Praxis, also known as motor planning, is the ability to combine information from the environment and successfully perform actions to completion. Despite this brief definition, the ability to perform praxis is quite involved. Occupational therapists often break praxis abilities down into specific parts.

Praxis – Ideation

Part one is called ideation, in which we use varying brain functions to support ideas. Ideation is the ability to grasp what is being seen and develop an idea as how to use objects in the environment to develop a course of action. How to spot ideation? Look at how your child plays with simple items. Is there intention and a bit of complexity to the moves? Can the blanket switch hands, fold up, cover different body parts, become a tent, etc.? If struggles are apparent with several items, and play appears limited, it may be due to ideation.

Arousal and Rhythmicity

Part two is arousal and rhythmicity. We need to be able to perform actions in a rhythmical manner. We also need to match our arousal or energy to the rhythm to perform. Difficulty with rhythmicity is often most apparent in how a child times their movement. People may describe children who struggle in this area as clumsy.

Complete Movement Efficiently

Part three is the ability to complete or execute the movement efficiently. Planning and sequencing movements with the ability to make real-time adaptions is the foundation for learning a multitude of skills. To help get a better idea of what a motor difficulty may look like, see the chart below.

When a difficulty is present in any one of these parts, it will affect the overall presentation of movement. Professionals use a variety of terms to describe the difficulties observed, including dyspraxia, developmental dyspraxia, coordination, or perceptual motor difficulties. Some children will end up with a diagnosis of Developmental Coordination Disorder. Meanwhile, others who present with difficulties will not have a diagnosis.

Regardless of the confusing terms, OTs are one group of therapists with the skills to address such motor issues in children. Therefore, they have specialized skills in understanding primitive reflexes, motor control based on neurological components, sensory processing, and perceptual processing. Our occupational therapists will assess which parts are leading to the difficulty and then help remediate the difficulty with fun and engaging activities. Above all, remember that it is never too late to address motor challenges! The positive outcomes can be considerable for a child. Lastly, if you have concerns, reach out to MOSAIC today to schedule a free screen or a full evaluation.

References

1. dyspraxiausa.org

2. www.dyspraxiafoundation.org.uk

3. Dyspraxia from an Occupational Therapy perspective by Natasha Patten BSc (Occupational Therapy)

4. CE-Article- September-2019.pdf (aota.org)

Every house has cups! If there are children in the home, they are often plastic which are perfect when it comes to cup activities. Here are some fun and simple activities for kids to do with cups. Each activity helps develop a variety of skills.

Memory

Arrange colored cups in various order / direction ( vertical, horizontal, diagonal) then rearrange and have child move back to original order. The more cups the higher the challenge. In addition to working on visual memory skills children can learn strategies to help with memory (repeating the pattern).

Stacking

Cups can be stacked in pyramids of all sizes and shapes or made into walls or towers. You are only limited by the number in your stash. Kids are working on eye hand coordination, bilateral skills, and motor planning. Math skills can be added as they count their stacks or create patterns with different colors.

Bowling with Cups

What kid does not like knocking things over?! Set up a mini bowling alley using overturned cups. Use the traditional triangle set up or be creative. Tennis balls work great for knocking them over. This game will help build eye hand coordination, visual perceptual skills, and motor planning. Playing in teams will help develop social skills of working together, turn taking and social communication skills.

Target Practice with Cups

Cups can make great targets for Nerf guns. Make the target more challenging by dangling them from a doorway. Other options are to set them up and try to toss a ping pong ball into them (a kid twist on a college game!). You can also tape them to the edge of a table and try to roll balls across the table into them. Fun variations include using a straw to blow light weight balls / cotton balls into the them or having them roll a ball down a paper towel roll (this one requires more planning and organizing to complete).

Up and Down

This is a group game that requires room to run. Divide kids into an Up team and a Down team. Scatter as many cups as possible around the playing area with half of them up and the other half down. Kids then race to flip over cups to their designated direction (up or down). When they hear, “STOP,” whichever team has the most cups pointing their way wins.

