Influence of Sensory Disorders on the Motor Development of Children - Essay Example

The aim of my professional practice is to become well-versed in how sensory impairments affect motor development in children with multi-sensory impairments. Previously, I mostly relied upon the input from the physiotherapist to direct me on how to support the physical needs of the pupils. My initial concern regarding one particular pupil was that due to his cognitive, visual and physical impairment, he had restricted opportunities to learn and develop. I felt it was crucial that I offer him the opportunity to experience movement and to learn from it. My main aim was to stimulate his interest, his ability to experience the world around him, and to motivate him to initiate movements outside his comfort zone. Through the assignment, I developed my knowledge and understanding on the movement displayed by the pupil in relation to his sensory impairments. I also gained a greater insight into the relationship between his physical experience and his cognitive abilities. In the course of my study and observations, I was able to uncover the reason why the pupil lacked the motivation to learn. All in all, I feel I am more able to incorporate the immediate environment as well as the activities which can overcome difficulties for pupils in accessing stimuli more effectively. Pupil Z individual observation programme – week 1 I completed a one-week individual observation programme on Pupil Z. In this programme, I decided to take a close look at Pupil Z’s movements. I wanted to find out about his natural movements and the ways in which any intentional actions were made. I wanted to gather information on the range of proper actions which can be made in order to ensure that I was making informed judgments about what I was seeing. I also wanted to use such informed judgments before I could develop a plan and implement a more meaningful movement experience for him. I decided I should use my observations and the standardised assessment format. This led me to explore a range of texts relating to the cognitive versus physical development of children, including studies on how pupils with multiple disabilities often suffer developmental delays. This led me to the use of Lillie Neilsen’s “Function Skills Assessment,” which is a formalised assessment tool highlighting significant milestones in the physical development of young children (Neilsen, 2000). I initially made some observations of Pupil Z while there were no stimuli or objects around him, first, while he was in a supported sitting position, and second, while he was on a supine position on the floor. Then I observed him when he explored different objects around him in these positions. I felt that this experience would enable me to compare his natural movements to his other movements when presented with objects and when given support by an adult. I was unable to observe his movement behaviours in the prone position as he did not tolerate being in this position too long and he communicated his discomfort by becoming increasingly distressed and by crying. Observation of Pupil Z’s movements without stimuli Due to his dystonic athetoid cerebral palsy, Pupil Z displayed abnormal involuntary movements that varied in intensity from mild to severe, and which often placed him in abnormal positions. For instance, his fists would often abruptly clench, his arms / hands would twist, and then his legs would stiffen and straighten. In his chair, his feet would straighten and extend for a few seconds and then relax, causing him to fall back onto his chair. His facial expressions were often quite tense. These events usually appeared in cycles of action and rest, action and rest. These overactive muscle responses often have a negative impact on his energy level, causing exhaustion and decreased energy soon after. Oftentimes, he would sleep after said incidents. When in a supine position (lying on his back), and on the floor where his limbs are free, he also displayed lots of leg movements (e.g. kicking) with his arms straightening out to his sides or moving about from time to time even when there were no objects or adults to reach for. These events seemed to also appear in cycles of actions and rest, action and rest. However, in this position he was able to maintain a relatively symmetrical position, one which provided comfort while still keeping him alert. He was also communicating pleasure through his facial expression (e.g. smiling) and vocalisation (e.g. laughing) in this position. Observation of Pupil Z’s movements when exploring objects I felt that it was necessary to observe Pupil Z, first, in structured activities where he could explore objects, and second, in a supported sitting position, where I could observe whether or not his movements would change. I also decided to observe him in a whole group session and self-occupation sessions in order to give him an opportunity to experience movement. The greeting session began with pupils seated in appropriate classroom chairs in a circle with one adult between two pupils. Pupil Z was in his normal activity time position in his wheelchair with a tray in front of him where he can access objects and equipment. He seemed to be relaxed and calm with his hands resting on his side. The adult leading the activity identified learning objectives, and then, using a cue (parachute) indicated that it was time for the morning circle. When it was Pupil Z’s turn to attend to the cue, an activity was indicated. The adult leading the activity moved the parachute vigorously, allowing him time to feel the area on his skin and attend to the sound it made. The adult gently touched the pupil’s arms resting on the side of his chair from shoulders to elbows and positioned these on the tray. In response to this support, the pupil’s arms suddenly stiffened and his fists clenched. It was evident that the pupil found it very difficult to keep his hands on the tray and that he needed active support in order to explore the parachute. A more favourable exploration was done by slowly moving the parachute under the child’s clenched fists in order to slowly acclimatize him to the object and the movement. He seemed to like this type of movement as he slowly relaxed his fists. However, after a period of coactive exploration, he soon lifted and withdrew his hands to the sides of his chair. After the above activity, a song was sung and the adult working with Pupil Z encouraged him to listen and to look at the parachute in time with the song. The song seemed to have a very calming effect on him. This was evident in how Pupil Z turned his head toward the adult singing to him while also making arm movements at the sides of his chair. During the song, the adult working with him allowed him to explore the parachute at the sides of his chair. It was evident that Pupil Z was moving his hands, he was relaxing his fists (opening hands), and that he wanted to reach for the parachute and explore it with his fingers even if only for a brief moment. Then, it was time to smell a vanilla essential oil. The adult working with him gently touched his nose and presented the smell. It was evident that Pupil Z was able to attend to the smell by stilling for a moment. Next, the adult leading the activity indicated that ‘it was time to say hello.’ The adult presented a drum to the pupils and waited for them to respond. When it was the Pupil Z’s time to say hello, the adult gently placed (with movement shoulders to elbows) his hands on the drum, positioning the drum on the tray and waited for his response. It was evident that he found it very difficult to control his hands and to explore the drum. Nevertheless, after a brief moment, he performed stroking hand movements over the drum surface. He had to lift his arms in order to explore the drum and he initially found it difficult to place his hands on the drum. He also needed hand-over-hand support to locate the drum and repeat the stroking action. This experience was very much controlled by the adult working with him. It lasted for only a few seconds. The session concluded with the adult using the body sign for ‘finish,’ and stroking Pupil Z’s arms in a downward motion. Looking at single arm and hand movement In the short session, Pupil Z was accessing a switch placed on his tray with one-hand support. During the recorded session, it seemed that he was tolerating physical contact with an adult. It was apparent that while doing so, he was also trying to move his arm up and down toward the switch. His head and arm movements throughout the short session (3 minutes) were continuous and they seemed to follow a pattern of movement. In this movement, one arm was supported, another moved forward, and his facial expression was quite tense and focused while trying to reach for the switch. It seemed that he found it beneficial to have this support and that he could better control his movements in pressing the switch. However, he found it difficult to repeat action. I carried out some observations on Pupil Z during self-occupation time. I wondered if Pupil Z would react in the same way in exploring objects when they were placed at the sides of his chair. The result showed that he was making intentional movements using his hands and fists to explore interesting tactile objects attached to the mat or string of balls / beads on the sides of his chair. These activities seemed to motivate Pupil Z in that he responded by smiling (see sample of DVD record). However, it was evident that he was unable to access and explore independently the same stimuli (e.g. tactile mat) on his tray. His movement seemed more limited. It was apparent that reaching these stimuli took more effort and concentration. For instance, he is seen making a swiping action over the surface of the tactile mats rather than exploring objects more intently. I felt it was an indication of the overall difficulty he found in moving his arms in a purposeful direction, and this in turn, impacted on his ability to explore objects. I also evaluated his responses to objects while he was in a supine position (lying on his back) and while he was on the floor. In these instances, he displayed lots of leg movements (e.g. kicking). There were also lots of feet reaching and arms straightening on either side as he felt objects he needed to explore (e.g. interactive board). He communicated his pleasure through his facial expressions (e.g. smiling) and vocalisations (e.g. laughing). He also preferred to use his feet rather than his hands to explore objects. For example, when positioned on his back / side, he usually used his feet to explore objects. He often turned on his back and/or thrust his heals against the floor in order to move himself to positions where he could explore the same stimuli. It has been evident to me that Pupil Z has been reaching intentionally with his feet in different ways, for example, moving mobile parts of objects and listening to the sounds it made. In light of my observations of Pupil Z, I felt that I should gather other possible formative data to support my observations and findings. I decided to gather data to reinforce my belief that Pupil Z was making intentional movements in terms of his physical, sensory and cognitive abilities. I chose Lillie Neilsen’s “Function Skills Assessment,” a formalised assessment tool in order to mark significant milestones in the pupil’s physical development. The results in this assessment showed that Pupil Z seemed to generally display the physical features, in terms of his gross and fine motor skills, of a 3–6 month old child. The type of gross motor skills he displayed included spontaneous feet movements and reaching (to hit target / obtain object) in a supine position (lying down with the face up). He was also able to turn from side to side, hold himself steady in midline position and raise his head when lying on his back. This position did not hold for much longer though. It was essentially very difficult to observe his activities in the prone position because he did not tolerate well lying on his stomach and he often became distressed in such a position. I also observed that the child was unable to lift or turn his head, that he often used his hands or forearms to bear his weight, and that he usually rolled himself on his back, as was his preferred position. However, such assessment is still not complete and I feel that I need to carry out further assessments on his responses to objects in the prone position. The type of fine motor skills the pupil displayed during this assessment confirmed my individual observation regarding significant delays in his fine motor skills, especially in the following areas: reaching, grasping, and manipulating objects. He does not have ‘midline organisation’ of hands for play and for weight-bearing. Such limitations also impact on his upper body strength, his head control (struggles to lift his head up in supported sitting position), and other activities like grasping and holding objects in his hands. Read More