Movement Education for the Disabled

Movement education is a philosophy that proposes that a child with a disability can enhance his or her learning through the use of movement. For individuals with disabilities, movement education is a treatment option. Movement education encompasses a broad range of activities. This essay provides a general overview of the types of movement disorders and movement education for the disabled as it is used in the public schools.

Keywords Adapted Physical Education; Cerebral Palsy; Language and Movement; Movement Disorders; Movement Education; Music Therapy; Multiple Intelligences; Neurodevelopmental Treatment; Play; Proprioceptive Disorders; Sensory Integration; Spatial Awareness

Overview

Professionals, such as teachers, therapists, and paraprofessionals, in special education need to possess a basic understanding of movement disorders. In addition, parents and caregivers need education on how to incorporate movement into everyday activities. If a child has difficulty moving, then the child will have difficulty experiencing his or her environment.

Movement disorders can occur independently; have a range of severity from mild/minimal to severe/profound; and/or occur in conjunction with a syndrome. If an individual lacks motor control, then he or she will have difficulty interacting with people and/or the environment. The lack of involvement can impact educational outcomes as the individual will not be able to use all of his or her available senses to learn from and interact with the environment.

Movement disorders can affect education in terms of writing, spatial awareness, body awareness, relationships, and proprioceptive disorders (Morris, 1991; Raines & Canady, 1990; Sawyer & Sawyer, 1993; Treviranus & Roberts, 2003; Workinger, 2005). Motor deficits in any of these areas can decrease an individual's ability to interact to the maximum extent possible with his or her environment. Through movement the individual learns to interact with the environment which directly influences the developmental areas of cognition, language, social, and self-help skills.

The discussion of movement education will provide an overview of different disabilities that movement disorders often impact. Movement disorders can be an individual disorder or a disorder related to developmental disabilities. For the purposes of this paper, movement education for disabilities will be framed around cerebral palsy. Motor deficits in cerebral palsy have advanced the knowledge base of understanding how movement disorders can be treated and incorporated into many different activities.

Defining Movement Education

Child development specialists value the need to develop the whole child. In developing the whole child, activities are centered on what children normally do-play. Through play, a child motorically engages with the environment as a mechanism to learn and integrate information about the physical, cognitive, motor, and language aspects of development (Pica, 2004).

Movement education can be simply defined as educating one to move his or her body. The field of physical education, occupational therapy, physical therapy, dance, gymnastics, games, and even speech therapy use principles of movement education. The concept of teaching someone through movement is not a new concept as evidenced in the child development literature. The importance of motor or movement skills is considered to be a basic activity of daily living. However, unless a significant motor impairment exists its importance in overall development is often overlooked. Educators are cautioned to remember the importance that motor development has a direct impact on cognitive skills.

Treating Cerebral Palsy

In the 1960s, a resurgence of the study of movement disorders occurred and focused primarily on individuals with cerebral palsy (McDonald & Chance, 1964; Workinger, 2005). One theory that gained a lot of attention was Kephart's (1960) perceptual-motor development theory. This theory of motor development hypothesized that behaviors develop through a hierarchy of motor movements. Kephart further stated that the use of motor activities in instruction enhanced an individual's academic performance. While his theory is not well supported for enhancing academic achievement, Kephart's theory advanced the dialogue of the interconnectedness of the neural networks for all developmental tasks. In other words, if there is a deficit in motor development then this deficit can influence other developmental areas.

In response to the growing literature on movement disorders in children with cerebral palsy, child development specialists (i.e., teachers, therapists) began to refocus on the fact that children, regardless of ability, learn through play. Play allows the individual to experiment, explore, and discover an individual's environment. Through play, an individual can use his or her motor skills to develop or enhance skills in language, cognition, emotional, social, and rhythm skills (Pica, 2004). Each of these skills serves as an important foundational skill in learning how to read, write, and perform mathematical computations (Pica, 2004).

The movement education literature has been heavily influenced by information gained from investigating cerebral palsy. Therefore, cerebral palsy will be used as a framework for discussion of movement education in terms of the disabled. Additionally, the reader will also be presented with limited information on the types of approaches for which evidence-based research exists. The information presented can be used when treating individuals with other disabilities such as autism and mental retardation.

