Rachel is eight years old. She was slow to crawl and walk. She still cannot pedal a tricycle, fasten small buttons, or tie her laces. She is very poor at sports and is often teased by the other children for her awkward running style. She is a messy eater and washes herself and brushes her teeth with great difficulty. Her mother says that she has a poor sense of direction and still confuses right with left. Rachel’s school work is satisfactory. Her writing is untidy, but if she prints slowly it is legible. Rachel has been tested by a psychologist and found to have some visual perception difficulties, but to be of normal intelligence. Her reading, spelling, and arithmetic are in the average range. A paediatrician has examined Rachel and detected no abnormalities that can account for her clumsiness. The term ‘clumsiness’ will be used in this chapter to refer to unexplained, significant difficulties in the coordination of movement in a child of average, or above average, intelligence. This sort of clumsiness is commonly associated with other forms of specific learning difficulty, such as reading difficulty. This does not mean, however, that most children with specific learning difficulty are clumsy. Many are, in fact, well coordinated. But clumsiness is far more common in children with specific learning difficulty than in other children. Clumsiness is more common in boys and quite often runs in families. The word ‘motor’ is used for movement. Gross motor skills involve large groups of muscles responsible for activities such as walking, running, jumping, hopping, and bicycle riding. Fine motor skills involve the hands and fingers, and are concerned with activities such as writing, drawing, using scissors, and tying knots. There are a number of standardized tests of both gross and fine motor proficiency. These may be performed by a physiotherapist, an occupational therapist, or a doctor. Activities must be carefully observed to detect the presence of tremors and other unusual movements. Balance, strength, tone, reflexes, and ability to interpret certain sensations are all assessed. It is essential that rare, serious conditions associated with poor coordination are excluded by a doctor.
Assessment of fine motor integration using bruininks oseretsky test of motor proficiency, 2nd edition, in 5 to 15 years of school going children