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Blog post from . . .

April 2016

 Assessment and Treatment of Fine Motor Development (For parents, teachers, pediatricians, and other professionals)

By Rita Patterson OT/L 

Part 1: Assessment of Fine Motor Development:

    Many children with and without any type of diagnoses, may experience difficulties with fine motor skills. Delays or difficulties in fine motor skills can be caused by underlying difficulties. For instance, fine motor difficulties may be the result of: poor sensory processing, poor attention, poor motor sequencing, and/ or poor motor control, poor postural control, Fine motor skill development relies on the foundational skills of postural control, hand dominance and overall strength and muscle tone. Thus poor fine motor skills can be a result of one or many underlying factors. A thorough occupational therapy evaluation will help to determine where the weaknesses exist. Treatment utilizes therapeutic activities to enhance and address the underlying issues, opposed to focusing grossly on the end product of fine motor skills.

    Poor fine motor skills can be due to a sensory processing disorder (www.sensory-processing-disorders.com ). (Please keep in mind, other neurological and / or other conditions may also result in poor development of fine motor skills, such as a co-existing “learning disability.” A more common example contributing to fine motor delays may be related to impaired sensory processing or poor sensory integration.  If ‘tactile defensiveness’ is present, a child may avoid any activities he/ she needs to practice with their fingers and hands, thus perpetuating to the delay.  If any sensory issues dominate a child’s behavior, fine motor difficulties can occur and can be difficult to self-remediate, due to the child’s tend to avoidance of what is most difficult for them. However, the relationship between what is the underlying problem and the fine motor difficulty may not be clear or apparent. The relationship between the surface problem and the underlying problem is typically not apparent to the lay person, without a thorough occupational therapy evaluation.  For example if a child is avoiding fine motor activities due to poor postural control or a need for movement, it will appear that the child is being defiant as he/she seeks the movement they need to help sustain his/her posture for seated activities.  If gravitational insecurity is present and a child has not had movement experiences to help him / her learn positional awareness. As a result, he or she may appear to not know where to place his pencil on the paper to begin to draw letters on the line.  If movement issues are present, children will avoid the very activities they need, and will avoid gaining the experiences they need to facilitate the skills that are lacking.  Consultation and evaluation by an occupational therapist can be instrumental to help to determine the reasons for the underlying factors when looking at fine motor and visual motor difficulties.  

  • Call Therapy Solutions for Children, Inc. to set up a thorough occupational therapy evaluation to determine why your child may be having difficulties with developing fine motor, visual motor, or handwriting skills.
  • Free phone consultations are available, to help determine if an occupational therapy evaluation and treatment would be beneficial. However, often a full evaluation including parent interview is necessary to determine the underlying difficulties.     

Part 2:  Description of Types of Treatment Activities for Facilitating Fine Motor Skills

 For purpose of this post, suggestions for fine motor activities are divided into two categories to stimulate development (Please refer to both lists provided):

 1) Category 1: Activities to Facilitate Fine Motor Development. These activities are the most commonly used for stimulating fine motor skills and are typically found in preschools, day care centers, kindergarten classes, etc.

  2) Category 2: Therapeutic Preparatory Activities for Fine Motor Development

These activities are typically used as part of an occupational therapy program and are focused on treating the underlying problems. These activities are to prepare the child for fine motor skills by enhancing the underlying neurology and muscle development. “Preparatory” activities prepare the central nervous system and the larger muscles of the body for more challenging tasks requiring higher level integration. These activities are therapeutic in that they build the foundational skills needed or pre-requisite skills needed for the development of fine motor skills.