Applications

Cerebral Palsy as a Movement Disorder

When treating individuals with disabilities, best practice calls for the use of a team approach (Mauer, 1999; Morris, 1991). Each team member (i.e., parent, teachers, therapists) brings a unique perspective and expertise to the team. As such, each team member must have a basic understanding of all the developmental areas. In terms of individuals with movement disorders, a basic understanding of motor movement terminology and how other team members use it is needed (Langley & Thomas, 1991; Treviranus & Roberts, 2003; Workinger, 2005). Cerebral palsy will be defined as a disorder and a brief overview of the types of motor movement and muscle tone differences will be provided.

The definition of cerebral palsy can slightly vary among authors. However, a basic definition of cerebral palsy is a movement disorder that is caused by neurological difficulties in the brain (Langley & Thomas, 1991; McDonald & Chance, 1964; Workinger, 2005). Additionally, the term cerebral palsy is an umbrella term that represents different types of movement disorders (Langley & Thomas, 1991; McDonald & Chance, 1964; Treviranus & Roberts, 2003; Workinger, 2005).

Cerebral palsy typically is defined by the type of motor movement and muscle tone differences the individual exhibits (Langley & Thomas, 1991; McDonald & Chance, 1964; Workinger, 2005). The types of cerebral palsy are spastic, dyskinetic, hypotonic, and ataxic (Langley & Thomas, 1991; McDonald & Chance, 1964; Treviranus & Roberts, 2003; Workinger, 2005). A basic definition/description of spastic cerebral palsy includes stiff muscles, limited range of motion, and resistance to passive movement (McDonald & Chance, 1964; Treviranus & Roberts, 2003; Workinger, 2005). Dyskinetic cerebral palsy is manifested by movements that seem uncoordinated, instability in posture, and movements that are not well timed and affected by the direction and spatial characteristics of the individual (McDonald & Chance, 1964; Treviranus & Roberts, 2003; Workinger, 2005). Motor movements that consist of extreme joint flexibility, instability in posture, and moves between spastic and atheotisis is defined as hypotonic (Langley & Thomas, 1991; McDonald & Chance, 1964; Treviranus & Roberts, 2003; Workinger, 2005). The last type of movement disorder is ataxic. Ataxia is characteristized by tremors, balance disorders, and uncoordinated movements (Langley & Thomas, 1991; McDonald & Chance, 1964; Treviranus & Roberts, 2003; Workinger, 2005).

According to Workinger (2005), limb movement disorders can be classified in different ways as well. Disorders can be classified as monoplegia (involving one limb); hemiplegia (involving limbs on one side of the body); diplegia (involving all limbs with movement difficulties in the legs); quadriplegia or tetaplegia (all limbs are equally involved or arms are more affected than legs); triplegia (involvement of three limbs); and, paraplegia (involvement of legs only) (p.4).

The development of normal movements disorders has been described by Connor, Williamson, and Siepp (1978), as cited in Workinger (2005), as a sequential development with one skill building the foundation for the next; an overlapping of the sequential development with the other areas of development; maturation of the motor system occurring first as gross motor skills and refined into fine motor movements allowing independent movement of each motor act; development of the motor system staring from the head and working its way down; and, developing movement from the proximal to distal (p. 20). Normal motor developmental milestones are beyond the scope of this paper. However, the reader is referred to the suggested readings for a more in-depth understanding and to investigate normal developmental norms for motor development.

Movement Education Approaches

When an individual has a movement disorder such as cerebral palsy, the individual does not move through the normal developmental sequence. The movement education programs available are as varied as the types of cerebral palsy. Approaches used to treat individuals with cerebral palsy include

• Neurodevelopmental treatment,

• Sensory integration,

• Music, and

• Language and movement.

