Sensory and motor developments are the underlying foundation for all future progress. Babies learn through interaction with their environment. In order to do so, an infant must have the abilities to sense, to feel, and to move freely and purposefully. Sensory and motor development affect the child’s ability to explore the surroundings, to turn his/her head in order to follow a moving object with the eyes, to reach and to grasp toys, to crawl, walk, run, climb and jump, etc.. These physical, interactive activities foster understanding and mastery of the environment, stimulating cognitive, language and social development.
Paediatric physiotherapy is holistic in nature to treat the whole child in order to facilitate the child’s physical and mental growth, general health and well-being, but not just the body in isolation. A paediatric physiotherapist helps to maximize a child’s sensory and motor function; to stimulate optimal physical development and physical fitness; to facilitate independent self care and daily living; to encourage participation in physical activities, so as to enhance better self-image, self-esteem and self-confidence.
Physiotherapy assessment and training are based on up-to-dated evidence with well-known theoretical framework such as, Neuro-sensory-motor-developmenntal Approach (Yvonne Burns 1979, Pauline Watter, 1987) ，Sensory-Integration (Jean Aryes, 1972) and Neurodevelopmental Therapy (Bobath, 1964). Treatment involves facilitation of gross and fine motor development, enhancement of sensory-motor integration, postural and movement control, strengthening, balance, physical fitness training, massage, mobilization, stretching, strapping; and prescription of orthosis, orthotics and special needs equipments, etc. Whatever techniques are used in therapy, enthusiastic parental involvement at home is essential for optimal long term results.
The NSMDA has been devised by Burns and Watter (1974) and revised for use with children with DCD by Watter and Bullock (1979) and Watter (1984). The items for assessment were grouped into eight major neurological areas, including visual motor, reflex activity, orientation and postural reactions, proprioception, spatial or vestibular function, tactile, gross and fine motor areas.
Watter and Bullock (1987) reported improvements on the Neruo-sensory-motor Developmental Assessment (NMSDA) that were maintained at 6-month follow-up after a 6-month developmental physiotherapy programme. The children underwent 10 minute home exercise programme for four times weekly. Also, each child received individual monthly physiotherapy treatment to review and update the programme.
84 children with DCD underwent a physiotherapy directed school based group programme for three times per week for 15 to 20 minutes. 50 children showed significant improvement after three months, where the remaining children needed six months to show improvement.(Watter and Bullock, 1989).
Our sensory systems detect sights, sounds, smells, taste, pain, temperature, pressure, position and movements of our body. Most people coordinate all this sensory information in a process called sensory integration to help form a complete understanding of the environment and respond accordingly. Sensory integration typically begins during gestation and develops through life.
Sensory integration disorder is usually evident at a young age. When sensory integration dysfunction occurs, the ability to distinguish and adjust to various sensations is disrupted, resulting in poor motor planning. Inappropriate behaviour among children inevitably interferes with social interactions, emotional skills and self-esteem. Some symptoms of sensory integration disorder include hypersensitivity or undersensitivity to sensory experiences, inability to self-regulate emotions, apparent clumsiness and difficulty adapting to new situations.
Treatment for sensory integration is designed for individual children by controlling the sensory stimuli. More challenging sensory activities are presented as the child successfully overcomes each stage of difficulty. An effective sensory integrative approach will help the child organize and respond to the environment in more adaptive ways.