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Fine Motor Development in the Early Years

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Presented By: Karen More OT Reg. (MB)Heather Keeble OT Reg. (MB)

Occupational Therapists with the Brandon Children’s

Therapy Team

Contact Information: morek@brandonrha.mb.ca

Presented At: LIFT conference October 23, 2009

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Agenda1. Developmental sequence of fine

motor and visual motor skills.2. Development of grasp patterns.3. Fine motor “red flags”.4. Steps for Fine Motor success.5. Positioning strategies in the

classroom.

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Agenda6. Muscle group development and

activities.7. Hand dominance and dexterity.8. Scissor skills.9. Keyboarding skills.10.Activity centers.11.Questions and Evaluation Form

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Pre-Printing SkillsMotor coordination issues affect 5-6% of school aged childrenEarly intervention often can help to resolve fine motor issuesWhile the coordination issues may seem subtle in the whole scheme of things; we know that they can have serious academic, social and emotional consequences

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School PerformanceStudy by “McHale & Cermak” (1992), examined the amount of time school-aged children were expected to perform fine motor activities in the classroom31-60% of a child’s school day in Grades 2-6 consisted of fine motor activities85% of these fine motor activities consisted of pencil & paper tasksWhat is the impact on school performance and self-esteem when a child spends 1/3 or more of their school day frustrated due to difficulties with printing skills?

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Motor development is a complicated balancing act!

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Visual-Motor DevelopmentWhat is realistic to expect at each age range?How do we know we’re challenging but not overwhelming?

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Visual-Motor Development

S e nsor im o to r F o un da tio nsp o stu ra l con tro l o f he a d, n eck a n d trun k;

s ta b i li ty o f sho u ld er , w r is t a nd f in g ers;b i la te ra l o rg an iza tio n , an d p ro pr iocep tiv e /k ine sthe tic

F ine M o to r Co n tro l

V isu a l S k i llsv isu a l a cu ity , tra ck ing a nd b in ocu la r v ision

V isu a l P e rce p tion

P roce ss ingo rga n izin g , in te rp re t ing , a nd p lan n ing

V isu a l M otor Sk il lscu rs ive w ri ting , p rin tin g an d d ra w ing

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The Three Year OldMay see: Circle, crossUses all fingers to hold crayon in the palm.Arm is down but not well planted elbow up.Starts to use opposing hand to stabilize.Starts to guide strokes by watching. Copies lines down and across.

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The Four Year OldMay see: Copies cross, imitates squareMature grasp starts to emerge – hold with thumb and one or two fingers.Arm is down but elbow remains up.Starts to purposely hold paper with opposing hand.Copies vertical, horizontal lines, circle and cross.Hand dominance emerging or established.

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The Five Year OldMay see: Copies square, imitates triangleMature tripod grasp with hand resting on the paper.Purposely holds and adjusts paper with opposing hand.Copies cross, circle, square and triangle.May know some letters (name) and numbers.

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And BeyondChild progresses to independently draw shapes, pictures, letters, numbers:

Triangles by age 6. Letter number

reversals corrected by age 7.

Diamond accurately drawn by age 7.

Uniform letter spacing by age 9.

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DefinitionsCue / Trace: Make a shape or line using dots or dotted lines as a cueImitate: You draw one with the child watching and then the child makes oneCopy: Child is shown a picture and is asked to ‘draw one that looks like this.’Draw on Request: ‘Draw a circle.’

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Developmental sequence of printing skills

Bangs or scribblesScribbles with directionImitates vertical & horizontal lines, circleCopies vertical & horizontal lines, circleImitates, copies +Draws spontaneous formsDraws faceImitates, copies diagonals, V

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Developmental sequence of printing skills

Imitates, copies YImitates, copies XDraws stick figureIdentifiable objects (ex. Happy face, sun)Imitates, copies squareCopies name in large irregular lettersCopies numbers

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When are kids ready?Can hold a pencil in writing position: What does that

look like?

Good postural controlHand preference evidentWhen they can form the basic strokes:

Vertical, horizontal, circular, cross, diagonal.

All necessary for letter formation.

Sufficient attention, cognition and interest.

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Development of Pencil/Crayon Grasp

Least Mature Grasp Most Mature Grasp

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Teaching The Tripod GraspTeach the tripod grip in the following manner:

Place the pencil on the desk with the lead pointing towards the printing (dominant) hand.

Pinch the pencil close to the tip with the tip of the thumb and index fingers

Flip the pencil over to rest behind the the first (proximal) knuckle of the index finger.

Tuck the middle finger under the pencilPinch Flip Tuck

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INEFFICIENT GRASPS

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Fine Motor “Red Flags”No preferred hand dominance establishedInability to print/copy nameInability to copy lines and simple shapes Immature pencil grasp

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Fine Motor “Red Flags”Immature self portraitUnable to generally color within the lines (i.e. random scribbling)Inability to use tools correctly (crayons, scissors, pencils, buttons)Signs of poor finger dexterity: Difficulty rotating objects in the hand with fingers For example, uses two hand to turn pencil to use

eraser instead of rotating pencil in hand Inefficient pencil grasp Difficulty turning pages

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This is not “just printing!”This early work lays the foundation for later school and life success.The challenge is to foster development while making it seem like fun.

