Potential Effects of Lower Brain Development on Academic Performance

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The academic setting is demanding in many ways.  A child's performance expectations are high and they seem to be continually rising each year.  School curriculum is written with the expectation that each child's brain is fully developed.  However, this is not always the case.  At times,the demands may outweigh a child's developmental capabilities, causing them to struggle within the classroom. 

There are so many areas of our brain functioning at once during any given moment.  Ultimately, the goal is to be able to achieve higher functioning tasks while also completing more automatic tasks (example: standing still without falling over while talking to someone).  In an underdeveloped brain, multi-tasking may be very difficult.  If the brain was already busy working hard at another job, then it has to "drop what it was doing" to come help out with the new challenge.  

Imagine if you were trying to load the dishwasher and your child bumped his elbow.  He is crying and requires your full attention to put a bandaid on his wound, give him a hug, and comfort him.  Meanwhile, the dishwasher has not loaded itself and all of the dirty dishes remain where you left them.  An underdeveloped brain can resemble this scenario.  A child who is focusing really hard on sitting still in her desk and then gets called on in class, now has to divert her attention to answering the question and she may slouch or lean over in her chair.  This change in posture may lead the teacher to believe that the student is "lazy" or "disinterested" when really it is just her brain's way of compensating. 

I have been completing an online course as part of my professional rotation which looks at some of the possible physical explanations for why it may be difficulty for some children to pay attention in the classroom.  Attributes of decreased attention may include retained primitive reflexes, incomplete pons and midbrain development (lower centers of the brain), or poor sensory processing.  Some children may have underdevelopment in multiple areas of the brain, making it difficulty for them to respond appropriately when you ask them to "pay attention".  Tasks that require bilateral coordination, fine motor control, visual motor integration, visual perception, visual tracking, eye teaming, proprioception, and vestibular processing may be difficult if the lower brain is not fully developed.  Within an academic setting, deficits in these areas can impact handwriting, pencil grasp, reading, attention, gross motor skills, and much more.  

This video from Brain Highways provides teachers with student feedback regarding individual brain processing: https://www.youtube.com/watch?v=lTMLzXzgB_s

For more information related to the Brain Highways online program, please visit www.brainhighways.com. 

Stay tuned to this blog for more specific information regarding the Brain Highways screener and what detected deficits may tell us about areas of academic difficulty. 

Very Brief Examples of Sign Language (Videos and Pictures) :-)

I have included videos and picture of some of the most frequently used signs from the school based setting below!  Please enjoy :-) 

 

Even within American Sign Language (ASL), there are sometimes multiple sign for the same language.  Similar to the spoken English language, one word may also have multiple meanings.  There may be different sign for the same word, depending on the meaning.  Using facial expression and body posture is also very important when signing.  In a way, these elements act as the user's "tone of voice" so that the other person better understands the sentiment or mood behind the message. When working with children, it is important to note that some may use alternate signs because they do not have the fine motor skills or isolated finger movements necessary to perform some hand shapes.  Children can understand and use sign language before they are even one year old, well before they are expected to have developed isolated finger movements. Therefore, the signs that a child uses may be slightly altered from the original gesture. I have attached the following videos to demonstrate:
 

Check out these videos:

• https://www.youtube.com/watch?v=Fha8ZsdxupI (Boy reads to his little brother using sign).
• https://www.youtube.com/watch?v=_-f1My_8OFE (Children signing animals).
• https://www.youtube.com/watch?v=FDGqqVecHGo (Adult signing animals at the zoo).
• https://www.youtube.com/watch?v=w48yGQ2B6fk (Children signing colors). 
• https://www.youtube.com/watch?v=GfpaHQD9WYc (Adults signing emotions). 
• https://www.youtube.com/watch?v=9M1ky9_nm4Y(Adults & Children signing the Alphabet).

Here are just a few very basic signs that one might see used frequently when working with children: 

           
          
                                                                                       

Sign Language in the School Setting

As part of my professional rotation, I am receiving one-on-one sign language instruction from a private tutor.  I am so blessed to be learning from such a knowledgeable individual!  I have chosen to begin learning about terms that are commonly used among children as I can immediately apply this information during my current rotation.  I will then address some terms and phrases more commonly used among adults. I am really looking forward to this brief yet broad introduction to sign language, as this has always been an interest of mine.  I have met so many wonderful people who I may have been able to communicate with more effectively if I had known sign language.  What a great opportunity this is!

My instructor advised me to purchase the book referenced below, as she has used it when teaching sign languages courses previously and has always found it to be user friendly, especially for beginners. 

Humphries, T., Padden, C., & O'Rourke, T. (1994).  A basic course in American sign language.  T.J. Publishers, Inc. (Second Edition).

Sign language can help to facilitate both expressive and receptive language for students within the school based setting.  For those who have difficulty producing the vocabulary needed to interact with peers, learning an alternate way of communicating can be a real game changer.  Many children demonstrate a decrease in behaviors and appear less frustrated when they have a reliable means of communication.  For some, sign language not only allows them to more readily communicate their basic wants and needs, but also decreases social isolation and encourages interactive play.  Within the academic setting, staff members always want to ensure that the child's cognitive capacity is being accurately represented and that no physical limitation is prohibiting the student from communicating effectively.  Sign language can be a great resource for some students who may otherwise have difficulty communicating all of their unique desires, thoughts, and ideas!

