Ecological InterventionM-ABC 2

1st April 2008

Christine Lynch O.T. (C)

M-ABCHistorical Perspective

• The evolution of the new M-ABC 2 can be traced back over 40 years to the 60s.

• The Test of Motor Impairment (TOMI) was originally developed by Denis Stott in the 60s, initially in Scotland and subsequently in Canada, as a research instrument to help detect motor dysfunction in school age children.

• A second group of researchers working out of the University of California under Prof Keogh had developed a checklist to help alert teachers to the existence of children with movement difficulties and to help investigate the educational significance of such difficulties.

• Eventually these two groups got together to produce the original M-ABC in 1992.

• Scott & Keogh did pioneering work and were part of the development of the new disciplines known as Human Movement Science, Kinesiology and Human Kinetics.

M-ABC• Sheila Henderson Trained as a Phys Ed Teacher in Scotland. Got

involved in research into clumsiness with Denis Stott. BA in Psychology from Guelph. Received a research fellowship from the National Research Council of Canada, Received an MA from the University of Waterloo for work on cognitive development and a PhD for studies of feedback in the development of highly skilled motor performance.

• David Sugden trained as a Phys Ed teacher in England. Became interested in children with movement difficulties when he was attending the University of California and worked with Prof Keogh, where he graduated with a MS in Phys Ed and a PhD in Special Ed.

• Both authors have published numerous articles and books within their fields of interest

MABC & Intervention

• The addition of an intervention guidelines was considered an unusual feature

• The manual contained a number of chapters related to intervention:Chapter 9. The Cognitive- Motor Approach to InterventionChapter 10. Linking assessment & managementChapter 11. Teaching individual skills – handling the learning processChapter 12. Creating the right atmosphere for successChapter 13. Considering organizational factorsChapter 14. A case study

• Work on the M ABC has taken place on both sides of the Atlantic. Knowledge of legislation as well as education and clinical practice on both continents helped in developing the M ABC with a truly international perspective.

M-ABC

• Chapter 9 of M-ABC Manual, 1992

“The Cognitive-Motor approach to intervention”

Two strong reasons for providing intervention:

• Improving motor competence opens the door to full participation in ADL

• Intervention can help with associated problems such as poor strategies for learning and low self esteem

• Model adopted in the MABC was based on the model of Information Processing, used in the field of cognitive psychology.

The Cognitive –Motor Approach

Based on • 1. The framework of IP: The solution to a movement problem is conceptualized as having 3

components: - Planning a motor act - Execution of the act - Evaluation of the act• 2. The learning Process: - Phase 1. Understanding the skill - Phase 2. Acquiring & refining the skill - Phase 3. Automatizing the skill - Phase 4. Generalizing the skill

The Cognitive-Motor approach to intervention

• Motor difficulties in children rarely occur in isolation.

• A lack of co-ordination is usually accompanied by a lack of confidence, low self esteem, underachievement in school and loneliness.

• The complex interaction that seems to exist between cognitive, affective and motor factors must be addressed if the process of assessment and interventions to be effective.

• The Cognitive-Motor approach to intervention is built upon the idea that cognitive, affective and motor competencies interact in a dynamic way.

• The children’s knowledge and understanding of the learning situation affect their motor competence.

• The amount of control the child is capable of exercising will influence the strategies adopted

• Emotional state interacts with motor competence• The way a child feels and thinks about their motor

competence will affect their willingness to participate in a movement learning situation

M-ABC

• Chapter 13 of M-ABC Manual, 1992

“Considering organizational factors”

• 3 Questions:

-WHO is involved?

- WHERE should the Intervention take place?

- WHEN should the Intervention take place

WHO• Parents

Parental involvement can be of direct benefit to the child.

• Classroom teachersTeachers should be involved to avoid conflicting advice.

Teachers should be kept informed of progress etc

To help give the teacher support in their involvement with the student.

• Other professionals: OT, PT, SLP, Psychologists, music/dance Therapists/Teachers, Phys Ed Teachers, Special Ed Teachers,, classroom assistants

WHERE

• Individually or Group?

• In the classroom/out of the classroom?

• In the school or out of school?

• In a clinical setting or other?

• In the community?

• …and so on

‘In school’ versus ‘out of school’

• Best if intervention can be arranged within the child’s own school.

