Handwriting and Fine Motor Skills

October 26, 2018

Welcome back to our series on handwriting! If you have been with us the last few months you have read about all of the components that make up handwriting and helped assess in your child if any of these are weak.  Today we are going to finish up our handwriting series by looking at the nuances of handwriting, the skills in the hand that allow for the best handwriting possible.

With all of the things we have learned there are just as many skills in the wrist and hand that contribute to optimal handwriting. Today we will explore those skills, warning signs that they are weak, and how to assist your child in improving them. The following skills are all imperative to handwriting.

  • Wrist extension stability

    • Importance of This Skill

      • The position of the wrist during handwriting is essential to developing fluid handwriting.  No other joint can provide direct control and stability to the digits as they hold and manipulate the writing utensil.  With good wrist stability a child holds their wrist in slight extension, that means their palm is position away from the forearm. This allows for better thumb positioning, arching of the hands, and isolation of finger movements.
    • What Good Wrist Stability Looks Like

      • Their paper should be placed at a slight angle to their body – pointing uphill if they’re right-handed, and downhill if they’re a left handed.
      • The outside edge of the hand and wrist should rest against the paper, rather than the heel of the hand and inner wrist. This helps to control the muscles of the hand.
      • The wrist should be below the writing line, not up in the air or hooked above it: this enables your child to see the tip of the pencil as they write.
        Image result for wrist stability during handwriting
    • Red Flags

      • When your child writes assess where the wrist is positioned.  If it is curled forward so the palm of the hand is close to the forearm.
      • When your child is write the wrist looks locked and is not flexible.
    • Activities to Improve (activities provided by OT Toolbox)

      • Lite Brite Position this old school toy on a slightly elevated surface to promote an extended wrist while managing the small pegs within the hand and with a tripod grasp.
      •  Table Top Easel– This one is double sided to allow for chalk, dry erase markers, and has a clip for attaching paper.  Use the easel for writing, drawing, painting, coloring, chalking, and games like Hand Man to make strengthening fun.
      •  Avalanche Fruit Stand Game– This game is a fun way to build fine motor skills with an extended wrist.
      • Dartboard–  Tossing darts encourages an extended wrist while holding the darts.  This set comes with magnetic darts, which is great for kids.
      •  Pop Beads–  The small size of pop beads promotes dexterity of the fingers as well as resistance to push the beads together.  Encouraging the child to do this task with both elbows on a table surface encourages an extended wrist.
      •  Stamps–  Grab a set of small rubber stamps or any stamp that has a small handle.  Tape a piece of paper to the wall or clip it to an easel.  Holding the handle while stamping on a vertical surface promotes a functional wrist position.
      •  Twister game–  Any game or activity that is done with the child extending their wrist as the press their upper body weight through the arm is a great strengthening exercise for wrist stability.
      • Beads– Threading beads with a string or plastic cord encourages and extended wrist with fine motor dexterity. Beads can be found in various sizes to meet the needs of the child.
      •  Wall Sticky Tack–  Sticky tack?  Really!  Use it to hand paper, mazes, tic tack toe boards, connect the dot pages, and coloring sheets right to the wall!  You can hang paper on the windows, like we did to really work on handwriting with a see-through effect. Writing on the wall is a great way to build wrist stability and promote an extended wrist.
      •  Etch-A Sketch– Another classic toy, the Etch-A Sketch is perfect for building an extended wrist.  Prop it up on a slanted position and be sure to place it upside down so the knobs are at the top.
  • Arches of the hands

    • Importance of This Skill

      • The hand is made of multiple arches that allow skilled movement of the fingers and controls the power of the grasp. There are two transverse arches, four longitudinal arches, and four diagonal or oblique arches of opposition in your hands. These arches also shape the hand to grasp differently-shaped objects. All skilled movements within the hands work off of these arches.
      • To see these arches cup your hands as if you are going to scoop up water. Now pinch your thumb and pinky together. Watch where you hand bends and moves consistently in different directions.  These arches need to be strong to allow proper use of the hand.
      • The arches divide the hand into the precision side and the power side of the hand.
        • The precision side of the hand is made up of the thumb and first 2 digits, that is why the most effective grasp is a tripod grasp. This grasp is most effect when the power side is resting in the hand.  Separation of the hand is imperative for handwriting as we will discuss later.
        • The power side of the hand is the ring finger and the pink
          Image result for hand arches
    • Red Flags