Neurodevelopmental Treatment (NDT)

Professionals often are faced with finding and using information from multiple sources (Langley & Thomas, 1991). One of the most widely used approaches for individuals with movement disorders is known as the Neurodevelopmental Treatment (NDT) approach. According to Langley and Thomas (1991), Berta and Karel Bobath developed NDT as "a means of treating underlying neuromotor deficits related to tone, movement, and posture of both a neurological and a developmental nature" (p. 1). The NDT approach targets the facilitation of normal movement patterns by focusing on the total person (Langley & Thomas, 1991). In other words, NDT does not only target the specific movement patterns but overall facilitation of the individuals' movement patterns within his or her environment.

According to Langley and Thomas (1991), the Bobath's NDT approach was influenced by proprioceptive neuromuscular facilitation; tactile stimulation; symmetry of movement; trunk stability; and functional movements (p. 3). The approach evolved from improving movement patterns in therapy situations to facilitating movement patterns into everyday life skills such as play and activities of daily living (p.5).

NDT is dynamic approach that focuses on the individual needs of the person through an understanding of normal and functional motor development. By adopting an approach that treats the whole child, professionals can turn any activity of daily living or play into a function which addresses motor movement.

Sensory Integration

Sensory integration treatment is an approach developed by Jean Ayres and used with a wide variety of disabilities (i.e., autism, learning disabilities, speech-language disorders). The purpose of sensory integration activities is to promote an individual's ability to use sensory information gained from the body and the environment in a meaningful manner. Mauer (1999) stated that "sensory integration (SI) theory is based on the belief that the integration of the sensory system is the foundation for successful development of motor abilities, organization, attention, language, and interpersonal relationships" (p. 383).

Ayres developed the approach to work with children with learning disabilities. Over time, the approach has been used with a wide variety of individuals with disabilities including autism, cerebral palsy, and speech-language deficits. As with NDT, sensory integration is a dynamic approach that facilities activities into play and activities of daily living.

The following activities are examples of the types of strategies one might use in sensory integration: to develop touch the individual could identify objects by placing his or her hand in a box and feeling the object without seeing the object; write letters in sand, or roll across the room in a box. The individual could jump on a trampoline, play hopscotch, or push and/or pull heavy objects to develop proprioceptive skills. To assist with motor planning, the individual could engage in a game of Simon Says, play kick ball, or navigate through an obstacle course.

Music and Movement

During and after World War II, music therapy gained wide acceptance as a rehabilitation tool. Using music as a therapeutic tool was found to relax and calm the individual which increased participation in the rehabilitation program (Standley, 2003). Music therapy is a therapeutic approach that is gaining acceptance with a wide variety of disorders across the lifespan (Kemper & Danhauer, 2005). Music and movement activities are often used in preschools to teach integration activities to young children. Incorporation of music and movement into learning information such as basic concepts, the alphabet, counting, and colors have long been viewed as an effective method of engaging the whole body in the learning process.

The premise behind the use of music and movement is that the use of everyday songs, music, and rhymes along with everyday movements assists the individual in integrating information into the cognitive-linguistic domains. For instance listening to music allows the individual to learn the rhythm of the language which is thought to assist in learning to read fluently.

Language & Movement

As children develop from infancy into early childhood, the development of language and motor skills occur simultaneously. While this is easily recognized in children who are developing normally, this is often overlooked in children with disabilities. Therefore, incorporating both developmental areas into a therapy regimen makes sense (Block, 2001; Pica, 2004; Raines, & Canady, 1990; Sawyer, & Sawyer, 1993).

Movement can be a form of nonverbal communication. Body position can allow the transmission of a thought or idea in a communicative dyad (Minton, 2003). Therefore, children with disabilities can benefit from learning language by engaging in movement. For example, a child can learn basic concepts (i.e., under, over ) by navigating an obstacle course. In other words, the child can crawl under table and over the chair.

While each of these treatment approaches are used in treating individuals with cerebral palsy, they are also being used to treat a variety of other disabilities. It is important to remember that movement disorders can affect any disability and/or age group.

Adaptive Physical Education

In the schools, the adapted physical education specialist is the individual most often thought of as teaching movement education. Adapted physical education is often needed by the individual with a disability to learn how to develop leisure and recreation skills. The individual responsible for developing an adaptive education program is the adaptive physical education teacher (APE). The APE teacher receives training in assessment and evaluation of motor skills for individuals with disabilities. APE services are part of special education services available to individuals with disabilities.

