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Stack #4505334
FINE MOTOR SKILLS
| Term | Definition 1 | Definition 2 |
|---|---|---|
| SENSORIMOTOR DEVELOPMENT | ● Process by which children learn to coordinate their sensory systems with their motor actions | |
| First 6 Months | ● Postural Control ● Somatosensory Skills ● Eye-hand Coordination ● Reflexive to Voluntary, Goal-oriented movement patterns | |
| 6-12 Months | ● Infants become more mobile ● Fine motor and motor planning skills ● MIDLINE SKILLS ● Auditory perceptions are heightened ● Gustatory and olfactory perceptions are integrated | |
| 1-2 Yrs | ● Tactile discrimination and localization becomes more precise ● Conceptualization develops through symbolic gesturing and vocalization ● Motor planning becomes more complex ● Motor planning contribute to self-concept | |
| 2-3 Yrs | ● Improved balance and postural control ● Further development of fine motor skills ○ Start of prewriting skills ● Praxis ideation also progress ○ They begin experimenting actions ○ Pretend play | |
| 3-7 Yrs | ● Sensorimotor competencies are challenged ● Social development and self-esteem ● Mastery and adaptation of skills ○ Mastery of handwriting, tool use, bilateral coordination, etc. ○ All of which contributes to social development and self-esteem | |
| INFLUENCES ON DEVELOPMENT OF HAND SKILLS ● Person: | intrinsic abilities and body functions | |
| INFLUENCES ON DEVELOPMENT OF HAND SKILLS ● Task: | nature and demands of the task | |
| INFLUENCES ON DEVELOPMENT OF HAND SKILLS ● Environment: | social, cultural, etc. | |
| Visual Skills | ○ Visual-motor coordination | |
| Visual-motor coordination | - learning new motor skills and refinement for accuracy and precision | |
| Somatosensory Functioning | - sensory systems of the skin, muscles, joints, and connective tissue that provide the brain with information about the body and its interaction with the environment ○ Tactile functions ○ Tactile and proprioceptive functions | |
| Tactile functions | - awareness of the characteristics of the object through touch and influence ability to hold | |
| Tactile and proprioceptive functions | - initiating and sustaining grasp | |
| Sensory Integration | ○ Sensory processing problems | |
| Sensory processing problems | - limit active manipulation of objects and motor planning skills | |
| Visual Perception and Cognition | ○ Awareness and knowledge about the object ○ Attentional control and problem solving | |
| Skeletal Integrity | ○ Hand joints ○ Bone integrity | |
| Muscle Function | ○ Muscle strength and endurance ○ Muscle tone | |
| CONTEXTUAL FACTORS AND HAND SKILLS 1 | ● Socioeconomic Status ● Gender and Role Expectations ● Importance of Objects to a Cultural Group ● Varied Age Expectations | ● Cultural Perception of the Need for ● Manipulative Materials ● Reasonable exposure to a variety of materials with the opportunity to handle them |
| contextual factors | these affect exposure to the exploration and use of a variety of objects and materials that influence the development of hand skills | |
| HAND SKILLS - EVALUATE FACTORS | ● Neuromuscular functions ● OPF (Ocular-physical findings) ● Crossing the midline ● Laterality ● Eye-hand coordination ● Arm-hand coordination ● Manual dexterity | |
| Neuromuscular functions | ○ Range of motion (ROM) ○ Functional strength (UE / LE) ○ Muscle bulk ○ Muscle tone ○ Functional grip and pinch strength | |
| OPF (Ocular-physical findings) | ○ Eyes, extremities, posture, gait, symmetry ○ Neurological signs ○ Scars, wounds, leg length discrepancy, splints, dislocation, subluxation | |
| Neurological signs: | drooling, cortical thumb | |
| Crossing the midline | - ability to move the hand/arm across the center of the body to the opposite side | |
| Laterality | ○ Hand Preference ○ Hand Dominance ○ Handedness | |
| – 2 to 4 years | Hand Preference | |
| – 4 to 6 years | Hand Dominance | |
| 6 years old | Handedness | |
| Eye-hand coordination | ○ shooting a bead in a hole | |
| Arm-hand coordination | ○ throwing the ball | |
| Manual dexterity | ○ Pick up small objects, buttoning, zipping, tying shoelaces | |