      • Ask the child to cup their hands and shake dice
      • Ask the child to “make spiders” on a table with their fingers
      • Ask the child to move their pinky and thumb together and apart several times
      • During all of these look for the depth of the “bowl” in the palm and for movement at the base of the pinky to pull it up into opposition to thumb. There should also be wrinkling of the muscles along the pinky-side of the palm as the muscles there contract.
    • Activities to Improve (From School OT)

      • Clay or play dough, especially rolled on table or between two hands with cupped palms (see putty exercises)
      • Knife for cutting play dough with “proper” knife grasp
      • Use a rolling ravioli-maker or dressmaker’s wheel to cut snakes of therapy putty
      • Small beads or games requiring holding a handful of objects in cupped palm.
      • Pour rice or sand into child’s hand and “see how much you can hold before it spills”
      • Paper-tearing, e.g. for collages
      • Large, whole-hand spray bottles: spray the plants or make art by spraying tissue paper over white paper so it bleeds its color when wet
      • Tongs or large tweezers (games include Bedbugs, Operation, and Zoo sticks or Rookie Sticks)
      • Dice games – must shake dice in cupped hands, “so you can hear them click”
      • Chinese hand balls   (look for small size)
      • Tennis ball with mouth: make your own here.
      • Massaging palms
      • The Taco Game – group game where you have to hold a foam “taco” closed with one hand while spinning a spinner or rolling dice and adding pieces with the other. This used to be available as a game kit, but I can’t find it now. Here’s a link to a blog where a mom made her own.
      • Touch each finger to thumb. For extra challenge, have someone else use their pinkies, hooked, to try to pull apart the circle of your thumb-to-finger. You should be able to resist until they get to your ring and pinky fingers.
      • Use chisel erasers (the old-fashioned erasers you can put onto the end of pencils) to pick up small items. Hold the erasers between thumb and index finger of each hand and use the flat/round edge to pick up dice or cubes or dominoes or Jenga pieces, or whatever and arrange them. You can pretend that the pieces are electrically charged, and if you touch them directly you will get a shock!
      • Spider on the mirror: place fingertips of one hand against like fingertips on other. Make the “spider” and its mirror image move different legs in different ways
  • Thumb opposition/open webspace

    • Importance of This Skill

      •  Thumb Opposition refers to the ability to turn and rotate the thumb so that it can touch
        each fingertip of the same hand. This allows us to grasp objects of various sizes and operate
        tools. Imagine trying to tie shoes, pull up a zipper or hit a ball with a bat without your
        thumbs.
      • The thumb should be controlled by 3 muscles at the base of the thumb which allows the thumb to rotate, turn, and oppose for all necessary activities. Without proper control and web space precise movements of the thumb and hand are not possible.
    • Red Flags

      • Poor stability and strength through these three muscles and the base of the thumb.
        • This results in substituting one larger muscle that pulls the thumb in against the side of the index finger, closing the thumb-index webspace.
          • This makes the hand appear pinched and leads to the inability to see any daylight between the thumb and the hand when pinching or manipulating objects.
          • When holding a pencil, this substitution means a pinched-in thumb position rather one with a round webspace and the thumbtip on the pencil. It could be a thumb-wrap, a thumb-tuck, or another ineffective grasp.
          • Often, these pinched-in grasps will mean heavy pressure of pencil against paper
          • It can lead quickly fatiguing hands
          • Some children will have difficulty keeping their pencils or coloring tools where they want the marks on the paper.
          • Have your child do a few pinching-type tasks (close a Ziploc bag, squish a ball of putty into a pancake) and by having them form the “OK” sign with thumb and index while I try to pull it apart with my two hooked pinkies. If they are unable to resist they may have trouble with web space and thumb opposition.
            Image result for open webspace
    • Activities to Improve

