1. INTRODUCTION
1. Levine identifies 4 motor pathways:
1. Gross Motor - large muscles and/or whole body
2. Fine Motor - muscles of hand and fingers
3. Graphomotor - handwriting
4. Oral Motor - speech muscles
2. This chapter focuses on gross motor and graphomotor functions



2. MOTOR ACTIONS
1. An action is a controlled, organized movement
2. Basic Concepts
1. Motor idea - a specific plan of action for a very basic movement
2. Motor proficiency - mastery of basic movements at automatic level
3. Motor actions are guided by analysis of sensory data (visual, tactile, etc)
4. Repeated motor experience enhances all aspects of processing
5. Feedback from the senses enables us to continue, modify, or stop an action
6. Motor engrams - stored patterns of familiar motor actions (movements become automatic)
7. Serial chaining - longer routines of stored sequences of motor movements
8. Motor inhibition - allows us to smooth out an action by inhibiting irrelevant or wasteful movements
9. Motor plan (ideomotor plan)- a conscious or semi-conscious image of a specific goal and a "blueprint" for accomplishing the action.
10. Praxis - implementing the specific action or motor plan
11. Automatized actions - actions that rely less heavily on conscious motor plans and more on motor engrams
3. Model of a Motor Action
1. Perceiving a need for an action
2. Selecting a particular action likely to meet the need, possibly requiring intentional planning and problem-solving strategies
3. Forming an image of what the action will look like
4. Forming a motor idea - a preliminary notion of how the motor system might respond
5. Refining the motor idea into a highly specific ideomotor plan, with the help of verbal instruction, spatial cues and/or memory of motor engrams
6. Praxis - implementing the action itself.
7. Quality-control - feedback provides information to adjust the movement while in process
8. Deciding whether the action is successful and should stop
9. Action decays or is stored in motor memory


3. FACTORS IN MOTOR DEVELOPMENT
1. Gross Motor Development
1. Increasing automaticity
2. Increasing speed without sacrificing accuracy
3. Increasing strength and stamina
4. Increasing propulsion and acceleration when running
5. Increasing ability to jump and throw (require both strength and coordination)
6. Increasing balance
7. Increasing coordination
8. Gender differences
1. Boys excel in strength and gross movements
2. Girls excel in fine coordination
2. Fine Motor Development
1. Increasing skill in eye-hand coordination
2. Increasing automaticity and speed
3. Increasing ability to use both hands together
4. Increasing graphomotor ability
3. Increasing motor inhibition in both fine and gross motor development



4. GROSS MOTOR ABILITY: DEVELOPMENTAL VARIATION AND DYSFUNCTION
1. Gross Motor Ability
1. Normal gross motor development has generally been described above
2. Gross motor proficiency can contribute to self-image and sense of competence
2. Gross Motor Dysfunction
1. Children with gross motor problems have significant difficulty with self-image and social success
2. Anomalies (neurological) of gross motor development associated with clumsiness:
1. Mixed dominance or excessive right or left handedness
2. The dominant hand does worse than the nondominant one
3. Hand preference manifested too early or too late
4. Persistent overflow movements
5. Poor reciprocal alternation
6. Difficulty imitating a sequence of movements
7. Slow motor reaction time
8. Difficulty with balance, body position sense, and proprioceptive feedback
3. Gross motor problems may have several underlying causes:
1. Difficulty interpreting sensory information
2. Lack of an ideomotor plan
3. Difficulty invoking or coordinating specific motor actions
4. Difficulty with motor memory or memory for a sequence of motor actions
5. Dyspraxia = difficulty accomplishing a motor action
6. Dyspraxia may be inconsistent across actions or times
4. Children with gross motor problems typically avoid athletics
1. They may become scholars to compensate
2. Avoidance and lack of practice widens the performance gap between typical and "clumsy" children
3. Some children avoid athletics not because of gross motor problems but because of secondary attention or language problems
3. Assessment of Gross Motor Functions can be accomplished by:
1. Case history interview
2. Observation of performance
1. Observers must employ very careful task analysis
2. Observers should compare easy and difficulty tasks
3. Questionnaires
4. Direct Assessment should include
1. Eye-hand/arm coordination (catching a ball)
2. Balance
3. Body position sense
4. Rapid alternating movements
5. Rhythmic activities
5. Differential diagnosis of clumsiness - can be caused by many medical and/or neurological factors:
1. Mild cerebral palsy
2. Joint or nerve inflamation
3. Hyperthyroidism
4. Muscular dystrophy
5. Congenital muscle disorders
6. Hydrocephalus
7. Brain tumor
8. Spinal cord disorder
9. Vision problems
10. Vestibular (inner ear) problems
11. Side effects of medications
12. Psychological disorders
13. Substance abuse
4. Management of Gross Motor Dysfunction
1. Types of intervention
1. Remedial physical education
2. Occupational therapy
3. Physical Therapy
2. Any management plan should identify and support relative strengths, trying to find some motor sphere in which the child can succeed:
1. individual vs. team sports
2. activities that use inner spatial vs. outer spatial data
3. Remedial physical education must ensure:
1. privacy, avoiding humiliation
2. adequate time for practice
5. Management of Gross Motor Talents
1. Balancing sports and academics is difficult if child has other learning disabilities
1. Academics can suffer even more because sports are a distraction and a way to avoid studying
2. But we can't deny athletics when it is a child's only source of self-esteem
3. Often best to reduce athletics and substitute remedial help
2. Managing gross motor talents requires:
1. Sensitivity and understanding
2. Close cooperation with parents and professionals
3. Flexibility



