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Prepare students to exercise their fine motor skills 

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Prepare students to exercise their fine motor skills 

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Focus on strengthening the main aspects of a correct, dynamic, functional and effective grasp. The skills are: ulnar and radial manipulation, wrist stabilization, open web space, thumb PIP flexion.

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Focus on strengthening the main aspects of a correct, dynamic, functional and effective grasp. The skills are: ulnar and radial manipulation, wrist stabilization, open web space, thumb PIP flexion.

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Doing more complex coloring, drawing or writing activities to encourage dynamic tripod grasp.In hand manipulation skills

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Doing more complex coloring, drawing or writing activities to encourage dynamic tripod grasp.In hand manipulation skills

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Finger Warm Up Exercises

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Affiliate and Referral links are used below to promote products I love and recommend. I receive a commission on any purchases made through these links. Please see my disclosure policy for more details.

Proper pencil grasp development for writing starts a lot earlier than you think in children. From the time your child starts grasping for objects with their hands, they are developing grasps.

If your child has ever received or been evaluated for Occupational Therapy, this is one thing that the therapist will be looking at when assessing their handwriting skills.
This post was last updated in September 2017 with updated information on static/dynamic tripod grasps and references.
Before we get started here are some term definitions that will help explain some of the hand grasps:

Radial - Thumb side of the hand

Digital - Finger or pinkie side of the hand; can also mean digits as in fingers

Palmar - Palm side, or inside part of the hand

Supinate - Palm facing up or forwards

Pronate - Palm facing down or backward

Typical Pencil Grasp Development in Kids

Let's start at the beginning. Again these are average ages ranges, every child is different. If you do suspect your child is behind in their development, please talk to your pediatrician or consult with your local Occupational Therapist.

Crude Palmar Grasp - 3-5 Months Old

By age 3.9 months your baby should be able to grasp a rattle or other objects.

By age 5.2 months they reach for objects with their whole arm using a crude palmar grasp (grabbing at objects with the pinkie side, or palmar side, of their hand. The thumb is not being used at this time.

Palmar Grasp - 6 Months Old

Your child will start using their entire hand to grasp at objects, including some thumb movement. This is called a Palmar Grasp.

Radial Palmar Grasp - 7 Months Old

They will begin to involve the thumb and all fingers while using more of the thumb side of their hand to grab objects or using a radial palmar grasp.

Raking Grasp - 8 Months Old

By 8 months your child will start to use a raking type grasp. This involves bending (or flexing) the fingers to bring objects into the hand and closer to them.

Radial Digital Grasp - 8-10 Months

Between 8-10 months old your child will start to perfect the pincer grasp using a Radial Digital Grasp & Inferior Pincer Grasp. A radial grasp refers to the fingers from the middle finger to thumb doing the grasping. As pictured, the child tends to use the pads of their fingers to grasp instead of the tips.

Inferior Pincer & Pincer Grasp - 10 Months Old

By the age of 10.2 months, they should be able to use a thumb-finger grasp (pincer grasp). The difference between the Inferior Pincer Grasp and a regular Pincer grasp is all in the placement of the fingertips.

The index and thumb are used in for this grasp. If the pads of the fingers are holding the object, that is an Inferior Pincer Grasp. A true pincer grasp is using the tips of the pointer finger and thumb.

You may also see this referred to as the "Pincher" grasp, however, the correct spelling is "Pincer".

Palmar Supinate Grasp - 12-15 months old

At this age, a young toddler begins use a palmar supinate grasp. It is a fisted grasp with the thumb wrapped at the top of the writing utensil. This is usually accompanied by scribbling. This is considered a primitive grasp.

Digital Pronate Grasp - 2-3 Years Old

By 2-3 years old, a child moves to a digital pronate grasp, pictured below. This is the beginning of an efficient looking hand grasp. The fingers are now pointed down towards the bottom of the writing utensil, however, all the fingers are being used along with a lot of whole arm movements. This is also a common grasp for self-feeding with utensils.

Static Tripod and/or Quadrupod Grasp - 3-4 Years Old

By age 3 to 4 a child will switch to a static tripod grasp or quadrupod grasp. They hold the writing utensils crudely and use the whole pads of their fingers on the writing utensil. There also may still be some wrist and forearm movement to move the pencil, with the fingers not moving, or static. The static tripod grasp is a 3 finger grasp, two fingers pinching the writing utensil and the 3rd (middle) finger tucked to the side of the pencil, forming a tripod. The 4th and 5th fingers are usually static next to these fingers and do not tuck into the palm of the hand yet.

A quadrupod grasp is also referred to as a 4 finger grasp, 3 fingers being on the pencil and then tucked on the 4th finger. It can also be static or dynamic. Dynamic is pictured below.

Dynamic Tripod Grasp - 5-6 Years Old

By the time your child hits kindergarten, they will use the most mature grasp, the dynamic tripod/quadruped grasp. They will use the tips of their fingers on the writing utensil and also hold the crayon/pencil more at an angle than vertical. This is much like an adult grasp.

Their finger movements are also dynamic, which means they move back in forth without any forearm or minimal wrist movement (the arm will be resting on the table or writing surface instead of floating above). This grasp is also referred to as a 3-finger grasp, the first 2 fingers on the pencil while resting on the middle finger. The 4th and 5th fingers are tucked into the palm of the hand and help to stabilize the hand on the table.

Again, these are average ages ranges and every child is different. This does give you a good idea of what to look for as your child starts to explore the wonderful world of writing.

If you would like to get printable cards of all these hand grasps, complete with descriptions and photos, you can check out my hand grasp development cards here.

There is a digital and printed version available. They are great to have on hand in your classroom as you evaluate students. Or in your home or therapy sessions as a handy resource and reminder.
References
" From Rattles to Writing - A Parent's Guide to Hand Skills " - Barbara Smith, MS, OTR/L

" The Handwriting Book " - Functional Skills for Kids Pediatric Therapist Team

" Pencil Grip - A Descriptive Model and Four Empirical Studies. " - Ann-Sofie Selin, Masters in special education.