Category 1. Activities to Facilitate Fine Motor Development

  • Tracing letters over sandpaper
  • Tracing letters in shaving cream (non-toxic) over sand paper
  • Play Doh activities, (such as rolling, pinching, making shapes)
  • Spray bottles and squirt guns
  • Tongs for developing the intrinsic muscles and separating the sides of the hands
  • Squeeze toys for water and air play
  • Eye droppers
  • Spinning toys/wind up tops to develop pincer grasp and thumb and finger opposition
  • Two handed building toys- Duplo, Lego’s, Tinker toys, beads, sewing cards
  • Hammer and nails with or without parquetry boards, to develop eye hand coordination
  • Bubble wrap
  • Playing cards dealing, counting, matching, picking up off the table or floor
  • Coins in a slotted container
  • Sticker play,(peeling off and placing onto designated spots on paper or on a line)
  • Ink stamps (stamp pictures on a line or within a square)
  • Puzzles
  • Blocks to stack and pull apart with or without velcro attachments for resistance
  • Velcro board
  • Snaps
  • Containers to open and close at snack time
  • Dress up dolls or action figures
  • Chalkboard and water designs (paint with water on chalkboard, erase lines using wet paint brush)
  • Clothes pin games (placing and removing clothes pins on a box or can)
  • Geoboards
  • Yarn activities, such as, pot holder kits
  • Breaking crayons to 1 ½ inch in length to allow for proper pincer grasp

Category 2: Therapeutic Preparatory Activities to Stimulate Development of Fine Motor Skills

Occupational therapists trained and experienced in using sensory integration assessment and theory, sensory motor processing treatment, and neurodevelopmental treatment techniques utilize sensory integration theory, and theories related to motor learning, and neural plasticity to enhance all aspects of motor development. Occupational therapists trained in assessment and treatment of reflex integration and reflex development can be instrumental in making changes for children with poor fine motor and writing skills.

Examples of Therapeutic Preparatory Activities to Facilitate Fine Motor Development:

  • Development of intrinsic muscles of the hand, and strengthening wrist, arm and shoulder muscles: Weight bearing on open palm, to facilitate stretch and contraction to the intrinsic muscles of the open hand. Puts intrinsic muscles of the hands on stretch, to give them added sensory and proprioceptive input, to prepare them to contract and enhance hand function.
    • Prone over ball or prone rocking on all fours
    • Crawling activities for stimulating the palm of the hand (palms fully open and flat)
    • Crawling while holding a small 2 inch toy with thumb squeeze, stimulates web space and separation of the two sides of the hand, one side for power and stabilizing, the other for dexterity.
  • Resistive crawling activities to stimulate ‘reflex integration’, particularly the asymmetrical tonic neck and symmetrical tonic neck reflexes. (Reflex integration is critical for the development of adequate eye-hand coordination, attention to task, and fine motor skills, to mention a few.).
    • Practice commando crawling activities forward and backward, prone on belly on a thick carpet.
    • In four point crawling position, ask child to crawl forward and backward, and use light pressure resistive to the crawl. Using light pressure to shoulders going forward, and using a pillow or a book to push lightly against the hips to provide resistance to backward crawling.
  • ​Large random arm and shoulder movements, such as: washing off or wiping down a table top or a vertical surface with large arm movements;
    • Using large scribbling strokes with tiny crayons and with the paper on the floor or taped to a vertical surface (not table top), to stimulate contraction for shoulder/ scapular stability, in different positions.
    • Using large scribbling strokes on paper on the floor over sand paper to add kinesthetic and proprioceptive feedback (prepares the muscles to be more responsive to movement sensations.
  • Prone activities on scooter board/hammock:  facilitates visual-motor, head and neck extension, and eye-movements, vestibular, bilateral and eye-hand skills:

*Repeat activities as often as possible, as they become more and more integrative in nature to enhance neural plasticity in the brain and to re-inforce correct pathways as well as accurate postural mechanisms; allowing for further growth in the foundational skills needed for adequate skill development of fine motor skills.

 Rita Patterson OT/L


  • Building Bridges through Sensory Integration by Yack, Aquilla and Sutton.
  • Sensory Integration and the Child by Dr. Jean Ayres,
  • Improving Upper Body Function
  • Facilitation of Fine Motor Skills by Mary Benbow 

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