By comparison, while one of my own favorite childhood pastimes was playing video games, in those days children spent a considerable amount of time outdoors as well, riding bikes, skateboarding, playing football, basketball, stick hockey or even games like Twister.

The question is whether this cultural shift in pastime activities, mainly with overall less physical activity, has affected our children?  If yes, to what extent?  Are these changes negative, positive or both, and are they reversible?

Body movement ranges from fine motor, like the crafty finger movements needed to operate a tablet, to gross body movements required to play a ball game or to peddle a bike.   While it’s obvious that body movement is essential to physical health, what you may be less aware of is that movement is critical for learning as well, and can benefit reading skills, copying skills, behavioral regulation, organization, the ability to follow multi-step directions, attention skills, as well as perceptual skills.

To illustrate this point, a common example in the field of neuroscience comes from the Ascidian sea squirt.  This organism possesses a very large brain mass and a very short body.  It spends its childhood swimming around and searching for a reef to affix itself to.  Once it matures, it finds a reef and plants itself onto it. Oddly enough, as soon as this takes place, the sea squirt’s brain mass shrinks considerably.  Experts deduce from this that movement is an essential component to brain mass and brain activity.  In the particular case of the sea squirt, quite literally if you don’t use it, you lose it.

Further proof linking movement to brain function can be found in the research of Jean Piaget on cognitive development, Jean Ayres on sensory development, and Peter Blythe and Sally Goddard-Blythe on Neuro Motor Immaturity (NMI).  Each of these academics and professionals demonstrate strong ties between motor movement and the development of learning, sensory function and academic achievement.

I recall watching a news report about a kindergarten class using a tablet as a medium to teach.  Such devices are far from uncommon in the classroom today.  As fabulous as the app was that they were using, the motor skills used for positioning the tablet, manipulating it, and making key selections were compensatory and immature.  These immature movements can be habituated through daily use of devices such as tablets, especially for a child who has immature motor skills to begin with.   A child will find “back door”, compensatory ways in which to manipulate such a device (i.e. using her entire hand to mimic the swiping motion) that may cause and/or facilitate an existing developmental delay in motor control.

So while sedentary activity like reading a book or finger swiping an app has its place, especially in the technological world we live in, more of an emphasis should be placed on the games, activities and movement of the childhood of yore.  In our rush to increase our children’s brain scope, we may very well be hindering them by NOT pushing them to get the basic body movement both their minds and bodies crucially need. [Indeed there are those who break all boundaries despite their inability to move their bodies as they might like to (i.e. due to birth defects, injury etc…)  But such individuals are the exception.   Human development is not so far away from the basic idea which the sea squirt’s life represents.  Our life experiences and ability to move outside our inner circle continuously advances us to learn.  We are stunting that ability in young children.  They have yet to apply knowledge to their life through a full spectrum of movement and experience and by shoving technology at them, which by definition is all about convenience and NON physical movement, we are eliminating the basic building blocks of developmental learning.  We might acquire children with minds that work at the speed of light, but then we might not.  By taking away the opportunity for basic movement, we are risking a whole Pandora’s box of both physical and mental deficiencies later on.

As parents, educators and therapists, we must fine-tune our sense of focus now more than ever.  Learning begins in utero and once the child is born, the floor is literally the best playground for him.  This is a point that cannot be stressed enough.  Get out your mats and blankets and place your baby on the floor from day one.  Have your child become comfortable in manipulating his hands and feet and learning how to focus on the limbs he can see and move about.  Aside from looking adorable, you will observe from week to week as his focus becomes more attuned and his limb movements more deliberate and fixed.   You are not only observing a baby enjoying his explorative play, but are witness to the genesis of his learning and development – something truly wondrous to behold.

While opportunities for sedentary forms of play have their own value and place, with the rise of health and learning issues that may be directly linked to inactivity it would serve us all better to integrate more play and movement into the lives of our children.

Paul Stadler is an OT with over 14 years of experience working with children from birth to 21 years of age with varied diagnoses.  He is an instructor of the INPP school-based program for Assessing Neuromotor Readiness for Learning, as well as a presenter at the 2012 and the 2013 American Occupational Therapy Association national conference on NMI.  He can be reached at 347-247-6835, paul@paulstadler.net or by visiting www.paulstadler.net

Back in the day, before the advent of home gaming systems, it was more common for kids and adults to take to the streets or the local parks where they played, socialized, and explored the world around them. Typical activities which created opportunities for various types of body movement included a game, a bike ride, or perhaps a stroll on a walking path. In addition, years ago, infants were placed on the floor more often than the infants of today. Infants and children were also held more often by a caregiver, and had more frequent physical contact with the environment.

