As an occupational therapist that works in the schools I often receive referrals for students with suspected delays in their fine motor skills. Fine motor skills refer to the ability to coordinate the muscles and structures in your hands and wrists to carry out precision tasks. These tasks can consist of stringing beads, shoe tying, writing, cutting, completing puzzles, and more. If a child does not properly develop these muscles in their hands and wrists then they may have difficulty completing daily fine motor tasks in the future.
When I evaluate a child, I don’t just focus on the child’s hands and how functional their fine motor skills are. I look at their whole body, which includes the core. Often, people refer to only the abdominals as the core; however, the core consists of structures that extend from the base of your skull down to your pelvis. Weakness in the core muscles can impact a child’s proximal stability. If this weakness is not addressed, then the body will begin using other joints to compensate for the lack of core strength. This may cause the child to use unnecessary energy throughout the day, which might lead to the child quickly fatiguing. If you notice your child has difficulty sitting upright without slouching, holds onto surfaces when walking or standing, has a difficult time transitioning to/from the floor without their hands, or has a wide base of support (W-sitting) when sitting on the floor, then your child may have some core weakness.
If I notice core weakness, then I turn my eyes to their arms to check for shoulder stability. After all, humans develop from proximal to distal (inside out). What this means is that our core musculature develops first. Proper core strength sets us up to have good shoulder stability. Having good shoulder stability then sets us up to develop proper elbow strength and stability. Once our bodies develop good strength and stability in these places, then our wrist strength can develop, and finally the small muscles in the hands develop. When normal development of the hands occurs, you will see a child begin to isolate their fingers and develop arches in the hand. This allows them to grasp and control small objects with ease. When normal development does not occur, your child may have a difficult time controlling a pencil, manipulating scissors, transferring coins from palm to/from fingertips. They may also complain that their hands are tired. Depending on a child’s health status, diagnosis, and results of an occupational or physical therapy assessment, it may be beneficial to implement core strength activities, instead of drilling them with only fine motor tasks.
In therapy, my go to activities to address core and upper body strength and stability is placing a child in a prone (face down) position with their arms extended so that they are able to weight bear through their arms. This position encourages the child to use their core and arms to push against gravity, which will activate the musculature around the core, shoulders, elbows, and wrist. This also helps to strengthen the musculature in the hand and promote development of the arches of the hand so that a child can easily isolate their fingers and manipulate small objectes. Since kids learn through play, I always try to make these positions fun and engaging for children, while they work on core and upper body strength and stability. Because let’s be honest, a lot of people (adults included) don’t enjoy the burn associated with core workouts.
Below are three positions to incorporate into a child’s play time.
Yoga Pose – Cow/Cat:
In yoga, people may call this position cow/cat. For people that know nothing about yoga, you may call this a table position.
Set-up: Have the child put their hands on the floor and keep their arms extended, directly under their shoulders. Next, have them place both knees on the ground, directly under their hips. A child’s first instinct might be to place their hips on their heels. You can use your hands to physically guide their hips and encourage them to keep their hips over their knees.
Plank on the Couch:
Set-up: Have your child lie on the couch and place their hands on the floor. Make sure they keep their arms extended. Next have them walk their hands away from the couch. This should allow their chest (and possibly part of their stomach) to come off of the couch, which will allow them to bear more weight through their arms. If the couch is too high, try using an ottoman or a small stability ball.
Set-up: On a soft surface, have your child place their hands flat on the floor with arms extended. From there, the adult should hold the child’s legs and bring them off the surface. Now your child is in a wheelbarrow stance. If the child has a hard time assuming this position and their core is dragging towards the ground, the adult can hold closer to the child’s core. Feel free to grab your child’s pelvis or thighs to reduce the load that your child is holding up. Ultimately, you want their core to be at a slight incline, starting from the base of their neck. If your child is able to, they can attempt to walk around on their hands.
To make these positions fun and challenging, have the child complete a variety of one-handed activities. For example, puzzles, stacking blocks, placing coins into a bank, tossing a ball into a low basket. In the cow and wheelbarrow position, your child can crawl and have relays. Lastly, remember to let your child rest as they need to.
-Brittany Stout, MOT, OTR/L