A neurodevelopmental movement programme for 4-8 year old hearing impaired children in the rural QwaQwa region of South Africa Jó-MARIé VAN DER MERWE BOTHMA 23240865 Thesis submitted for the degree Philosophiae Doctor in Psychology at the POTCHEFSTROOM CAMPUS OF THE NORTH-WEST UNIVERSITY PROMOTOR : Dr. M. Dunn CO-PROMOTOR : Prof. S. Kokot NOVEMBER 2012 ACKNOWLEDGMENTS The completion of this study was a culmination of the support, encouragement, love and enthusiasm of many individuals. I would therefore like to express my sincere appreciation and thanks to each of the following: My promotor, Dr. Munita Dunn, for her continued belief in me, encouragement, and support. Her contribution to this study was valuable and respected. Thank you for all your patience. My co-promotor, Professor Shirley Kokot, for her guidance and expertise in the field of neuropsychology and developmental movement programmes. Your passion in this field is contagious. Professor Martin Kidd of the Department of Statistics and Actuarial Sciences at the University of Stellenbosch for his assistance in the data analysis stage of this study. Mrs. Penny Kokot Louw, for the linguistic and technical editing of this study. The children with hearing impairment at the school who enthusiastically participated in the study. You are the ones that this is all about. Mrs. Steyn, for her permission to conduct this study at the school, as well as Mrs. Audrey Vermeulen, Mrs. Karen Kunz and the school staff, for their contribution to the collection of the data. The North West University Financial Support Services, for granting me a postgraduate bursary, which contributed to covering the financial expenses of this study. My family, friends and loved ones (old and new), who have stood by me and encouraged me to follow my dream. Especially my mother who dropped off many nutritious meals whenever she noticed my empty fridge. i My husband, Jacques Bothma, for his continued encouragement, love, support, patience, humour, financial contribution, total understanding and unconditional belief in me. I’ve never met someone that gives me so much space and time to be just who I want to be. Thank you for that. Our precious baby, who made an appearance on an ultrasound just as I was busy wrapping up the last two chapters of this study. Your timing is miraculous! A final thanks and acknowledgement to my Personal Saviour with whom all things are possible. The dissertation was ultimately completed after many self-rewarding treats, countless early morning hours, numerous frothy Rooibos tea cappuccinos and fine Belgium chocolate! ii SUMMARY Being hearing impaired does not only affect a child’s academic performance, but can also influence a child’s overall development and ability to succeed academically. Evidence suggests that the outlay in early childhood has a large impact on a child’s readiness to learn. Neurodevelopmental movement programmes are generally not accepted as evidenced-based practice and their effect on academic performance is often underrated. Movement, however, is regarded by many as essential to learning and there seems to be a positive interchange between the brain and the body. This study reports on the influence of a neurodevelopmental movement programme on the development, behaviour and performance on a neurodevelopmental evaluation scale of four to eight year-old children with hearing impairment children. The study furthermore provides a report of the results of the psychometric assessment in the form of a neurodevelopmental profile for this specific sample. Children were selected from a special needs school in the rural QwaQwa Free State area of South Africa. Two groups of children (an experimental and comparison group) were used in this study, with both groups undergoing a pretest and posttest phase using three test batteries (Griffiths Mental Developmental Scales- Extended Revised, Child Behaviour Checklist, and a neurodevelopmental evaluation scale). The experimental group was subjected to a fourteen-week neurodevelopmental movement programme. The comparison group underwent a placebo intervention. The results indicate that the children in the experimental group showed an improvement in some aspects of specific development following the intervention (locomotor functioning, performance related abilities, and practical reasoning skills). General developmental age showed significant improvement in both the experimental group and the comparison group. No behavioural aspects showed significant improvements following the intervention, whereas some neurodevelopmental aspects, such as the vestibular system (Tandem Walk and One Leg Stand) and the reflex system (TLR – reflex) showed significant improvements. The results of this empirical investigation aid in