"He's just not very coordinated."
"She's out of shape."
Fitness professionals sometimes apply positive or negative labels to children based on a subjective or objective assessment. More than ever, those labels are some version of "unfit" or "physically inept," owing to many factors, including inadequate playtime, a general lack of physical education and poor nutrition. Unfortunately, without the right intervention strategy a negative label may inadvertently derail a child and stymie a natural inclination toward movement. It's our job as caring adults and fitness professionals to validate interest in play and exercise while supporting and encouraging children to be physically active for life. This article explores why it's crucial to rethink the way we assess foundational movement competencies in youth.
Reasons for a Paradigm Shift
Young kids used to have free time, and they spent it being active in unstructured play. Through continual activity, their brains and muscles learned how to work together to climb trees, roll down hills, roughhouse nonviolently with others and participate in a variety of other tasks with competence and confidence. This scenario, sadly, is no longer the norm.
Physical education professionals used to assess kids' capacities for base-level competencies. "You can run, so let's see how fast," "You can do a pushup, so let's see how many you can do" and so on. Tests told us how fit children were, compared with a benchmark standard, and how to stratify programming accordingly.
Today, kids aren't as active as they once were, and fitness professionals are observing a unique trend: Because children are not spending time playing in an enriching environment, they are not developing a foundational level of movement competency. This affects assessments, because the baseline is compromised or even nonexistent.
And yet, despite widespread losses in ability, our assessments continue to focus on the foundational skills in which kids' capacities are dwindling! This thwarts many well-meaning interventions and leads to programming that includes more of the modalities children have difficulties with, thereby reinforcing deficits.
For example, if a child is assessed as being a slow runner, a fitness pro may presume that making the child run more is the solution. While running more can be part of an intervention, odds are that the child has grown up in an area with limited access to safe outdoor areas for play or is not encouraged to step away from computers and TV at home. She likely has little or no access to physical education. And judging by current norms, her parents are probably inactive and lack genetic sports aptitude.
The million-dollar question is this: How would this child have developed the necessary sensory skills of rhythm, body awareness, proprioception or basic biological capacity to become a proficient runner? Judging by the typical modern home environment, when would she have spent hours chasing, crawling, skipping, hopping or doing other enjoyable play-based activities that develop the foundational components of a higher-level movement like running?
Testing for physical benchmark standards is an important aspect of physical assessment. However, fitness professionals must take into account the current state of youth fitness and prioritize both assessment and programming to highlight competency. This is a superior approach to empowering children to become fit.
Assessing-or Screening-Movement Competency
While tests of capacity hinge on quantitative measures (how much, how far, how many), ompetency is better assessed qualitatively. Semantically, screen is a better term than assessment.
Movement screens determine whether a child has ground-level competency for required skills and a variety of movements. A screen doesn't determine how "good" or "bad" a child is compared with other children (assessment); rather, it gauges obstacles to progress.
For example, consider the following qualitative screen, which uses a scale of 1–4:
- The child is consistently unable to perform the skill for a variety of reasons. This score reflects a true developmental detriment that a licensed, board-certified professional needs to address. It's important to note that a score of 1 doesn't merely suggest poor performance; it indicates a complete lack of ability that requires intervention.
- The child is inconsistent with the skill and unable to perform it correctly at least 50% of the time. Regardless of ability, this score suggests that the child can learn; he just needs more practice and time. The intervention might include more activities related to the particular skill.
- The child displays competency in the skill more than 50% of the time. She may be slightly inconsistent, but there is no concern about limitations in respect to the core process of skill development.
- This suggests mastery, meaning that a child demonstrates the skill correctly nearly 100% of the time. A score of 4 is often difficult to attain without guidance. For continued skill development, tasks must become progressively more challenging.
Fitness educators can use this general guideline to determine where limitations lie and can address them either in programming or by outsourcing to an appropriate professional, such as an occupational therapist. The goal is not to have all children attain a 4, but rather to identify children who need more help or progression, and to provide this through programming. Movement competency is targeted so that movement capacity has the opportunity to improve.
When you understand what you're screening for, you can use these criteria informally over time, as well as formally for specific skills. Either way, screening provides valuable information that accurately informs programming so that all children have an opportunity to be fit for life.
The Foundation and Beyond
To prioritize competency within a qualitative screening/assessment plan, fitness professionals must know the most foundational building blocks of physical fitness. The fundamental movement skills involved with locomotion (running, skipping, etc.), stability (postural stability and mobility) and object manipulation (catching, throwing, etc.) are considered the "benchmark" skills for assessment criteria (Gallahue & Donnelly 2003). While these basic skills do create a foundation for physical competency, a child's ability to acquire and retain these skills depends on proper development of a much more deeply-seated system—the collaboration of sensory input with motor output.
