pre writing skills

need to understand stroke position concepts

motor, cognitive, sensory systems must work together

grasp patterns-most mature
lateral tripod and lateral tripod grasp

Developmental stages in writing readiness
gross grasp without stability- mature grasp with
stabalizing with non- dominate hand

hand manipulation
shifting, transitioning, rotation

develpomental sequence
1. pre writting skill 
2. grasp patters- most mature 
3. developmental stages in writting readiness 
4. in hand manipulation

proximal control and stability assesment
posture: symmetrical, upright 
proximal stability to obtain distal mobility ( starts with
trunk control- shoulders-wrists-fingers) 
endurance

proximal control and stability intervention strategies
1. provide appropriate levels of external support 
2. props, wedges, or foot rests 
3. various seating for trunk support 
4. supporting paper with non dominate hand 
5. working on trunk control

hand writing screening
postural control, ROM, hand control, pre-writing
skills, letter/ number formations, bilateral hand skills,
visual motor/ perceptual skills. sensory motor skill &
environment, cognitive ability 
*** these skills develop predictably and sequentially

positioning assesment with interventions
1. desk and chair height: recommended 90-90-90
seated position, feet securely on the floor 
2. paper: orientation, slant so that it aligns with
forearm
3. vertical or horizontal work space

hand control assessment
1. hand dominance 
2. in- hand manipulation 
3. mature use of radial and ulnar side of hand 
4. grip pressure 
5. pencil grip 
6. endurance
7. isolate finger movements

Star this term
You can study starred terms together


hand control intervention and strategies
1. Explore options for writing tools and pencil grips
2. You slanted surfaces to encourage wrist extension
3. Encourage distal finger control with small
movements and small 
pencils
4. Weighted gloves and pencils
5. Give boundaries of where to write or color
6. Gradually decrease the size of area to color
7. During handwriting session monitor and provide
feedback
8. pencil warm ups

readiness or ready to print ( ask yourself if the child)
1. Has established handedness
2. Can Tell apart a big and little line and big and little
curve
3. Can hold a pencil in writing position
4. Understanding directionality up around down under
5. Demonstrates a satisfactory level of attention
cognitive skills and 
collaboration

strategies to improve hand writting skill
1. Vertical surface
2. Various pencils or pencil grips
3. Paper tape to desk or on a clipboard
4. Highlighting lines or spaces
5. Letter strips
6. Different colored paper
7. Pen versus pencil
8. Hard or soft lead pencil

Visual motor skills
Using vision to guide motor output

Sensory motor skills assessment looks at?
1. Crossing the midline
2. Motor planning
3. Tactile and auditory
4. Proprioceptive and kinesthetic awareness
5. visual
6. Attention and focus

visual perceptual/ fine skills assessment
Ability to make sense of what is seen

Considerations for handwriting interventions
1. learning style 
2. Organizational skills
3. Classroom accommodations 
4. Left-handed writers

Visual perceptual skills interventions and
accommodation
1.During handwriting my term provide feedback: letter
formation spacing accuracy letter closure
2. Explore options for writing paper
3. Copying notes from table instead of bored
4. Multi sensory exploration such as Sand trays & play
doe 
5. Use manipulatives which enhance hand eye
coordination and motor 
planning
6. Puzzles mosaics

Compensation strategies
Wordprocessor tablet keyboard 
classroom strategies accommodations additional time
for assignments 
sloppy copies acceptable preferential seating 
letter strips on desktop 
vertical strips on desktop 
vertical surface
use of live scribe pen 
cursive writing instead of printing

Prehension
Holding manipulation moving objects around the
pants

Developmental progress of mature grasp birth to
one-year
1. Whole hand grasp
2. ulnar Palmer grasp 2 to 3 months
3. palmer grasp
4. Radial Palmer grasp 
5. Raking grasp 7 to 8 months
6. Pincer grasp

Newborn hand grasps
Reflexive grasp primitive squeeze unable to voluntarily
release

3 to 4 month hand grasps
Ulnar Palmer grasp 
hands at midline

4-5 month hand grasps
palmer grasp 
rolling over helps develop forearm rotation
prone on elbows and Crawling provide proprioceptive
input to hands helps inegrate grasp reflex encourages
wrist extension promotes expansion of palm for arch
development

6 mo grasps
radial palmer grasp

7-9 mo. grasp
volentary release 
supination
inferior pincer

10-12 mo grasp
neat pincer grasp, 3 jaw chuck, wrist extension

19-36 mo hand skills
translation 
rotation

3-5 years hand skills
hand dominance emerges 
uses static tripod grasp
able to draw vertical line, horizontal line, circle, square
and diagonal lines 
demonstrates increasing skills in mature pinch and
grip

Mature Pinch patterns
-Tip pinch: tip to tip, 2 point, finger tip prehension 
-3 point pinch: 3 jaw chuck, palmer prehension 
- lateral pinch: key pinch

Mature grip pattern
- hook grip
-power grip
-spherical grip: round objects
- cylindrical grip 
- tripod grip

Motor skills
Learn sequences of movements that combined to
produce more efficient actions in order to master
particular test

Motor learning
Acquisition of motor skills motor learning occurs
through repetition practice and feedback

Teaching techniques
1. Providing just-right challenges
2. Use of multi sensory cues for teaching and feedback
verbal tactile visual and kinesthetic
3. Allowing for practice sessions and repetition
4. Allow for mistakes: positive feedback for
improvement

Proprioceptor's
Sensory organ located in muscle tendon in joints to
provide information about body position proprioceptor
signal changes in the muscle tone and function in
response to muscle location muscle tension and joints
within

Sensory integration
The ability of our brain and nervous system to take in
sort out tonight and organize sensory information from
our environment so that we can use this information to
learn and respond appropriately

8 senses
Olfactory tactile gustatory vestibular visual
proprioception auditory kinesthesia

Sensory integration development
There is a hierarchy of development that can best be
explained by thinking of the sensory system as a
foundation or building blocks

vestibular system
The sensory system that responds to gravity and keeps
people informed of their body's location in space.

