Fine Motor Development in
the Early Years
1
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
2
Agenda
1. Developmental sequence of fine motor
2.
3.
4.
5.
and visual motor skills.
Development of grasp patterns.
Fine motor “red flags”.
Steps for Fine Motor success.
Positioning strategies in the
classroom.
3
Agenda
6. Muscle group development and
activities.
7. Hand dominance and dexterity.
8. Scissor skills.
9. Keyboarding skills.
10.Activity centers.
11.Questions and Evaluation Form
4
Pre-Printing Skills
Motor coordination issues affect 5-6% of
school aged children
Early intervention often can help to resolve
fine motor issues
While the coordination issues may seem
subtle in the whole scheme of things; we
know that they can have serious academic,
social and emotional consequences
5
School Performance
Study by “McHale & Cermak” (1992), examined the
amount of time school-aged children were expected
to perform fine motor activities in the classroom
31-60% of a child’s school day in Grades 2-6
consisted of fine motor activities
85% of these fine motor activities consisted of pencil
& paper tasks
What is the impact on school performance and selfesteem when a child spends 1/3 or more of their
school day frustrated due to difficulties with printing
skills?
6
Motor development is a complicated balancing act!
7
Visual-Motor Development
What is realistic to
expect at each age
range?
How do we know
we’re challenging
but not
overwhelming?
8
Visual-Motor Development
Visual Motor Skills
cursive writing, printing and drawing
Processing
organizing, interpreting, and planning
Fine Motor Control
Visual Perception
Sensorimotor Foundations
postural control of head, neck and trunk;
stability of shoulder, wrist and fingers;
bilateral organization, and proprioceptive/kinesthetic
Visual Skills
visual acuity, tracking and binocular vision
9
The Three Year Old
May see: Circle, cross
Uses 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.
10
The Four Year Old
May see: Copies cross,
imitates square
Mature 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.
11
The Five Year Old
May see: Copies square,
imitates triangle
Mature 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.
12
And Beyond
Child 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.
13
Definitions
Cue / Trace: Make a shape or line
using dots or dotted lines as a cue
Imitate: You draw one with the child
watching and then the child makes one
Copy: Child is shown a picture and is
asked to ‘draw one that looks like this.’
Draw on Request: ‘Draw a circle.’
14
Developmental sequence of printing skills
Bangs or scribbles
Scribbles with direction
Imitates vertical & horizontal lines, circle
Copies vertical & horizontal lines, circle
Imitates, copies +
Draws spontaneous forms
Draws face
Imitates, copies diagonals, V
15
Developmental sequence of printing skills
Imitates, copies Y
Imitates, copies X
Draws stick figure
Identifiable objects (ex. Happy face, sun)
Imitates, copies square
Copies name in large irregular letters
Copies numbers
16
When are kids ready?
Good postural control
Hand preference
evident
When they can form the
basic strokes:


Can hold a pencil in
writing position:
 What does that look
like?
Vertical, horizontal,
circular, cross, diagonal.
All necessary for letter
formation.
Sufficient attention,
cognition and interest.
17
Development of Pencil/Crayon
Grasp
Least Mature Grasp
Most Mature Grasp
18
19
Teaching The Tripod Grasp
Teach 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 pencil
Pinch Flip Tuck
20
INEFFICIENT GRASPS
21
Fine Motor “Red Flags”
No preferred hand dominance
established
Inability to print/copy name
Inability to copy lines and simple
shapes
Immature pencil grasp
22
Fine Motor “Red Flags”
Immature self portrait
Unable 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
23
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.
24
7 Steps to Fine Motor Success
1.
2.
3.
4.
5.
6.
7.
Stability of trunk, shoulder and elbow
Wrist extension
Grasp (pincer and tripod) & release
Arches of the hand/separation of 2 sides of the
hand
Finger isolation
Thumb opposition and web space
In hand manipulation
“Stability before mobility”
25
Start with Position
Check 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.
26
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.
27
Seating Position
28
Positioning Strategies
On 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
29
The Value Of Vertical
“Children learn on their feet, not their seat!”
Supports the “Three’s Company” = eyes & hand on
the same plane
There 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 position
Doing activities in the vertical allows small muscles of
the hand to develop, which is important to develop a
mature pencil grasp
30
“Fine Motor” Pre-requisites
Good 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.
31
Indicators of Poor Core
Strength:
“Leaners”
“Slouchers”
Appear lethargic
Trouble carrying items / objects
Rest head on hands
Move constantly in their chairs
32
Core Strength Activities:
Working on a vertical surface for flannel
boards, painting chalk, or white boards
Large motor games


Wheelbarrow / animal walks
Playground equipment
Alternate positions

Lying on tummy, kneeling
Mov n’ sit cushions
33
Indicators of Shoulder Girdle
Weakness
Keeps elbows tucked
Rests elbow on chair when raising arm
Supports raised arm with other hand
Trouble with large movements on the
chalkboard
Move their paper during writing / drawing
tasks instead of their arm
Blackboard lines are shaky and uncontrolled
34
Shoulder Girdle Activities:
Work on vertical surfaces
Large Motor Games