" The Fine Motor Olympics Manual " - Marcia P. Bridgeman

For more handwriting tips like this one, check out my Handwriting Pinterest board below.

Follow Heather | Growing Hands-On Kids's board Handwriting Tips and Activities on Pinterest.
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1 Chapter 13 A FINE MOTOR PROGRAM FOR PRESCHOOLERS Carol Anne Myers* CHAPTER OUTLINE VERTICAL SURFACES MANIPULATIVES The Manipulatives Program Fine Motor Planning SCISSORS DRAWING AND WRITING Hand Preference Activities to Help Develop Pencil Grasp and Control WHAT MAKES THERAPY EFFECTIVE? CASE STUDY The activities and suggestions included in this chapter were developed at the Newton Early Childhood Program (formerly the Brookline-Newton Early Childhood Collaborative) in the metropolitan area of Boston. The program serves preschoolers from 3 through 5 years of age with mild to severe special needs. This chapter focuses primarily on activities that are used with children who have mild to moderate special needs, but in some cases they may be adapted for use with children who have severe needs. Occupational therapy (OT) services in the Newton Early Childhood Program are provided to children who attend integrated preschool classrooms (a combination of typically developing children and children who have with special needs), in substantially separate *Taken in part from Myers CA (1992). Therapeutic fine-motor activities for preschoolers. In J Case-Smith, C Pehoski, editors: Development of hand skills in the child. Rockville, MD, American Occupational Therapy Association. self-contained class-rooms, as well as to children who attend community nursery schools. The children who are in community nursery schools usually receive related services such as speech and language, OT, and physical therapy during their after-school hours. Many of the children who receive OT services have learning differences that may result in a learning disability diagnosis in later years, or mild to moderate sensory processing difficulties. Some of the children who receive OT, however, have no area of disability other than a discrete weakness in fine motor skills. Although the program is comprehensive in the types of OT intervention that are provided, this chapter focuses on the fine motor program, which refers both to the use of manipulatives, as well as to prewriting skills such as the use of scissors and drawing implements. The theoretical rationale for the fine motor program described in this chapter is based primarily on the work of Mary Benbow, as gleaned from her workshops and publications (see Chapter 15). Her perspective has provided an invaluable foundation on which to base the work of the program. Many of her ideas for fine motor activities with older children have been adapted for the work with preschool children. The philosophy of the fine motor program is based on the classic OT theory that intervention should enhance the client s ability to participate in his or her occupation, which has long been recognized as a requirement for survival and, to varying degrees, as a source of pleasure (Hopkins & Smith, 1978). The occupation of the preschool child is to be independent and successful in all of the areas of the classroom and playground, both with play activities as well as with self-care. Specifically in respect to fine 267

2 268 Part III Therapeutic Intervention motor skills, the overall goal is for students to be able to participate productively in classroom learning centers such as the art area, manipulatives area, and writing center. Young preschoolers work at mastering a variety of manipulatives and simple art projects, whereas older preschoolers develop the skills to independently use complex, multistep manipulatives, and to participate in multistep art projects as well as prewriting tasks. Parents and teachers often overemphasize prewriting activities for young preschoolers, while short-changing them on the use of manipulatives that will develop their overall hand function. This overemphasis on academics may have been encouraged by the overall national trends toward increased standardized testing of students of all ages. Windsor (2000) stated that at the preschool level, tool use and whole body play in the environment are preferred to practice with pencils, pens, and tabletop exercises (p. 19). It is critical for parents of students in the program to understand that all aspects of hand development are valuable, and that the provision of a rich variety of manipulative materials will benefit all students as they move toward developing prewriting skills. To fully assist students in being functional and independent with all of the classroom activities, therapists either use materials that are similar to classroom materials, or they borrow materials from the classroom for the OT sessions. This practice enhances the generalization of skills learned during the OT sessions to the classroom setting, and is particularly applicable in two circumstances: (a) students who avoid fine motor areas in the classroom because of low self-confidence, and (b) students with fine motor planning difficulties. Most of the children in the program who receive OT services to address fine motor delays receive them once weekly, for 30 minutes, in either an individual or small group setting. The ideal arrangement is to schedule sessions with pairs of children who have been carefully matched by age and by specific needs. Case-Smith (2000) found that occupational therapists use of play activities and peer interaction were important predictors of [fine motor] skill levels at the end of the year (p. 379). Pairing children for OT sessions provides structure as well as peer support to encourage success with challenging activities. Having two students work together also enhances the therapist s ability to make the activities seem like games rather than exercises. In a study examining performance outcomes for OT that addressed fine motor skills, Case-Smith (2000) noted that the most surprising finding [in the study] was that the therapist s use of play and peer interaction predicted the fine motor outcomes and that among the intervention variables, play and peer interaction were the only significant predictors (p. 378). In addition to providing direct services to students, the occupational therapists consult with parents and classroom teachers. Once a child is comfortable with the activities in the therapy settings (usually after 6 to 8 weeks), therapists typically provide recommendations to the child s classroom teachers and sometimes recommend that the parents provide a modified home program. Parents should not attempt to mimic the role of the therapist or teacher; rather, parents provide appropriate materials and naturalistic, enjoyable opportunities for the child to demonstrate and use at home the skills that have been learned in therapy and school. Surrounding the child with a team of people who are familiar with the child s strengths and weaknesses and who understand the goals of the intervention program greatly enhances the therapy process. VERTICAL SURFACES Vertical and slant board surfaces are an extremely important part of the fine motor program. Benbow (1995) emphasized the importance of working on a vertical surface to encourage appropriate hand and wrist position for fine motor and handwriting skills. Both vertical and slant board surfaces correctly position the wrist in extension, which supports thumb abduction so that the thumb can work skillfully with the fingertips. Stable wrist extension and thumb opposition also facilitate total arching of the hand for skillful manipulation of objects. Therefore, providing a vertical or slant board work surface is an important modification that parents and teachers can incorporate as they work or play with the child. Activities performed above eye level on vertical or near-vertical work surfaces such as floor and table easels promote wrist stabilization in extension with precision finger skills (Benbow, 1995, p. 257), as well as the development of arm and shoulder muscles. Whenever possible, teachers are encouraged to provide activity areas in which the children are working upright (sitting, kneeling, or standing) with their arms and hands moving against gravity at an easel or other vertical work surface, rather than leaning over small tables. When children work on a horizontal surface,