| Reach and Carry | ● Reach ● Sequence of Development ● Carrying (moving and lifting) | |
| Reach | ○ Transporting the hand to the target with precision (time and space component) | |
| Sequence of Development | ○ Visual Regard ○ Random arm movements ○ Swiping and batting of objects ○ Reaching with extended arm ○ Midline orientation of the hands ○ Symmetric bilateral reaching ○ Unilateral Reaching | |
| Midline orientation of the hands | ■ Initially hands are held close to the body | |
| Symmetric bilateral reaching | ■ Can happen in supine or sitting position | |
| Unilateral Reaching | ■ Dissociation of the 2 sides of the body during movement happens | |
| Carrying (moving and lifting) | – smooth coordination of body movements accompanied by stabilization of the object in the hand | |
| CLASSIFICATIONS OF GRASPS | ● Nonprehensile vs. Prehensile Movements ● Precision vs. Power Grasps | |
| Nonprehensile | - pushing or lifting an object with the finger or the entire hands | |
| Prehensile | - involves grasp of an object and subdivided according to the purpose of the grasp | |
| Precision | - opposition of thumb and finger | |
| Power | - use of entire hand | |
| TYPICAL DEVELOPMENT OF GRASP 1 | ● Ulnar – Palmar – Radial | |
| TYPICAL DEVELOPMENT OF GRASP 2 | ● Palmar contact – Finger Surface Contact – Finger Pad Contact | |
| TYPICAL DEVELOPMENT OF GRASP 3 | ● Use of long finger flexors to increasing control of intrinsic muscles with extrinsic muscles | |
| TYPICAL DEVELOPMENT OF GRASP 4 | ● Mass – hook – spherical – cylindrical – pad to pad – tip to tip – tripod | |
| RELEASE | ● To release, arm must move into position accurately and stabilize as fingers and thumb extend ● Depends on control of arm and hand movements | |
| Involuntary release | – dropping or forcibly removing | |
| Releasing of objects with stabilization | ■ Hand – mouth – other hand ■ Other hand stabilizes object before release | |
| ■ Happens at 9 months | Releasing of objects without stabilization | |
| GROSS PREHENSION PATTERNS | ● Hook Grasp ● Spherical Grasp ● Cylindrical Grasp | |
| FINE PREHENSION PATTERNS | ● Lateral Pinch ● Pad to Pad Pinch ● Tip to Tip ● Three-Jaw Chuck | |
| IN-HAND MANIPULATION SKILLS | ● Translation ● Shift - linear movement (pencil) ● Rotation ● With Stabilization | |
| Translation | ○ finger to palm translation ○ palm to finger translation | |
| Rotation | ○ simple rotation ○ complex rotation | |
| simple rotation | - turning object 90° or less | |
| complex rotation | - 180°-360°, could be rotating once or repeatedly rotating (opening containers) | |
| BILATERAL HAND USE | ● Symmetrical ● Reciprocal ● Differentiated Asymmetrical ● Crossing the Midline | |
| Reciprocal | - hands take turn in movements (climbing ladder, biking) | |
| GRADING OF HAND SKILLS - Grade G | Can assume, maintain, AND use | |
| GRADING OF HAND SKILLS - Grade F | Can assume AND maintain BUT cannot / has difficulty in use | |
| GRADING OF HAND SKILLS - Grade P | Can assume OR maintain, BUT with difficulty / needs assistance | |
| GRADING OF HAND SKILLS - Grade A | Cannot assume or maintain | |
| STAGES IN LEARNING TO COLOR 1 | PICTURE AREA - covers a large paper with color STROKE CONTROL - uses random lines USE OF COLOR - n/a | |
| STAGES IN LEARNING TO COLOR 2 | PICTURE AREA - covers an “81/2 x 11” piece of paper w/ color STROKE CONTROL - colors grossly, using one stroke direction USE OF COLOR - uses random color | |
| STAGES IN LEARNING TO COLOR 3 | PICTURE AREA - colors a medium-sized area or picture STROKE CONTROL - colors with more consistent direction USE OF COLOR - uses several colors | |
| STAGES IN LEARNING TO COLOR 4 | PICTURE AREA - colors a small area (geometric) STROKE CONTROL - accommodates the paper stroke USE OF COLOR - begins to use some appropriate colors | |
| STAGES IN LEARNING TO COLOR 5 | PICTURE AREA - colors medium-sized design STROKE CONTROL - n/a USE OF COLOR - n/a | |
| STAGES IN LEARNING TO COLOR 6 | PICTURE AREA - colors small design with attention to detail STROKE CONTROL - adjusts the stroke to fit the area, keeping the paper still USE OF COLOR - uses appropriate colors | |
