Lecture 4 Flashcards
what is the direction of motor development skills?
proximal to distal and head to toe
what is essential to controlling hand and finger movements?
control and stability of joints closest to the body
when children are first learning how to grasp objects, what are the hands doing?
they use the whole hand and all fingers are doing the same thing at the same time
what can influence motor skill development?
social and cultural factors
how can you provide culturally competent care and family centred care?
-don’t assume that families adhere to cultural norms
-ask parents:what do you consider important to your child/family?
-remember: each family has unique specific caregiving routines regardless of what ethnic group they belong to
how are postural mechanisms basic components of fine motor skills?
a strong and stead trunk provides a base of support needed for activities requiring fine motor skills
its important to focus on the activity not staying upright
what is the perfect fit for trunk stability?
-feet firmly supported
-ankles, knees, hips at 90 degrees
-proper chair depth
-height of the table should be 2 inches above the height of the elbow
what are some signs of trunk instability?
slouched posture
supporting body with arms
face close to work
falling out of chair
sitting on edge of chair
what is one of the key features of children with cerebral palsy?
poor postural control
what can be beneficial for task performance for children with disabilities?
alternative postures
what can we do if a Childs feet do not touch the ground?
use a stool, container, or block of wood
what can we do if the chair is too deep/wide?
add cushion/foam to the back/side of the chair
what can we do if the desk does not fit properly?
use desk without storage compartment
adjust the desk height
adjust the chair height
what are some trunk instability solutions?
attaching arm/foot rests
higher desk surface
desk cut out
slanted desk top
wedge cushion
what do dexterous hand movements depend on?
the interaction of all UE joints such as scapulothoracic, glenohumeral, elbow and wrist joints
how is the shoulder joint relevant to fine motor skills such as writing?
muscles around the shoulder joint make it stable
to write we use slow, controlled shoulder movements
a loose shoulder joint makes fine motor activities difficult
what are some signs of shoulder instability?
-slight shoulder internal rotation, adduction, or flexion
-may hold arms close to body during fine motor activities
-shoulders may be elevated near ears
-forearm and wrist not supported when writing
-may hold fine motor tools too tightly
how is wrist extension relevant to fine motor tasks such as writing?
the best position for manipulating small objects is with the wrist in slight extension
wrist extension allows for thumb and finger opposition and arching of the hand
what are some signs of wrist instability?
elbow positioned above wrist (not stabilizing forearm)
elbow joint is slightly flexed or pronated
excessive wrist flexion
excessive ulnar deviation
what are some activities to support shoulder and wrist development?
chair pushups
animal walks
jumping rope backwards
monkey bars
yoga
what is hand strength important for?
endurance and to use the small muscles of the hands
what does fine motor skill efficiency significantly influence?
-quality of the task outcome
-speed of the task performance
how do the fixed and mobile parts of the hand adapt to everyday tasks?
by forming bony arches
what do the bony arches of the hands allow for?
so the hand can conform to objects being held
what is largely responsible for changes in the shape of the arches?
intrinsic muscles of the hand
when do the arches of the hands become functional?
when the muscles of the hands develop which is around the age of 2
what are the arches of the hands?
longitudinal
oblique
transverse
what is the function of the longitudinal arch?
grading finger movements
what is the function of the oblique arch?
opposition
what is the function of the transverse arches?
proximal- stability
distal- mobility
what are some things the arches of the hands allow us to do?
-cup the hand and form a concave surface to hold objects
-position the fingers to manipulate different sized and shaped objects
-change thumb orientation for grasping
-increase surface area of the hand in contact with the object to increase sensory input
what are some functional signs of difficulty with arches?
-difficulties with distal finger skills (opposition and tip to tip finger touching)
-difficulties cupping hands (cupping snacks, glass, etc)
-loss of or underdeveloped hand arches make it difficult for hand use
what are some examples for activities to promote hand use?
-play doh balls
-animal walks
-shaking dice
-playing card games
when does motoric separation of the two sides of the hand occur?
it begins when the child begins to crawl and and weight bear on the ulnar side while carrying toys with the radial digits
when does finger separation occur?
around 40 months
what is called the skilled side of the hand?
the radial side (thumb, index, and middle fingers)
what does the radial side of the hand do?
performs precision and manipulation skills
what is called the power side of the hand?
the ulnar side (ring and pinky fingers)
what does the ulnar side of the hand provide?
stability and power grip
what does separation of the two sides of the hand allow us to do?
-crawl and carry
-develop fine motor control and skilled, fast, small movements
-separation of the motor functions of the two sides of the hand are necessary for non fatiguing legible handwriting, cutting, etc
what are the functional signs of difficulties with separation of the two sides of the hand?
