1. Occupational Therapy IWK & AVH
Trends in Fine Motor
Occupational Therapy IWK & AVH
Refer to foundation skills and best Practice

2. Deskwork - Proper Positioning
A strong and steady trunk provides the base of support needed for successful fine motor tasks
Important to focus on the activity, not focus on staying upright
- So when child is doing a fine motor task such as coloring, printing, cutting and are not positioned properly, more energy into sitting and keeping balance not in activity

3. Positioning - The Perfect Fit
Proper Chair Size
feet flat on floor
ankles, knees and hips at 90 degrees
make sure chair is not too deep
back should be supported
two fingers’ space between back of knee and seat

4. Positioning - The Perfect Fit
Proper Chair Position
should be able to sit back comfortably and bend slightly forward at the waist
the arm should be at least at a 30 degree angle from the trunk
Proper Desk Size
height of the top of the desk or table should be about 2” above the height of the elbow

5. The Perfect Fit -back supported -seat depth appropriate
-feet supported

6. Sitting at the Desk: Tips and Tricks…
It is often a challenge to provide optimal desk position for each student in the classroom
If feet don’t reach the ground
use stool, container, phone book, block of wood, Jettstep
If chair is too deep/ too wide
add phone book/ cushion/ foam to back of chair, smaller chair
add foam/ cushion to sides if too wide
If child slides in seat
Anti-slip material
- Well we always don’t have a perfect chair to work with so…….
-suggestions to assist with positioning
-look for another chair that is smaller or narrower
- Perhaps the wood working class at middle/high school would consider a project and make a step for your student- it helps both sets of students

7. Seating Trend .....
Many students will need to adjust their positioning or have the ability to move during the school day
Allow students to stand at their desks
Dynamic seating options: Hokki stool, Move N’ Sit cushion, disco disc etc.
- Suggestions form audience

8. Handwriting
“Writing refers to the expression of ideas and information for the purposes of communicating. Handwriting on the other hand, refers to the fine-motor skill of writing letters in order to communicate those ideas and information.”
Not being able to form letters easily constrains writing
Students need to work on handwriting as a foundation before they can be expected to concentrate on the message they are writing.
When student is not struggling with letter formation, he/she is freer to write fluently
Department of Education, English Language Arts Primary-3, April 2013

9. Best Pratice for Handwriting
Practice 20 minutes, three to five times week is recommended.
Printing practice should be done as a separate activity. Focusing only on learning to print.
Structured teaching will help prevent or correct bad habits.
Printing Like a Pro, Sunny Hill Centre for Children Therapy Department, 2013

10. “ However ten minutes several days of week devoted to teaching handwriting is justifiable and necessary, especially in the lower grades.”
Department of Education: Handwriting P-3 ELA document April 2013
Discussion…….
-Discussion- Best practices vs department of Education vs Halifax RSB- feels very strongly about embedding handwriting teaching in with other activities vs. a separate activity vs valley school board -

13. Grasp The development of grasping skills starts at birth
Grasping skills are important building blocks for more refined manipulation
Experiencing grasping activities helps to develop these skills
Grasping is necessary for functional skills such as crayon use, feeding self and playing with toys

14. Why are grasp patterns difficult for some children?
Poor muscle development
Poor attention
Limited exposure to fine motor activities
Lack of interest in coloring activities
Not teaching early hand development skills….lack of awareness of their importance

15. Pencil Grip….
Being able to hold a crayon correctly is a readiness skill for handwriting
Teach pencil grasp to your students. When children are young, it is worthwhile encouraging an efficient type of grasp.
Pencil Grip Song
Handout refer audience

16. Pencil Grasp…..
Adapting it when needed i.e. provide a pencil grip (eg. Cross Over, CLAW, Grotto)

17. Pencil Grip…..
Research has shown that having a good pencil grasp does not ensure legible handwriting; nor does having a poor pencil grasp doom one to illegible handwriting.
There are other factors that may contribute to a student having difficulty with handwriting other than pencil grasp…
Pencil grip is just “one piece of the puzzle”
Look at quality of print as well as complaints of fatigue or discomfort to see if a concern

