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Valerie Dejean
writes on Vestibular Dysfunction

Levels of Processing Disorder

Severe: Interacts with objects primarily for sensory and motor properties (e.g. spins the rubber tires on a toy truck repeatedly but does not attempt to "drive" the truck). No imitative actions or purposeful gesturing. Largely expresses self through pleasure and distress.

 Less Severe: Plays in single actions, such as lines up cars. Plays with simple cause and effect toys. Imitates single acts on request, such as touching a body part.

Moderate: Plays with simple construction toys. Learns from repeated hand over hand demonstration. Starts to attempt simple multi-step tasks such as simple clothing.

 Milder: Simple pretend play such as feeding a baby doll or putting the toy people on the swing. Attempts to draw purposefully. Begins to play games with simple rules such as holding hands and going around in a circle. Understands object functionality: comb for the hair, etc.

 Mild: Attempts most activities appropriate for his/her age, though sequencing and qualitative problems are observed. Not afraid to try new activities.

Normal: Performs developmentally appropriate tasks with good organization and execution.

Praxis is a uniquely human quality that allows individuals to develop higher-level skills and to interact purposefully with each other and the world. An infant innately learns to sit, stand, walk, and babble. It is when the infant breaks from the sensory motor aspect of object use: repeatedly banging a spoon on the table: to purposeful object use: attempting to eat with a spoon: that she begins to utilize praxis. Individuals with "dyspraxia" have difficulty executing unfamiliar tasks, even though there is adequate motor and conceptual capacity to do so. A child with dyspraxia that approaches the train table at the toy store might push a train back and forth on a section of track or open and close a bridge repeatedly, yet typically will show little sense of purpose or intention. In short, praxis is necessary in order for behavior to become purposeful.

 Ideation Praxis involves three processes: (1) ideation, having an "idea" of what to do, (2) organization, creating an internal plan of action, and (3) execution. Ideation is one's ability to generate an idea of how one might interact with an object or the environment. If an individual has no idea what to do with an object, s/he cannot play or "interact" with that object. Individuals with dyspraxia often wander a room full of toys, pausing briefly to push buttons or manipulate an object, yet never engaging in creative play: they literally have no idea what to do with each object. Ideation is a cognitive process believed to be largely dependent upon the brain's ability to respond properly to sensory input.

Sensory integration provides the body with a body schema: essentially, a map of what the body can do. This map gives the brain all the information it needs to decide what to do with the sensory input it receives. However, if this body map is compromised (inaccurate, incomplete or non-existent), the brain cannot respond properly to sensory input, and ideation becomes difficult or impossible. Organization The organization aspect of praxis: the "how to do it" step: is an internal plan of action that bridges ideation and execution.

 First, an individual decides what to do, and then a plan of action is determined. In most individuals, this process is automatic: an idea occurs followed rapidly by an action, with no awareness of the organizational plan that formed in that split second to orchestrate the action. Individuals with dyspraxia, however, tend to organize themselves cognitively: they must think through how to accomplish the desired action before they execute it. These individuals often require repeated exposure to an activity in order to master it: they are essentially organizing the action consciously, then committing it to memory, since the body is less able to automatically determine the necessary steps for execution. Over time, these individuals need to learn to generalize their experiences to other situations.

Execution Execution is the motor part of praxis: the physical manifestation of the desired action. While it is not necessarily the major source of difficulty in developmental dyspraxia, it is the only part that can be observed. The dyspraxic child at the train table demonstrates difficulty executing purposeful play, but it is likely that her true difficulty is in determining what to do (ideation) or how to do it (organization). Individuals with dyspraxia have difficulty imitating actions, sequencing activities, and executing higher-level reasoning.

How Does Praxis Relate to My Child? Or What Does Praxis Have to Do with My Child? Many children with developmental challenges have motor planning difficulties. Difficulties with motor planning are often at the heart of these children's frustrations. As a child grows, s/he moves away from simply experiencing the world and is instead called upon to master his/her world. Toys become more complex, requiring more intricate and sequenced motor planning behavior.

 Motor planning problems make it difficult for a child to master an object, leading to increased frustration. Learning can be challenging for children with motor planning problems since the gestures of others do not always make sense to them. Motor planning problems decrease a child's ability to imitate the actions of others. Some dyspraxic children find it easier to develop their own way of playing with something as opposed to attempting to learn someone else's way or "the right way." This, in turn, makes social interaction more difficult. As a child grows, language also becomes more complex, requiring more complex and sequenced oral motor movements, and more complex use of words to represent ideas. For the child with dyspraxia, ideating and organizing language can also be a tremendous challenge.


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