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  1. HANDS ON Fine Motor Development in the Early Years

  2. Presented By: Karen More OT Reg. (MB) Heather Keeble OT Reg. (MB) Occupational Therapists with the Brandon Children’s Therapy Team Contact Information: Presented At: LIFT conference October 23, 2009

  3. Agenda • Developmental sequence of fine motor and visual motor skills. • Development of grasp patterns. • Fine motor “red flags”. • Steps for Fine Motor success. • Positioning strategies in the classroom.

  4. Agenda 6. Muscle group development and activities. • Hand dominance and dexterity. • Scissor skills. • Keyboarding skills. • Activity centers. • Questions and Evaluation Form

  5. Pre-PrintingSkills • Motor coordination issues affect 5-6% of school aged children • Early intervention often can help to resolve fine motor issues • While the coordination issues may seem subtle in the whole scheme of things; we know that they can have serious academic, social and emotional consequences

  6. School Performance • Study by “McHale & Cermak” (1992), examined the amount of time school-aged children were expected to perform fine motor activities in the classroom • 31-60% of a child’s school day in Grades 2-6 consisted of fine motor activities • 85% of these fine motor activities consisted of pencil & paper tasks • What is the impact on school performance and self-esteem when a child spends 1/3 or more of their school day frustrated due to difficulties with printing skills?

  7. Motor development is a complicated balancing act!

  8. What is realistic to expect at each age range? How do we know we’re challenging but not overwhelming? Visual-Motor Development

  9. Visual-Motor Development

  10. May see: Circle, cross Uses all fingers to hold crayon in the palm. Arm is down but not well planted elbow up. Starts to use opposing hand to stabilize. Starts to guide strokes by watching. Copies lines down and across. The Three Year Old

  11. May see: Copies cross, imitates square Mature grasp starts to emerge – hold with thumb and one or two fingers. Arm is down but elbow remains up. Starts to purposely hold paper with opposing hand. Copies vertical, horizontal lines, circle and cross. Hand dominance emerging or established. The Four Year Old

  12. May see: Copies square, imitates triangle Mature tripod grasp with hand resting on the paper. Purposely holds and adjusts paper with opposing hand. Copies cross, circle, square and triangle. May know some letters (name) and numbers. The Five Year Old

  13. Child progresses to independently draw shapes, pictures, letters, numbers: Triangles by age 6. Letter number reversals corrected by age 7. Diamond accurately drawn by age 7. Uniform letter spacing by age 9. And Beyond

  14. Definitions • Cue / Trace: Make a shape or line using dots or dotted lines as a cue • Imitate: You draw one with the child watching and then the child makes one • Copy: Child is shown a picture and is asked to ‘draw one that looks like this.’ • Draw on Request: ‘Draw a circle.’

  15. Developmental sequence of printing skills • Bangs or scribbles • Scribbles with direction • Imitates vertical & horizontal lines, circle • Copies vertical & horizontal lines, circle • Imitates, copies + • Draws spontaneous forms • Draws face • Imitates, copies diagonals, V

  16. Developmental sequence of printing skills • Imitates, copies Y • Imitates, copies X • Draws stick figure • Identifiable objects (ex. Happy face, sun) • Imitates, copies square • Copies name in large irregular letters • Copies numbers

  17. Can hold a pencil in writing position: What does that look like? Good postural control Hand preference evident When they can form the basic strokes: Vertical, horizontal, circular, cross, diagonal. All necessary for letter formation. Sufficient attention, cognition and interest. When are kids ready?

  18. Development of Pencil/Crayon Grasp Least Mature GraspMost Mature Grasp

  19. Teaching The Tripod Grasp Teach the tripod grip in the following manner: Place the pencil on the desk with the lead pointing towards the printing (dominant) hand. Pinch the pencil close to the tip with the tip of the thumb and index fingers Flip the pencil over to rest behind the the first (proximal) knuckle of the index finger. Tuck the middle finger under the pencil Pinch Flip Tuck


  21. Fine Motor “Red Flags” • No preferred hand dominance established • Inability to print/copy name • Inability to copy lines and simple shapes • Immature pencil grasp

  22. Fine Motor “Red Flags” • Immature self portrait • Unable to generally color within the lines (i.e. random scribbling) • Inability to use tools correctly (crayons, scissors, pencils, buttons) • Signs of poor finger dexterity: • Difficulty rotating objects in the hand with fingers • For example, uses two hand to turn pencil to use eraser instead of rotating pencil in hand • Inefficient pencil grasp • Difficulty turning pages

  23. This early work lays the foundation for later school and life success. The challenge is to foster development while making it seem like fun. This is not “just printing!”