| TOOL USE | ● Requires in-hand manipulation and cognitive skills ● Requires the use of both hands (lead-assist hand) | |
| Developmental Stages of Cutting - 2 yrs old | Snipping | |
| Developmental Stages of Cutting - 2.5 yrs old | Cut across a 6in piece of paper | |
| Developmental Stages of Cutting - 3-3.5 yrs old | Cuts a circle | |
| Developmental Stages of Cutting - 4.5-5 yrs old | Square | |
| Developmental Stages of Cutting - 6-7 yrs old | Complex cutting skill | |
| Developmental Sequence of Cutting -1 | shows interest in scissors | |
| Developmental Sequence of Cutting -2 | holds and manipulates scissors appropriately | |
| Developmental Sequence of Cutting -3 | opens and closes scissors in a controlled fashion | |
| Developmental Sequence of Cutting - 4 | cuts short, random snips | |
| Developmental Sequence of Cutting -5 | manipulates scissors in a random fashion | |
| Developmental Sequence of Cutting -6 | coordinates lateral direction | |
| Developmental Sequence of Cutting -7 | cuts a straight forward line | |
| Developmental Sequence of Cutting -8 | cuts geometrical shapes | |
| Developmental Sequence of Cutting -9 | cuts simple figure shapes | |
| Developmental Sequence of Cutting -10 | cuts complex figure shapes | |
| Developmental Sequence of Cutting -11 | cuts non-paper materials | |
| COMPONENTS OF CUTTING | ● Grasp or prehension of the scissors ● Lead-Assist Hand Use ● Paper-scissors relationship ● Cutting Skills | |
| Lead-Assist Hand Use | ○ Assist hand is more active, holds the paper and orient it through the rotation (iniikot ung paper) | |
| HOLDING THE SCISSORS 1 | ● THUMB on the upper handle and the INDEX FINGER or INDEX AND MIDDLE FINGER on the lower handle, while the others are gently flexed | ● THUMB on the small loop, MIDDLE AND RING FINGER through the larger loop, index finger curled over the larger loop or extended to the scissors for stability, while the others are curled into the palm for strength |
| PAPER - SCISSORS RELATIONSHIP; EARLY DEVELOPMENT | ● Paper is initially held against the table for support ● Paper is held in place and the scissors are moved to accomplish the task | |
| PAPER - SCISSORS RELATIONSHIP; TYPICAL PATTERNS | ● Scissors being maintained in a relatively stationary position and the paper is moved to accommodate the cutting action | ● Holding the paper in front of the blade, holding it behind the blade, holding it so it crosses over the scissors, and holding it in multiple positions in relation to the blade |
| Two Major Types of Cutting Motion | ○ short, segmented action – snipping ○ longer gliding action that is more continuous in nature | |
| CUTTING ACTION; TYPICAL PATTERN | ● Appropriate combination of short, segmented cuts integrated with longer gliding actions ● Cutting in forward motion | |
| CUTTING ACTION; ATYPICAL PATTERN | ● Snip, return to the edge of the paper, and restart the cutting multiple times | |
| BALL SKILLS | ● Reflect the child’s ability to use voluntary release skills | |
| DEVELOPMENTAL SEQUENCE | ● Throwing a ball forward ● Throw a ball at 3 ft distance ● Throw a ball at 5 ft distance ● Overhand throw to a target ● Underhand throw to a target | |
| PEABODY DEVELOPMENTAL MOTOR SCALES | ● Standardized rating scales of gross and fine motor development ● Provides qualitative and quantitative measures ● Norm-referenced tool containing 249 items ● Helpful for monitoring progress | |
| PEABODY DEVELOPMENTAL MOTOR SCALES Population: | children, ages birth to 5 years, with motor, speech-language, and/or hearing disorders | |
| SUBTESTS ● Reflexes | (8 items, birth to 11 months) | |
| SUBTESTS ● Stationary | (30 items, sustain control of his body within its center of gravity) | |
| SUBTESTS ● Locomotion | (89 items, crawling, walking, running, hopping, and jumping) | |
| SUBTESTS ● Object Manipulation | (24 items, throwing, kicking, and catching a ball, 12 months and older) | |
| SUBTESTS ● Grasping | (26 items, one hand to two hands) | |
