**5.1 Study I**

The first study (Niklasson, *et al.*, 2009) was quantitative, naturalistic and examined whether sensorimotor therapy utilizing the training program RB, might be an appropriate technique for sensorimotor proficiency. The 232 children (181 boys, 51 girls) whose mean age was 9.3 yr. (SD=2.7), presented with attention and motor difficulties (according to the School Health Care) as explained by their parents before starting training. The children were divided into three groups, i.e., a younger group (7yr. old or younger, n=65), a middle group (8 to 10 yr. old n=91), and an older group (11 yr. old or older, n=76). The program has seven categories as explained above (**4.3**). The training period was close to 3 years on average. Analyses in a repeated-measures design indicated significant improvement of sensorimotor skills among the three age groups, but the older children performed better than the others on several tests. There were only a few differences between the sexes. Our conclusion was that RB may be a functional technique for training children and young people with sensorimotor difficulties and might constitute a complement to regular treatment of DCD, Specific Learning Difficulties (SLD), and ADHD, but controlled studies are necessary before more decisive conclusions can be drawn. Therefore, we plan to begin a controlled study in the near future.

#### **5.2 Study II**

The second study (Niklasson, *et al.*, 2010) was qualitative and aimed at gaining an increased understanding of the effects of sensorimotor therapy, using the training program RB, on the physical and psychological development of children and young people. The records of 8 children who had completed the program were randomly selected from a cohort of 232 with sensorimotor difficulties and concentration problems. The participants, 7 boys and 1 girl, averaged 9 years of age. The Empirical Phenomenological method (the EEP-method, Gunnar Karlsson, 1995) was used for the analysis, which resulted in 29 categories which yielded 3 overarching themes: a) the introduction of sensorimotor exercises, b) regression to earlier sensorimotor and psychological behaviors, and c) transformations in which the sensorimotor and psychological skills of the children matured and developed. The themes formed the kinesthetic-vestibular developmental model illustrating how sensorimotor exercises push the therapy process forward with recurrent regressions being followed by positive developmental phases. The results of the study were generalized to the remaining 224 children in the cohort by comparing each individual's records to the kinesthetic-vestibular model.

#### **5.3 Summary**

The aim of the training was to enhance physical maturity and sensorimotor development. Initially, the participants struggled with aberrant primitive/primary reflexes, underdeveloped postural reactions and gross motor milestones all of which were a hindrance in the learning process. Goddard Blythe (2009) is recommended as a learned companion when it comes to a more detailed description of how these phenomena can affect a child's possibilities at school and in its social life. Our quantitative naturalistic study (Niklasson, *et al.*, 2009) showed a significant increase in the physical and sensorimotor maturity of participants after completion of the training. The findings also suggested that problems of concentration and attention should be viewed as connected to sensorimotor difficulties. After training, participants generally performed better at school in reading, writing and physical education although with some children difficulties with mathematics persisted. Regarding improvements in the area of reading and writing, we suggested that not only is the integration of primitive/primary reflexes of importance but also the maturation of the vestibular system due to there being a close connection (Simon, Aminoff, & Greenberg, 1989; Goddard, 2002) between the vestibular apparatus and horizontal tracking required for these skills. As a reminder of this chapter's heading, it is of significant interest that physiological improvements in participants were the results of development which had not previously taken place. By this I mean that participants in the study developed as a child would in its early years of life (as explained in **3.6**) despite them being much older. Results from the qualitative study (Niklasson, *et al.*, 2010) showed psychological improvements shaped as regressions and transformations. Viewed in the totality of the training, the phenomena (of regressions and transformations) were complementary and were labeled as either negative or positive developments. The study identified three periods of regression (negative developments) all of which were followed by transformations (positive developments). Using the concept 'negative development' for regression does not necessarily imply something bad. In this context and in accordance with Kris (1952) who distinguished a regression where the ego itself is in charge, a 'regression in the service of the ego', we suggested the opposite. Regression and progression (Werner, 1957; Loewald, 1981) are complementary and of great importance concerning both organization on the psychological level and physical development (McGraw, 1995). The qualitative study was able to show, for the first time as far as we know, both physical and psychological regressions and transformations in connection with sensorimotor training. But what might be the driving force?
