Motor Development Therapy

A teacher explains why many children in the pre-primary years are having physiotherapy and occupational therapy
By Maxine Horwitz

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As a pre-primary teacher, I’ve had many children in my classes who are undergoing one or another form of motor developmental therapy. I’ve noticed instant changes, such as the amount of confidence the child has gained and improvements in their coordination, muscle movements and their schoolwork or activities. However, teachers are aware that expert recommendations are often frowned upon and that parents are sometimes reluctant to follow through and have their child assessed by a professional. That’s why parents should be helped to understand the advantages of both physiotherapy and occupational therapy, and how the two differ.
Physiotherapists and occupational therapists are trained to help a child tackle any obstacle with ease, and to give them the assistance they need when it comes to motor planning and development in a non-threatening environment.
Motor development involves basic movement abilities and is split into gross and fine motor movements. The gross motor movements involve large body movements – for example running, climbing, sitting and crawling. It also means the child has control over actions, for example sitting without slouching at a table or on the floor, or running without being clumsy.
Signs that something may be wrong
Paediatric physiotherapist Lauren Mayer, who has extensive knowledge and experience in neuro-developmental therapy (NDT), identifies the following signs that might alert a parent that something is wrong: slouching, fidgeting, clumsiness, lack of effort in activities and physical lack of co-ordination when swimming or bike riding, or a child who tires easily when walking. Mayer encourages parents to ask if they themselves struggled to ride a bike or play games involving co-ordination and physical activities when they were growing up. When your child is at home, does he or she wriggle when watching TV or sitting? Is your child lying down to do puzzles on the floor?
I had a child in my class, let’s call her Lilly, who started with me at three-and-a-half, about the average age of her peers. She started the year a confident, friendly, social child with many friends. She enjoyed the indoor activities and some of the areas in the outside playground. She did however avoid climbing on the jungle gyms. When her friends were trying to master the monkey bars and fireman pole, she would just stand at the bottom and watch them. When encouraged to join her friends she became anxious and would isolate herself from them, not being able to play their games because physically her body did not have the strength or skills for climbing. Her avoidance of games and isolation showed a lack of confidence, which in a three-and-a-half-year old is a big area of concern.
I recommended to her parents that she go for a physio assessment. She then started going for physio once a week, and the improvement was almost immediate. She started climbing the jungle gyms after her third physio session and by her sixth week was already trying to do the monkey bars. She was dismissed from physiotherapy after six months, a different, stronger, more confident and happier child.
Lilly had lower muscle tone, which refers to the state of muscle tension. Normal tone is that which is high enough to resist the effects of gravity in both posture and movement. When a child has lower muscle tone this can affect the child in many areas, such as postural control, fine motor control, speech, control over movements and co-ordination.
Louise Brewster, another physiotherapist with paediatric and NDT qualifications agrees with Mayer, and adds, “Look out for the child who is very active and who comes across as being disruptive in the class. These children have no control over their speed of movements and so they seem out of control.” Mayer suggests that once recommended, it is important to take your child for an assessment immediately. This should be addressed sooner rather than later, preferably before a child reaches Grade 1.
Towards a more active life
With the added workload a child will face in primary school, parents should encourage children to go into Grade 1 equipped with the correct skills, tools and confidence necessary to flourish in their new school, with friends and their environment.
Mayer says, “It’s important for a parent to find a trained paediatric physiotherapist with NDT certification and you should ask your doctor or your child’s teacher for at least three recommended therapists.”
She encourages parents to help their children to become more active, to sit up straight, and to encourage them to dress themselves (even if only on a weekend if you have weekday time restraints), to take walks, go to swimming lessons and to limit TV and computer time.
If the problem is not treated, long-term effects can include sore joints, headaches, back pain, poor posture, low self-esteem and not being able to take part in and enjoy sport. If play skills are affected, these children will miss out socially and will be less confident. This will result in a lonely and very unhappy child.
Brewster says that parents do not seem to realise that therapy helps a child to reach their maximum potential, as opposed to coping; or that it helps a child to have a great quality of life as apposed to just functioning. She believes that when a child needs more than one form of therapy it is best to start with physio, to get the muscular or postural problems ironed out first.
OT and physiotherapy
Sometimes one form of therapy is all a child needs, which is why when a parent is told their child needs physio or occupational therapy (OT) it is in their child’s best interests to have the assessment.
Candy Mervis, an occupational therapist with a special interest in sensory integration, helps us understand OT better by explaining the difference between OT and physio. “With OT there are four main areas a therapist concentrates on. These are sensory integration, gross motor, fine motor and visual perceptual skills. Sensory integration is how we process information that comes through our senses. Sensory experiences include touch, movement, body awareness, sight, sound and the pull of gravity. So the process of the brain organising and interpreting this information is called sensory integration,” Mervis says.
“Vestibular skills, which is a sense of movement and balance, and proprioception skills, which is the awareness of muscles and joints in space, and awareness of our body position, are what the OT concentrates on when addressing the gross and fine motor skills of the child.
“Visual perceptual skills are how we understand and process information we see, such as colours, shapes and puzzles.”
Mervis encourages parents and teachers to be aware of children with behavioural difficulties, emotional problems, an inability to concentrate for specific amounts of time, children who avoid messy activities, kids that are constantly on the go and children with poor endurance.
These are all problems an OT will help the child tackle, in a comfortable environment. Mervis says “younger children love therapy, they see it as an extra-mural activity like ballet or soccer, something fun where work is disguised as play”. She believes the younger a child has issues tended to, the better. “The rate of development when young is much quicker than when we are older. Think of how quickly a child learns and masters a language as opposed to how long it takes an adult to learn the same language,” explains Mervis.
She encourages parents to look for an OT who is sensory integration trained (if the child has sensory integration problems). It also helps if the OT has close contact with the school and parents.
She also feels it’s important that parents are involved, going to therapy sessions with their child, taking the ideas they see and extending these at home. “The rate of improvement in a child who has involved parents working with them at home is enormous,” she says. “If problems are not tackled the long-term effects can be detrimental to a child’s schooling and life. They could confront learning difficulties in formal schooling, problems with reading, writing and spelling, and a possible further delay in development.”
With both physio and OT, depending on the severity of the individual case, therapy generally lasts anywhere between six months to two years.
As a teacher, I would encourage any parent to give their child an opportunity to feel good and confident about themselves and to help them reach their full potential. The gap we see between a child who does not need therapy and one who does – in both work and play – is generally quite large. This gap usually narrows once the child is undergoing physio or OT and there is normally no gap once a child is dismissed from therapy.