      • Activities to open the web space:
        •  squeeze foam balls, animals and shapes that are rounded
        •  tennis ball “hungry guy” (make a slit in the middle of a tennis ball): Hide pennies,
          pegs, beads and other small things inside. Squeeze to open and shake out the
          contents, then feed the “hungry guy” by slipping in the “food”.
        • catch, throw and squeeze rubber “pinky” balls, tennis balls and similarly sized balls
        • bulb syringe games (usually in infant supply sections of stores) or turkey baster to
          squirt water, or have a race by squeezing them to blow cotton balls and pompoms
          across a finish line.
        • craft activities that require using bottles to squeeze: glue, glitter glue, puffy paint,
          fabric paint, etc.
        • sponges: squeezing large sponges to wring out the water is great for opening and
          strengthening the hands. Help wash the car, wash toys and dolls in the sink or
          bathtub, squeeze sponges on your friends during water play outdoors, bring a bucket
          or cooler filled with water and sponges to cool off on a hot day when on picnics,
          soccer games or other outings.
        • Shuffling cards using both hands with palms cupped.
          Note: Try to keep the ring and pinky fingers tucked into the palm so that the THUMB,
          INDEX and MIDDLE fingers do the work
        • Tongs, tweezers, connected chop sticks, strawberry hullers: use these to pick up
          small objects for sorting, such as beads, marbles, beans, pompoms and cotton balls.
        • Corn cob holders, toothpicks or large push pins (thumb tacks): Place a picture over
          a sheet of craft foam or cork board (or trivet). Then use the push pin or corn cob
          prongs to punch holes along the lines of a picture. Hold it up to let the light shine
          through.
        •  Push a toothpick point into a styrofoam tray or plate, or in aluminum foil placed
          over craft foam or corkboard to make a picture.
        • Place coins or bingo chips in narrow slots; a piggy bank is perfect, Connect Four
          game.
        • Eye droppers: make colorful dribble art creations by placing drops of colored water
          on a paper towel or coffee filter.
        • Spinning tops
        • Geoboards: make shapes and letters using rubber bands on geoboards
        • Games: pick-up sticks, Jenga, Don’t Spill the Beans, tiddly winks games, Ants in the
          Pants; tong games: Operation, Crocodile Dentist, Bedbugs
        • Wind up toys
        • Pegboard activities, Lite Brite
        • Ziplock bags: encourage using fingertips to press and seal
        •  Buttoning, snapping
        •  pop beads
        • linking chains
        • stringing beads
        • peel stamps and stickers
        • crumple small bits of tissue paper using fingertips, dip in glue and paste onto a paper
          plate or paper to make a flower bouquet
        • tear small pieces of paper with finger tips and paste them onto a sheet of paper to
          make a picture
        • pop the bubbles on large or small bubble pack by pinching with thumb and index
          finger
  • Separate function of the two sides of the hand

    • Importance of This Skill

      • Early separation of the two sides of the hand is sometimes present at birth. It develops when an infant crawls and bears weight on the pinky side of the hand while carrying toys with the thumb and index side. A different nerve controls some of the muscles of the pinky and ring fingers from the index, middle, and thumb digits, and with experience we learn to inhibit movements of ring and pinky while the other digits are working.
      • When writing, this separation is important because it allows us to stabilize the side of our hand and pinky against the page so that we can slide along and keep our writing on the line without much effort. Try writing on a line while not allowing your hand to touch the paper, your shoulder will fatigue and your writing will be affected.
      • Cutting with scissors requires separation of the two sides of the cutting hand for precision in steering while opening and closing the scissors
        Image result for separation of hand
    • Red Flags

      • Watch your child during the following activities and watch if they are able to close their pinky and ring finger into their hand and use their thumb, pointer,, and index finger.  The inability to do this is an indicator of dysfunction.
        • cutting
        • snipping
        • threading a large needle
        • moving pegs
        • flipping pennies over
        • Spinning a top/winding a toy
    • Activities to Improve (from School OT)

