Fine Motor Development in Children

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In what order do the reflexes develop? Proprioceptive Placing (arms)-->Palmar Grasp-->Traction Response-->Avoidance Response-->Instinctual Grasp  
What is proprioceptive placing (arms) ○ Asymmetry may indicate CNS dysfunction, peripheral nerve injury, and primary muscle weakness ○ Bilateral response may be CNS dysfunction ○ Replaced by visual placing  
What is traction response? ○ Pull to sit at wrist = flexion of shoulders, elbows, wrist, and fingers ○ Strong enough to support child's entire weight ○ Usually tested with palmar grasp  
What is the avoidance response? ○ Hand moves away from the stimulus ○ Opposite of instinctual grasp  
What is instinctual grasp? ○ Orients hand towards object to grasp ○ Radial orientation occurs first, then ulnar ○ Supination with radial stimulus, pronation with ulnar  
In what order does reach develop? Gross asymmetrical (ATNR) UE movement-->Visual regard-->Swipe (accidental)-->One handed indirect reach (integration of ATNR)-->Symmetrical bilateral reach (supine then sitting)-->One handed direct reach  
In what position is the arm in swipe? Abduction  
What happens in one handed indirect reach? Child uses both hands: one gets proprioceptive input, the other hand mirrors and gets object  
What happens in one handed direct reach? ○ Only one hand reaches ○ No supination until ER used in reach  
What are the three grasp pattern trends? • Whole hand to fingers • Proximal to distal • Ulnar to radial  
In what order do developmental grasp patterns develop? Ulnar-palmar grasp-->Palmar grasp-->Radial-palmar grasp-->Raking grasp-->Scissors grasp or lateral/key pinch-->Radial-digital grasp-->3 jaw chuck-->Inferior pincer or forefinger grasp-->Neat & superior pincer grasp  
What happens in ulnar-palmar grasp? Child uses 4, 5, and ulnar palm ○ Thumb not involved  
What happens in palmar grasp? Child uses 3, 4, and middle palm ○ Forearm pronates ○ Thumb not involved  
What happens in radial-palmar grasp? Child uses 2, 3, and radial palm ○ Most mature infant pattern ○ Thumb not involved  
What happens in a raking grasp? Child's fingers loosely extend, then flex to get object (tenodesis)○ Object gets trapped between fingers ○ Thumb not involved, prone begins to stretch out thumb  
What happens in a scissors grasp or lateral/key pinch? Child on hands and knees, object held between adducted thumb and lateral index finger  
What happens in a radial-digital grasp? 1st thumb opposition  
What happens in a 3 jaw chuck? Thumb opposed index and middle ○ Initially held at base of fingers  
What happens in an inferior pincer or forefinger grasp? Thumb opposed to middle of index ○ Poking occurs  
What happens in a neat & superior pincer grasp? Thumb to end of index finger, Neat pincer grasp - pad to pad, Superior pincer grasp - tip to tip  
What is the order of grasps beyond development? Hook grasp-->Power grasp-->Spherical grasp-->Cylindrical grasp-->Disc grasp  
What is a power grasp? Object diagonal/oblique in palm, ulnar side stabilization  
What is a spherical grasp? Wrist extended ○ Requires good extrinsic control  
What is a cylindrical grasp? Hold jar to open in palm ○ Contrast with radial digital grasp  
What is a disc grasp? Fingers abducted, adducted if object small ○ Graded by size of object  
In what order does bilateral coordination develop? Hand to hand play-->Symmetrical grasp at midline-->Associated bimanual movements and bilateral simultaneous play-->Complementary movements-->Coordinated asymmetric movements-->Coordinated bimanual skills  
What is hand to hand play? Play without an object.  
What is symmetrical grasp at midline? Hands join together at midline and an object can be held between them (indirect reach).  
What is associated bimanual movement? One hand hold an object while the other hand manipulates it.  
What is bilateral simultaneous play? Play with a toy in each hand.  
What are complementary movements? Movements of the hands in different directions, may break objects.  
What are coordinated asymmetric movements? One hand is active, the other passive.  
What are coordinated bimanual skills? Speed, accuracy, & dexterity increase, at 2 y.o. each hand does something different but together (scissors/buttons).  
What are the pre-requisites to carrying skills against gravity? Co-contraction occurs in more distal joints of wrist/hand, forearm is stable in all positions (supinate), use shoulder rotation effectively with all movements of the humerus.  
What is the order of release development? Avoidance reaction-->Accidental release-->Transfers-->Release against a surface-->Active release-->Graded release-->Precise release.  
