Basic Therapy Foundation

Introduction

The history of Basic Therapy originated from our aim to help children who are struggling with problems related to their native language. We wanted to assist children who had delayed speech- language development or, had developmental speech-language disability related problems, such as dysgraphia and/or dyslexia, (have weak spelling or formal dysgraphia). In the early period we utilized speech therapy and developmental education methods, observed and described the different symptoms, and attempted to correct these symptoms with a broad range of methods from various approaches.

Our experience was that even though we achieved slow progress in improving speech and reading, this improvement often did not last. The weakness was in making the improvement automatic; the children were able to move past their original level, but the new skills did not reach the level of becoming automatic. It was very common that when they paid attention exclusively to the language task the new skill was apparent, but for example in conversation they paid attention to the topic and the several months of work seemed to be for naught.

However a new skill can only be taught with assurance if the previous one has proceeded down the road to becoming automatic.

The anatomic/neurobiological basis for the above mentioned problem may be that the “subject to be learned” requires more mosaics and longer connective paths in the cerebral cortex for every “new” skill. For the “skill” to become automatic the basal ganglia and their connections are utilized, and the cerebral cortex, being partially freed up, can prepare for a new task.

We were not satisfied with our results, and so we sought out methods that would allow us to “reach into the brain” and delve into the formation of language through developmental science, aided by the nearly unbelievable, but well-documented plasticity of children’s brains.

In the professional literature numerous authors – Piaget, Ayres, Tobis-Loewenthal, Schilling and Hottiger with many others – have shown that later intellectual development, including language development, is built upon the sensory and motor development of the child.

Originally we set off according to the developmental neurology oriented school of the Philadelphia Rehabilitation Center founded in the late 1950s and early 1960s, which in theory proceeds from the most prominent steps in motor development (creeping, crawling, paralateral ambulation, transverse ambulation and early selection of lateral dominance) and considers the culmination of this process to be speech, which is built upon these.

We adopted some of their principles and a few of their practices. Utilizing current scientific language we would formulate our therapeutic theory in the following manner: if the linguistic module develops insufficiently, it is worthwhile to examine the motor module (motor coordination and motor control) from several aspects, because speech and language (with related reading-writing ability) later develops based on these areas.

According to the scientific literature, 70% of children with speech-language development problems and/or reading/writing disorder have difficulty or delayed development in certain areas of motor development, and correcting these facilitates language development (our continuously growing assessment data and therapeutic results and experience also agree with this, and we have been examining children since 1992). This is why we consider our treatments to be based upon DEVELOPMENTAL SCIENCE.

The Structure of our Work

Our therapeutic method has two main directions: one is a general developmental line of our therapy focusing on groups for children with general developmental delay; the second direction is a more therapeutic oriented approach, where each therapist has to focus on the individual development of each child. Thus, we perform our treatments on the children as development and therapy.

A criterion for the treatment is that the therapist must see through the supervision of each child individually, truly accepting their organic mental and social guidance during the many hours of weekly work (6 hours per week). Currently we are managing a nationally accredited 165-hour training program (theoretical and practical) leads to this undertaking, and a maximum of 5 children can be in each group, since this is how many can be individually supervised while at the same time forming a group. Maintaining communication with the parents is also important, and if possible with the nursery school and school as well. In this outline we will not delve deeply into our therapy, because that would exceed the possibilities of the 10 day short-course.

For the general development-line however, our method can be used on anywhere from one to 10-15 children at one time, and while it does not delve anywhere near as deep as our therapy, it also proved to be useful.

Preliminary Examination

We start with a preliminary, but complex examination that takes about an hour and a half. This we will train the students of the course to give – we can measure whether the child is in need of Basic Development, our general line of the Basic Therapy Method.