      • Roll small balls of play dough or putty in fingertips
      • Tear paper while keeping ring and pinky fingers tucked into palms
      • Make things with small beads
      • Color in small pictures or do page of sticker targets with small color dots (available at office supply stores). Especially when the picture is clipped or taped up onto a vertical surface, child will start to automatically stabilize on the side of the hand while using index and thumb to place stickers in precise places.
      • Scissor cutting or writing or coloring or painting or eye droppers or tongs or tweezers… with a “magic penny” held against the palm with the ring and pinky fingers curled in (its magic like Dumbo’s magic feather that helped him fly)
      • Toothpick or thumbtack designs in play dough, clay, or putty spread out on flat surface (even better if it’s a vertical surface!)
      • Water guns or squirt bottles with one- or two-finger triggers. Keep other fingers tight around handle or neck
      • Roll tissue paper into balls to glue onto paper for collages
      • Penny flipping: line up a row of pennies and flip them all over one at a time as quickly as possible
      • Finger pattern games: copy adult in positioning individual fingers as demonstrated, working on moving just one finger at a time
      • Hold a tube of toothpaste or a small bottle in one hand and try to remove/replace the lid without using the other hand
      • Use learning scissors to encourage separation while cutting
      • Snapping fingers
      • Place two pennies and two paper clips in palm of hand. Try to move one penny to fingertips and place on table without using other hand, then one paper clip, and so on. Increase number of items as it gets easy.
  • In-hand manipulation skills

    • Importance of This Skill

      • In hand manipulation is the ability to shift objects around the hand with the fingers.  It is necessary to do this in order to examine an object by touch or vision, to get something positioned or place for a task. This depends on mobility and coordinated control at the base joints of your fingers (called metacarpal or MP joints), which allows for  the thumb opposition skills discussed earlier in different positions.
        Image result for in hand manipulation skills
      • There are many different such movements possible and they include
        • Rotation is the act of turning something (of course), but there several types. Simple rotation can be seen when you pick up a pencil that is oriented across your body and then flip it about in your hand so that it is in the writing position. If you try this, you’ll see that one way is simpler than the other, depending on whether the point of the pencil is facing to the right or to the left.  Precision rotation involves turning something in the fingertips, such as rotating a coin to read the words around the edge or to flip a coin over and over in the fingertips. Finally, there is a lateral shift movement of the thumb against fingers such as to wind up a small toy, that some people call rotation.
        • Translation is the movement of objects between palm and fingertips, such as selecting one coin from several in your palm and moving it to the fingertips with only one hand active. Also referred to as squirreling (to palm) and de-squirreling (to fingertips) small items.
        • Shift is the balanced movement with opposed thumb and finger such as to thread a needle, push a button through a hole, pick a small bit of lint off of fabric, or poke a pin into a pincushion.
    • Red Flags

      • Children who are lacking these higher-level developmental fine motor skills often appear “fumbly” when trying to use their fingers to maneuver small objects.
      • They may use two hands for a task that we would consider a one-handed task, or they may set down an object to pick it up a different way rather than shifting it within the hand.
      • Watch for a child to set down an object when re-positioning it.
    • Activities to Improve

      • Place two pennies and two paper clips in palm of hand. Try to move one penny to fingertips and place on table without using other hand, then one paper clip, and so on. Try it with more items as it gets easy.
      • Bead stringing, especially when the lacing tip is shorter than the bead
      • Pegs and pegboards, especially when several pegs are held in the hand while placing each one
      • Place pennies or buttons into slots (cut one into the plastic lid of coffee can and draw a face so you are “feeding” the can)
      • Lacing boards, sewing cards, beginner sewing kits (with yarn and felt, for example)
      • Play finger tug’o’war with coffee stirs, plastic lace (gimp), or a marble
      • Modeling clay or play dough, especially when making small objects
      • Pencil walk and flip: hold a pencil as if you are going to write with it. Keeping the tripod position, walk your fingers up towards the eraser. When you get there, flip the pencil over without using other hand or a surface to brace it. Walk fingers back to the other end, still keeping the tripod position, and repeat.
      • Flip a pencil or coin over and over in fingertips
      • Hold a small plastic cup filled with water (the lid from liquid laundry detergent works well for this) upright in the tips of fingers. Turn the lid without spilling by turning it in fingertips.
      • Several finger puppets on one hand or multi-finger puppet
  • Hand and finger strength