| SUBTESTS ● Visual-Motor Integration | (72 items, building blocks, copy a design, etc.) | |
| 3 GLOBAL INDICES OF MOTOR PERFORMANCE ● Gross Motor Quotient | (3 of 4 subtests) | |
| 3 GLOBAL INDICES OF MOTOR PERFORMANCE ● Fine Motor Quotient | (grasping and visual-motor integration) | |
| 3 GLOBAL INDICES OF MOTOR PERFORMANCE ● Total Motor Quotient | (combination of gross and fine motor subtests) | |
| TEST OF INFANT MOTOR EVALUATION (TIME) | ● Miller, L. J., & Roid, G. H. (1994) ● Measures the motor abilities of children ages 4 months to 3.5 years. ● Designed to measure neuromotor changes in children who have atypical development | |
| TEST OF INFANT MOTOR EVALUATION (TIME) Assesses: | ○ Mobility ○ Stability ○ Motor organization ○ Functional performance ○ Social-emotional abilities | |
| QUALITY OF UPPER EXTREMITY SKILLS TEST (QUEST) | ● DeMatteo, C., Law, M., Russell, D., Pollock, N., Rosenbaum, P., & Walter, S. (1992) ● Designed to evaluate movement patterns and hand function in children with cerebral palsy from 8 months to 8 years of age | |
| QUALITY OF UPPER EXTREMITY SKILLS TEST (QUEST) 4 domains: | ○ Dissociated movements ○ Grasp patterns ○ Protective extension reactions ○ Weight-bearing ability | |
| MOTOR PROBLEMS - INADEQUATE ISOLATION OF MOVEMENTS | ● use total patterns of flexion or extension throughout the upper extremities ● unable to combine wrist extension with finger flexion or elbow flexion with finger extension ● unable to perform differentiated movements with each arm and hand | |
| MOTOR PROBLEMS - POORLY GRADED MOVEMENTS | ● difficulties in appropriately adjusting the force needed for grasp or release ● lack of ability to use the middle ranges of movement effectively ● associated with tactile sensory problems, abnormal tone, and/or muscle weakness | |
| MOTOR PROBLEMS - INSUFFICIENT FORCE INTERFERES WITH GRASP CONTROL | ● difficulties with regulation of force may be due to poor tactile discrimination and/or spasticity ● muscle weakness | |
| MOTOR PROBLEMS - POOR TIMING OF MOVEMENTS | ● Improper timing of muscle contractions leads to the use of movements that are too fast or too slow for the intended purpose | |
| MOTOR PROBLEMS - LIMITED VARIETY OF MOVEMENT PATTERNS | ● restricted repertoire often associated with biomechanical or neurologic issues affecting movement range and/or coordination | |
| MOTOR PROBLEMS - DISORDER IN BILATERAL INTEGRATION OF MOVEMENTS | ● Inability to bring both hands to midline effectively or to maintain the use of both hands at midline long enough to accomplish a task ● other children can hold objects symmetrically at midline but are unable to dissociate arm movements | |
| MOTOR PROBLEMS - LIMITATIONS OF TRUNK MOVEMENT AND CONTROL | ● impair development or effective use of equilibrium reactions ● trunk instability or abnormal posture results to difficulty with smooth, accurate placement of the hand and arm being used for a fine motor task | |
| SEQUENCING OF INTERVENTION SESSIONS - PREPARATION | ● Positioning of the child (the whole body, to just hands) ● Attending to postural tone issues ● Improving postural control (pelvis, shoulder, head) ● Improving muscle strength | |
| SEQUENCING OF INTERVENTION SESSIONS - DEVELOPMENT OF HAND SKILLS | ● Promoting isolated arm and hand movements, such as external rotation, supination, and wrist extension ● Enhancing reach, grasp, carry, and release skills ● Enhancing in-hand manipulation skills | ● Facilitating bilateral hand use skills ● Generalizing skills (integration of hand skills into functional activities) |
| POSITIONING | ● Consider the optimal position for eliciting the particular skills desired in that child and the position in which the child will use the skills | |
| Supine Position | – arm movements and visual regard | |
| Prone on Elbows | – shoulder stability and cocontraction in 90° of elbow flexion, dissociation of the two sides of the body during weight bearing on one arm while manipulating with the other, gross bilateral manipulation of objects, and visual regard of the hands | |
| Side-lying | - unilateral arm movement to bat at an object and for hand-to-hand play | |
