Module 5 - Motor Control and Motor Learning

Jonny demonstrates poor precision in his grasp and uses the ulnar fingers of his hands rather than his thumb, middle and index finger to do activities such stabilizing a bead before stringing it. Other manipulation tasks are also affected by this poor precision. He uses 2 hands together to throw any size ball.

Jonny is right hand dominant for tasks and can cross mid-line, although he tends to use either hand for tasks. Jonny has difficulty in processing the sensory information to the point that it affects his posture and muscle tone. Due to this, he has poor endurance, leans on others for support and often needs to use his other non-dominant hand for support rather than to help in completing a bi-manual task. He tends to avoid activities that are physical in nature, using inappropriate behaviors such as crying, whining, or emotional outbursts. This is exacerbated in his preschool, where there are an increased number of children, more unstructured time and less consistent follow-through in using the strategies that are set up for him.

Motor programming may be an additional factor for Jonny. In addition to his fine motor precision, as he needs additional time to complete tasks that have sequences of activities, such as bead stringing and just making snips on a piece of paper. He has difficulty with self-help tasks such as opening and closing fasteners and independently undressing or dressing without cues and prompting, even though he can complete most individual steps independently.

The strategies that are built into Jonny’ program are to use backward chaining to complete self-help activities, with multiple practice opportunities and well as visual supports that provide a more permanent picture of the motor plan that is being addressed. Jonny participates in sensory activities to reduce arousal and to calm him before going to the motor room for activities with the large group. Social stories or a visual schedule are used to prepare him for the activities that are coming. Prior to fine motor tasks, weight-bearing activities ask or manipulating small toys is encouraged to strengthen arm, shoulder, hand and finger movements. The OT consults with Jonny’s teacher in the daycare to carry over the strategies.

From what I have learned in the recent module, I would try to use play to increase Jonny’s motor planning skills. Play is a goal for Jonny already, but I would adjust strategies by observing his play without supports at this time given the information I have on Jonny and motor planning. I will incorporate strategies that will begin at the level of functioning he is at without support, adding strategies such as imitation, using motivating toys (which is already a strategy), and visual play schemes created with his help ( ideation) . I would gradually increase the complexity and encourage flexibility to expand play to help increase motor planning for Jonny. I would encourage the staff that supports Jonny in his daycare to make the daycare staff aware of Jonny’s motor planning difficulties and consider adding additional strategies there as they become successful for him in his specialized preschool.

Miller-Kuhaneck, Heather. Autism: A Comprehensive Occupational Therapy Approach 2nd Edition. Bethesda: The American Occupational Therapy Association, Inc., 2004.