TREATMENT

 

Action Kids Therapy offers a comprehensive program to assist children who struggle with motor skills.  Program options include:

 

• Upper body and fine motor strengthening-pencil grasp, scissor use and more.

• Neurodevelopmental Facilitation Techniques.

• Bilateral coordination skills & balance.

• Activities of daily living training to include: dressing, feeding, grooming, fastener manipulation, utensil use, etc.

• Handwriting training.

• Ocular Motility Skills.

 

 

The following information is a good summary regarding both fine and gross motor skills, provided by the Encyclopedia of Children’s Health:

 

MOTOR SKILLS

 

Motor skills are actions that involve the movement of muscles in the body. They are divided into two groups: gross motor skills, which include the larger movements of arms, legs, feet, or the entire body (crawling, running, and jumping); and fine motor skills, which are smaller actions, such as grasping an object between the thumb and a finger or using the lips and tongue to taste objects. Both types of motor skills usually develop together, because many activities depend on the coordination of gross and fine motor skills.

 

 

FINE MOTOR SKILLS

 

Infancy

 

The hands of newborn infants are closed most of the time and, like the rest of their bodies, they have little control over them. If their palms are touched, they will make a very tight fist, but this is an unconscious reflex action called the Darwinian reflex, and it disappears within two to three months. Similarly, infants will grasp at an object placed in their hands, but without any awareness that they are doing so. At some point their hand muscles relax, and they drop the object, equally unaware that they have let it fall. Babies may begin flailing at objects that interest them by two weeks of age but cannot grasp them. By eight weeks, they begin to discover and play with their hands, at first solely by touch, and then, at about three months, by sight as well. At this age, however, the deliberate grasp remains largely undeveloped.

 

Hand-eye coordination begins to develop between the ages of two and four months, inaugurating a period of trial-and-error practice at sighting objects and grabbing at them. At four or five months, most infants can grasp an object that is within reach, looking only at the object and not at their hands. Referred to as "top-level reaching," this achievement is considered an important milestone in fine motor development. At the age of six months, infants can typically hold on to a small block briefly, and many have started banging objects. Although their grasp is still clumsy, they have acquired a fascination with grabbing small objects and trying to put them in their mouths. At first, babies will indiscriminately try to grasp things that cannot be grasped, such as pictures in a book, as well as those that can, such as a rattle or ball. During the latter half of the first year, they begin exploring and testing objects before grabbing, touching them with an entire hand and, eventually, poking them with an index finger.

 

One of the most significant fine motor accomplishments is the pincer grip, which typically appears at about 12 months. Initially, infants can only hold an object, such as a rattle, in their palm, wrapping their fingers (including the thumb) around it from one side. This awkward position is called the palmar grasp, which makes it difficult to hold on to and manipulate the object. By the age of eight to 10 months, a finger grasp begins, but objects can only be gripped with all four fingers pushing against the thumb, which still makes it awkward to grab small objects. The development of the pincer grip—the ability to hold objects between the thumb and index finger—gives the infant a more sophisticated ability to grasp and manipulate objects and also to deliberately drop them. By about the age of one, an infant can drop an object into a receptacle, compare objects held in both hands, stack objects, and nest them within each other.

 

 

Toddlerhood

 

Toddlers develop the ability to manipulate objects with increasing sophistication, including using their fingers to twist dials, pull strings, push levers, turn book pages, and use crayons to produce crude scribbles. Dominance of either the right or left hand usually emerges during this period as well. Toddlers also add a new dimension to touching and manipulating objects by simultaneously being able to name them. Instead of only random scribbles, their drawings   include patterns, such as circles. Their play with blocks is more elaborate and purposeful than that of infants, and they can stack as many as six blocks. They are also able to fold a sheet of paper in half (with supervision), string large beads, manipulate snap toys, play with clay, unwrap small objects, and pound pegs.

 

 

Preschool

 

The more delicate tasks facing preschool children, such as handling silverware or tying shoelaces, represent more challenge than most of the gross motor activities learned during this period of development. The central nervous system is still in the process of maturing sufficiently for complex messages from the brain to get to the child's fingers. In addition, small muscles tire more easily than large ones, and the short, stubby fingers of preschoolers make delicate or complicated tasks more difficult. Finally, gross motor skills call for energy, which is boundless in preschoolers, while fine motor skills require patience, which is in shorter supply. Thus, there is considerable variation in fine motor development among this age group.