• Through a ‘whole school’ approach.• More communication can take place within the school.• Program planning can take place within the context of the

school curriculum.• Primary objective is increased access to the curriculum, best

way is to plan a program with constant reference to that curriculum.

• Easier to merge direct and indirect intervention within the school setting.

• Possibly more room for flexible timetabling

Development of EI

• There is an increased awareness of the impact of movement difficulties on children’s lives.

• There has been greater interest and advancements within the research world into motor development, its impairments and their causes and consequences.

• The authors of the original MABC stated that they hoped and intended that future revisions will continue to reflect developments in the educational, medical and psychological understanding of developmental movement difficulties as well as responding to the changing context of educational provisions and the principles that guide these.

Introduction to EI• EI is based on the original ‘Cognitive-Motor Approach’,

• Advances in research on motor control/motor learning and the development and changes in clinical practice have influenced thinking and led to further elaboration rather than radical change.

• The same original concept together with new ideas on how best to help children become confident competent movers

• Definition:

Ecological: ‘The relationship between an organism and their environment’

The Manual5 Chapters

• Chapter 1:Introduction to EI

• Chapter 2: Performing & Learning Motor Skills

• Chapter 3:Collecting information & planning the program• • Chapter 4: Implementing an IE program

• Chapter 5: Showing the way through examples

Chapter 1. Introduction to EI

• EI is a way of thinking• Based on motor development literature• Intervention should be an integral part of daily living• Different individuals play different but equally important

roles. Coordinated by a ‘Movement Coach’• Overriding principle is that success of an intervention

program is a function of the dynamic interaction between:• The Child• The Environment • The Task

The aims of EI The primary aim is to improve movement competence, so that the

child can participate fully in activities of daily living with success and confidence:

• at home• at school• in the community• in recreation and leisure contexts Increased movement competence, increased confidence and

better strategies should result in a happier child and happier family.

Main objective:

Learn to Move and Move to Learn

WHO will benefitFour broadly defined categories:

• Children of normal intelligence who have, or who are suspected of having Developmental Coordination Disorder.

• Children of normal intelligence who have a possible movement difficulty along with other difficulties, such as attentional problems or difficulties with reading.

• Children who were in an ‘at risk’ category either before or soon after birth e.g. premature, low birth weight.

• Children whose movement difficulty is recognised symptom of a medical condition e.g. Tourette’s, Fragile x.

WHERE should intervention take place?• Intervention should happen where ever the child is.• May depend on who is involved and what resources are

available• No single approach has found to be the ‘right’ one Maybe within a small group:• At school• Local sports centre or club• The child should be in a familiar context, surrounded by

peers or others who are normally present in that setting Individual intervention maybe required:• At a clinic or developmental centre

• Intervention is seen as long term• Must be incorporated into the daily routine of the

child at home, at school and in the community• Parents and other family members should be

involved whenever possible• The context in which the child is learning should be

meaningful for the particular.task.• All should work in a similar manner.• The Movement Coach ensures that the right things

are happening in the right place at the right time.

WHO can deliver EI

• No professional restrictions on who can use EI, to help a child with movement difficulties.

• The ideas, strategies and techniques of EI need to be absorbed before they can be put into practice.

• Many individuals will work together to help the child with movement difficulty become more competent, under the guidance of the Movement Coach.

Movement Coach

• Takes responsibility for over seeing and directing the intervention as well as teaching the child directly

• The MC might be an OT or PT, Special Ed teacher, PE teacher, classroom teacher, parent or other

• The MC takes responsibility to train others

WHEN can EI begin

• EI is suited to any child at any time.

• Should begin as soon as the child is recognized as having difficulties.

• With young children, low key intervention is appropriate & effective

• EI principals can also be applied at secondary school level

HOW OFTEN is intervention needed.

• EI is a process that is on going throughout a child’s day

• There may be a formal component e.g. handwriting group, or PE club. These should be ‘little and often’. 20/30 minutes, as often as 3 to 5 times a week.

• At times intervention might be entirely incidental, and for extended periods of time, e.g helping at home, tidying up etc

• The goal being to help the child function in all real-life settings

WHY choose EISix reasons:

1) Consistent with the WHO’s International Classification of Functioning, Disability and Health. Which emphasises that there is no simple relationship between impairment and the ability to function as an active member of society.