The course of our examination as it follows:

  1. Case history (anamnesis)
    A medical and developmental oriented examination form is filled out with the parents (we will provide the form used in Hungary, which can be linguistically and culturally adopted). The case history form can be filled out by the parents before the examination, or we can fill it out together with them in combination with an introductory conversation. During the introductory conversation with the parent we double check (from the filled form and also verbally) which complaints, problems and symptoms caused them to request the examination of their child.
  2. Phoneme hearing, speech perception and comprehension test
    In Hungary, we use a nationally tested and well-used method for testing the hearing of phonemes and speech perception in connection with the Hungarian language. These tests vary according to the language, thus in this outline we will not write about this area. However we point out their importance, since one of the most common causes of problems in native language abilities is a problem in the hearing of phonemes, or deficiencies in speech perception and comprehension.
  3. General knowledge of one’s closed environment and family
    The clarification of the child’s general knowledge about the world around her/him, family situation, social relationships, attitudes towards games and learning, personal interests, creativity, sports, previous developmental, educational methods used, handling of setbacks and relationship with adults.
  4. Understanding time and its relations
    We have a part during the examination when we ask the child about time and time-related grammar and knowledge of his/her daily rhythm of life.
  5. General motor skills test
    This is an examination of the general movement development of the child.
    1. Developmental gross motor skills
      • motor skills in infancy
      • possible existence of deteriorating reflex deficiencies
      • muscle tone of the trunk and limbs, and balance reactions
      • forms of locomotion in infancy: types of ambulation and movements imitating animals
    2. Running
      examination of running in different variations
    3. Agility
      on one and two legs, in place and in motion
    4. Transverse motor skills
      starting with easier exercises and proceeding with more and more difficult ones
    5. Rhythm test
      • movement rhythm
      • speech rhythm
      • clapping rhythm
      • coordinated performance of the above rhythm types
    6. Test of fine motor skills
      • hand related
      • face, mouth and jaw muscles related
      • muscles moving the eyes and their control
    7. Test of motion planning (A. Luria)
    8. Test of spatial motion along the three spatial axes
    9. Balance
      • static
      • transitional
      • dynamic balance, here the simultaneous work of both legs is observed, joint and simultaneous exertion of strength
    10. Lateral Dominance
      determining the dominant eye, hand and foot (our test measures technical and gesticular lateral dominance), and the quality of the dominant motor skills
    11. General characterization of the child’s motor skills
      • we determine whether the Basic Development (our general-line of therapeutic method) could be necessary or useful for the child
      • we evaluate the exercises on a six point scale according to pre-determined considerations, but we also provide a written assessment

The Development in Practice

Our program is comprised of several steps.

  1. First we rectify the basis of motor skills
    Gross motor skills - Agility - Balance
    Every child, every infant and toddler goes through this basic movement development, and during this time every kind of motor skill has an effect on the others, and vice versa.
    Through this we start up/set into motion the cerebellum-cerebral cortex-vestibular system, as well as the basal ganglia system and naturally several other areas of the brain also, here I am only highlighting the target systems.
  2. Special gymnastics elements
    Following this we teach a special kind of gymnastics to the children, which starts off from the foundations of motor development (simultaneous movements in space and in rhythm of the limbs on the same side of the body), then it embraces transverse movements, exercises that cross the center line of the body, movements of the upper and lower limbs that are independent in space, and then exercises that coordinate these independent motor skills. We teach rhythmic movements, rhythmic speech (the division of words into syllables), the coordination of rhythmic movement and speech and rhythmic “intendation” (Dr. András Pető’s method, it is worth seeing how useful it can be in a foreign language, but experience indicates it would be). Finally we teach series of exercises that are difficult, where the independent control of hands and legs is combined with jumps, and hand/foot motions move in spatial directions or planes that differ from one another.
    We consider our primary task to develop independent movement control.
  3. Fine Motor Skills
    Developmentally, following the above exercises we begin intently improving fine motor skills like:
    • manual dexterity
    • oral and lingual dexterity
    • exercises for controlling eye muscles
    Naturally, up to this point we have also mixed fine motor skill practice into the preceding developmental material.
  4. Lateral Dominancy
    We reinforce the dexterity of the dominant hand and foot (if this has already been established)
    In the case of problems with lateral dominance, after working with the central axis the brain is better disposed for stabile one-sided dominance to emerge in fortunate instances after a half year of work, since we traverse the path of human motor development in the treatment up to this point.
    The exercise groups II., III., and IV. above very strongly engage the basal ganglia system, as well as the cerebral cortex’s motor learning and motor control/planning systems, for example the posterior parietal region and the pre-motor frontal region (we are just highlighting a few, since we work the entire motor/sensory system.
  5. Serial movement exercises and prefrontal cortex related exercises
    The development of essential apprehension of motor skills, serialization, delayed reactions and concentration. (In principle this includes Felicie Affolter’s intermodal approach in perception development).
    The so-called prefrontal cortex exercises (this deals with the system of connections between the prefrontal cortex – basal ganglia – limbic system – cerebellum). Here we achieve the OBJECTIVE from the aspect of the maturation of learning.
    We began from the basic area of automatized gross motor skills – agility – balance. With the prefrontal exercises we have arrived at the development of stereotypes and immediate breaking of them, simultaneous attentiveness to multiple factors and the formation of series from these.
    The unexpected exchange and alteration of one or more factors constitutes the theoretical basis of this exercise group. We can also include exercises with balls in this group.
    There is no need for the prefrontal cortex to perform simple, automatic behaviors, this can be accomplished to a great extent by pre-wired sub-cortex paths. The coordinated development and control of sensory input, thoughts and motor actions and responses is necessary, however. All of this is connected with “reward training”, and consequently the abilities of attentiveness, recollection, response selection and particularly adaptability.
    For the above series of exercises we teach discipline and breathing exercises on the one hand and limbering, strengthening and stretching exercises on the other. If it is necessary we can supplement this with areas of developmental education, but these methods probably vary according to the country (memory, temporal orientation, Gestalt, body image, spatial orientation, etc.)

