Hand Function, Hand Writing and the Fine Motor Olympics: Hand Function, Hand Writing and the Fine Motor Olympics PowerPoint developed by: Rhonda Tapp Edwards, MS, OTR/L West Kentucky Educational Cooperative Occupational Therapy Services


Qualifications: Qualifications Insert your’s here:


Introduction: Introduction The purpose of the presentation to provide educators with information on sensory motor fine motor hand development skills and to explore ways to decrease referrals


Presentation Objectives:: Presentation Objectives: Participants will be able to identify: components that enable a child to print components that make up the topic of Hand Function components of Hand function that directly relate to handwriting and handwriting problems Possible reasons for increased referrals to OT Possible solutions to decrease referrals to OT referral process - pre-referral strategies parent/volunteer + fine motor program & overseen by OT parent/volunteer + handwriting program & overseen by OT DOSE suggestions How to make/adapt activities and How to use sensory adaptations to increase attention and control modulation


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Sensory Adaptations: Sensory Adaptations Enhance attention, enhance modulation increase sensory methods in teaching


Handwriting Readiness: Handwriting Readiness Controversy: when are children ready for formal handwriting instruction? What problems arise from not mastering writing readiness skills? Ponder: Could this be the cause of Literacy problems? Decreased test Scores?


Handwriting Readiness: Handwriting Readiness Readiness factors needed to write require integrity of a number of sensoriomotor systems 1. Letter formation 2. sufficient fine motor coordination


Six Prerequisites needed prior to handwriting instruction: Six Prerequisites needed prior to handwriting instruction Small muscle development Eye-hand coordination Ability to hold tools basic strokes (| ─ о + /  \ × ∆) Letter perception Orientation


What’s first: What’s first Pre-writing strokes Small group or individual supervised practice for correct grasp and letter formation Kinesthetic methods, involve all senses possible Drop ball and stick method and adopt manuscript that more closely resembles cursive to avoid learning two motor plans for most letters


Components of Hand Function: Components of Hand Function NEUROMOTOR muscle tone muscle strength positioning trunk stability range of motion balance reach use of two hands together sensory integration visual perception motor planning sense of touch


Components of Hand Function: Components of Hand Function HAND DEVELOPMENT muscles of the hand shoulder and wrist stability supination grasp patterns release separation of the two side of the hand arches of the hand finger isolation thumb opposition and open web space in-hand manipulation


Components of Hand Function: Components of Hand Function COGNITION sequencing skills psychosocial skills


Components of Hand Function: Components of Hand Function EXTERNAL FACTORS characteristics of the object: size, shape, weight orientation of the object: on a surface or held in space stability of the object


POSITIONING: POSITIONING The student’s positioning will affect their fine motor and handwriting skill level


POSITIONING: POSITIONING Proper Chair Size feet flat on floor thighs parallel with floor ankles, knees, hips 90° seat not too large, student can reach back space between knee and seat front = 2” (able to put 2 fingers in this space does not tilt student back


POSITIONING: POSITIONING Proper Chair Position student can sit comfortably bend slightly forward at waist small space between chest and desk top arm at 30° angle from trunk


POSITIONING: POSITIONING Proper Desk Size height of desk or table should be 2” above the height of the elbow when seated


POSITIONING: POSITIONING Position of Paper when seated properly, student should fold hand on desk and place paper under writing hand in the Δ formed angle paper 20-35° with top right side point higher for right-handed; 30-35 ° with top left hand point higher for left-handed place line or tape on desk as memory aid.