2) EI is part of the complete package which includes the M-ABC-2 test and checklist, providing a smooth link between assessment and intervention

3) The approach to teaching movement skills within EI has a solid theoretical base. Two complementary theoretical frameworks of motor performance and learning which together provide a set of principled guidelines for good practice.

WHY choose EIContinued:

4) Consistent with current thinking about intervention for children with difficulties: It is child & family-centered, it takes account of the environment in which the child exists (family, school sports), use multiple inputs from professionals and is not dependent on one highly trained therapist.

5) Strong empirical base ( based on the earlier title of Cognitive-Motor Approach). Which has been developed further as a result of experience and feedback.

6) When well executed, EI is rewarding for children and delivers and helps them become more competent movers who enjoy motor activity.

Chapter 2. Performing & Learning Motor Skills

Theoretical Framework

1. How we perform motor skills• In the original MABC the intervention model was

presented entirely within the framework of the presented Information Processing (IP) Approach.

• Since then new insights into how we might help children with movement difficulties have evolved. Referred to as Dynamic Systems (Ecological) Approach.

• Both of these approaches are complimentary in what they tell of Motor control.

• Both frameworks acknowledge that Affective factors, such as the child’s general level of motivation, attitude to learning and confidence will influence their ability to learn new skills.

• Both approaches address the same questions..how do we plan our actions and how do we execute them?

• Two differences: (1) DS theory is less keen on separable components and view perception and action as inseparable. (2) DS theory places more emphasis on HOW we organise the movement required to complete an action.

Simplified IP model

• Planning an action: Movement planning involves the intake of sensory information through the sensory (& perception) system. It requires the translation of this info into decisions for a plan of action.This is followed by the prep of a response.

• Executing an action: The spatial, force requirement, timing & over all sequencing & organising of the action plan. Strong influence of affective factors.

• Using feedback: The feedback can come from inside (intrinsic) or outside (extrinsic). The info we receive can relate to the outcome of an action /knowledge of results (KR) or about the quality of the movement/ knowledge of performance (KP). The affective variables also need to be considered.

Dynamic System (DS) Approach

• In DS the environment affords or invites action. Links the action to the size of the body and parts.

• Body scaling: the ‘fit’ between the child & the demands of the task. Link between the action and size of the body

• How many Degrees of freedom are controlled in a given action

• The DS approach is based on understanding how we control movements which involves physics, biomechanics,& neuro-chemistry of muscle function

• Features: power of the environment

• The use of body scaled information

• The ‘fit’ between body properties and relevent features of the environment

Theoretical Framework2. The Learning ProcessProgression towards solving a movement problemPhases of Learning:Phase 1 Understanding the skill: involves the child’s cognitions about the demands of the

task. This phase is the ‘knowing’ part of the task and for children with difficulties is often the most challenging part.

Phase 2 Acquiring & refining the skill: involves practice, the recognition and the reduction of errors. It involves processing feedback and relating this to the internal model of action

Phase 3 Automatizing the skill: involves performing the task without (or with minimal) conscious control.Maybe a difficult phase for children with movement difficulties to reach.

Phase 4 Generalizing the skill: occurs when the skill is used in novel and different contexts. For this to occur the skill must be learned, retained and most importantly there must be recognition that a situation demands that particular skill

Chapter 3. Collecting Information & Planning the Program

Children who might benefit from EI• EI is suitable for a wide range of children, particularly Groups 1 & 2 - Children of normal intelligence who have, or who are suspected of having Developmental Coordination Disorder. - Children of normal intelligence who have a possible movement difficulty along with other difficulties, such as attentional problems or difficulties with reading.• The Movement Coach : - The person who takes responsibility for managing the child’s movement difficulties - Lobby for resources & help clarify priorities - Interprets information and pulls it together - Negotiate with other professionals - Be in a position to adjust program according to family’s needs• The Team: Child, Parents, School staff, Therapists, Coaches etc

Assessment:• Standardized tests (MABC 2 motor test)

• Dynamic assessment (MABC-2: Flexibility of the test & materials which may be modified adapted or supplemented in conjunction with the Qualitative Observations)

• Criterion-referenced tests (MABC2 Checklist)

• Interviews (With child, adults, use of tool e.g. PEGS)

• School Reports (performance in reading/writing etc)

• Application of exclusionary criteria (differential diagnosis, lower IQ etc.)