    • Importance of This Skill

      • There are over 25 muscles of each hand called intrinsic muscles. Overall weakness of these muscles can be an issue in fine motor skill development. Often some muscles are notably weaker than is typical and this makes certain types of grips or movements more difficult than others. Keep in mind, though, that the higher-level manipulation skills require a good balance of strength and stability throughout the hand so that any area of weakness will impact them.
      • Also, the extensor muscles of the hand develop later than the flexor muscles, and often strength issues are more notable in extension. For example, lifting each finger up from a “spider” position on a table is often more difficult than curling each finger up from a palm-up position.
        Image result for hand and finger strength in kids
    • Red Flags

      • Watch if your child has difficulty
        • picking up small items (bits of food, Cheerios, coinsetc.) using the pads and tips of
          the index finger and thumb.
        • holding a pencil, crayons and markers with a 3 or 4 finger tip pinch
        • holding and using feeding utensils effectively
        • fastening closures (zippers, snaps, buttons) on garments easily
        • using scissors
        • imitating various finger positions during finger play  (e.g., touching each finger to
          the thumb-opposition, making the “A-ok” sign)
        • manipulating small items within the hand (e.g., transferring coins within the palm
          out to the fingertips).
    • Activities to Improve

      • Hole punches and staplers
      • Clay or play dough — squeeze, flatten with heavy rolling pin, use play-doh® extruding and squishing tools
      • Cooking projects, especially with batter or dough
      • Construction tools (hammer, saw, etc. at child’s developmental level)
      • Glue bottles, puffy paint, fabric paint, glitter glue in squeeze bottles
      • Popbeads
      • Clothespins, large tongs
      • Stress balls and squeezy fidget toys
      • Squeeze toys — balloon pump, paint sprayer, large squirt gun or spray bottle
      • Ziplok bags — keep thumbtip and fingertip together rather than using a “key grip” (aka “lateral pinch”).
      • Buttoning, snapping

 

  • Grasp patterns

    • Importance of This Skill

      • Occupational therapists and educators have long recommended
        the mature dynamic tripod grasp. This grasp provides the most control of the
        pencil. Variations of this grasp (lateral tripod, dynamic quadrupod, adapted
        tripod) are common in children with legible handwriting. A grasp with an
        open web space between the thumb and fingers is preferred.
        Image result for grasp patterns for handwriting
      • Examples of functional grasps
        Image result for grasp patterns for handwriting
    • Red Flags

      • Pencil grasp should be considered for modification if the child also has difficulty with
        spacing, fatigue, in-hand manipulation skills, and alignment of letters and
        words on the writing line.
      •  Pencil grasp with cause for concern
        Image result for grasp patterns for handwriting
    • Activities to Improve

      • Push toothpicks into a spice container.
      • Thread beads onto dry spaghetti poked into play dough.  (Work on color matching with this one, too!)
      • Thread cereal onto string.
      • Push acorns into play dough.
      • Drop dry beans into small containers.
      • Press sticks into play dough.
      • Position washers onto screws.
      • Paint with small squares of cut up kitchen sponges.
      • Press push pins into a bulletin board or recycled containers.
      • Push golf tees into a shoe box.
      • Press game pieces into play dough.
      • Use tweezers to place small balls of tissue paper into a container.
      • Push small pieces of pipe cleaners into a cardboard box.

Over the past few months we have enjoyed detailing many aspects of development that need to be assessed in the event of handwriting deficits.  This is not all encompassing because so many factors can affect handwriting.  If you find concern in some or many of these areas please feel to contact us for an assessment to determine if your child could benefit from an occupational therapy assessment.  Please watch for our upcoming series on sensory integration.

 

 

 

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