Review of systems to train psychomotor skills in hearing impaired children Victor M. Peñeñory
Cristina Manresa-Yee
Inmaculada Riquelme
University of San Buenaventura Ave. 10 de Mayo, La Umbria Cali - Colombia +57 4882222
University of Balearic Islands Crta. Valldemossa, km 7.5 07122 Palma +34 9712559721
[email protected]
[email protected]
University Institute of Health Sciences Research, Dep. of Nursing and Physiotherapy University of Balearic Islands +34 971171310
[email protected] Cesar A. Collazos University of Cauca Cll 5 No. 4 - 70 Popayan - Colombia +57 8209900
[email protected]
Habib M. Fardoun University of King Abdulaziz Kingdom of Saudi Arabia 21589 Jeddah +34 655403027
[email protected]
ABSTRACT Research reports psychomotor deficits and delays in hearing impaired (HI) children due to their auditory deprivation and its consequences. In this work, we examine the basic psychomotor deficits in HI individuals and we revise the literature to compile and classify systems that help to train and enhance their psychomotor skills.
CCS Concepts • Applied computing, Life and medical science
Keywords Psychomotor development; impairment; Children
Psychomotor
deficits;
Hearing
1. INTRODUCTION
Daniyal M. Alghazzawi University of King Abdulaziz Information Systems Department Kingdom of Saudi Arabia 21589 Jeddah
[email protected]
the acquisition in motor performance sets the basis for posterior complex psychological abilities, such as the symbolism or the impulsivity regulation. Therefore, the adequate development of basic psychomotor areas, such as body schema (related to body awareness) and body image (related to self-esteem), posture, balance, gross and fine motor skills, space and rhythm may determine the successful achievement of future cognitive, emotional or social processes. The aim of this work is twofold: (1) to examine the basic psychomotor deficits in HI individuals (Section 2) and (2) to revise the literature to compile and classify the systems that help to train and enhance the psychomotor skills in this population (Section 3).
2. PSYCHOMOTOR DEFICITS IN INDIVIDUALS WITH HI
Hearing impaired (HI) children can present hearing loss levels varying from mild to profound [29]. The auditory deprivation and concomitant processes such as vestibular damage may interfere in the sensorimotor function, which produces an especial development of their psychomotor abilities. Research reports deficits and delays for HI children in their psychomotor development in motor skill performance, balance, dynamic coordination, visuomotor coordination, among others [18, 27, 34, 37].
We can classify the psychomotor competences into:
Psychomotricity integrates the cognitive, emotional, symbolical and physical interactions in the individual’s capacity to be and to act in a psychosocial context [15]. During the child’s development,
2.1 Fundamental motor skills
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[email protected]. REHAB 2016, October 13-14, 2016, Lisbon, Portugal © 2016 ACM. ISBN 978-1-4503-4765-5/16/10…$15.00 DOI: http://dx.doi.org/10.1145/3051488.3051515
•
Fundamental motor skills which include coordination, balance, posture, body schema and image. • Perceptual motor skills which include spatial and temporal skills and rhythm. • Cognitive skills which include reasoning and memory. Whereas psychomotricity encompasses a wide set of competences, we focus on those related to motor skills (physical activities), which can be affected by the psyche (mental processes). Motor development, measured by different psychomotor scales, is reported as worse in HI children than in their normal hearing (NH) peers, independently of the cochlear implant use [18]. Although self-efficacy of HI children seems similar to that of NH [14], poor motor performance is related with the quality of symbolic play, language ability and difficulties in social relationships in this population [16, 23]. Posture results from the combination of the internal representation of body orientation in space and the central integration of multisensory inputs. A continuous multisensory feedback provided by the vestibular system (informing about the movements and spatial position of head), the visual system and the proprioceptive
