Fine Motor Development

Authors: Edwards, S. J., Gallen, D. B., McCoy-Powlen, J., & Suarez, M. A. (2018)
Source: Hand grasps and manipulation skills: Clinical perspective of development and function. SLACK Incorporated.

Breaks symmetrical flexion/extension pattern.
Facilitates separate side use of the body.
Assists with neck turning, visual fixation, and reaching.
Builds blocks for visually directed reach and eye-hand coordination, essential for grasp.
Residual effects: Difficulty with crossing midline, confused laterality, handwriting, and drawing symmetric figures.

Triggered by pulling on the arm (passive stretch of shoulder adductors and arm flexors).
Elicits flexion of shoulder, elbow, wrist, and fingers a few weeks post-birth.
Essential for open hand during voluntary reach and grasp.
If unintegrated, prevents visual exploration and object manipulation.

Response to light, distal contact to hand: extension and abduction of fingers, withdrawal of hand.
If fingertip touched, object dropped; if palmar aspect touched, grasp maintained.
Risk of ataxic reach and overpronation of hand when striving for voluntary prehension.
Often leads to crude palmar grasp using the ulnar side of the hand.

Persistent reflex can hinder object release.
Fractionated grasp reflex emerges at ~4 months, integrates by ~10 months.
Deep pressing stimulus elicits isolated finger responses.
Important precursor for thumb to finger opposition; developing this reflex is critical for skilled manipulation of objects.

Origin: Reflexive grasp begins in utero at approximately 11 weeks.
Transition to independent grasp occurs by the end of the first year, dependent on CNS maturation and reflex integration.
Movement patterns evolve from less differentiated to more specialized skills.

The age for definitive identification of handedness is not established.
Influenced by various factors: object size/shape, grasp type required, prior knowledge of the object, task complexity, and demands.
Typically strengthened between ages 3-7; continues to develop until age 9.
Drawing and writing reinforce preferred hand; skills become “adult-like” around ages 10-12.

Age: 2 years old.
Struggles with fine motor tasks, showing generalized weakness and low tone within typical range.
Demonstrates delayed visual-motor milestones but makes consistent progress.
Observations: Uses radial palmar grasp for small objects, especially when seated on the floor; difficulty with precise grasping when not supported.
Discussion Questions:
1. Compare expected grasp for a normally developing 2-year-old.
2. Analyze performance differences between floor and high chair settings.
3. Speculate about the causes for Keisha’s reliance on vision in grasping tasks.

Rotation: Retaining an object in the palm while visualizing and moving with the wrist.
Translation: Moving an object toward/away from the body.

3 to 4 Months: Bilateral holds emerge; hand-to-hand transfers begin.
4 to 6 Months: Coordination improves; reaches become goal-directed.
6 to 7 Months: Two-object actions develop; banging objects together as skills improve.
7 to 12 Months: Sequential actions and complex manipulations develop.

Translation: Movement in and out of the palm; includes simple and reciprocal shift.
Rotation: Simple and complex types allowing for manipulation around axes.

Birth to 4 Months: Reflexively drop objects; limited purposeful control.
By 15 Months: Development of precise release into small openings becomes refined.
Graded extension assists with accuracy; proximal stability and distal mobility are required for improvement.