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7 Steps to Fine Motor Success1. Stability of trunk, shoulder and elbow2. Wrist extension3. Grasp (pincer and tripod) & release4. Arches of the hand/separation of 2 sides of

the hand5. Finger isolation6. Thumb opposition and web space7. In hand manipulation

“Stability before mobility”

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Start with PositionCheck how child is positioning him/herself for the activity.Do they have adequate support?When postural control is affected, arm movement and fine motor control are often impacted.May see: Rounded back, resting head on hand, resting

trunk forward on desk, constant repositioning, leaning on walls, friends or teachers.

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Positioning Strategies At the table: (sometimes easier said than done!) Feet flat on the floor, hips/knees bent

at 90° Table height, about 2 inches above

the level of the elbows Placing items on a slanted surface or

working in vertical may encourage more upright posture.

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Seating Position

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Positioning StrategiesOn the floor: Cross legged sitting more stable than

long sitting or side sitting Back supported against a wall may be

best for some children Mats/carpet pieces to provide some

cueing as to boundaries

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The Value Of Vertical“Children learn on their feet, not their seat!”Supports the “Three’s Company” = eyes & hand on the same planeThere are many activities that promote fine motor development that can be completed at a vertical surface, e.g. painting, stamping, coloring, tracing, connect the dots, printing, etc.Avoids “gaze shift”, better for someone with “low tone”, and promotes neutral wrist positionDoing activities in the vertical allows small muscles of the hand to develop, which is important to develop a mature pencil grasp

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“Fine Motor” Pre-requisitesGood general trunk tone and strength for good position and alignment.Adequate shoulder, arm and wrist strength in order to stabilize and use the fingers. Bilateral coordination between the helping hand and the doing hand.

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Indicators of Poor Core Strength:

“Leaners”“Slouchers”Appear lethargicTrouble carrying items / objectsRest head on handsMove constantly in their chairs

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Core Strength Activities:Working on a vertical surface for flannel boards, painting chalk, or white boardsLarge motor games Wheelbarrow / animal walks Playground equipmentAlternate positions Lying on tummy, kneelingMov n’ sit cushions

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Indicators of Shoulder Girdle Weakness

Keeps elbows tuckedRests elbow on chair when raising armSupports raised arm with other handTrouble with large movements on the chalkboardMove their paper during writing / drawing tasks instead of their armBlackboard lines are shaky and uncontrolled

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Shoulder Girdle Activities:Work on vertical surfacesLarge Motor Games Tug of war, Push-Pull activitiesWeight-bearing Activities Chair push ups, wall push ups, lying

on the floor when doing activities

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Indicators of Poor Forearm Control

Whole arm movements observedForearm is lifted off the surface‘Thumbs Down’ when cuttingElbow ‘lifters’

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Forearm Control Activities:‘Thumbs Up’ Activities Shaking Hands, holding thumb’s up,

turning doorknobsSlanted writing surfacesDrawing / coloring while in prone (i.e.. on tummy)Pouring activities

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Indicators of Poor Wrist Control

Bent wrist during paper and pencil activitiesMoves excessively during coloring activitiesWrist bends during cutting

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Wrist Control Activities:Play doughWriting above eye levelUsing rolling pinsStamp and Ink padsCutting activities‘Strong hand’ ideas

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Indicators of Poor Bilateral Coordination

Does not hold their paperTrouble guiding paper when cuttingDifficulty opening containersDifficulties with fasteners i.e.) buttons, tying shoes, double sided zippersDifficulty using a ruler

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Bilateral Coordination Activities:

Stringing beadsPlaying musical instrumentsUsing a rolling pinFinger playsClapping and rhythm games

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Hand Preference – Doer Hand

By kindergarten like to see at least a preference developing.Cases of a child being truly ambidextrous are rare i.e. being able to do tasks equally well with either hand.Observe which hand leads in many different activities. Self feeding, catching, giving something to others

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Hand Preference Activities:

Encourage, never force a hand preference.Talking about the different jobs our hands do at group time raises awareness

Doer hand and helper handDemonstrate how both roles are really important to get things donei.e. scissoring, holding paper when coloring, holding while block building

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Indicators of Poor Dexterity

Poor pencil gripProduction of large lettersPoor pencil controlDifficulty with Self help i.e..) opening lunch containersDifficulty with scissor use

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Dexterity Activities: Games (Don’t Spill

the Beans, Ker-Plunk, marble runs)

Coins in centre play

Craft Activities (process not end product)

Construction toys/blocks

Store Centre incorporates many dexterity activities

Puzzles Play dough Stringing and lacing

activities with beads, pasta, cereal on pipe cleaners, string waxed string.