 

 

School Age

 

By the age of five, most children have clearly advanced beyond the fine motor skill development of the preschool age. They can draw recognizably human figures with facial features and legs connected to a distinct trunk. Besides drawing, five-year-olds can also cut, paste, and trace shapes. They can fasten visible buttons (as opposed to those at the back of clothing), and many can tie bows, including shoelace bows. Their right- or left-handedness is well established, and they use the preferred hand for writing and drawing.

 

School-age children six to 12 years old should have mastered hand and eye coordination. Early school age children should be able to use eating utensils and other tools, be able to help with household chores, such as sweeping, mopping, and dusting; care for pets; draw, paint, and engage in making crafts; and begin developing writing skills. Children will continue to fine-tune their fine motor skills through adolescence with such activities as sports, crafts, hobbies, learning musical instruments, computer use, and even video games.

 

Helping a child succeed in fine motor tasks requires planning, time, and a variety of play materials. Fine motor development can be encouraged by activities that youngsters enjoy, including crafts, puzzles, and playing with building blocks. Helping parents with everyday domestic activities, such as baking, can be fun for the child in addition to helping the child develop fine motor skills. For example, stirring batter provides a good workout for the hand and arm muscles, and cutting and spooning out cookie dough requires hand-eye coordination. Even a computer keyboard and mouse can provide practice in finger, hand, and hand-eye coordination. Because the development of fine motor skills plays a crucial role in school readiness and cognitive development, it is considered an important part of the preschool curriculum.

 

 

Common Problems

 

Fine motor skills can become impaired in a variety of ways, including injury, illness, stroke, and congenital deformities. An infant or child up to age five who is not developing new fine motor skills for that age may have a developmental disability. These problems can include major health conditions including cerebral palsy, mental retardation, blindness, deafness, and diabetes. Children with delays in fine motor skills development have difficulty controlling their coordinated body movements, especially with the face, hands, and fingers. Signs of fine motor skills delays include a failure to develop midline orientation by four months, reaching by five months, transferring objects from hand to hand by six months, a raking grasp by eight months, a mature pincer grip by one year, and index finger isolation by one year.

 

Developmental coordination disorder is a disorder of motor skills. A person with this disorder has a hard time with things like riding a bike, holding a pencil, and throwing a ball. People with this disorder are often called clumsy. Their movements are slow and awkward. People with developmental coordination disorder may also have a hard time completing tasks that involve movement of muscle groups in sequence. For example, such a person might be unable to do the following in order: open a closet door, get out a jacket, and put it on. It is thought that up to 6 percent of children may have developmental coordination disorder, according to the 2002 issue of the annual journal Clinical Reference Systems. The symptoms usually go unnoticed until the early years of elementary school. It is usually diagnosed in children who are between 5 and 11 years old.

 

 

Parental Concerns

 

Parents, teachers, and primary caregivers need to have a clear understanding of how young children develop fine motor skills and the timetable for development of the skills.

 

 

Fine Motor Skills Development Tests

 

The Lincoln-Oseretsky Motor Development Scale is an individually administered test that assesses the development of motor skills in children and adults. Areas covered include fine and gross motor skills, finger dexterity and speed, and hand-eye coordination. The test consists of 36 tasks arranged in order of increasing difficulty. These include walking backwards, standing on one foot, touching one's nose, jumping over a rope, throwing and catching a ball, putting coins in a box, jumping and clapping, balancing on tiptoe while opening and closing one's hands, and balancing a rod vertically. Norms have been established for each part of the test for children aged 6 to 14.

 

The Beery-Buktenica Test, also known as VMI or Developmental Test of Visual-Motor Integration, is designed for individuals two years of age through adult. The text identifies problems with visual perception, fine motor skills (especially hand control), and hand-eye coordination. It is usually administered individually but can also be given in groups. The child is given a booklet containing increasingly complex geometric figures and asked to copy them without any erasures and without rotating the booklet in any direction. The test is given in two versions: the Short Test Form, containing 15 figures, is used for ages three through eight; the Long Test Form, with 24 figures, is used for older children, adolescents, and adults with developmental delay. A raw score based on the number of correct copies is converted based on norms for each age group, and results are reported as converted scores and percentiles. The test is not timed but usually takes 10 to 15 minutes to administer.

