Fine Motor Development

Question 1

Important to know!!!

Answer 1

• pincer grasp = 12 months
• in hand manipulation = integrated by age 4

Question 2

Hand skills and childhood occupations

Answer 2

• play
• ADLs
• education

Question 3

Components of hand skills

Answer 3

• reach
• grasp
• carry
• release
• in hand manipulation
• bilateral hand use
• tool use

Question 4

Reflexes impacting hand development

Answer 4

• development occurs proximal to distal (distal hand skills is last to develop)
• asymmetric tonic neck reflex
• palmar grasp reflex

Question 5

Asymmetric tonic neck reflex (ATNR)

Answer 5

• must be integrated by 6-8 months of age
• helps with delivery of the baby through the canal
• why do we need this for fine motor skills? Need to be able to turn your head to manipulate an item
• kids with CP often don’t integrate this

Question 6

Palmar grasp reflex

Answer 6

• if item placed in hand, hand closes
• integrates at about 4 months
• newborns when they hold your hand, they do palmar grasp reflex
• when something goes into the palm, the palm closes
• needed to manipulate objects, can explore objects without the distal development developed yet

Question 7

Reach

Answer 7

• movement and stabilization of the arm and hand for the purpose of contacting an object without the hand
• develops a little bit earlier

Question 8

Development of reach

Answer 8

1.) visual regard of objects and activation of the arms (seeing where they are and they want to interact with them, visual attending, may want to interact with the things in front of them)
2.) swiping or batting (the realization that they can move, unskilled movements, general movements)
3.) midline orientation of hands develop (hands come to midline right at their chest grabbing their hands)
4.) hands move further away from the body
5.) symmetrical bilateral reaching
6.) unilateral reaching
7.) hands open more than necessary
8.) trunk extension and rotation
9.) arm placement and finger extension accuracy improves

• a block on the counter: with stabilization
• as development occurs, you are going to know that you do not have to open hands as much, the more accuracy, the more we develop
• why is that bilateral reaching is first? Unable to separate the body yet, both hands have to be doing the same thing

Question 9

Grasp

Answer 9

• attainment of an object with the hand closes

Question 10

Sequential development of grasp

Answer 10

• ulnar grasp, palmar grasp, and radial grasp
• palmar contact, finger surface contact, and finger pad contact
• use of long finger flexors, use of intrinsic muscles with extrinsic muscles
• ulnar = stabilization and strength
• radial = specific movements
• starts in the palm and then moves out

Question 11

Development of grasp patterns

Answer 11

• no voluntary hand use (palmar reflex) = integrated at 4 months
• palmar grasp (thumb not involved)
• crude raking = whole hand grasps the item
• radial digital grasp = pick it up with their fingers on the radial side
• use of thumb to attain tiny objects = getting into pincer grasp by age one, can pick up one at a time
• refined use of thumb and finger pad control for tiny and small objects (approximately 12 months)
• you do not need to know the age, just know the specifics of having pincer grasp and refine use of finger by age 1

Question 12

Order of developing grasp patterns

Answer 12

• palmar grasp
• radial palmar grasp
• raking grasp (all fingers doing the same motion at the same time)
• inferior pincer grasp (more proximal, not fully developed)
• radial digital grasp (difference between RDG and TJC is using more digits rather than making it out dismally to three jaw chuck)
• three jaw chuck grasp
• pincer grasp
• superior, neat, fine, tip pincer grasp
• disk grasp (opening containers)
• spherical grasp (arches of hands involved, holding a ball)
• cylindrical grasp (holding a cylinder)
• look into these grasps to see how the kids are developing

Question 13

Development of grasp patterns

Answer 13

• inhibition of ulnar side of hand-fingers on ulnar side will stabilize movement (stabilization)
• slight wrist extension
• forearm supination
• increased gradation of intrinsic muscles of hand
• gradation = hands doesn’t open too much, the hands open at the appropriate size for the activity

Question 14

Carry

Answer 14

• movement of the arm in space for the purpose of transporting a hand held object from one place to another
• sometimes the kids will carry something and then cannot maintain the grasp as they are walking

