When the body just won’t cooperate…

By Kathy Mulka, BScOT(c), MEd

Sensory processing issues can compromise a person’s ability to function properly. This makes everyday tasks that require “motor (movement) skills and coordination” difficult to carry out (1). A client of mine, “Bobby” (not his real name), was struggling with such issues.

I first started seeing Bobby about his anxiety. His psychologist referred him to me as she recognized that his anxiety appeared to have a sensory component that she thought I could help him with. Initially, the goal was to help Bobby learn to regulate his brain and nervous system through play-based sensory approaches. These approaches would naturally work on helping him to feel calmer and more organized, leading to less anxiety for him overall. Bobby was eager to play some of the games and activities I suggested. After a few OT sessions, his parents, teachers and Bobby himself, started to notice significant changes in his mood and behaviour. The therapy we’d been doing together started to help him feel less anxious and more regulated.

One day, on the drive over to see me, Bobby shared with his mother, that other kids were being mean to him. Not directly, but by the things they weren’t doing. They weren’t playing with him, they weren’t noticing him, they weren’t waiting for him. They were ignoring him and he felt isolated and left out.

This 9-year-old boy; struggles with sensory processing issues and motor planning difficulties. These challenges are neurological conditions known as Sensory Processing Disorder or SPD (2) and Dyspraxia (also known as Developmental Coordination Disorder or DCD) (3). These brain-based problems interfere with a child’s ability to use and understand their senses for function. And when an individual’s neurological development is affected like this young man’s, it can cause neurodevelopmental delays that make it difficult for them to perform coordinated motor movements for physical activities; that most normally developing children find easy to carry out.

How one processes sensory input can affect a person’s ability to manage life tasks

Sensory processing disorder can make it difficult to manage environmental sensory input, and make it difficult to read internal body cues, such as knowing where their body is in space. These limitations can make everyday living a challenge -- challenges that can make it difficult to manage life tasks in a sensory overloading environment where light, noise, movement, touch and other sensory input can create anxiety, frustration and sometimes even panic. If not properly managed, sensory processing issues and motor planning difficulties can continue to worsen over time. Functional problems like getting dressed, or doing school work in a busy classroom, can interfere with the ability to learn, develop and lead a successful life. Sometimes not discovering these early developmental and sensory concerns can continue to impair an individual into their adulthood.

Good sensory processing is the foundation for being able to feel one’s body in space. If this is compromised, then motor planning problems can occur. Motor planning issues include having difficulty coordinating your movements easily and automatically without thinking about them. Examples of motor planning issues can include: poor balance & coordination, clumsiness and difficulty learning and carrying out motor skills such as dressing, catching, jumping, running, and writing (4).

For Bobby, going to hockey practice, putting on his hockey gear, carrying a hockey stick, and then opening a door to keep up with his peers, can feel exasperating on an ongoing basis. It takes his brain more time to process and feel in his body what it needs to do. As a result, he is constantly left behind by others. He feels frustrated because his teammates and coaches don’t understand that it takes him more time to get organized and that it is harder for him to carry out tasks like getting ready for hockey practice. They don’t understand why he takes so long to get dressed and why he seems so upset about putting on gear (he can’t stand the feeling of his uniform but grits his teeth and bares it because he so badly wants to play hockey). His peers and coach don’t have a clue as to why he can’t just get going or that he could really use some help rather than their judgement. This is an invisible kind of disability that can be super impactful on the individual’s self-esteem and confidence. In this particular case, Bobby is regularly not included with his peer group, nor does he know how to explain to others that daily life skills are very difficult for him and that he would like some help.

OT intervention for better sensory processing and motor planning

During this particular OT visit, Bobby’s mom and I took the time to listen carefully to Bobby as he shared what was bothering him. We made a list of what he would like help with and how things could be made easier for him. Once he was able to share his feelings and worries, I asked him to play some games with me. Knowing he was still feeling a bit vulnerable, I focused on an activity I knew he could be successful at and have fun with while building his confidence in his motor planning skills. We started by playing on a rocker board (a specially designed balance board) and throwing magnetic darts at a magnetic target. This particular game works on natural reflexes such as stability, balance and equilibrium, vestibular function and eye-hand coordination. With repeated practice his skill and confidence on this apparatus, continues to improve. When he was ready, I began to increase the challenge by adding different components to our play. I gave him a plastic bat and hung a tether ball that he could swing towards while maintaining his balance without falling off the board. He really enjoyed this game and, without thinking, he began to use better eye-hand coordination and visual perceptual skills while on an unstable surface. He was also developing better righting reactions that are needed to help increase appropriate balance reactions and reduce his clumsiness over time. We then switched to progressively harder boxing targets while he wore some cool boxing gloves. Boxing gives him the challenge of throwing punches left and right and improves vestibular function, bilateral coordination, eye-hand coordination, balance, strength and core skills. It’s also is a good workout and releases natural “feel good” chemicals that helps his “stressed” brain and nervous system to feel more organized, and eventually leads to a calmer nervous system. By the end of 20 minutes of OT games, he was smiling and had forgotten the “upset” that he brought with him to the visit. He eagerly showed his mom what he had learned and exclaimed how much he liked the boxing. His mother noted how calm and happy her son was and smiled at me knowingly.