understanding the impact of movement programmes on a child with hearing disability’s general development and neurodevelopmental development. iii KEY TERMS Neurodevelopment Neurodevelopmental movement programme Sensory motor subsystems Hearing impairment Movement iv DECLARATION OF TERMS Within the context of the study: • The masculine and feminine form of the pronoun is used interchangeably during the literature review and refers throughout to both sexes, except where specifically indicated otherwise. • The term ‘children’ is used interchangeably with ‘learners’ when referring to an educational setting. • The term ‘hearing impairment’ is used interchangeably with ‘hearing loss’, ‘hearing disability’ and ‘deaf’. • The researcher used the past tense in all references to the research process because the research report was finalised after the research process was completed. Referrals to other authors and research studies are generally made in the present tense, depending on the context of the statement, because these statements were seen as still applicable. • The author of this study is referred to as the researcher. v TABLE OF CONTENTS ACKNOWLEDGEMENTS (i) SUMMARY (iii) KEY TERMS (iv) DECLARATION OF TERMS (v) TABLE OF CONTENTS (vi) LIST OF ADDENDA (xii) LISTS OF FIGURES AND TABLES (xiii) CHAPTER 1: Introduction and Overview of Study 1 1.1 Introduction 1 1.2 Problem Statement and Motivation for the Study 9 1.3 Goal and Objectives of Research 10 1.3.1 Research Goal 10 1.3.2 Objectives 10 1.4 Hypotheses for the Study 11 1.5 Research Methodology 12 1.5.1 Research Approach 12 1.5.2 Research Design 13 1.5.2.1 The Social Problem and the Sample 14 1.5.2.2 The Comparison Group Pretest-Posttest Design 16 1.5.2.3 Data Analysis and Dissemination 17 1.6 A Brief Definition of Key Terminology 18 1.6.1 Hearing Impairment 18 1.6.2 Movement 18 1.6.3 Neurodevelopmental Movement Programme 19 1.6.4 Neuroplasticity 19 1.7 Ethical Aspects 19 1.7.1 Avoiding Harm to the Learners 20 1.7.2 Informed Consent and Voluntary Participation 20 1.7.3 Deception of the Learners 21 1.7.4 Violation of Privacy and Confidentiality 22 1.7.5 Actions and Competence of the Researcher 22 vi 1.7.6 Release of the Findings 22 1.8 Contextualization of the Study 23 1.9 Conclusion 24 CHAPTER 2: The Auditory System and Hearing Impairment 25 2.1 Introduction and Chapter Preview 25 2.2 The Structure of the Ear and the Auditory System 25 2.3 Development and Process of Hearing 31 2.3.1 The Mechanism of Sound 32 2.3.1.1 Frequency 33 2.3.1.2 Intensity 34 2.3.1.3 Complexity 34 2.3.2 The Audiogram and Hearing Assessment 35 2.4 Disability and Impairment 38 2.4.1 Hearing Impairment 39 2.5 Incidence and Prevalence of Hearing Impairment 42 2.6 Classification of Hearing Loss 44 2.6.1 The Age of Onset of the Hearing Loss in Relation to Language and Speech Development 44 2.6.2 The Location of the Loss in the Ear 45 2.6.2.1 Conductive Hearing Loss 45 2.6.2.2 Sensorineural Hearing Loss 47 2.6.2.3 Mixed Hearing Loss 49 2.6.3 The Cause of the Hearing Loss 49 2.6.3.1 Prenatal-or Congenital Hearing Causes 50 2.6.3.2 Perinatal Causes 53 2.6.3.3 Postnatal Causes or Acquired Disorders 53 2.7 Amplification 55 2.7.1 Children and Hearing Aids 57 2.8 Education, Language and Communication in Children with Hearing Impairment 58 2.8.1 Auditory-Oral and Auditory-Verbal Approaches 61 vii 2.8.2 Total Communication (TC) 62 2.8.3 Sign-Bilingualism Approach 62 2.9 The Impact of Hearing Impairment 64 2.9.1 Hearing Impairment: Social and Emotional Development 65 2.9.2 Hearing Impairment: Language and Cognitive Development 67 2.9.3 Hearing Impairment: Behaviour Difficulties 68 2.10 Conclusion 70 CHAPTER 3: Child- and Neurodevelopment 71 3.1 Introduction and Chapter Preview 71 3.2 Developmental Constructs 72 3.3 The Development of the Child 77 3.3.1 Neurodevelopment 77 3.3.1.1 The Development of the Nervous System and the Human Brain 78 3.3.1.2 The Organisation of the Nervous System 82 3.3.1.3 Neuron Cells and Myelination 96 3.3.2 Locomotor Development 109 3.3.2.1 The Reflexive / Spontaneous Movement Phase 110 3.3.2.2 The Rudimentary and Fundamental Movement Phase 116 3.3.3 Personal-Social Development 119 3.3.3.1 Erikson’s Psychosocial Theory 120 3.3.3.2 Social and Emotional Development and the Hearing Impaired Child 122 3.3.4 Cognitive Development 124 3.3.4.1 Piaget’s Cognitive Developmental Theory 124 3.3.4.2 Vygotsky’s Sociocultural Theory and the Information Processing Perspective 128 3.3.4.3 Cognitive Development and the Child with Hearing Impairment 129 3.3.5 Language and Communication Development 133 3.3.5.1 Language Development and the Child with Hearing viii Impairment 136 3.3.5.2 A Critical Period in Acquiring Language 139 3.4 Conclusion 142 CHAPTER 4: The Neurodevelopmental Basis of Human Movement and