 

 

Age & Corresponding Skills  

 

One to three months              

Reflexively grasps finger or toy placed in hand. 

 

Three months                         

Grasping reflex gone. Briefly holds small toy voluntarily when it is placed in the hand.

 

Four months                           

Holds and shakes rattle. Brings hands together to play with them. Reaches for objects but frequently misses them. 

 

Five months                            

Grasps objects deliberately. Splashes water. Crumples paper. 

 

Six months                              

Holds bottle. Grasps at own feet. May bring toes to mouth. 

 

Seven months                         

Transfers toy from hand to hand. Bangs objects on table. Puts everything into the mouth. Loves playing with paper. 

 

Nine months                           

Able to grasp small objects between thumb and forefinger. 

 

Ten months                            

Points at objects with index finger. Lets go of objects deliberately. 

 

Eleven months                       

Places object into another's hand when requested, but does not release. 

 

Twelve months                       

Places and releases object into another's hand when requested. Rolls ball on floor. Starts to hold crayon and mark paper with it. 

 

Fifteen months                       

Builds tower of two blocks. Repeatedly throws objects on floor. Starts to be able to take off clothing, starting with shoes. 

 

Eighteen months                    

Builds tower of three blocks. Starts to feed self well with spoon. Turns book pages two or three at a time. Scribbles on paper. 

 

Two years                               

Builds tower of six or seven blocks. Turns book pages one at a time. Turns door knobs and unscrews jar lids. Washes and dries hands. Uses spoon and fork well. 

 

Two and a half years              

Builds tower of eight blocks. Holds pencil between fingers instead of grasping with fist. 

 

Three years                            

Builds tower of nine or ten blocks. Puts on shoes and socks. Can button and unbutton. Carries containers with little spilling or dropping. 

 

Four years                              

Dresses self except for tying. Cuts with scissors, but not well. Washes and dries face. 

 

Five years                               

Dresses without help. Ties shoes. Prints simple letters. 

 

SOURCE  :   Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, 5th ed.  and Child Development Institute, http://www.childdevelopmentinfo.com. 

 

 

 

GROSS MOTOR SKILLS

 

Gross motor skills development is governed by two principles that also control physical growth. Head to toe development refers to the way the upper parts of the body develop, beginning with the head, before the lower ones. The second principle of development is trunk to extremities. Head control is gained first, followed by the shoulders, upper arms, and hands. Upper body control is developed next, followed by the hips, pelvis, and legs.

 

Encouraging gross motor skills requires a safe, open play space, peers to interact with, and some adult supervision. Promoting the development of gross motor abilities is considerably less complicated than developing fine motor skills. Helping a child succeed in gross motor tasks requires patience and opportunities for a child to practice desired skills. Parents and other persons must understand the child's level of development before helping him or her master gross motor skills. Children reach developmental milestones at different rates. Pushing a child to perform a task that is impossible due to development status promotes frustration and disappointment. Children should be allowed to acquire motor skills at their own paces.

 

There are a number of activities parents can have children do to help develop gross motor skills. These include:

 

• playing hopscotch and jumping rope; activities that help children learn balance

• hitting, catching, kicking, or throwing a ball, such as a baseball, football, or soccer ball; activities that help develop hand-eye or foot-eye coordination

• kangaroo hop, in which children hold something, such as a small ball or orange, between their knees and then jump with their feet together frontward, backwards, and sideways

• playing wheelbarrow, in which someone holds the children's legs while they walk on their hands along a specific route

• walking on a narrow bar or curb, while holding a bulky object in one hand, then the other hand, and then repeating the activity walking backwards and sideways

• toss and catch, in which children toss an object, such as a baseball, in the air and then catch it, while sitting or lying down and also while using alternate hands

 

Infancy

 

The first gross motor skill infants learn usually is to lift their heads and shoulders before they can sit up, which, in turn, precedes standing and walking. Lifting the head is usually followed by head control. Although they are born with virtually no head or neck control, most infants can lift their heads to a 45-degree angle by the age of four to six weeks, and they can lift both their head and chest at an average age of eight weeks. Most infants can turn their heads to both sides within 16 to 20 weeks and lift their heads while lying on their backs within 24 to 28 weeks. By about nine to 10 months, most infants can sit up unassisted for substantial periods of time with both hands free for playing.

