“Nate, stand up”. Nathan is five, has cerebral palsy and takes a while to prepare to move his body. Thirty seconds or more can pass between the request to move and getting a response. He is quiet, then there may be a quiver of movement. Sure enough, after some patience, up comes the leg and he rises to standing with only a little assistance. In the context of the classroom, this extra waiting time is surely difficult. Nathan either arrives late to an activity or his aide is lifting and initiating for him throughout the day and a behavioral expectation is set up.
Children with motor planning difficulty need extra time to initiate and carry out their movement. Many of us live in a world where time is scarce and we don’t feel that we have time to wait. On the other hand, starting with the end in mind is crucial and takes a lot of training, repetition and patience. What have you decided to do when faced with this dilemma?
Latency in initiation has long been described and noted as an impairment in children with cerebral palsy. Response latency, also known as reaction time, is defined as the interval of time between application of a stimulus and detection of a response, or the time between Nathan deciding he is going to stand up and Nathan starting the movement.
Using Nathan as an example, you have a goal to make transitions faster. In this way, he will be participating at a higher level in the classroom and arriving to activities closer their start time. What are the factors that affect latency in the initiation of movement?
- Neuromuscular system:
- insufficient range of motion
- abnormal postural control
- inadequate force generation to move against gravity or muscle contraction
- decreased force production to move in a defined period of time
- Cognitive system:
- inability to recognize a command or signal to move (any sensory signal)
- difficulty recalling and selecting a movement plan
- difficulty assembling and initiating a plan to move
2) Contextual Factors:
- Personal What are the habits that are helping or hindering progress? Is there challenging behavior? Sensory issues complicating the progress? Is the child’s attitude positive about the situation? Is there something motivating to move toward? What is Nathan’s past history with the movement and current attitude towards the movement? Maybe Nathan expects to be moved around and likes this more passive approach to the day. Perhaps he is not at all interested in the activity he is being asked to move toward.
- Environmental What are the sound and light qualities of the room? The touch, movement speed and voice qualities of the person working with him? Should Nathan join a few minutes late, or start the transition a few minutes early?
Some Behavioral Considerations: In Dr. Jane Nelson’s Positive Discipline, several areas of behavior challenge in children are defined: Undue attention, misguided power, revenge, and assumed inadequacy. In the context of this discussion, let’s take a moment to look further at assumed inadequacy. It is stated the children will “continue to act inadequate until they give up the belief that they are”. In this situation, helpers often respond by giving up, doing for or over-helping. The child’s response is retreating further, becoming passive, and showing no response or improvement. What are the steps to take as a helper? Show faith, encourage any positive attempt, no matter how small. Teach skills and show how. Encourage, encourage, encourage.
Of course, to be realistic, not every situation is going to be perfect. School is demanding and fast paced. It’s a group setting, after all. However, being mindful helps overall daily practice which, in turn, builds better habits. If the child’s mechanical capacity (or range of motion) is sufficient, then start helping with the initiation and strength required for transitions and do this in the most motivating/least distracting environment. Once you have attained these foundation requirements, then work on building motor control. This requires personal motivation from the child. To begin, take a few moments to engage the child in an idea, game or motivating destination. Motor control building requires problem solving, self-correction and feeling the consequences of mistakes while maintaining positive self-esteem and motivation. Next, as the child initiates the movement, let them take charge and provide just enough assistance to build success; you feel this through your hands. Resist any urge to initiate and make it fast and easy. It is difficult but essential to let the child take charge of their body and begin to participate to the fullest. Changing the child’s response time requires patience, encouragement, practice and consistency in a variety of settings. Response time is slow to change, but with patience and consistency, significant changes will have a greater possibility of happening over the course of a school year. This opens up a whole range of future participation, from having less aide assistance to watching the child make and carry out more independent choices.