Thoughts on the Mechanism of Effect for Basic Development

Up to this point we have been trying to refer to anatomical systems that are induced into functioning. The development is moto-sensory in character, so it sets into motion every area of the brain related to motor function and every area of perception related to this.
Looking from a neurological/histological point of view, we are working on the re-formation, reinforcement and repair of defects in the synaptic network, which is why it is important for there to be a large number of movements performed in the proper manner.

  1. We develop every area along the skill-ability-automatization line, since children with ability problems have problems in making actions automatic in both the motor and cognitive areas (see above). We powerfully engage the systems affected by the cerebellum and the basal ganglia, which are the main areas controlling automatic actions.
  2. The basal ganglia are one of our initial objectives that are to be developed. Through this we develop implicit procedural memory and implicit learning. According to experience, progress in both of these areas aids the work of the speech therapists.
  3. The entire development facilitates the central integrating processes, because this central control is insufficient in children with ability problems. It is difficult to define what this central control process is. Perhaps it can be described as follows: the precise identification of stimuli and the comparison of the stored objective with the one that is determined and with the response mechanism. On the basis of the data in the literature the underachievement of the children does not arise from slowness in either the sensory or motor phases, but instead from the slow nature of complex central processes.
  4. The frontal lobe – basal ganglia system has a strong connection with the commencement of forming a sentence, improved accuracy in sentence formation and the motivation to construct a sentence. We often experience this during the course of our development program, and it can also be supported by data from the literature, making it one of the pivotal factors of our program in the realm of language. We also experience the commencement of a disposition towards and skill at drawing, because perhaps this is dependent upon exercising the parietal lobe and not the development of fine motor skills.
  5. Considering the neuro-biological functioning of the brain, we begin with the “vertical axis” (brain stem vestibule cerebellar system – basal ganglia – cerebral cortex motor areas). During our treatment we reach the axis from the so-called “front to back line” (prefrontal – basal ganglia – limbic system – cerebellum). We affect the embracing ark of the lateral brain areas less (temporal, parieto-temporal and occipito-temporal). Nevertheless, linguistic ability requires the functioning of these areas! However, the development of these areas are under the competency of the speech therapy and the corrective education/special education, but we are able to underpin their work and provide work-share and assistance to help them with difficult cases. And due to the fact that we know from the results of imaging procedures that the brain functions in a synchronized mosaic-like manner to achieve each objective, our task is to establish the opportunity for synchronization – particularly through motor skill development.

Commonly Observed Indications of Developmental Delay or Impairment in Motor Skills

In this part we are would like to share our experience and observed indications of developmental delay or impairment related to the basic development of motor skills. Our observations are:

  • Muscle tone disorders: hypotonia extending most often to the limbs and pelvic area, and less commonly to the trunk.
  • Compulsory poses, if for example the lower limb is in a particular pose, the upper limbs and possibly the trunk assume the characteristics of this pose, since independent control and innervation have not developed.
  • Compulsory movements: for example if the limbs move, particularly with difficult to perform or newly learned movements, the mouth and tongue, as well as the eyes sometimes perform the same movement together with them.
  • Transverse movements are very weakly developed.
  • Skills of independence are still more weakly developed: the separate control of the upper limbs – lower limbs – head/neck – body and their coordination.
  • The simultaneous, combined exertion of the two halves of the body, particularly the two legs is often weak.
  • The weakness in fine motor skills manifests itself in the underdevelopment not only of deficiencies in manual dexterity, but also on one hand in dysarthria (the motor weakness of speech performance due to innervation disorders or limpness in the muscles of the mouth, pharynx and soft palate) and particularly in the control and performance of eye movements.
  • Dysdiadochokinesia is very common (inability to perform rapid, alternating movements).

