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I. Patterns of development


  1. Fine motor skills include reach, grasp, carry, voluntary release, in-hand manipulation, and bilateral hand use. Definitions are

    1. Reach: Extension and movement of the arm for touching or taking hold of objects. Development progresses from swipe at object (2 months), to both hands, to midline and clasp (3 to 4 months), to unilateral arm reaching (4 to 5 months).

    2. Grasp: Hold or grip of an object with the hand.

      1. Development progresses from reflexive grasp or an involuntary grasp (at birth), to ulnar palmar grasp (3 months), to palmar grasp (5 to 6 months), to radial palmar grasp (6 to 7 months), to radial digital grasp (8 months), to pincer or the holding of a small object against the tip of the index finger (12 months) (Table 45-1).

      2. Grasping patterns vary based on object's size and shape.

    3. Carry: Transportation of a handheld object from one place to another.

      1. A combination of movements of the shoulder, body, and distal joints of the wrist and hand to hold the item.

      2. Makes appropriate adjustments as necessary to maintain the holding of the item.

    4. Voluntary release: Intentional letting go of a handheld object at a specific time and place. Development progresses through sequence of five phases: no release (0 to 1 month.); involuntary release (1 to 4 months); two-stage transfer (5 to 6 months); one-stage transfer (6 to 7 months); and voluntary release (7 to 9 months).

      1. Two-stage transfer: The child brings an object or finger food to the mouth with both hands and may release one or both once the object is stabilized in the mouth.

      2. One-stage transfer: The child holds the object at midline with both hands and pulls it out of one hand and into the other. The release is, therefore, a forced withdrawal accomplished by the opposite hand.

      3. The child begins the voluntary release by stabilizing his or her arm and/or hand on surface → releases without stabilizing → modulates force (demonstrates in stacking activities).

    5. In-hand manipulation: Adjustment of an object within one hand without the assistance of the other hand

      1. The three in-hand manipulation skills are translation (finger-to-palm and palm-to-finger), shift, and rotation (simple and complex).

        • Translation is to transfer an object from the fingertips to storage in the palm of the hand (finger-to-palm) or to retrieve objects from storage in the palm of the hand to fingertips for action (palm-to-finger).

        • Shift is to move the fingers linearly on an object. An example is to move the fingers along the shaft of a pencil.

        • Rotation is the movement of trolling a small object between the pads of the thumb and fingers (simple rotation) or using the thumb and fingers to turn an object end over end (complex rotation).

      2. Requires the hand to perform two separate functions simultaneously. That is, the thumb, index, and middle finger perform manipulation skills while the fifth and ring finger side provides stabilization.

      3. Poor in-hand manipulation skills are linked to clumsiness or poorer performance ...

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