Motor Influences on Learning

The ability to interact with one's environment is essential in developing the knowledge and skills for activities of daily living. Learning is dependent on sensory input (visual, auditory, tactile, movement) (Gardner & Hatch, 1989). As information is gained about different learning styles, the use of movement education in teaching activities will gain acceptance for all individuals with disabilities not just with individuals with the most severe motor deficits.

Movement education is based on the concept that learning is enhanced through direct participation in the activity (Morris, 1991; Pica, 2004). For example, reading a book about walking does not have the same influence as being allowed to practice the skill of walking. Motor skill development and activities that support this development also allow for social participation. Social participation in activities allows the individual to work on self-esteem and body awareness.

Academic areas are beginning to incorporate movement into instruction. For example, Peebles (2007) reported that movement could serve as a motivator for students having difficulty in reading fluently. The use of movement allows the individual to become active in fluent reading by engaging the kinesthetic aspects of rhythm (Block, 2001; Pica, 2004; Raines, & Canady, 1990; Sawyer, & Sawyer, 1993; Standley, 2003).

The National Association for the Education of Young Children (NAEYC) (1997) position statement regarding developmental appropriate practice emphasizes the idea that a child's development is complex and multifaceted. As such the teachers, therapists, facility, and caregivers need to develop the whole child. In terms of motor development, a child who works on his or her physical skills through activities such as running, balancing, and throwing can develop life long leisure skills. One concern of society is the lack of physical activity in the youth. Therefore, children with disabilities should be encouraged to engage in leisure activities for the same health benefits as any individual.

Conclusion

The reappearance of the study of movement disorders occurred in the 1960s in response to individuals with cerebral palsy. Authors discussed the impact a deficit in motor development can have on other developmental areas. In the late 1980s, Gardner and Hatch (1989) proposed that multiple intelligences impact an individual. The multiple intelligences theory gave birth to the recognition that individuals have different learning styles. As each of these areas, regardless of ability, continues to be researched, the concept of movement education is gaining a research base in the literature (Block, 2001; Kemper & Danhauer, 2005; Langley & Thomas, 1991; Pica, 2004; Raines, & Canady, 1990; Sawyer, & Sawyer, 1993).

Movement education is becoming a more widely used method of learning for individuals with disabilities. Educators are recognizing that a child learns through the active involvement and play. Professionals are becoming acquainted with the use of multiple modalities in teaching that can enhance the learning process (Block, 2001; Kemper & Danhauer, 2005; Langley & Thomas, 1991; Pica, 2004; Raines, & Canady, 1990; Sawyer, & Sawyer, 1993). The types of movement education programs are as varied as the individuals who make up a school population. Movement education offers programs through physical activity paired with music, language, and/or sensory modalities.

In closing, movement education for the disabled proposes the involvement of the whole person versus just the skills (i.e., walking, grasping, etc.) that allow movement. This concept is important when working with individuals with disabilities, as each individual is unique. This distinctiveness does not allow each individual to respond to every treatment program in the same way. Thus, as educators recognize the diversity of learning styles within the regular education classroom, they will find that many of the techniques and philosophies discussed can be adapted for all learners.

Terms & Concepts

Adapted Physical Education: Adapted physical education is an adapted or modified form of physical education that meets the individual needs of a child with disabilities who has movement delays.

Cerebral Palsy: Cerebral Palsy is a term that includes a wide range of non-progressive diseases that cause movement disorders in individuals. Cerebral palsy can range from mild to severe/profound motor movement impairments.

Movement Disorders: Movement disorders are neurologically based disorders that affect the speed, fluency, quality, and ease of movement.

Movement Education: Movement education is a philosophy to teaching physical education to individuals with disabilities.

Music Therapy: Music therapy uses music to facilitate the achievement of therapeutic goals.

Multiple Intelligences: Multiple intelligences are a theory of learning proposed by Gardner. In this theory, it is believed that individuals possess eight different intelligences: linguistic, logical-mathematical, spatial, bodily-kinesthetic, musical, interpersonal, intrapersonal, and naturalist.

