and reaching. When on their stomach, the infants hands are typically close to their chest. With this reflex, head rotation will result in the straightening of one arm and the bending of another - resulting in the "push off" to roll. Likewise, if the infant turns their head to look at an object, the brain prepares the body reach towards the object, whether it be to deflect the object from harm, or obtain the object to manipulate.
While the ATNR is useful for an infant who is trying to obtain a rattle, one could see how it could be very problematic in a grown adult. Imagine driving a car, and turning to look over your left shoulder. Suddenly your left arm extends and your in your neighbors lane! (Now that I've mentioned this example, perhaps you actually know some people who "drift" like this when they are driving. Looks like you might know someone with an ATNR that isn't fully integrated!).
Residual ATNR activity isn't in itself problematic. However, it can become just another drop in the bucket of school related difficulties. For example, let's say a student is having trouble writing. Say, they have trouble recognizing letters and understanding the direction letters go. To help them with writing tasks, instead of having them print independently, you have them copy sentences from the blackboard. Great strategy! Now let's say the student has some residual ATNR activity and the board is positioned on the right side of the room. Everytime they look up to the board, their right hand moves EVER SO slightly to the right. When they focus their attention back to their paper, they are no longer in the place where they left off. Now they must take an additional moment or two to determine where they left off, and where their hand needs to be. Doesn't some that difficult, but what if this happened for every word. For every letter. How frustrating for the child. How exhausting for the mind!
The ATNR is "activated" by turning your head to the right or left. The reflex is extension (reaching outward) of the arm and leg of the side you are turning to, and flexion (bending inward) of the opposite arm and leg. Its purpose is starting the brain to "blueprint" functional rolling and reaching. When on their stomach, the infants hands are typically close to their chest. With this reflex, head rotation will result in the straightening of one arm and the bending of another - resulting in the "push off" to roll. Likewise, if the infant turns their head to look at an object, the brain prepares the body reach towards the object, whether it be to deflect the object from harm, or obtain the object to manipulate.
While the ATNR is useful for an infant who is trying to obtain a rattle, one could see how it could be very problematic in a grown adult. Imagine driving a car, and turning to look over your left shoulder. Suddenly your left arm extends and your in your neighbors lane! (Now that I've mentioned this example, perhaps you actually know some people who "drift" like this when they are driving. Looks like you might know someone with an ATNR that isn't fully integrated!).
Residual ATNR activity isn't in itself problematic. However, it can become just another drop in the bucket of school related difficulties. For example, let's say a student is having trouble writing. Say, they have trouble recognizing letters and understanding the direction letters go. To help them with writing tasks, instead of having them print independently, you have them copy sentences from the blackboard. Great strategy! Now let's say the student has some residual ATNR activity and the board is positioned on the right side of the room. Everytime they look up to the board, their right hand moves EVER SO slightly to the right. When they focus their attention back to their paper, they are no longer in the place where they left off. Now they must take an additional moment or two to determine where they left off, and where their hand needs to be. Doesn't some that difficult, but what if this happened for every word. For every letter. How frustrating for the child. How exhausting for the mind!
The Symmetrical Tonic Neck Reflex (STNR)
The STNR is similar to the ATNR in that head position impacts the position of the limbs.If the infant extends the neck to look upward, both arms will also extend (or straighten) and both hips will flex (bend). If the infant bends their neck downward (putting their chin to their chest), both arms will flex (bend) inward, and both legs with extend (straighten).
This reflex's purpose is the "blueprint" for getting into the crawling position. Note that I said GETTING into the position and NOT crawling. The movement of this reflex involves symmetrical, or same sided, movement - meaning the each arm does the same as its counterpart, and ditto for the legs. However, if you get down on all fours and try it out yourself, you'll find that the act of crawling requires opposite movement (meaning while one arm straightens the other arm beds, and ditto for the legs). As the infant begins to integrate the reflex, their voluntary movement will produce this pattern, and TADA you have a crawler. My youngest appears to have an overriding STNR. At 9 months, this poor guy just can't seem to alternate movement of his arms and legs. As a result, he resorts to "bunny hopping" to get around - frustrating for him, and us! Right now, it's not yet a problem. But it can turn into one...
Residual STNR activity in school age children can become problematic. Once again, movement of the head results in involuntary movement of the arms. Copying from a blackboard, looking to an instructor, looking down to read a text - all creates movement that the child has to attend to and adjust in order to function. It's exhausting!
This reflex's purpose is the "blueprint" for getting into the crawling position. Note that I said GETTING into the position and NOT crawling. The movement of this reflex involves symmetrical, or same sided, movement - meaning the each arm does the same as its counterpart, and ditto for the legs. However, if you get down on all fours and try it out yourself, you'll find that the act of crawling requires opposite movement (meaning while one arm straightens the other arm beds, and ditto for the legs). As the infant begins to integrate the reflex, their voluntary movement will produce this pattern, and TADA you have a crawler. My youngest appears to have an overriding STNR. At 9 months, this poor guy just can't seem to alternate movement of his arms and legs. As a result, he resorts to "bunny hopping" to get around - frustrating for him, and us! Right now, it's not yet a problem. But it can turn into one...
