Dr. K.

Naresh Babu
M.O.T(Neuro)., MSc.(Psy)., FAOT(N.R).,
Senior Occupational Therapist,

Praxis and its Importance

for
Activities of Daily Living
 “The brain can refer to its body percept to plan movements,
in much the same way as we use maps to navigate a journey”
– Dr. Jean Ayres.
“Motor planning is the most complex form of function. It
What is involves ideation, planning and execution and requires
attention and integration of all the senses. If a child has to
Praxis? perform a new task, the child needs to have the ability to
organize the sensory input from his body, adequate
awareness of his body, and the ability to navigate his
environment.”
“Children at first learning to perform a non-habitual activity,
might appear uncoordinated and get frustrated. Occupational
therapy focus on building confidence and assurance in
developing the skills to perform any new task on their own.
 PRAXIS
IDEATION

IDEOMOTOR

EXECUTION

PLANNING AND
SEQUENCING

INTEGRATION
 Praxis skills are based on planning and sequencing.
Planning and Sequencing are important to enable the
child to perform many everyday task such as walking,
Aspects of running, jumping, playing on play ground or sports.
Self-care skills tasks such as dressing and eating,
Praxis grooming etc.,
Impacts on child ability to organize themselves and
learn new routines
It also influence on academic skills like writing,
drawing, cutting.
It has 3 parts: stored gesture representation, stored tool
knowledge, and a dynamic body schema.
 Ideomotor Praxis – Completing single step motor
tasks such as combing hair and waving goodbye.
Ideational Praxis – Completing Multi-step tasks,
Types of brushing teeth, making a bed, putting clothes on
in order, buttoning, buckling, or lacing.
Praxis Oro-motor Praxis – Coordinating muscle
movements needed to pronounce words.
Constructional Praxis – Establishing spatial
relationships , accurately positioning or moving
objects from one place another.

National Centre for Learning Disabilities estimates 2% general population is affected with dyspraxia 70% of them being male children.
 Ideational dyspraxia – Involves a ideational
plan of the movement, the kinetic component
is intact but ideational component either loss
Ideational or impaired. Loss the idea of how they should
interact with an object.
Dyspraxia Eg., Candle, Matchbox., Making cup of tea.,

Engram is a unit of cognitive information inside the brain, theorized to be the means by which memories are strored as biophysical or
biochemical changes in the brain in response to external stimuli.
 Idemotor dyspraxia – Inability to correctly
imitate hand gestures and voluntarily mime
tool use. Ideo Kinetic dyspraxia is apparent
dissociationn of the idea of the action with its
Ideomotor execution. (stored tool use)
Dyspraxia Eg., Cannot perform on verbal commands,
Clumsy.

Engram is a unit of cognitive information inside the brain, theorized to be the means by which memories are strored as biophysical or
biochemical changes in the brain in response to external stimuli.
 Muscular strength: An ability to exert force against resistance.
Motor (muscle) planning: The ability to move the body with appropriate
sequencing and timing to perform bodily movements with refined
control.
Motor (Physical) learning: A change in physical performance resulting
Building from practice or past experience.
Postural control: The ability to stabilize the trunk and neck to enable
coordination of other limbs.

Blocks of Sensory processing: Accurate registration, interpretation and response

to sensory stimulation in the environment and one’s own body.
Body awareness: Knowing body parts and understanding the body’s
Praxis movement in space in relation to other limbs and objects.
Balance: The ability to maintain position whether that is static, dynamic
(moving) or rotational.
Coordination: Ability to integrate multiple movements into efficient
movement.
Executive Functioning: Higher order reasoning and thinking skills.
 Young Children Trouble With: School-Age Children Trouble With: Teens and Adults
Trouble With:

• Poor pencil grip and letter formation, • Speech control—

• Learning to walk, jump, hop, slow handwriting volume, pitch,
skip, throw, or catch a ball articulation
• Fine motor skills: holding a pencil,
• Pronouncing words and being buttoning, cutting with scissors • Writing and typing
understood
• Over- or under- sensitivity

Identify • Establishing left- or right- • Playing sports, riding a bike, and •

to light, touch, space,
taste, or smells
Personal grooming and

Praxis •
handedness

Bumping into things •

other activities requiring
coordination

Sensing direction
•
other self- help activities
Cooking or other
household chores

Issues • Moving the eyes— instead,

moving the whole head
• Speaking at a normal rate or in way
that can be easily understood
•

•
Driving
Clumsiness

• Being sensitive to touch: irritated Making social connections due to speech

by clothing on skin, hair challenges
brushing, nail- cutting, or teeth-
Phobias and obsessive behaviors
brushing
 ❚ Clumsy Child - Orton (1930) ; Gubbay ( 1965)
❚ Perceptual Motor Disorder – Kephart (1960)
❚ Dyspraxia - Walton (1962)
Conditions ❚ Minimal Brain Dysfunction – Clements (1966)
❚ Developmental dyspraxia -Ayres ( 1970)
mostly has ❚ Somatodyspraxia- Ayres ( 1989)
❚ Developmental Coordination Disorder - APA (1990)Sugden
Praxis D. Developmental coordination disorder as a specific
learning disability. Leeds Consensus Statement. 2006:1-6.
❚ Minor Neurological Dysfunction - Hadders-Algra & Touwen (
problems 1992)
❚ DAMP syndrome – Deficits in Attention, Motor Control and
Perception - Sweden concept Gillberg 1992, Christiansen,
2000
 Drawing and pencil skills lacking in a skillful
outcome.
Activities of daily living (e.g. dressing
independently, holding and using cutlery,
Major toileting).

challenges Chewing and swallowing food.

