Enhancing Fundamental Motor Skills for Carson with Cerebral Palsy: A Motor Learning Approach

QUESTION

Case Study 1 – A student with Cerebral Palsy. Carson is a 5-year-old boy who lives at home with his mother, father, twin sister and baby brother. Carson has Cerebral Palsy which has impacted his function on the right side. His right foot requires a brace for toe clearance with gait and he keeps his right elbow bent and wrist and hand curled. He does have most of the range of motion in his joints when stretched, however is limited when he actively/independently tries to open his hand, straighten his elbow and pull his foot towards his shin by about 50%. Carson has reduced light touch sensation and proprioception as well on the left. He has passed a vision and hearing screening. Carson has difficulty with clearing objects on the floor in the classroom. He does well to navigate the level hallway but does have difficulty maintaining pace with his peers. Carson is unable to pedal a tricycle on the playground. He has difficulty keeping up with the other children while running in the gym. When instructed to catch a ball, he turns his head away, closes his eyes, and holds his left arm out. Carson was able to kick a static ball but not a rolling ball. He kicks in an upright position, takes a small step forward, pulls his leg back in a straight position, and contacts the ball with his toes. Carson is unable to balance on one foot greater than one second or hop on one foot. During the screening process, you provided multiple demonstrations. Carson was well behaved but needed multiple reminders and often lost attentional focus. What are Carson’s biggest rate limiters for performing fundamental motor skills? What is the goal and explain how you will help Carson obtain it through your practice and feedback schedules. Be very specific about practice and feedback schedules, and include a rationale for each based upon motor learning principles. a. Develop a specific and measurable goal that includes a timeline. b. Describe at least 4 activities based on LRE that are appropriate for your participant and your set goal from 4a. (Adapted Physical Activity) c. Develop a practice schedule to achieve your goal such as variable practice, part vs. whole practice, mental practice, distribution of practice, or a combination of these. (Chapter 16) d. Describe your rationale for choosing that practice schedule (4) such as factors such as the type of motor skill, complexity of skill, and learner characteristics. e. Develop an extrinsic feedback schedule including type, frequency, and amount of feedback. (Chapter 17) f. Describe your rationale for choosing that feedback schedule.

ANSWER

 Enhancing Fundamental Motor Skills for Carson with Cerebral Palsy: A Motor Learning Approach

Introduction

Carson, a 5-year-old boy with Cerebral Palsy, faces challenges in performing fundamental motor skills. This case study aims to identify Carson’s rate limiters for motor skill performance, develop a specific goal, and design a practice and feedback schedule to help him improve his motor skills.

Carson’s Rate Limiters

Muscle Impairment: Carson’s limited range of motion and muscle weakness on the right side affects his ability to open his hand, straighten his elbow, and pull his foot towards his shin.
Reduced Sensation and Proprioception: Reduced light touch sensation and proprioception on the left side impact his coordination, balance, and perception of limb positioning.
Visual Deficits: Carson’s avoidance of catching a ball, closing his eyes, and turning his head suggests potential visual deficits affecting his hand-eye coordination and tracking skills.

Specific Measurable Goal

By the end of the next six months, Carson will be able to independently catch a rolling ball with both hands while maintaining focus on the ball and exhibiting proper hand-eye coordination.

Practice Activities Based on LRE

Balloon Volleyball: A low-stress game to enhance hand-eye coordination and tracking, played indoors.
Obstacle Course: Incorporating crawling, stepping over objects, and reaching for objects to challenge balance and proprioception.
Target Throwing: Using bean bags to practice throwing accuracy and bilateral coordination.
Balance Beam: Assisted balancing on a low beam to improve proprioception and postural control.

Practice Schedule

A variable practice schedule will be implemented. Each session will include a mix of different motor skills, such as catching, throwing, balancing, and kicking, to encourage skill transfer and prevent Carson from anticipating the same task repeatedly.

Rationale for Practice Schedule

Variable practice optimizes learning by challenging Carson’s motor planning and problem-solving skills. The diverse tasks engage different muscle groups and neural pathways, enhancing his adaptability in real-world situations.

Extrinsic Feedback Schedule

Feedback will be provided intermittently, focusing on the quality of movement rather than each attempt. Feedback will be provided after every third or fourth attempt for each skill.

Rationale for Feedback Schedule

Intermittent feedback allows Carson to develop intrinsic feedback mechanisms, promoting self-correction. Too frequent feedback may lead to dependency, hindering his ability to self-assess and adapt.

Conclusion

By identifying Carson’s rate limiters and implementing an evidence-based motor learning approach, we can enhance his fundamental motor skills and overall motor competence. Through variable practice and intermittent feedback, Carson will gain the ability to catch a rolling ball, improving his coordination, visual-motor integration, and self-regulation skills. This tailored intervention aligns with motor learning principles and aims to empower Carson to participate in activities with increased confidence and success.