Question 15

Release

Answer 15

• intentional letting go of an object in the hand at a specific time and place

Question 16

Development of voluntary release

Answer 16

1.) inhibition of palmar grasp reflex (needs it to go away, you cannot release something if you still have palmar reflex)
2.) pulls out something of the other hand (the hand doesn’t necessarily release it, they just pull it out of the other hand)
3.) transfers freely, releasing hand fully opened (opposite hand stabilizes)
4.) releases objects without stabilization (just drops something and lets it go)
5.) excessive finger extension

• this is why there are so many toddler toys about specific release patterns

Question 17

In hand manipulation

Answer 17

• adjustment of an object within the hand after the grasp
• many skills we do with our intrinsic muscles throughout the day
• all fully developed by age 4

Question 18

In hand manipulation skills (all consistent by age 4)

Answer 18

• finger to palm (pick it up with their fingers and move it to the palm)
• palm to finger
• shift = linear movement on the radial side (slide your fingers up and down a pencil)
• simple rotation = fingers act with the thumb, 90 degrees or less (picking up a pencil to write when the top of the pencil is by your pinky)
• complex rotation = fingers move independently of the thumb greater than 90 degrees (picking up a pencil to write when the tip of the pencil is by your pinky)
• clinical observation of rotation deficit = kiddos switch their hand to erase (looking at rotation!)
• not necessarily focused on where they pick it up
• gives us more information about the child’s intrinsic hand muscles, don’t focus much on whether or not it’s simple or complex

Question 19

Bilateral hand use

Answer 19

• effective use of 2 hands together to accomplish an activity
• begins with hands doing the same activity
• evolves to hands completing different tasks
• will do it together and then bilateral hand will specialize

Question 20

Tool use

Answer 20

• using an item to complete an occupation

Question 21

Progression of pencil grasp

Answer 21

• gross grasp (all fingers wrapped around it, sometimes thumb is involved)
• digital pronate grasp (hand is pronated and fingers are all on it pointed down)
• 5 finger grasp (correct position, but all fingers are on it)
• static quadrupod grasp/static tripod (stabilizing and moving to radial side, may see 3 or 4 fingers on it)
• dynamic tripod (three fingers stabilizing pencil and fingers doing the movement)
• we can get along fine without a dynamic tripod, but if we are with the kids who are having trouble, they are still developing, so the goal of progression is to get to the dynamic tripod
• extremely challenging to change the pencil grasp after age 7
• neuroplasticity
• habits (motor learning component combined with decreased neuroplasticity so the last thing they want to do is change their habits)
• so important to establish the skills when the children are 3 to 5 years old

Question 22

General problem affecting hand skills

Answer 22

• inadequate isolation of movements
• poorly graded movements
• poor timing of movements
• poor bilateral integration
• limitation in trunk movement and control
• can’t grade the amount of force they can do something
• need a nice stable core for stability for the rest of the body
• people who get referred for handwriting issues have core strength difficulty

Question 23

Frames of references

Answer 23

• biomechanical
• motor learning
• developmental (covers a lot during gross and fine motor)
• neurodevelopmental (kids with mild tone may have to do weight bearing interventions)
• sensory integration (kids are extremely sensitive to touch, so they may not explore as much)
• cognitive (going to give them the words and teach them how to hold it)
• behavioral (explore why they do something and modify the behavior)

Question 24

Evaluation of hand skills

Answer 24

• occupational performance
• skilled observation
• occupational analysis
• AROM/PROM
• strength
• tactile and proprioception functioning
• muscle tone
• sensation
• reflexes

Question 25

Evaluation: clinical observations

Answer 25

- reach and release - grasp patterns - dexterity - in hand manipulation - bilateral hand use - hand preference - tool usage - postural control - sensory factors - how do they grasp it? - should have all in hand manipulation by age 4 - do they cross midline? - do they switch hands or prefer one hand? - hand preference (boys sometimes doesn’t establish until age 7, they are behind on motor/grasp patterns and dominance) - if the kid does not have a strong hand preference, they are weak on the both sides (NOT ambidextrous, their neuro system just have not been developed yet)

Question 26

Evaluation of hand skills: standardized

Answer 26

- Peabody Developmental Motor Scales, 2nd Edition (PDMS-3) = birth to 5 years and 11 months - Bruininks-Oseretsky Test of Motor Proficiency (BOT-3) = ages 4 years to 25 years and 11 months - Miller Function and Participation scales (M-Fun) = ages 2, 6-7, and 11