3 A Fine Motor Program for Preschoolers 269 BOX 13-1 Some Examples of Activities for Use on a Vertical Surface 1. Making pictures with stickers. 2. Colorforms or Unisets (these activities provide a board on which to arrange reusable plastic stickers, and they are available in a wide variety of themes and designs). 3. Feltboards or flannel boards, which permit the placement of figures depicted in stories or scenes created by the child. 4. Magnet letters or shapes on a magnet board (available in story themes as well). 5. Chalkboards: Use sidewalk chalk (wide-diameter chalk) broken into to 2-inch pieces for children to hold with the tips of the thumb, index finger, and middle finger. In one favorite activity, the child draws a design with the chalk and then uses a paintbrush with water to magically erase the design. 6. Geoboards (rubber band designs created on a grid of nails). 7. Painting or drawing. 8. Ink stamping activities. 9. Pegboards, many different varieties (Lite Brite Cube uses small pegs and by design is oriented on the vertical). they often place their wrists in neutral or flexion, which does not promote skillful use of the intrinsic muscles. Switching activities from a horizontal to a vertical orientation can transform an ordinary or mediocre activity into a powerful tool for encouraging fine motor skill development. Many activities can be oriented on the vertical by placing the materials (e.g., geoboard) on the lower lip of a tabletop easel. In the Newton Early Childhood Program, children are expected to work regularly on vertical work surfaces. With a minimal amount of modification and equipment expense, many activities can be adapted easily for use on a vertical surface (Box 13-1). It is beneficial for the shoulder, arm, wrist, and hand development of all preschoolers to work on activities at a vertical or near-vertical surface on a regular basis. For older preschoolers who are working on representative drawing and writing letters, students use a slant board that is at an estimated angle of 20 degrees. A low-cost way to provide multiple slant board surfaces in a classroom is to place 3-inch three-ring binders at the writing table; the ring side of the binder is placed horizontally toward the middle of the table so that the slope of the binder slants down toward the edge of the table where the student is sitting. The students use these slant board binders as drawing and writing surfaces. They are relatively inexpensive, and are easy for teachers to store when the writing center is being used Figure 13-1 Tripod grasp with extended wrist, and forearm resting on the surface of a 20-degree slant board. for a different purpose. Parents also have used these binders as slant boards at home, and often purchase a three-hole zipper storage bag that can hold the child s markers inside the binder for traveling. A variety of more sophisticated alternatives are available from many sources, some of which are listed in the Appendix. Because it is recommended that students use a slant board surface well beyond their preschool years, many parents opt to purchase a more permanent work surface, such as Write-Slant Boards, which provide a helpful clip at the top to stabilize the paper. The reason older preschool students draw and write on the 20-degree slant board instead of the vertical or near-vertical surfaces is because the 20-degree angle encourages students to rest their hand and forearm on the work surface, whereas the vertical and near-vertical surfaces do not. With the older students, therapists are encouraging the development of a tripod or quadrupod grasp, with accompanying intrinsic muscle movements of the fingers while drawing or writing, which means that the hand and forearm must rest on the table (Figure 13-1). Having parents and teachers provide a 20-degree slanted work surface helps students to make the transition from drawing with their hands off the table to drawing and writing with their hands resting on the table, as expected. Although older students in elementary school may have developed the appropriate mature writing grasp, a slant board encourages the ideal posture an erect spine while drawing or writing and enhances students endurance for completing lengthy homework assignments. For therapists who are attempting to demonstrate the value of vertical or slant board surfaces to parents or teachers, it is helpful to ask children to perform a task such as a pegboard or a drawing activity on a horizontal surface, and then ask them to perform the same activity on a vertical surface. The difference in the child s hand position and ability is often dramatically evident in such a demonstration. Observing that

4 270 Part III Therapeutic Intervention difference first-hand helps parents and teachers to understand why working on the vertical is so valuable. Examples throughout this chapter illustrate how working on the vertical or slant board surface maximizes the therapeutic benefit of the activities. MANIPULATIVES Young children, especially 3-year-olds, should spend more time with fine motor manipulatives than writing utensils. Sometimes parents and teachers feel that young children should begin to practice with pencils and markers, but this early practice may result in a poor pencil grasp, partially because children may be asked to use writing utensils before their hands are ready for that kind of refined activity. Benbow (1995) specifically noted that boys tend to avoid fine motor activities in lieu of computer games, while girls who practice with writing implements at an early age without proper adult attention or supervision may then adopt pencil grips that are inefficient or even harmful (p. 255). Benbow (1988) further noted that pencil postures fixed early by repeated use at an intermediate level of skill will later affect negatively on graphomotor performance when speed and volume demands increase (p. v). Therefore children should be developing their hands for a variety of activities in a variety of positions before they are expected to draw or write with the proper grasp. In preparation for writing, the hand progresses through the following motor milestones (Benbow, 1995): 1. Development of wrist stabilization in extension to support skilled finger movements. 2. Development of a stable open index finger-thumb web space when performing skilled activities. The open web space should have a circular shape. This position is frequently compromised in children who have hyperextension of the interphalangeal joint of the thumb; rather than a circular web space; these children form a crescent moon with a small opening. The thumb is in a fixed position, thereby making intrinsic muscle activity difficult (Figure 13-2). Children with this problem must be monitored carefully when they perform fine motor activities to find those activities that encourage the use of the thumb in a flexed position. 3. Development of palmar arches in the hand, represented by a concave surface on the palm. 4. Development of an awareness of the skill side of the hand; this means that the child consistently orients skilled activities toward the thumb, index Figure 13-2 Hyperextended thumb and compromised web space on lace tip. finger, and middle finger. These three fingers are hereafter called the skill fingers. 5. Development of intrinsic muscle movement in the fingers; this kind of fine muscle movement can be seen when the ulnar side of the hand is stabilized on the table while the fingers move a pencil to write, or when the fingers make fine movements to thread a needle. The intrinsic movements are best observed in activities that require the tips of the thumb, index finger, and middle finger to be touching while they are performing small movements of midrange flexion and extension of the metacarpal-phalangeal (MCP) joints. Many so-called fine motor activities involve the use of the hands and fingers, but do not necessarily elicit the fine motor movements of the intrinsic muscles at the MCP joints. One example of an activity that parents often cite as proof of their child s fine motor abilities is the use of a computer mouse. The use of a mouse involves primarily the arm and shoulder muscles, with slight flexion of the index finger for clicking the mouse. (In cases in which the mouse has a scroll wheel, the middle finger does use some intrinsic muscle movement to scroll, although students usually point and click more often than they scroll.) Although skilled use of a mouse is difficult for children with overall upper extremity motor control issues, many students with significantly reduced fine motor skill with manipulatives are able to successfully use a mouse. That is because the mouse does not require the skilled use of the intrinsic muscles of the skill fingers working together with an open thumb-index finger web space; it falls short as a fine motor activity. Adding insult to injury, instead of using their hands to work a variety of real puzzles, many preschool students with poor fine motor skills work puzzles on computer screens. Parents and teachers of children who have poor fine motor skills are strongly encouraged to limit the child s time on the computer, and increase the availability of a variety of concrete materials that will encourage fine motor skill development.

