PHYSIOTHERAPY - APPLIED TO THE CHILD WITH DYSLEXIA

							PHYSIOTHERAPY - APPLIED TO THE CHILD WITH DYSLEXIA

Written by:- Sally Wright MCSP. Dip. Physio. Physiotherapist. June 1989

Many of our parents are initially puzzled when their child with dyspraxia is referred
for a course of physiotherapy. This is very understandable. Traditionally,
physiotherapists are concerned with movement and coordination and their child may
not have obvious coordination difficulites. Most people's experience of physiotherapy
is in the field of rehabilitation where we are concerned with regaining muscle strength
and range of movement following accident or illness.
It is true that we are very knowledgeable about movement and coordination, we study
anatomy and physiology in great detail. We are also concerned with other aspects of
human functioning including the nervous system and human psychology, and this too
is studied during our training.
With children we have to understand how these systems develop the order in which
skills are aquired and what is needed to achieve these skills. We not only need to
understand motor development but also the development of vision, hearing and
speech and how these influence the development of perception and learning.
The development of vision, hearing, speech and movement are to a large extent,
genetically determined but can be influenced by other factors. Many parents report
similar learning difficulties to those experienced by their child - this is the genetic
influence. An example of an external influence is frequent ear infections experienced
by some of our children. All this development is taking place within an environment
which is different for every child so this also has an influence.
How, though, does development influence learning? To understand this we have to
have a basic knowledge of the nervous system. This is represented diagramatically
below:

INPUT                                PROCESSING                          OUTPUT
Eyes                          Learning                              Movement
Ears
Skin                          Brain
Musclesljoints
Balance                               Feedback

Information from the devloping sensory systems is transmitted to the brain via
sensory pathways. This incoming information is processed in the brain via a multitude
of interconnecting pathways and relayed to other centres within the brain where it is
made 'sense' of and translated into perception and learning. This processed
information is also relayed back to the sensory systems and used to modify movement
(coordination) and behaviour (eg. concentration). There is a continuous feedback-
system- thus it can be understood that all areas are connected either directly or
indirectly. It follows that if your child has problems in the functioning of any area
shown in the diagram it can affect the way they learn - they may have difficultiy
translating concepts into action - dyspraxia.

Very few children with dyspraxia have defects in their sensory systems, mostly their
difficulties arise from poor functioning of the processing system, often along with
immaturities or inefficiencies of development. Because the pathways are all
connected, poor functioning in one area causes poor functioning in another - there is a
"knock-on" effect and the child's problems are perpetuated.
By working to improve the quality of ingoing information we can help stop this
downward spiral - this is where physiotherapy (and the work of other professions)
comes in. W can't work on learning itself but the "ingredients" needed to acquire these
skills.
Let me give you as an example how a physiotherapist might choose to help the child
with writing difficulties. These difficulties could be due to one or more of the reasons
listed below.

1. Poor shoulder control causing poor pencil control.
2. Poor sensory awareness of the fingers and where the arm is in space this also
causes poor pencil control especially when the child has to look away from the board
to copy from the blackboard for instance.
3. Poor eye/hand skills - again causing poor pencil control.
4. Poor visual Interpretation of what the child Is copying.
5. Poor sequencing and scanning left to right, ie. may copy things down in the wrong
order.
6. Poor directional sense and inability to translate direction onto paper.
7. Inability to transfer visual Information Into verbal.
8. Inability to transfer verbal Information Into visual.
9. Poor organisational skills.

A detailed assessment is necessary in order to detirmine exactly which of the above is
causing the difficulties. Once the contributing factors have been established, a
treatment program can be planned. This program will need to be followed through
into the classroom and you will be asked to back up the physiotherapy program by
working with your child at home. A unified approach is essential to avoid confusing
the child and to ensure the best results possible for that child. Liason between
professionals involved is also essential.
Physiotherapists differ in the methods they use to achieve their aims but all aim
towards the same goal. I may choose to use the following methods to help the above.

1. Poor shoulder control - lots of weight bearing exercises through the arms to help
increase tone of muscle groups controlling shoulders and thus improve coordination.
2. Poor sensory awareness - lots of tactile (touch) work to increase awareness of arms,
hands and fingers.
3. Poor eye/hand skills - ball work, tracing patterns etc.
4. Poor visual interpretation -help the child break down what he is seeing into its'
component parts and then build up into a whole. Use verbalising to help.
5. Poor sequencing and scanning - strengthen the small muscles controlling movement
of the eyes and use tracking exercises to help the eyes to learn to work together when
following an object. Encourage the child to work from left to right.
6. Poor directional sense - relate directions to the child, help them to alise the
permanence of right/left and then translate this onto paper.
7. Inability to translate visual to verbal - practise this by expressing visual things
verbally.
8. Inability to translate verbal to visual - the reverse of the above.
9. Poor organisational skills - increase body awareness and thus improve organisation
of the body in movement patterns.
I hope that now you understand how physiotherapy can be applied to the treatment of
the child with dyspraxia and also that you have a better understanding of your child's
problems.
Physiotherapy is not of benefit to every child with dyspraxia but, where appropriate,
can make a very real contribution in resolving the problems faced by such a child and,
what's more, the child usually enjoys the sessions.