-difficulties isolating power and skilled side
-unable to hold multiple objects
-whole hand functions as unit
what are some examples of activities to promote separation of the two sides of the hand?
-clothespin activity
-tweezers/tongs
-progressed scissor use
-taking a cap off with one hand
what is finger isolation of individualization?
moving each finger or thumb independently
what is finger opposition?
touching the thumb to the tip of each finger, requiring thumb rotation
what is a pincer grasp?
opposition of the thumb and first finger
what is the web space?
the opening formed with the thumb touching the first finger
what does the ability to perform opposition and maintain an open web space depend on?
-development of the hand arches
-development of the muscles inside the hand
-separation and function of the two sides of the hand
when does a developing child begin to isolate their index finger/
12 months
when do complex finger movements begin?
over the age of 3 years old
what does finger isolation, opposition, and an open web space allow us to do?
skilled fine motor manipulation
finger feed
grasp and use tools
manipulate clothing fasteners
what are functional signs of difficulties with finger isolation, opposition, and open web space?
-lack of circular space between thumb and index
-difficulties with pincher grasp
-“raking” to retrieve items
-“thumb wrapped” position for pencil grip
what are some examples of activities to promote finger isolation, opposition, and an open web space?
-finger puppets
-clothespins
-musical instruments
-“where is thumb kin?”
what is “reach”?
extending the hand away from the body to grasp and object or to place an object
what is the exploratory reach age?
1-3 months
what is a newborns reach like?
asymmetric, seemingly random arm movements
what does a baby who’s a few days old reach look like?
visual regard of objects and responsive arm movement (vision is important in the development of proprioception of the hand prior to reach)
what does reach look like in the first few months for a baby?
arm abducted, swipes or bats at objects- hands are first kept close to the body at midline, then away so as to see hands
what age is perceptual learning /transition stage for reach?
3-6 months
what does a 5 month old reach look like?
symmetrical, bilateral reaching (supine then sitting)
when does unilateral reaching begin to occur?
6 months
in regards to reach, what occurs as trunk stability and scapular control increases?
shoulder flexion, slight ext, rotation, full elbow extension, forearm supination, and wrist extension occurs
what is necessary for reach?
dynamic trunk control
what is “Carry”?
transportation of a hand help object from one location to another; moving and lifting
what happens at the shoulder joint while carrying?
shoulder rotation, flexion, and abduction are used
what are functional signs of difficulty with reaching and/or carrying?
abduction and internal rotation is used to initiate reach
shoulder elevation and lateral trunk flexion used as compensatory movement
difficulty staying upright when reaching or carrying
what are some examples of activities to improve reach and carrying?
optimize visual regard of the object
activities to encourage reach to an item, progression of difficulty of object placement
optimize position initially and change position
what is grasp dependent on?
coordination of forearm, wrist and hand
what does grasp enable?
combined with other movements it enables the child to perform functional skills (e.g spoon use, building blocks, crayon use)
what are the grasp pattern sequences?
-ulnar before radial
-palmar before finger grasp
-extrinsic muscle activation before intrinsic
when does grasp development begin?
in utero and matures with growth, weight bearing, and experience
initially, is grasp reflexive or voluntary?
reflexive (hands alternately open and close in response to stimuli)
when does the grasp reflex decrease?
around 4-6 months and then voluntary ulnar palmar grasp emerges
when do infants develop purposeful grasp?
around 4-6 months
what are signs of difficulties with grasp?
-holds item in palm rather than fingertips
-uses whole hand as a unit rather than fingers
-finger flexion or fisting
-difficulty with play
what are some examples of activities to promote grasp?
pincer grasp- cheerios, clay
radial digital grasp- peg board, large puzzle pieces
vertical surface activities
manipulative play
what are 2 general principles of grasp?
larger objects are easier than smaller ones
grasp is easiest with arm and hand supported
what is in hand manipulation?
complex process of holding, adjusting, and moving a grasped object within one hand
when does in hand manipulation begin?
begins around 18 months and continues through to 7 years
what does in hand manipulation allow us to do?
-adjust an object for more efficient placement in hand
-place an object on a surface
-release an object with precision
what do all in hand manipulation require?
the ability to control the arches of the palm
what does precision manipulation require?
coordination of the fingers and thumb (so full ROM of the CMC joint of the thumb)
what are the skilled triad muscles of the thumb?
flexor pollicis brevis
abductor pollicis brevis
opponens pollici (and opponent digiti minimi)
what are the 3 major categories of in hand manipulation?
translation
rotation (simple, complex)
shift (with/without stabilization
what is translation for in hand manipulation?
moving a small object with thumb and index (& middle) finger
does finger to palm translation use intrinsic or extrinsic hand muscles?
extrinsic
what are some tasks that utilize finger to palm translation?