Sensory processing (responding appropriately to
in Praxis the environment).
Articulation of sounds.
Limited play repertoire.
Self-esteem.
 • Break new tasks into smaller steps wherever possible, even if it seems silly (not only does this offer
supported skill development, but also reduces anxiety).
• Repetition: Recognize that additional practice is often required to master a new task.
• Physical guidance: Physically guide the child through new motor tasks so that they learn what the
movement feels like.
• Visual cues: to learn new tasks and routines.

Strategies • Improve sensory processing: To ensure appropriate attention and arousal to attempt the tasks, as well as
ensuring the body is receiving and interpreting the correct messages from the muscles in terms of their
position, their relationship to each other, the speed at which they move and how much force they are
using.

to build • Multi-sensory approach (using as many of the 7 senses) to learn new skills will ensure a child has the
best chance at learning appropriate strategies to respond to a physical demand or challenge.
• Cognitive planning strategies can be used to talk the child through tasks.
up Praxis • Strengthen the ‘core’ (namely the large central muscles) of the body to provide greater body (especially
trunk) stability.
• General muscle strength can be used as a coping strategy where “floppy” muscles are a challenge.
• Break verbal instructions into parts: Instead of “Go and get your lunchbox and your hat and go
outside”, say “Get your lunchbox.” When the child has followed that instruction, say “Now get your hat”
then “OK, now you can go outside”.
• Repeat the instruction: Ask the child to repeat the instruction to ensure that they have understood what
they need to do (e.g. “Go and get your bag then sit at the table. What do I want you to do?”).
• ‘First/Then’: Use this concept to help the child know what order they need to complete the command
(e.g. “First get your jacket, and then put on your shoes”).
 • Avoidance and poor behavior.
• Difficulty participating in sport activities.
If it is • Poor self esteem when they realize their skills do not match their
peers.
untreated • Bullying when others become more aware of a child’s difficulties.
• Poor fine motor skills (e.g. writing, drawing and cutting).
 • “The Just Right Challenge was coined first by Dr. Jean Ayres
Occupational Therapist on her work of Sensory Integration
theory and framework. It involves providing task /environment
/equipment modifications in order for a person to able to
complete a meaningful activity without too much or too little
Occupational challenge”.
Therapy - • The goal of the just right challenge is to find a happy medium
between too easy, which can lead to “I’m so good at this so I
The Just Right don’t have try” or too difficult, which can lead to “this is too
hard for me, so I’m giving up”
Challenge • Providing the just right challenge involves trial and error to find
the perfect fit. End goal is engagement, participation, and
completion on meaningful occupations and daily tasks.
 Space Visualization (SV)
Figure Ground Perception (FG)

SIPT - Manual Form Perception (MFP)

Kinaesthesia (KIN)
Finger Identification (FI)

Sensory Graphesthesia (GRA)

Localization of Tactile Stimuli (LTS)

Integration Praxis on Verbal Command (PrVC)

Design Copying (DC)
Constructional Praxis (CPr)

and Praxis Postural Praxis (PPr)

Oral Praxis (OPr)

Test Sequencing Praxis (SPr)

Bilateral Motor Coordination (BMC)
Standing and walking Balance (SWB)
Motor Accuracy (MAc)
Postrotary Nystagmus (PRN)
PRAXIS TEST
 Put one hand on your nose and one hand on your stomach
Put one foot on the other foot
Praxis on Put both arms out to the side

Verbal Put one hand on your foot and one hand on your head
Put one foot on your other knee
Command Put your elbows together

(PrVC)
The child’s ability to translate verbal commands
Cross your legs and bend to the front
Put the backs of your hands together
into practic acts.
Put one elbow on the back of your hand
Put the bottoms of your feet together.

Examiner verbally requests the child to assume each of 24 different unusual positions and each position is scored for accuracy and time .
 Postural
Praxis
Facility in assuming different
and unusual body postures.

The child is asked to assume each of 17 different postures while it is being demonstrated by the examiner and to hold each po sture for 7 seconds.
 Constructional
Praxis (CPr)
Skill in three dimensional construction

This test assesses practic skill in relating objects to each other in an orderly arrangement or systematic assembly through b uilding with blocks.
 Sequencing
Praxis (SPr)
Competency in perceiving, remembering,
and executing a series of hand and finger
movements

This test assesses the child’s ability to execute a series of planned hand or finger movements demonstrated by the examiner.
 Sequencing
Praxis (SPr)
Competency in perceiving, remembering,
and executing a series of hand and finger
movements

This test assesses the child’s ability to execute a series of planned hand or finger movements demonstrated by the examiner.
 Oral Praxis
(OPr)
Ability to imitate movements and positions
of the tongue, lips and jaws

This test assesses the child to imitates the examiner’s movement of the tongue, teeth, lips, cheeks, or jaw.
 Design
Copying (DC)
Accuracy and approach in copying designs.

This test retains and increases the advantages of design copying test for differential diagnosis.
 • BOTMP 2 – Bruininks-Oseretsky Test of
Motor Proficiency
Standardized • School AMPS 2 – School Version
Assessment of Motor and Process Skills (
Assessment ADL Task Performance)
tools of • TGMD 2 – Test of Gross Motor
Development
Occupational • PDMS 2 – Peabody Development Motor
Therapy Scales
• MABC 2 – Movement Assessment Battery
for Children
Thank you
Dr K. Naresh Babu

Naresh OT Mantras/Motto
•Stretch to Smile.
•Ignore the behaviour not the child.
•Serve to survive in meaningful way.
•Don’t use Red ink below 5 th std to mark
mistakes. Instead write what is expected.
•Don’t try to correct it but comment it in
positive words. Correction happen on its
own.
•Differently able to Definitely able to cope
up in the community.