SHERBORNE FOR STUDENTS WITH PMLD
by Katie Coldwells
Introduction
Much research since Piaget’s stages of childhood development have added to
our knowledge and understanding of hoe children learn and there can be no
doubt that movement is fundamental to all learning, whether it be cognitive,
social or emotional. Students with PMLD work within Piaget’s first stage of
human development, the sensori motor stage, which covers the first twelve
months of life.
The following definition found in Ouvry (1987) where reference is made to the
categories of PMLD was outlined by Kirman & Bicknell (1975) who noted that
students with PMLD can be described as :
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•
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those who may arbitrarily be defined as achieving an intelligence quotient
of less than 20 if a standard test can be applied to them
those children with multiple disabilities, in particular non-ambulant children
with cerebral palsy or spina bifida
those children who have very disturbed behaviour, who are overactive or
withdrawn or non-communicating, destructive or self destructive (p.16).
From birth to twelve months a baby’s cognitive, social and emotional
development is facilitated through constant movement. Within the first year of life
a baby develops from reflex responses to internal and external stimuli to
deliberate and self-motivated functional movements, such as rolling, crawling and
walking, which they use to explore and interact with their immediate social
physical and sensory environment.
In the forward to the second edition of Developmental Movement for Children,
says ‘to understand the Sherborne approach to movement teaching is to
understand movement in the context of early childhood development’ (Sherborne
V. p x)
How we perceive interpret and control movement
Dr P MacLean, on of America’s leading scientists in the evolution and
development of the brain postulates the theory that proposes three distinct areas
of the brain.
1. The Reptilian area of the brain – automatic reflex responses; regulates
fight or flight responses; the motor area of the brain.
2. The Limbic area of the brain – emotions, electro mechanical messages;
shivering; sweating; what to remember and what to forget.
3. The Neocortex area of the brain – thinking, problem solving
The Reptilian brain included the brain stem, the medulla oblongata, pons and
cerebellum
All sensations perceived by the body go first through the brain s tem and then are
sent on by the pons (the switchboard of the brain) to the Limbic area and the
Neo-cortex area for interpretation and response. Nerve nets must first be
developed in the Reptilian brain. The rest of the brain can then know what is
happening in t he outer world and then respond to it. The Reptilian brain forms
nerve nets encoded with our sensory motor-based patterns upon which learning
all the rest of our lives will build.
As the reptilian brains forms prenatally and in the first 15 months of life we
develop a hundred trillion nerve nets that link all our senses and movement. In
utero and after birth the constant movements and experiences of movements
‘fed’ into a baby by adults stimulate the development of these dormant nerve
connections, pathways and networks between the Reptilian brain and the Limbic
and Neo-cortex areas of the brain. It is through movement that these dormant
nerve networks are woken up. From this we can see why Piaget’s sensori motor
stage of development is centred on movement, which creates the vital foundation
block for future learning.
Two most important senses in our ability to perceive and control movement are
the vestibular and proprioceptive senses. The vestibular sense give us
information about gravity and motion and the proprioceptive sense about our
body’s muscular, tendon, ligament and joint movement position in space i.e.
standing, sitting, laying. These two senses are intrinsically linked and work
together to enable us to maintain our balance while stationary on in motion.
The vestibular sense tells the brain whether we are static or moving, and in which
direction. The vestibular sense has two main ‘centres’. The inner ear and a
reticulum of nerves based just above the brain stem in the medulla oblongata;
these two nerve centres are joined by the vestibular nerve. This system
maintains both static (stationary) and dynamic (moving) equilibrium (balance).
Static equilibrium is the orientation of the body mainly the head, relative to
gravity. e.g. when you are standing still. Dynamic equilibrium maintains the
body’s position mainly the head in response to sudden movement e.g.
acceleration, deceleration and rotation, when you are in motion. e.g. walking.
Each time we move our head we stimulate a series of complex sensory
processes within the inner ear, which send nerve impulses along the vestibular
nerve to the brain stem and onto the cerebellum. The cerebellum monitors and
makes corrective adjustments in the muscles activities. It is these corrective
adjustments that cause the motor system to increase or decrease its impulses to
specific muscles especially the torso and neck muscles to relax or contract. In
this way muscles are constantly adjusting instantly so we do not lose our
balance. With information from the inner ear we are able to maintain a stable
bodily posture relative to the ground. When the head moves dues to rotation of
the body, an equally complex but different series of processes within the inner
ear detect imbalance and send a series of nerve impulses to the vestibular
reticulum and onto the cerebellum for appropriate muscle response. Connection
between the vestibular system, neo-cortex and the core muscles of the trunk and
the eyes is highly important to the learning process. When we do not move and
activate the vestibular system we are not taking information from the
environment. ISE (Individualised Sensory Environment) by K Bunnings (SALT)
based a part of her development of early functional communication programmes
on vestibular stimulation e.g. rocking, spinning, swinging. One of the aims of this
programme was to engage students who presented frequent patterns of selfstimulatory behaviours as means of self-isolation to engage with people and/or
objects. A frequently observed pattern of self-stimulatory behaviour amongst
many students with PMLD, ASD, SLD, EBD during times of stress, self-isolation
or over stimulation environment is head rocking or whole body rocking.