• Other appropriate assessment

From Assessment to Intervention planning

• Profile of child’s motor strengths and weaknesses• Choose target skills that are - 1) specific - 2) decided with the child - 3) manageable within the context (home, school, other)• Assign priorities in conjunction with child & team - Child selected - Parent selected - School selected - Therapist identified• The Movement Coach plays a crucial role in obtaining consensus among the

team.• Consider non-motor factors: e.g. behavioural observations etc

Assessing the Environmental Context

• Primary principle of EI is that practice is little & often• Family: - Intervention plan needs to fit comfortably with family life - Involve the family in providing support - Consider family routine - Parent education• School: - in-class support (individual, group) - available personnel - available specialists: PE teacher. LA teacher• Clinic - OT/PT: support to teachers & parents, supply activity suggestions etc• Community - Sports Centre, club etc (* Daniel Can Do)• Plan for positive interaction between child & environment

Collating information for planning program

• Interactive model of Child - Environment -Task

• EI will be more successful if it becomes part of the every day life of the child & family

• Collecting & collating all the info is a crucial role of the Movement Coach

• The form called the ‘Assessment Summary & Intervention Plan’ is included with the MABC 2 test

• Form can be shared with EI team members

• This summary can be used as an ongoing reference for parents & professionals

Chapter 4. Implementing an EI Program

• Turning plans into action:• Setting the scene• Working in a meaningful context• Learning specific skills through task analysis, task

adaptation and expert scaffolding • Facilitating the learning process through

instructions, practice and feedback• Learning specific movement skills is not enough-

Motor Learning in a broader context

Setting the scene• Following collection and collation of data• Movement Coach appointedStep 1. Call a meeting of relevant team members: Discuss data from form and possible target skills etcStep 2. Obtain firm commitments from those involved: The MC masterminds the overall plan. May need to deliver service, train others and/or guide othersStep 3. Discuss scheduling & practice: Little & Often (practice every day if possible, habit forming, help function in everyday life))Step 4. Establish lines of communication & set up timetable for action: Who will play an active role and who will play a supportive role. May involve many individuals over an extended period of time.Step 5 Discuss relationship between ‘learning to move’ and ‘moving to learn’ Increased competence in movement skills may lead to improvement in other areas , such as self control, co-operation with others, self esteem, confidence etc

Considerations

• Structure: Children with movement difficulties are often disorganized and have difficulty taking responsibility, they need clear structure to provides stability & for learning to take place.

• Group approach: Makes the learning environment more fun and fosters co-operation and can help develop general support to each other at an emotional level

• Making learning fun: Movement tasks should be challenging, exciting, lead to success, increase confidence and heightened self esteem

FunctionalWorking in a meaningful context

• Functional tasks, chosen by child & significant others

• Relate to child’s everyday life• Tasks should be realistic and relevant• Activities are fun & enjoyable• Teach active rather than passive movement

Encourage the setting of short, medium and long-term goals

Learning Specific skillsStrategies

• Task Analysis

• Task adaptation:

• Expert scaffolding:

• These are invaluable strategies, which can be combined

together when necessary to ensure participation & provide

successful learning opportunities

Task Analysis

• Planning: What the child needs to know about the task and simplify these requirements

• Execution: What the child has to be able to do to perform the task, break these down to more manageable parts & make it easier.

• Evaluation: What sort of feedback is available and how should it be presented to the child.

• Task analysis is a means to an end, the aim is to help the child solve one movement problem. The long-term aim must be to help the child use that skill flexibly in as many situations as possible.

• Ensure that the component parts can be built up again into the desired whole

Mini-skills

• The child should receive sufficient practice at each stage to make that mini -skill automatic & flexible. The child should perform the tasks in a number of situations within the following scenarios:

• Child stationary - Environment stable

• Child moving - Environment stationary

• Child stationary - Environment moving

• Child moving - Environment moving

Task Adaptation

• Either change the task the child cannot manage, or find an alternative.

• May use adaptations while still working on mastering the skill.

e.g. use velcro while still learning to do buttons or

tie laces

e.g. use softer ball while learning to hit baseball

Expert scaffolding

• Is closely related to the task analysis and adaptation. But the goal is to help the child achieve that skill that is just beyond him.

• May involve a person supporting or physically assisting the child at the start of the task.