But does this matter? Is it just a reflection on the past or has this change in our children’s activity possibly impacted their development and future academic achievement?

If we were to stop for a moment and look around us, we would see that all living things are in constant motion. Even remaining perfectly still – an act that is actually one of the most difficult movements – requires a balance of muscle contraction, good posture and balance skills from our vestibular and vision centers, to find a point zero or a centering point for our bodies to come back to. Further assessment shows that difficulties in this area arise many times in the classroom and at our dining room tables when children are “on the go”, frequently readjusting their position, or perhaps compensating by sitting on their knees or slouching.

These compensations may be just due to fatigue, but they may signal a deeper issue with balance and motor control.

In utero, one of the first forms of movement are primitive reflexes. After we are born, they assist us as infants with head control, exploration of our environment, hand eye skills, visual motor integration, balance and posture skills, and hand development. During the first year of life, these reflexes are integrated and mature into higher centers of the brain. During this transition, we develop more voluntary control over our bodies. We can see examples of these primitive reflexes in an infant under six months of age. Whenever their head turns to one side, an arm and leg will typically extend outward whilst the other arm and leg will have a tendency to flex closer to the body. This is a form of involuntary control. Here is another example: As the head is lifted up, the arms and legs extend outward, and as the head is tucked in the arms and legs will also be tucked in.

Over the course of the first year of life, these responses should no longer be part of an automatic response. If, for some reason, these primitive reflexes remain in place without integrating and maturing into the child’s overall development appropriately, they can interfere later on with abilities that a child needs to read, such as tracking smoothly across a page. Children who retain their primitive reflexes have a tendency to trip or bump into objects. They can have difficulty sitting or standing still, or learning to distinguish between right from left, and suffer from poor handwriting skills, poor copying skills, disorganization, toe walking, “W” sitting, and attention deficits.

Recently I treated a 7 year old girl and a 14 year old boy who presented with similar concerns, including decreased attention, difficulty with focusing, trouble following multistep directions,  poor eye tracking, poor reading comprehension and reduced spatial awareness. Both were clumsy, had poor confidence, academic underachievement, were “on the go” and had difficulty sitting and standing still. On assessment, they were asked to stand with their feet together, their hands at their side and looking straight ahead, and they nearly toppled over just after a few seconds of doing so. They had difficulty moving their eyes smoothly from left to right without moving their head, and had difficulty with reading and reading comprehension.

Both had received services addressing their issues with balance, posture, and sensory integration. But their parents reported that as one issue was resolved, there was another one right behind it to be addressed, like a never ending line of problems that the parents felt should have been addressed in their child’s prior years of services.

Research has demonstrated that an average of 33% of children in mainstream classrooms will have many of these issues, while in special education classrooms they affect more than 90% of the students. Many of these children have received related services such as occupational therapy, physical therapy, speech therapy, SEIT’s, and modified instruction.

Our development of these skills as babies is facilitated by early forms of free movement – from being on the floor on our tummy and back, being rolled or from rolling over, lifting our heads up off the floor and grabbing a toy within our reach, bringing our hands together, pushing our chests off the floor with our hands, and crawling through obstacles such as a tunnel or an obstacle course. We learn through movement. Our visual motor skills, fine motor skills, gross motor skills, sensory motor skills are matured and developed from movement. But it also requires the maturation of our reflexes and development of our balance and posture to provide a strong foundation and maximize our abilities in the years to come.