5 A Fine Motor Program for Preschoolers 271 THE MANIPULATIVES PROGRAM The primary components of an OT session include Wake Up Hands, Strong Hands, and Smart Hands. Therapists regular use of these positive phrases is powerful for students, who quickly learn to use them to identify the attributes of their activities. Many of the classroom teachers also provide Wake Up Hands activities before beginning a fine motor or prewriting tabletop activity with the older preschoolers. Wake Up Hands Wake Up Hands activities provide sensory stimulation to the hands, including tactile stimulation as well as proprioceptive/kinesthetic stimulation, resulting in overall readiness for later activities. A wide variety of soft objects, including gel-filled balls, rubber animals, and countless other items are used during Wake Up Hands. Activities include squeezing the objects, rolling them on the table, rolling them all over the hands (with each hand taking turns), grabbing them with the thumb and index finger (pincer grasp), poking them with either the thumb or index finger, and using them isometrically by having both hands press the object. Students also perform a variety of motions with their hands such as clapping, rubbing, or shaking. A variety of textures might be provided through materials such as unscented lotion, powder (including dry Jell-O powder), and fabrics from rough to smooth. The therapists also provide rubber bands or elastic sewn into circles of various sizes so that students can perform a variety of pulling activities, one finger at a time. Students seem to particularly enjoy placing the rubber band in a way that traps their fingers, and they enjoy moving their fingers against the resistance while pretending to escape from the rubber band trap. Thera- Band and Thera tubing also can be used for pulling and stretching activities during Wake Up Hands. One of the most popular Wake Up Hands activities is the accordion tubes, sometimes called rapper snappers. These tubes provide excellent resistance to finger, arm, and shoulder muscles when students expand the tubes, and provide similar input when they are manually contracted to become small again (Figure 13-3). During a game, the tubes can be called caterpillars; therapists ask students to pretend they are turning baby caterpillars into big ones, and then back into babies. For a whole-body motion that provides an excellent motor break before a tabletop session, students pair up and connect their accordion tubes. They then make the caterpillars pop by pulling, tug of war style, on their respective tubes until the tubes come apart with a large popping sound. From a safety perspective, be sure that the students have enough space for this activity, as some of the smaller students literally fall backward from the momentum until they Figure 13-3 Figure 13-4 tube toys. Accordion tube toys ( rapper snappers ). The caterpillar pop game using accordion learn how to position their feet effectively to brace themselves. This activity can be repeated for several minutes, as students select a new partner for each caterpillar pop (Figure 13-4). All of the preceding materials are used for sensory stimulation and also for basic practice with motor planning or imitation games. The therapist demonstrates the movement, and the children imitate it. For example, the teacher or occupational therapist can bend the tube into a variety of shapes, which the students must then imitate with their own accordion tube. Representative shapes are best, such as an elephant s trunk, telephone receiver, window, or crown, so that the children can concretely imagine a use for each new shape. After a few examples provided by an adult, students enjoy coming up with their own shapes to suggest. Meanwhile, all of the students fingers, hands, and arms are being stimulated in a positive, enjoyable way.