18. Developmental progression of skills….
A child would learn to:
Trace
Imitate
Copy
Draw

19. Prewriting Lines and Shapes
Horizontal Line (2 years) ―
Vertical Line (2 years) l
Circle (3 years) o
Cross (4 years) +
Right diagonal (4-5 yrs) /
Square (4.6 yrs)
Left diagonal (4-5 yrs) \
Triangle (5.3 years) ∆
Please keep these milestones in mind when you are teaching primary
students how to print. Expectations need to match their development.
Give the example that the letter X will be difficult for a child who can not make a diagonal line, it doesn’t mean that student can’t learn how to make an X but it may take more practice and more self correction

20. Readiness for Formal Writing Instruction
Hand dominance
Knowledge of simple size and shape concepts (big line/little line, big curve/little curve)
Ability to hold a crayon with fingers place correctly (for their age)
Satisfactory level of attention, cognitive skills and cooperation
Imitation of a vertical line, horizontal line, circle and cross
Olsen, Jan Z. & Knapton, Emily. Handwriting Without Tears Pre-K Teachers’s Guide (2008) Cabin John MD, Handwriting Without Tears

21. Progression of Handwriting
Line development
Print letters easily and automatically
Work on simple words
At first do not worry about staying on the lines
As you see improvements, focus on proper positioning on the lines and consistent letter sizing
Progress to having student to print entire sentences
Encourage student to focus on spacing between letters and within words
Proper use of punctuation
Comment on not to use dots when teaching printing

22. Tips and Tricks
Follow the developmental sequence of tracing, imitation and copying
Don’t forget to practice lines and shapes (drawing/art/multi-sensory) in addition to handwriting
Be sure to supervise your student to ensure they follow the correct steps and not just end up with a good end product e.g. start your letter a the top , proper letter formation

23. Tips and Tricks …
Continue to teach letter formation to your primary classroom but be aware that your 4 year old students may need extra attention to handwriting later in the year
Use a multi-sensory handwriting approach
Practice handwriting or cutting with an object held in palm by ring and baby finger (stabilization of the hand)

24. Teaching Strategies for Handwriting
Step One:
Modeling: Show the student a few times how to form each letter using a chalkboard or white board. Include numbered arrows that show correct letter formation as this provides a good visual cue. Having a letter strip with arrows showing letter formation on the student’s desk is also suggested for classroom work times.
This is missing now. Kids are just copying
Kids need to be able to problem solve and figure out why things don’t look right
Printing like a pro is a cognitive approach – this is the trend- kids learn better using a cognitive approach- self talk, evaluate and practice

25. Step Two
Self-Talk: Encourage repetitive talking out loud of directions of proper letter formation, i.e., self-talk of direction of movement (e.g., “i= down , lift, dot”). Verbally model the self-talk and prompt the student to talk out loud, repeating the same set of directions each time. Using the same self-talk phrase each time is important for best learning.
Use can HWT as an example here, “big line down, frog jump, little line, little line”

26. Step Three
Self Evaluation: It is important for the student to look at their work to see how closely their letter formation matches the target letter. Self-evaluation can also be in the form of circling their best-formed letters. Discuss with the student why they chose those letters.
Use “Check Your Work” cards to remind students of self evaluation
Check your work card can be based on expectations of the class or what is reasonable for that child to expect. – if for class, did I use capitals, on the line, spaces between words, sky grass dirt etc

27. Step Four
Practice: Use a wide variety of writing tools. In addition to using a pencil for practicing, have the child write with chalk on a chalkboard or with felt markers on a white board.
multisensory

