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Kate - recognising the problem

The previous blog explored the case of Sophie and, through the lenses of physical activity, motor development, exercise physiology, and pedagogy, we learnt how her daily life may or may not impact on her future. It explored different research traditions and tried to draw out a single message about how to support students like Sophie to develop safely at home, school and in the community.

This week’s blog explores the pedagogical case of Kate, a six year old who is doing well in most areas of school except when it comes to fine and gross motor skills. Looking through the lenses of motor development, and biomechanics we learn that Kate struggles in comparison to typically developing children. By focusing on her self-esteem, avoiding competitive situations, giving her more visual cues and by practicing whole body movements the blog suggests that she can develop her motor skills.

 

Volume 2.3:

Templin, T.J., Rietdyk, S., Claxton, L., & Savage, M. (2014). Kate: Recognizing and addressing developmental coordination disorder. In K.M. Armour (ed.) Pedagogical cases in physical education and youth sport (pp. 35-48). London: Routledge.

 

Kate

Kate is six. She is thriving in all aspects of school except in her PE lessons and at recess but on the whole she is a very successful learner. Up until recently any difficulties she was experiencing were put down as simply being part of the ‘growing up process’ and the real mix of abilities that are associated with young children. However, her teachers have started to notice that while she thrives in many aspects of school she is beginning to slip behind in some areas and is rapidly falling behind in others. 

Kate’s handwriting and sequencing in class reflects some of her difficulties and her teachers have been surprised to see her looking frustrated (an odd expression on her face they feel) during these activities and during PE. Kate’s gross motor activity is noticeably behind her peers and she is experiencing gait and balance issues during different activities. She appears clumsy and out of sorts when playing with other children. Her natural enthusiasm for school has increasingly begun to wane in PE and she is struggling to keep up with her classmates.

Fortunately for Kate, her teachers – her class teacher, PE teacher and the school’s special education teacher – have shared their concerns and they are determined to help. After a meeting with Kate’s parents it was agreed that Kate’s case should be discussed in consultation with three Kinesiology professors. After a joint meeting, and much discussion, a clearer picture starts to build.

Kate was born after a difficult pregnancy, had frequent ear infections as a toddler (for which ear tubes were used) and was a late walker. On top of that she broke her leg when she was three and has had difficulties at home in activities such as climbing the stairs and using her knife and fork at meal times. Furthermore she avoids playing with the local children and with her older sister.

Subsequent to this meeting with Kate’s parents the Kinesiology professors tested Kate using the ‘Movement Assessment Battery for Children’ and the ‘Bruininks-Oseretsky Test of Motor Proficiency’. They found that her balance, auditory memory, sequential and symmetrical movement, and writing activities were significantly below the norm for a child of her age and she was referred to a paediatrician and a physical therapist for further assessment. It was only after this referral that Kate was diagnosed with Developmental Coordination Disorder (DCD). 

 

The Pedagogical Case

Templin and colleagues explored Kate’s case from two perspectives: (1) motor development, and (2) Biomechanics. Following this they discussed how Kate could be supported in school and in PE.  

Research suggests that DCD is one of the most common developmental disorders in childhood. The prevalence of DCD is estimated at between 6 and 13 percent of all school-aged children in the US, with boys more likely to experience it than girls. It has been associated with:

  • Incompetence in motor activity
  • Low motivation and confidence to participate in motor activity
  • Withdrawal or exclusion from participation
  • Low academic performance
  • Low social esteem
  • Low popularity
  • Low levels of physical fitness
  • Increased long-term health risk factors

Children with DCD have difficulties with fine and gross motor skills and while they might otherwise be very successful in other classroom learning activities they are challenged in movement activities. However, while DCD usually presents at an early age the difference between a ‘typically developing’ (TD) child and a child with DCD may be closer by adolescence (but it may not). Diagnosis is commonly (as shown in the case study above) two-fold. Teachers or carers often raise the first concerns before the eventual diagnosis is made through formal assessment. Therefore, it is important that teachers and carers are aware that DCD exists and may impact on their students learning.

From a motor development perspective controlling our body “is an inherently complex and difficult process that extends well into the second decade of life”. When TD children move they often appear “fluid, coordinated and relatively efficient” which suggests that they have postural control, can coordinate their body parts, and are developing both muscular strength and neural maturity. TD children are also able to undertake more task-appropriate movements i.e. a soft kick when close to someone and a harder kick when further away. In contrast Kate would have difficulties with many of these movement tasks. 