So, if you are looking for some fun and simple ways to keep kids entertained, try some of these out. These games can also be great for a family get together, birthday parties, and sleep overs. For more ideas or advice on building play skills, check out Building Play Skills for Healthy Children and Families.

It seems everywhere you look, we are a nation obsessed with tongue ties. But why? What is the great debate? Let’s break it down.

“The reason we’re hearing about tongue-tie more now is that the last 10 to 11 years have demonstrated that the part of the tongue responsible for suction is the middle of the tongue, not the tip,” says Bobby Ghaheri, MD (otolaryngologist). This research refers to the part of the tongue restricted by a posterior tongue tie which Ghaheri states is “still under the front of the tongue but less visible.” Hence the name, posterior tongue tie. Frena is a small band of tissue that extends from the floor of the mouth to the bottom of the tongue. In addition to tongue ties, tethered oral tissue (TOTs) can define six other oral frena located bilaterally, in the upper and lower buccal cavities or cheeks, and upper and lower lips. Frena can either support movement or restrict it. However, frena cannot be stretched due to their collagen make up.

What is a Tongue Tie?

A tongue tie, or ankyloglossia, will present as an overly short or thick frenulum that restricts the tongue’s movement. Similarly, a lip tie can occur as well as buccal cavity ties. There are different classifications of each, however assessing function is what drives treatment or intervention.

Signs of TOTs in infancy may include difficulty breastfeeding causing failure to thrive and/or maternal pain. It can also be an issue causing “picky” eating or difficulty transitioning to solids. A child may develop a lisp due to structural problems and other issues may be evident across the lifespan. The following images depict restriction of the frena vs. supporting function.

What are all the Acronyms?

Let’s clarify the acronyms seen in the literature and on social media. These terms also identify team members when a tethering of tissue is present or identified.

• TOTs – Tethered Oral Tissue
• IBCLC/CLC – Individual/International Board Certified Lactation Consultant; if breastfeeding is an issue, this is one professional to consult.
• SLP – Speech Language Pathologist; professionals who have training in feeding, speech, and oral sensory motor function. Can have training and/or a certification in orofacial myology.
• OT – Occupational Therapist; can be TOTs informed and can assist in posture and alignment of the body, oral motor dysfunction, and body work such as craniosacral therapy or myofascial release.
• PT – Physical Therapist; can be TOTs informed and have continuing education in craniosacral therapy, myofascial release, or more. There can be torticollis with tongue ties and PTs are essential practitioners in this area.
• RDH -Registered Dental Hygienist; can be trained in orofacial myofunctional therapy.
• OMD -Orofacial Myofunctional Disorder; one or more of the following can be an OMD: abnormal tongue resting posture, teeth grinding, lip incompetency and/or noxious oral habits, nasal breathing issues, tongue thrust swallowing, chewing difficulties, or oral placement issues related to speech.
• OMT – Orofacial Myofunctional Therapy; a treatment modality used to treat OMDs. This is not a profession.
• COM – Certified Orofacial Myologist; SLPs can become a COM, which is an extensive process involving clinical and written exams and continuing education requirements to maintain certification.
• ENT – Ear, Nose, and Throat doctor or otolaryngologist. An ENT may assess structure, complete a release, and/or to assess an airway.
• Dentist/Orthodontist – professionals on TOTs team for assessment and intervention.

What to do when Tongue Ties or TOTs are Present:

In infancy, a pediatrician can refer to IBCLC, SLP, etc. A diagnosis of TOTs does not immediately mean a release is necessary. An assessment of function will determine intervention. A speech language pathologist can conduct this assessment and be vital in pre-op care, post-op care, and functional therapy, whether oral sensory motor or orofacial myofunctional (only after the age of four). Following assessment, a release is considered with relation to age and the severity of the restriction both in classification and in function. A dentist or ENT may release a tie via laser or scissors. They will prescribe stretches to complete after the procedure, and an SLP can complete treatment in collaborative care if trained accordingly.

The Takeaway 

In conclusion, when researching a proper assessment of oral structures with possible restrictions, consult professionals knowledgeable in the area, whether dentist, SLP, PCP, IBCLC, or ENT. Function is a determining factor for the indication to release or not. Navigating TOTs is a team effort in evaluation and treatment. A speech language pathologist is a professional that can be instrumental in oral motor development, feeding, and speech across the lifespan, and orofacial myology after the age of four. Choose a team wisely! Untreated oral ties can lead to a host of problems, including dental and orthodontic issues such as altered jaw and teeth development, breathing issues, reflux, head and neck pain, chronic jaw issues and/or difficulty chewing, poor dental hygiene, digestive issues, sleep apnea, and speech issues.

If you are struggling breastfeeding, it may not be related to TOTs. Check out What Exactly is a Good Latch? for breastfeeding tips.

References

1. Tongue Tie – What Everyone Needs to Know

2. TOTs 101 for Parents

Curious about visual perceptual skills? Your occupational therapist may use a variety of terms to describe challenges your child may be having with vision. Firstly, it’s important to understand that when discussing vision, the term acuity refers to how well the eyes can see (i.e. whether or not a person needs glasses). Visual perception, however, refers to how the brain sees and interprets the information. Then, after ruling out other visual concerns related to acuity and oculomotor skills, your therapist may conduct a variety of visual perceptual tests.

Visual Perception Skill Assessments

The assessments your OTs have access to here at MOSAIC are: “Test of Visual Perceptual Skills”, “Motor Free Visual Perceptual Test”, and the “Beery VMI”. Some of the assessments test just the eyes and the brain’s interpretation, and some of the assessments test visual perceptual skills in combination with visual motor skills (involvement of the hand). Also, there are a variety of sub categories in most of these assessments:

• Figure ground
• Spatial relations
• Discrimination
• Form constancy
• Visual and sequential memory
• Visual closure

Therefore, all of these terms are skills kids need to be successful with school and everyday functions.

Visual Perceptual Skill Terminology

• Figure ground refers to the eyes’ ability to see a specific item amongst a busy background. (Locating a specific sock in a busy sock drawer)
• Spatial relations refers to the eyes’ ability to understand the position of objects in relation to oneself or in relation to other objects. (Spacing of letters on the paper in relation to the line or in relation to other letters)
• Visual discrimination is the eyes’ ability to tell the difference of main features in an item’s position, shape, form, and color (Telling the difference between capital letters versus lower case letters)
• Form constancy refers to your eyes’ ability to identify an item whether it’s upside down, turned over, a different color, or a different size (Being able to identify letters when looking at a newspaper from the other side of the table)
• Visual memory and sequential memory are the eyes’ ability to look at something for a given time and be able to recognize it and its sequence after a brief lapse in time. (Remembering a family member’s phone number)
• Visual closure is the eyes’ ability to recognize objects or letters when only parts of the item is visible. (Recognizing the item in a dot to dot picture)

How to get Help

Your child could likely have challenges with one or many of these sub categories. All areas of vision greatly impact your success with academics. For example, if you are seeing challenges with reading and writing, first be sure to rule out any visual concerns. Schedule and appointment with an optometrist before seeking further testing for visual perception. An optometrist will gather a baseline on acuity and oculomotor skills. But, if you aren’t sure and need more guidance, schedule a free screen with one of our occupational therapists. They will determine if your concerns warrant a full evaluation or a referral out to a vision specialist! Also, you can check out another MOSAIC blog on visual perception here.

Have you had those days when you have been hunched over at your computer all day for work and start to notice a headache? Or, perhaps you’ve had neck pain that extends between your shoulder blades? Why is having good posture so important? What exactly does this look like?

Lower back pain is one of leading healthcare costs world wide, and many other people suffer from mid back or neck pain. One of the key elements that physical therapists will tune into is an individual’s posture, as this can be a contributing factor to your pain and decreased function. Posturing exercises are just some of the exercises that you may be performing in PT. However, even if you don’t need any physical therapy, it is important to keep good posture so you don’t develop any physical symptoms.

Posture and the Lumbar Spine

When addressing an individual’s posture, we need to focus on 3 areas of the vertebral column. The cervical spine, thoracic spine, and the lumbar spine. We need to build a good foundation from the base up, and the easiest place to start is with the lumbar spine. Often times sitting in a chair will cause a person to have a posterior pelvic tilt. This, in turns, causes the lumbar spine to flex forward. By teaching you the correct anterior tilt, we put the lumbar spine in its more natural lordotic position.

