Fine Motor Development Process

What is the contribution of contextual factors to hand skills? (4)

- Social and cultural factors influence development

- Culture can determine objects held (chopsticks vs. spoon)

- Cultural norms vary on age expected to achieve skills

- Culture influences perception of child's need for manipulative materials

What are some general developmental considerations? (4)

- Development of movement patterns from mass to specific

- Proximal to distal

- Ability to combine patterns of stability and mobility

- Joints must be able to stabilize at any point in the normal ROM

What is the contribution of body functions to hand skills? (5)

- Somatosensory functions

- Sensory integration

- Visual perception and cognition

- Skeletal integrity

- Strength

How do somatosensory functions affect hand skills? (2)

- Haptic perception (knowledge of objects gathered through active touch)

- Somatosensory information guides the amount of force required in grasp and manipulation

How does sensory integration affect hand skills? (2)

- Hypersensitivity can affect development of hand skills

- Motor planning deficits associated with limitations in somatosensation

How does visual perception and cognition affect hand skills? (2)

- Vision guides fine motor development

- Cognition influences fine motor interests, child's attention, interest in fine motor tasks, and curiosity

How does skeletal integrity affect hand skills? (3)

- Hand's joint and bone structures

- ROM

- Muscle function

How does strength affect hand skills? (2)

- Limitations in strength and endurance

- Muscle tone affects what the hand is able to do (hyper and hypotonicity)

What are the components of hand skills? (6)

- Reach

- Grasp

- Carry

- Voluntary release

- In-hand manipulation

- Bilateral hand use

What is reach?

Extension and movement of the arm for grasping or placing objects

What is grasp?

Attainment of an object with the hand

What is carry?

Transportation of a handheld object from one place to another

What is voluntary release?

Intentional letting go of a handheld object at a specific time and place

What is in-hand manipulation?

Adjustment of an object in the hand after grasp

What is bilateral hand use?

Use of two hands together to accomplish an activity

How do hand skills develop during reach and carry? (5)

- Visual regard

- Midline orientation

- Symmetric then unilateral

- Increased smoothness, consistency, ability to adjust movement

- Increased shoulder rotation with supination

How do hand skills develop with the sequential development of grasp patterns? (6)

1. Reflexive grasp

2. Voluntary palmar

3. Radial palmar

4. Radial digital

5. Pincer grasp, precision grasp

6. Wide variety of grasping patterns based on object size and shape

What are the classifications for in-hand manipulation? (5)

1. Finger-to-palm translation

2. Palm-to-finger translation

3. Shift

4. Simple rotation

5. Complex rotation

What grasp is seen at 10 months?

Pincer

What grasp is seen at 12-15 months?

Palmar supinate

What grasp is seen at 2-3 years?

Digital pronate

What grasp is seen at 3-4 years? (2)

- Quadrupod

- Static tripod

What grasp is seen at 5-6 years?

Dynamic tripod

What motor skill prerequisites must be considered developmentally for in-hand manipulation? (7)

- Movement into and stability in various degrees of supination

- Wrist stability

- Opposed grasp with thumb opposition and object contact with the finger surface (not in the palm)

- Isolated thumb and radial finger movement

- Control of the transverse metacarpal arch

- Dissociation of the radial and ulnar sides of the hand

- Successive increases and decreases in fingertip forces

How does voluntary release develop? (4)

1. Child initially stabilizes on surface to release

2. Learns to release without stabilizing

3. Release pattern is refined

4. Learns to modulate force, demonstrates stacking

How does bilateral hand use develop? (5)

1. Symmetric patterns dominate initially

2. Bimanual action emerges in 10-12 months

3. Reciprocal and alternating hand movement

4. Simultaneous manipulation

5. Differentially uses two hands

How do ball-throwing skills develop? (4)

1. Fling

2. Child learns to dissociate trunk and arm movements

3. Can control direction with shoulder stability

4. Accuracy and distance increase

How does tool use develop? (2)

1. Development of scissor use

2. Development of spoon and fork use

How might hand skills relate to a child's occupation of play? (4)

- Legos

- Barbies

- Games

- Sports

How might hand skills relate to a child's ADLs? (3)

- Dressing

- Bathing and hygiene

- Eating

How might hand skills relate to a child's school functions? (4)

- Manipulative activities

- Crayons, paper, pencils

- Scissors

- Building with materials

What types of motor problems may be associated with impaired hand skills? (9)

- Disorder in bilateral integration and control

- Trunk instability or abnormal posture

- Compensatory patterns of movement (ex. using other hand to stabilize)

- Inadequate isolation of movements (ex. only moves fingers all together)

- Poorly graded movement

- Lack of ability to use middle ranges of movement

- Insufficient force

- Poor timing of movements

- Limited variety of movement patterns

What types of somatosensory problems may be associated with impaired hand skills? (5)

- Poor tactile discrimination can result in less feedback from the hand's movement

- Children with CP may have tactile discrimination problems

- Degree of tactile impairment is not always associated with degree of motor impairment

- Motor planning problems

- Children with developmental coordination disorder can have limited somatosensory perception

How can the learned non-use phenomenon be associated with impaired hand skills in children with hemiplegia?

Do not want to use weaker arm because it is easier to only use fully functional arm

What are some developmental disabilities that hand skill problems may be associated with? (6)

- Visual impairment/blindness

- ADHD

- Autism spectrum disorders

- Development coordination disorder

- Cognitive disorders

- Motor disorders