Motor Control: Fine Motor Skills in Pediatrics

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Examples of Fine Motor Activities

coloring, drawing, writing, cutting, pasting, manipulating small objects, zipping, and buttoning.

Fine Motor Synonyms

eye hand coordination, visuomotor coordination, and distal extremity dexterity.

Performance Problems Due to Fine Motor Deficits

difficulty cutting and pasting, manipulating objects, lack of smooth clapping or tapping, tendency to hold a pencil awkwardly, tenseness in writing and drawing, and production of strokes that are too heavy or too light.

Elements of Fine Motor Development

bilateral motor control, reach/grasp, object manipulation, and tool (or implement) usage.

Step 1 of Developmental Sequence of Acquiring Bilateral/Gross Motor Control

control of the muscles of the trunk.

Step 2 of Developmental Sequence of Acquiring Bilateral/Gross Motor Control

ipsilateral movement of the limbs (an arm and a leg on one side of the body) independent of movement on the other.

Step 3 of Developmental Sequence of Acquiring Bilateral/Gross Motor Control

contralateral movement of the limbs (an arm and a leg on opposite sides of the body).

Step 4 of Developmental Sequence of Acquiring Bilateral/Gross Motor Control

crude two-handed movements, each hand performing the same movements.

Step 5 of Developmental Sequence of Acquiring Bilateral/Gross Motor Control

one handed movements.

Step 6 of Developmental Sequence of Acquiring Bilateral/Gross Motor Control

lead-assist hand roles.

Bilateral Motor Control Birth - 3 Months

baby asymmetrical and NOT bilateral in arm movements.

Bilateral Motor Control 3-10 Months

baby symmetrical and bilateral in arm movements.; crude two-handed movements where both hands are moving as one unit performing the same action.

Examples of Bilateral Motor Control 3-10 Months

holding rings in both hands, holding something with both hands in midline, and transferring objects.

Bilateral Motor Control 10-12 Months

unilateral hand movements crude; reach.

Bilateral Motor Control 15-18 Months

lead-assist hand patterns.

Bilateral Motor Control Early Childhood & Beyond

more refined movements and skilled lead-assist activities.

Reach

movement and stabilization of the arm and hand for the purpose of contacting an object.

Grasp

attainment of an object with the hand.

Steps of Reaching & Grasping

“batting”, grasp goes from reflexive to voluntary, and then eventually ability to release an object.

Power Grasp

involves the use of the entire hand.

Precision Grasp

involves opposition of the thumb to the fingertips to change the object's position or move the implement.

Object Manipulation

the manual control of objects with one or both hands; in this stage of development our hand doesn’t move as one unit anymore and we can separate it into ulnar and radial thanks to the palmar arches.

Object Manipulation Examples

putting a puzzle together, building block towers, using legos, placing an earring in your ear lobe, putting on socks, opening the lid of a jar, holding a clock and setting the dial, and rinsing dishes under running water.

In-Hand Manipulation Translation

linear movement from finger surface to palm or palm to finger.

In-Hand Manipulation Shift

the final adjustment of an object after the grasp.

In-Hand Manipulation Rotation

movement of an object around one or more of its axes; simple or complex rotation.

Tool Use

use of tools to accomplish specific goals; development moves from simple to complex; involves the use of lead-assist hand patterns (functional asymmetry).

Examples of Tool Use

from hammer, brushes (gross, less refined) to pencils and scissors (require much more precise skill).

Implementing Usage Skills with Tool Use

to use a tool or implement properly, the individual must hold it correctly and maintain the appropriate relationship between the tool and the object on which it is used (hammer with nail, scissors with paper, knife with food item).

Step 1 of Scissor Skills

two hands on two handles of the scissors. Another person holds the paper.

Step 2 of Scissor Skills

scissors held in one hand, wrist usually inverted; child holds paper in other hand, wrist also inverted, but child may work with paper on the table for support initially.

Step 3 of Scissor Skills

scissors held in one hand, thumb up (supinated forearms) and paper held in other hand, supinated forearm.

Scissor Skills

cutting action moves from snipping to continuous cutting as child gains confidence and control with tool.

Grasp Progression with Writing

palmar grasp, static tripod (entire hand moves not just fingers) transitional grasp, and dynamic tripod (fingers move instead of entire hand).

Developmental Progression of Writing

pre-writing, scribbling, simple line drawing, tracing, and freehand drawing.

Step 1 of Scribbling Progression

coloring large space without pattern and no attention to boundaries.

Step 2 of Scribbling Progression

coloring with regard to the blackline drawing, staying closer to boundaries.

Step 3 of Scribbling Progression

coloring within 6” diameter spaces then 2” diameter spaces then smaller spaces with more complex designs.

Step 4 of Scribbling Progression

random direction strokes.

Step 5 of Scribbling Progression

unidirectional strokes.

Step 6 of Scribbling Progression

strokes that change direction to fit the space.