Motor skills therapist

PsicomotristaPsicomotristaMotor skills therapist

Motor skills therapist:

Núria Bruscà
Motor skill Specialist
Gabinet d’especialitats mèdiques associades

Motor Skill therapy is a very valid therapeutic discipline to help fragile X children find their own balance and confidence. Motor development provides the children with a solid base for emotional, the cognitive (including language) and unconscionus development.

Motor Skill therapy focuses on the relation between the body and all the aspects of the being. It works with the body because as our “container”, the matter with which we relate to the outside through our senses. It deals with a body that moves and expresses itself to relate to itself and to the outside, and with the windows of this body that open to the outside, the senses.

In all cases, children find themselves in a new body that they cannot control because all their neurological structures aren’t yet matured, or are only partially mature. Experience is the only tool available to them to develop susceptible areas as it has been shown that it is the experience or the action which prompts development of neurological connections, not vice versa.

As children acquire experiences, sensory-psycho-motor experiences in this case, they will be able to relate gradually to their environment. Children have no other means to do so but their own body and expressions, and that’s why it is essential to respond to all kind of stimuli and variables, in order to create an adaptive behavior.

As we see, it is necessary for all children to proceed through their own ontological development, to experience all the psychomotor development stages: …to slither, to crawl, to stand. The experimentation of all these stages enables children to mature neurologically as strengthens binocular vision, and locomotive systems by communicating both brain hemispheres through the callous body. Once the child has grown, he will have to experiment with more complex motor patterns, related to growth and his own routine life.

By definition the child with FXS has a delay in motor skill development: it causes behavioral autism at a very early age (often due to motor and sensory defenses) from which it is necessary to rescue them as soon as possible so that they do not slip permanently in this unfortunate and low interactive stage. This is where I would like to point out the importance of intervention in time, and of early stimulation in children with FXS.

There is a defined period of time in which each structure is still quite plastic and can be matured in order to reach its full potential. In this sense time is against us. We should take advantage of the golden age of each maturing structure.

Children with FXS need to have their senses tested. If we do not know how this window to the outside responds we cannot know how the child perceives the environment, which are their specific difficulties when they see-look-are watched,  hear-hear themselves – are heard, smell, touch-are touched. It is therefore necessary to implement a wide sense-perceptual stimulation.

Motor Skill therapy with a FXS child is very similar to what you would do with a child without this problem. Any child can develop at any time a delay. I do not care if a child’s development is slow, it is observed and respected (should study the causes and when they begin to encounter difficulties,restore it), what worries me is that for reasons beyond the child, plasticity in these gold stages will go unnoticed because we have not heard him enough. I understand the early stimulation only in those cases where the child does not have enough with his own resources, or when the environment has a lack of stimuli and therefore can not interact (we mean any change in stimulus in the internal or external environment of an organism that causes a change in activity).

My approach and the basis of my work is the tonic dialogue and the emotional connection. We are dealing with the emotions of children who live them with their nerves on edge. They are very perceptive of the moods. I take this skill and sensitivity to connect with them and let myself enter their world. So I must work to understand the emotional and the unconscious. It is also necessary to know when the child is involved in a right challenge (that stimulates the child’s internal drive, and that leads him a little above his current capacity).

The basis of our work is the psychomotor content: spontaneous motor activity, muscle tone, basic postures, balance, general dynamic coordination , special dynamic coordination, lateral dominance, breathing, relaxation, motor control, rhythm and temporal orientation, motor creativity, spatial guidance, scheme and body image. All this, within a game or recreational activity creates the space where the expression of the child takes place above all.

Acording to he psychomotor approach, children with FXS   usually have these problems:

1. Sensory defence and widespread disorganized processing of sensory stimulus. SENSORY

2. Poor self-control. SELF-CONTROL, WARNING

3. Developing poor posture. POSITION

4. Difficulties in practice. PRAXIS

5. Fine motor skills, visual perception and visually impairement. VISUAL

6. Obstacles related to their psychological condition. PSYCHOLOGICAL


Sensory rejection (the child protection against stimuli wich he does not control): auditory, olfactory, tactile and visual. It is the priority of treatment, because this determines the enjoyment of life.

The reason for the refusal is an extraordinary sensory sensitivity to the intention and the affection, therefore the trust with the therapist is a therapy in itself. As it stands Wilbarger, we work:

• Deep pressure touch

• Proprioception

• Intense work or co-contraction

• Movement

• Oral and breathing activities  

• Sensory-motor activities

All the above with changes in the environment, interaction and leisure activities.


Motor rejection (which prevents the child to act as it is a difficulty):

• Gravitational insecurity

• Postural insecurity (due to low muscle tone and hyperlaxed joints it provides a use of rigid fixation motor protocols to maintain postural stability)

• Fear of the unusual, new or difficult movements.

• Difficulty to isolate body parts for specific functions

• Hypotonia, lax ligaments and soft connective tissues

These difficulties are restrictive of fine motor skills, oral motor skills, large motor skills and respiratory postural habits (difficulty in speech and self-control).

The work posture improves muscle tone, breathing more deeply (which in turn reduces anxiety) and abdominal control.

Specifically addressed in therapy:

• Deep safety exercices (falls…), acceptance of risk, adaptation of the height

• Setting new postural habits

• Experimentation with new patterns of movement and positive referral of the non recommended motor patterns

• Specific coordination of different segments. Segmental discrimination.

• Work based on the tonic dialogue, to gradually change the child’s tonic response


Children with the FXS are characterized by:

• Difficulties in coordination (problems of conception and initiation of the practice which is sometimes disguised with the imitation)

• Good imitation ability

• Short decision-making for action capacity

• Little sense of rhythm (difficulty in organizing time)

• Slow and disorganized sequencing

• Inability to collect specific information about the different senses

The treatment would be directed to:

• Coordinative activities providing long process through movement

• Taking advantage of imitative abilities

• Providing self-monitoring, placing the child in a position to decide and help you solve problems

• Sequencing activities and activites of rhythm through play, music, habits, …

• Sensory therapy, improve somatosensory functioning

Actions in the fine motor skill area (difficult due to the laxity of the joints and the hypermotility of hands)

1. Adaptation of tools

2. Increasing sensory awareness, discriminative skills and work specifically manual skills (stability of the wrist…)


Spatial difficulties due to an altered visual guidance: difficulties in visual space perception, the spatial perception of body and in the analysis of visual information.

These difficulties are also worked on the body because it improves the somatosensory and vestibular systems which affect vision. We work to develop two-dimensional and three-dimensional space. The buildings and the computer can be valid tools.


Some problems are:

• Poor social skills

• Emotional lability

• Little decision-making capacity

Through the game, tales, positive conditioning, should be worked at all times to promote greater acceptance of risk, frustration, satisfaction, success, and happiness.


The objective is to achieve the modulation of cycles of self-control and lucidity.

The work consists on the intense experience of the present moment to gradually increase the time needed to complete an ongoing task. In turn, the improvement of this aspect is closely related to the work of all aspects mentioned above.

The ultimate goal is to help balance the person so it can enjoy life. This means: express, choose, make decisions, be independent at work, home, school and with others.

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