Praxis is the ability to generate an idea and the organization of a plan of action for executing a motor act. It is a process of action performance, and it is composed of four components: (a) ideation, (b) planning, (c) execution, and (d) sequencing. Ideation represents the first step in praxis and involves identifying a movement goal, a gestalt motor image of possible means of achieving the desire action.
Motor planning refers to the ability to order, plan and sequence a series of intentional motor actions.
Motor execution requires balance and coordination and motor control
Projected action sequences involve actions that require timing and movement through space. Examples of these are ball skills, running, and sports-related skills.
The defining characteristic of praxis is the ability to produce an adaptive response to environmental demands.
In therapy we are centrally concerned with the child’s ability to organize and participate in play and self-care activities. Referral for OT and PT at Developmental Pathways for Kids may indicate presenting problems suggestive of poorly developed praxis. Examples of such problems include:
- unable to organize playing by himself
- doesn’t know what to do with toys and often breaks them
- wants to join other kids on the playground but can’t do the activities without help from adults
- loves to ride her rocking horse but repeatedly has to be helped step by step to get on and off
- has difficulty putting on clothes and is now beginning to have tantrums habitually
In many cases, language delay is also present. Some children with praxis challenges are overly active and seem oblivious to danger and others are unusually fearful and shy away from gross and fine motor activities. Many of these referred children will be evaluated for Developmental Dyspraxia.
Developmental Dyspraxia is a type of coordination disorder where the child is unable to mentally visualize and “figure out”, or plan, new or skilled movements. These movements might involve large muscle actions, like learning how to roller skate or do a cartwheel; or fine hand/finger skills for handwriting or using tools like scissors or eating utensils.
Children with milder impairment have a “mental picture” of what they wish to do (called ideation) but cannot execute the body positions and action sequences to accomplish it. More severely impaired children do not have a mental image of the possibilities of a given object. Object cues of what-to-do-with-this-object, are called “affordances.” Children with severe dyspraxia do not recognize affordances.
Even more significantly, Jean Ayres, PhD (who was the originator of sensory integration practice) found that a child with dyspraxia showed an underlying pattern of impairment in the detection, organization, and discrimination of sensory information from the skin (tactile), joints and muscles (proprioception), and/or vestibular system (inner ear “equilibrium”). Her hypothesis for successful intervention was to treat the underlying sensory processing issues—not an educational process to teach the child how to execute specific movements.
This approach is the underlying theme in all of the work we do at Developmental Pathways for Kids. For children who have problems with praxis we address the underlying sensory processing difficulties using a sensory integration treatment approach. This entails the use of vestibular, proprioceptive, and tactile-based therapeutic activities that are combined in a playful context to motivate the child to make meaningful adaptive responses to “just-right” therapeutic challenges presented by the therapist.
Therapeutic goals are disguised by the artful therapist as play, thus obtaining the child’s optimal engagement.