| Sitting Position | – for fine motor skills use ; stable chair with adequate foot support | |
| IMPROVING POSTURAL TONE AND CONTROL | ● inhibitory or facilitation techniques ● UE weight bearing for improving postural control and stability; increase overall stability | ● Slow rotatory movements using small ROMs between: ○ SH internal and external rotation ○ Forearm pronation and supination |
| IMPROVING MUSCLE STRENGTH | ● Improving strength may improve skilled hand use in children ● focus on strength needs to be addressed carefully in children with tone problems, because a primary focus on strength would diminish focus on coordination | |
| PROMOTING ISOLATED ARM MOVEMENTS | ● Address specific movements in the upper extremity apart from specific hand skills | |
| Problems in supination results to | abnormal posturing at the trunk, shoulder, elbow, or wrist | |
| 30 | for children with more severe involvement, ___ of supination is achievable , the minimum amount needed to handle materials on a table effectively | |
| 90 | for children with less motor impairment, encourage to obtain and use at least ___ of supination to accomplish functional activities | |
| REACH AND CARRY PROBLEMS | ● use of abduction and internal rotation to initiate reach ● use of shoulder elevation and lateral trunk flexion to increase the height of the arm for reaching and carrying | ● inability to coordinate the degree of hand opening or the hand position with the timing of the reach ● difficulty maintaining an upright body posture when reaching or carrying forward or across the midline |
| REACH AND CARRY PROBLEMS; INTERVENTION 1 | ● controlled initiation of arm movements | ○ positioning for postural stability and visual regard ○ initial emphasis is on general arm movement – hand and arm placement – finger extension |
| REACH AND CARRY PROBLEMS; INTERVENTION 2 | ● introduce structured activities to assist the child in using elements of a more mature reaching pattern | ○ placement of objects in relation to body that allows best reaching pattern |
| REACH AND CARRY PROBLEMS; INTERVENTION 3 | ● improve sustained trunk control in the midline and trunk rotation with arm movements to decrease compensatory movements in carrying | ○ Consider stabilizing SH to prevent scapular elevation, etc. |
| REACH AND CARRY PROBLEMS; INTERVENTION 4 | ● mobile arm support systems | |
| REACH AND CARRY PROBLEMS; INTERVENTION 5 | ● provide objects that have high color contrast or bright, solid colors to children with visual impairment | |
| GRASP PROBLEMS | ● Fisting or finger flexion, prevents hand opening ● Wrist flexion w/ finger ext ● Excessive forearm pronation, interferes use of radial finger grasp patterns ● Thumb adduction in grasps that should use opposition, often w/ MCP or IP flexion | ● Inability to use thumb abduction and adduction w/ MCP & IP ext ● " initiate/sustain thumb opposition ● " use grasp patterns that control the intrinsic finger muscles ● " vary grasp in accordance with object characteristics and activity demands |
| GRASP PROBLEMS; INTERVENTIONS | ● match preparation techniques, such as positioning, handling, or strengthening, to the child’s problem ● grading tactile input from well tolerated to more difficult to tolerate ● have the child actively explore sizes, shapes, and textures of objects | ● when selecting objects, keep in mind the child’s interests, sensory needs, and motor skills ● Splinting ● Adapted materials |
| Positioning strategies for effective grasp | ○ Side-lying Position ○ Supported Sitting | |
| Side-lying Position | - reduce stress on overall body posture and facilitates opening of hand easily | |
| Supported Sitting | - opening of hand is easier object is placed below the seat of the chair and lateral to the child’s body ; wrist extension is emphasized with grasp by positioning objects above the table surface or at chest height | |
