1.1 Introduction
Health and well-being are not simply the product of absence of disease. They are the sum total of a system and systems which function well together. Dys-ease as opposed to the pathological features associated with disease can result from lack of synergy within the functioning of systems. Dys-ease produces a variety of symptoms ranging from behavioural and specific learning difficulties in children to emotional and psychological problems in adults.
Problems arising from dys-ease or dysfunction can be compounded for social reasons by the operational restrictions imposed on the various professional disciplines responsible for identifying problems and prescribing effective remedies.
Parents are often caught in this professional no-manâs-land, first seeking medical advice or reassurance when concerned about aspects of their childâs development. If no underlying medical condition can be found, the family tends to be passed on to the next service in the system allocated to take on responsibility for the childâs development. More often than not, this is education, but few educators are qualified to investigate or treat physical dysfunction, while health practitioners are not primarily concerned with educational difficulties. Spanning these two disciplines lies the domain of the educational psychologist, well qualified to assess and diagnose conditions in which physical dysfunction plays a part (e.g. developmental coordination disorder, attention deficit disorder, attention deficit hyperactivity disorder, ASD), but not in a position to provide a remedy for a range of physical symptoms. The result is that many of these children simply âfall through the netâ of services intended to identify children at risk and offer appropriate support or intervention â neither âbad enoughâ for medical treatment nor âgood enoughâ â to realize their potential in the classroom.
This group of children is often subjected to numerous assessments, but go on to receive either inadequate or inappropriate intervention. Inappropriate intervention is the type that tends to focus on the symptoms of underlying dysfunction instead of tackling underlying causes. If, for example, teaching more of the same does not ameliorate the presenting problem, while it can provide ongoing support, it is not the solution.
Similarly, a specific group of adults who present with symptoms which formerly would have been described as âneurosesâ may have a history of a cluster of underlying physical factors which have combined over time to make the individual more vulnerable to stress.
The now redundant term âneurosisâ describes relatively mild forms of mental illness that is not caused by organic disease, involving symptoms of stress (depression and anxiety). Neurosis affects only part of the personality, is accompanied by a less distorted perception of reality than in a psychosis, does not result in disturbance of the use of language and is accompanied by various physical, physiological and mental disturbances (as visceral symptoms, anxieties or phobias). The term neurosis was coined by the Scottish doctor William Cullen in 1769 to refer to âdisorders of sense and motionâ caused by a âgeneral affection of the nervous systemâ. For him, it described various nervous disorders and symptoms that could not be explained physiologically. The term was re-defined by Carl Jung and Sigmund Freud over a century later, who used it to describe a variety of mental disorders in which emotional distress or unconscious conflict is expressed through various physical, physiological and mental disturbances, which may include physical symptoms (e.g. hysteria, hypochondria) or emotional symptoms (such as phobias, panic, anxiety and depression).
Today, many of these conditions do respond to medical and behavioural therapeutic interventions, others do not. In seeking to find a solution for those who do not respond to standard treatment or who are recidivists, further investigation for signs of neuromotor immaturity can help to identify additional underlying factors which may be involved in the continuation of symptoms and which might respond either to a physical intervention programme, combination of a physical programme and behavioural therapy or a different type of medical solution.
It is stressed that in all cases, this screening test should not be used to form a diagnosis but only as a basis for further investigations.
1.2 How to Use This Manual
The manual comprises four chapters.
Chapter 1 provides a general introduction for all readers. It includes a definition of Neuromotor Immaturity (NMI) and its implications and a literature review of links between NMI and specific learning difficulties followed by a description of the role of primitive reflexes in normal development.
The INPP method is described and compared with other well-known motor training programmes including Sensory Integration (SI), the Bobath therapy and the Vojta method.
Chapter 2 comprises the INPP screening test for use with children (4â16 years).
Chapter 3 explains the links between neuromotor immaturity and symptoms of anxiety, agoraphobia and panic disorder in adults.
Chapter 4 comprises the INPP screening test for use with adults.
Chapter 1 is recommended to all readers. Chapters 1 and 2 are relevant for professionals working with children; Chapters 1, 3 and 4 to professionals working specifically with adults. Professionals working with children and adults should read all chapters.
1.3 Overview
Neuromotor functioning provides one indication of maturity in the functioning of the central nervous system. It is also linked to functioning of the vestibular, proprioceptive and postural systems, which collectively provide a stable platform for centres involved in oculo-motor functioning and subsequently visual perception. Individuals with neuromotor immaturity frequently experience difficulties with related skills such as balance, coordination and visual perception, which can affect behaviour and educational performance in children and result in chronic anxiety and emotional sensitivity in adults.
Problems connected to neuromotor immaturity can be subtle and diffuse, failing to fit into any single diagnostic category but nevertheless undermining an individualâs ability to function with competence and confidence. Children may present in a physicianâs consulting room as a behavioural problem or emerge in the classroom as a low achiever; adults seeking medical help may complain of a range of symptoms for which no abnormality is detected on clinical investigation.
One method of identifying signs of neuromotor immaturity is through the use of standard tests to assess retention of primitive reflexes and development of postural reactions and other tests for âsoft signsâ of neurological dysfunction. Soft signs, which have previously been dismissed as being too generalized to be useful for diagnostic purposes, are minor neurological signs indicating non-specific cerebral dysfunction.
The presence or absence of primitive reflexes at key stages in development provides acknowledged signposts of maturity in the functioning of the central nervous system. Primitive reflexes emerge in utero, are present in the full-term neonate and are inhibited in the first six...
