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OTA 140 - Pediatrics > Fine Motor Skills and Handwriting > Flashcards

Fine Motor Skills and Handwriting Flashcards

1
Q

Components of Hand Skills

A

1) Patterns; rely on sensory input to “choose” appropriate hold.
a. Reach
b. Grasp
c. Carry
2) Voluntary Release
3) In-hand Manipulation
4) Bilateral Hand Use

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2
Q

Dissociation of Hand

A

Young babies use UE as a whole at first (ie: swipe at a toy bar at age 3 mo.). Must gain proximal stability before mobility of hands. If you can’t control core, you can’t control limbs.

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3
Q

Building Blocks for In-Hand Manipulation

A
  • Stability/movement in supination
  • Wrist stability
  • Thumb opposition
  • Radial side of hand (control side)
  • Transverse metacarpal arch (ability to “fold” hand in half)
  • Dissociation (dividing hand into stability/control sides. Vulcan salute!)
  • Fingertip force (how hard you press button)
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4
Q

Compensatory Motor Behaviors for In-Hand Manipulation

A
  • Changing hands
  • Transferring from hand-to-hand
  • Two object manipulation (unscrewing jar)

These are limitations when observing for in-hand manipulation.

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5
Q

Ball Throwing Skills

A
  • Works on ability to use voluntary release.

* Has a visual component.

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6
Q

Tool Use

A
  • More complex functionality for hand skills.

* Drawing, Writing, Cutting, etc.

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7
Q

Eating Tool Use

A 
Starts around 16 months old.
• First Spoon
• Then Fork
• Then Knife (should be able to use by age 4)
• Learn hand preference.
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8
Q

Hand Skills in Play

A
  • Purposeful and FUN!
  • Visual exploration with object handling
  • Requires more fine motor skill with age.
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9
Q

Motor Problems for Hand

A
  • Disabilities that may affect hand
  • Inadequate isolation of movements
  • Poor movement grading
  • Insufficient force
  • Poor timing of movement
  • Limits in variety of movement
  • Bilateral integration problems
  • Limitations of trunk control
  • Compensatory movement patterns
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10
Q

Hand Skill Factors with Special Needs

A

1) Somatosensory Problems
2) Learned non-use with hemiplegia
3) Developmental conditions (ADHD, ASD, DCD)

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11
Q

Amount of day spent on fine motor/handwriting in school?

A

Up to 60% of school day.

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12
Q

Writing Development – Prewriting Steps

A

1) Stirring spoon (12 mo.)
2) Scribbling (14 mo.)
3) Imitating vertical straight line (23-24 mo)
4) Imitating horizontal line (27-28 mo)
5) Circles (33-34 mo)
6) Crosses (39-40 mo)
7) Tracing line, 2 deviations (41-42 mo)
6) Diagonals and Shapes (4-6 yrs)
7) Letters

  • Prewriting strokes are precursors to letters. Must understand up/down/across before they can put them together.
  • Motor, cognitive and sensory systems working together
  • Prewriting starts at an early age
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13
Q

Hand Preference/Grasp Maturation

A

Typically established by age 3; by 3.5, uses static tripod grasp and emerging dynamic tripod by age 4.

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14
Q

In-Hand Manipulation (Prehension) Skills

A

Precise, skilled finger movements made during motor tasks.
• Adjusting objects in hand while maintaining grasp.
• SHIFT: moving object with digits proximally/distally
• TRANSITION: working items to/from palm to fingertips
• ROTATION: rotating object using thumb opposed to index/long finger

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15
Q

Factors that Affect Acquiring Handwriting Skills

A
  • AROM (arm)
  • Integrity/structure of arm, hand, fingers
  • Posture
  • Strength/endurance
  • Eye-hand coordination
  • Motor planning
  • Visual perception skills
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16
Q

Areas of Assessment for Handwriting May Include

A
  • Visual perception skills
  • Fine motor skills
  • Cognitive skills
  • Sensory skills
  • Gross motor skills
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17
Q

Visual Perceptual Skills RE: Handwriting

A

Ability to organize/interpret what is seen.
• DISCRIMINATION: detect difference betw items
• VISUAL MEMORY: remember/recall a shape/word
• FORM CONSTANCY: realize/recognize forms are same if moved/turned/resized
• SEQUENTIAL MEMORY: remember sequence of chain of letters to form word
• FIGURE GROUND: identify foreground from background
• VISUAL CLOSURE: identify form when incomplete

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18
Q

Standardized Assessments Used for Handwriting Difficulties

A
  • Peabody Developmental Motor Scale-2
  • Hawaii Early Learning Profile (HELP)
  • Bayley Scale of Infant Development
  • Erhardt Prehension Assessment
  • Bruininks-Osteretsky Test of Motor Proficiency
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19
Q

