Motor Planning Training
© Marion Stanton
©Marion Stanton
www.contactcandle.co.uk
Practical activity – the value of
support
• Write with your dominant hand standing on
one leg.
• Get someone to hold you steady and then
repeat writing.
©Marion Stanton
www.contactcandle.co.uk
Motor Planning
• Learning to drive, swim dance.
©Marion Stanton
www.contactcandle.co.uk
Most Common types of Neuro-Motor
Difficulties.
Autism
Cerebral Palsy
Proprioception
Involuntary Movement
Perseveration
Muscle Tone
Impulsivity
Initiation
Initiation
ATNR
Disinhibition
Radial Ulnar
Aksathisia
Proximal Instability
Dystonia
Most Common types of Neuro-Motor
Difficulties.
Retts
Down Syndrome
Dystonia
Impulsivity
Fluctuating tone
Low muscle tone
Eye hand coordination
Fatigue
Initiation
Eye/hand coordination
Switching
Finger isolation/extension
Finger isolation
Unstable sitting position
ATNR
ATNR
(asymmetrical
tonic neck reflex)
 A reflex extension of
the arm following the
pointed direction of
the chin when turning
the head to one side.
Accommodation
Encourage the person to
look up until the last
moment when they go to
point.
Impaired eye/hand co-ordination
 A person points without looking
or without allowing enough time
between movements to scan
the display and locate the
target.
 Some people cannot look and
point at the same time e.g. with
ATNR.
 Some people maintain that
they find it easier to use
peripheral vision but people
often become more accurate
and more independent if they
develop their looking skills.
Accommodations
 Hold back until the
person has looked.
 Ensure
aids
are
appropriately positioned
to make it as easy as
possible for the person
to look and point.
Perseveration
 The person repeats
previous selection or
tends towards
certain selections.
Looks like repetitive
behaviour.
Accommodations
Bring the person back
to a central point
between each selection.
Shake the arm every
few selections.
Change positions on
the communication
board.
Radial/Ulnar Stability
 Unequal pull on muscles.
Accommodation
 The muscles in the hand,
wrist or forearm do not
co-ordinate well together
causing the index finger
to swerve resulting in
Temporary use of a
splint.
selections off to the
side of the target
Use the hand that
facilitates as a splint.
Body Stability
 Proximal instability
 Shoulder
and/or
trunk
instability due to muscle
weakness. Often an over arm
pointing action is used.
 Unstable sitting position
 Muscle weakness
spinal problems.
and/or
Accommodations
Good supportive
seating
Supportive clothing
Lifting the side that
sags.
Akathisia
 Described as a sense of
‘inner
restlessness’,
that has a strong
component of motor
restlessness.
 The person cannot keep
physically
still
or
maintain
a
static
posture
for
an
extended period of
time.
Accommodations
Let the person have
frequent movement
breaks.
Use ‘fidget’ toys.
Use timer for time to
be on task.
Crossing the midline
 Difficulty crossing over
the mid point of one’s
body when pointing.
Accommodations
Position the aid to the
right (left for left
handed people) Centre
the aid in line with
shoulder.
Provide firmer hold,
resistance, lift on
selections that are
cross the mid line.
Impulsivity
 The person points
before they have
had time to consider
a response often
without good aim.
Accommodations
Hold back until they
have looked.
Make sure they relax
before they point.
Talk quietly.
Backward resistance.
Tremor
 Can be either a
continuous tremor or
extension tremor.
Accommodation
Firm pressure in the
facilitators hand.
Disinhibition
 Auditory – cannot
Accommodations
 Visual – cannot ignore
Physical and verbal
support to keep focus
on target.
ignore stimuli.
stimuli.
Reduce external
stimuli when
appropriate/necessary.
Initiation
 Problems with
starting a movement.
Accommodations
Verbal prompts ‘1,2,3
go’.
Slight physical
prompt under the arm.
Pulling back the
forearm to bring in
some tension.
A gentle shake of the
arm.
Proprioception
 Lacks awareness of
themselves in space.
 May be recognised by
people trying to get
contact with large
surface areas.
 Sometimes repeated
physical behaviour.
Accommodation
Lean against the
body.
Second skin.
Gentle, deep
pressure on hand,
arms, shoulders.