• Takes the child from their staring point and provides the necessary support to participate and learn the task

Facilitating the Learning process

Four phases of learning:• Understanding the skill• Acquiring the skill• Automating the skill• Generalising the skillAt each phase there are factors to consider:• Instructions• Practice• Feedback

Understanding the skill

The overall aim at this stage is that the child learns what is required in the task

• Instructions should be short & simple. Pick out the essential components, present one at a time. Use demonstration.

• Practice is crucial. The action should be performed several times in a block of time (blocking) and the task should be consistent, e.g catching a ball 20/30 times with no modifications.

• Feedback should be simple & frequent.

Acquiring the skill

Correct movement patterns need to be practiced and refined

• Instructions have more emphasis on detail and increase in number & complexity

• Practice can become more randomised & variable

• Feedback: introduce self evaluation & self regulation

Automating the skill

• Instructions: less general instruction and can be more precise with periodic reminders

• Practice at this stage will vary from skill to skill and will involve a mix of constant & variable

• Feedback will be less frequent with more emphases on self evaluation and self regulation. Able to process feedback from different sources (vision, touch, proprioception)

Generalising the skill

Generalisation is more likely when tasks are similar.• Instructions should be aimed at helping the child

recognise that a particular situation demands a certain skill. Encourage the child to look at the best fit.

• Practice should be variable in nature, most of the time to encourage flexibility. Constant practice may be required to fine tune motor patterns

• Feedback should be given regarding how the child has utilised transfer of information

Motor Learning in a broader contextGrouping Children• Can engineer environment that encourages children to participate in

movement• Aids social development• Allows children to learn from each other• Makes it more fun• Can happen in many locations• More cost effectiveGrouping TasksThree broad categories are outlined in the MABC2. These areas can be

developed and expand and will frequently overlap1) Tasks involving Manual Dexterity2) Tasks involving Aiming & Catching3) Tasks involving Balance

Non Motor issues

• Children with isolated movement difficulties are less common that children with multiple problems

• Always consider the whole child when planning a program

• When forming groups, always consider how the non-motor difficulties might effect the group

• Movement programs can have a positive effect on other aspects of child’s development

Monitoring & Evaluation By individual members of team

• Check with child that, whether he feels he is making progress• Check whether the activities are enjoyable and or engaging the

child’s attention.• The team must keep note of developments in the child’s non-

motor behaviour. May have increased self esteem, which may help him try out other tasks or encourage more interaction with peers.

• Through increased participation & skill learning, may have gained new friends

• Working in pairs & in a group with others can be really productive

Monitoring & Evaluation By the Movement Coach

• Required to monitor progress at each phase f the program and oversees the program as a whole.

• Is the child making progress and is he happy• Is everything going well with each team member• Change maybe indicated• The MC may have to develop & expand on the range of

activities • May need to realign targets & priorities• The MC must discuss positive & negative outcomes • Must closely observe the child in each of the situations that have

been designed to help

Formal Evaluation

• Evaluation can occur at various levels.• Through the on going process evaluation maybe informal.• More formal evaluation maybe required on a 6 month or yearly

basis• Maybe required to provide evidence for the efficacy of their

intervention approach• Records should be kept on - Data from standerdised tests - The child’s view of his progress - The extent to which the the original targets for the child have been met form all team members -Data on other aspects of the child’s development

Chapter 5. Showing the Way through Examples

• Examples of case studies involving children with movement difficulties illustrating how EI can be applied.

• This should help EI users learn how to plan an appropriate intervention program.

What might a EI Program look like?

• Child identified/assessed

• Needs identified

• Movement Coach appointed (case manager/coordinator)

• Child & team identifies goals

- Tie shoe laces

- Play soccer

- Improve printing

• EI to take place in all environments

Different team members have different responsibilities

• Team members: Child, parents, teacher, classroom SSA, LA teacher, soccer coach, Therapist (MC)

• Child included in a FM group at school which will help address shoe lace tying & other dressing & ADL skills (run by an SSA). Parents to encourage & reinforce at home. Suggestions given. Overseen by MC

• Child in small printing group (run by LA teacher) Little & Often. Home work sent home. Parent involvement. Overseen by MC

• Child registered with friend at local rec centre for intro to soccer. Reinforcement of shoe lace tying can take place. MC to consult/liaise with soccer trainer & check on progress

• Parent committed to practicing ball kicking skills at home with son three times weekly (little & often)