About Our Special Gymnastics

  1. Our gymnastics powerfully engage the corpus callosum for the harmonizing of the movements of the two sides of the body and coordinating separate transverse lateral functioning,
  2. develop every area of the brain and spinal cord that takes part in motor skills and necessitates large scale integration from both the vertical and horizontal systems of pathways,
  3. improve the learning and regulation of motor skills and systems regulating the visual field (frontal lobe and parietal and parieto-occipital areas), as well as the sense of time for movements, because ↴
  4. every one of our gymnastic movements is composed in rhythm and in space,
  5. the goal of every one of our gymnastic movements is to powerfully engage the basal ganglia, since our primary objective is to make these gymnastic movements automatic (as we say, we send it from the cortex to below the cortex), and through this open new learning possibilities for the cerebral cortex,
  6. every one of our movements aims at and succeeds in increasing muscle tone, similar to rhythmic sports gymnastics.

The role of rhythm in linguistic organization – the improvement of rhythm is considered important by every developmental system – is supported by research that has found that children suffering from specific language impairment (dysphasia, specific language impairment), in addition to having deficits in perceiving quick transitions of sound, have distinct difficulties in organizing rhythmic movements.

Once again we summarize the guiding principles of our programme:

  • achieving independent control
  • the coordination and integration of the independent control that is achieved
  • skill -> ability -> automatization: the model for every learning strategy
  • developmentally, motor skills aid in the emergence of language ability

Who is the Program for? What age groups?

  • Children in the last year of pre-school (the kindergarten year, over 5 years old) who have poor motor dexterity, have not developed dominant handedness or have shown signs of dyslexia,
  • Children in the last year of pre-school who have clearly noticeable difficulties with gross and fine motor skills,
  • Children in the last year of pre-school who have or have had serious speech impairments: late development of speech, impediments to speech production that are hard to treat and possible suspicion of dysphasia,
  • School age children with dyslexia,
  • School age children with dysgraphia, for the improvement of the formal aspect of writing,
  • Some children suffering from ADHD, if they are dyslexic, because the two disorders overlap with one another (a portion of children suffering from ADHD are also dyslexic, and a portion of dyslexic children suffer from ADHD),
  • It may prove to be effective in the development of children who have borderline mental retardation,
  • The program is outstandingly effective in the case of pseudo-mental retardation.

Basic Development

Development

  • for lack of ability in the native language
  • for immature nervous systems
  • for developmental problems in motor coordination

Pre-schoolers from 5 years old

  • Problems in speech development (delayed development, dysphasia, etc.)
  • Problematic motor skill development (Gross and fine motor skills)
  • Late selection of lateral dominance
  • Mild intellectual disability
  • Special cases of ADHD

School Age to 16 years old

  • Dyslexia, dysphasia, formal dysgraphia
  • Mild intellectual disability
  • Special cases of ADHD

Comments:

  • We do not treat children with this method until they are 5-6 years old, because our program is similar to sports training (the proper performance of large numbers of specific movements, without particular equipment or games) and in Hungary the developmental theory is that only play should be used to develop children up until the age of 5!
  • Basic Development does not help for problems with spelling! In our language improving speech perception helps in spelling!
  • The program can help for formal dysgraphia (poor quality or illegible letter formation or control of writing), but this is a special method that we teach in a course separately!
  • According to the current literature and attitudes the problems of children with ADHD is psycho-organic in origin. In reality the causes of ADHD can be put on a wide scale, with organic causes on one end (for example children born at 6 months or with a lack of oxygen) and on the other end the majority with psychosocial causes (for example unexpected, unwanted and neglected children). Since our program is based on neuro-biology – the reorganization, concentration and repair of the synaptic network – we can really only hope to help children with ADHD from organic causes for the most part.
  • According to the results in Hungarian scientific literature, the “critical” (optimal) developmental period of human motor coordination lasts until age 16. This is why we designated this as our age limit. In reality, according to our experience, from the age of 14 the program depends on whether the child wishes to pursue this as a sport and treatment of 20-30 year old adults is possible according to their motivation.