6 272 Part III Therapeutic Intervention Another Wake Up Hands activity is putting on your [imaginary] power gloves, which students can either do for themselves or have done by an adult. To put on the gloves, each finger is grasped at the fingertip by the thumb and index finger of the other hand, and gentle pressure is exerted as the thumb and index finger slowly travel down to the base of the finger. Each finger is stimulated in turn until all 10 are complete, at which point the gloves have been put on. This provides both tactile and proprioceptive stimulation, and also provides a mental image of powerful hands that is a good mindset for students preparing for a fine motor task. It is, of course, a more powerful sensation for an adult to provide the stimulation than for the children to provide it for themselves, although with a large group sometimes it is impossible for an adult to get around to each child in a timely fashion. Wake Up Hands with 4- and 5-year old children often includes two components: the primarily sensory component with the soft objects and varied textures, and a higher-level demand such as finger plays. Many of the students have difficulty isolating individual fingers, and also with imitation and fine motor planning. Carefully chosen finger plays tend to be motivating for them, and observing students performing finger plays is an excellent way to quickly learn a great deal about their current level of hand development. Choose finger plays that include developmentally appropriate finger motions such as the following: forming a circle with the thumb and index finger, isolating the index finger or the thumb, or forming a cupped palm (see Appendix for a good source of finger plays). Many young students have difficulty forming a circle with their thumb and index finger; the circle tends to be flattened rather than round. These are often the same students who have difficulty forming an open thumb-index finger web space with drawing implements. The finger plays provide an additional way for students to practice using their fingers in a variety of positions, and a way for the therapist to visually gauge their progress. For students for whom the combination of language and motor planning demands is too high, therapists have them practice the motor component of a finger play separately before adding the language component. Strong Hands Although activities from any of the three components of a therapy session may address multiple areas of development, the rationale for labeling the activity is to help students understand its primary goal. The use of these specific terms has provided unexpected benefits, particularly the use of the term Strong Hands. The students with less than average hand grasp strength are often the students who are least likely to take risks with novel fine motor tasks. When Strong Hands is presented as a regular activity, students quickly learn to view their hands as strong. Verbal encouragement (e.g., Look how strong you are. You made the rocket fly across the table! ) helps students to believe that they can become stronger through games and activities. Students actually enter a session enthusiastically asking, What are we doing for Strong Hands today? When students have less than average hand grasp strength, their parents and teachers are encouraged to provide hand strengthening activities naturalistically throughout the week. Therapists provide beneficial activities and attitude boosting encouragement, but children should become stronger through daily activities that are a natural part of their routine. A first step for many teachers and parents is to discontinue the practice of performing a task for the child if the child is not able to perform it for himself or herself. Adults are asked to say, Let s do it together rather than Let me help you. Even if the adult provides most of the power for the task, having the child do even part of it helps to develop the motor plan for the task and allows the child to use whatever level of strength is available to assist. A common example of this situation occurs in the classroom when students bring a snack from home. Many of the individually wrapped snacks that parents send in with students, in fact, are challenging even for adults to open. When necessary, adults open these containers hand-over-hand with the students, both to assist them as well as to gauge for themselves how difficult the task really is. When students are empowered by participating in the task from the start, they are much more likely to perform the task independently in the future. Activities to encourage hand strength are listed in Box In addition to these ideas, strength-based toys including classroom building toys such as Duplos and Bristle Blocks also are valuable. Furthermore, therapists can use a variety of different containers to encourage the development of both strength and skill. For example, the OT clinic has a large collection of cookie tin style containers of varying resistance, and materials often are placed inside the containers ahead of time. One of the activities in the session is for the children to open their own containers to see what materials will be used for the next activity. In addition to cookie tin containers, therapists use a variety of zipper containers, screw-top jars of all sizes, Rubbermaid containers, plastic lunch boxes, and many others to challenge children s hands in a variety of functional ways. Using different kinds of containers, with the expectation that what s inside will be new or interesting each week, has provided excellent motivation for students who were previously reluctant to attempt opening containers on their own. Hand-over-hand assistance is provided at just the right level to encourage students to do as much as they can by themselves.

7 A Fine Motor Program for Preschoolers 273 BOX 13-2 Activities to Encourage Hand Strength 1. Play Dough a. Use a garlic press to make spaghetti. b. Use rolling pins to make pretend cookies (shoulder and arm strength). c. Press cookie cutters into flattened play dough. d. Find hidden objects such as pegs, marbles, or toys. Note: Crayola Model Magic or clay also can be used, depending on how much resistance is desired. Homemade play dough provides less resistance than the commercial variety. 2. Water sprayers (e.g., those found in a drug store for spritzing hair) a. Spray water onto pictures drawn with markers to make them melt. (Note: This activity works best if the markers are relatively new and the drawing has just been completed.) b. Spray a mixture of water and food coloring to color snow (in northern climates). c. Spray plants or outdoor bushes. d. Spray the walls while in the bathtub, with the shower curtain partially closed. 3. Geoboards: This is a grid of nails or plastic points. Use rubber bands of varying thicknesses to create designs, or use nylon potholder loops for less resistance. (Cotton cloth loops often are too thick to successfully stay on the points.) 4. Newspapers: Tear newspapers to stuff a scarecrow or other classroom project. 5. Wringing out sponges or washcloths (e.g., as part of a clean-up activity, or in the bathtub). 6. Squeeze toys such as the Swinging Monkey and the Flying Fist (see Appendix for sources). Smart Hands Smart Hands manipulative activities typically emphasize multiple skills within one activity. For example, using a wind-up toy encourages isolated use of the thumb and index finger, but may also require a significant amount of finger strength, depending on the resistance of the particular wind-up toy and on the shape of the winding knob or key. It is important for therapists to be familiar enough with their manipulatives to know which ones are appropriate for 3-yearolds, and which ones are more appropriate for 4- or 5-year-olds. Classroom teachers often need guidance about this as well. Some of the classroom building manipulatives require more eye-hand coordination than is expected for the typical 3-year-old, and if teachers expect and encourage students to participate in a too-demanding activity, students may begin to feel that they are not successful with manipulatives. When referring specifically to in-hand manipulation, Case-Smith (1995) stated that practice of a component skill (e.g., translation) may or may not generalize into improved functional performance (e.g., ability to button). Although task analysis demonstrates that a similar movement pattern is necessary in object translation and buttoning, the therapist cannot assume that in-hand manipulation skill will generalize to the task (pp ). Therefore the therapists provide activities that are not just OT materials, but also provide direct experience with typical, age appropriate classroom manipulatives. Although therapeutic activities that address the component skills of a task are beneficial, for the most successful transfer of learning and skills to the classroom setting, preschool students need the concrete experience of learning to use specific classroom manipulatives within the OT session. Following is a list of some of the most popular Smart Hands activities and manipulatives used in the program: 1. Play dough (bilateral coordination, fine motor planning, skilled finger use): Play dough can provide excellent strengthening activities for preschool students, but also can be used to encourage the development of skills. The following activities are used with students who are ready for more skilled use of play dough: a. Drawing in flattened play dough using a peg, b. Rolling play dough balls: There are three levels of difficulty available for this activity: (a) using one hand and rolling the play dough on the table, (b) rolling the play dough between two hands in the air, or (c) using the thumb, index finger, and middle finger to roll a small ball, and c. Using play dough to make representative objects (e.g., rolling a snake form and decorating it with different colors and sizes of pegs to create a caterpillar; rolling balls and stacking them to make a snowman, drawing the facial features and buttons using a small stick peg, and then adding two stick pegs for the arms). As students become more skilled in their ability to make a variety of shapes, their ability to create complex creations will increase. Another variation is to use small toys with the play dough (e.g., small plastic babies from the baby shower section of a party store inspired students to make cribs, playpens, diapers, and many other representative objects from play dough to use with the babies). 2. Stringing/lacing activities (skilled grasp patterns, eye-hand coordination, bilateral use of hands): Of all the manipulative activities available to the students, this has proved to be one of the most valuable. Benbow (1995) stated that bead stringing is the classic preschool activity for developing speed and dexterity in the alternate use of translation patterns (p. 260).

