PRAXIS (COORDINATION- PLANNING AND MOVEMENT)

Praxis is the process of deciding what your body has to do and then doing it.

Praxis is the ability to conceptualise, plan, and organise movements in order to complete unfamiliar motor tasks. Praxis is not itself a sensory system, but rather it is a higher level cognitive function that depends on the integration of multiple sensory systems, particularly tactile perception and proprioception in order to function efficiently.

There are two aspects of praxis:

• Ideation: is the ability to create a concept or mental image of a novel task.
• Motor Planning: is the ability to organise and plan novel actions.

Praxis is dependent on accurate sensations being received from all sensory systems in the body: sight, hearing, balance, touch, awareness of body position and movement.

A child with praxis problems may have difficulties with any or all of these parts. As a result they may be confused when expected to do something, very disorganised in their behaviour and perform tasks in an illogical way. They may seem clumsy, accident prone or messy. The child's difficulty may be poorly understood - particularly if they are bright but disorganised in their actions.

A child with poor praxis will expend much more energy than their peers when engaged in similar activities. They will have to think about how to carry out movements which are automatic to others, and therefore may be only able to concentrate on one thing at a time. For example they may have to put so much conscious effort into handwriting that they are not able to listen to a teacher's instructions or write down homework. Unfamiliar tasks will be particularly difficult as the child has not yet had the chance to practice the necessary sequence of movements.

When there are difficulties with Praxis

• The child may get frustrated when trying to put trousers on because they put both feet into one trouser leg, pulls then gets stuck.
• They may be clumsy and move awkwardly, often tripping when trying to run
• Handwriting may be illegible
• Even moving from one body position to another, such as sitting to standing, can be difficult.
• Imitation games like 'Simon Says' and 'The Hokey Pokey' can be difficult, especially if the child is expected to do them quickly.
• Eating and forming speech sounds may be difficulty as well.

Often, once a tasked is learned an individual is only able to successfully complete the task in the original environment i.e. they are not able to transfer their skills to accomplish the task in a new/ different environment. They would have to learn the task again in the different environment. As such, individuals tend to try and control everything because transitions and change involve motor planning new activities, which are often accompanied by anxiety and stress.

Implications for learning

• A child who has difficulties with praxis will require more repetitions to learn a task or activity. Self-care activities and daily living activities such as bathing, dressing and meal preparation may be challenging for the child and they may require other strategies to help them remember the sequence, such as the use of visual aids and using hand-over-hand to help them learn new tasks.
• Handwriting and writing tasks will be a challenge.
• The child may not like to engage in physical activities as sporting activities require timing, sequencing, speed and coordination all of which are possible areas of difficulty for the child.
• The child may show consistently poor performance in many activities that require motor skill and flexible problem solving. Such a child may not know what to do with an object or how to begin a task. They may resist unfamiliar tasks, preferring repetitive play to novel activities. This child may appear 'bossy' or 'manipulative' to others because of their need to feel in control of the situation and to know exactly what to expect.

Praxis activity ideas

• Ride tricycles or bikes
• Gymnastics
• Climbing wall
• Surfing
• Horse riding
• Karate
• Swimming
• Play 'Simon says' (for younger children)
• Sing songs with movements e.g. 'Incy Wincy Spider' (for younger children)
• Play balloon volleyball
• Step-by-step visual aids may help the child to plan and sequence self-care skills such as tooth brushing and showering. Some people often find it useful to make a step-by-step strip and laminate it so it can be placed in the bath/ shower room. If this is successful, the same strategies can be applied to other areas to encourage independent life skills, such as in the kitchen for meal preparation. The website www.do2learn has some useful resources and ideas.

• Animal walks

• Duck (holding ankles)
• Elephant (swaying arm in front)
• Bunny hops (hands first, then feet)
• Kangaroo (jumping)
• Snake (sliding on tummy)

• Demonstrate different repeated sequences of movements for the child to copy. If this is difficult for the child ask them to say the action when performing the sequence,

• E.g.. jump, clap, jump, clap
• Jump, jump, clap, jump, jump, clap
• Begin with a sequence which the child can follow and then make the
• Sequence more complicated as the child's ability improves.

• Simon says - incorporate all body parts.

• Jump dot to dot on a twister mat or make circles/squares to go on the floor.

• Obstacle course:

• Stepping in/out cardboard boxes
• Crawling through a table
• Crawling with small pillow / bean bag on the child's back
• Wriggling under chair
• In and out cones / cushions / books
• Continuous jumping on the spot/in squares

• Keeping a balloon in the air

• Tape on the floor:

• Walk along the line
• Jump side to side over the tape
• Hop along the line

• Jumping over a rope moving slowly back and forth

• Walk with balloon / ball between the legs

• Walk with bean bag on the head 

• Complete drawings from verbal instructions

• Art projects or constructions toys which require putting pieces together to create an object will challenge the child's ability to organise parts into a whole. It is important to start at a level at which the child can succeed and then gradually increase the difficulty as the child's ability improves.

• Action rhymes and songs can be useful - especially with younger children.

• Aerobic stepping to a rhyme- ideally done in a group. The children continuously march on the spot while singing (to the tune of London Bridge is falling down):

• Lift your knees up step in time, step in time, and step in time
  Lift your knees up step in time,
  Follow my rhyme.
  Continue singing but change the activity e.g.
  Swing your arms and step in time
  Close your eyes and step in time
  Step so soft (hard, fast, slow) and step in time
  Clap your hands and step in time.

• Charades - the child has to use movements only to convey the name of something. Begin with simple miming - e.g. pretending to be an animal, and progress to more complex mimes.

• Mirror image copying - child stands facing an adult or child who produces different body postures for the child to copy. Encourage the child to keep looking at their partner. Do not 'talk through' the actions unless the child has difficulty copying them.

When able to do the above activities, progress to these more difficult activities:

• Spotty Dogs - Jumping with same side arm and leg - Stand with your right leg and arm forwards jump and swap bringing your left arm and leg forwards - Jumps should be performed with continuous movement ie without extended pauses.
• Progress to: Jumping opposite arm and legs together.
•  In standing touch elbow to opposite knee - repeat with the other side with continuous movements. Continue until this is a smooth movement.
• Progress to: moving your hand behind you and touch the opposite heel - repeat on the other side with continuous movements.

Useful resources

• Raising A Sensory Smart Child by Lindsey Biel and Nancy Peske
• Building Bridges through Sensory Integration by Ellen Yack, Paula Aquilla and Shirley Sutton.
• Sensory Integration Education https://www.sensoryintegration.org.uk/What-is-SI

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