Residual STNR activity in school age children can become problematic. Once again, movement of the head results in involuntary movement of the arms. Copying from a blackboard, looking to an instructor, looking down to read a text - all creates movement that the child has to attend to and adjust in order to function. It's exhausting!
2. Kinesthetic Awareness
Reflexes are essentially the first experience an infant has a "moving". They set up the stage for an infant to meet developmental milestones - rolling, sitting, standing and walking. And while we try to promote an infant to achieve these motor milestones, typically, they are not something that we can TEACH a child. They start these movements by reflex activity, and then transition to purposefully moving their bodies by experiencing life and their own internal drive.
As the brain matures and our muscles grow stronger, we no longer rely solely on reflexes to move. Now, we begin to bring our other sensory systems into the planning of movement. We use our tactile, proprioceptive and vestibular senses to get an idea of how our body is moving. We develop an awareness of our body in space - a "kinesthetic awareness" - which helps us determine how fast, how hard, how long......
As the brain matures and our muscles grow stronger, we no longer rely solely on reflexes to move. Now, we begin to bring our other sensory systems into the planning of movement. We use our tactile, proprioceptive and vestibular senses to get an idea of how our body is moving. We develop an awareness of our body in space - a "kinesthetic awareness" - which helps us determine how fast, how hard, how long......
The Proprioceptive System
The proprioceptive system gives us our sense of how our body and limbs are moving through input to our muscles and their joints. Even when we are not actively "moving", our muscles are working. Just to sit, your trunk and neck muscles need to work against the force of gravity to get into the upright position. Then those muscles need to determine how to sustain that force to maintain that position. A good way to really picture just how had your muscles work even when you are "resting" is to think of what happens when you doze off while sitting up. One minute, your neck muscles are keeping your head upright. You start to doze, and suddenly those muscles release their tension, causing your head to fall forward or backwards. Who would've know those muscles were holding that kind of weight!
Kinesthetic Sense:
Because out bodies need to get into and maintain various positions throughout the day - from sitting down, to walking, to eating, etc. - the receptors to input in our muscles and joints are constantly being activated and sending information about what our bodies are doing to our brain. The message sent to our brains from proprioceptive receptors are essential for the "kinesthetic sense".
Force & Speed:
Because the proprioceptive system is responsible for understanding "load" to our muscles, it makes sense that it is also responsible for telling out brains what kind of force and speed we need to react to this load.
Proprioceptive Glitches
For the typical person, gravity alone provides enough "load" to our muscles to tell our brains where are body parts are located. However, where there is a glitch in proprioceptive processing, gravity alone is not enough. The brain craves more information - WHERE IS MY BODY? Agatha Oden refers to individuals who lack "kinesthetic sense" as noodles. They "melt" into their surroundings, looking for anything to support them. They lean against peers, lean against walls, slink out of their chairs, collapse at the carpet. Likewise, because their system is not efficient at understanding speed and force, these children seem to "fling" as they move. Their movements lack refined precision, that graded control, that brings us from awkward to functional.
Kinesthetic Sense:
Because out bodies need to get into and maintain various positions throughout the day - from sitting down, to walking, to eating, etc. - the receptors to input in our muscles and joints are constantly being activated and sending information about what our bodies are doing to our brain. The message sent to our brains from proprioceptive receptors are essential for the "kinesthetic sense".
Force & Speed:
Because the proprioceptive system is responsible for understanding "load" to our muscles, it makes sense that it is also responsible for telling out brains what kind of force and speed we need to react to this load.
Proprioceptive Glitches
For the typical person, gravity alone provides enough "load" to our muscles to tell our brains where are body parts are located. However, where there is a glitch in proprioceptive processing, gravity alone is not enough. The brain craves more information - WHERE IS MY BODY? Agatha Oden refers to individuals who lack "kinesthetic sense" as noodles. They "melt" into their surroundings, looking for anything to support them. They lean against peers, lean against walls, slink out of their chairs, collapse at the carpet. Likewise, because their system is not efficient at understanding speed and force, these children seem to "fling" as they move. Their movements lack refined precision, that graded control, that brings us from awkward to functional.
The Tactile System
The tactile system is how we first begin to understand the world around us. The sense of touch is so strongly related to emotions, feelings of safety and self - it is no wonder it plays such as huge role in neurological development. There are two primary functions of the tactile system - to protect and to discriminate.
Discriminatory Touch
Discriminatory Touch
4. Auto Pilot & Higher Level Skills
"Auto Pilot" is a term used by Athena Oden, PT to describe the basic understanding of where your body is in space, and how to use it. In Auto Pilot, the child has used their reflexes to build those developmental stepping stones. They have tapped into their tactile, vestibular and proprioceptive system to develop an understanding of their joints and muscles and how to move through space. They have integrated their visual and auditory system to know how to use what they see and hear in terms of planning movement. They have mastered their blue prints.
