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Introduction

? 1.1 OVERVIEW(1)

A significant percentage of children in mainstream schools have been found to have immature motor skills and postural instability.(2,3,4) Such neuromotor immaturity is often rooted in the continued presence of a cluster of primitive reflexes (normally present in infants up to 6 months of age, and then replaced over time by postural reactions). Research has shown that there is a direct correlation between immature motor skills and educational achievement. With proper guidance and instruction, teachers and other professionals can be trained to screen for signs of such delay, so that appropriate referrals can be made or physical intervention programmes introduced. This book provides all the tools and guidance needed to identify children with such immaturity, implement a physical programme if appropriate and evaluate outcomes.

There are many motor training and movement programmes available, but the model developed by the Institute for Neuro-Physiological Psychology (INPP) described in this book is unique in having been evaluated in practice and offering a means of assessing neuromotor status in the pre-school and school-aged child both at the beginning and at the end of intervention.

The book is organised in three sections:

1. The first section offers a series of screening tests for children aged 4-7 years to assess the presence of three reflexes, control of static balance, coordination, visual perception and visual-motor integration.
2. The second section provides a similar series of screening tests for children from 7 years of age and above.
3. The third section details a complete developmental movement programme designed to be used with whole classes or smaller groups of children over the course of one academic year.

This book is supported by additional test materials and observation and score sheets to download available from www.wiley.com/go/blythe/neuromotorreadiness2. and enhanced by INPP video training materials, available for download purchase from https://www.inpp.org.uk/accessnmr.

? 1.2 RATIONALE FOR SCREENING AND REMEDIATION OF NEUROMOTOR IMMATURITY

The INPP programme for schools is based on a clinical programme developed at the INPP and it has been used since the 1970s. In 1996, key tests were selected from the INPP full diagnostic assessment and clinical programme and adapted by the author for use with larger groups of children in a school setting.

This adapted series of screening tests is intended to be used by teachers, doctors and other trained professionals involved in child development and education as a screening tool only. It will not provide sufficient detailed information to justify a diagnosis, nor is it intended to replace standard neurological examinations, psychological or educational assessments usually carried out by trained psychologists, remedial specialists, medical and other non-medical professionals. It will, however, provide tools that enable a teacher to identify children who are under-achieving as a result of immature neuromotor skills and who are likely to benefit from the INPP programmes or other physical remedial programmes.

The INPP developmental movement programme comprises a series of daily exercises, based on movements normally made by the developing child in the first year of life. These movements must be carried out every day under teacher supervision. One of the major differences between the INPP programme and many other programmes designed to improve coordination and balance, is that the INPP exercises take children back to the very beginning of balance training and postural development.

? 1.3 WHAT IS THE INPP?

The Institute for Neuro-Physiological Psychology was established in 1975 by psychologist Peter Blythe PhD with several aims in mind:

1. To carry out research into the effects of immaturity in the functioning of the central nervous system (CNS) in children with specific learning difficulties (and adults suffering from anxiety states, agoraphobia and panic disorder).
2. To develop reliable methods of assessing CNS maturity.
3. To devise effective remedial intervention programmes.

Children seen at the INPP are examined on an individual basis using a series of standard medical tests to assess a range of physical abilities:

• gross muscle coordination and balance;
• patterns of motor development;
• cerebellar involvement;
• dysdiadochokinesia (ability to carry out rapid alternate movements);
• aberrant primitive and postural reflexes;
• oculomotor functioning (control of eye movements);
• visual perception;
• visual motor integration (VMI);
• audiometric examination and dichotic listening.

The diagnostic assessment findings provide the basis for an individual regime of physical exercises which the child carries out every day at home under parental supervision. The exercises take between 5 and 10 minutes a day over a period of approximately 12 months. The child is reviewed at 6 to 8 weekly intervals to assess progress and adjust the exercises accordingly.

One of the problems with the INPP clinical programme has always been that it involves detailed assessment on a one-to-one basis, is costly in terms of professional time and can, therefore, only reach a relatively small number of the children who would benefit from this type of assessment and intervention. It was to overcome this problem that, in 1996, the author selected a reduced number of tests from the INPP diagnostic assessment and compiled the shortened screening tests in this book, which have been designed to be used as a screening device by teachers and other professionals involved in education and child development, to enable them to identify children with signs of neuromotor immaturity.(5)

? 1.4 THE INPP DEVELOPMENTAL MOVEMENT PROGRAMME FOR SCHOOLS

As part of the same package, the author also devised a unique developmental movement programme for use in schools. The concept behind the combined screening tests and developmental programme was that teachers could be trained in a 1-day course how to administer the screening tests, enabling them to identify children with signs of neuromotor immaturity in the classroom and implement effective intervention.

The Developmental Movement Programme is designed to be used with a whole class of children or smaller selected groups for 10 minutes a day, every school day, over the course of one academic year. Teachers do not select specific exercises for individual children but use the developmental movements in sequence, progressing according to the abilities of the class with the slowest child setting the pace.

This programme has been widely used in individual schools throughout the UK, in other European countries and as far afield as South Africa and Mexico. Research carried out on the screening tests and developmental movement programme has consistently shown that:

1. Neuromotor immaturity is a factor amongst children in mainstream schools.
2. There is a link between neuromotor immaturity and lower educational performance.
3. The INPP Developmental Movement Programme is effective in reducing markers of neuromotor immaturity.
4. When clear signs of neuromotor immaturity (> 25%) and educational under-achievement coexist, children who followed the INPP developmental movement programme showed greater improvements in measures of non-verbal cognitive performance and reading.(6)
5. Small group studies have indicated that children who were under-achieving by more than a year in reading and who had clear signs of neuromotor immaturity (> 50%) made significantly increased gains in reading at the end of the year having followed the INPP Developmental Movement Programme.(7)

? 1.5 WHAT IS NEUROMOTOR IMMATURITY?

Neuromotor performance describes a complex functional behaviour which results from activation of the central and peripheral nervous systems and involves motor structures which operate through the musculoskeletal system involving multiple inputs from the individual's internal and external environment. The systems and structures responsible for movement within an individual are constantly evolving throughout the developmental process, but at certain stages in development a child is expected to have attained a certain level of neuromotor performance. Motor milestones and motor performance provide outward signs of functional neuromotor maturity.

Neuromotor immaturity describes the retention of immature patterns of movement control. These may occur as a result of classical neurological signs (pathology) or be reflective of a functional or developmental delay in the pathways involved. The INPP screening tests are aimed at identifying various 'soft signs'* of neurological dysfunction together with the presence of three primitive reflexes in the school-aged population. These tests do not point to causation, nor do they predict learning outcomes in individuals, but they can help to identify the presence of obstacles to educational achievement. Furthermore, in many cases, these obstacles can be removed with the use of a specific developmental movement programme.

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