Transcript Ecological Intervention

Ecological Intervention
M-ABC 2
1st April 2008
Christine Lynch O.T. (C)
M-ABC
Historical Perspective
• The evolution of the new M-ABC 2 can be traced back
over 40 years to the 60s.
• The Test of Motor Impairment (TOMI) was originally
developed by Denis Stott in the 60s, initially in Scotland
and subsequently in Canada, as a research instrument to
help detect motor dysfunction in school age children.
• A second group of researchers working out of the
University of California under Prof Keogh had developed a
checklist to help alert teachers to the existence of children
with movement difficulties and to help investigate the
educational significance of such difficulties.
• Eventually these two groups got together to produce the
original M-ABC in 1992.
• Scott & Keogh did pioneering work and were part of the
development of the new disciplines known as Human
Movement Science, Kinesiology and Human Kinetics.
M-ABC
• Sheila Henderson Trained as a Phys Ed Teacher in
Scotland. Got involved in research into clumsiness with
Denis Stott. BA in Psychology from Guelph. Received a
research fellowship from the National Research Council of
Canada, Received an MA from the University of Waterloo
for work on cognitive development and a PhD for studies
of feedback in the development of highly skilled motor
performance.
• David Sugden trained as a Phys Ed teacher in England.
Became interested in children with movement difficulties
when he was attending the University of California and
worked with Prof Keogh, where he graduated with a MS in
Phys Ed and a PhD in Special Ed.
• Both authors have published numerous articles and books
within their fields of interest
MABC & Intervention
• The addition of an intervention guidelines was considered an unusual
feature
• The manual contained a number of chapters related to intervention:
Chapter 9. The Cognitive- Motor Approach to Intervention
Chapter 10. Linking assessment & management
Chapter 11. Teaching individual skills – handling the learning process
Chapter 12. Creating the right atmosphere for success
Chapter 13. Considering organizational factors
Chapter 14. A case study
• Work on the M ABC has taken place on both sides of the Atlantic.
Knowledge of legislation as well as education and clinical practice on
both continents helped in developing the M ABC with a truly
international perspective.
M-ABC
• Chapter 9 of M-ABC Manual, 1992
“The Cognitive-Motor approach to intervention”
Two strong reasons for providing intervention:
• Improving motor competence opens the door to full
participation in ADL
• Intervention can help with associated problems such as
poor strategies for learning and low self esteem
• Model adopted in the MABC was based on the model of
Information Processing, used in the field of cognitive
psychology.
The Cognitive –Motor Approach
Based on
• 1. The framework of IP:
The solution to a movement problem is conceptualized as having 3
components:
- Planning a motor act
- Execution of the act
- Evaluation of the act
• 2. The learning Process:
- Phase 1. Understanding the skill
- Phase 2. Acquiring & refining the skill
- Phase 3. Automatizing the skill
- Phase 4. Generalizing the skill
The Cognitive-Motor approach to
intervention
• Motor difficulties in children rarely occur in
isolation.
• A lack of co-ordination is usually accompanied by
a lack of confidence, low self esteem,
underachievement in school and loneliness.
• The complex interaction that seems to exist
between cognitive, affective and motor factors
must be addressed if the process of assessment and
interventions to be effective.
• The Cognitive-Motor approach to intervention is built
upon the idea that cognitive, affective and motor
competencies interact in a dynamic way.
• The children’s knowledge and understanding of the
learning situation affect their motor competence.
• The amount of control the child is capable of exercising
will influence the strategies adopted
• Emotional state interacts with motor competence
• The way a child feels and thinks about their motor
competence will affect their willingness to participate in a
movement learning situation
M-ABC
• Chapter 13 of M-ABC Manual, 1992
“Considering organizational factors”
• 3 Questions:
-WHO is involved?
- WHERE should the Intervention take place?
- WHEN should the Intervention take place
WHO
• Parents
Parental involvement can be of direct benefit to the child.
• Classroom teachers
Teachers should be involved to avoid conflicting advice.
Teachers should be kept informed of progress etc
To help give the teacher support in their involvement with
the student.
• Other professionals: OT, PT, SLP, Psychologists,
music/dance Therapists/Teachers, Phys Ed Teachers,
Special Ed Teachers,, classroom assistants
WHERE
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Individually or Group?
In the classroom/out of the classroom?
In the school or out of school?
In a clinical setting or other?
In the community?
…and so on
‘In school’ versus ‘out of school’
• Best if intervention can be arranged within the child’s own
school.
• Through a ‘whole school’ approach.
