©marion stanton motor planning training © marion stanton

©Marion Stantonwww.contactcandle.co.uk

Motor Planning Training

© Marion Stanton

©Marion Stantonwww.contactcandle.co.uk

Practical activity – the value of support

• Write with your dominant hand standing on one leg.

• Get someone to hold you steady and then repeat writing.

Motor Planning

• Learning to drive, swim dance.

©Marion Stantonwww.contactcandle.co.uk

Most Common types of Neuro-Motor Difficulties.

AutismAutism Cerebral PalsyCerebral PalsyProprioception Involuntary Movement

Perseveration Muscle Tone

Impulsivity Initiation

Initiation ATNR

Disinhibition Radial Ulnar

Aksathisia Proximal Instability

Dystonia

Most Common types of Neuro-Motor Difficulties.

RettsRetts Down SyndromeDown SyndromeDystonia Impulsivity

Fluctuating tone Low muscle tone

Eye hand coordination Fatigue

Initiation Eye/hand coordination

Switching Finger isolation/extension

Finger isolation Unstable sitting position

ATNR

ATNR (asymmetrical

tonic neck reflex)

A reflex extension of the arm following the pointed direction of the chin when turning the head to one side.

AccommodationAccommodation

Encourage the person to look up until the last moment when they go to point.

Impaired eye/hand co-ordination

A person points without looking or without allowing enough time between movements to scan the display and locate the target.

Some people cannot look and point at the same time e.g. with ATNR.

Some people maintain that they find it easier to use peripheral vision but people often become more accurate and more independent if they develop their looking skills.

Accommodations Hold back until the person has looked.

Ensure aids are appropriately positioned to make it as easy as possible for the person to look and point.

Perseveration

The person repeats previous selection or tends towards certain selections. Looks like repetitive behaviour.

AccommodationsBring the person back to a central point between each selection.

Shake the arm every few selections.

Change positions on the communication board.

Radial/Ulnar Stability

Unequal pull on muscles.

The muscles in the hand, wrist or forearm do not co-ordinate well together causing the index finger to swerve resulting in selections off to the side of the target

AccommodationTemporary use of a splint.

Use the hand that facilitates as a splint.

Body Stability Proximal instability Shoulder and/or trunk

instability due to muscle weakness. Often an over arm pointing action is used.

Unstable sitting position

Muscle weakness and/or spinal problems.

AccommodationsGood supportive seating

Supportive clothing

Lifting the side that sags.

Akathisia

Described as a sense of ‘inner restlessness’, that has a strong component of motor restlessness.

The person cannot keep physically still or maintain a static posture for an extended period of time.

AccommodationsLet the person have frequent movement breaks.

Use ‘fidget’ toys.

Use timer for time to be on task.

Crossing the midline

Difficulty crossing over the mid point of one’s body when pointing.

AccommodationsPosition the aid to the right (left for left handed people) Centre the aid in line with shoulder.

Provide firmer hold, resistance, lift on selections that are cross the mid line.

Impulsivity

The person points before they have had time to consider a response often without good aim.

AccommodationsHold back until they have looked.

Make sure they relax before they point.

Talk quietly.

Backward resistance.

Tremor

Can be either a continuous tremor or extension tremor.

AccommodationFirm pressure in the facilitators hand.

Disinhibition

Auditory – cannot ignore stimuli.

Visual – cannot ignore stimuli.

AccommodationsPhysical and verbal support to keep focus on target.

Reduce external stimuli when appropriate/necessary.

Initiation

Problems with starting a movement.

AccommodationsVerbal prompts ‘1,2,3 go’.

Slight physical prompt under the arm.

Pulling back the forearm to bring in some tension.

A gentle shake of the arm.

Proprioception

Lacks awareness of themselves in space.

May be recognised by people trying to get contact with large surface areas.

Sometimes repeated physical behaviour.

AccommodationLean against the body.

Second skin.

Gentle, deep pressure on hand, arms, shoulders.

