New Technique Addresses Neuro-Motor Immaturity
Child can’t sit still? A simple and effective remedy is available.
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