• More communication can take place within the school.
• Program planning can take place within the context of the
school curriculum.
• Primary objective is increased access to the curriculum,
best way is to plan a program with constant reference to
that curriculum.
• Easier to merge direct and indirect intervention within the
school setting.
• Possibly more room for flexible timetabling
Development of EI
• There is an increased awareness of the impact of
movement difficulties on children’s lives.
• There has been greater interest and advancements within
the research world into motor development, its
impairments and their causes and consequences.
• The authors of the original MABC stated that they hoped
and intended that future revisions will continue to reflect
developments in the educational, medical and
psychological understanding of developmental movement
difficulties as well as responding to the changing context
of educational provisions and the principles that guide
these.
Introduction to EI
• EI is based on the original ‘Cognitive-Motor Approach’,
• Advances in research on motor control/motor learning and the
development and changes in clinical practice have influenced thinking
and led to further elaboration rather than radical change.
• The same original concept together with new ideas on how best to help
children become confident competent movers
• Definition:
Ecological: ‘The relationship between an organism and their
environment’
The Manual
5 Chapters
• Chapter 1:Introduction to EI
• Chapter 2: Performing & Learning Motor Skills
• Chapter 3:Collecting information & planning the program
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• Chapter 4: Implementing an IE program
• Chapter 5: Showing the way through examples
Chapter 1. Introduction to EI
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EI is a way of thinking
Based on motor development literature
Intervention should be an integral part of daily living
Different individuals play different but equally important
roles. Coordinated by a ‘Movement Coach’
Overriding principle is that success of an intervention
program is a function of the dynamic interaction between:
The Child
The Environment
The Task
The aims of EI
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The primary aim is to improve movement competence, so
that the child can participate fully in activities of daily
living with success and confidence:
at home
at school
in the community
in recreation and leisure contexts
Increased movement competence, increased confidence
and better strategies should result in a happier child and
happier family.
Main objective:
Learn to Move and Move to Learn
WHO will benefit
Four broadly defined categories:
• Children of normal intelligence who have, or who are
suspected of having Developmental Coordination Disorder.
• Children of normal intelligence who have a possible
movement difficulty along with other difficulties, such as
attentional problems or difficulties with reading.
• Children who were in an ‘at risk’ category either before or
soon after birth e.g. premature, low birth weight.
• Children whose movement difficulty is recognised
symptom of a medical condition e.g. Tourette’s, Fragile x.
WHERE should intervention take place?
• Intervention should happen where ever the child is.
• May depend on who is involved and what resources are
available
• No single approach has found to be the ‘right’ one
Maybe within a small group:
• At school
• Local sports centre or club
• The child should be in a familiar context, surrounded by
peers or others who are normally present in that setting
Individual intervention maybe required:
• At a clinic or developmental centre
• Intervention is seen as long term
• Must be incorporated into the daily routine of the
child at home, at school and in the community
• Parents and other family members should be
involved whenever possible
• The context in which the child is learning should
be meaningful for the particular.task.
• All should work in a similar manner.
• The Movement Coach ensures that the right things
are happening in the right place at the right time.
WHO can deliver EI
• No professional restrictions on who can use EI, to
help a child with movement difficulties.
• The ideas, strategies and techniques of EI need to
be absorbed before they can be put into practice.
• Many individuals will work together to help the
child with movement difficulty become more
competent, under the guidance of the Movement
Coach.
Movement Coach
• Takes responsibility for over seeing and
directing the intervention as well as
teaching the child directly
• The MC might be an OT or PT, Special Ed
teacher, PE teacher, classroom teacher,
parent or other
• The MC takes responsibility to train others
WHEN can EI begin
• EI is suited to any child at any time.
• Should begin as soon as the child is
recognized as having difficulties.
• With young children, low key intervention
is appropriate & effective
• EI principals can also be applied at
secondary school level
HOW OFTEN is intervention needed.
• EI is a process that is on going throughout a child’s day
• There may be a formal component e.g. handwriting group,
or PE club. These should be ‘little and often’. 20/30
minutes, as often as 3 to 5 times a week.
• At times intervention might be entirely incidental, and for
extended periods of time, e.g helping at home, tidying up
etc
• The goal being to help the child function in all real-life
settings
WHY choose EI
Six reasons:
1) Consistent with the WHO’s International Classification of Functioning,
Disability and Health. Which emphasises that there is no simple
relationship between impairment and the ability to function as an
active member of society.
