Fine motor
Fine motor refers to all the skills you need using your hands and fingers. These include skills like drawing, cutting, colouring, folding paper etc. The development of fine-motor skills is dependent on a lot of components which will be broken down here.
Dissociation
This refers to the movement between smaller joints in the hands. It is the ability to move the finger joints separate from the others and separate from the wrist. We evaluate this by looking at thumb-finger touching and the way in which a child holds a pencil and colours.
Thumb-finger touching
This refers to the child’s ability to touch each finger to the thumb. We look at whether or not the child has does this with dissociated joints or if it is done with straight fingers. We look at the sequence of movement as well as the quality. When a child does this action we pay attention to how hard they push and whether or not he uses vision. We also look at the coordination while he does the movement. He is first asked to do it with one hand at a time and then both hands together. If they struggle more when both hands do the action at the same time, it indicates difficulty with bilateral coordination
Bilateral coordination
This refers to the use of both hands together. It develops in an order.
1. One hand supporting and one hand doing the action – like drawing
2. Hands working in the same direction – like rolling out playdough
3. Hands working in directly opposite directions – like tearing paper
4. Hands working in different directions – like cutting
When we assess bilateral coordination we look at the level the child is at as well as the quality of the actions performed.
Sequencing
This refers to the ability of a child to do a movement in the correct order. During thumb-finger touching they have to touch each finger starting at the index finger, working their way to the pinky. Should the child miss a finger it indicates difficulty with sequencing. This is also checked when a child has to perform an action of diadokokinesia.
Diadokokinesia
This refers to the action where a child is required to slap the knee with the hand alternating between the palm of the hand and the top of the hand. This is called pronation (palm on the leg) and suppination (top of the hand). During this activity we are looking to see if the child dissociates between the radius and ulnar in the forearm which enables wrist movement. This is important for writing. We again look at coordination and sequencing as well as whether the child hits hard or soft or needs to compensate by using vision.
Pencil Grip
This refers to the way in which a child holds a pencil when drawing or colouring in. The grip also develops in different stages dependent on the childs’ age. By the age of 4-5 we are looking for a normal static tripod grip which involves the thumb, index and middle finger. By the age of 5-6 we want a more dynamic grip which develops through the dissociation of the finger joints.
Scapular stability
This refers to the stability around the scapula. If a child shows “winging” or scapular protrusion it is an indication that the stability is compromised. This can either be due to muscle tone or muscle strength on the muscles surrounding the scapula. When a child struggles with scapular stability, they often fixate during fine-motor tasks, influencing the dissociation of joints and then the control of the movement which in turn influence the quality of the output.
Eye-movement
When assessing this aspect, we look at whether or not a child can smoothly track a stimulus across the midline, keeping their eye on the stimuli and not under or overshoot. We also check convergence and divergence, which is the ability of the child to keep focusing on a stimulus that moves closer to the nose and back away. We lastly check quick localization which is the ability of the child to locate a jumping stimulus quickly without over or undershooting. Eye-movement is important for eye-hand coordination.
Eye-hand coordination
This refers to the ability of the child to stay between lines when drawing, colouring and cutting. Here we use eye movements as well as fine motor skills to do tasks.
Midline crossing
This refers to the child’s ability to use the one side of the body on the opposite side. This gets assessed throughout, but is best seen when the child has to draw a line across the page, starting at the far most left side going all the way to the right. If there is a difficulty the OT will note postural changes in the child. They lean to the left (if they are right handed), turn their shoulders or shift their bum on the chair. When a child struggles with midline crossing they likely struggle with bilateral coordination which influence the outputs of their fine-motor activities.
I hope this helps you to understand what OT speak about when they refer to fine-motor terms.
Happy parenting