system (informing about the position and movement of the different parts of the body) triggers brain motor commands to adapt to the environmental context, allowing posture stability and balance. Balance is the capacity to control the gravity centre over a particular support and a sensorial environment. It is crucial in the development of many gross motor skills, such as standing on one leg, one leg hoping or running [25]. Children with HI are at risk for balance deficits, which are more important in those individuals with vestibular dysfunction [25]. Thus, it has been reported that static and dynamic balance is poorer in HI than in NH, with reduced limits of stability, higher and faster body sways, and more energy expenditure to maintain stability [5]. In contrast to NH, HI are notably affected by sensory conditions and become strongly visiondependent, mainly in challenging postural situations, such as irregular surfaces [5]. Coordination implies the correct connection in the contraction of muscles groups to perform the interested movements, a gesture or an attitude, inhibiting unwanted movements. There is coordination in gross and fine motor function (i.e. hand, visuomotor, asymmetric movements). Coordination in gross motor function, or the execution of large body movements (ex. running), is likely to be delayed in HI children, although these children reach development levels similar to those of NH children in later ages [22]. HI children showed slower reaction times and presented deficiencies in the coordination of actions requiring accurate visuomotor, spatial and temporal coordination (ex. catching a ball) [35]. HI showed also to be less efficient than NH in learning motor sequencing [24]. Furthermore, neuroimaging studies have shown that auditory deprivation affects motion perception processing [3]. Coordination in fine motor function or manipulative skills, such as manual dexterity is also altered in HI children and tend to be delayed as prelingually HI children get older [19, 24]. As fine motor function has been associated to postimplant expressive and receptive language, Horn et al. [19] suggested that auditory deprivation may lead to atypical development of motor and language skills which share common cortical processing resources.
2.2 Perceptual motor skills Spatial skills, understanding the position of objects in the world and the relationships and transformations of these objects [12], and temporal skills, identifying the timing, order, and sequence of stimuli [30] are very related. HI compensate the lack of auditory inputs with an increased attention of visual stimuli at the peripheral visual field in near space and to central stimuli in far space [9, 32], high location memory [8] and refine touch and visual spatial orientation in the allocentric reference frame (which codes object positions relative to other objects) [39]. Spatial discrimination at midline and lateral positions are highly dependent of the hearing condition [6]. Nevertheless, organization of space seems to be altered in HI. Neuroimaging studies have shown an atypical hemispheric bilateral or left pattern in the control of spatial attention in HI, in contrast with NH which displayed right hemisphere dominance [7, 8]. Zhang et al. [39] stated that while HI showed similar allocentric reference frame than NH, egocentric reference frame (encoding object positions relative to the person’s body) was impaired and egocentric tasks (i.e. goaldirected actions towards the objects) were slower than in NH. Further, it has been broadly recognized that a correct acquisition of spatial language is important for thinking about space. The lack of a conventional language has been related with poor performance on non-linguistic spatial tasks, mainly the tasks requiring the
combination of different mental representations of space [17]. Research shows that HI individuals, especially when they use sign language, may have their spatial abilities enhanced [4], contrary to the temporal ones. Temporal auditory processing is poor in HI. Cochlear hearing loss also decreases the ability to use temporal fine structure cues for detecting non-speech and speech signals among the fluctuating background sounds [28]. Event-related brain potentials revealed less precise phonological representations of rhythm of oral language or location of sign language in HI, compared to NH [10].
3. SYSTEMS TO TRAIN PSYCHOMOTOR SKILLS The search was conducted in the main databases with the following key words: hearing impairments, children, psychomotor and synonyms. During the literature review, we found different contributions to the area of psychomotor training in HI children. To analyze the different contributions, these were classified according to the psychomotor competence to be developed in the child. We classified the works into groups considering the fundamental motor skills (which, in turn is divided into posture, coordination and balance), and perceptual motor skills (which is divided into spatial and temporal skills and rhythm).