2) EI is part of the complete package which includes the M-ABC-2 test
and checklist, providing a smooth link between assessment and
intervention
3) The approach to teaching movement skills within EI has a solid
theoretical base. Two complementary theoretical frameworks of motor
performance and learning which together provide a set of principled
guidelines for good practice.
WHY choose EI
Continued:
4) Consistent with current thinking about intervention for children with
difficulties: It is child & family-centered, it takes account of the
environment in which the child exists (family, school sports), use
multiple inputs from professionals and is not dependent on one highly
trained therapist.
5) Strong empirical base ( based on the earlier title of Cognitive-Motor
Approach). Which has been developed further as a result of experience
and feedback.
6) When well executed, EI is rewarding for children and delivers and
helps them become more competent movers who enjoy motor activity.
Chapter 2. Performing & Learning
Motor Skills
Theoretical Framework
1. How we perform motor skills
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In the original MABC the intervention model was
presented entirely within the framework of the presented
Information Processing (IP) Approach.
Since then new insights into how we might help children
with movement difficulties have evolved. Referred to as
Dynamic Systems (Ecological) Approach.
• Both of these approaches are complimentary in what they
tell of Motor control.
• Both frameworks acknowledge that Affective factors, such
as the child’s general level of motivation, attitude to
learning and confidence will influence their ability to learn
new skills.
• Both approaches address the same questions..how do we
plan our actions and how do we execute them?
• Two differences: (1) DS theory is less keen on separable
components and view perception and action as inseparable.
(2) DS theory places more emphasis on HOW we organise
the movement required to complete an action.
Simplified IP model
• Planning an action: Movement planning involves the intake of sensory
information through the sensory (& perception) system. It requires the
translation of this info into decisions for a plan of action.This is
followed by the prep of a response.
• Executing an action: The spatial, force requirement, timing & over all
sequencing & organising of the action plan. Strong influence of
affective factors.
• Using feedback: The feedback can come from inside (intrinsic) or
outside (extrinsic). The info we receive can relate to the outcome of an
action /knowledge of results (KR) or about the quality of the
movement/ knowledge of performance (KP). The affective variables
also need to be considered.
Dynamic System (DS) Approach
• In DS the environment affords or invites
action. Links the action to the size of the
body and parts.
• Body scaling: the ‘fit’ between the child &
the demands of the task. Link between the
action and size of the body
• How many Degrees of freedom are
controlled in a given action
• The DS approach is based on understanding how we
control movements which involves physics,
biomechanics,& neuro-chemistry of muscle function
• Features: power of the environment
• The use of body scaled information
• The ‘fit’ between body properties and relevent features of
the environment
Theoretical Framework
2. The Learning Process
Progression towards solving a movement problem
Phases of Learning:
Phase 1 Understanding the skill: involves the child’s cognitions about the
demands of the task. This phase is the ‘knowing’ part of the task and
for children with difficulties is often the most challenging part.
Phase 2 Acquiring & refining the skill: involves practice, the recognition
and the reduction of errors. It involves processing feedback and
relating this to the internal model of action
Phase 3 Automatizing the skill: involves performing the task without (or
with minimal) conscious control.Maybe a difficult phase for children
with movement difficulties to reach.
Phase 4 Generalizing the skill: occurs when the skill is used in novel and
different contexts. For this to occur the skill must be learned, retained
and most importantly there must be recognition that a situation
demands that particular skill
Chapter 3. Collecting Information &
Planning the Program
Children who might benefit from EI
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EI is suitable for a wide range of children, particularly Groups 1 & 2
- Children of normal intelligence who have, or who are suspected of
having Developmental Coordination Disorder.
- Children of normal intelligence who have a possible movement
difficulty along with other difficulties, such as attentional problems
or difficulties with reading.
• The Movement Coach :
- The person who takes responsibility for managing the child’s
movement difficulties
- Lobby for resources & help clarify priorities
- Interprets information and pulls it together
- Negotiate with other professionals
- Be in a position to adjust program according to family’s needs
• The Team: Child, Parents, School staff, Therapists, Coaches etc
Assessment:
• Standardized tests (MABC 2 motor test)
• Dynamic assessment (MABC-2: Flexibility of the test &
materials which may be modified adapted or supplemented in
conjunction with the Qualitative Observations)
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Criterion-referenced tests (MABC2 Checklist)
Interviews (With child, adults, use of tool e.g. PEGS)
School Reports (performance in reading/writing etc)
Application of exclusionary criteria (differential
diagnosis, lower IQ etc.)
