BrainSTARS: Praxis Jeanne E. Dise-Lewis, PhD, Margaret Lohr Calvery, PhD, and Hal C. Lewis, PhD, BrainSTARS

Children with praxis have difficulty with active motor planning. Motor sequences, which were once automatic, need to be relearned.

Use everyday activities:

• Break complex motor tasks into components.  Master one component at a time before you ask your child to complete the whole sequence on his own.

Brushing Teeth

1. Uncap toothpaste.
2. Pick up toothbrush.
3. Apply toothpaste to toothbrush.
4. Wet toothbrush under faucet.
5. Brush teeth.
6. Spit.
7. Rinse brush.
8. Put toothbrush away.
9. Rinse mouth.
10. Put cap on toothpaste.

• Placing your child “in the natural environment” will be more effective than giving verbal directions alone.  Environments in which behaviors naturally occur will prompt  those behaviors.
• Encourage and model active play. Take your child outside and play basketball with him, rather than telling him to turn off the TV and go outside for a break.
• Passive activities such as TV watching, computer play, video games will not remediate motor planning problems.
• Demonstrate and model motor tasks, and let your child practice through imitation.

Change the Environment:

1. Even relatively simple activities require motor planning.  If your child has difficulty with common motor planning tasks (e.g., taking his seat, putting on his jacket, getting out of his chair, taking shoes on and off, opening his backpack), practice in a calm and non-pressured environment until it becomes more automatic.
2. Provide your child with easy-to-use clothing (Velcro instead of shoelaces) to minimize problems with motor planning.

Teach new skills:

1. To alter repetitive play routines, model expanded play behavior.  Engage your child with toys, which have multiple purposes and encourage several activities with each toy.
2. Teach motor activities in clear, sequential steps:

Example
Taking off a jacket

1. Unzip jacket.
2. Pull jacket off shoulders with both arms.
3. Pull left arm out.
4. Grab right sleeve with left hand.
5. Pull right arm out.

Example
Getting out of a chair

1. Put both feet flat on the floor.
2. Scoot to the edge of chair.
3. Put hands on the armrest or seat of the chair.
4. Lean forward.
5. Use hands and arms to push off.

As a child develops competence, she can recite the sequence to you as she accomplishes it.

See other BrainSTARS articles.

From BrainSTARS, Brain Injury: Strategies for Teams And Re-education for Students, © 2002 Jeanne Dise-Lewis, PhD. Used with permission. The manual is available in English and Spanish. For more information or to order copies, call 720.777.5470 or chris.moores@childrenscolorado.org. A short video on how to use the BrainSTARS manual is available at www.youtube.com/BrainSTARSprogram.

Jeanne Dise-Lewis, PhD is a child clinical psychologist, director of the Psychology Program for the Department of Rehabilitation Medicine at The Children’s Hospital, and Professor of Psychiatry and Rehabilitation Medicine at the University of Colorado Anschutz Medical Campus. Dr. Dise-Lewis is a Magna cum Laude graduate of St. Joseph’s University in Philadelphia, the University of Pennsylvania (MS in Human Learning and Development), and the University of Denver (PhD in Child Clinical Psychology). A member of the faculty of the University of Colorado Health Sciences Center since 1984, Dr. Dise-Lewis has extensive experience in working with children and families of individuals who have acquired brain injuries. For the past 23 years, she has been the director of the Rehabilitation Psychology Services at The Children’s Hospital, creating several innovative programs of services for children who have medical needs and their families. She has developed workshops and presented papers nationwide in the area of pediatric traumatic brain injury.  She has been the principle investigator of three federal grants and has developed the BrainSTARS Manual, along with other innovative consultation programs regarding acquired brain injuries in children and adolescents. She is the PI of a grant funded by the Centers for Disease Control and Prevention titled “An Investigation of Outcomes associated with Pediatric Traumatic Brain Injury” and currently is the co-director of a Personnel Preparation grant funded by the US Department of Education, “Preparing School Psychologists to Meet the Needs of Students who have Acquired Brain Injury.” 

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