3.1 Fundamental motor skills In this section, we present the interactive systems and applications that aimed at training the fundamental motor skills of HI children, which involved coordination, posture and balance. Iversen and Kortbek [20] built an interactive floor addressing children with cochlear implants. They developed two games aiming at calibrating their cochlear implants ant training the language by the development of their body movement in a school setting. Wille et al [38] designed an interactive application using virtual reality for motor rehabilitation of upper body limbs. They evaluated the system with children during 3 weeks. Results showed an improvement in their hand function. They also found that systems based on games encourage children to perform therapy activities without stress. Marnik et al. [26] built a therapeutic and educational tool that used computer vision and graphics for children with developmental problems, e.g. HI children. The system allowed interacting with natural body movements and gestures to interact with the elements of the game. The child performed simple physical exercises or followed instructions, such as “standing on a specified place and rise hands”. Egusa et al. [13] developed an interactive system based on puppets and recognition of body gestures (using a Microsoft Kinect), which allowed HI children to get involved with the story. The aim of the proposal was the development of body expression for deaf children. Radovanovic [33] conducted research on the impact of video games on the visual-motor integration in HI children. An experiment was conducted with 70 profoundly deaf students aged between 7 and 10 years (27 formed the control group). The result of the experiment was that children who were part of the experimental group had a higher score than children in the control group, in activities where visual-motor skills were required. They highlighted the positive effects of the use of video games for the development of these skills in HI children, especially in younger kids. Noorhidawati et al. [31] reported how mobile technologies could impact the psychomotor development of children. In the report they
explored the conditions and learning activities that should ensure mobile apps to interact with children. They conducted an experiment with 20 mobile apps with 18 preschoolers and one of the findings of the experiment was that the use these interactive systems could improve development processes in sensory, physical, emotional and verbal expression. Conner et al. [11] proposed an interactive system using Microsoft Kinect to help children perform a correct body posture before carrying out exercises such as squats. The pilot evaluation showed that children could perform the exercise correctly and correct their body posture when following the instructions of the system. Zhu et al. [40] designed a role-playing collaborative game involving tangible objects that allowed interacting with digital elements. The children through this game could develop their expression and body movements while playing with their team mates fighting against the enemies waving their weapons according to different rhythms.
3.2 Perceptual motor skills When HI children carry out activities involving perceptual motor skills, they can develop a sense of space, time and rhythm. We wound a scarce number of works in this area. Jouhtimäki et al. [21] developed a game called the brave troll, which aimed at supporting deaf children in the acquisition of rhythm patterns that would help later in their language development. Sogono and Richards [36] worked the spatial sense. They designed an electronic game that allowed HI children such as those with only one functional ear, to train localization of sounds in space. Their main contributions were templates for designing this type of multisensory games. Finally, HI children also have problems in understanding abstract concepts like time. Aditya et al [1] started a project to help children with learning disabilities to better understand this concept using objects and visual effects. They made use of smart watches that instead of showing the time in the traditional way, represented it by the activities that the child perform in their daily lives.
3.3 Summary of works Table 1 shows the distribution of the works found by their impact on fundamental motor skills and perceptual motor skills. Table 1. Works according to their impact on fundamental motor skills and perceptual motor skills. Skills
Competences Coordination
Fundamental motor skills
Perceptual motor skills
Works [33]
Balance Posture
[11]
Spatial
[36]
Temporal
[1]
Rhythm
[21, 40]
[13, 20, 26, 31, 38, 40],
4. CONCLUSIONS HI children besides having difficulties in communication and language skills, also have deficits in their psychomotor skills that are important for the normal development of their emotions, actions and social activities. Therefore, it is important to contribute to the psychomotor development or this population.
The aim of this article was to list the problems HI children have and to compile the endeavors being done in the field to show which areas could be enriched with the use of technologies and interactive systems. This review shows there is a lack of proposals of tools to support these children during their therapy or education. Therefore, this encourages us to participate actively in the generation of interactive systems which address the psychomotor development needs of the HI children in a motivating and engaging context.
5. ACKNOWLEDGMENTS This work has been partially supported by the project OCDSCUD2015/07 funded by the University of Balearic Islands and TIN2015-67149-C3-3-R funded by MICINN, Government of Spain.
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