Play: Play is considered to be a child's work in cognitive development. Play can consist of interacting with either real or imaginary people, animals, or objects.

Proprioceptive Disorders: Proprioceptive disorders are disorders which affect an individual's awareness of posture, movement, and changes in equilibrium and the knowledge of position, weight, and resistance of objects as they relate to the body.

Sensory Integration: Sensory integration allows the brain to integrate information received from the body's five sensory systems: sight, sound, smell, tastes, and body position.

Spatial Awareness: Spatial awareness is an individual's ability to know where one is in space.

Bibliography

Block, B.A. (2001). Literacy through movement: An organizational approach. Journal of Physical Education, Recreation & Dance, 72 , 39-48.

Connor, F. P, Williamson, G.G. & Siepp, J.M. (1978). Program guide for infants and toddlers with neuromotor and other developmental disabilities. In M.S. Workinger (2005), Cerebral Palsy Resource Guide for Speech-Language Pathologists (pp.20-21) Thomson-Delmar Publishing.

Gardner, H., & Hatch, T. (1989). Multiple intelligences go to school: Educational implications of the theory of multiple intelligences. Educational Researcher, 18 , 4-9.

Geerdink, Y., Aarts, P., & Geurts, A. C. (2013). Motor learning curve and long-term effectiveness of modified constraint-induced movement therapy in children with unilateral cerebral palsy: A randomized controlled trial. Research in Developmental Disabilities, 34, 923-931. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=85251608&site=ehost-live

Hall, A. (2007). Mini literature review based on brain research and its effect on educational Practice. Retrieved December 21, 2007 from ERIC database http://eric.ed.gov/ERICWebPortal/Home.portal?%5fnfpb=true&ERICExtSearch%5fSearchValue%5f0=ED018037&ERICExtSearch%5fSearchType%5f0=no&%5fpageLabel=RecordDetails&accno=ED497408&%5fnfls=false&objectId=0900019b80176b3c

Jelle Vuijk, P., Hartman, E., Mombarg, R., Scherder, E., & Visscher, C. (2011). Associations between academic and motor performance in a heterogeneous sample of children with learning disabilities. Journal of Learning Disabilities, 44, 276-282. Retrieved December 15, 2013, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=60405960&site=ehost-live

Kemper, K. & Danhauer, S. (2005). Music as therapy. Southern Medical Journal, 98, 282-288. Retrieved December 23, 2007 from http://www.smajournalonline.org/pt/re/smj/abstract.00007611-200503000-00007.htm;jsessionid=Hz2YqV222p8MC4wGP6GSQjhh2P7pJv2TrrXCWNmTMz2lz0Kkw08Z!1390229169!181195629!8091!-1

Kephart, N. (1960).. The slow learner in the classroom. Columbus. Charles E. Merrill Publishing Co.

Langley, M. & Thomas, C. (1991). Introduction to the neurodevelopmental approach. In Langley, M.B. & Lombardino, L.J. (Eds.). Neurodevelopmental strategies for managing communication disorders in children with severe motor dysfunction. (pp. 1-29). TX: Pro-Ed.

McDonald, E. & Chance Jr., B. (1964). Cerebral palsy. Englewood Cliffs, NJ:

McDonald, E. & Chance Jr., B. (1964). Cerebral palsy. Englewood Cliffs, NJ: Prentice- Hall, Inc.

Mauer, D. (1999). Issues and applications of sensory integration theory and treatment with children with language disorders. Language, Speech, and Hearing Services in Schools, 30 , 383-392. Retrieved December 21, 2007 from EBSCO online database, Academic Search Premier, http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=4867793&site=ehost-live

Minton, S. (2003). Using movement to teach academics: An outline for success. Journal of Physical Education, Recreation & Dance, 74 , 36-40.

Morris, S. (1991). Facilitation of learning. In Langley, M.B. & Lombardino, L.J. (Eds.). Neurodevelopmental strategies for managing communication disorders in children with severe motor dysfunction. (pp.251-297). TX: Pro-Ed.

