COD Fine Motor Handout

Hand function is extremely important in the life of people of all ages, as it is critical for increasing their independence in taking care of themselves, doing schoolwork, and most importantly PLAY! During normal development, sensory functioning, visual motor functioning, and postural functioning work together to influence a child's development.

In typical development, the infant gradually learns to use both sides of the body together and independently. The infant first uses his arms in uncoordinated, asymmetric patterns. Next, the infant gradually learns to move the arms together in the same pattern. The next ability the child achieves is to use both arms independently of one another for separate parts of an activity. Finally, the infant will achieve the coordinated actions of both hands. An important example of the child using both arms independently of the other is crawling. Crawling is a very important developmental milestone because it involves the communication of the left and right sides of the brain and promotes weight bearing through the shoulders, arms and hands which is very important for fine motor development and motor coordination. Children who do not bear weight on their open hands do not develop the arches in their hands, which are very important for efficient fine motor function. Inefficient fine motor control is often evidenced by delayed fine motor skills such as poor in-hand manipulation patterns, poor crayon or pencil control and poor use of scissors.

An important fine motor skill is in hand manipulation, which is a series of grasps and releases to move an object held in one hand. This should occur during the preschool years, and the three types of in hand manipulation patterns are as follows:

1) translation- which is the linear movement of the object from fingers to the palm of the hand and back. This should occur by 18 months of age.

2) shift- which is linear movement of the object between fingers, such as turning pages of a book or removing a pen lid with one hand

3)rotation- which is movement of the object around one or more of its axes, such as picking up a pen to use it

Another important part of fine motor efficiency is hand dominance. Dominance begins with a hand preference, which is usually established by 3 years of age. True dominance does not occur until the age of seven, and this is when children usually begin distinguishing between right and left. If dominance is changed from left to right (by someone else, such as making the child use the right hand when he wants to use his left) it may slow the development of the left hand and the child may never develop the same manipulation with the right hand. If a dominance is never established, a child may never develop proficiency in either hand, he may have delayed muscle and joint memory of skilled movements, gross motor skills may be poorer and it may lead to decreased speed and accuracy in test completion. It is normal to do some things with both hands, such as batting with the left and writing with the right, but it is most efficient to be consistent, such as always writing with the right hand and always batting with the left instead of switching hands every time one uses a bat.

While hand preference is being developed, the child begins to develop a pencil grasp. By the age of five, most children develop the pencil grasp they will use throughout their lives. The typical development of pencil grasps is as follows:

2-3 years- digital pronated grasp- the forearm is turned away from the body, the crayon or pencil is held toward the thumb and the shoulder directs the movement.
3½ -4 years- static tripod grasp- thumb opposition is necessary, the crayon or pencil is held between the thumb and two fingers, and the movement comes from the wrist or elbow
5 years- dynamic tripod grasp- thumb opposition is necessary, the crayon or pencil is held between the thumb and two fingers and the movement comes from the hands or fingers
Less mature grasp patterns, such as a static tripod grasp, do not mean that the child has illegible handwriting, only that the he or she probably has poor endurance for writing activities.

When writing, the trunk of the body should be supported, with feet, knees and hips flexed at 90°. The paper should be turned with the right corner higher for right handed people and the left corner higher for left handed people.

Pre-writing occurs as follows:

the child can connect the dots to complete a line
the child can imitate a line (watches someone draw it and then draws it themselves)
the child can copy a picture of the line (the line is already drawn and the child can copy it)
the child can draw lines when asked

Progression of directional lines and shapes are as follows:

spontaneous scribble in a horizontal direction
spontaneous scribble in a vertical direction
spontaneous scribble in a circular direction
imitation of horizontal, vertical line, circle, cross, right to left diagonal, square, left to right diagonal, X, triangle then diamond.

Scissors use is as follows:

child opens and closes scissors appropriately
child cuts short random snips
child cuts straight line
child cuts simple geometric shapes

Using scissors is a skill that is needed for many school related tasks as well as daily living tasks. The mature grip for scissors involve the thumb being up with the middle and ring fingers inserted into the bottom loop of the scissors and the index finger placed below the bottom loop.

Occupational therapists can help with fine motor delays in the above mentioned areas by seeing children for individual therapy sessions, and more importantly by helping parents gain the knowledge necessary to improve their child's fine motor functioning.