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

• bject)

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

• f 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

• f 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

Facilitation of in-hand Manipulation

• Placing items into small opening

– Shapes into a shape sorter – Turing objects over – Form board Activities

Treatment

• Always consider why the child presents with a

deficit.

Building a Foundation for Success

• 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