The Manchester Motor Skills Intervention

Cork University 22nd November 2011Caroline Bond

Caroline.Bond@manchester.gov.uk

Background

An initial referral for a child with a statement for dyspraxia and attention difficulties in a primary school

Lack of assessment and intervention materials for schools

Small OT team and long wait for OT input Specialist teachers and EPs keen to develop

materials to address this need Education project group formed with consultation from

OT team

Areas covered by the programme

Whole School approach comprising:- Primary school audit tool- Resources for classroom staff A targeted motor skills (Wave 2) intervention

comprising- KS1 and KS2 assessment tools- An intervention planning booklet Half day training for SENCo and TA pairs and

follow on practitioners workshops

The targeted interventionThe programme consists of: The MMSA assessment The MMSP targeted interventionIt is for: Children who show signs of gross motor, fine

motor or organisational difficulties Children with a medical diagnosis e.g CP only

included after discussion with an OT The teacher checklist is designed to help select

children to participate and actively involves teachers in observation and assessment

The Manchester Motor Skills Assessment

What do schools need? An assessment that focuses on relevant skills, is quick to complete and informs intervention and assessment of progress

What form should an assessment of children’s motor skills take? Strongest evidence is for cognitive-motor approach to assessment of motor skills (Wilson, 2005)

The best evidenced motor skill norms were used (Crawford et al 2001) where possible

Tools were developed and revised over a year with OTs, teachers and TAs

Inter-rater reliability testing with 37 children in 11 schools found high levels of agreement between researchers and TAs

(Bond, C., Cole, M., Crook, H., Fletcher, J., Lucanz, J. & Noble, J. (2007). The development of the Manchester Motor Skills Assessment (MMSA) – An initial evaluation. Educational Psychology in Practice, 23(4), 363-379)

What does the MMSA look like now?

The process of drafting and re-drafting has lead to: KS1 and KS2 assessment tools focusing on functional

skills relevant to the school context (gross, fine motor skills and organisational skills)

The assessment is designed to be done before the child takes part in a motor skills group and at the end

Children are assessed individually on 10 tasks and each assessment takes approximately 15 minutes

Scoring the assessment

For each item the child is rated on a four point scale, which follows a skill acquisition model

0 = Not able to complete task 1 = Early stage of skill acquisition 2 = Becoming more competent 3 = Fluent Scoring descriptors provide extra detail to enable accurate scoring The assessment helps to:

(a) show progress

(b) help with programme planning A DVD has been developed to support training

The Manchester Motor Skills Assessment

Training DVD example

Using the assessment information 1

Maximum score is 30 Generally 15-18 would be maximum score

for a child with global difficulties to participate in the group

Where a child has specific difficulties in one area the score profile, teacher information and knowledge of group profile used to decide whether the child would benefit from being in the group

Using the assessment information 2

Use individual profiles and knowledge of the children to identify who will work well together in a group

Use profiles to identify key areas for individual children to work on

Balance the range of activities in the session to suit broad needs of the group e.g. more fine motor or organisational tasks

The Manchester Motor Skills intervention Programme

Developed in response to research and school need for:

Intervention programmes with a built in assessment component

Intervention that could be delivered by school staff

Evidence based motor skills programmes Programmes linked to theory of motor skill

learning and development

Running motor skills groups

Ideally have 2 adults running sessions initially Group size: 4 children if 1 adult, or 6 if 2 adults Run sessions daily for 20 minutes 8 weeks or 3-4

sessions per week for 12 weeksStructure (Ripley, 2001) Whole group warm up Paired activities 3x 2 minutes (mix of fine and

gross with individual target setting) Collaborative group cool down activity End of session – review, rewards

Key principles

Emphasis is upon the group being a positive, fun experience to boost confidence

A cooperative approach with frequent opportunities for working together and building relationships

Activities are repeated over 5 sessions to enable children to build fluency

Children’s target setting and tracking sheets enable them to see their own progress

MMSP - Informed by existing literature

Overall structure (Ripley, 2001) Cognitive motor approach (Wright and Sugden,

1998; Sugden and Chambers, 2005) Visualisation strategies (Wilson et al. 2002) Mastery experiences (Bandura, 1994) Active problem solving (Mandich, Polatajko,

Missiuna & Miller, 2001) Frequent practise (Sugden & Chambers, 2005) Praise and reward to boost performance (Crust,

2005)

Follow up

Once children have completed a block of sessions they are reassessed and a decision made whether they would benefit from a further block (some progress) or referral on (no or ltd progress)

Children given a break between blocks and class teachers encouraged to work on some specific areas in order to generalise skills

Some schools have found it useful to run KS1 one term then KS2 the next

How effective is the MMSP? (Bond 2011)

Repeated measures design with 24 children assessed using the MMSA

Pre -------------- T2 ------- T3 -------------- T4

6months Intervention 6 months

Results

T3T2 T4T1

1.5

2.0

2.5

3.0

Effect sizes 0.010 0.603 0.023

Monthly progress

Follow up survey

Development project finished in 2008. All 39 schools that had been part of project surveyed in 2009 with 59% response rate

60% continuing to deliver the motor skills intervention

School level impact was variable External support from the team was rated highly More support requested re handwriting

interventions

Future developments

Training has been revised and continues to be available to schools

Feedback has lead to shift of focus to sustainability and whole school approach

Both the whole school and targeted elements may be published as the Manchester Motor Skills Assessment and Intervention Package

Continued research is needed to build the evidence base in relation to the effectiveness of the intervention, to develop the assessment tool and develop a parent involvement element

Any questions?

References

Bandura, A. (1994). Self-efficacy. In Ramachaudran, V. S. (Ed.) Encyclopedia of human behaviour (Vol. 4, 71-81). New York: Academic Press.

Bond, C., Cole, M., Crook, H., Fletcher, J., Lucanz, J. & Noble, J. (2007). The development of the Manchester Motor Skills Assessment (MMSA) – An initial evaluation. Educational Psychology in Practice, 23(4), 363-379.

Bond, C. (2011) Supporting children with motor skills difficulties: An initial evaluation of the Manchester Motor Skills Programme. Educational Psychology in Practice, 27(2), 143-153.

Bond, C. (in press) Developing provision for children with motor skill difficulties: the role of EPs. Educational Psychology in Practice.

Crawford et al (2001) Identifying Developmental Coordination Disorder: Consistency between tests in Missiuna, C. (ed) Children with developmental coordination disorder:strategies for success. Hawthorn Press:London.

Crust, L. (2005). Imagery: Mental drills for physical people: how recreating all-sensory experiences can profoundly affect your performance. In Walker, I. (Ed.), Sports Psychology: the will to win, 11-25. London: Peak Performance.

ReferencesMandich, A. D., Polatajko, H.J., Missiuna, C. & Miller, L.T. (2001).

Cognitive strategies and motor performance in children with developemental coordination disorder. In Missiuna, C. (Ed.). Children with Developmental Coordination Disorder: Strategies for Success, 125-143. New York: Hawthorn Press.

Ripley, K. (2001). Inclusion for children with dyspraxia/DCD: A handbook for teachers. London: David Fulton Publishers.

Sugden, D. & Chambers, M. (Eds.). (2005). Children with developmental coordination disorder. London: Whurr.

Wilson, P. H (2005) Practitioner Review: Approaches to assessment and treatment of children with DCD: an evaluative review. Journal of Child Psychology and Psychiatry 46:8 pp 806-823.

Wright, H. & Sugden, D. E. (1998). School based intervention programme for children with developmental coordination disorder. European Journal of Physical Education, 3, 35-50