Facilitation of Fine Motor and Visual Skills, Building a Foundation - PowerPoint PPT Presentation

Facilitation of Fine Motor and Visual Skills, Building a Foundation for Success Stacy Krueger OTR/L, C/NDT

Building a Foundation • Fine motor skills are the purposeful and controlled movements of small movements of the fingers and hands. • These movements coordination with the large muscles of the arms and trunk for stability • These movements combine with the eye for functional eye-hand coordination

Visual Skills • Visual skills play a huge role in the development of hand function • About 4 months of age, infants use their hands as a result of visual information • By 6 months infants have an acuity of 20/20

Visual Fixation • Keeping gaze on a stationary object • Develops starting 1-2 months of age

Visual Tracking • Visual pursuit or tracking of a moving object • Develops typically between 3 and 4 months of age within a range of 1-2 feet

Visual Tracking • Eyes to Midline (1-3 months) • Eyes past Midline (2-3 months) • Eyes downward (2-3 months) • Eyes upward (2-3 months) • Eyes to 180 degrees (2-3 months) • Eyes without Head movement (4-6 months)

Visual Saccades • Looking from one object to another • Develops typically between 3 and 4 month of age.

Facilitation of Visual Skills • Set the Environment – Quiet with low visual stimulation • Have child positioned appropriately – Start with most supportive • Supine • Reclined • Supported sitting • Provide appropriate Stimulation

Facilitation of Visual Skills • Step 1: Attract attention – Face or colorful object – Sound if not over stimulating • Step 2: Maintain attention • Step 3: Add movement – Slow in linear and arc motions within the horizontal plane – Near child (i.e., <12 inches) • Step 4: Duration – Limit to 1-2 minute intervals – Be cautious of visual fatigue

Facilitation of Visual Skills • Visual Saccades – Present one object – After infant fixates on object – Present second object between 6 and 8 inches apart from initial toy

Stimulus Strength Characteristic High Stimulus Strength Low Stimulus Strength Contrast High Low Size Large Small Color Colored Target No Color Movement Movement No Movement Stability/Lights Flickering No Flickering

Color Preferences • Month 1: Green, Yellow, Pink • Month 2: Bright Red, Blue, Orange • Month 2+: Two contrasting colors (i.e., black and white, green and yellow)

Development of hand skills • Grasp • Reach • Carry • Voluntary Release • Bilateral Hand use • In-hand Manipulation

Structure for Function Two components of the musculoskeletal system that need to be considered include: • Bones and Joints • Muscle Function

Bones and Joints • Integrity of the arms and hands are important to hand function – Alignment – Range of motion – Congenital or acquired anomalies (i.e., missing digits or bone deformities)

Muscle Function • Muscle function is a combination of strength, endurance, and tone. – Inadequate Strength can result in inability to initiate movements needed (i.e., flexion or extension of fingers). – Decreased Endurance will limit a child’s ability to sustain an activity (i.e., maintain grasp on an object)

Muscle Tone • Abnormal muscle tone affects the stability of and the types of movements possible – Hypertonia: Typically loss of ROM and decrease speed of movement – Hypotonia: Typically increased joint ROM and decreased stability – Fluctuating Tone: Typically have full ROM, however can only maintain joint stability at extreme flexion or extension

Common Deficits affecting Function • Poor posture control • Joint misalignments • Decreased range of motion • Muscle Weakness • Fisted hands with or without indwelling thumb

Principles to Guide Treatment • Proximal to Distal – Development occurs proximal (head and trunk) and progresses distally (hands and feet) • Mass to Specific – Less differentiated movements proceed more specialized movements (i.e., gross grasp prior to isolated finger movements)

Facilitating Proper Alignment • Manual Cues to facilitate proper alignment of Trunk, Scapula, and Upper Extremities. – Manual mobilization of joints – Passive range of motion – Neurodevelopmental Treatment • Supplementary Treatment Tools