Sensory skills, often referred to as perceptual motor skills, hinge on the sensory system's ability to communicate information effectively to the brain and then have the brain coordinate an appropriate motor response (California Department of Education 2014). Motor responses require a child to process multiple sensory inputs. For example: A child sees a beanbag moving toward him (visual sense). This feedback helps him predict where the beanbag will be (temporal sense) so he can move his hand toward it (and catch it). When his hand makes contact with the beanbag, the pressure of his grasp (proprioceptive sense) must be sufficient to secure the weight and size of the bag without it hitting the ground.
All of the above could be considered hand-eye coordination. However, if a child struggles with this skill, it's too easy to label him as "bad" at hand-eye coordination. In reality, he might lack a sensory skill that prevents him from developing competency. Instead of just having him do more hand-eye coordination drills, a fitness educator who understands perceptual motor skills (see the sidebar "Perceptual Motor Skills" for more) might perform basic screens to determine which sensory skills need honing. Research suggests that when perception improves, motor response improves (Thelen 1995).
Considering the importance of perceptual motor skills in forming lifelong physical and cognitive competence, fitness educators must understand, target and utilize a primary screen for these skills. With this information, it becomes possible to create more effective programs for physical development, as well as form referral relationships with licensed professionals such as occupational therapists, in order to prevent children from succumbing to a lifelong battle with ineptitude labels.
The following five screening protocols help determine a child's level of sensory ability in relation to four of the most critical perceptual motor skills. You can perform these protocols either as a base-level screen or as a follow-up when a child displays a deficit in a higher-level skill. Simple and practical, these field screens are quick and easy to administer and will provide useful feedback for modifying programming or recommending outside intervention.
These are not clinical standards. Unless you are a board-certified professional, you are not qualified to diagnose developmental issues. However, fitness professionals can serve as a "first line of defense" to help children get the help they need.
SCREENING FOR VISUAL AWARENESS
Vision is one of the most critical human senses for balance and coordination. If a child's ability to focus is weak or he can't track objects, it can make most physical and cognitive activities difficult. There are many clinical assessments for determining visual competency; however, this screen is simple and fast.
If a child has difficulty with visual processing, she may struggle with any of the following:
- hand-eye coordination (having difficulty with catching/receiving objects)
- reading comprehension (unable to follow lines on page)
- balance (unable to focus on a stable object)
- spatial awareness (unable to perceive space accurately)
Screen for Visual Tracking
- Face the child, roughly an arm's length away.
- Move a finger in the air in nonsequential directions.
- Instruct the child to track the moving finger by moving only her eyeballs. The head does not move.
- After roughly 10 seconds, instruct the child to cover one eye and track only with the open eye for roughly 10 seconds.
- Repeat with the other eye.
Criteria for concern (a score of 1 on the 1–4 scale):
- The eyes cannot consistently track the movement either together or singularly.
- The eyes may "jump" or cease to move, requiring the head to move significantly to track the movement.
SCREENING FOR VESTIBULAR AWARENESS
Vestibular awareness helps us maintain head and body orientation in space as we move, or as the world is moving around us. Without this ability, nearly any activity requiring balance and orientation becomes arduous. While clinical assessment of vestibular awareness involves precise protocols, certain "simple" aspects of vestibular awareness can be screened in the field. The vestibulo-ocular reflex allows the eyes to focus on a target and move in the opposite direction to the head, establishing orientation. If this reflex is not functioning appropriately, the eyes will always follow the head movement. This may make it difficult to balance or focus on objects in a dynamic environment.
If a child has difficulty with vestibular processing, he may experience any of the following:
- poor balance
- poor body orientation
Screen for Vestibular Awareness: Head Rockers
- Have the child partner up with another child or the instructor (instructor is recommended).
- One partner holds a tennis ball or other object about the same size (a finger works, too). The other partner stands an arm's length away.
- The partner holding the ball calls out "right," "left," "up," "down," "diagonal" or "circle" without moving the ball.
- The focusing partner must move his head in the indicated direction, keeping his eyes focused on the ball.
- Repeat for 30 seconds.
Criteria for concern (a score of 1):
- The eyes follow the movement of the head and are unable to focus on the object.
- The eyes focus inconsistently, following the head, though returning to focus on the object.
SCREENING FOR PROPRIOCEPTIVE AWARENESS
Proprioception allows us to create a mental "map" of where our limbs are in orientation to one another at any given time; we make this map using pressure receptors in our joints. If these receptors translate information to the brain ineffectively, it becomes difficult to know where our limbs are in relation to one another, especially as we move. Furthermore, muscle contraction is impaired if joints and muscle tendons don't effectively transmit information about force and velocity.
If a child has difficulty with proprioceptive processing, she may struggle with any of the following:
- poor posture
- general weakness
- coordination and movement proficiency
Screen for Proprioceptive Awareness: 1. Mirrored Limbs
- Stand to the right or left of the child and instruct her to close her eyes.