Tug of war, Push-Pull activities
Weight-bearing Activities

Chair push ups, wall push ups, lying on the
floor when doing activities
35
36
Indicators of Poor Forearm
Control
Whole arm movements observed
Forearm is lifted off the surface
‘Thumbs Down’ when cutting
Elbow ‘lifters’
37
Forearm Control Activities:
‘Thumbs Up’ Activities

Shaking Hands, holding thumb’s up,
turning doorknobs
Slanted writing surfaces
Drawing / coloring while in prone (i.e..
on tummy)
Pouring activities
38
39
Indicators of Poor Wrist
Control
Bent wrist during paper and pencil
activities
Moves excessively during coloring
activities
Wrist bends during cutting
40
Wrist Control Activities:
Play dough
Writing above eye level
Using rolling pins
Stamp and Ink pads
Cutting activities
‘Strong hand’ ideas
41
42
Indicators of Poor Bilateral
Coordination
Does not hold their paper
Trouble guiding paper when cutting
Difficulty opening containers
Difficulties with fasteners i.e.) buttons,
tying shoes, double sided zippers
Difficulty using a ruler
43
Bilateral Coordination
Activities:
Stringing beads
Playing musical instruments
Using a rolling pin
Finger plays
Clapping and rhythm games
44
45
46
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
47
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 hand
Demonstrate how
both roles are really
important to get
things done
i.e. scissoring,
holding paper when
coloring, holding
while block building
48
Indicators of Poor Dexterity
Poor pencil grip
Production of large letters
Poor pencil control
Difficulty with Self help i.e..) opening
lunch containers
Difficulty with scissor use
49
Dexterity Activities:




Games (Don’t Spill
the Beans, KerPlunk, 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.
50
51
52
Indicators of Visual Motor
Weakness
Coloring outside the lines
Difficulty with basic shapes, pre-printing
symbols
Poor letter formation
Difficulty cutting with scissors
Difficulty with spacing, writing on the
line, and sizing
53
Visual Motor Activities:
Tracing
Mazes
Dot to dot
Coloring
Jacks, eye dropper activities, puzzles,
etch-a-sketch
Hammering, stencils, templates,
painting
54
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.
55
Letters without Pencils
Start big and move to
small


Draw in the air, on
easels, vertical board
Unlined paper
Be 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 playdough, clay, bread
dough, pipe cleaners
etc.
Movement and music
Trace with fingers over
sandpaper or tactile
letters.

Always trace using
correct letter formation
56
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
57
Learning to Print Requires:
Blending of attention
Fine motor coordination
Memory (visual memory for symbols,
whole word memory, spelling rules)
Visual Processing
Language
Higher Order Thinking
58
Legibility Mechanics
Placing Text on Lines
Sizing Letters and Words
Spacing Between Letters
Spacing Between Words
Spacing on Paper
59
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.”
60
How to teach printing
guidelines:
Daily practice is recommended
10 minutes of instruction – 5 minutes of
practice
Homework is not necessary
Children should face teacher directly
Instructional Stages:



Imitation (teacher demonstration)
Copying (if correction still required, go back to
imitation stage)
Independent printing
61
Scissor Skills
A bilateral hand activity
Hand positions need to be taught
Skills develop in a progression
62
How to hold Scissors
Two thumbs up position (for the paper
and the scissors)
Elbows close to the body
63
Cutting Progression
Controlled opening and closing of
scissors
Random snipping of a variety of
materials
Cutting along a short continuous line
Stopping at a specific point
64
Cutting progression cont’d
Cutting out curved lines
Cutting out simple geometric shapes
Cutting out complex shapes
65
Keyboarding Skills
When 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 option
Discussion with school team and parents regarding if
use of computer is the best option for child to
complete academic work
66
Keyboarding Recommendations
The key is: practice, practice, practice and motivation
The goal of keyboarding is for the child to learn
home row keys; to be able to use the proper finger
for each assigned key
School Division program: Touch Typing, Typing
Master
Commercially available: Mavis Beacon Teaches
Typing (approx. $30)
Practice time: suggestion for 3 times per week, 10-15
minutes (combination of home and school training)
67
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 monitor
When 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-taking
Neo-Smarts are a good option for children who require a
computer in the early years to complete the majority of their
academic work
Laptops become more appropriate later in the middle years,
once the student is proficient with keyboarding skills
The laptop can then be used not only as a word processing tool,
but also for possible internet use, powerpoint, excel, etc.
68
Activity Centres
Attached handout for activity centre
ideas
Explains the purpose of the activity,
why the child would benefit from it, and
what skills are focused on
Includes list of recommended materials
Dollar-store shopping list
69
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)
70
Contributing AuthorsMichelle Barnabe Chartier

Thank you to the
following
Occupational
Therapists who so
generously
contributed their
ideas, wisdom,
materials and
presentations to this
project:

















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
71
Questions
Any questions about the material
presented today?
Please complete a course evaluation
before you leave today.
72