As many of you know I run a professional development program called Team Talk with Cathy Love (OT).  Our topic this week was Praxis.  Having only discovered the full scope of Praxis last year, I really pushed for this topic to be included in our topics for the 2017 year.  Well, what a rabbit hole. It was difficult to even get a common understanding.  Good old Wiki defines Praxis as a form of critical thinking and comprises the combination of reflection and action.  Praxis can be viewed as a progression of cognitive and physical actions.

But it is also known as…..

The final exam in the U.S. for speechies is known as the Praxis exam

There is also a winery in Tasmania called Praxis (really great wine!)

Many different ideas.

So, what is it?

Praxis is a neurological process that facilitates skilled and adaptive motor function, it is not just motor planning or the completion of novel actions. It is different from apraxia – a neurological impairment that causes an inability to perform particular purposeful actions. It is different from developmental verbal dyspraxia.

The more novel a task, the more praxis is required.  The more familiar a task the more automatic, the process, the less praxis.  But we should note that we never do anything the same way exactly twice.

Praxis requires:
*Ideation: the ability to generate a goal for an action and have a general idea of how to achieve that goal.
*Motor Organisation and Planning: the ability to organise the motor components of an action in an orderly manner.
*Execution: of the action.
*Feedback: the ability to review the effectiveness of the action. “What did I do?” “How did I do it?” “What was my impact?” and adjust or modify as necessary based on the sensory input received and the cognitive recognition of the effectiveness of the action at meeting the goal.

I bet you are thinking that this sounds like Executive Function.  That was my thought too!  And it is, but then it is also more …

Cathy likes the description of Developmental Coordination Disorder.  If you want to read some more check out Developmental Coordination Disorder which is described in the DSM 5.  Can child has a great article.

Our OT friends are much more knowledgeable in this area, but as speechies Praxis has an impact in our sessions as well, as we need to plan and support our students as well.

Before learning about praxis my speechie brain was focused on the motor components (planning and sequencing movements) when motor planning is only the tip of the iceberg.  And I have to say that I was really only thinking about my work with Verbal Dyspraxia and Oral Dyspraxia.  Now I am reflecting on ideation, motor, execution and feedback throughout my day whether I am playing with a 2-year-old, building language with a kinder kid or when working with speech.

I read an analogy that Praxis is a process that involves accessing the library of books in our brains.  A limited range of books in their library and/or difficulty accessing the books they have stored.
In therapy, we aim to assist our clients to build bigger libraries with more detailed books, that have indexes so parts of movements and concepts can be easily accessed and flexibly used in new and adaptive ways.

Think about the child who doesn’t know how to use a toy – Maybe they don’t have a book or a plan for this toy.  So, in therapy, my sessions have changed to provide lots of chances to build affordances with toys and actions.  Think about when you are teaching verbs or basic concepts, if the child doesn’t have a plan or affordance for that action, it is more difficult for them to learn the word.  So now if we are working on push, we push a range of things across the floor, when we work on roll we roll us and objects. We build experiences while modelling language.  We build the link between language and the action.

The link between praxis and Autism is well established.
Ideation – ASD kids have poor affordances as they are ‘stuck on what they know.  ASD kids have a smaller variety of ideas. We need to build experiences and support the exploration of new ways and experiences.
Motor planning – We know that many children with Autism also have motor planning and coordination difficulties.   How we get our body to do what we want it to do.
Feedforward – Children on the spectrum find it really difficult to anticipate and predict what will happen next.  Children with ASD have trouble getting their bodies ready for action.
Feedback – What did I do?  How did I do that?  Children with ASD have difficulty evaluating their response and putting in place change.

When supporting praxis

  • provide heaps of opportunities to practice
  • explicitly and systematically teach skills
  • specific instructions
  • meaningful experiences
  • adjust the task and environment for success
  • build capacity to problem solve and generalise
  • play to the child’s strength
  • coach approach

I still seek out support from my OT friends about Praxis, however, I have found that considering the possible presence of praxis difficulties for my clients and altering my approach to support the growth of praxis, has had great pay offs.