Chair with sides.

Weights.

Dystonia Slow, rhythmic, twisting

involuntary muscle contractions, which force the body into abnormal, sometimes painful movements or postures.

Dystonia can affect any part of the body including the arms, legs, trunk, neck, eyelids, face or vocal cords.

AccommodationWAIT. Dystonia is painful and involuntary but it does pass.

Gentle massage may help.

Low Muscle Tone

Hypotonia

Floppy muscles making it difficult to lift limbs and put physical pressure on anything.

AccommodationsLower the aid, give the arm a lift, pull back to create tension and increase tone.

High Muscle Tone

Hypertonia Having very tight

muscles making it difficult to be accurate when pointing, sometimes over shooting target and pushing aid away due to force of movement.

AccommodationsGive arm a gentle shake/gentle massage.

Position the aid directly in front.

Involuntary Movements

Difficulty in controlling part or parts of the body.

Occasionally person will have better control of their head rather than their hand.

AccommodationsAnchoring (either with facilitation or supports) so that person is trying to move from the elbow rather than the whole arm or whole body.

Try to establish a part of the body that the person has control over.

Stopping

Difficulty in stopping thoughts and movements once started.

AccommodationsPull back to slow movements.

Coactively stop the person to give a model

Verbal prompting

Finger Isolation/extension

Difficulty isolating and/or extending an index finger.

Instability at base of index finger – causes difficulty extending the index finger whilst flexing the other fingers.

AccommodationsHand moulding

Activities which encourage index finger isolation.

Avoid crooking your finger under the persons finger.

Occasional use of a finger splint.

Undecided hand dominance

Using both hands for a task only requiring one. Both hands come up at once and it is hard to isolate one from the other.

AccommodationsFind out if anyone in family is left handed. If not encourage right handed dominance.

Vision Issues

Difficulty scanning the communication aid.

People with visual spatial impairments have great difficulty localising objects in 2 and 3D space.

AccommodationsUse good contrast.

Experiment with position of aid.

Try different sized/coloured pictures.

Tactile Sensitivity

Sensitivity to soft physical touch.

Even the thought can be distressing.

Accommodations

A firm hold is better. Sensitive receptors are in the surface of the skin.

Give the person verbal prompts. Let them know what is going to happen.

Fatigue

Muscles tire from repetitive use, over/lack of use or from intense amount of concentration used in achieving task.

AccommodationsWork at the person’s best time of day.

STOP at regular intervals to allow for recovery.

Carry on from the last point rather than going back to the beginning.

©Marion Stantonwww.contactcandle.co.uk

VALIDATION

• No claim of authorship without validation either by independent verification or other means.

• Other means include information that the communication partner couldn’t have known. Doesn’t have to be the truth but needs to refer to something that has happened.

©Marion Stantonwww.contactcandle.co.uk

Strategies to develop independence

• Slowly fade support • Help with timing using verbal prompts or other

cues.• Ensuring switch users have the best set up for

them.• Ensure those who eye-point look at you

immediately after they have made a selection.• Make sure the spacing of selections is the most

suitable for individual need.• Use the ladder.• MONITOR EYE CONTACT.

Monitoring access

©Marion Stantonwww.contactcandle.co.uk

©Marion Stantonwww.contactcandle.co.uk

©Marion Stantonwww.contactcandle.co.uk

©Marion Stantonwww.contactcandle.co.uk

Moving back to earlier strategies

When:• New support staff• Less predictable or more complex text• New communication aid• Not well or tired or tense for any reason• In a test situation or when being watched

by unfamiliar people• Subtle attempts to fade back are noticed!

Connection between FC/FCT and MPT

• The name change

• Prejudice

• Poor practice

• Connection to accepted practice

• Discussion

©Marion Stantonwww.contactcandle.co.uk

CONTACT

• www.candleaac.com

• info@candleaac.com

©Marion Stantonwww.contactcandle.co.uk