The Thoracic Spine

Now for the thoracic spine, we will often have our shoulder blades protracted (rounded forward) and thoracic spine flexed. In other words, increased kyphosis. This puts the muscles in our back on constant stretch. Even though it doesn’t feel like a traditional stretch, these muscles are getting lengthened all day long. In order to correct this, think about pinching a quarter blade between your shoulders. The key is to squeeze together and DOWN, not together and up. Elevating your shoulders will likely cause further tension/stress in your shoulders and neck.

Posture and the Cervical Spine

Lastly, we have the cervical spine. Usually, people are flexing their lower cervical spine and extending their upper cervical spine. We call this forward head posturing. To correct this, we perform a chin tuck. This is similar to trying to make a double chin in a goofy photo. By performing this action, we create extension in the lower cervical spine and flexion in the upper cervical spine.

Be sure to talk with your physical therapist about correct posturing. Each person is unique and needs their own individual exercise program. Additionally, it would be beneficial to review your workplace environment and make necessary changes. To help you get started, check out our Computer Workstation Setup Guidelines.

References

1. Kim LH, Vail D, Azad TD, et al. Expenditures and Health Care Utilization Among Adults With Newly Diagnosed Low Back and Lower Extremity Pain. JAMA Netw Open. 2019;2(5):e193676. doi:10.1001/jamanetworkopen.2019.3676

2. Mahmoud, N. F., Hassan, K. A., Abdelmajeed, S. F., Moustafa, I. M., & Silva, A. G. (2019). The Relationship Between Forward Head Posture and Neck Pain: a Systematic Review and Meta-Analysis. Current reviews in musculoskeletal medicine, 12(4), 562–577. https://doi.org/10.1007/s12178-019-09594-y

3. Schünke Michael, Schulte, E., & Schumacher, U. (2011). In Thieme Atlas of anatomy (Second, pp. 2–35). essay, Thieme.

Dyslexia is a well-known disorder that is characterized by difficulty with reading and writing. What is not well-known is that there are different types of dyslexia. Thus, children with a diagnosis of dyslexia or specific reading dysfunction may exhibit very different skills and challenges with regards to reading and writing. Griffin and Walton (Dyslexia Determination Test, 2003) listed the following seven different types.

Types of Dyslexia

1. A dysnemkinetic label means poor memory for motor movements when printing or writing letters and numbers. Letter and number reversals are prominent and, generally, reading deficits are mild.
2. A dysphonetic pattern presents with difficulty matching sounds to letters. This results in difficulty sounding out words and using knowledge of phonics to write words. This is evident in both phonetically regular words such as stop and phonetically irregular words such as cough. A typical spelling error might be solw for slow.
3. A dyseidetic pattern presents with slow reading due to an over reliance on phonics to sound out words. A person cannot visualize the whole word and thus, recognize it by sight. Phonetically regular words (e.g. camp) will be read and spelled much more easily than sight words (e.g. laugh).

Mixes

The remaining four types are mixes, a combination of the above three primary types.

1. This is a mix of dysphonetic and dyseidetic patterns resulting in difficulty recognizing sight word and using phonics to sound out and spell words.
2. This is a mix of dysnemkinetic and dysphonetic patterns. Letter reversals are present and there is an inability to use phonics to sound out or spell words.
3. This is a mix of dysnemkinetic and dyseidetic patterns. The difficulty will be reading and spelling of sight words. Letter and number reversals will also be present.
4. This is a mix of all three primary patterns – dysnemkinetic, dysphonetic, and dyseidetic. Thus, deficits exist in letter and number orientation, matching sounds to letter symbols in order to sound out or spell words, and reading and spelling sight words.

Remediation will be most effective by identifying the type of dyslexia. Then, the teacher will select teaching techniques according to the type of dyslexia present. To learn more about how dyslexia affects learning, check out our blog, Understanding Dyslexia. For additional resources, check out The Dyslexia Resource.