28. Handwriting Expectations in Each Grade Level
(© N. Pollock, J. Lockhart, B. Blowes, K. Semple, M. Webster, L. Farhat, J. Jacobson, J. Bradley & S. Brunetti, 2009})
Primary
􀂉Correct letter formation
􀂉 minimal eraser marks or smudging
􀂉Smooth lines
􀂉Consistent pressure i.e. markings are not too light or too dark
Grade 1
􀂉 Consistent spacing between letters and words
􀂉Consistent size of letters
These should be considered guidelines, always consider the individual student and their individual learning or motor difficulties

29. Grades 2/3
􀂉 Correct letter placement e.g. hanging letters, such as “g” do hang below baseline
􀂉Appropriate orientation to baseline
􀂉Appropriate use of margins
􀂉Good organization on page
Grades 4/5/6
􀂉 Text clear and easy to read
􀂉 Precise letter formation e.g. good closure and finish of strokes
􀂉Regular spacing between letters and words
􀂉No crowding
(© N. Pollock, J. Lockhart, B. Blowes, K. Semple, M. Webster, L. Farhat, J. Jacobson, J. Bradley & S. Brunetti, 2009})

30. Tips and Tricks…
Do not use upper case letters when teaching children to recognize or write their name
Emphasize starting all letters at the top to discourage bad habits that are difficult to change later
If a child has not chosen a hand dominance, always be careful to place the crayon/marker at midline
Use broken crayons to promote pincer grasp
Avoid dot-to-dot when working on letters, use yellow marker instead

31. Technology
Despite the dramatic rise in available technology for students to produce written work, printing remains an essential functional skill to express thoughts, ideas and knowledge in the classroom and beyond.
Never completely give up on handwriting because it is a life skills. There are many times in your life that you need to handwrite (writing your signature, filling out a job application, or completing a questionnaire). However, technology certainly plays an important role for the success of many students.

32. Why Keyboard ?
When students have mechanical and organizational writing difficulties, keyboarding may be their primary means of written communication expression
Keyboarding is becoming a life skill, research indicates it should be taught in 3rd or 4th grade

33. Advantages of Keyboarding
Less distal finger control
improved legibility
improved accuracy
improved efficiency
easier to correct typing and spelling errors
improves word finding abilities
less hesitant to reevaluate and edit written work
improved quality and productivity

34. Disadvantages of Keyboarding
More difficult in certain environments
Computers not always available in classroom
child may not be familiar with keyboard arrangement, therefore keyboarding may decrease speed
children may become frustrated and composition may become affected

35. Consider technology when…
Legibility is poor at a grade 3 to 4 level- can sometimes start earlier
A student’s handwriting begins to hold them back
A student is resistant to handwriting
Poor organization within writing

36. Tips and tricks…
Ensure students that need technology have opportunities to become familiar with the keyboard and its functions
Engagement in meaningful keyboarding activities is the best way to learn keyboarding; young people learn to keyboard through doing activities such as writing stories, playing computer games, doing schoolwork and writing letters or s. (Niles-Campbell, Tam, Mays &Skidmore)
What grade do you start……
Grade 2 most have digit isolation otherwise not developed
Some research says grade 3-4
Some encourage computer skills in primary

37. Ergonomic Considerations
Proper positioning
Eye gaze should be at top third of monitor
Wrist should be in a neutral position
Consider finger isolation
Desk, mouse, keyboard, chair and monitor considerations

38. Scissor Cutting
The tips of the thumb and middle finger are in the holes of the handles of the scissors. The index finger is on the outside of the handle to stabilize the scissors, and the ring and little finger are curled into the palm. The wrist of the cutting hand should be bent up (Benbow, 1991).
Thumbs up!!

