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Mary Jones, OTR/L of Sensational Kids, LLC in Bradenton, FL

Rehabilitating Limb Dyspraxia with the Interactive Metronome®

+What is Limb dyspraxia?

Also known as postural praxis - difficulty imitating different body/limb positions, and motor control.

Dyspraxia entails the partial loss of the ability to coordinate and perform certain purposeful movements and gestures in the absence of motor or sensory impairments.

+What is Limb dyspraxia?

Considered a syndrome reflecting motor system dysfunction at the cortical level, exclusive of the primary motor cortex

Can be considered a form of a motor agnosia. Patients are not paretic but have lost access to information about how to perform skilled movements

+Other forms (sub-types) of dyspraxia

Dyspraxia is also referred to as the following: Buccofacial dyspraxia Orofacial dyspraxia Ideational dyspraxia Ideomotor dyspraxia Limb-kinetic dyspraxia Verbal dyspraxia

Dyspraxia may be accompanied by a language disorder called Aphasia (difficulty expressing or understanding written or spoken language).

+Things to look out for…

Client takes your hand to

perform an action (as if your

hand will work better than

theirs)

Delays in responding to

requests

Often the client appears

unusual in their movements –

can appear stiff, clumsy, or

delayed in their motor skills

+More things to look out for…

Inconsistency in motor responses.

Difficulty learning a series or sequence of movements

Difficulty imitating

An action takes a long time to learn.

+Even more things to look out for…

Most dyspraxic clients are considered to be either cognitively impaired, or willfully uncooperative due to their difficulties responding.

Often, when writing or typing, the same scribble or key combinations appear over and over again

+Yep, more things to look out for…

A client might leave the table repeatedly because they have a motor pattern for getting up and going. Often, these clients will welcome your breaking of the pattern, rather than appearing angry if you obstruct

You may have a strong sense that the client understands much more than they are demonstrating.

Often, there is poor bilateral coordination.

Also, there is usually no clearly dominant hand.

+And finally…

There may be poorer performance of tasks that involve alternating contraction and extension of opposing muscle sets.

Sometimes, when a dyspraxic client does respond, the movement is quick and impulsive. Slow and controlled movement may be rarely seen.

+Limb dyspraxia: special considerations

Require more trials to create or re-establish motor patterns

Require more time to practice using motor patterns when appropriate, and not using the pattern when not appropriate

Over time, and with practice, the client can become more and more adept at controlling their extremities.

With progress builds cognition – cognitive ability that they always had, but could not demonstrate.

With increased cognition, the client becomes more functional – this may translate to a more GENERALIZED response to their environment, or to a development of functional ROUTINES to master specific situations.

+

IM : a valuable

tool to access the

neuro-networks

responsible for

motor processing

speed and

delivery.

+Customizing IM to facilitate rehabilitation of the client with dyspraxia

Step 1• Set up the client with IM station at the Phase

One level (learning to associate with the beat).

• Use low repetitions, a tempo that facilitates success (often higher than the 54 bpm default setting), and a volume setting that is comfortable to the individual.

• Practice initially with reference tone only, and using upper extremity access to the triggers (both hands, right hand, left hand)

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Step 2 • Once a client has reached a level where they

have an automated response to an IM task (no longer challenging executive functions) they can progress to higher levels of difficulty

• This may include: a change in tempo (often a little slower), introduction of guide sounds (Phase Two level) and difficulty settings graded from easiest (300) to gradually harder (auto) levels.

• Access to triggers may be modified, but should aim to progress to more fluency over excessive resistance.

Customizing IM to facilitate rehabilitation of the client with dyspraxia

+Session by session, client by client, be sure to consider…

Environment

Positioning – just right level of support

Access to triggers

Component steps to tasks

Most efficient feedback for client

+Refine your baseline data

discipline specific standardized testing

functional observations and assessments

social and tool-use pantomiming

video-recording and use of media to log subtle changes (with appropriate consent forms completed)

+Cueing strategies

Physical

Verbal

Imitation

Pictoral

Numeric

Media

Definition

Memory

Pantomiming/social stories

+ Grounded activities allow for increased focus on limb movement over concurrent whole body balance

+Contain environment

contain and master isolated limb movements

+And so much more…

If you are looking for CEUs, look no further than Interactive Metronome®.

We have an extensive catalog of over 100 webinars with topics on everything from autism to motor deficits to ensuring clinical profitability

and success with IM.

And our new badging system makes it easy to identify the information that is tailored to your

practice. No more wasting time looking for CEUs! It is time to take your clients’ training to the next

level!

+The End

For more information:

visit www.interactivemetronome.com

or call (877) 994-6776 (*US Only)

Know your party’s extension?

call (954) 385-4660