8 274 Part III Therapeutic Intervention There are students for whom learning the motor plan for stringing objects is tremendously challenging, and they literally might spend many months practicing this task to master the ability to place just one large ring onto a 1 4 -inch diameter rope. The stringing activity that is selected depends on the fine motor problem the therapist is trying to address. For example, some students do not yet have consistent object permanence, and if the objects they are stringing are so large that they cannot see the string emerge from the other side with just one thrust, they will be unable to imagine how to continue the activity. Activities (a), (b), (d), and (e) from the following list are best for these students. Other students have difficulty with the eye-hand coordination necessary to place the tip of the string into the object. Activities (a) and (c) are good starting activities for these students. Some students have such difficulty using two hands together that they benefit from stringing a series of eye bolts on a wooden shape, because the therapist can help stabilize the wooden shape with the eye bolts while the student concentrates on placing the string tip into the eye bolts. It is best for the student to also hold onto the wooden shape along with the therapist, as this enhances the development of bilateral coordination. Three main factors, therefore, should enter into the therapist s decision about which stringing activity is best for a student: (a) the size of the hole in the object, (b) the length of the hard tip on the string, and (c) the stability of the object (e.g., is it fixed or does the child have to stabilize it in the hand). Following is a list of efficacious stringing and lacing activities, in an estimated order of difficulty from easiest to hardest: a. Placing inch rings on a 1 4 -inch diameter rope that has duct tape stabilizing the end of the rope. (Note: Oversized rings can be obtained either from a hardware store or manufacturers recyclables; they are not typically available in a toy store; see Figure 13-5). b. Placing 1 2 -inch rings onto gimp (because the gimp stays stiff and a pincer grasp is not necessary). c. Stringing plastic frogs (Ideal Funtastic Frogs) designed with a small hole on one side and a large hole on the other side (holes range in size from 1 8 inch to 1 2 inch, depending on which of the three sizes of frogs are selected), with a cord that has a 2-inch long hard tip (the different size holes allow this activity to be graded at several different levels; see Figure 13-6). d. Small rubber shapes (Lauri Beads and Baubles ) with a inch hole and cord with a 1-inch hard tip (see Figure 13-7). Figure 13-5 for lacing. Figure 13-6 One-quarter inch rope with inch rings Ideal Funtastic Frogs for lacing. e. Inserting a 1-inch hard cord tip through a series of eye bolts arranged on a wooden shape (use pre-drilled wooden basket bottoms from a craft store and grade the activity based on the size of eye bolts placed into the holes; see Figure 13-8). f. Stringing small pony beads. g. Stringing large wooden beads. The challenge with large beads is that several thrusting motions of the skill fingers are necessary to move the string all the way through the bead, which is challenging for many students. Using the thread the needle motion to push a string through a large bead requires skilled intrinsic muscle movements. h. Once students have mastered placing individual objects onto strings, they then transition to per-

9 A Fine Motor Program for Preschoolers 275 Figure 13-7 Baubles ) Rubber shapes for lacing (Lauri Beads & Figure 13-9 upper left). Tops, including a stemless top ( optic top, Figure 13-8 Eye bolts lacing activity. forming tasks that involve more complex sequencing, such as lacing cards. 3. Finger isolation activities (individual finger skill, pincer grasp): a. Hopping ants: Use the plastic ants from the commercial game, Ants in Their Pants, and encourage students to use an index finger to make them jump. Once students have mastered the basic finger movement, therapists can set up a variety of items for the ants to jump over, or targets at which they can jump. b. Spinning tops: Therapists should provide a wide array of tops for spinning, with the easiest tops being those with a thick stem. Spinning tops helps students isolate the thumb and index finger, and also encourages a skilled finger motion (similar to the finger-snapping motion). A stemless top can be used for students who do not yet have the dexterity or motor planning ability to use a top with a stem (see Figure 13-9; the top in the upper left of the picture is the stemless top). c. Geoboards: These are mentioned in the Strong Hands section of this chapter, but they also encourage isolated use of the thumb and index finger or, sometimes, just the index finger to stretch a rubber band down from a top point to a bottom one. As the designs become more complicated, this activity also helps develop fine motor planning ability. d. Eye droppers: Eye droppers can be used as a table top activity, at a water table in the classroom, or in the bathtub at home. Water can be mixed with food coloring to make dribble pictures by dripping the food coloring onto paper towels or coffee filters. (Note: young 3- year-olds with fine motor delays usually have difficulty with the motor planning necessary for this activity, so it is more often used with the older preschoolers.) e. Tissue paper pictures: The therapist gives the children scraps of tissue paper, and asks them to roll each piece into a small ball by using only the skill fingers. The balls can be glued onto construction paper to form a picture. Sometimes the therapist can draw a general shape (e.g., a pumpkin outline) and the children can make enough tissue paper balls to fill up the outline. f. Coins and buttons: Children can play a variety of games with buttons and coins, including using the skill fingers to insert them into a bank, picking them up and arranging them as part of a counting or matching game, making designs with buttons on the table, sorting buttons according to size, and so on. Teachers in the

