Development Exploration: Fine Motor Skills - Study Notes

Development Exploration: Fine Motor Skills

Instructor: Erin Wells, OTD Date: $7/2/2026$

Learning Objectives

1. Review the developmental milestones associated with fine motor skill development.

2. Explore common evaluations associated with fine motor skill assessment.

3. Explore common intervention strategies for fine motor skills.

Development of Reach and Grasp

Reach Development

Reach progresses through three distinct developmental phases:

• Exploratory Phase: Occurs between $1-3$ months.

• Perceptual Learning/Transition Phase: Occurs between $3-6$ months.

• Skill Achievement Phase: Occurs between $6-9$ months.

Grasp Development

Grasp development follows a similar three-phase progression but at later age ranges:

• Exploratory Phase: Occurs between $3-6$ months.

• Perceptual Learning/Transition Phase: Occurs between $6-12$ months.

• Skill Achievement Phase: Occurs between $12-24$ months.

Infant Grasp Progression

The progression of grasp within the infant's hand follows a predictable anatomical path:

1. Ulnar Raking and Grasping: This develops first, appearing at approximately $4$ months.

2. Medial Hand Shift: The grasp then shifts toward the middle of the hand at approximately $5$ months.

3. Radial Side Development: Eventually, grasping with the radial side of the hand will develop from $6$ months and onward.

Fine Motor Milestones by Age

18-24 Month Fine Motor Skills

Specific skills achieved during the late toddler period ($18-24$ months).

2-3 Year Fine Motor Skills

Specific skills achieved during the early preschool years ($2-3$ years).

3-4 Year Fine Motor Skills

Specific skills achieved during the mid-preschool years ($3-4$ years).

4-5 Year Fine Motor Skills

Specific skills achieved during the late preschool years ($4-5$ years).

Grasp Types and Handwriting Progression

Common Fine Motor Grasps

• Tip Grasp

• Cylindrical Grasp

• Hook or Snap Grasp

• Palmar Grasp

• Spherical Grasp

• Lateral Grasp

Handwriting Grasping Development

The development of the pencil grasp follows a chronological sequence as hand dexterity increases:

• Cylindrical Grasp: Developed between $1-1\frac{1}{2}$ years.

• Digital Grasp: Developed between $2-3$ years.

• Modified Tripod Grasp: Developed between $3\frac{1}{2}-4$ years.

• Tripod Grasp: Developed between $4\frac{1}{2}-7$ years.

Evaluation and Assessment Tools

Batelle Developmental Inventory (BDI) - Motor Section

• Target Ages: Birth to $7$ years old.

• Administration Time: Approximately $10-15$ minutes.

• Explanation of Process: This tool is used to assess developmental milestones, identify developmental delays, determine eligibility for services (such as early intervention), and assist in the development of Individualized Education Programs (IEPs).

• Structure: The assessment is divided into three primary domains: gross motor, fine motor, and perceptual. The evaluator begins at the child’s specific age level and assesses/scores each domain. This is a battery-style standardized test.

• Example Testing items/Tasks: Use of blocks and shapes, cups, round beads, color chips, and foam boards. A specific material kit is included with the assessment.

HELP (Hawaii Early Learning Profile) - Fine Motor

• Target Ages: $0-3$ years old (though it can extend up to $6$ years old).

• Administration Time: Total assessment takes $45-90$ minutes; the specific Fine Motor section takes approximately $15$ minutes.

• Explanation of Process: This assessment relies on observations of the infant during play in their natural environment and interviews with the parent or caregiver.

• Example Testing items/Tasks: Using dangling objects, small blocks, and board books to observe specific behaviors such as reaching, grasping, manipulation of objects, and the pincer grasp.

m-FUN (Miller Function & Participation Scales) - Occupation-based

• Target Ages: $2.6-7.11$ years.

• Administration Time: Total assessment takes $40-60$ minutes; individual assessments take $5-10$ minutes.

• Explanation of Process: Focuses on visual motor abilities and play to measure fine motor and gross motor abilities. It utilizes an observation checklist to monitor behavior during specific activities.

• Example Testing items/Tasks: The Penny Bank task. The child is asked to pick up pennies and place them into a small bank. This task is used for all ages within the $2.6-7.11$ range and assesses:

  • Pincer grasps

  • In-hand manipulation

  • Motor accuracy

  • Crossing the midline

Peabody Developmental Motor Scales (PDMS-2) - Fine Motor Scales

• Target Ages: Birth to age $5.11$.

• Administration Time: $20-30$ minutes per subtest. The full test takes $45-60$ minutes depending on the child's age, knowledge, and abilities.

• Explanation of Process: The evaluator sets up the necessary materials for a task (e.g., a shape board with three shapes) and provides instructions to the child. The evaluator observes the performance and scores based on specific criteria. The test uses "Entry Points" based on age (e.g., $25-33$ months) to determine where to start testing.

• Standardized Scoring Rules:

  • Basal: The level at which the child scores a $2$ (correct) on $3$ consecutive items.

  • Ceiling: The level at which the child scores a $0$ (cannot perform) on $3$ consecutive items.

• Example Testing items/Tasks: Using a rattle, building a tower of $7$ cubes, and performing scissor-grasp cubes.

Intervention Strategies

The Importance of Strengthening

Strengthening is identified as a key component of fine motor intervention. A fundamental principle mentioned is that "Proximal Stability leads to [Distal Mobility]."

McKie Splint

• Function: Provides stability specifically at the Metacarpophalangeal (MCP) joint.

• Indications: Very helpful for individuals with hypotonia (low muscle tone) or joint laxity.

• Application: Can be utilized during fine motor and visual motor interventions to provide the necessary stability for task performance.

• Note: Practitioners are encouraged to not stop strengthening exercises even when using splints.

Constraint Induced Movement Therapy (CIMT)

• Process: This involves splinting or restraining the unaffected limb to encourage the use and development of the affected limb.

• Implementation:

  • True CIMT: A very intensive treatment course involving multiple hours of therapy every day.

  • Modified CIMT: A less intensive approach that can also be utilized for fine motor rehabilitation.