In typical lab experiments (using equipment such as force plates, a motor capture system, and electromyography [EMG]) Kate would appear less able when completing more complex movement patterns. Standing on two feet would be relatively in keeping with a TD child however if she was asked to close her eyes or stand on foam rather than a solid floor she would find it more difficult. Additionally if Kate was asked to perform a simultaneous task then it would be expected that she would “have even more difficulty maintaining balance when given a concurrent cognitive task such as naming simple objects.” Put simply she would make more mistakes than a TD child in both her physical and cognitive performance. Motor capture would show that her ability to catch a ball, for example, would be limited by a smaller range of motion and flexibility in her arm segments which in turn would make her appear more rigid in her movement.

If we take a biomechanical perspective then we come to understand the complexity of a task such as walking. The body is a top-heavy system with two-thirds of our weight being located in the head, arms and trunk. Therefore, when walking we must both push away from the ground with one foot and control our forwarded momentum with the other. All the while the top-heavy body is shifting our centre of mass around. To maintain balance this centre must remain within the outermost edges of our feet. Consequently, even though walking might look smooth our “gait is mechanically unstable” even on the smoothest of surfaces. When uneven paths, ramps, obstacles and more advanced movement patterns are included then our instability is increased.

Children with DCD adopt “safer walking strategies”. This means that they can demonstrate “a forward trunk inclination, less hip flexion, and greater knee flexion during stance.” When walking, especially in the dark, the support phase is often lengthened and stride length and gait speed are markedly reduced. These difficulties are further increased when concurrent tasks are introduced (for example naming objects or carrying a tray of marbles). To help children with DCD (from a biomechanical perspective) the PE teacher should either work with a qualified clinician and/or help the child develop through challenging locomotor tasks such as “walking on tumbling mats, walking through sand, traversing slopes, stepping over obstacles, walking under structures, walking in the dark, counting while walking, carrying a tray with marbles, etc.”

Combining the motor development and biomechanical perspectives building Kate’s self-esteem will be very important. She needs support from her teacher, the special education teacher and her peers. It also means that direct competition with peers or repeated failures at a given movement task should be avoided. One way that the PE teacher can help Kate is by providing her with more verbal cues and more demonstrations and, perhaps, even physically assisting her when trying a skill. This will help with sensory-integration as will engaging the full body through movements such as running, hopping and jumping. By using different “equipment, activities, and spaces” the PE teacher can help Kate to develop her movement patterns.

In summarising the findings, Templin and colleagues suggest that the teacher can adopt a number of strategies:

  • Prepare an Individual Education Plan
  • Ensure the student gets plenty of practice going from simple to more complex activity phases
  • Engage the student and others (parents, special educator etc.) in goal setting.
  • Don’t focus on motor development alone but work on developing self-esteem
  • Involve children in activities of their choice
  • Modify activities that require fast movements and responses
  • Avoid activities that involve competition with peers
  • Provide feedback and praise your students often!
  • Use safety equipment such as helmets in ball games
  • Let students be leaders in areas where they are competent
  • Give students a visual model of a new skill and increase his/her opportunities to repeat skills and receive constructive feedback.

The messages that emerge from this pedagogical case are not dissimilar to the messages that have emerged from the body of research discussed in the previous 96 blogs. Students such as Kate are individuals and as such we need to find ways of interesting and including them. PE is often accused of being somewhat inflexible when it comes to its practices and favours certain ways of learning and performing. Kate is an example of a student who needs something different and, as this book will demonstrate, she is not alone. That said there are simple ways of helping her to succeed in PE. If some of these approaches were applied to more lessons then perhaps more students would gain real success in PE.

What’s next? As part of this blogs I propose the following as a way of considering the implications of this research on your teaching- Think, Act, Change (or TAC for short).

Think about findings of the paper – do they resonate with you? Use the comment box below to ask a question, seek clarification, may be challenge the findings.

Act on what you’ve read. What do you believe? Is it your responsibility to make changes or is this just something else that I’ve put on your plate? Is there action to take? If so, what might it be?

Change what you do in response to your thoughts and actions? Is this a personal undertaking? If you want to do something or are looking for help then please let the community know about it.

I wouldn’t expect every paper to get beyond the T or even the A of TAC but if one paper resonates enough to get to C then hopefully all this is worthwhile. Good luck.

 

Acknowledgements: I would like to thank Vicky Goodyear for her work behind the scene as copy editor. Her help certainly forms a vital part of the production of this blog, and in getting out on time and in a semblance of coherence. However it is important to note that any mistakes that remain are mine.

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