Development of Skills with Noggins

Fine motor skills involve the coordinated movements of the small muscles in the hands and fingers. These skills include, but are not limited to, using manipulatives (small objects), grasping, and tool use (scissors, tweezers, writing instruments such as pencils, markers, and crayons). In most cases, these types of activities also require vision. This combination of motor skills (movement) and vision is referred to as visual motor skills, and may include such activities as coloring, tracing, writing, and cutting with scissors. Where it is fine motor skill that allows the child to hold the pencil, and grasp the scissors, it is visual motor skill that allow them to connect the dots, and cut on the line. These general skills, among other more specific abilities like in-hand manipulation (moving small objects around in one hand), visual perception (interpreting what is seen), and motor planning (thinking of, planning, and carrying out a movement) are necessary for virtually all academic, play, and self-care activities. These typically develop along a similar timeline for all children, and progress in a manner of skills being built upon one another.

Fine and visual motor skills have been a focus of teachers, therapists, and parents, and play a large role in child development. They should be strongly addressed when delays exist, as deficits in underlying skills may hinder the development of more complex and age-appropriate abilities. This is especially evident in handwriting, a complex ability heavily scrutinized in school, which is built upon a variety of underlying, prerequisite skills. Fine and visual motor skills are developed through an experiential approach of using tools and various grasp patterns when exploring and performing tasks, as well as the building of prerequisite factors, such as strength, range of motion, and coordination.

What does the literature say?

Fine and visual motor skills have been the topic of research literature for many years. They have been examined in numerous studies, looking closely at both the general abilities and the underlying skills. These underlying skills, and their role in handwriting, were explored in a study by Volman in 2006, stating that “children with handwriting difficulties appear to perform less proficiently on measures of visual perception, fine motor skill, visual-motor skill, and cognitive planning. The area of fine motor skill, which was further analyzed by Schneck in 1991, showed that problems manipulating a pencil, were due in part to deficits in proprioceptive-kinesthetic sensation (sensing pressure and movement). This difficulty with proprioceptive-kinesthetic feedback ultimately required compensatory techniques (ways to adjust for deficits) according to Schneck. Compensation was noted in two forms. The first being visual, where “the eyes are kept fixed on the pencil point”, which caused significant fatigue due to such intense visual focus. The second form of compensation was a “tight grip of the pencil in order to provide some feedback from the joints”, which also led to fatigue (Schneck, 1991).

Fine motor skill, especially that specific to handwriting and pencil grasp, is also built on another prerequisite ability called in-hand manipulation, which refers to “the process of using one hand to adjust an object for effective placement in that hand before use, placement, or release” (Lee-Valkov, 2003). This skill emerges alongside hand preference (using one hand more than the other) on the developmental timeline at approximately two to three years of age. The relationship between hand preference and coordination has been shown by Schneck, in 1991, claiming “that a child who develops a hand preference early is likely to develop motor activities demanding coordination and fine dexterity earlier than a child who develops hand preference late”. These two underlying components were shown to significantly impact the development of a mature pencil grasp for handwriting. Schneck in 1991, showed that “a relationship exists between the development of a preferred hand and the development of the dynamic tripod grip”. This dynamic tripod grasp, Schneck claimed in 1991, was most efficient, and involved the aforementioned in-hand manipulation. According to the study by Schneck in 1990, “Children 3 years of age can be expected to use pencil grips ranging from primitive to mature, By the age of 4 1/2 years, children can be expected to use transitional or mature grips, Children 6 years of age and older typically use the lateral tripod or the dynamic tripod grasp”. Where Schneck claimed that the dynamic tripod grasp was most efficient, with the lateral tripod being a close second, it was Schwellnus in 2012, that added the quadrupod grasps, both dynamic and lateral, stating that “No differences were found in speed or legibility among the four mature grasp patterns” and “Dynamic and lateral tripod, and quadrupod pencil grasp patterns produced writing with similar speed and legibility and are suggested to be equally functional for writing”. It was study by Lee-Valkov in 2003 that identified a distinct difference in grasp patterns, stating that power grasps (used for strength) were often static (hand and fingers are locked in position), where as precision grasps (used to delicate operations) were dynamic (the fingers move). This idea was demonstrated by Schneck in 1990, showing that children tend to use more of a power (static) grasp when coloring the center of a picture, and a precision (dynamic) grasp when coloring the edges. With that said, it was further explained in this study that “as a child refines their skills, they tend to use the same grip for both the edge and the center of a picture”.

Fine motor skills for children also encompass scissor use. This is a complex task requiring a variety of the aforementioned prerequisite skills. The combination of proper grasp, positioning of the scissors, and coordinated movements is necessary for effective use. Mitchell in 2012 summarized the grasp, position, and movement, explaining that the scissors are held “with the thumb through the top loop and radial fingers (index and middle) through the bottom loop, positioned between the DIP and PIP joints. The fingers of the cutting hand were flexed (bent), and movement of the radial fingers was used to open and close the scissors. The ulnar fingers (ring and pinky) remained flexed and fairly still. The forearm of the cutting hand was maintained in mid-position with regard to supination and pronation (as if shaking someone’s hand), and the elbow was flexed at approximately 90 ̊”. The scissors should be upright, with the top loop and blade being directly above the bottom loop and blade.

The fine motor and visual motor abilities, and their associated prerequisite skills mentioned are of significant importance in the overall development of a child. It is imperative that these areas remain a strong focus, and that intervention, when necessary, is effective. Fine motor interventions have been shown to be most effective when a “child-centered activity approach”, utilizing “behavioral (reinforcement and fading) and learning (cueing and motivating) principles to undergird interventions” (Case-Smith, 2013). Furthermore, it has been stated that “a child’s functional performance is intricately influenced by the opportunities and challenges presented by the social and physical environments” (Case-Smith, 1995). This means that the environment and context can impact how a child performs tasks. These contextual factors were shown to have the greatest beneficial effect when based on play. Case-Smith in 2000 noted the “importance of therapeutic use of play in intervention”, and again in 2013, stating “Motor interventions that resulted in significant changes in children’s motor performance incorporated use of meaningful play activities”. This idea of using play activities to teach and develop skills has been proven, and should certainly be incorporated into interventions. Where “short-term interventions have had a significant effect on fine motor and visual–motor integration skills” (Ohl, 2013), so have long term programs, and curriculum modifications. McHale, in 1992 stated that effective modifications of curriculum might include the “providing of alternative modes of response and learning, or the reduction of the volume of written work while ensuring that adequate practice for learning new tasks is being provided”. Lust, in 2011 added the idea of all students, not only those with significant fine motor delays, benefitting from this type of curriculum modification.

Finally, it was shown that specific fine motor programs, beyond that of modification of a curriculum, had significant benefit. Lust (2011) stated that a multi-sensory, fine motor program was more beneficial that merely handwriting activities. This was confirmed by Ohl, in 2013 citing the benefits to both fine and visual motor skills from this type of programming. The aforementioned studies are merely a small sample of information. Fine motor skills have been examined thoroughly over the years, and will continue to be considered paramount in the overall development of children. They encompass a variety of abilities, and a wide range of underlying skills. These skills and abilities must be addressed, and as shown, it is the inclusion of play that has the potential to improve the effectiveness of interventions. “Play is our brain’s favorite way of learning” – Diane Ackerman