10 276 Part III Therapeutic Intervention preschool program often use button activities to reinforce academic concepts while challenging fine motor skills. To encourage the development of finger dexterity, the buttons or coins must be moved or turned over without bringing them to the edge of the table. Large containers of mixed buttons often are available at local fabric stores. 4. Puzzles (dexterity, fine motor planning, strength): It is beyond the scope of this chapter to discuss the visual perceptual aspects of puzzles, but in addition to developing part-to-whole skills and other kinds of visual matching (e.g., with formboard puzzles), puzzles can encourage the development of fine motor skills. Some students have such reduced dexterity that it is challenging for them to insert wooden pieces into a formboard, and they often incorrectly assume that because they cannot physically insert the piece, their initial impulse about where to place it must have been wrong. It is particularly concerning when students correctly surmise where to place a piece, but then assume that their visual assessment was wrong because they cannot insert the piece successfully. These students are provided with puzzles well within their range of ability from a visual perceptual aspect, and are helped to develop the physical strategies for inserting the pieces successfully. They work first with wooden puzzles, and then eventually work on inserting pieces to Lauri rubber puzzles, which often are more challenging in terms of both finger dexterity and fine motor planning. Puzzles with small pegs on top of each piece are helpful for developing thumb-index finger isolation. 5. Zoo Sticks (strength, motor planning, grasp): This plastic toy has an animal at the top, with two long tweezer tips extending from either side of the body. The child grasps the middle of the tweezers and squeezes to pick up small objects. The therapist scatters cotton balls across the table, and the animals clean up the trash by picking up the cotton balls and transferring them to a container placed in the middle of the table. (Cotton balls have proved to be the most successful material for preschoolers to pick up.) Students with less skilled hands tend to use a fisted grasp on the shaft of the tweezers, whereas more skilled students tend to use only their skill fingers (Figure 13-10). 6. Wind-up toys (grasp, strength): Wind-up toys are available in a variety of levels of resistance, as well as with a variety of different kinds of knobs. The larger the diameter of the knob, the easier it usually is for students to turn. Some wind-up toys come with a built-in key-shaped knob, which is typically the easiest kind to wind. Therapists should be familiar with the resistance levels of the various wind-up Figure Zoo sticks with cotton balls. toys in their collection so they can provide the appropriate level of challenge for a given student. There is remarkable variety in the levels of resistance among the different wind-up toys available. Windup toys are particularly useful because the motor plan for the winding motion is important for functional tasks such as turning the volume knob on a radio, or closing a screw-top jar. 7. Stickers: This activity is good for students who are just learning to isolate the thumb and index finger to pull a sticker from the backing, before the OT session the therapists remove the background paper surrounding the stickers so that it is easier for the students to be able to determine the exact edge of the stickers to pull them off independently. Students begin with large-size stickers and transition to smaller stickers. Eventually they can separate stickers from the background paper with no difficulty. Therapists can use a variety of stickers, including the colorful circle stickers of various sizes (which do not have the background paper) available at office supply stores. 8. Buttoning (grasp patterns, motor planning): For therapists who have access to a sewing machine, a simple homemade button game can be created using interfacing sewn between two 4-inch square pieces of fabric. Half of the sewn squares have a buttonhole in the middle, and the other half have a button sewn onto them. The game can be graded in difficulty, based on the button size. Each set of two sewn squares should have two matching buttons associated with it; one button is sewn to the matching cloth square and the other button is loose. Children first practice putting the loose button through the hole and pulling it out the other side. Once they understand the concept of putting the button through the hole, they use the button that is sewn to the matching cloth square. At least some of the buttons and buttonholes should

11 A Fine Motor Program for Preschoolers 277 Figure Lateral pinch grasp. Figure The button game. be large, so that there is room for the therapist s fingers along with the child s during the hand-overhand stage of teaching (Figure 13-11). Once children can button and unbutton all of the square sets in the button game, they are ready to button and unbutton a variety of old cardigan sweaters (with varying button sizes to grade the activity for difficulty) that are stored in the OT clinic for that purpose. It is surprising how motivating it is to students to button and unbutton a grown-up sweater. (Note: For practice with buttoning an adult size cardigan, the sweater is placed on the table, not worn by the student.) The sweaters also help students to understand sequencing buttons on a garment. Eventually, students work on buttoning and unbuttoning their own garments. 9. Bristle Blocks (strength, visual motor, motor planning): Although a wide variety of classroom-type manipulatives are available, Bristle Blocks are one of the most valuable because they are so versatile. They are initially used as part of a strength-building program, as they can be difficult for some students to join and separate. Once students have mastered the strength component of Bristle Blocks, they are then able to build in a variety of ways. These blocks provide more variety than Duplos, because they can be used in both horizontal and vertical orientations. They encourage the development of eye-hand coordination, and can also be used to encourage the development of representative building (e.g., students can make a table, bed, house), which in turn can facilitate many other areas of development (e.g., visually copying from a model, language, cooperative play). Although all of these activities encourage the development of the muscles needed for fine motor skills, the therapist needs to attend to how each child performs them. A child with poor hand skill often finds a way to use the less-skilled lateral pinch grasp, even in the bestdesigned activity (Figure 13-12). For children with significant hyperextensibility in their joints, however, alternative grasp patterns may be necessary for them to perform an activity successfully. Because of their joint laxity, they often do not have a good physical foundation in their fingers to support skilled grasp patterns with small manipulatives. Children with hyperextensible fingers use the limits of their hyperextensible joints to create grasp patterns that provide them with the stability they need for motor tasks. By choosing these alternative grasp patterns, however, they sacrifice the ability to use fine, skilled movements because they are choosing stability over skill. Hyperextensible finger joints are not particularly unusual, but they sometimes require that adults working with a child help that child to be successful in fine motor tasks through a variety of adaptations. For example, the dexterity necessary in fine motor tasks perhaps should be reduced until the child is better able to sustain skilled grasp patterns with small objects. Also, the child may use an adapted pencil grasp (rather than the traditional tripod grasp ) that provides both stability and skill at the same time. Benbow (1995) stated that the functional use of the hand depends more on joint stability than joint mobility. Children adopt many ways to make their hands work for them when they lack joint stability (p. 267). The therapist must know the limits of the child s hand skills well enough to know when to try to elicit a more traditional skilled grasp with manipulatives, and when to recognize that the child is using as skilled a grasp as is physically possible for that child. The preceding list of activities is meant to provide enough examples so therapists will be guided in their ongoing selection of a wide variety of therapeutic activities and toys. Parents, teachers, and children constantly contribute new activity ideas, and many of the traditional preschool activities (e.g., gluing pasta and