Paul Stadler is an occupational therapist with over 14 years of experience working with children from birth to 21 years of age with varied diagnoses. He is adjunct professor for Daemen College for infant and childhood development, a speaker at the 2012 American Occupational Therapy Association national conference on Neuro Motor Immaturity, a licentiate of INPP (inpp,org.uk), an instructor of the INPP school-based program for Assessing Neuromotor Readiness for Learning: The INPP Developmental Screening Test and School Intervention Program. He can be reached at 347 247 6835, paul@paulstadler.net or by visiting www.paulstadler.net

by Paul Stadler MS OTR\L NDT (INPP)

Josh is a seven-year-old boy who is always “on the go” and cannot sit still. He has difficulty with slow and graded coordinated movements. Getting dressed is rushed and mealtime is messy, since he has a difficult time coordinating his body. Josh will usually spill his glass once a meal due to difficulty slowing down, has poor handwriting, and experiences difficulty in processing multi-step directions. Further, he is sensitive to touch, and frequently bumps into objects. Forging friendships are difficult due to his “my way or no way” attitude. He has had difficulty with sharing. At the same time, Josh was able to ride a scooter when he was two years old, and has always enjoyed high playground equipment.

Sound like your child, student, or someone you know? Josh is behaviorally immature, but procedures are available to remedy the situation without medications. For most children, growing up typically means going to the local playground, playing ball in the street, going to a park and participating in some roughhousing, climbing, or other types of movement games. Whether this is freeze tag, baseball, football, hide-and-seek, or red light-green light, the idea of playing a game requires a constant movement of our bodies. Even in red light-green light, where the idea is to go forward when the players are looking at the counter’s back, they have to freeze when the counter turns around.

“Freezing,” however, involves the ability to remain still. This is one of the most complicated movements. It requires us to sustain control of both our flexor muscles and extensor muscles. If, for example, you had to stand in place with your arms at your side, hands open in a relaxed position, feet together, keeping your head looking straight ahead, you would need full control of a number of muscles, including those in your stomach and back, to work together so you would not topple forward or fall backward. Reactions to this position would include difficulty in maintaining this position, pursing of lips, tightening of lip muscles, clenching of hands, splaying fingers, and swaying and correcting posture. Some would even lose their balance and fall.

Questions that come to mind are, Can the child: Sit through circle time? Process multi-step directions? Find their place on the rug? Other questions include, Does the child: Slump when sitting at the desk? Have a difficult time learning left from right? Require extra time getting his or her jacket on? Have a difficult time remaining still during a lineup? Have the need to be “on the go”? Have poor motor coordination?

If the answer to some of these questions is yes, the child may be showing signs of neuromotor immaturity. Such immaturity can be caused by, among other factors, a difficult pregnancy, various factors during birth, delayed motor skill acquisition (walking after 18 months), or, paradoxically, accelerated motor development (walking by ten months).

Think about when you shine a light in someone’s eye. The pupils automatically get smaller in order to control the amount of light entering the eyes. The same thing happens in our motor systems. When a pregnant woman says that the baby kicked her or is stretching its arm, it may be something called the asymmetrical tonic neck reflex (ATNR). That is, whenever the baby turns its head, the arms and leg on one side stretch out and the arm and leg on the other side flex. It is an automatic reflexive movement and will stay reflexive typically until the baby is four to six months old. At that time, it should integrate and allow the baby to develop more mature voluntary movement.

If this reflex remains active and does not integrate, it causes difficulty in hand-eye coordination, the ability to control the arm and hand when writing, and the ability to cross the vertical midline (for example, a right-handed child may find it difficult to write on the left side of the page). In addition, development of moving the eyes in a smooth and coordinated manner may be affected.
The baby “kicking” the pregnant woman, discussed above, is an example of one reflex and is a part of many reflexes that are clinically assessed during a formal evaluation along with gross motor coordination, fine motor, cerebellar function tests, and visual motor and perception. These developmental problems can be addressed using a method developed by the Institute of Neuro-Physiological Psychology (INPP) in Chester, England. The INPP method is a developmentally based approach, meaning it goes to the source of the issue by identifying motor patterns that may have arisen as early as infancy that have not matured.

A personalized reflex inhibition, stimulation, or integration program is generated for a child, which usually lasts no more than 15 months, with a typical program lasting for 12 months. The program requires the child to complete a five-to-seven-minute motor exercise program daily. In addition, the INPP has developed a school-based program for children from four to seven-and-a-half. This program has been used in many school systems in the United Kingdom and has significantly influenced the lives of many children around the world. Additional information on the INPP method can be obtained at its website, INPP.org.uk. You can also contact me, a Licentiate of the INPP method and certified in the school-based program, at 347-247-6835 or otpt747@aol.com.

Originally published in 5 Towns Jewish Times