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August 4 2012 7 04 /08 /August /2012 16:18


What is it?

Spatial awareness is the ability to be aware of oneself in space. It is an organised knowledge of objects in relation to oneself in that given space. Spatial awareness also involves understanding the relationship of these objects when there is a change of position. It can therefore be said that the awareness of spatial relationships is the ability to see and understand two or more objects in relation to each other and to oneself. This is a complex cognitive skill that children need to develop at an early age. Spatial awareness does come naturally to most children but some children have difficulties with this skill and there are things that can be done to help improve spatial awareness.


When a child is developing their spatial awareness they begin to become aware of their placement in relation to the things around them. They are central to this, and they need to understand their location as well as concepts like distance, speed and placement (over, under, behind etc.). Spatial awareness is part of our overall perception. The development of perception can be difficult for children with developmental co-ordination disorder (DCD), autism, cerebral palsy and many other conditions. As perception is the organisation and interpretation of sensory stimuli from our environment, the child would need to have adequate body awareness to be able to form the relationship of their body with the the stimuli and objects within that space. This is key to developing spatial awareness. Proprioception is the awareness of where our limbs are in space. This is developed alongside spatial awareness. For example, when a baby reaches for a toy it learns how far it needs to stretch the muscles in it's arms (proprioception) in order to reach the distance of the toy (spatial awareness). The next time the baby reaches for that toy it would have learnt something about the amount of muscle stretch needed and the distance of the toy. This can then be applied to a similar object at a similar distance another time. The child will eventually become familiar with where its limbs are without having to look at them. Distances, speed and placement will be integrated so that the child will know what they can reach and can't reach when they stretch their arm.


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   Signs and Symptoms

As spatial awareness develops the child will learn the concepts of direction, distance and location. They will understand that when they walk to an object the object will become closer to their body. they will know that objects that are far away appear smaller because of the distance. They begin to appreciate the space around themselves and the proximity of others around them. As they grow older their movements become more controlled and constrained around others as they are more aware of their personal space.


Children with poor spatial awareness tend to have visual perceptual difficulties as well. They may appear clumsy and may bump into others. They often stand too close or too far away from the people or objects that they are interacting with. In the classroom they may have difficulty with presentation of written work and may find it hard to structure and organise such work. These children often find it hard to tell their left from right and they confuse positional language i.e. over, under, in or out, left or right. This makes it hard for them to follow directions that use such language. They may have difficulty with PE, team games and games that use apparatus.


In the classroom the child with spatial awareness difficulties often finds mathematics hard. This is due to the abstract concepts of the subject especially where shapes, areas, volume and space is involved. They will have problems reproducing patterns, sequences and shapes. Their strengths, however, are with the more practical and concrete subjects. These children will often find that they excel at using a multisensory way of learning. They tend to have good auditory memory skills and have strength in speaking confidently whilst being able to listen well. They tend to have good verbal comprehension skills and their strength is usually in verbal and non verbal reasoning.


Developing Spatial Awareness

In order to be able to relate ourselves to objects in a given space, we need to have an accurate body schema. This is a sense of where your body is in space and where it is in relation to the whole of you. For example we need to know the exact location of our arms in relation to our trunk. The body schema develops through our muscles and touch receptors (proprioception and tactile senses combined with other senses). This gives us a map or image of the way we perceive ourselves to look and is linked with our body awareness. Asking a child to draw a picture of a person will give a trained therapist a very good indication of the child's body schema and it will provide the therapist with information on the child's spatial awareness. The therapist can also detect spatial awareness difficulties in a child's handwriting. A child with poor spatial awareness may leave out the spaces between words, start the sentence in the middle of the page, have difficulty keeping on the line or write diagonally instead of horizontally. These are visual perception problems that are related to spatial awareness.


An occupational therapist will also be able to identify a child with spatial awareness difficulties when observing their gross motor skills. The difficulties may be seen during team sports such as football where the child needs to judge distance and speed of a ball coming towards them, as well as the distance between themselves and the person they need to kick the ball to. They may also appear clumsy, move into spaces that they are not meant to be in during the game and often bump into team members.


