Purposeful motor… we have heard the term but what does it mean? Why is it important? How does it help? To understand it we must first understand Praxis. Praxis is a smooth chain of motor actions based on a thought about something we want to accomplish. Guess what? This is something as small as taking a sip of water! Everything we do purposefully throughout our day is purposeful motor even if we don’t realize how that chain of action is occurring.
Praxis involves 4 steps:
1. Have a thought or idea about what it is we want to do.
2. Cognitively develop a motor plan of how to execute it.
3. Complete the action.
4. Make adjustments as needed to accomplish the action if the first try doesn’t succeed.
Let’s use the taking a sip of water example. I decide I need a drink, then subconsciously, I work out a plan to accomplish that. The next step is to complete that chain of actions (extending my arm to reach for the cup, closing my fingers around the cup, lifting the cup and bringing it towards my mouth, tilting it back as I bring it to my lips, taking a sip, and swallowing). But let’s say I am not looking, and I reach for my cup but miss it. I get that sensory feedback that it is not in my hand, and I can make the adjustments I need to make it happen on the next try.
Those with Apraxia, like our spellers, have difficulty with Praxis. Apraxia means the lack of or absence of Praxis. Therefore, executing smooth, purposeful chains of action is difficult. You may hear us refer to the brain/body disconnect. What we mean by that is that the brain has the idea but has difficulty either motor planning or executing the motor plan. This is also affected by sensory difficulties that our Spellers face as they are not getting reliable sensory feedback for that fourth step of Praxis. This makes it difficult to make adjustments and for them to know exactly where their body is in space.
So how can we help those with Apraxia? We motor coach/prompt them through activities just like we do with spelling in S2C. (Did you know that spelling is purposeful motor itself?) Choose a task, or have your speller share their goals – this can be a self-care task, a chore around the house, a fun activity, or anything else you can think of. Now here is the important part, we have to find the right place to start and break the task down into small enough steps. No step is too small to accomplish. Most importantly, presume competence in the body just as much as we do in the brain. It can be done! Exude confidence always! It just might take a while and only be accomplished one step at a time, but that is ok! As the task becomes easier, we pull back on the prompting – just like with spelling – so that the speller can become more independent in the task. We are helping the speller build neuronal connections to make the activity more automatic.
Want to hear another cool thing? Spelling helps other purposeful motor tasks, and other purposeful motor tasks help with spelling. The more that purposeful activities are practiced, the more control our Spellers will get over their body in general. This can also help with regulation over time!
Practice! Practice! Practice!
Katlyn Billue is an S2C Practitioner, Certified Occupational Therapy Assistant, and Mentor for I-ASC. She loves working alongside the spellers as a motor specialist to accomplish their goals!