POSITIONING: POSITIONING Modifications supported use is easier than unsupported use (arms on desk vs off desk easels or slanted top desk help child sit straighter and also allow wrist extension


Shoulder Stabilityfor position and support of the arm and hand during fine motor task: Shoulder Stability for position and support of the arm and hand during fine motor task Shoulder - provides support and mobility to the arm Parts of the shoulder include: the shoulder blade (scapula); upper arm bone (humerus; back of the ribs (thorax); and the collar bone (clavicle). 4 joints of the shoulder ball and socket (glenohumeral joint) which most people think of as the shoulder, gives the most movement shoulder blade (scapula) - attached to the back, necessary to keep shoulders from hunching up next to ears collar bone (clavicle) attached to the scapula (AC joint) breast bone (sternum) attached to clavicle, allows shrugging and rounding of shoulders; students that slump sometimes have problems with this joint.


Shoulder Stability: Shoulder Stability Development of Shoulder stability begins to develop as an infant props on elbows when lying on stomach continues to develop with propping on extended arms, all fours, and then crawling


Shoulder Stability: Shoulder Stability Signs of decreased shoulder stability student may hold arms close to body while doing as fine motor task student’s shoulders may hunch up close to their ears student may hold tool too tightly, increasing the tightness of the muscles, decreasing and limiting fine motor movements


Shoulder Stability: Shoulder Stability Modifications use vertical surfaces - black or white boards, paper taped to walls or doors inclusion of shoulder strengthening activities in class and PE - arm circles, wheelbarrow walking


Somatosensory Perception: Somatosensory Perception In order words, a Sense of Touch Many terms are used in the literature to describe somatosensory processing. Tactile, proprioceptive, and haptic perception give a student information about the materials they are using Different types of receptors provide fine spatial discrimination and give pain and temperature information. According to Case-Smith (1998) decreased somatosensory registration and discrimination seem to be related to delays in manipulation skills.


Sense of Touch: Sense of Touch Tactile discrimination the ability to determine, without using vision, where the body is touched and what is touching it if a student has decreased tactile discrimination, the ability to get meaning from the environment is diminished if the student can’t rely on their tactile system for information then the student needs to use more visual cues


Sense of Touch: Sense of Touch Proprioceptive and kinesthetic system information on position and movement monitors the direction - amount regulation of force of movement or grasp. Essential in monitoring fine motor tasks gives feedback, maintains movement decreased proprioception and kinesthesia = use of too much pressure


Sense of Touch: Sense of Touch Haptic Perception What it is How it is activated When it starts Not dependent on vision Example = stereognosis


Muscles of the Hand: Muscles of the Hand Extrinsic Muscles Intrinsic Muscles


Muscles of the Hand: Muscles of the Hand Thenar eminence: Hypothenar eminence: Deep muscles:


Release: Release The developmental sequence of release Automatic release - the first releases are reflexive Voluntary release - develop a voluntary release from age 7-9 months; refined in precision, speed, and dexterity through 5 years of age Problems that can impact release


Wrist Stability: Wrist Stability Description of Wrist The need for extension


Wrist Stability: Wrist Stability Extension - allows optimal working of the intrinsic muscles and thumb to move into the hand and work with the fingertips The angle of the wrist extension controls the length of the finger flexors. The finger flexors cross at the wrist on the palmar surface of the hand 40° of wrist extension allows full finger flexion, efficient muscle function (Case-Smith & Berry, 1998)


Wrist Stability: Wrist Stability Flexion – Positioned down Allows for power grasp, such as when you open a jar.


Wrist Stability: Wrist Stability Supination - palm is facing up. allows the student to look at the fingers allows the thumb and radial fingers better ease of movement


Wrist Stability: Wrist Stability Pronation - palm is facing down. most important range = supination full pronation to midposition supination (Exner, 95).