| VOLUNTARY RELEASE PROBLEMS | ● Fisting and tight finger flexion ● Difficulty with sustained arm position during object placement and ● release ● Difficulty combining wrist extension with finger extension | ● Inability to use slight forearm supination to allow for release in small areas or near other objects and with visual monitoring of the placement ● Overextension of the fingers in release, limiting control of specific object placement |
| VOLUNTARY RELEASE; INTERVENTIONS 1 | ● FOCUS: hand opening, arm placement and stability, accuracy of object placement | |
| VOLUNTARY RELEASE; INTERVENTIONS 2 | ● splinting may be helpful in supporting the child’s wrist or facilitating increased wrist and finger extension | |
| high tone and fisting or muscle weakness | - tenodesis | |
| fisting | – focus on the ability to move the arm while maintaining some finger extension; use large objects; releasing to the side of the body; release into a container with a large opening | |
| for those who use tenodesis pattern | – increase voluntary finger extension while sustaining the wrist in neutral | |
| for those who use wrist flex with voluntary release | – placement of container lateral to midline at a sufficient distance to promote elbow extension | |
| IN-HAND MANIPULATION SKILLS PROBLEMS | ● Limited finger isolation and control ● Inability to effectively cup the hand to hold objects in the palm | ● Inability to hold more than one object in the hand at the same time ● Insufficient stability for controlling object movement at the finger pads, resulting in objects being dropped frequently |
| IN-HAND MANIPULATION SKILLS PROBLEMS; INTERVENTIONS | ● encourage the child with no in-hand manipulation skills or only finger-to-palm translation to manipulate objects between the two hands and use support surfaces to assist in object manipulation | ● use objects that do not roll and that are small (not tiny) are often the easiest for the child to handle |
| Palm-to-finger Translation | – first place object on the middle phalanx of the child’s index finger - volar surface of the proximal phalanx – palm to promote thumb isolation and control to move the object | |
| Simple Rotation Skills | - place the object in the child’s hand (in a radial grasp pattern) and ask the child to turn it upright | |
| BILATERAL HAND USE SKILLS PROBLEMS | ● Difficulty attending to two objects simultaneously due to cognitive delays ● Deficits in integration of the two body sides, impaired sensation with a lack of attention to one body side ● Lack of bilateral motor experience | ● Cannot effectively sustain both hands at midline ● Difficulty using supination during bilateral activities ● Overflow movement and associated reactions in one upper extremity when using the other |
| BILATERAL HAND USE SKILLS PROBLEMS; INTERVENTIONS | ● Promote ability to stabilize materials with the more involved UE while manipulating with the more proficient arm or hand ● Stabilization with grasp are often easier than are symmetrical bilateral skills or stabilization without grasp | ● Activities that elicit symmetrical bilateral hand use ● Toys and materials selected for bilateral activities must require both hands to be used ● Consider adaptations for children with no potential to develop these skills |
| PROBLEMS AND SUGGESTED ACTIVITIES FOR CUTTING; DIFFICULTY WITH OPENING & CLOSING SCISSORS | ● practice games that involve squeezing and letting go ● practice games that require pinching with thumb ● cue the child “open”, “close” ● use scissors that open automatically | ● cut resistive materials to help the child feel the correct movement ● use tiny scissors ● wrap the loops with foam or tape to help the child make shorter, more controlled cutting movements |
| PROBLEMS AND SUGGESTED ACTIVITIES FOR CUTTING; POOR ARM POSITION | ● Play games or chants that practices thumb-up position ● Rest arm on the table, provide tactile reminders ● Press elbow in and toward the body while cutting | |
| PROBLEMS AND SUGGESTED ACTIVITIES FOR CUTTING; DIFFICULTY GUIDING THE PAPER TO STAY ON THE LINE | ● Glue several large shapes or targets on the paper and cut to a particular shape ● Paths with tactile cue ● Place paper between two cardboard shapes and have the child hold it like a sandwich and cut around the cardboard |
Created by:
avemaria