  24. 7 Steps to Fine Motor Success • Stability of trunk, shoulder and elbow • Wrist extension • Grasp (pincer and tripod) & release • Arches of the hand/separation of 2 sides of the hand • Finger isolation • Thumb opposition and web space • In hand manipulation “Stability before mobility”

  25. Start with Position • Check how child is positioning him/herself for the activity. • Do they have adequate support? • When postural control is affected, arm movement and fine motor control are often impacted. • May see: • Rounded back, resting head on hand, resting trunk forward on desk, constant repositioning, leaning on walls, friends or teachers.

  26. Positioning Strategies • At the table: (sometimes easier said than done!) • Feet flat on the floor, hips/knees bent at 90° • Table height, about 2 inches above the level of the elbows • Placing items on a slanted surface or working in vertical may encourage more upright posture.

  27. Seating Position

  28. Positioning Strategies • On the floor: • Cross legged sitting more stable than long sitting or side sitting • Back supported against a wall may be best for some children • Mats/carpet pieces to provide some cueing as to boundaries

  29. The Value Of Vertical • “Children learn on their feet, not their seat!” • Supports the “Three’s Company” = eyes & hand on the same plane • There are many activities that promote fine motor development that can be completed at a vertical surface, e.g. painting, stamping, coloring, tracing, connect the dots, printing, etc. • Avoids “gaze shift”, better for someone with “low tone”, and promotes neutral wrist position • Doing activities in the vertical allows small muscles of the hand to develop, which is important to develop a mature pencil grasp

  30. “Fine Motor” Pre-requisites • Good general trunk tone and strength for good position and alignment. • Adequate shoulder, arm and wrist strength in order to stabilize and use the fingers. • Bilateral coordination between the helping hand and the doing hand.

  31. Indicators of Poor Core Strength: • “Leaners” • “Slouchers” • Appear lethargic • Trouble carrying items / objects • Rest head on hands • Move constantly in their chairs

  32. Core Strength Activities: • Working on a vertical surface for flannel boards, painting chalk, or white boards • Large motor games • Wheelbarrow / animal walks • Playground equipment • Alternate positions • Lying on tummy, kneeling • Mov n’ sit cushions

  33. Indicators of Shoulder Girdle Weakness • Keeps elbows tucked • Rests elbow on chair when raising arm • Supports raised arm with other hand • Trouble with large movements on the chalkboard • Move their paper during writing / drawing tasks instead of their arm • Blackboard lines are shaky and uncontrolled

  34. Shoulder Girdle Activities: • Work on vertical surfaces • Large Motor Games • Tug of war, Push-Pull activities • Weight-bearing Activities • Chair push ups, wall push ups, lying on the floor when doing activities

  35. Indicators of Poor Forearm Control • Whole arm movements observed • Forearm is lifted off the surface • ‘Thumbs Down’ when cutting • Elbow ‘lifters’

  36. Forearm Control Activities: • ‘Thumbs Up’ Activities • Shaking Hands, holding thumb’s up, turning doorknobs • Slanted writing surfaces • Drawing / coloring while in prone (i.e.. on tummy) • Pouring activities

  37. Indicators of Poor Wrist Control • Bent wrist during paper and pencil activities • Moves excessively during coloring activities • Wrist bends during cutting

  38. Wrist Control Activities: • Play dough • Writing above eye level • Using rolling pins • Stamp and Ink pads • Cutting activities • ‘Strong hand’ ideas

  39. Indicators of Poor Bilateral Coordination • Does not hold their paper • Trouble guiding paper when cutting • Difficulty opening containers • Difficulties with fasteners i.e.) buttons, tying shoes, double sided zippers • Difficulty using a ruler

  40. Bilateral Coordination Activities: • Stringing beads • Playing musical instruments • Using a rolling pin • Finger plays • Clapping and rhythm games

  41. Hand Preference – Doer Hand • By kindergarten like to see at least a preference developing. • Cases of a child being truly ambidextrous are rare i.e. being able to do tasks equally well with either hand. • Observe which hand leads in many different activities. Self feeding, catching, giving something to others

  42. Encourage, never force a hand preference. Talking about the different jobs our hands do at group time raises awareness Doer hand and helper hand Demonstrate how both roles are really important to get things done i.e. scissoring, holding paper when coloring, holding while block building Hand Preference Activities:

  43. Indicators of Poor Dexterity • Poor pencil grip • Production of large letters • Poor pencil control • Difficulty with Self help i.e..) opening lunch containers • Difficulty with scissor use

  44. Games (Don’t Spill the Beans, Ker-Plunk, marble runs) Coins in centre play Craft Activities (process not end product) Construction toys/blocks Store Centre incorporates many dexterity activities Puzzles Play dough Stringing and lacing activities with beads, pasta, cereal on pipe cleaners, string waxed string. Dexterity Activities: