Developing Fine Motor Skills

By Dana Daymude, OTR/L

When assessing a child’s handwriting and fine motor skills, it is very important to look at all of the joints of the upper extremity, not just the hand. Many children who experience fine motor delays also experience weakness and instability of the shoulder, elbow, and wrist. Occupational therapists are skilled in assessing these joints and centering treatment around strengthening and stabilizing the joints with weight bearing and compression type activities. OT’s often start with strengthening and stabilizing the proximal joints (joints closest to the body) and work their way down.

Shoulder girdle: It is very important to have a stable base when engaging in movement. For fine motor work, this means having a strong and stable shoulder girdle. Animal walks, wheel barrow walks, chair or wall push-ups, pouring water from a pitcher, and ball walks are just a few of activities that can be easily done at home to address the shoulder girdle.

Elbow: It is important for the forearm to rotate freely during fine motor work. We often see the forearm pronated and flexed in children with fine motor delays. Shifting a slinky back and forth between the palms, balancing an object on a spoon, carrying a book or tray, and flipping cards are just a few activities that can be done at home to improve forearm and elbow stability.

Wrist: In children with fine motor delays, OTs often see flexion of the wrist in the effort to help stabilize the joint. This has a negative cascade effect in hand movement and precision. Writing on vertical surfaces, painting on an easel, pounding a hammer, typing, or coloring while laying on floor are just a few activities that can be done to address wrist extension and strengthening.

As we move down to the hand and fingers, there are essential hand components that need to be developed for higher level fine motor skills. These include developing the arches of the hand, precision handling, separation of the hand, and stabilizing the thumb web space. Let’s take a closer look at these areas.

Hand arches: Having mature arches helps with grasping various shaped objects securely and grading precision movements. Fun activities to help develop hand arches include cupping hands to shake dice, sealing zip-loc bags, rolling putty or Play-Doh in the palm, cutting food or Play-Doh with a plastic knife, and stacking small blocks using short tweezers.

Precision handling: There are two types of precision handling: translation (thumb and index finger moving together towards and away from palm, like when threading a needle) and rotation (turning or rotating an object between fingertips).  Stringing beads, picking up coins or small objects with thumb and index finger bringing them to the palm to hold then releasing one at a time, flipping a pencil from lead position to eraser position, and finger tug of war are some great activities to do to address precision movements.

Separation of the hand: Being able to stabilize one side of the hand while engaging in dexterity or movement with the other side of the hand is important for many fine motor and precision activities. Squeezing a water bottle with index and long finger while stabilizing the bottle with ring and small finger, unscrewing a toothpaste lid, cutting, snapping fingers are all great activities to address hand separation.

Thumb Stabilization: It is important that the thumb-index webspace is stable and the thumb has full range of motion. Shuffling cards, sealing plastic bags, lining up dominos, and putty work are just a few activities that can be done to strengthen the thumb.

If you have any concerns about your child’s handwriting or fine motor skills, give us a call. We are here to help!

Resources: Loops and other Groups by Mary Benbow, M.S. OTR