Standardized Assessments for Visual Perception

A
  • Test of Visual Motor Integration-Revised (TVMI-R)
  • Motor Free Visual Perception Test-Revised (MFVPT-R)
  • Test of Visual Perceptual Skills-Revised (TVPS-R)
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20
Q

Handwriting Assessments

A
  • Children’s Handwriting Evaluation Scales (CHES-S and CHES)
  • Evaluation Tool of Children’s Handwriting (ETCH)
  • Print Tool (not standardized)
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21
Q

What to Look for When Observing Child Writing

A
  • How the child works
  • How the child is organized
  • How the child uses time
  • Contexts in which the child writes
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22
Q

AOTA 5 Approaches to Intervention

A

1) Create or Promote
2) Establish or Restore
3) Maintain
4) Modify
5) Prevent

  • All may apply to handwriting interventions!
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23
Q

Learning Styles

A

1) Tactile or Kinesthetic
2) Visual
3) Auditory

24
Q

Sensory Processing Intervention Areas for Writing

A
  • Crossing the midline
  • Eye-hand coordination
  • Visual perceptual skills
  • Directionality
  • Motor planning
25
Q

Classroom Accommodations

A
  • Decrease amount of written work
  • Use a tape recorder
  • Use a computer/word processor
  • Allow extra time to complete
  • Provide written list of homework
  • Use a packing buddy
  • Emphasize content of assignments
26
Q

% of general elementary school population that struggles with handwriting

A

Between 10% - 30%

27
Q

DSM-5 categorization for handwriting as learning disorder

A

Learning disorder falls under “Written Expression” category. Student must have errors in spelling, grammar, and punctuation; lack of clarity of ideas; and poor organization of written work.

28
Q

Factors Affecting Legibility of Handwriting

A

1) Early in-hand manipulation skills
2) Letter formation
3) Horizontal alignment (adhering to margins)
4) Size (too large/small)
5) Spacing between letters/words
6) Placing of letters
7) Slant

29
Q

Most effective frame of reference for handwriting intervention

A

Motor Control FOR seems to show significantly greater improvement. This involves intensive practice of handwriting (as opposed to visual-perceptual activities, etc).

30
Q

Cursive writing (benefits; age to learn)

A

Cursive is motorically and perceptually easier for some children due to decreased need to lift the pencil—less starting/stopping. End of 2nd to beginning of 3rd is optimal developmental time to introduce cursive. Simplified, vertical letters are recommended (more similar to letters students read).

31
Q

Most mature grasps

A

Dynamic Tripod and Lateral Tripod

32
Q

Lateral Quadrupod and Four-Finger Grip

A

Can be as functional and efficient as tripod grasps.

33
Q

Lateral Grasp or Thumb Wrap Grasp

A

These close the web space between the thumb and index finger. Can be fatiguing or painful but offer stability and power.

34
Q

Grasp/Posture Evolution from Age 2 to 5

A

2nd Year: Uses all fingers to hold crayon in palm of hand. Writing hand wrist doesn’t touch table. Helping hand is of no use, due to inhibitive posture (which provides stability).

3rd Year: More advanced posture allows helper hand to start to be used. Wrist still off table, may still use all fingers to hold crayon.

4th Year: Utensil held with a more mature grasp. Shoulders more relaxed, but still retracted for stability. Helper hand more deliberately holding paper. Writing hand still not touching table.

5th Year: Mature grasp has evolved, and dominant elbow/wrist/hand all lie on table. Shoulders relaxed, better handwriting position/posture.

35
Q

Performance Skills and Client Factors that Impact Handwriting

A
  • In-Hand Manipulation
  • Active Range of Motion (trunk, shoulder girdles, elbows, forearms, wrist, fingers)
  • Integrity/Structure of Arm, Hand, Fingers (edema, deformities, wounds)
  • Posture (Trunk, Shoulder Girdle, Elbow, Wrist, Finger Stability); Trunk stability is key!
  • Strength and Endurance
  • Midline Crossing
  • Eye-Hand Coordination
  • Motor Planning
  • Visual Perception Skills
  • Directionality
36
Q

Sequence of Development of Tool Usage

A
  • Child moves entire arm with shoulder, thumb and index finger toward paper
  • Movement at forearm, more stable shoulder
  • Upper arm/forearm more stable; movement at wrist and whole hand
  • Movement at metacarpal joints of fingers or with static tripod grasp
  • Dynamic movement at thumb/index finger, middle finger stabilizing utensil, other stabilizing/maintaining wrist angle
37
Q