-crumpling paper
-picking up and bringing a cheereio to palm
-getting a coin out of change purse
-threading a needle
does palm to finger translation use intrinsic or extrinsic hand muscles?
intrinsics (requires isolated thumb control)
what are some tasks that utilize finger to palm translation?
moving a peg from palm to fingertips
moving a cheerio to put in mouth
buttoning
what is simple rotation in hand manipulation?
turning a small object around the pads of the fingers d thumb (90 degrees or less)
is strength demand high or low for rotation in hand manipulation?
usually low
when does simple rotation occur?
after finger to palm translation
what are examples of simple rotation in hand manipulation tasks?
unscrewing a bottle cap
picking up small pegs from surface and putting into a peg board
rolling clay between thumb and index
what is complex rotation in hand manipulation?
turning an object end over end round its axis, usually 180 to 360 degrees using finger an thumb movements
what are examples of complex rotation in hand manipulation?
turning paper clip so opposite end can be placed on paper
turning an egg timer over
turning over pegs placed upside down
turning pencil over to use eraser
what is shift in hand manipulation?
moving an object by the finger pads in a linear manner
what are examples of shift in hand manipulation?
-moving a coin from finger pads to fingertips for placement
-moving paper in non-preferred hand on paper when cutting with scissors
-moving fingers down a pencil to position for writing
-turning the pages of a book
what is one of the last in hand manipulation skills to develop?
shift
what is in hand manipulation with stabilization?
with stabilization is added if the hand is holding one or more objects with the last two fingers
what is an example of translation with stabilization?
holding money to put in a pop machine
getting two or more coins out of a purse
what is an example of rotation with stabilization?
holding a key ring with keys and rotating the correct one to put in the lock
what is an example of shift with stabilization?
holding a pen and pushing the cap off with the same hand
what are some signs of difficulties with in hand manipulation?
awkward with small toys
uses forearm rotation
uses opposite hand or body to stabilize or move a toy
what are signs of difficulties with object release?
fisting- increased muscle tone
difficulty combining wrist extension with finger extension
overextension of fingers
what are some activities to promote finger extension?
dependent on the issue
transferring objects from hand to hand
very object size
splinting
what are signs of difficulty for bilateral hand use?
cognitive delays- cannot attend to two objects
difficulty sustaining both hands at midline
difficulty with supination during bilateral activities
when is hand dominance fully established?
between 3 and 9 years old
what is the pivot point for steady forearm movement for right handed people?
elbow
what is a challenge with left handed children in terms of writing?
they may develop awkward grip patterns: hook or ulnar/pinky grip which has less stability and control
which direction do left and right handers move the pencil?
right- away from the center of the body
left-toward the center of the body
what is visual perception?
the ability to organize and interpret what is seen
what is the visual receptive component of visual perception?
the process of extracting nd organizing information from the environment
what is the visual cognitive component of visual perception?
the capacity to organize, structure, and interpret visual stimuli, giving what is seen meaning
what is visual motor integration?
coordinate visual information with a motor response to produce written output
what is one of the most common reasons for referring students to OT?
hand writing
what may poor handwriting be indicative of?
motor coordination problems
ADHD
DCD
motor delays
what may be the strongest predictor of handwriting legibility?
visual motor integration
what is the OTs role in the team approach for handwriting?
mechanics- positioning, pencil grip, letter memory and formation, sizing and spacing
what is the most efficient pencil grip?
the tripod grip
what are some outcomes of a poor pencil grip?
-put joints at risk for damage in the long term
impede the development of legible and efficient handwriting
what should be the primary writing tool?
pencil
what is the best writing tool for pre schoolers?
crayons
what are golf pencils good for?
facilitating control
what are triangular pencils good for?
promoting proper grasp
what are some cons of fat pencils?
if the pencil is too wide it will encourage an improper grip, children tend to hold these in a fisted grip
what is a pro of using markers?
easy to get results (ie. dragging)
what is a con of using markers?
may impede hand strength and coordination development
what may heavy pressure of a pencil on paper be due to?
too tight of a grip
what are some ways we can reduce pencil pressure?
corrugated cardboard
tinfoil on cardboard
number 3 mechanical pencil
what are some ways we can increase pencil pressure?
use carbon or tracing paper
softer lead pencils B
what are some tips for writing?
write on vertical surface
be ergonomically correct
trace letters with index finger
draw letters in the air
draw letters in rice or sand
crumple a wad of paper
what are pros of keyboarding?
keyboarding may be a primary means of written communication expression for those who have writing difficulties
it is becoming a life skill
what are some advantages of keyboarding?
less distal finger control
improved legibility
improved accuracy
improved efficiency
what are some disadvantages of keyboarding?
more difficult in certain environments
computers not always available in classrooms
child may not be familiar with keyboard
