Movement Issues that can Impede Access to Learning and Communication Aids

 Many people who have difficulties with communication and/or learning often also have movement difficulties and/or sensory problems. The following list of neuro motor issues have been identified as some of the key issues that arise. Beside each one we have suggested some ways in which we can support a person to lessen the negative effects of the movement issue.




How the Neuro Motor issue manifests itself.

 What facilitation and other strategies might help.

Initiation. Difficulty getting started with a movement.

I,2,3, go! Light nudge or tap. Make a sound, verbal prompt to associate/spark movement.

Impulsivity. Points before they have had time to consider a response, often without good aim.

Hold back until they have looked.

Slow them down and talk quietly.

Backward resistance on hand/arm. Amount of backward resistance will depend on other factors. For example, you can’t apply a lot of backward pressure with someone who had dystonia or contractures.

Develop Rhythm.

Perseveration. Repeating the last movement or a habitual movement.

Pattern needs breaking. Bring back to the same spot between selections. Use backward resistance. Amount of backward resistance will depend on other factors. For example, you can’t apply a lot of backward pressure with someone who had dystonia or contractures.

Provide short distraction then return to task.

Proprioception. Sense of self in space.

Give physical contact. Tight fitting clothes, things to hold, weights may help. Give pressure when holding. Amount of pressure needed will depend on other factors. For example, you can’t apply a lot of pressure with someone who had dystonia or contractures.

Sequencing. Making movements in a set order.

Check for vision issues. Check for tracking ability. Provide more resistance at the start of the sequence. Coactively model if necessary.

Switching. Moving between one thing and another such as a monitor and key board.

Make sure that the keyboard is angled so that it is in a similar plane to the monitor. On screen keyboards may help. Provide backward resistance until person has switched attention.

Akathisia. Need for constant motion.

May need to move in order to learn. Agree what will work so that they can manage the task in hand. Give regular “movement” breaks. Slowing the movement down. Use fiddle toys if appropriate.

Dysmetria. Forceful movements causing over or undershooting of target.

Can affect eyes or the arm or other parts of the body. Steadying the person and creating a rhythm can help. Slowing everything down and backward resistance.

Ulna/Radial Instability. Muscles of wrist and forearm or finger pull unequally.

Hold hand in correct position. Splints may but don’t overdo. For finger instability you may need to reposition the board. Gently pulling back on the skin at the base of the index finger can help. If ulnar radial imbalance is severe and has resulted in contracture advice should be sought from the physiotherapist on how much physical support it is safe to apply.

Low Tone. Floppy muscles.

Exercises to raise tone. May need to provide support from under the arm when really low tone or if aid too high. Picking the sleeve up or using a wrist band to hold them above the selection set may help. Putting selection set lower (sometimes as low as knee level).

High Tone. Tight muscles

Exercises to lower tone. Sometimes a shake of the arm can achieve some loosening. Gentle massage. Be careful not to overdo any support as it can have the reverse affect of making the arm even tighter than before. If high muscle tone has resulted in contractures advice should be sought from their physiotherapist about how much physical support it is safe to apply.

Fluctuating Tone. Sometimes floppy and sometimes tight.

Apply supports as suggested for high and low tone individually tailored according to the persons tone in the moment.

Contracture. Muscles pulling bones out of shape.

Great care must be exercised when giving physical supporting. Contractures are permanent issues which you cannot counter with physical support. You need to work with them. Good seating and positioning of the aid and supportive bracing can help. Seek advice from their physiotherapist.

Involuntary movement. Unwanted movements. The more the person tries to target the more random the movement becomes.

A feature of Athetoid cerebral palsy and some other disabilities. Fixing is very important. Some people can fix themselves by putting an elbow of forearm on the table or an arm rest. May help to hold at the elbow so that your hand becomes the arm rest and so that the person initiates movement from the elbow instead of their shoulders or whole body.

Atonic Neck Reflex. Retained reflex where the head jerks when the person tries to pointing making looking and pointing at the same time virtually impossible.

May not be able to look and point. Encourage looking just before point and as it is initiated.

Dystonia. Painful spasms which cause writhing movements that the person cannot control.

No physical support that can stop this. Do not facilitate when someone is in spasm. Keep the atmosphere calm, keep your voice calm and soothing and wait for the spasm to pass before you continue the task.

Tremor. Shakes when starting a movement or all of the time.

A firm hold can reduce tremor. Fixing can also help.

Fatigue. Tiredness setting in after a few selections.

Stop for a few second at the point of fatigue. Do not fall into the trap of repeatedly going back to the earlier, easier tasks because someone starts to error after a few selections. Check for fatigue first by carrying on where you left off.

Hand/eye coordination. Looking and pointing at the same time.

Hold the person back until they have looked at the target. Develop a good rhythm. Make sure that ATNR is not the issue in which case you will need to follow the advice for ATNR which is different.

Index finger Isolation. Being able to use the index finger to point.

It is very rarely advisable to hold your finger under the person’s finger to achieve isolation. Gently pulling back the skin at the base of the finger might help. Use exercises such as putting the finger into play dough and fine motor games. A finger splint might help as long as it isn’t used at all times.

Proximal or trunk instability. Slouching.

Use good supporting seating. Verbal prompts to sit straight can help. Sometime it might be necessary to physically correct position. However, if contractures have resulted seek advice from the person’s physiotherapist first.

Unstable seating position. Unsteady on the chair.

Use good supporting seating. Verbal prompts to sit straight can help. Sometime it might be necessary to physically correct position. However, if contractures have resulted seek advice from the person’s physiotherapist first.

Hemi-neglect. Inattention to one side of the body.

This can also affect the eyes so that they may see one half of the selection. Providing the person with support on the unaffected side might help. Also, presenting selections with 180% rotation so sees both sides can help.

Visual impairment. Could be cortical (to do with the brain) or short sightedness or long sightedness or problems with depth of field or range.

Cortical visual impairment is where the message from the brain to the eyes is not working properly. Visual stimulation using contrasting colours and lights can improve sight in some cases. High contrasts in the selection set are important. Larger than usual targets may help.

Visual disinhibition. Unable to ignore visual stimuli in the corner of the eye.

Can appear as distractibility but the person is in fact unable to stop a movement in the corner of their eye from. Verbal reminders. Close the curtains and keep things around the person still if needed.

Auditory disinhibition. Unable to ignore sounds even when they appear quiet to others.

Similar effect to visual disinhibition. Can’t block out all sounds – for example aeroplanes can be a problem. Quieter environment helps.

Tactile sensitivity. Over reacts to light touch. Often finds deep pressure easier.

Give good firm hold. It is often the surface nerves of the skin that are sensitive rather than the deeper ones. Also, let them lead so that the physical contact is expected. For example put your hand out for them to take the initiative. This is a good strategy for working towards independence as well.

Crossing the mid-line. Finds it difficult to point to items across from their dominant side.

Put things to the right (or left if the person is left handed) of centre. Give backward resistance while the person organises themselves. Give more backward pressure when crossing than when on preferred side. If the person also had contractures seek advice from the physiotherapist on the amount of pressure is appropriate.

Stopping. Difficulty stopping a movement. For example, continuing to write a C until it becomes an O.

Initially hold back to model stopping. Give verbal support.