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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