 

One of the major tasks in gross motor development is locomotion, the ability to move from one place to another. Infants progress gradually from rolling (eight to 10 weeks) to creeping on their stomachs and dragging their legs behind them (six to nine months) to actual crawling (seven to 12 months). While infants are learning these temporary means of locomotion, they are gradually becoming able to support increasing amounts of weight while in a standing position. In the second half-year of life, babies begin pulling themselves up on furniture and other stationary objects. By the ages of 28 to 54 weeks, on average, they begin navigating a room in an upright position by holding on to the furniture to keep their balance. Eventually, they are able to walk while holding on to an adult with both hands and then with only one. They usually take their first uncertain steps alone between the ages of 36 and 64 weeks and are competent walkers by the ages of 12 to 18 months.

 

 

Toddlerhood

 

Toddlers are usually very active physically. By the age of two years, children have begun to develop a variety of gross motor skills. They can run fairly well and negotiate stairs holding on to a banister with one hand and putting both feet on each step before going on to the next one. Most infants this age climb (some very actively) and have a rudimentary ability to kick and throw a ball. By the age of three, children walk with good posture and without watching their feet. They can also walk backwards and run with enough control for sudden stops or changes of direction. They can hop, stand on one foot, and negotiate the rungs of a jungle gym. They can walk up stairs alternating feet but usually still walk down putting both feet on each step. Other achievements include riding a tricycle and throwing a ball, although they have trouble catching it because they hold their arms out in front of their bodies no matter what direction the ball comes from.

 

 

Preschool

 

Four-year-olds can typically balance or hop on one foot, jump forward and backward over objects, and climb and descend stairs alternating feet. They can bounce and catch balls and throw accurately. Some four-year-olds can also skip. Children this age have gained an increased degree of self-consciousness about their motor activities that leads to increased feelings of pride and success when they master a new skill. However, it can also create feelings of inadequacy when they think they have failed. This concern with success can also lead them to try daring activities beyond their abilities, so they need to be monitored especially carefully.

 

 

School Age

 

School-age children, who are not going through the rapid, unsettling growth spurts of early childhood or adolescence, are quite skilled at controlling their bodies and are generally good at a wide variety of physical activities, although the ability varies according to the level of maturation and the physique of a child. Motor skills are mostly equal in boys and girls at this stage, except that boys have more forearm strength and girls have greater flexibility. Five-year-olds can skip, jump rope, catch a bounced ball, walk on their tiptoes, balance on one foot for over eight seconds, and engage in beginning acrobatics. Many can even ride a small two-wheel bicycle. Eight- and nine-year-olds typically can ride a bicycle, swim, roller skate, ice skate, jump rope, scale fences, use a saw, hammer, and garden tools, and play a variety of sports. However, many of the sports prized by adults, often scaled down for play by children, require higher levels of distance judgment and hand-eye coordination, as well as quicker reaction times, than are reasonable for middle childhood. Games that are well suited to the motor skills of elementary school-age children include kick ball, dodge ball, and team relay races.

 

In adolescence, children develop increasing coordination and motor ability. They also gain greater physical strength and prolonged endurance. Adolescents are able to develop better distance judgment and hand-eye coordination than their younger counterparts. With practice, they can master the skills necessary for adult sports.

 

 

Common Problems

 

There are a range of diseases and disorders that affect gross motor skill development and skills. Among young persons, developmental problems such as genetic disorders, muscular dystrophy, cerebral palsy, and some neurological conditions adversely impact gross motor skill development.

 

Gross motor skills can become impaired in a variety of ways, including injury, illness, stroke, and congenital deformities. Developmental coordination disorder affects motor skills. A person with this disorder has a hard time with skills such as riding a bike, holding a pencil, and throwing a ball. People with this disorder are often called clumsy. Their movements are slow and awkward. People with developmental coordination disorder may also have a hard time completing tasks that involve movement of muscle groups in sequence. For example, such a person might be unable to do the following in order: open a closet door, get out a jacket, and put it on. It is thought that up to 6 percent of children may have developmental coordination disorder, according to the 2002 issue of the annual journal Clinical Reference Systems. The symptoms usually go unnoticed until the early years of elementary school; the disorder is usually diagnosed in children who are between five and 11 years old.