39. What Problems Do You See?
Poor scissor grasp
Switches hands or uses two hands
Scissors in palm instead of in fingers
Scissors on joint
Jagged cutting
Tears paper instead of cuts
Poor control of opening and closing scissors
Paper and scissors rest on desk throughout the cutting task
Child has difficulty controlling paper and scissors at the same time
Child doesn’t know where to start first cut
Child cuts without ever turning paper

40. Tips & Tricks to Support Thumbs Up
Do you see this?
thumb down
Tips & Tricks to Support Thumbs Up
Playing card games, especially being the dealer
Hole punch
Squirt bottle for watering plants
Snapping fingers
Games with small pieces to manipulate (Tricky Fingers or Tiddlywinks)
Turning a key in a lock or on a wind-up toy
Put a sticker on student’s thumb, they always need to see the sticker when cutting

41. Tips & Tricks that Support Finger Control For Holding Scissors
Do you see this?
on joint
Tips & Tricks that Support Finger Control For Holding Scissors
Eye droppers
Tongs
Clothes pins
Pennies in bank
Pegs
Unifix cubes
Opening bottles, jars
Tweezer games
Two hands

42. Tips & Tricks for Stabilization of the Hand
Do you see this?
fingers splayed
Tips & Tricks for Stabilization of the Hand
Ring and Little Finger Anchors: Curl the ring and little finger into the palm by holding a small object against the palm (e.g. pom-pom, play-doh ball, marble…) while cutting
Play other games or pick up objects with thumb, index and middle finger with the ring and little finger against their palm.
For example, place coins in slots or play connect four, cube twirl etc.
This activity can be practiced at other times during the school day such as snack time.

43. Or this?
Tips & Tricks
Child uses table for support. Child’s thumbs are down for the holding hand.
Thumbs up for both Encourage tucking elbows hands
against body
Pull chair away from table during cutting activity
-use a marker line

44. Or This?
Tips & Tricks
Keeps scissors pointed forward and rotates paper with helping hand when turning corners or curves
Takes smaller snips (i.e, when turning corners)
Right-handed: cut in a counter-clockwise direction around shape.
Left-handed: cut in a clockwise direction around shape.
Child cuts without ever letting go of the paper. Notice that both hands are at the right of midline.
-use a marker line

45. Or this? Tips & Tricks This may indicate poor motor planning
Child cannot figure out how to get scissors to the shape.
Tips & Tricks
This may indicate poor motor planning
Provide specific instruction on how to approach and execute cutting task
Provide increased opportunities with specific instruction
If the child is unable to figure out how to get to the shape with the scissors, the child can draw a line to the shape from the edge of the paper
-use a marker line

46. Progression for developing control of scissors Part 1
Child demonstrates interest in scissors
Child experiments with opening and closing scissors, not necessarily cutting paper(hand position may vary)
Child orients scissor blades to paper to begin snipping (hands do not rest on table)

47. Progression for developing control of scissors Part 2
Child gains more finger control with the scissors positioned toward fingertips
Child begins to cut in a forward motion across a 4-inch strip of paper without adjusting holding hand

48. Progression for developing control of scissors Part 3
Child uses one hand to adjust paper while the other hand controls the scissors, cutting across an 8-inch wide piece of paper
Move holding hand forward as the scissors pass

49. Progression for developing control of scissors Part 4
Child cuts forward on a line
Child cuts turning corner(s)
Cutting past the shape/line to the edge of the paper before rotating object (Note: We don’t teach this, they just do it… however, we will sometimes structure a project this way to teach those that can’t break down the steps for organizing the sequence on their own.)
Rotate object (the paper, not the scissors) to cut around the corner

50. Progression for developing control of scissors Part 5
Child cuts out straight-line shapes (square, triangle)
Child cuts out curved-line shapes (circle, oval)
Child cuts out simple shapes (heart, moon)
Child cuts out complex shapes (star, hand)
Notice that the two hands must shift between the tasks of moving and holding. For example, one hand holds while the other opens and closes the scissors blades, then the scissors hand must hold while the holding hand shifts position on the paper.

51. Cutting References and Resources
Klein, Marsha, Pre-Scissor Skills, Therapy Skill Builders, 1987
Knight and Gilpin Decker, Hands at Work and Play, Therapy Skill Builders, 1994 (activities only)
Web pages
Scissor Skills.pdf

52. Questions?