Encourage children to swim, climb jungle gyms, ride bikes, climb trees, to run, take long walks and to play games with balls or bean bags, to balance on low walls, to draw, paint, read, do puzzles and all the fun things we used to do as children before computers and 24-hour children’s TV channels became top priorities. An active child is a happy child.


Anonymous wrote 7 years 1 week ago daughter (almost three) is very pigeon-toed...should I be doing anything, and if so, do I need OT or physio? Actually, I think it's her knees. Thanks SO much for this was perfectly timed.

admin wrote 7 years 1 week ago

Hi there, for a list of practitioners please check out our health care practitioners category in the resource section (you can access this from the drop-down menu of the navigation menu above). We do recommend seeking professional advice for all health-related issues. All the best!

Gale wrote 7 years 2 weeks ago

Hi, who can you recommend for sensory integration therapy in Fourways Broadacres area? Concerned about a healthy relationship between my child and teacher at his new school next year. I am hoping the teacher takes time to understand my son and his sensory integration issues. Would like the OT to keep in touch with the school teacher on at least a monthly basis - is this a reasonable request?

admin wrote 7 years 2 weeks ago

Hi Gale. You could get in touch with The Children’s Therapy Centre in Petervale. Contact Joanne on 083 303 1190.

anonmous wrote 7 years 2 weeks ago

I’m not sure who to contact regarding this, but from next year (2013) I am going to be starting my Biokinetics practice in the Pietermaritzburg area. I am extremely interested in dealing with children with low muscle tone, and want to utilize both land and water-based rehabilitation and exercise techniques. If you have any contacts for me with regards to this subject, please contact me.
Kelly Rottcher

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