 

Children with any one or combination of developmental coordination disorder symptoms should be seen by a pediatrician who specializes in motor skills development delays. There are many ways to address gross motor skills impairment, such as physical therapy. This type of therapy can include treating the underlying cause, strengthening muscles, and teaching ways to compensate for impaired movements.

 

Parental Concerns

 

Parents, teachers, and primary caregivers need to have a clear understanding of how young children develop gross motor skills and the timetable for development of the skills. The Lincoln-Oseretsky Motor Development Scale is an individually administered test that assesses the development of motor skills in children and adults. Areas covered include fine and gross motor skills, finger dexterity and speed, and hand-eye coordination. The test consists of 36 tasks arranged in order of increasing difficulty. These include walking backwards, standing on one foot, touching one's nose, jumping over a rope, throwing and catching a ball, putting coins in a box, jumping and clapping, balancing on tiptoe while opening and closing one's hands, and balancing a rod vertically. Norms have been established for each part of the test for children aged 6 to 14.

 

 

When to Get Help

 

Parents, who suspect that their child has a delay in developments should follow their instincts in having that child evaluated. The earliest intervention possible offers the highest response and success rate among children with special needs. Parents should contact an Occupational Therapist any time they have a concern about their child's motor skill development. Parents should keep in mind that children develop at different rates and try to focus on the skills their children have mastered instead of those they may have yet to master. Still, there are certain signs that may point to a problem, and these should be discussed with an Occupational Therapist. These signs include not walking by 15 months of age, not walking maturely (heel to toe) after walking for several months, walking only on the toes, and not being able to push a toy on wheels by age two. Toddlers may begin to prefer one hand to the other, the first sign of right- or left-handedness, or to use both hands equally. This preference should be allowed to develop naturally. Parents should call a doctor if the child does not seem to use one hand at all or has a strong hand preference before he or she is one year old.

 

 

Age & Corresponding Skills      

 

One month                             

May hold up head momentarily.

 

 

Two months                           

Lifts head when placed on stomach. Holds up head briefly when held in a seated or standing position.

 

 

Three months                         

Holds head and shoulders up when placed on stomach. Puts weight on forearms.

 

Four months                           

Holds head up well in sitting position. Can lift head to a 90-degree angle when placed stomach. May start to roll over.

 

Five months                            

Has full head control. When pulled by hands to a sitting position, the head stays in line with body.

 

Six months                              

Rolls over (front to back first). Bears a large. percentage of body weight when held in a standing position.

 

Seven months                         

Can stand with support. May sit without support for short periods. Pushes upper part of body up while on stomach.

 

Eight months                          

Stands while holding onto furniture. Sits well unsupported. Gets up on hands and knees; may start to crawl backwards.

 

Nine months                           

Crawls first by pulling body forward with hands. May move around a room by rolling.

 

Ten months                            

Pulls up to standing. Is very steady while sitting; moves from sitting to crawling position and back. Crawls well.

 

Eleven months                        

"Cruises," walking while hanging onto furniture. Walks with two hands held.

 

Twelve months                       

Walks with one hand held. May walk with hands and feet. Stands unsupported for longer periods of time.

 

Fifteen months                       

Walks without help. Crawls up stairs. Gets into a standing position without support.

 

Eighteen months                    

Seldom falls while walking. Can walk and pull toy. Runs. Climbs stairs holding railing. May walk backward.

 

Two years                               

Kicks a ball. Walks up and down stairs, two feet per step.

 

Two and a half years              

Jumps with both feet. Jumps off step. Can walk on tiptoe.

 

Three years                            

Goes upstairs one foot per step. Stands on one foot briefly. Rides tricycle. Runs well.

 

Four years                              

Skips on one foot. Throws ball well overhand. Jumps a short distance from standing position.

 

Five years                               

Hops and skips. Good balance. Can skate or ride scooter.

 

SOURCE : Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, 5th ed. and Child Development Institute, http://www.childdevelopmentinfo.com.