• Other appropriate assessment
From Assessment to Intervention
planning
• Profile of child’s motor strengths and weaknesses
• Choose target skills that are
- 1) specific
- 2) decided with the child
- 3) manageable within the context
(home, school, other)
• Assign priorities in conjunction with child & team
- Child selected
- Parent selected
- School selected
- Therapist identified
• The Movement Coach plays a crucial role in obtaining consensus
among the team.
• Consider non-motor factors: e.g. behavioural observations etc
Assessing the Environmental
Context
• Primary principle of EI is that practice is little & often
• Family:
- Intervention plan needs to fit comfortably with family life
- Involve the family in providing support
- Consider family routine
- Parent education
• School:
- in-class support (individual, group)
- available personnel
- available specialists: PE teacher. LA teacher
• Clinic
- OT/PT: support to teachers & parents, supply activity suggestions etc
• Community
- Sports Centre, club etc (* Daniel Can Do)
• Plan for positive interaction between child & environment
Collating information for planning program
• Interactive model of Child - Environment -Task
• EI will be more successful if it becomes part of the every
day life of the child & family
• Collecting & collating all the info is a crucial role of the
Movement Coach
• The form called the ‘Assessment Summary & Intervention
Plan’ is included with the MABC 2 test
• Form can be shared with EI team members
• This summary can be used as an ongoing reference for
parents & professionals
Chapter 4. Implementing an EI Program
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Turning plans into action:
Setting the scene
Working in a meaningful context
Learning specific skills through task analysis, task
adaptation and expert scaffolding
• Facilitating the learning process through
instructions, practice and feedback
• Learning specific movement skills is not enoughMotor Learning in a broader context
Setting the scene
• Following collection and collation of data
• Movement Coach appointed
Step 1. Call a meeting of relevant team members: Discuss data from form
and possible target skills etc
Step 2. Obtain firm commitments from those involved: The MC
masterminds the overall plan. May need to deliver service, train
others and/or guide others
Step 3. Discuss scheduling & practice: Little & Often (practice every day
if possible, habit forming, help function in everyday life))
Step 4. Establish lines of communication & set up timetable for action:
Who will play an active role and who will play a supportive role.
May involve many individuals over an extended period of time.
Step 5 Discuss relationship between ‘learning to move’ and ‘moving to
learn’ Increased competence in movement skills may lead to
improvement in other areas , such as self control, co-operation
with others, self esteem, confidence etc
Considerations
• Structure: Children with movement difficulties are often
disorganized and have difficulty taking responsibility, they need clear
structure to provides stability & for learning to take place.
• Group approach: Makes the learning environment more fun and
fosters co-operation and can help develop general support to each other
at an emotional level
• Making learning fun: Movement tasks should be challenging,
exciting, lead to success, increase confidence and heightened self
esteem
Functional
Working in a meaningful context
• Functional tasks, chosen by child & significant
others
• Relate to child’s everyday life
• Tasks should be realistic and relevant
• Activities are fun & enjoyable
• Teach active rather than passive movement
Encourage the setting of short, medium and longterm goals
Learning Specific skills
Strategies
• Task Analysis
• Task adaptation:
• Expert scaffolding:
• These are invaluable strategies, which can be combined
together when necessary to ensure participation & provide
successful learning opportunities
Task Analysis
• Planning: What the child needs to know about the task and
simplify these requirements
• Execution: What the child has to be able to do to perform the task,
break these down to more manageable parts & make it easier.
• Evaluation: What sort of feedback is available and how should it
be presented to the child.
• Task analysis is a means to an end, the aim is to help the
child solve one movement problem. The long-term aim
must be to help the child use that skill flexibly in as many
situations as possible.
• Ensure that the component parts can be built up again into
the desired whole
Mini-skills
• The child should receive sufficient practice at each stage to
make that mini -skill automatic & flexible. The child
should perform the tasks in a number of situations within
the following scenarios:
• Child stationary - Environment stable
• Child moving - Environment stationary
• Child stationary - Environment moving
• Child moving - Environment moving
Task Adaptation
• Either change the task the child cannot manage, or
find an alternative.
• May use adaptations while still working on
mastering the skill.
e.g. use velcro while still learning to do buttons or
tie laces
e.g. use softer ball while learning to hit baseball
Expert scaffolding
• Is closely related to the task analysis and adaptation. But
the goal is to help the child achieve that skill that is just
beyond him.
• May involve a person supporting or physically assisting
the child at the start of the task.