Spatial awareness develops naturally when children have the ability to freely explore their environment. Babies learn about themselves and how they relate to their surroundings naturally. They learn to manipulate objects as they become mobile and learn about distances and sizes when they are able to move towards the objects. There are, however, situations that interfere with or prevent the natural development of spatial awareness. The child may have some developmental difficulty or a disability that results in poor spatial awareness. In other circumstances there may have been a lack of opportunity for the child to freely explore the environment during it's early developmental stages. The child may have been ill at key developmental points or may have missed opportunities for other reasons.



Occupational therapists work closely with parents and schools to provide suitable remedial exercises for a particular child with spatial awareness difficulties. The activities may involve games that work on judging distance and placement such as throwing beanbags into hoops, buckets or over lines (target games). They may use obstacle courses to involve the body and help the child to be aware of where they place their limbs in relation to the obstacles. Music and movement helps with placement, co-ordination and use of space. Games such as bowls or marbles help the child to develop a judgement of space.


At home parents can help to develop spatial awareness in the following manner:

  • By discussing locations of objects i.e. the kettle is in the kitchen on top of the counter to the right of the toaster. 
  • An object may be hidden in the child's bedroom and instructions given to the child of where to find it. 
  • Parents could discuss which objects are closer or further away from the child and compare the relationship of the distance between several objects and the child.
  • They could play the "Robot Game" where the child pretends to be a robot and the parent gives directions such as "turn left" or "stop at the door" or "turn right".
  • Playing games such as "Simon Says" helps with spatial awareness as well as using equipment such as tunnels to crawl through or outdoor climbing frames.
  • Use jigsaw puzzles, tessellation games and arranging 2D and 3D shapes.
  • Model making using pictures as a guide to build the models.


If a parent is concerned about their child's spatial awareness they should seek advice from their child's GP, school or health care professional.



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December 3 2011 7 03 /12 /December /2011 22:09

Dyspraxia.jpg What is it?

A child with dyspraxia can present with a wide spectrum of difficulties. The term is, however, used to describe co-ordination difficulties with evidence of significant perceptual problems in the majority of cases. Caution should be taken when using the term as it may eventually be loosely applied to every child who shows a little forgetfulness, disorganisation and clumsiness in their daily routines. Children develop at different rates and this should always be taken into consideration when looking at individual cases.


The term dyspraxia is taken from the Greek word duspraxia. Duspraxia is formed of dus (or dys) and praxia(or praxis which is taken from an older Greek word prassein).Praxis is to practice an act or a  function, pass through, experience; therefore "to act". Dys means impaired, ill or abnormal, so the literal meaning of dyspraxia is ill-doing or abnormal act.




Developmental dyspraxia is an immaturity of the organisation of movement. The brain does not process information in the way that allows the full transmission of neural messages. A child with dyspraxia will find it hard to plan what to do and how to do it. Dyspraxia is also known as Developmental Co-ordination Disorder (DCD), Perceptual-Motor Dysfunction, and Motor Learning Difficulties. The terms Clumsy Child Syndrome or Minimal Brain Damage are no longer used.     


Children and adults with dyspraxia find it difficult to learn how to plan and co-ordinate their movements. the condition is therefore also known as a "motor learning disability". Someone with dyspraxia will find it hard to carry out smooth and co-ordinated movements because the simultaneous perceptual and motor processes of carrying out an act successfully is a complex task that requires conscious imaging, planning, positioning, balance, muscle activation and co-ordination.


Dyspraxia often comes with language problems and sometimes a degree of difficulty with perception and thought. Dyspraxia does not affect a person's intelligence, but it can cause difficulties with learning, especially for children.



 What Causes Dyspraxia?

For the majority of people with dyspraxia there is no known cause. Current research suggests that it is due to an immaturity of neuron development in the brain. It is not a result of brain damage and people with dyspraxia have no clinical neurological abnormality that would explain the condition.