National Association for the Education of Young Children (NAEYC). (1997). Developmentally appropriate practice in early childhood programs serving children from birth through age 8. 22 pp. Washington, DC. Retrieved December 21, 2007 from http://www.naeyc.org/about/positions/pdf/PSDAP98.PDF

Pica, R. (2004). Experiences in movement: Birth to age eight. Clifton Park NY: Delmar.

Peebles, J. (2007). Incorporating movement with fluency instruction: A motivation for struggling readers. Reading Teacher, 60 , 578-581, Retrieved December 21, 2007 from EBSCO online database, Academic Search Premier, http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=24286613&site=ehost-live

Raines, S.C., & Canady, R.J. (1990). The whole language kindergarten. New York: Teachers College.

Sawyer, W.E., & Sawyer, J.C. (1993). Integrated language arts for emerging literacy. Clifton Park, NY: Delmar.

Standley, J. M. (2003). Music therapy with premature infants: Research and developmental interventions. Silver Spring, MD: American Music Therapy Association.

Association.

Treviranus, J. & Roberts,V. (2003). Supporting competent motor control of AAC systems. In J.C. Light, D. R. Beukelman, & J. Reichle(Eds.), Communicative competence for individuals who use AAC: From research to effective practice. (pp. 199-240). MD: Paul Brookes, Publishing.

Workinger, M. (2005). Cerebral Palsy Resource Guide for Speech-Language Pathologists (pp.20-21) Thomson-Delmar Publishing

Suggested Reading

American Music Therapy Association (n.d.). Retrieved December 21, 2007 from http://www.musictherapy.org/

Ayres, A. J. (1972). Sensory integration and learning disorders. Los Angeles, CA: Western Psychological Services.

Baumgarten, S. (2006) Meaningful movement for children: Stay true to their natures. Teaching Elementary Physical Education, 17 , 9-11, Retrieved December 21, 2007 from ERIC database http://0-www-uk1.csa.com.novacat.nova.edu/ids70/view%5frecord.php?id=2&recnum=8&log=from%5fres&SID=318f1a4ee5fa9fe7efbf72f756be2cfc&mark%5fid=search%3A2%3A0%2C0%2C10

Halfon, N. (2001). Brain development in early childhood. Building Community Systems for Young Families Reports, 141, 1-28.

Halfon, N. (2001). Brain development in early childhood. Building Community Systems for Young Families Reports, 141, 1-28. Juelsgaard, C. (1996). Early childhood motor skills information packet. Retrieved December 21, 2007 from ERIC database http://0-firstsearch.oclc.org.novacat.nova.edu/WebZ/FSFETCH?fetchtype=fullrecord:sessionid=fsapp4-56818-fal9lwu2-36gcby:entitypagenum=24:0:recno=25:resultset=7:format=FI:next=html/record.html:bad=error/badfetch.html:entitytoprecno=25:entitycurrecno=25:numrecs=1

Katz, L. (2003). State of the art of early childhood education. Opinion Papers, 150, 1-17.

McMahon, S. (2004). Multiple intelligences and reading achievement: An examination of the inventory of multiple intelligences. Journal of Experimental Education, 73 , 41-52. Retrieved December 21, 2007 from EBSCO online database Education Research Complete, http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=14899344&site=ehost-live

Neuro-developmental Treatment Association (NDTA). (n.d.) Retrieved December 21, 2007 from https://www.ndta.org/index.php

2007 from https://www.ndta.org/index.php

Hezkiah, A. (2005). Adapted physical activities for the intellectually challenged adolescent: Psychomotor characteristics and implications for programming and motor intervention. International Journal of Adolescent Medicine Health, 17, 33-47.

Rimmer, J. (2007). Introduction to cerebral palsy and exercise. Retrieved December 21, 2007 from The National Center on Physical Activity and Disability Disabilities and Conditions http://www.ncpad.org/disability/fact%5fsheet.php?sheet=119

Wigram, T. & DeBacker, J. (Eds). (1999). Clinical applications of music therapy in developmental disability, paediatrics and neurology. London: Jessica Kingsley Publishers.