Wrist Stability: Wrist Stability Modifications - horizontal surfaces promotes the wrist in neutral or flexion vertical surfaces put the hand in an optimal position for fine motor and writing; aids shoulder stability Using an easel or 4” binder promotes wrist extension


Arches of the Hand: Arches of the Hand Importance to hand function Allow hand to cup Gives position for skilled use Grades finger power Allows multiple sized object manipulation Allows for thumb movement


Arches of the Hand : Arches of the Hand Structure and development bones, intrinsic muscles, extrinsic muscles Stability Intrinsic responsible for change in hand arches (Strickland, 1995) present at birth; not functional until 2nd year of life (Case-Smith & Berry, 1998) Three types of arches: longitudinal, oblique, and transverse


Arches of the Hand: Arches of the Hand Longitudinal Arch – made of four rays from carpal bones in the hand to finger tips; allow grading finger movements


Arches of the Hand: Arches of the Hand Oblique Arch – gives power to the hand from thumb to each finger, allowing the thumb to touch each finger


Arches of the Hand : Arches of the Hand Transverse Arch – two, cup hand to form concave surface in palm Proximal Transverse Arch – reasonably fixed; provides stability Distal Transverse Arch – allows for mobility


Slide44: Two Sides: Skill and Power Skill Side of Hand – thumb, index, and middle fingers aka - radial side Necessary to develop fine motor control and thumb opposition allows skilled, fast, small movements Two Sides of the Hand


Separating the Two Sides of the Hand: Separating the Two Sides of the Hand Power side = ulnar side stability power for grip


Separating the Two Sides of the Hand: Separating the Two Sides of the Hand Development Begins at crawling crawling with object on thumb side Finger isolation seen at 40 months (Erhardt, 1982) Importance of using both sides together Correct scissor use assists in hand separation


Finger Isolation, Opposition, Open Web Space: Finger Isolation, Opposition, Open Web Space Finger Isolation Finger Opposition Web Space


Finger Isolation, Opposition, Open Web Space: Finger Isolation, Opposition, Open Web Space Development 12 mos – Except for above, difficult for children 3 and under (Pehoski, 1992) Complex patterns begin after age 3


Finger Isolation, Opposition, Open Web Space: Finger Isolation, Opposition, Open Web Space Opposition & Maintaining Open Web Space depend on Development of hand arches Intrinsic muscle development Separation of two sides of hand


In–Hand Manipulation: In–Hand Manipulation Complex process Purpose Begins at 18 mos. continues through age 7 Child not a mini adult Age of proficiency needs research Requires tactile system Coordination thumb and fingers Regulation


In–Hand Manipulation: In–Hand Manipulation Terms – three major categories of in-hand manipulation described by Exner (1989) Translation Rotation Shift With Stabilization First developed without stabilization


In–Hand Manipulation: In–Hand Manipulation Generally, 50% of children will have developed Finger to palm 1.5 – 2.0 Palm to finger 2.0 – 2.4 Simple rotation 2.0 – 2.4 Complex rotation 2.5 – 2.9 Finger to palm, stab 3.0 – 3.4 Ulnar shift of pen 4.0 – 4.4 Radial shift of pen 4.5 – 4.9 Palm to finger, stab 5.0 – 5.4 Complex rotation, 6.0 – 6.4 with palmar stabilization Exner, C.E., “In-hand manipulation skills in normal children: A pilot study.” Occupational Therapy Practice 4, (1990): 68


Grasp Patterns: Grasp Patterns Progression = non-holding grasps → holding grasps → manipulative grasps Begin in utero For Prehension or Precision Tool grasp


Grasp Patterns: Grasp Patterns Non-holding Nonprehensile Hand movement without grasp Object pushed or lifted


Grasp Patterns: Grasp Patterns Holding Grasp/Nonmanipulative: Object held partly or entirely within the hand Object is not moved within the hand Two holding grasps Hook – carry purse/lunchbox Power – hammer/knife


Grasp Patterns: Grasp Patterns Link Grasp/Blended Grasp power with a small object (key) Thumb opposes index finger No finger movement needed


Manipulative/Precision Handling Grasps: Manipulative/Precision Handling Grasps Held between fingers and thumb and allows object to be moved by fingers; Two main types Palmar Pinch Grasp – frequently used Pad-to-pad 3 point pinch/ 3 jaw chuck Superior forefinger grasp Tip Pinch/Pincer grasp Used to pick up and manipulate small objects (pegs, pennies) Tip of thumb meets tip of any finger; all finger joints are flexed


