Fysioterapeuten 8-2020

FYSIOTERAPEUTEN 8/20 15 neighbour next door asking if your child has started to walk yet is wondering, perhaps even judgmental. Or is it only us parents who perceive it that way because we are vul- nerable of criticisms towards our children? Motor difficulties «Diversity in motor development is not a problem, they all learn to walk anyway», some would say. But in contrast, it might play a role in later in life if the child is lag- ging behind. Delayed achievement of motor milestones may be one of the first indicators for motor impairments, but can also be a marker for more global developmental dis- orders (5). As a physiotherapist, I have met these children and experienced how their motor difficulties may be accompanied with social and emotional difficulties, learning difficulties and risk of bullying. Motor dif- ficulties are often identified at school entry, as this is where the struggles have impact on their daily life, like writing, play and sports activities. Nevertheless, this does not mean that their motor difficulties were not present earlier, and also that their difficulties were not detectable at an earlier point. In a follow up study of children with motor difficulties, the authors concluded that: «we were defini- tely wrong in believing that mild to mode- rate problems would have little or no clinical importance in the long run»(6). Hence, the diversity in motor function may be a lifelong problem for the individual. An important question is whether we as a society are com- plicit in the creation and the maintenance of this problem? And if so, how can we deal with it? Time to act? With the proper measures, smaller develop- mental delays can be detected at an early sta- ge both in high risk, and low risk infants (7). One side of early identification is access to a time slot for early intervention. The term «early» is questionable. At what time are we talking about? The development of the brain in the first two years of life is a critical pe- riod, and thus probably a good therapeutic window for early motor stimuli (8). Thus, it’s possible that intervention in this period would be more effective than an interven- tion at a later point. Brain plasticity justifies early intervention – however – the brain is plastic throughout our lifespan. What if an infant with suspected, mild motor difficul- ties will catch up with its peers, if he just gets enough time? (9). And if early intervention was suggested; how comprehensive should an intervention for infants with suspected motor difficulties be? The comprehensiveness of an interven- tion may be dependent on the severity of the delay or difficulties, but how people rate se- verity is probably highly subjective. An alternative perspective – gender- biased motor performance? Can gender be involved when motor func- tion and its diversity are understood and valued? In addition to the biological diffe- rence between the sexes, gender can be un- derstood as identity, symbols and structure. At all these levels, which are affected by material, sociocultural and socio-economic factors, we find conditions that influence health and development (10). Identity is gendered and our self-under- standing is developed in a constant interac- tion with what the environment connects to femininity and masculinity. The envi- ronment is contributing when motor skills are developed and we are all present in a gendered environment. What is considered feminine or masculine are deeply hierarchi- cal, where the latter most often is conside- red superior (11). Motor behaviour is often divided between gross and fine motor skills, where the latter includes grasping and mani- pulating small toys, dressing and the use of cutleries. These are activities often achieved earlier in girls than boys, yet, there seems to be put more emphasis on the acquisition of rolling walking and jumping. Why are we more interested in gross motor skills than fine motor skills? An obvious first thought is that gross motor behaviour is much more visible. Walking is clear and obvious skill while a pincher grasp is barely noticed. La- ter in life, in school and academia, writing rather than running fast or jumping high would be more important. Nevertheless, the gross motor skills seem to be valued more in infancy. Gender can be present in culturally pro- duced symbols or adjectives. Masculinity may be aggressive, ambitious, self-confident, athletic, strong, independent and competi- tive. Femininity may be loving, mild, sensi- tive, shy, understanding, warm, gentle and tender. In terms of motor behaviour, early achievement of motor milestones may be seen as masculine and if so, we need to criti- cally appraise how we rate or evaluate motor function. As a woman, and mother of a girl, I am always already embedded in our cul- tural understandings of appropriate gende- What are we rushing for?

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