Supplementary Treatment Tools • Bracing • Strapping • Splinting

Supplementary Treatment tools • Kinesiotape

Facilitating Increased Strength • Weightbearing • Using Upper Extremities for support during functional positions – Prone on forearm – Sidelying and side-sitting to each side – Prop-sitting – Quadruped

Establish Midline • This is important motor skill to help discover hands and prepare for future fine motor activities. • Facilitation of midline: – Bring hands to midline when being held, during feeding, when seated in supported sitting. – Alternative positions include: • Sidelying • Cradled

Facilitating Open Hand Position • Open hand position is important prior to developing hand skills • Manual cues – Gently massage the muscles on the palm and base of the thumb – Gentle stretching through typical range of motion – Tap or stroke the back of the hand and fingers

Facilitating Open Hand Position • Positions to promote open hands include: – Prone positioning • Over Boppy or wedge • Shoulders and arms forward – Sidelying • Promote relaxation • Once hands are open place rattles or objects into hands to promote prolonged stretching

Development of hand skills • Grasp • Reach • Carry • Voluntary Release • Bilateral Hand use • In-hand Manipulation

Grasp • Attainment of an object with the hand – 0-2 Months grasp is reflexive – Active gross grasp occurs >2 Months of age

Facilitating Grasping • Palmer Grasp – Use rattles with: • Easy grasp handles • Safe to put in the mouth – Have arms positioned forward – Use both right and left hands

Facilitating Grasping • Radial Palmer Grasp – Use thumb, index, and middle fingers against the palm – Offer objects towards thumb and index finger side of hand

Facilitating Grasp • Raking Grasp – Picking up small objects using fingers and thumb – Provide opportunities to retrieve small items from smooth surface (i.e., high chair tray)

Facilitating Grasping • Pincer Grasp – Utilizes the tip of the index finger and thumb – Present object in front of patient between your fingers to encourage pinch versus gross grasp – Use small toys: • Small pegged form boards • Pull toys with strings

Reach • Extension and movement of the arm for grasping and placing objects – Reaching with an extended arm occurs between 3-4 months • Joint motion required – Trunk rotation – Slight humeral abduction – Shoulder flexion and rotation – Forearm supination – Wrist extension – Finger extension

Facilitating Reaching • Provide manual cues and physical assistance – Start with as much assistance as needed to achieve movement – Decrease amount of input as child develops skill – May continue to require manual cues to facilitate proper alignment during reach • Remember a child needs scapular and trunk stability to allow for functional reaching

Facilitating Reaching • Positioning Progression – supine – reclined – supported sitting – prop positions – unsupported sitting

Facilitating Reaching • Object Position Progression – Midline – Gradually working away from midline on same side of upper extremity – Reaching across midline

Facilitating Reaching • Object Position Progression – Low – Chest height – Shoulder height – Eye level – Over head height

Combining Reach and Grasp • Retrieving objects from a container • Large opening gradually working toward smaller openings • Shallow containers working toward deep containers

Carry • Transportation of a hand-help object from one place to another • Successful Carry Requires: – Stabilization of object in the hand – Co-contraction of musculature in wrist and hand – Smooth combination of body movements – Control motions of the shoulder and forearm

Facilitation of Carry • Infant – Bang objects at midline – Bang objects onto objects • Toddler – Move items to target locations

Voluntary Release • Intentional letting go of a hand-held object at a specific time • Voluntary release requires: – Control of arm and finger movements

Facilitation of Release • Manual cues – Gently flex the wrist – Tap, rub, or stroke back of the hand – Hold wrist and gently shake hand to drop object

Facilitation of Release • Treatment – Offer a second (more preferred) object once child is holding an object – Encourage release into a large opening of a container

Bilateral hand use • Use of two hands together to accomplish an activity – Using one hand as a “holder” and a second to “manipulate”

Facilitating Bilateral hand Use • Allow patient to “choose” what hand they want to use as a holder and manipulator • Visual Modeling • Hand-over-Hand assistance • Simple assembly tasks – Stacker Rings – Mr. potato Head

In-hand manipulation • Adjustment of an object in the hand after grasp – Turning – Flipping – Rotating