• Takes the child from their staring point and provides the
necessary support to participate and learn the task
Facilitating the Learning process
Four phases of learning:
• Understanding the skill
• Acquiring the skill
• Automating the skill
• Generalising the skill
At each phase there are factors to consider:
• Instructions
• Practice
• Feedback
Understanding the skill
The overall aim at this stage is that the child learns what is
required in the task
• Instructions should be short & simple. Pick out the
essential components, present one at a time. Use
demonstration.
• Practice is crucial. The action should be performed several
times in a block of time (blocking) and the task should be
consistent, e.g catching a ball 20/30 times with no
modifications.
• Feedback should be simple & frequent.
Acquiring the skill
Correct movement patterns need to be practiced and
refined
• Instructions have more emphasis on detail and
increase in number & complexity
• Practice can become more randomised & variable
• Feedback: introduce self evaluation & self
regulation
Automating the skill
• Instructions: less general instruction and can be
more precise with periodic reminders
• Practice at this stage will vary from skill to skill
and will involve a mix of constant & variable
• Feedback will be less frequent with more
emphases on self evaluation and self regulation.
Able to process feedback from different sources
(vision, touch, proprioception)
Generalising the skill
Generalisation is more likely when tasks are similar.
• Instructions should be aimed at helping the child
recognise that a particular situation demands a
certain skill. Encourage the child to look at the
best fit.
• Practice should be variable in nature, most of the
time to encourage flexibility. Constant practice
may be required to fine tune motor patterns
• Feedback should be given regarding how the child
has utilised transfer of information
Motor Learning in a broader context
Grouping Children
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Can engineer environment that encourages children to
participate in movement
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Aids social development
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Allows children to learn from each other
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Makes it more fun
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Can happen in many locations
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More cost effective
Grouping Tasks
Three broad categories are outlined in the MABC2. These
areas can be developed and expand and will frequently
overlap
1) Tasks involving Manual Dexterity
2) Tasks involving Aiming & Catching
3) Tasks involving Balance
Non Motor issues
• Children with isolated movement difficulties are
less common that children with multiple problems
• Always consider the whole child when planning a
program
• When forming groups, always consider how the
non-motor difficulties might effect the group
• Movement programs can have a positive effect on
other aspects of child’s development
Monitoring & Evaluation
By individual members of team
• Check with child that, whether he feels he is making
progress
• Check whether the activities are enjoyable and or engaging
the child’s attention.
• The team must keep note of developments in the child’s
non-motor behaviour. May have increased self esteem,
which may help him try out other tasks or encourage more
interaction with peers.
• Through increased participation & skill learning, may have
gained new friends
• Working in pairs & in a group with others can be really
productive
Monitoring & Evaluation
By the Movement Coach
• Required to monitor progress at each phase f the program
and oversees the program as a whole.
• Is the child making progress and is he happy
• Is everything going well with each team member
• Change maybe indicated
• The MC may have to develop & expand on the range of
activities
• May need to realign targets & priorities
• The MC must discuss positive & negative outcomes
• Must closely observe the child in each of the situations that
have been designed to help
Formal Evaluation
• Evaluation can occur at various levels.
• Through the on going process evaluation maybe informal.
• More formal evaluation maybe required on a 6 month or
yearly basis
• Maybe required to provide evidence for the efficacy of
their intervention approach
• Records should be kept on
- Data from standerdised tests
- The child’s view of his progress
- The extent to which the the original targets for the child
have been met form all team members
-Data on other aspects of the child’s development
Chapter 5. Showing the Way through
Examples
• Examples of case studies involving children
with movement difficulties illustrating how
EI can be applied.
• This should help EI users learn how to plan
an appropriate intervention program.
What might a EI Program look like?
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Child identified/assessed
Needs identified
Movement Coach appointed (case manager/coordinator)
Child & team identifies goals
- Tie shoe laces
- Play soccer
- Improve printing
• EI to take place in all environments
Different team members have different
responsibilities
• Team members: Child, parents, teacher, classroom SSA, LA teacher,
soccer coach, Therapist (MC)
• Child included in a FM group at school which will help address shoe
lace tying & other dressing & ADL skills (run by an SSA). Parents to
encourage & reinforce at home. Suggestions given. Overseen by MC
• Child in small printing group (run by LA teacher) Little & Often.
Home work sent home. Parent involvement. Overseen by MC
• Child registered with friend at local rec centre for intro to soccer.
Reinforcement of shoe lace tying can take place. MC to consult/liaise
with soccer trainer & check on progress
• Parent committed to practicing ball kicking skills at home with son
three times weekly (little & often)