When considering the brain, the cerebral cortex (the upper most part of the brain) receives impulses from sensory organs through a network of nerve fibres passing from the brain stem. As a child grows and learns, the connections between the nerve cells (neural pathways) become established and reinforced with successful learning. When a child learns a series of movement patterns the repetition of movement reinforces the pattern so that its planning is almost reflex. The use of external sensory input such as sight and sound together with the learned movement patterns will enable the cerebral cortex to judge the best course of action and send out appropriate motor impulses.


The cerebral cortex is divided into a right hemisphere and a left hemisphere. Each side has different functions and operates quite separately. Some functions are shared, but the sides generally work independently to provide its information that is brought together to complete the whole picture e.g. the left hemisphere receives the information in a jumbled, disjointed way and

needs to work well together with the right hemisphere so that the information, images and actions are interpreted correctly for the right results.


In children with dyspraxia, the two hemispheres of the cerebral cortex are not working in harmony to produce the desired results. The basic development of the hemispheres appear reduced, and as they determine whether a person is right or left handed, you will often find that children with dyspraxia will use both hands without developing a dominant hand for some time. This affects fine motor activities even further e.g. handwriting skills. 


The cerebral cortex also surrounds the "thalamus", "hypothalamus" and "pituitary gland of the limbic system. The limbic system is responsible for the instinctive and automatic responses with the body and it is closely linked to emotional behaviour. A mature cerebreal cortex would be able to dampen down the limbic system's emotional response to external stimuli. If the cerebral cortex does not mature as expected, the individual would be excitable, over emotional and extremely sensitive to external sensory input.



  Symptoms of Dyspraxia

 The symptoms of Dyspraxia can be evident from an early age. Babies may be irritable from birth and may exhibit significant feeding problems. They are slow to achieve expected developmental milestones. For example, by the age of 8 months they may still not be able to sit up independently. Many children with dyspraxia fail to go through the crawling stage, preferring to "bottom shuffle" and then walk. Later, they will avoid tasks that require good manual dexterity.


The essential features of dyspraxia are often linked and associated with Developmental Co-ordination Disorder (DCD). The two are often considered the same. This can be confusing and the terminology used may depend on which country you are living in. There are, however, some inherent differences between dyspraxia and DCD. Dyspraxia has been generally considered under the umbrella term of DCD which is outlined below as defined in the DSM-IV. A diagnosis of DCD can be made if the following criteria are met:

  • A marked impairment in the development of motor co-ordination

  • The impaired motor co-ordination significantly interferes with academic achievements or activities of daily living

  • The significant motor co-ordinationdifficulties are not due to general medical conditions such as cerebral palsy, hemiplegia or muscular dystrophy and the criteria are not met for Pervasive Developmental Disorder.

  • If mental retardation is present, the motor difficulties are in excess of those usually associated with it.        

  The difference between DCD and dyspraxia is that: "The term DCD describes a more generalised motor co-ordination difficulty which shows a marked difference between the levels of skills that would be expected for age or level of intelegence and significantly interferes with academic or activities of daily living. This is not caused by another medicalcondition (for example cerebral palsy) and it is not part of a pattern of general learning difficulties. The term dyspraxia describes an immaturity of the development of the organisation and sequencing of movement. It can also affect speech, perception and thought. Not all people with DCD have dyspraxia, but often the words are used interchangeably. Difficulties associated with both DCD and dyspraxia have an impact on living and learning in all areas of a child's life, at home, school and at play."Dyspraxia Foundation.




 Jean Ayres (1965) defined dyspraxia as a disorder of sensory integration interfering with the ability to plan and execute skilled non-habitual tasks. The child with dyspraxia has a praxis/planning problem and does not know how to move, whereas the child with DCD has difficulty with co-ordination and execution. the child with DCD knows what to do, but does not do it very well. There is still some debate over terminology and the term dyspraxia tends to be used more generally in the UK.