When these children encounter a new experience - let's say their first time printing their name on a worksheet, they can analyze the situation and pull up a blue print. In this case, they process that to complete this activity, they need to sit upright on their chair and hold a pencil. They pull that plan up from their neurological system. And suddenly, their body is on Auto Pilot. They NO LONGER need to put any thought into what muscle to use to hold their head upright, sit upright on a chair, hold a pencil, maintain a grasp on..... It is unconscious. And this is what needs to happen, because right now, they need to put all of their concentration into the NEW HIGHER LEVEL task - printing letters.
When these children encounter a new experience - let's say their first time printing their name on a worksheet, they can analyze the situation and pull up a blue print. In this case, they process that to complete this activity, they need to sit upright on their chair and hold a pencil. They pull that plan up from their neurological system. And suddenly, their body is on Auto Pilot. They NO LONGER need to put any thought into what muscle to use to hold their head upright, sit upright on a chair, hold a pencil, maintain a grasp on..... It is unconscious. And this is what needs to happen, because right now, they need to put all of their concentration into the NEW HIGHER LEVEL task - printing letters.
Houston, We Have A Problem....
So now let's paint the big picture....
Baby Houston has an overriding STNR reflex. He can get into the crawling position, but has trouble alternating his arms and legs. Everytime he moves looks up or down, his arms and legs tend to move. Rather than attempting to crawl, Baby Houston likes to pull himself up and cruise along the furniture in a standing position. There doesn't seem to be anything abnormal about this, and his parents are actually proud that he is starting to "walk" early.
Meanwhile, because Baby Houston isn't crawling, he isn't getting that vestibular input of his head tilting up and down through space. He isn't learning the "feeling" of holding your head up against gravity. Likewise, he isn't getting that proprioceptive input - so much proprioceptive input - of his trunk muscles to remain straight, of his arms to extend while holding the weight of his body, the movement of his shoulder and elbow joints as his arms move..... And finally, he isn't getting that tactile input to the palms of his hands, the feeling of different pressures and textures as he crawls through his environment. But it doesn't look like a big deal, because Baby Houston is walking just fine. He is fidgety at mealtime, and doesn't like to color or draw, but really likes to be outdoors.
So now it's time for Baby Houston to go to kindergarten. On the first day of school, he has to write the letter H. He goes to sit down at his desk, get his arm stable for writing, hold his pencil, and move his fingers. But there is no blue print for this. So now, every muscle contraction, every joint movement - is conscious. He has to think about and plan EVERY detail. There is no auto pilot. And now we are asking him to do a new task that would typically require more concentration - figuring out how to form strokes in a letter.
The demands are too much. There is too much to calculate. So what happens? One of any of these situations.....Houston falls off the chair; Houston breaks down and starts crying; Houston acts out and starts throwing materials; Houston attempts the task, but has no control. In any event, Houston, we have a problem.
Baby Houston has an overriding STNR reflex. He can get into the crawling position, but has trouble alternating his arms and legs. Everytime he moves looks up or down, his arms and legs tend to move. Rather than attempting to crawl, Baby Houston likes to pull himself up and cruise along the furniture in a standing position. There doesn't seem to be anything abnormal about this, and his parents are actually proud that he is starting to "walk" early.
Meanwhile, because Baby Houston isn't crawling, he isn't getting that vestibular input of his head tilting up and down through space. He isn't learning the "feeling" of holding your head up against gravity. Likewise, he isn't getting that proprioceptive input - so much proprioceptive input - of his trunk muscles to remain straight, of his arms to extend while holding the weight of his body, the movement of his shoulder and elbow joints as his arms move..... And finally, he isn't getting that tactile input to the palms of his hands, the feeling of different pressures and textures as he crawls through his environment. But it doesn't look like a big deal, because Baby Houston is walking just fine. He is fidgety at mealtime, and doesn't like to color or draw, but really likes to be outdoors.
So now it's time for Baby Houston to go to kindergarten. On the first day of school, he has to write the letter H. He goes to sit down at his desk, get his arm stable for writing, hold his pencil, and move his fingers. But there is no blue print for this. So now, every muscle contraction, every joint movement - is conscious. He has to think about and plan EVERY detail. There is no auto pilot. And now we are asking him to do a new task that would typically require more concentration - figuring out how to form strokes in a letter.
The demands are too much. There is too much to calculate. So what happens? One of any of these situations.....Houston falls off the chair; Houston breaks down and starts crying; Houston acts out and starts throwing materials; Houston attempts the task, but has no control. In any event, Houston, we have a problem.
Sensory Strategies and Activities
Sensory intervention using involves two things - first, modifying the environment to compensate for sensory deficits. For example, an adult may help a child understand his personal space by providing him with a masking tape square at the carpet. Sensory intervention also involves having the child go through movements or sensations in a safe environment - to help his neurological system "practice" how to move and begin to make neurological "maps" to use as the autopilot plan.