What occurs in a release avoidance reaction? Fingers extend and abduct following stimulation to dorsum of hand.  
What is accidental release? Release occurs involuntarily (likely flexion of wrist).  
What occurs in a release transfer? Release occurs using the mouth or other hand.  
What are the two types of release transfers? Two stage transfer & one stage transfer/purposeful release.  
What occurs in a two stage transfer? Stability phase: place wrist/arms on body; together, or on a surface, Release phase: hands relax and let object fall out of hand.  
What occurs in a one stage transfer/purposeful release? Direct transfer of object from hand to hand, stability in UE without stabilization on external surface.  
What occurs in a release against a surface? Purposeful tenodesis, rolling an object out of the hand against a surface stabilizer.  
What occurs in an active release? Tenodesis without stabilizing, flinging object combines elbow, wrist, and finger extension, cannot precisely place the object.  
What occurs in graded release? Can release to stack 2 objects with forearm stabilized or release object without stabilizing with other hand, can drop an object in a circular container.  
What is the progression of movements in graded release? Arm fully extends-->better elbow stability with more flexion-->increased wrist stability, but no control of MCP’s.  
What occurs in precise release? Child maintains wrist and MCP stability to precisely release objects, good UE stability, can stack 3 blocks.  
What are manipulation skills? Movement of an object to accomplish a task.  
What is in-hand manipulation? A series of grasps and releases to move an object held in one hand, requires dissociation of fingers and thumb, occurs during preschool years.  
What are the five pre-requisites for in hand manipulations? Thumb stability in opposition and abduction, isolated finger use, & curve/adjust distal transverse arch, able to grasp on the finger surface, wrist stability in neutral to extension position, partial supination.  
What are the 3 types of manipulation? Translation, shift, and rotation.  
What is translation? Linear movement of object from fingers to palm and back.  
What is shift? Linear movement of object between or among fingers.  
What is rotation? Movement of an object around one or more of its axes.  
What occurs in translation? Basic pattern is fingers to palm, palm to fingers requires isolated thumb movement and movement of finger from flexion to extension.  
What occurs in shift? Can occur vertical or horizontal, object usually ends in position against finger pads (turning pages).  
What occurs in rotation? Occurs at fingertips, requires skilled thumb and fingers.  
What is simple rotation? Object moves at 180 degrees or less.  
What is complex rotation? Object moves more than 180 degrees.  
What is in hand manipulation with stabilization? Holding at least one object on the ulnar side of hand while manipulating another object with the radial side, all three types of manipulation can occur with or without stabilization.  
What is laterality? Two paired structures (arms, legs, eyes, ears), with one side chosen over the other.  
What is dominance? Usually cerebral dominance in language.  
What is preference? First choice, usually established by age 3, stable by 5.  
What is proficiency? Skill & strength.  
What are the classifications of handedness? Pure right handed, right handed, pathological right handed, mixed right and left-handed, pathological left-handed, pure left handed.  
What occurs in pure right handedness? Always use this hand, strongly left hemisphere dominant for language.  
What occurs in right handedness? Usually use this hand for most activities, but not as strongly.  
What occurs in pathological right handedness? Due to neurological dysfunction, switched from left hand to right handedness, language function in right hemisphere, may create specific learning problems.  
What occurs in mixed right and left handedness? Use right hand for writing and either hand for other manual skills, inconsistency detracts from overall writing.  
What occurs in pathological left-handedness? Due to neurological dysfunction, switched from right hand to left handedness, show mixed hand dominance, if language not specialized in one hemisphere causes learning problems.  
What occurs in pure left handedness? Language in right hemisphere, naturally or genetically left handed.  
What occurs if a child has a lack of established dominance? Gross motor skills are poorer than in children who have a preference, clumsy due to delayed kinesthetic/proprioceptive memory of skilled movements, decreased speed and accuracy in task completion, decreased precision as one hand never become proficient.  
What are the types of pencil grasp from least to most mature? Held in palm, supinated grasp->Pronated grasp(transition)->Digital pronated grasp->Static tripod->Dynamic tripod.  
What occurs in the held in palm, supinated pencil grasp? Shoulder direct movement, fisted grasp on pencil.  
What occurs in the pronated (transition) pencil grasp? End of pencil toward thumb with pronated forearm, shoulder direct movement.  
What occurs in the digital pronated pencil grasp? End of pencil toward thumb with pronated forearm, shoulder direct movement.  
What occurs in a static tripod pencil grasp? Must have thumb opposition, held between thumb and two fingers, movement from wrist and elbow.  
What occurs in a dynamic tripod pencil grasp? Neat pincer grasp movement comes from hand/fingers.  

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