Who is the Program for?
Based on the Problems of the Child!

Disphasia, Disgraphia, ADHD, generally delayed development, Mild intellectual disability

Comments:

  • The program (since it is not therapy) can only be used for the mildly mentally retarded with great caution and supervision!
  • Outstanding results can be achieved for the pseudo-mentally retarded, who only seem to be mentally retarded during intellectual testing due to partial ability disorders (for example one of our children was sent to a school for the mentally retarded due to serious partial ability problems in the native language, which we were able to help out with, and after returning to a normal school won regional mathematics competitions)
  • A child’s problems with reading comprehension are most often a result of problems with their reading technique. In these cases the program helps both with both reading technique and reading comprehension. If, however the child has poor or no reading comprehension despite outstanding reading technique, we must find the reasons that caused this concurrence, and we must try to assist with the actual cause.

The Advantages of Our Method

  • The only equipment necessary is a trampoline. However, the more developmental implements the teacher can use alongside basic development, the easier it will be to maintain the children’s motivation.
  • A classroom or a room with similar size is sufficient for the program. There is no need for a gymnasium, but of course the size of the space needed always depends on the number of children participating in the group.
  • We do not recommend this program for more than 15 children. Above this it becomes impossible to see which children need individual attention in some area. However, it can be used as sport training for up to 15 children, and it has proven to be good exercise for healthy children without problems.

The Difficulties with Our Method

  • The time required for development is at least one hour twice or three times a week!
  • Less than this and it cannot be called basic development.
  • The greatest difficulty is the sport-like nature of our program: certain movements must be performed for a certain number of repetitions. It is difficult to motivate little children (5 to 8 years old). It is dependent on the leader of the program maintaining motivation, since every sport type activity depends on motivation. During the course we teach a multitude of ideas for play and for structuring the hour.

Finally...

...a few illustrations from our study, where we processed the developmental data for 60 of our children from the preliminary examination and the check-up examination (the time between the preliminary examination and the check-up examination was 6-12 months). The study cannot be considered a precisely elaborated mathematical or statistical essay, because the children naturally did not only take part in basic development, but also participated in other developmental programs in their pre-schools and elementary schools. Despite this, the charts perhaps show something about the areas we examined.

There were no children who did not speak at all in the group examined by the study (although it can occur), so there were no children at zero points. There were some who spoke only a few words or used only one or two vowels ( 1  point). The improvement in speech production was great, because while the number of children providing perfect speech production did not grow much, groups  1  and  2  disappeared in practice and the number of children with  3  or  4  points increased significantly. Our best results were in the areas of the clarification of the motor production of sounds, the expansion of vocabulary and particularly the commencement of sentence structuring.

In the study, 30 of the 60 children were of school age, and able to take a reading test. The groups contained only a small number of cases, so what is worthy of attention is instead that the non-dyslexic group doubled at the time of the check-up, and the dyslexic group fell from 70% to 55%.

At the time of the check-up essentially every child characterized reading with the same phrase, “It got easier”.

Conclusion

We intend for the introduction above to be a course introduction. We will offer a course about our development program to our colleagues from abroad in the French, English and Hungarian languages. We await applications from all countries where the training can be held in the French, English or Hungarian languages. The length of the course is 5 working days (Monday to Friday) twice (10 total days), for about 8 hours a day. We will present theory in the course, but the majority will be training for the introductory examination and providing the system in practice according to our own experiences. (If children can also be provided for the course, we can also teach techniques for leading the classes.)

  • Previous training in health care, education or speech therapy is suggested for the course. It helps if the participants have experience in working with children.
  • The maximum number of participants in the course is 20 students.
  • The opportunity for supervision from our foundation represents a separate subject of negotiation in each country or site.
  • Registration address: info@alapozoterapiak.hu

Contact

  • Address: Hungary, 1125 Budapest, Kútvölgyi út 49.
  • Post: Alapozó Terápiák Alapítvány, 1535 Bp., Pf. 701.
  • Tel.: +36 1 392 0190
  • Fax: +36 1 230 3602
  • Email: info@alapozoterapiak.hu
  • Tax number: 18081132-1-43
  • Account number: BB 10104105-56095046-00000001