Below is a list of some commonly used signs within the school setting, all of which I have had a chance to learn and review with my sign language instructor.

• animals (zebra, horse, cow, bird, duck, chicken, sheep, pig, turkey, bear, elephant, giraffe, tiger, lion, rabbit, owl, mouse, Mickey Mouse, caterpillar, bug, spider, nothing, monkey, fish). 
• colors (brown, black, grey, orange, pink, red, blue, green, yellow, white purple).
• numbers (1-20)
• emotions (angry, happy, sad, surprised, tired, bored). 
• interesting 
• smart, clever
• more 
• no 
• yes 
• stop 
• please 
• thank you 
• want 
• don't want 
• schedule, list 
• snack, eat 
• hungry 
• thirsty 
• bathroom, toilet 
• walk 
• swing 
• run 
• jump
• work
• play 
• look 
• read 
• book
• sit 
• toy
• first 
• then 
• school 
• home 
• pay attention, focus 
• listen 
• clean up 
• draw 
• study 
• test 
• know 
• don't know 
• understand

Look for a future post with instructional pictures related to some of the signs listed above! :-)

Sample Goals for School Based OT

Below are some potential goals for a student in the school base setting.  For the purposes of this example, we will refer to the student as Jeanette.  As shown here, sometimes the occupational therapist may choose to create a general overarching goal related to academic achievement and then list more measurable objectives within that goal. 

Jeanette will improve the accuracy and legibility of her handwriting to help facilitate success with academic tasks.

1. Jeanette will copy the uppercase alphabet with an average of 80% accuracy for letter formation on targeted trials.
2. Jeanette will copy the lowercase alphabet with an average of 80% accuracy for letter formation on targeted trials. 
3. Jeanette will be able to write her name independently, using case specific letters, with accurate letter formation in 80% of documented trials.  

Jeanette will improve her motor coordination skills to increase functional independence within her educational environment. 

1. Jeanette will independently manipulate snaps on her own body in 80% of targeted trials. 
2. Jeanette will be able to independently manipulate buttons on her own body, without requiring verbal cues for alignment or error correction in 80% of targeted trials. 
3. Jeanette will complete the first step of shoe tying by independently crossing laces and tying a knot in 5/5 trials; advancing to being able to tie her shoes. 

Jeanette will improve her fine motor capabilities in order to increase independence and promote success across academic settings.

1. Jeanette will use a functional tripod/quadrapod grasp on her writing utensil during 80% of targeted writing attempts.
2. Jeanette will use isolated finger movements to complete fine motor activities, requiring no more than two verbal prompts for finger isolation in 80% of targeted trials.  

Personally, I have been very impressed with the interprofessionalism and teach based approach that is consistently implemented in the school based setting.  Rather than making recommendations based solely on data gathered during an OT evaluation, the therapist must rely on reports and data gathered across academic settings.  This helps the therapist to gain a more accurate picture of how that child is performing throughout his/her day.  The team generally consists of the child's parent(s)/guardian(s), administration such a the principle or vice principle, a special education coordinator, psychologist, social worker, speech therapist, physical therapist, and occupational therapist.  Only those services which are needed in order to support the child's educational experience will be represented on the team.  For example, if a child does not have any gross motor delays and is able to functionally access all areas of the school, he/she may not require physical therapy services.  Additionally, parents/guardians may invite outside representatives such as a behavioral analyst or an early intervention therapist to the individualized education plan (IEP).  All team members must agree on all goals and objectives during the IEP meetings.

Commonly Used OT School Based Assessments

Based on my observations and experiences within a school setting, it is common for an occupational therapist to use both informal and formal assessment tools when evaluating a student. I will report upon the assessments which I have seen most commonly used within the school district I am in.  It should be noted that other school districts or therapists may prefer different assessments. There are no right or wrong answers as long as the therapist is able to obtain the information needed :-)

Informal assessments may include a classroom observation, assessment of strength through a variety of different motor activities, and evaluation of any or all of the following: grasp, ability to complete a fine motor task, visual tracking, sitting posture, ability to attend to a task, and so much more.

Formal assessment measures may include standardized or non-standardized tests:

Standardized:

• The Beery-Buktenica Developmental Test of Visual-Motor Integration which includes the following subtests: 
• Visual Motor Integration (assesses one's ability to copy shapes that gradually increase in complexity)
• Visual Perception (assesses one's ability to match a picture to the stimulus within a field of distractors).
• Motor Coordination  (assesses one's ability to draw a line that follows a path while staying within the designated area).
• Peabody Developmental Motor Scales (assesses developmental milestones, targeting specific subtests related to occupational therapy including object manipulation, grasping, and visual-motor integration). 

Non-standardized:

• The Motor-Free Visual Perceptual Test 
• The Brain Highways screener (assesses lower brain development especially of the pons and midbrain, proprioception, vestibular abilities, visual tracking, and eye teaming). 
• The Handwriting Without Tears Print Tool (assesses elements of handwriting such as orientation, line placement, sizing, spacing, and letter formation). 
• Handwriting samples from class (assess the elements of handwriting listed above).