The proprioceptive sense is the body’s sense of itself in space. All our muscles,
ligaments and tendons have proprioceptive receptors, which sense the degree of
stretch in the muscles, ligaments, tendons and joints. These stretch receptors let
us constantly know everything about our physical position, e.g. standing, sitting,
crouching etc. They provide the necessary feedback for us to move and maintain
our balance. Successful movement requires secure balance, which depends
upon a sophisticated propriceptive system constantly aligning every part of the
body. Proprioception gives the feedback necessary to maintain optimum muscle
contraction and relaxation for balance. From birth a child’s constant movements,
initially reflex reactions in response to internal and external stimuli, generates
constant feedback from the proprioceptors to the motor cortex of the brain that
allows more and more complexity of movement. Within 12 months a baby
develops from reflex reaction to walking. The core part of t he development starts
with the use of the main inner trunk muscles e.g. pushing up, rolling and sitting to
walking. The phrase ‘being centred’ invokes the importance of the proprioceptive
sense.
SDM offers experiences which have nor parameters or boundaries – each
encounter has its own dynamic which varies every time. It is the richness of
these ever changing experiences of movement and the resulting developing
perceptions of the world around us, through different physical positions and
changes in ways of moving, which give a quality and dynamic to an individual’s
life that cannot be created or experienced independently. Sherborne philosophy
of everyone participating and succeeding at their own level is particularly
pertinent to work with students with PMLD; in that any response in t he form of
movement elicit a smile or excitement from the supporting partner, thus
generating opportunities for an interactive cycle which can be initiated by either
person (Appendix 3)
Conclusion
All these experiences can be repeated regularly with the primary aim of
encouraging each student to initially experience and anticipate and hopefully
initiate a particular experience or movement. The more often routine movement
experiences are shared it will enable students to develop a greater movement
vocabulary and indicate through smile, vocalisation or eye contact or objections,
preferences or dislikes. SDM offers staff infinite opportunities, which enable
students to communicate definite choices, preferences and dislikes.
As Veronica Sherborne points out in her introduction to her book underlying all
her activities are certain beliefs.
1. Movement experiences are fundamental to the development of all children
but are particularly important to children with special needs who often
have difficulty in relating to their own bodies and to other people.
2. The input or ‘feeding in’ of movement experiences has to be more
concentrated and more continuous for children with special needs than for
children in mainstream school. (Sherborne V. p xiv)
Suggested Activities
Notes regarding suggestions for activities.
All experiences must be within the student’s range of joint and muscle flexibility
Manual Handling and Health & Safety Policies should be followed.
Current risk assessments should be applied to all lessons and activities.
Body Knowledge
A. Awareness of Body Parts
Tapping, rubbing, finger walking, hands to shoulders, feet to hops, (extremities)
on the top, front, back, outside, inside with arms and legs straight and bent.
Where possible students touch their own arms, legs, etc. and experience
touching a peer or adult.
Whole leg and arm movements up and down, to the side, together and none at a
time with hands and feet on the floor and with hands and feet off the floor. Small
circular movements with limbs, and large circular movements. Rotation inwards
and outwards.
Always start from midline position with arms and legs in midline position working
out and back to the centre of the body. Where this is not possible work as close
to the midline as feasible.
Legs need to be laying down to increase awareness of bottom and back, laying
supine and prone give awareness of tummy and chest. Encourage head lifting
where possible to watch own actions as prone increases the strength of neck
muscles and turn, and supine increases awareness of tummy, shoulders and
neck. (for some pupils be careful laying prone as these may encourage extension
of the spine as in the reflex extensors. Check with physiotherapist that you are
not encouraging spine extensor reflexors). Try the same movement experiences
lying on each side in turn.
Include all usual movements for awareness for digits, wrists, elbows, knees,
ankles and toes.