Hand Preference

A
  • Typically developed by age 3
  • 3.5 years, uses static tripod; dynamic tripod emerges by age 4
  • Take notice of how things are handed to an infant; always present items at middle of child’s body to not influence their hand preference.
38
Q

Posture for Handwriting

A
  • Trunk stability is foundation
  • Enables upright seating posture
  • Leaning compromises energy use and effective use of hands
  • Most efficient handwriting happens when shoulders/scapula in resting, neutral position
  • Posture influenced by desk height; should be 2 inches above flexed elbow
  • Best sitting position: hips and knees at 90˚, feet flat on floor, ankles at 90˚
39
Q

Efficient Grasp Pattern

A

Ideal handwriting grasp (ie: dynamic tripod); forearm is maintained in a neutral position. Wrist stability (ideally straight or slightly extended) and elbow stability (kept in one position) are also maintained.

40
Q

Arches of the Hand

A

Formed as intrinsic muscles develop; shape the hand for grasping objects of different sizes; enable skilled movements of the fingers; and control power/force of prehension.
• Lack of hand arches interferes with strength/coordination; may compensate by holding pencil tight against palm/no web space

41
Q

Midline Crossing

A

Ability to continue a motor act (like writing) without switching hands at the point in front of body’s centerline. Inability may indicate an immature nervous system. May also indicate ambidextrousness!

42
Q

Indicators of Poor Eye-Hand Coordination

A
  • Inability to pick up object from table
  • Inability to hit a ball with a bat/racket
  • Difficulty staying within lines when coloring/doing mazes
43
Q

Indicators of Poor Motor Planning

A
  • Bumping into people/knocking things down
  • Feeling the wall as a guide while walking
  • Inability to “feel” the pressure needed to write with a pencil (held too tight/loose)
44
Q

Indicators of Poor Visual Perception Skills

A
  • Reversed or inverted letters (b,d; u, n)
  • Complains that eyes hurt/itch
  • Turns head while reading across page; holds sheet of paper at odd angles
  • Closes one eye while working
  • Cannot near- or far-point copy accurately
  • Does not recognize object/word if incomplete
  • Misaligns letters (colliding, irregular spacing, off-line)
45
Q

Skills Examined by Visual Perception Tests:

A
  • Discrimination
  • Visual Memory
  • Form Constancy
  • Sequential Memory
  • Figure/Ground
  • Visual Closure
46
Q

Universal Design for Learning (UDL)

A

Research-based framework for designing curriculum that enables all individuals to gain knowledge, skills, and enthusiasm for learning. Provides curricular flexibility to reduce barriers, provide supports, and maintain high achievement standards for all students.

47
Q

Components of Executive Function (may interfere with handwriting abilities)

A
  • Inhibition
  • Shift
  • Emotional Control
  • Initiation
  • Working Memory
  • Plan/Organize
  • Organization of Materials
  • Monitoring (self-awareness of performance)
48
Q

IEP vs. 504 Plan

A

Primary difference is that students receive special education and related services with an IEP; they do not with a 504.

49
Q

Low-Technology Solutions for Successful Handwriting

A
  • Colored pencils/markers
  • Slant boards
  • Pencil grips/Finger positioners
  • Graphic organizers
  • Finger spacers/popsicle sticks
  • Raised line or colored lined paper; Gray box; Strips of paper
  • Stylus/digital pens
  • Weighted/mechanical pencils
50
Q

High-Technology Solutions for Successful Handwriting

A
  • Class computer stations
  • Laptops
  • iPad/apps
  • Netbooks
  • Portable word processors
51
Q

Keyboarding for Handwriting Impaired

A
  • Improves legibility; reduces spelling errors
  • Present as early as possible, so handwriting difficulties do not interfere with written expression skills
  • Encourage eye and stretching breaks
  • Can use accessible keyboards if needed
52
Q

Performance skills that may affect handwriting:

A
  • Muscle Tone
  • Strength
  • Endurance
  • Posture
  • Integrity of structures
  • Visual perception
  • Sensory processing
53
Q

Benefits of keyboarding (over handwriting)

A
  • Improves legibility

* Decreases spelling errors

54
Q

Signs child has difficulty writing due to poor motor planning:

A
  • Hesitation in continuously forming letters
  • Not understanding where to begin writing on paper
  • Alternates beginning at bottom/top of letters
  • Letters of varying sizes/cases
55
Q

Typical developmental sequence of acquisition of fine motor skills

A

1) Reflexive grasp
2) Palmar grasp
3) Inferior scissors grasp
4) 3-jaw chuck grasp

OTA 140 - Pediatrics (18 decks)

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