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Indicators of Visual Motor Weakness

Coloring outside the linesDifficulty with basic shapes, pre-printing symbolsPoor letter formationDifficulty cutting with scissorsDifficulty with spacing, writing on the line, and sizing

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Visual Motor Activities:TracingMazesDot to dotColoringJacks, eye dropper activities, puzzles, etch-a-sketchHammering, stencils, templates, painting

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Copying, Drawing and Coloring

Consider experiences with many media and sensory modalities before going straight to the paper and pencil.All aspects of fine motor control require good integration of visual motor and sensory skills.Use multiple senses to reinforce the motor and visual aspects.

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Letters without PencilsStart big and move to small

Draw in the air, on easels, vertical board

Unlined paperBe consistent in verbal and visual cues (top/bottom, left/right)Drawing in shaving cream, plastic bags filled with paint, sand, rice, grain

Form letters with play-dough, clay, bread dough, pipe cleaners etc.Movement and musicTrace with fingers over sandpaper or tactile letters.

Always trace using correct letter formation

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Variety is the Spice of Life

Vary the Surface: Smooth

paper/rough paper Rubbings Rice Sand Aluminum foil with

white board markers

Sand paper and chalk

Vary the Writing Tool:

Crayons Chalk Markers Paint brush Fingers Short may assist with

finger placement Golf pencils, short

primary pencils (cut one in half)

Pencil Grips

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Learning to Print Requires:Blending of attentionFine motor coordinationMemory (visual memory for symbols, whole word memory, spelling rules)Visual ProcessingLanguageHigher Order Thinking

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Legibility MechanicsPlacing Text on LinesSizing Letters and WordsSpacing Between LettersSpacing Between WordsSpacing on Paper

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Learning to print requires direct instruction. It is not innate to the brain.

Hard work and lots of practice are required.

“The Intent to Prevent.”

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How to teach printing guidelines:

Daily practice is recommended10 minutes of instruction – 5 minutes of practiceHomework is not necessaryChildren should face teacher directlyInstructional Stages: Imitation (teacher demonstration) Copying (if correction still required, go back to

imitation stage) Independent printing

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Scissor SkillsA bilateral hand activity

Hand positions need to be taught

Skills develop in a progression

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How to hold ScissorsTwo thumbs up position (for the paper and the scissors)

Elbows close to the body

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Cutting ProgressionControlled opening and closing of scissorsRandom snipping of a variety of materialsCutting along a short continuous lineStopping at a specific point

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Cutting progression cont’dCutting out curved linesCutting out simple geometric shapesCutting out complex shapes

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Keyboarding SkillsWhen is it most appropriate to introduce keyboarding skills?Indicators of keyboarding readiness: age appropriate bilateral coordination skills, visual motor skills and finger dexterity Visual scanning and tracking skills developing “Red Flag” by the end of Grade 2, if child is unable to successfully complete printed work that is legible, consult OT regarding introduction of keyboarding program as an optionDiscussion with school team and parents regarding if use of computer is the best option for child to complete academic work

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Keyboarding Recommendations

The key is: practice, practice, practice and motivationThe goal of keyboarding is for the child to learn home row keys; to be able to use the proper finger for each assigned keySchool Division program: Touch Typing, Typing MasterCommercially available: Mavis Beacon Teaches Typing (approx. $30)Practice time: suggestion for 3 times per week, 10-15 minutes (combination of home and school training)

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Keyboarding Recommendations

Keyboarding training emphasis: sit with proper posture at computer, with feet on the floor (90 degree rule), keep both hands on the keyboard or “hovering”, keep wrists up, eyes stay focused on the monitorWhen is a laptop appropriate in the classroom?School divisions may have note-taking devices available, such a the “Neo-Smart” which is lightweight, compact and designed only for note-takingNeo-Smarts are a good option for children who require a computer in the early years to complete the majority of their academic workLaptops become more appropriate later in the middle years, once the student is proficient with keyboarding skillsThe laptop can then be used not only as a word processing tool, but also for possible internet use, powerpoint, excel, etc.

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Activity CentresAttached handout for activity centre ideasExplains the purpose of the activity, why the child would benefit from it, and what skills are focused onIncludes list of recommended materialsDollar-store shopping list

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Reference Printing/Writing Materials

Handwriting without tears (Jan Z. Olsen OTR, 2003)Loops and other groups (Mary Benbow OTR, 1990)The Print Club (L. Fowles, et. Al. 1999) Fine Motor Skills For Children with Down’s Syndrome (Maryanne Bruni, BScOT (Reg), 2006)Modified Basic Skills Series (Penny Groves, 2001)

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Contributing AuthorsThank you to the following Occupational Therapists who so generously contributed their ideas, wisdom, materials and presentations to this project:

Michelle Barnabe Chartier Luella Bartel Monica Desgagnes Erin Dojack Susan Flynn Donna Glasgow Marsha Katz Gina Kirchmann Sue Mitchell Jane Nattrass Nancy Stillinger Marlene Waldron Debra Koritar Leanne Austin Sarah Frank Shirley Sutton Karen More Heather Keeble

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QuestionsAny questions about the material presented today?Please complete a course evaluation before you leave today.