The infant school child with dispraxia could display the following symptoms:

  • Late in reaching developmental milestones as a baby e.g. rolling, sitting, standing walking and speaking
  • May not be able to run, hop jump, kick a ball as their peers can
  • Difficulty keeping friends or knowing how to behave in company
  • Has difficulty understanding concepts such as "in", "on", "in front of" etc.
  • Difficulty walking up and down stairs
  • Poor at dressing
  • Falls frequently
  • Poor pencil grip
  • very immature drawings
  • Easily distressed and prone to temper tantrums
  • Often bumps into things
  • Hand flapping
  • Difficulty pedalling a tricycle
  • Lack of sense of danger (jumps from heights etc.)
  • Messy eater (may prefer using hands and frequently spills drinks)
  • Lack of imaginative play
  • May be sensitive to sensory stimuli

The junior and senior school child will probably continue to have the difficulties experienced by the infant school child with little improvement if their needs are not addressed by this stage. It is unlikely that major changes in their ability would occur, but they can make good progress in school with understanding, support and good coping strategies. children with dyspraxia may lose self confidence and motivation as they find school work increasingly difficult. By the time they reach secondary school their attendance record is often poor.


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Helping the Child with Dyspraxia 

Occupational therapists are able to assess children with movement and co-ordination problems to determine the exact nature of the difficulties and how it impacts the child's day to day life. The intervention will focus on how the child manages daily activities at home, school and play and it will work on the assumption that children develop skills as a consequence of the interaction between the child, the environment and the task.


The use of Sensory Integration techniques will focus on the underlying impairment of which the treatment will aim to improve the functional performance.


The main areas of the school curriculum that children with dyspraxia struggle with are in the areas of literature, handwriting, mathematics and PE. Children with dyspraxia have difficulty with concentration and listening skills. They may have literal use of language and this will affect their reading and spelling ability. They may read well, but not understand some of the concepts in language. Some exercises such as those in Take Time by Mary Nash-Wortham and Jean Hunt may provide help in these areas. Computers can provide support and the Wordshark 2 is a programme available from the Dyspraxic Foundation.


Poor handwriting is one of the most common symptoms of dyspraxia. A child with poor handwriting does not need to be told that their writing is bad. They can see that they are not as good as their friends. It is important therefore to concentrate on the positive rather than the negative. Please see my previous posting on Handwriting for ways to support handwriting difficulties.


The following is a list of assessment tools often used by occupational therapists:


Perceived Efficacy and Goal Setting System (PEGS) Developed by MissiunaC, Pollock N, and Law M (2004) Available from The Psychological Corporation/Harcourt Assessment

Assessment of Motor and Process Skills (AMPS) and School Assessment of Motor and Process Skills (School AMPS) For information see www.AMPS-UK.com

Pediatric Evaluation of Disability Inventory (PEDI) – for children up to 7.5 years of age. Developed by Hayley et al(1992) available from The Psychological Corporation/Harcourt Assessments

Movement Assessment Battery for Children (Movement ABC). Developed by Henderson S and SugdenD (1992) available from The Psychological Corporation/Harcourt Assessment

DevelopmentalTest of Visual Motor Integration (VMI) developed by Beery K, Buktenica N, Beery N (5th Edition 2004) Available from Ann Arbour Publishers and nferNELSON

Bruininks-Osteretsky Test of Motor Proficiency developed by Bruininks R, (1978) published by American Guidance Service

Test of Visual Perceptual Skills – non-motor (TVPS) developed by Gardner M (1996) available from Ann Arbour Publishers

Motor-Free VisualPerceptual Test (MVPS) developed by Mercier L, Hebert R, Collarusso R, Hammil D (2002) available from Ann Arbour Publishers

Sensory Profile developed by Dunn W (1999) available from Harcourt Assessment (see also www.sensoryprofile.com)








 On a recent course hosted by the COT (college of Occupational Therapists) it was considered that DCD is the official medical diagnosis of which dyspraxia is a symptom ("Is it DCD or isn't it?" Dido Green and Carolyn Dunford 16th April 2012 - London) - amendment added 24/04/2012.



Useful links:


Includes handouts on cognitive approaches to intervention, fine motor difficulties,



For 40 best online tools for occupational therapists

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