12 278 Part III Therapeutic Intervention beans to make collages) provide the same kinds of appropriate fine motor challenges as those listed in the preceding list of Smart Hands activities and manipulatives. When therapists consult with teachers, it is valuable to suggest new activities, but it is even more valuable to point out those activities and toys already available in the classroom that help children to develop good hand skills. One particularly helpful way to provide a workshop at a local nursery school is not only to bring toys from the OT clinic, but also to select toys from the school s classrooms ahead of time so that their merits can be pointed out to teachers. Incorporating the school s toys and materials into the workshop can regenerate teachers interest in toys that previously seemed humdrum. FINE MOTOR PLANNING Many preschool students who receive OT services have a fine motor planning problem, which may or may not be accompanied by immaturities in fine motor skills. The students with more severe fine motor planning difficulties tend to have a diagnosis of Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS), or Autism Spectrum Disorder, whereas the students with milder fine motor planning difficulties may have no formal diagnosis at all. For all students with motor planning difficulties, assistance in the form of hand-over-hand help, visual modeling, picture sequence directions, and verbal cues should be provided when unfamiliar fine motor tasks are presented. The assistance is faded as the student becomes more independent with the task, with hand-over-hand assistance being eliminated first. Once a student has mastered the use of a specific manipulative or toy, a similar manipulative or toy is introduced. This process is repeated over time, with occasional repeated presentation of the original manipulative or toy, so that the student develops improved ability to generalize among similar fine motor tasks. One reason that therapists provide such a large variety of activities within one activity domain (e.g., stringing tasks, wind-up toys, tops) is so that students with motor planning difficulties can sharpen their ability to apply motor plans from one fine motor task to a different one. For students with moderate to severe motor planning difficulties, coordinating matching materials between the classroom and OT clinic is particularly critical. The classroom staff is instructed in the physical or verbal cues that should be used with that student, and cues fade in all settings as the students make progress. Students with a milder level of fine motor planning difficulty are able to quickly make associations among similar tasks, and do not need the daily repetition of the exact same motor tasks because they are able to generalize much more easily from tasks performed in the OT sessions to materials available in the classroom. For students with fine motor planning difficulties, however, it is especially critical for the occupational therapist to be aware of the kinds of materials available in the students classrooms so that the OT activities will ultimately provide the students with the skills they should successfully and independently use with the fine motor materials at school. It is often difficult for students with moderate to severe motor planning difficulties to complete multistep art projects. Students in the self-contained class for autism spectrum disorders complete the same therapistplanned art project every single day for 1 week. The repetition over 1 week s time significantly increases their independence by the end of the week. Because it is difficult for these students to make generalizations, even though the project is the same every day for a week, it seems new enough each day so that it is still interesting and challenging to them. They are able to recognize their improved independence as they complete the fifth and final version of the project. A typical art project for this class might include a page with three outlines of circles, accompanied by three circle-shaped pieces of construction paper in red, yellow, and green. The students must either follow a visual model, picture sequence directions, or verbal instructions to correctly glue the construction paper circles to create a picture of a stoplight on the paper. See Figure for an example of step-by-step picture sequence directions for a play dough activity. Roll the dough Push the cookie cutter Take the extra away Cookie on the pan Figure Step-by-step picture sequence directions for making play dough cookies.

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Chapter 13. A FINE MOTOR PROGRAM FOR PRESCHOOLERS Carol Anne Myers* CHAPTER OUTLINE - PDF Free Download

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1 Chapter 13 A FINE MOTOR PROGRAM FOR PRESCHOOLERS Carol Anne Myers* CHAPTER OUTLINE VERTICAL SURFACES MANIPULATIVES The Manipulatives Program Fine Motor Planning SCISSORS DRAWING AND WRITING Hand Preference Activities to Help Develop Pencil Grasp and Control WHAT MAKES THERAPY EFFECTIVE?

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Jan Mcclesky Worksheets & Teaching Resources | Teachers Pay Teachers

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Browse Jan McClesky resources on Teachers Pay Teachers, a marketplace trusted by millions of teachers for original educational resources.

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Welcome to The Handwriting Clinic, where handwriting is fun! Please like our Facebook page for updates SUMMER PROGRAM UPDATE: Our summer program is now full except for a few slots specifically for students 2nd - 6th grade for WHAM curriculum (Print Legibility Only) with Laura Battaia, OTR.

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I've been using these with 6th grade special ed, and they are a big hit. The students enjoy matching seasonal change cards with yoga poses. One boy does not like to do the poses with us, but does like to read. This deck made him very happy, as he read the season cards to us.

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Kids Yoga Stories - Yoga Resource, Yoga Cards, and Yoga Store for Kids

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Yoga resources for kids, classroom yoga resources, yoga poses for kids, and yoga cards for kids to get them moving, learning, and having fun. Mindfulness resources for kids, mindful resources for teachers to help create calm classrooms. | Kids Yoga Stories.

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A structured, scaffolded movement and rhythm program, which helps with brain development, learning, and achievement.

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Therapy Toys & Products for Neurodivergent people of all ages and skill levels, hand-chosen by our in-house Paediatric Occupational Therapist to meet our standards in 3 areas: fun, function, and quality.

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DEVELOPING FM SKILLS PRO-D SESSION Shared Learning Feb 2022