B. Awareness of Trunk
Rolling
You will need two adults. One adult at the shoulders and one at the hips. This
can be done for any student except those who for medical reasons cannot lay
prone. Use crash mats or gym mats depending upon pupils needs. Do not use
bean bags for health and safety reasons. It this is not possible to land then give
child opportunity with due safety and risk assessment on Floatation in pool.
Rolling a small student with PMLD up and down adults legs (SDM p11)
Making small body shapes, arms and legs tucked into trunk. (being contained by
large adult in small body shape)
C. Weight Bearing Parts of the Body.
Especially important for non-ambulant PMLD. Position student on side and then
roll up into a supported kneeling position and then move to weight bearing on
knees.
Small student with PMLD use between two or three adults depending upon
support required. Larger student with PMLD us house.
Move small distance with adult moving student’s legs.
Large student with PMLD us hoist to lower student to kneeling position. Adult
encourage crawling motion with legs.
Student is weight bearing through knees and hips.
For those who cannot move legs sufficiently slide student on knees.
On knees move backwards and sideways.
D. Awareness of Hips
This can be experienced during kneeling by gently rotating trunk and in sitting
position. In a laying position hold the legs still and the top half can be moved to
give and awareness of stretching in the hip area. Rocking in cradled position,
forwards, backwards, and side to side and rowing.
In hoist lower student into standing position to simulate walking / running.
E. Dynamics of Movement
Two of the most difficult experiences for the majority of students with PMLD are
the experience of strong movements and fast free flow movement.
For strong movement one adult support the student from behind, seated or
standing, and the student or adult gently hold hands and pull forwards while the
supporting adult maintains student’s position.
Small student with PMLD sit in blanket. One adult holds blanket to balance
student while other adult sits beck to back with student and pushes them.
Larger student with PMLD use hoist instead of blanket.
For fast free flow movement use blankets, physio ball, spinning in the hoist,
sliding or being pulled or pushed across the floor.
This is particularly good in warm water for children with very high muscle tone.
Again Floatation can be used. Use trampet / min rebounder.
Whole Body Movement
Rolling, sliding, spinning (in a blanket or on a parachute) plus running (there are
ambulant PMLD!) Use hammocks for sideways movements and swings for
forwards and backwards movements. Use trampet / mini rebounder.
Lycra warps and elastic ropes.
The student lies on the length of the adult body. Adult rocks from side to side.
Student experiences whole body rocking.
Awareness of Body in Gravity
Lay student on back. Holding hip and shoulder roll student up onto one site.
Balance in the position and experience giving into gravity to return students to
floor. Use appropriate mats. (not bean bags!) Use trampet / mine rebounder
Use hoist to lift and lower.
Note : All these experiences are on a continuum e.g. strong to light; fast to slow
etc. So there are endless variables within these experiences.
Labans’s Analysis of movement
What part of the Body is Moving?
Direction the body is moving in space
How the body is moving i.e. the Dynamics of the movement
Awareness of Others
Trust
At the very beginning of the session use large physio ball to roll to each student
and partner. Put student’s head on ball, say name into ball to feel vibrations. Tap
name on ball etc. First roll to other students calling name as you roll ball. Then
roll ball around circle or bounce to any student call name.
Log Roll
Supporting students on the back of able student / adults while rocking side to
side and back and forwards.
Use of blankets, lycra, parachute, tunnels and elastic rope.
Arrange students with PMLD and carers in a circle with all feet touching. Adult
Carer kneel behind student with elastic around students with the carer on the
outside encouraging students to lean backwards on elastic to get sense of
trusting and feel strength of movement on elastic.
Carers and students in cradle position create a train as well as a circle all trying
to move forwards and backwards. With older students with PMLD use blankets
and hoist to assist movement.
Use water environment and support devices to explore movements with
minimum but appropriate adult support.
a range or resources can be used or adapted. The physio ball is a useful aid for
students who have little movement in the hips, trunk and limbs to experience with
their hands, feet, knees motion and weight bearing and weight transfer from
hands to feet and knees. The rebounder can provide a range of stimulating
experiences for the whole or part of the body.
Able students can be a positive support in these activities and approaches
should be made to mainstream schools to enlist volunteers on a regular basis.
SDM is one of the best ways to build peer advocacy systems.
References
Hannaford C. (1995) Smart Move, Arlington : Great Ocean Publishers.
Ouvry C (1987) Educating Children with Profound Handicaps, Kidderminster : BIMH
Sherborne V, (1980) Development Movement for Children, Cambridge : Cambridge
Sherborne V, (1980) Development Movement for Children, London : Worth.
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