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NEUROMOTOR IMPAIRMENTS
Rosemary
Crossley
The term 'neuromotor impairment' can refer to any problem with producing desired movement patterns due to neurological dysfunction or brain damage. Some of the neuro-motor impairments which often affect people with developmental disabilities are briefly described below. It is important to realize that these are disorders of movement, and not disorders of understanding.
Impaired eye/hand co-ordination
Eye/hand co-ordination is the ability to co-ordinate eye and hand movements. In the simplest sense, the ability to keep your eyes on what you’re doing. More complex aspects include correlating perception of depth and strength of movement. People with impaired eye/hand co-ordination find it hard to maintain eye-contact with the target when pointing or typing.
Problems with inhibition
Inhibition refers to the stopping unnecessary or inappropriate movements e.g. we inhibit ourselves from picking our noses when being photographed. To make controlled, voluntary, movements it is necessary to inhibit involuntary movements.
Disinhibition is the opposite of inhibition. Many people with poor eye/hand co-ordination are visually disinhibited — that is, they are unable to inhibit the automatic movement of their eyes to anything in their environment which moves or makes a noise.
Initiation problems
Difficulty in starting a movement, even though the person wants to move. People with initiation problems may need a spoken or physical prompt to start moving e.g. a tap on the elbow to start signing.
Abnormalities of muscle tone
Normal muscle tone is the state of the muscle which allows free natural movement.
Some people’s muscle tone is too low (hypotonic) – their limbs feel floppy and heavy. They may have difficulty initiating movement and may tire quickly.
Some people’s muscle tone is too high (hypertonic) ¬– their muscles feel tight and their limbs feel stiff. They may move jerkily and find it hard to change direction.
Perseveration
Perseverative movements or actions are repeated more than is necessary or appropriate. There can be perseveration in speech "I went to the shops, shops, went to the shops to shops to buy shops." There can be perseveration in written words "I am in in inside in my class." Sometimes perseveration of a sequence will cue another unwanted word as in the above example of in and inside. Sometimes a typist cannot get as far as a word — they get stuck on the first letter and hit it again and again, or they hit the correct letter then every other letter in the row.
Reduced proprioception
Proprioception is a sense that most of us are unaware of. It is a multi-functional sense - it tells our brains where we are in space, and it tells our brains what our bodies are doing from micro-second to micro-second.
Whole body proprioception
Your brain knows where we are in space because we constantly have input from the vestibular system, the semi-circular canals in our ears, which tells us where we are in relation to the earth’s gravitational field, combined with input from our eyes (if it’s light and we can see) and touch – the pressure from feet on the floor, or bottom on chair.
Proprioception of separate body parts
Your brain knows where your limbs are and what they are doing because of a complex and extremely rapid feedback system. Messages from every joint are constantly relayed to the brain, to update this information. Without this information your brain would be totally unable to direct your movements, because it wouldn’t know where to send the messages to, or what your starting position was.
People with reduced whole body pro-prioception may try to obtain more feedback, by engaging in repetitive movements, especially rocking. They are likely to enjoy activities such as trampolining or swimming which provide increased feedback and they may find sitting still quite uncomfortable.
People with reduced pro-prioception of separate body parts will have difficulty co-ordinating sequences of movement. Achieving bladder and bowel control may be difficult for children with reduced pro-prioception because if they can’t localize sensation they will not be able to void voluntarily. Activities done by touch alone, such as bottom-wiping, may be impossible.
NEURO-MOTOR IMPAIRMENTS PARTICULARLY AFFECTING SPEECH
Aphasia or dysphasia
Loss or impairment of the ability to use words. In the US ‘aphasia’ is only used in reference to people with acquired disabilities – in the UK and Australia it is used more widely.
Expressive (Broca’s) aphasia affects the ability to use words. There may be problems with recall of words, confusion between words with similar sounds (e.g. saying 'knife' for 'life'), or difficulty in repeating something just heard.
Apraxia or dyspraxia
A neurological condition which prevents a person from reliably reproducing movements on demand. A person who has this condition may be able to reproduce the same movements spontaneously or involuntarily e.g. a child who spontaneously waves goodbye may not be able to wave his hand on request.
A person with severe oral apraxia is often said, quite incorrectly, to be able to 'speak when he wants to' because he has been heard to speak in the past. In fact, what he said may have been involuntary (e.g. swear words) automatic (e.g. completions — ‘Shut the “door”’) or spontaneous (e.g. greetings) and it's precisely voluntary speech which he is unable to produce, that is, he cannot talk whenever he wants to.
Reproduction of sequences of fine movements, such as those involved in speech, handwriting and manual sign is especially likely to be affected in dyspraxia/apraxia. With some activities a visual cue helps – e.g. a student with dyspraxia who cannot write the answer to a simple question may be able to copy notes from the blackboard reasonably accurately. The same student is likely to find typing or multiple choice more effective for answering questions because the demands on motor memory are reduced.
Dysarthria
An impairment in the functioning of the musculature of respiration, phonation and articulation due to a lesion in the peripheral nervous system, central nervous system or both. Involvement of the muscle groups controlling the tongue, the palate, the vocal cords and breathing seriously affects the intelligibility of speech. Dysarthria is a common complication of cerebral palsy.
Echolalia
The repetition of previously heard utterances exactly as heard. Echolalic speech is fairly commonly associated with other word-finding problems. Individuals with echolalia are often diagnosed as autistic.
Word finding problems
Frequent inability to find the correct word. We all experience occasional word finding difficulties: “Can you bring me the whatsit from the whosits?” or calling someone we know very well by the wrong name. For some individuals the problem is so severe it prevents functional communication. It is similar to expressive aphasia.
None of the impairments described above prevent students learning, but they certainly make it much harder for students to show what they have learnt. Students with such impairments will need special provision, and specialist help should be sought.
Rosemary Crossley, M.Ed., Ph.D.
March 2006
Ph. (61-3) 9509 6324
Fax. (61-3) 9386 0761
e-mail: dealcc@vicnet.net.au
Autism/ASD, Cerebral Palsy, Down Syndrome, Intellectual Impairment, Learning Disability, Fragile X Syndrome, Rett Syndrome, Stroke/CVA,
Persistent/Permanent Vegetative State, Acquired Brain Damage,
Motor Neurone Disease/ALS, and Huntington's Disease.
DEAL has been able to help people with all of these diagnoses to communicate.