Chair with sides.
Weights.
Dystonia
 Slow, rhythmic, twisting
involuntary muscle
contractions, which force
the body into abnormal,
sometimes painful
movements or postures.
 Dystonia can affect any
part of the body including
the arms, legs, trunk,
neck, eyelids, face or
vocal cords.
Accommodation
WAIT. Dystonia is
painful and involuntary
but it does pass.
Gentle massage may
help.
Low Muscle Tone
 Hypotonia
 Floppy muscles making
it difficult to lift limbs
and put physical
pressure on anything.
Accommodations
Lower the aid, give
the arm a lift, pull back
to create tension and
increase tone.
High Muscle Tone
 Hypertonia
 Having very tight
muscles making it
difficult to be
accurate when
pointing, sometimes
over shooting target
and pushing aid away
due to force of
movement.
Accommodations
Give arm a gentle
shake/gentle massage.
Position the aid directly
in front.
Involuntary Movements
 Difficulty in controlling
part or parts of the
body.
 Occasionally person will
have better control of
their head rather than
their hand.
Accommodations
Anchoring (either with
facilitation or supports) so
that person is trying to
move from the elbow
rather than the whole arm
or whole body.
Try to establish a part
of the body that the
person has control over.
Stopping
 Difficulty in
stopping thoughts
and movements once
started.
 Accommodations
Pull back to slow
movements.
Coactively stop the
person to give a model
Verbal prompting
Finger Isolation/extension
 Difficulty isolating
and/or extending an
index finger.
 Instability at base of
index finger – causes
difficulty extending the
index finger whilst
flexing the other
fingers.
Accommodations
Hand moulding
Activities which
encourage index finger
isolation.
Avoid crooking your
finger under the
persons finger.
Occasional use of a
finger splint.
Undecided hand dominance
 Using both hands
for a task only
requiring one. Both
hands come up at
once and it is hard
to isolate one from
the other.
Accommodations
Find out if anyone in
family is left handed. If
not encourage right
handed dominance.
Vision Issues
 Difficulty scanning
the communication
aid.
 People with visual
spatial impairments
have great difficulty
localising objects in
2 and 3D space.
Accommodations
Use good contrast.
Experiment with
position of aid.
Try different
sized/coloured
pictures.
Tactile Sensitivity
 Sensitivity to soft
physical touch.
 Even the thought
can be distressing.
Accommodations
A firm hold is
better. Sensitive
receptors are in the
surface of the skin.
Give the person
verbal prompts. Let
them know what is
going to happen.
Fatigue
Muscles tire from
repetitive use,
over/lack of use
or from intense
amount of
concentration
used in achieving
task.
Accommodations
Work at the person’s
best time of day.
STOP at regular
intervals to allow for
recovery.
Carry on from the last
point rather than going
back to the beginning.
VALIDATION
• No claim of authorship without
validation either by independent
verification or other means.
• Other means include information that
the communication partner couldn’t
have known. Doesn’t have to be the
truth but needs to refer to something
that has happened.
©Marion Stanton
www.contactcandle.co.uk
Strategies to develop
independence
• Slowly fade support
• Help with timing using verbal prompts or other
cues.
• Ensuring switch users have the best set up for
them.
• Ensure those who eye-point look at you
immediately after they have made a selection.
• Make sure the spacing of selections is the most
suitable for individual need.
• Use the ladder.
• MONITOR EYE CONTACT.
©Marion Stanton
www.contactcandle.co.uk
Monitoring access
©Marion Stanton
www.contactcandle.co.uk
©Marion Stanton
www.contactcandle.co.uk
©Marion Stanton
www.contactcandle.co.uk
Moving back to earlier strategies
When:
• New support staff
• Less predictable or more complex text
• New communication aid
• Not well or tired or tense for any reason
• In a test situation or when being watched
by unfamiliar people
• Subtle attempts to fade back are noticed!
©Marion Stanton
www.contactcandle.co.uk
Connection between FC/FCT
and MPT
•
•
•
•
•
The name change
Prejudice
Poor practice
Connection to accepted practice
Discussion
©Marion Stanton
www.contactcandle.co.uk
CONTACT
• www.candleaac.com
• info@candleaac.com
©Marion Stanton
www.contactcandle.co.uk