5. DEVELOPMENTAL OUTPUT FAILURE (FINE MOTOR UNDERPINNINGS)


1. Normal fine- and graphomotor development have generally been described above
2. Developmental output failure (dysfunction) typically begins in the middle grades when demands for output increase
3. Evolving expectations for output in school include:
1. Increased use of symbols
2. Integration of information from multiple sources and various perspectives, involves increased memory demands
3. Increased sustained attention to detail
4. Increased demand for rapid automatic retrieval of information
5. Increased demand for retrieval of multiple, synchronized bits of information
6. Increased demand for large chunks of output
7. Increased need for verbal fluency, sentence formulation, effective writing
8. Intensified demand for speed, appropriate strategies, and organizational skills
9. Increased demand for automatic, efficient graphomotor skills for writing
10. In summary, writing requires:
1. Efficient coding of ideas
2. Effective, fast, effortless memory
3. Appropriate expressive language
4. Synthesis and organization
5. Sustained attention to detail
6. Graphomotor proficiency
4. Developmental output failure arises from a cluster of dysfunctions in b, c, d, e, and f (above):
1. Graphomotor Dysfunction - Four types of graphomotor dysfunction hamper output and written fluency
1. Impaired kinesthetic feedback
1. When kinesthetic feedback is impaired children rely on visual feedback and monitoring, and write with eyes close to the page
2. Using primarily visual feedback may work for nonverbal activities such as sewing, building models, or fixing things
3. Using primarily visual feedback for writing is too slow and mechanical, so writing is slow, awkward, and lacks automatization.
4. Handwriting may be legible, but production is very slow, lacks automaticity, and demands too much attention
5. These children often have a distorted pencil grip because they can't "perceive" the relationship of fingers to pencil
6. These children often exert too much pressure on the pencil, bearing down hard to get a better proprioceptive sense - results in fatigue, cramps in the hand, broken pencil points, torn paper, difficulty with ball point pens that are too slippery
7. Often the result is reduced quantity of writing
2. Eye-hand coordination problems (poor visual perception and feedback)
1. These children are often poor at both nonverbal activities and writing
2. Child may have difficulty with writing off the side of the paper, keeping margins straight, not staying on the lines, downward or upward slant of a line, problems with spacing, difficulty arranging columns in math. Letters may be legible but poorly spaced.
3. Dyspraxia (fine motor production problems) may result from:
1. Difficulty forming a motor image (ideomotor plan) of the required movement
2. Difficulty actually implementing the plan motorically (knowing what you want to do, but having difficulty making the muscles do what you want them to)
3. Writing is painfully slow and very awkward. Letter formation may be jerky, wavy, bizarre. Child may seem to laboriously "draw" each letter.
4. Motor Memory Problems
1. Child has difficulty retrieving the motor plan to form a letter
2. Lots of corrections, scratch outs, retracings, and erasures.
3. Writing is often illegible, same letter formed different ways and with minimal strokes.
4. Child may never learn cursive because the demands on motor memory is much greater, and probably should be allowed to print.
2. Retrieval Memory Problems
1. When writing a child must retrieve letter formation, spelling, grammar, punctuation, capitalization, scheme of ideas, vocabulary etc.
2. To be successful many of these must become automatic and synchronized, leaving room for higher order thinking, planning, etc.
3. Children with retrieval problems can't synchronize all the things needed at the same time to write efficiently
3. Attention Problems
1. Minimally motivating writing tasks may induce fatigue, distraction, boredom, and impulsivity
2. These children have difficulty monitoring, proofreading, attending to the details of writing
3. They have difficulty planning a composition because of poor organization, previewing and synchronization.
4. They may not meet the demands of the assignment either because of poor monitoring, or because they didn't pay attention to the assignment
4. Language Problems
1. Children with oral expressive language problems will also have written expression problems
2. They may have problems with:
1. word-finding (vocabulary)
2. syntax
3. narrative organization
4. metalinguistic awareness of what "sounds good"
5. Organization Problems - children may have problems with:
1. Spatial disorganization of materials - books, notebooks, pens, worksheets. Items are forgotten, lost, left at home, etc.
2. Temporal/sequential disorganization - difficulty allocating time for tasks, late for class, sequencing steps in narratives, math problems, or any long term assignment
3. Difficulties with synthesizing and organizing ideas/data when reading or writing
6. Functional Profiles and Productivity
1. Clusters of these 5 types of dysfunctions reduce output and productivity
2. A single dysfunction may not be especially problematic (e.g. awkward pencil grasp) because most children can compensate and are resilient
3. When dysfunctions cluster together they may all be relatively mild but still cause major problems because natural resiliency is compromised
5. Effects/Repercussions of Developmental Output Failure
1. Children with developmental output failure are vulnerable to depression, social maladjustment, underachievement because impaired productivity in the middle grades can be a point of no return academically
2. If a lack of productivity in school is accompanied by poor results in other areas (sports, music, etc) the result can be a profound sense of inadequacy.
6. Alternative Production Channels - Other areas in which children with developmental output failure can find satisfaction and self-esteem
1. Artistic endeavors
2. Mechanical skills
3. Nonathletic games (chess, computers)
4. Crafts
5. Music
6. Collections (stamps, coins)
7. Wage earning
8. Pets, animals
9. Special responsibilities

NOTE: Remedial strategies for developmental output failure are discussed in Chapter 10 Writing and Spelling, and also in Chapter 15 Management Strategies