The range of the TSMT and HRG exercises have been continuously expanding since their inception in 1993. Parents who are persistent with the therapy and contacted us, confirmed their children’s development.
Similarly to other movement therapies, its mechanism of action is complex as well, and cannot be understood with a one-sided approach. Its main elements are illustrated in the figure below.
Assessment and targeted therapy
Before the therapy is started, in each case a Longitudinal Complex Examination (LongiKid), assessing the child’s age-specific features is performed. This test of nearly 400 developmental skills or milestones will help to accurately determine the child’s profile in the following areas:
Maturity of the nervous system: It examines the child’s profile of primitive reflexes, atypical reactions, as well as subcortical functions of the motor areas of the brain.
Area of motor development: Measures the skills required for the motor coordination and ease of movement in the field of gross motor skills, fine motor skills and graphomotor skills.
Area of cognitive development: It examines 18 skills in 5 areas of attentional functions and serves as a good predictor of successful schooling and, if necessary, provides special educational guidance to parents.
Speech and language development: It is able to determine expressive and inclusive language skills, which in case of delayed speech development or language disorder helps in defining the exact level of input during the process of development.
Psycho-social development: Examines the child’s cooperation, interactions, and involvement in the tasks.
Additional developmental areas: During the training, our examiners with the help of physiotherapists learn the examination of posture and muscle tone, besides, by means of the audiology and visual examination protocol as part of the screening, they can filter out the possibly co-occurring sensory issues as well. In this case, the child is recommended to be referred to additional specialist care.
After the accurate screening results are acquired, we create a personalized treatment plan, in which the individual needs of the family are considered, and later the achievement of the development goals is confirmed by follow-up tests every six months.
In order to function properly as a human, we need a so-called integrated use of our sensory and motor systems. While sensory systems (sight, hearing, smell, taste, touch, proprioception) transmit information from the environment to the cerebral cortex, our motor system responds accordingly to the environment: sometimes reflexively, for example when instantaneously snatching our hand away when touching a hot pot, but sometimes intentionally. Both the sensory and the motor systems are capable of functioning adequately when the information and the given motor response both accurately reflect reality and able to find the optimal performance in response: the best way for our nervous system to learn to coordinate that is through learning.
However, it is very common that due to some external or internal reason (illness, fatigue, extreme stimuli), we cannot process the sensory inputs correctly and the given motor responses become inaccurate.
The denser the nervous system connections between our sensory and motor systems are, the better we can protect ourselves from unexpected events - so even when we are tired, our nervous system is able to compensate with no significant changes in performance.
There may be plenty of reasons why sensory-motor integration has not been completed properly in a child and why he or she is over- or under-responding to some stimuli. The child may also have trouble with the execution of the movement itself. That is why in the case of TSMT and HRG, the child’s visual, auditory, tactile, proprioceptive and vestibular channels are used in all tasks, in both passive and active situations.
Training theory and the regression approach
The TSMT and HRG tasks are not only personalized, but the task difficulty is increasing, which enhances the children’s development. The main feature of individual therapy is the parents’ involvement in the process: they consult the therapist in person on a weekly or at least monthly basis. During these sessions parents and therapist adjust the tasks accordingly, with the child’s personal development goals in mind. The case is similar with group sessions, where the therapist each year aligns the lessons according to the changing individual profile of the children, and the tasks are weighted according to the leading symptoms of a group.
During the training, we place great emphasis on supporting our therapists in mastering the steps and hierarchy of motor development. For this reason, they do not necessarily treat the symptom itself, but – due to the regression approach - go back to the very first point of failure: for instance, if it is the graphomotor skills that are lagging in a child, they will avoid practicing writing exercises with him, or if the child has attention deficit, they will avoid exercises that require his full attention, and gradually move forward to more complex tasks instead.
Since we expect a long-term change in the nervous system due to the tasks, the tasks themselves must be performed regularly – at least three times a week for individual therapy and twice a week in group sessions, using the “training theory for nervous system”, since at least 30-40 repetitions are needed to strengthen a certain synapse. Just think of the effort made when learning a language or when learned to drive until you achieved fluency or mastered driving skills and became able to drive without intentional attention.
In many cases parents who visit us are not aware of their children’s capabilities and do not know what can be expected of them, especially in young children. Most often, the first examination can be helpful, since this is the first time parents realize in which areas their child might lag behind, besides they become aware of the age-appropriate tasks their child can successfully complete.
Both in TSMT and in HRG therapies parents play a key role, for besides performing the exercises, it’s them who make it possible for their children to attend the developmental sessions regularly. For this reason, it is crucial that parents won’t start therapy unless they consider it necessary and understand the developmental goals. This is the therapist’s responsibility to communicate clear goals and highlight for parents the importance of their collaboration.
If this is met, the parent can more easily establish regularity in the process of development, which is not only essential for the improvement, but also provides security for the child, just like the small rituals, the lack of smart devices and the atmosphere of the sessions, which greatly contribute to the attunement in therapy as well.
Often the biggest obstacle is the child’s stubbornness that stands in the way of his or her improvement: “He can pay attention when he wants,” or “he can pay attention when he is interested in something”, parents often say. However, it may lead to serious delays if the child limits his range of interest at an early stage and rejects all cooperation outside of that range, since as a child, he cannot distinguish between his individual interests and his actual needs. Just as we don’t let our kids have sweets all the time, as parents, we should not let the child’s motivation be restricted to certain types of stimulation only. Varied and consciously designed movement tasks that require the child’s cooperation can definitely help parents to achieve that.
In addition to the different exercises, the TSMT and HRG therapists place great emphasis on the use of appropriate vestibular - or equilibrium stimuli. Jane Ayres Ph.D., the creator of Sensory Integration Therapy (SIT), was the first to recognize that in children with certain symptoms (autism, hyperactivity, “clumsiness”), the body’s balance system is affected in some way, and she was the first to consciously use vestibular stimuli, such as swings or hammocks, in the process of sensory integration.
The vestibular system is one of the systems that starts developing at the earliest stage of development of the human body, and its precise functioning does not only serve as a basis for our motor development, but also plays a role in spatial orientation, associative word learning (Grabherr et al., 2011), and the development of mathematical skills (Moeller et al., 2016). Besides, it is equally important in the development of self-awareness (Berthoz, 2000; Jeannerod, 2006) and empathy (Lopez et al., 2000, 2013).
Compared to the previous decades, sedentary lifestyle has become widespread worldwide, severely affecting our children – not providing the adequate amount of stimulation for the vestibular system. Not only can this lead to excessive movement – hyperactivity, but also can cause sensory avoidance in children. Those are children who are scared of climbing on slides, climbing on climbing frames or playing catch with their peers. Our tasks therefore always include a personalized amount of vestibular stimuli, which, in addition to conscious planning of tasks, promotes the maturation of the nervous system through “building from below”, indirectly contributing to the reduction of symptoms.