- Manually move the child's right or left arm in space, following nonsequential patterns.
- Instruct the child to mirror this movement with her other limb.
Criteria for concern (a score of 1):
- inability to match the range, sequence or cadence with the opposing limb
- involuntary resistance to manual movement of the limb
Proprioception also helps us identify traction and compression at joints, providing feedback for proper muscular tone and force to overcome gravity. This is an essential function that may be impaired when pathology is present or if a child is inactive at a young age.
Children are born with primitive reflexes that help them survive while their neuromuscular system is developing. One of these reflexes, the tonic labyrinthine reflex, brings the body into full, rigid extension when the head is tilted backward (Magnus 1926). An engaging physical environment during infancy helps develop manual control over these reflexes, creating voluntary movement. When pathology is present, or a child is inactive, primitive reflexes such as the tonic labyrinthine reflex remain dominant. The result is that the proprioceptive feedback necessary to create muscle tone and strength for voluntary torso extension is diminished or absent. As a result, a child may exhibit poor posture and have difficulty coordinating movement.
The following screen provides feedback about possible difficulties related to an underdeveloped tonic labyrinthine reflex.
Screen for Proprioceptive Awareness: 2. Prone Back Extension
- Have the child lie on his stomach with arms bent, hands palm-down, forehead on the back of the hands.
- Instruct the child to keep his legs and feet on the ground and minimize head movement as he lifts the head and chest off the ground.
- Ask the child to hold this position as long as possible, keeping his legs and feet in contact with the floor and minimizing head movement.
- Time how long he can keep his chest from touching the ground while keeping both feet on the ground.
Criterion for concern (a score of 1):
- Either the child cannot lift his chest off the ground at all, or he displays immediate difficulty or fatigue (in less than 10 seconds).
SCREENING FOR TEMPORAL AWARENESS
Temporal awareness is a sense of timing and rhythm. Any coordinated activity requires a degree of movement timing or precision. For a child who is unable to identify and mirror a rhythm, activities such as running, skipping, dancing and group games can be frustrating. While an inability to dance well or general clumsiness may be common among children, it's still important for kids to display a general sense of rhythm syncopation. If this essential skill is not developed, higher-level skills will be frustrating.
If a child has difficulty with temporal processing, he may struggle with any of the following:
- awkward movement
- poor rhythm syncopation
- lack of "smooth" movement transitions
- poor movement precision
Screen for Temporal Awareness: Clap Syncopation
- Perform a short, syncopated clapping rhythm.
- Instruct the child to repeat the rhythm.
- Repeat 5–10 times with various cadences and rhythms.
Criterion for concern (a score of 1):
- The child is consistently unable to repeat the rhythm syncopations correctly.
A single screen cannot determine overall competency. It's essential to look for patterns of competency through various activities. For example, if a child has consistent difficulty with skipping (a rhythmic, temporal activity), the clap syncopation screen alone cannot determine overall competency with temporal awareness. However, for a child who displays difficulty with rhythmic activities over time, clap syncopation may be a useful part of the screening and intervention process.
A Long, Fit Life
As fitness professionals work with a broad range of children with diverse needs, it's important to target and understand the true foundations of fitness and physical literacy. This knowledge helps to build physical skills as opposed to merely labeling shortcomings. Perceptual motor skills competency is an essential building block that helps kids learn physical and cognitive skills for life. Simple qualitative screens like the ones offered here allow fitness professionals to address concerns with more specialized programming and proper outsourcing to experienced professionals. The result: Frustration is minimized, participation is maximized, labels are eliminated, and children become more confident, competent and physically active for life.
Developmental literature mentions various perceptual motor skills that healthy children normally acquire. The most frequently highlighted (Sabau et al. 2014; Hatzitaki et al. 2002; Bushnell & Boudreau 1993; Gallahue & Donnelly 2003) in regard to physical, cognitive and behavioral development are listed below:
- Body awareness. The child understands the parts of the body and the various ways they move.
- Directional awareness. The child can differentiate between the left and right sides of the body and can move correctly in all planes of motion.
- Spatial awareness. The child senses how much space her body occupies and is able to move comfortably around other people and objects.
- Temporal awareness. The child has a solid sense of timing and can distinguish rhythms, an ability linked to understanding grammar (Gordon et al. 2015); the rhythm of speech appears to help kids sort language into words and phrases. In their best-selling book, SPARK: The Revolutionary New Science of Exercise and the Brain, John Ratey, MD, and Eric Hagerman highlight research in which students who learn to move to complex rhythms experience increases in brain plasticity, improving both coordination and academics (Ratey & Hagerman 2008).
- Visual awareness. The child can focus, track objects and take in the broader field of view. He is also aware of what is happening in the immediate vicinity. Studies have shown that outdoor play and focusing for distance may decrease rates of nearsightedness (myopia) (American Academy of Ophthalmology 2011).