A child who struggles with motor planning and sensory processing issues deserves attention and understanding from those around him so that he does not have to feel like he cannot carry out the task in front of him. With better knowledge and understanding from family, peers, teachers and coaches, life can be made a little less frustrating. With just a little help from Bobby’s coaches and classmates, he can begin to feel more included and not left behind. What most of us take for granted when participating in physical activities with others, can be an absolute nightmare for a child with sensory processing issues and motor planning difficulties.

Do you know someone with sensory processing issues and motor planning challenges? Here are some tips to make it easier and more manageable for individuals with such a profile:

• Allow the child more time to transition and organize themselves before beginning a task.

• Make yourself available and/or find a peer that can be helpful or just wait with the child who is experiencing difficulties. Teach classmates to be respectful, patient and kind to those who appear slower or more compromised.

• If you see a child struggling, ask if you can lend a hand to make things easier.

• Meet with parents and ask how you can help.

• Educate yourself about sensory issues and motor planning challenges (see more information below).

What is motor planning? Motor planning means to carry out any new or non-habituated task. Difficulties with motor planning include:

• Difficulties with tasks that have several steps. Daily tasks such as getting dressed, self-care routines, getting books and backpacks together, keeping a desk or locker neat and tidy, putting away or handing in tests or papers without assistance and learning new motor skills are some examples of motor planning.

• Difficulties with tasks that use the two sides of the body or all four limbs such as biking, swimming, skating, dancing, jumping jacks, learning to dribble a ball and so forth.

• Coming up with ideas how to begin a physical activity or plan out the sequence of an activity.

Ways to help kids who struggle with motor planning:

• Simplify and break down the task into a maximum of three steps. You can add steps after the first three are mastered.

• Physically model how to carry out the task so the child can watch for themselves and have a ‘picture or movie’ of how the activity is carried out.

• If the child is willing, use hand over hand support to show how to carry out the task.

• Teach the child the steps to the task and then take pictures of them doing each step or draw out each step so the child can refer to it until he has learned the motor plan.

• Reach out and ask a qualified OT who has been trained and specializes in working with children who have sensory and motor planning difficulties.

• Be patient – frustration is normal for someone who struggles with motor planning.

• A child with motor planning challenges can have lower self-esteem because their body doesn’t cooperate and this can be confusing and annoying. They lack the confidence to carry out tasks with ease. This can be embarrassing and hard to explain to others.

1 Impacts of Developmental Coordination Disorder on Postural Control Mechanisms in Children and Early Adolescents. Sirine Guetiti, Geneviève Cadoret, Félix Chénier, and Mariève Blanchet, in Journal of Motor Learning and Development. First Published Online: 30 Apr 2024. In Print: Volume 12: Issue 3. Page Range: 635–665.

2 Sensory Processing Disorders in Children and Adolescents: Taking Stock of Assessment and Novel Therapeutic Tools. Noemi Passarello, Vincenza Tarantino, et al. Brain Sci. 2022 Nov; 12(11): 1478.

3 Harnessing real-life experiences: the development of guidelines to communicate research findings on Developmental Coordination Disorder/dyspraxia. Catherine Purcell, Annie Dahl, et al. Research Involvement and Engagement volume 10, Article number: 84 (2024).

4 Children and young people’s experiences of living with developmental coordination disorder/dyspraxia: A systematic review and meta-ethnography of qualitative research. Áine O’Dea, Mandy Stanley, Susan Coote, and Katie Robinson, PLoS One. 2021 Mar 4;16(3).

Kathy Mulka, BScOT(c), MEd is SIPT (Sensory Integration & Praxis Test) certified and specializes in Occupational and Sensory Integration Therapy at Unlimited Potentials Occupational Therapy for Children & Adults. For more information about sensory integration, motor planning and motor delays go to www.unlimitedpotentials.ca.