Fine Motor

Now that we have discussed gross motor skills, it’s time to talk about fine motor skills!

Fine motor skills refer to the ability to use the small muscles of the hand, with adequate strength, dexterity and coordination, to grasp and manipulate objects of different sizes, weights and shapes. They involve the coordinated efforts of the brain and muscles, and they’re built on the gross motor skills that allow us to make bigger movements.

Fine motor skills consist of multiple aspects including:

1. Strength in fingers and hands
   
2. Coordination to support grasping or holding objects
   
3. Manipulation when moving objects between our fingers and hands

From a very early age, fine motor skills facilitate interactions with the world we live in and therefore create opportunities for learning. As children develop, fine motor skills then assist the development of:

• Independence in self-care activities such as doing up buttons, cleaning teeth, opening lunch boxes or food packets and using cutlery. 
  
• Development of early literacy and numeracy with control and use of a pencil for drawing, writing or colouring, cutting and pasting.
  
• And finally play! Picking up, moving or manipulating toys accompanied with their vivid imaginations. 

The most important fine motor skills children need to develop include the following:

• The palmar arches allow the palms to curl inward. Strengthening these helps coordinate the movement of fingers, which is needed for writing, unbuttoning clothes, and gripping.
  
• Wrist stability develops by early school years. It allows children to move their fingers with strength and control.
  
• Skilled side of the hand is the use of the thumb, index finger, and other fingers together for precision grasping.
  
• Intrinsic hand muscle development is the ability to perform small movements with the hand, where the tip of the thumb, index finger, and middle finger touch. 
  
• Bilateral hand skills permit the coordination of both hands at the same time. 
  
• Scissor skills develop by age 4 and further provides hand strength and hand-eye coordination.

I thought I’d offer some personal perspective on the use of fine motor skills, as I have recently received surgery for carpal tunnel release, on my left wrist. The experience made me realise how we often take our fine motor skills for granted. Without the use of my left hand, I experienced a lack of independence, the ability to coordinate both my hands together to pick up objects, to eat food and even to fully dress myself. 

After undergoing surgery, I had lost all the function of my left hand and started the process to rebuild and strengthen my fine motor skills including regaining a full range of motion, muscle strength, flexibility, independence and function. I was participating in a similar process of regaining fine motor skills, a process of which babies, toddlers and young children follow as they grow. 

To demonstrate this, I thought I would detail the common stages of fine motor skill development by ages. 

At 0-6 months old, babies demonstrate reflexive grasp when objects are placed in their hand, they are reaching and grasping for objects, mastering a controlled grasp (at 6 months), holding an object in the palms of their hand (with 2 hands at 3 months and 1 hand at 5 months) and recovering an object dropped in their visual field. 

At 6-12 months old, they are grasping and putting objects to their mouth, demonstrating controlled release of objects, picking up small objects with a thumb and one finger, their Pincer grasp develops (using index finger and thumb to grasp objects), they are transferring objects between hands (the beginning of crossing midline skills) and they start to show a preference for one hand over the other (beginning the development of right-handed vs. left-handed dominance). 

At 1-2 years, a child can build towers of two-three small blocks, turn the pages of a book (multiple at a time), they can clap their hands together (this is the beginning of bilateral coordination!), they can wave goodbye, scoop objects up with a spoon or small shovel and bang objects together using both hands (the beginning of bilateral coordination!)

At 2-3 years, children can string four large beads, turn single pages, snip with scissors, hold a crayon with thumb and fingers. They are using one hand consistently for most activities, picking up small objects with thumb and one finger and can also  imitate circular, vertical and horizontal stokes with some wrist action, along with illustrating dots, lines and circular strokes.

At 3-4 years, a child can build a tower of nine small blocks, manipulate clay material (rolls balls, makes snakes, cookies), use their non dominant hand to assist and stabilize the use of objects, snip paper using scissors, copy circles and imitate a cross. 

At 4-5 years, a child is cutting on the line continuously, copies a cross and square shape, they are writing their name and the numbers1-5, copying letters and can dress/undress themselves. 

At 5-6 years, a child is cutting out simple shapes, copying triangle, colours within the lines, and has a 3 fingered grasp of a pencil.

At 6-7 years, a child is forming letters and numbers correctly, writes consistently on the lines, has controlled movement with pencil and endurance for writing and tying shoelaces 

At 7-8 years, a child is maintaining legibility of handwriting, and has greater independence in self-care tasks such as doing up buttons. 

Comparatively, I worked through the stages of development as follows: 

Post operation, my hand function in my left hand was starting back at the 6-month-old stage. My left hand was completely immobile, wrapped in a tight bandage and was instructed to not move it and place no pressure on my hand in any way. My left arm was placed in a sling and required to be elevated at all times.

Around one week after surgery, my bandages were able to be removed and so to were my stitches. I was allowed to freely move my hand as able, however it was incredibly stiff, had very little range of movement and was limited by the pain.

I then commenced my passive (assisted) and light active movements of my fingers. This included supporting and moving each joint of my fingers as far as I could every 2 hours. It was repetitions and persistence of these movements that retrained my brain and body to work together so functionally I could use my left hand. 

During week 2 of  post-surgery, the movements of my fingers had improved to the point where I could now complete pincer grasp, transfer objects between both hands and increase my bilateral coordination of tasks. However, with very little pressure or resistance. I slowly tried to reintroduce simple daily activities to increase my independence, this meant I could pick up paper, hold my phone etc. 

By week 3, I was using my non-dominant hand (left) to stabilise and support my activities. I wanted more independence, so I pushed myself, within reason – much like a child would. I started to dress and undress myself with both hands including buttons and zippers, I was able to manipulate objects including hair bands to put my hair up, use cutlery, type on the computer with greater speed and open and close doors. 

Now 3 months post-surgery, my grip strength is almost where it was before surgery. Going through this experience highlighted the importance of fine motor skills development. Much like a child, it was important for me to regain those skills in order to not be dependent on someone else to support simple everyday tasks. 

If you’d like to help your child develop their fine motor skills, here are some ideas that you can do at home, together. Often the repetition of everyday activities is a simple yet effective helping hand!

• Allow your child to assist with meal preparation, like stirring, mixing, or pouring ingredients. 
  
• Put together a puzzle as a family.
  
• Play board games that involve rolling dice.
  
• Finger paint together.
  
• Let your child set the dinner table.
  
• Teach your child how to pour their own drinks.
  
• Have your child roll and flatten clay with their hands, and then use a cookie cutter to make cutouts.
  
• Show your child how to use a hole puncher.
  
• Practice placing rubber bands around a can. 
  
• Place objects in a container and have your child remove them with tweezers.
  

If you’d like more information, please check out these websites below!

schools.shrewsburyma.gov/ot/fine-motor

education.vic.gov.au/childhood/professionals/learning/ecliteracy/emergentliteracy/Pages/finemoto.aspx

Madeleine Simms

ORIGINALLY PUBLISHED JULY 1, 2020

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