- Vestibular awareness. The child has an internal sense of where the head and body are positioned in relation to gravity.
- Auditory awareness. The child accurately interprets and responds to sound. Studies show that the ability to successfully integrate sound and movement translates to improvements in reading ability (Ahissar et al. 2000).
- Tactile awareness. The child can differentiate objects by size, texture and shape. Also referred to as haptic awareness (Bushnell & Boudreau 1993), this skill includes the ability to respond to touch, either in competitive situations, to counter a move—as in wrestling; or in cooperative partner situations—as in dance.
- Proprioceptive awareness. The child accurately interprets the internal sense of where the body and specific joints are in space and in relation to one another, and what they are doing.
As you can see, perceptual motor skills are critical not only for physical development but for cognitive and behavioral development as well. These skills are the foundation for learning physical and cognitive skills (Sabau et al. 2014) and develop naturally in a sensory-rich physical environment. The best type of environment is one where kids have options, challenges and opportunities to practice using various types of sensory input to create motor outputs (California Department of Education 2014).
Traditionally, kids practiced these skills during "free play," refined them during physical education and applied them at advanced levels by participating in organized activities. The small percentage of children who did not develop necessary sensory skills—because of pathology or a debilitating environment—worked with licensed professionals such as occupational therapists.
Fewer and fewer children are fully developing these sensory skills and, without them, the higher-level skills that enable children to be active for the rest of their lives are much harder to acquire. Moreover, the deficit negatively affects cognitive ability as well.
Statistics on the health and fitness of our nation's youth paint a bleak picture:
- Only about 3.8% of elementary schools, 7.8% of middle schools and 2.1% of high schools offer daily physical education (Kann, Brener & Weschsler 2007).
- Despite the U.S. Department of Health and Human Services' recommendation that children get at least 60 minutes per day of moderate- to vigorous-intensity aerobic physical activity (HHS 2008), it appears that only about 27% of kids achieve this (Kann et al. 2014).
- According to the Centers for Disease Control and Prevention, about 17% of U.S. children aged 2–19 are obese (Ogden et al. 2014).
Here's the back story on these statistics: A growing number of children are experiencing difficulty, frustration and, eventually, disinterest in physical activity as a daily habit. Many fitness professionals are well aware of this unfortunate trend and are passionate about making a change; however, current youth fitness assessments merely reinforce labels of ineptitude.
Ahissar, M., et al. 2000. Auditory processing parallels reading abilities in adults. Proceedings of the National Academy of Sciences, 97 (12), 6832—37.
American Academy of Ophthalmology. 2011. More time outdoors may reduce kids' risk for nearsightedness, research suggests. ScienceDaily. Accessed Oct. 10, 2016. www.sciencedaily.com.
Bushnell, E.W., & Boudreau, J.P. 1993. Motor development and the mind: The potential role of motor abilities as a determinant of aspect of perceptual development. Child Development, 64 (4), 1005—21.
California Department of Education. 2014. Perceptual and motor development domain. California Infant/Toddler Learning & Development Foundation, 1—5.
Gallahue, D., & Donnelly, C.F. 2003. Developmental Physical Education for All Children (4th ed.). Champaign, IL: Human Kinetics.
Gordon, R.L, et al. 2015. Musical rhythm discrimination explains individual differences in grammar skills in children. Developmental Science, 18 (4), 635—44.
Hatzitaki, V., et al. 2002. Perceptual—motor contributions to static and dynamic balance control in children. Journal of Motor Behavior, 34 (2), 161—70.
HHS (U.S. Department of Health and Human Services). 2008. 2008 Physical Activity Guidelines (Chapter 3: Active Children and Adolescents). Washington, DC: U.S. Department of Health and Human Services.
Kann, L., Brener, N.D., & Wechsler, H. 2007. School Health Policies and Programs Study 2006. Physical education. Journal of School Health, 77 (8), 385—97.
Kann, L., et al. 2014. Youth risk behavior surveillance—United States, 2013. Morbidity and Mortality Weekly Report, 63 (4), 1—168.
Magnus, R. 1926. Cameron Prize Lectures on some results of studies in the physiology of posture. The Lancet, 585—88.
Ogden, C.L., et al. 2014. Prevalence of childhood and adult obesity in the United States, 2011—2012. Journal of the American Medical Association, 311 (8), 806—14.
Ratey, J.J., & Hagerman, E. 2008. Spark: The Revolutionary New Science of Exercise and the Brain. New York: Little, Brown.
Sabau, E., et al. 2014. Perceptual—motor development of children in elementary school. Procedia—Social and Behavioral Sciences, 114, 632—36.
Thelen, E. 1995. Motor development: A new synthesis. American Psychologist, 50 (2), 79—95.
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