Pencil Grasp: Pencil Grasp Dynamic tripod and lateral tripod


Tool Grasp: Tool Grasp Scissor Grasp Preschool Crayon Hold Knife Hold or Diagonal Volar Grasp Tweezers Hold


Use of Two Hands Together: Use of Two Hands Together Observe use of both hands together Bilateral Motor Coordination requires different but complementary actions Gross Symmetrical bilateral skills: Stabilize objects with one hand while manipulation of object by other hand Complementary hand use


Fine Motor Olympics in the Classroom: Fine Motor Olympics in the Classroom Purpose To teach how to use the program within the classroom Describe the activities, materials, scheduling, and record keeping First step, OT screens students


The Classroom : The Classroom Classroom Environment Establishing individual plans from the record form Uses peer to peer teaching when possible Three activities a week Follow-up Parent Participation Activities for Classroom carry over


The Classroom Program: The Classroom Program The Book Different sections Materials Index


The Classroom Program: The Classroom Program OT Screening


The Classroom: The Classroom Look at Tips for Individualizing Activities Handout


The Classroom Program: The Classroom Program


The Classroom Program: The Classroom Program Establish the schedule Only work with up to two students at one time Activities can be done in 5-10 minutes Record each student’s results as they happen to be accurate Schedule Follow-up with the team Set up a method of communication Add to your kit so you and two can do the activities


Slide68: Especially for teachers What you need Handwriting Prerequisites handout What can we do? Finger Muscle Warm-ups Tools to Promote Hand Development Art Projects List Toys List Warm-up Activities for Printing or Cursive


Real Life: Real Life Go back and talk with your OT/PT staff; talk about the caseload and see if this information could be effective in your district If you decide to try this method, track OT referrals, participation in the program and see if direct OT intervention is decreased after 6 months, 1 year


What This Means To Your District: What This Means To Your District OT staff don’t teach handwriting; they work on the underlining components needed to accomplish the task successfully positioning is primary hand development skills have a great impact lack of these skills are leading to greater number of referrals to OT More importantly, they may be negatively impacting tests scores and performance


Next Steps : Next Steps Talk with your Occupational Therapy staff Enlist volunteers for a fine motor program that can be supervised by teaching staff and OT staff Provide a training and planning to establish the program Keep accurate records of student progress Do a program review Steps to Starting Fine Motor Olympics in Your school


Next Steps : Next Steps REMEMBER – THIS KIT CONTAINS SMALL OBJECTS AND SHARP OBJECTS THAT HAVE THE POTENTIAL TO HURT A CHILD IF LEFT UNATTENDED WHILE PERFORMING THE TASKS. ALWAYS SUPERVISE THE ACTIVITIES. Steps to Starting Fine Motor Olympics in Your school


Next Steps : Next Steps Bridgeman, M. (2002). The Fine Motor Olympics Manual. Framingham, MA: Therapro Graphics on slide 26 from http://www.emedicine.com/NEURO/topic657.htm from the article: Ascending spinal cord tracts – Sensory Tracts Graphics on slides 15, 20 from http://www.peterson-handwriting.com/Early%20childhood/Lefthandedchild.html from the article: Coaching Ergonomics – The Position Skills. Honaker, D. (2003). Ready, Set, Write! Video and Manual. Lubbock: Honaker Slide # 5 Smith, J., Allen, A., & Pratt, P (1996). Occupational Therapy for Children. St. Louis: Mosby Slides 7,8,9,10,15 Sumler, J. (undated). Age Appropriate Skills. www.otexchange.com slide 7 Steps to Starting Fine Motor Olympics in Your school


Next Steps : Next Steps Questions or too tuckered out to think? Steps to Starting Fine Motor Olympics in Your school