Tactile system
Alerts us a danger and helps us learn Through touch

Proprioceptive and kinesthesia system
Sensory system that provides us with information
arising from the muscles joints and ligaments of the
body provides awareness of joint position and
movement and body parts developed a child
experience and learn by moving

Auditory and visual systems
a variety of visual and auditory sensations lay the
groundwork for future development of visual
perceptual and language skills bases on tactile on
vestibular system influence auditory visual
multisensory communication

Olfactory and gustatory systems
Alert us a danger we all use certain sensorimotor
strategies it's help us maintain optimal levels of
alertness

Parasympathetic
the branch of the nervous system that automatically
calms us down when the reason for arousal has passed

Sympathetic
part of the nervous system that controls the "flight or
fight" responsep

Play
Generally defined as a pleasurable activity that is
spontaneous

Intrinsic movement
Self initiated or drive to action for which the reward is
the activity itself

Internal control
Child is in control of actions and to some degree the
outcome of the activity

Freedom to suspend reality
Participate in make-believe or pretend playmaking

Pretend play
Requires higher level of cognitive function

Playfulness
One's disposition to play individual style on how to
approach problems which reflects a child personality

Developmental sequence 2 years
Solitary play, dependent on adults, understand simple
instructions, books, attention span short

Developmental sequence 3 years
Parallel play, takes turns, imaginative play, draws
person, cuts with scissors, needs controlled freedom

Developmental sequence 4 years
cooperative play, highly social, talkative, dresses
self,enjoys responsibility, follows rules

Developmental sequence 5 years
Highly cooperative play, has friends, organize table
games, involved in the environment

Play development in children with disabilities
-Normal developmental sequence delayed 
-unable to experience sensation or atypical
-longer response 
-often passive and play or less interested 
-limited variability movement 
-have restricted language 
-has decreased attention span 
-struggle with social interactions 
-difficulty with transitions 
-difficulty with understanding verbal and nonverbal
cues 
-physical barriers

Essential dimensions of play
1. Voluntary enjoyable purposeful spontaneous
2. Creativity expanded using problem-solving
3. Expands new ideas
4. Helps adapts socially
5. Helps with emotional issues

What do toys teach children?
1. Figure out how things work
2. Pick up new ideas
3. Build muscle control and strength
4. Use their imagination
5. Solve problem
6. Learn cooperative play with others

Types of play
Motor/ physical,social play, constructive play, games
with rules

Motor/Physical play
High movement gross and fine motor integration of
nerves muscles and brain

Social play
Social opportunities -social rules, give-and-take,
recipocity, cooperate and sharing

Constructive play
Manipulating environment- Drawing, building, fantasy
play-try new role, situations, experiment

Games with rules
Teaches children that rules must be followed

Forms of play
Solitary play, parallel play, group play

Solitary play
Spending time on their own exploring environment
from sound of voice feelings on body

Parallel play
2 to 3 children playing side-by-side little interaction

Group play
3 to 4 children child driven communicate and socialize
learning and sharing taking turns like to play with
adults

Gen. principles for normal development
Sequential and predictable maturation and experience
biological systems 
changes horizontal and vertical cephalic to coddle 
proximal to distal 
gross to find

The transition from immature to matureish gross
motor is facilitated by
1. refluxes
2. gravity 
3. inate desire to master our environment

change in year 1: motor development
floppy- strong and balanced 
non- functional closed flat hand- coordinated limber
hand

0-1 month developmental milestones
physiological flexion 
reflexive, random, repeated movements of limbs 
gaining volentary eye control, mouth, head and neck

2-5 month developmental milestones
masters rolling ( prone to supine)
lifting head
3 mo. lifts head and raises on elbows on prone

5-7 mo. developmental milestones
sits unsupported with hands free for play

7-10 mo. developmental milestones
crawls/ quadruped
pulls to stand
uses rational movement

11-15 mo developmental milestone
walks

18 mo developmental milestones
runs well

2-3 years developmental milestones
peadles tricycle 
catches large ball

3-5 year developmental milestone
balance and hop on one foot 
kicks ball
gallops

5-6 year developmental milestones
skips, swings, climbs with agility

red flags that indicate developmental delays posture
-floppy head and/ or extreamities 
- poor extensor strength 
- fatigue quicker than others 
- leans rather than sits or stands up right 
- hyper extended joints 
- open mouth, drooling 
- wide base of support

red flags that indicate developmental delays motor
control/ coordination
-clumsy 
-extra effort or unable to make transition 
-avoidance of leaving the ground 
- difficulty crossing midline or alternating between left
and right 
-asymmery of movement 
- poor quality of movements

red flags that indicate developmental delays hand
control
-avoids developmentally appropriate fine motor tasks 
- lacks use of radial side of hand for precision 
-lacks in hand manipulation

red flags that indicate developmental delays
interaction with environment
-avoids play with peers
- avoids interaction with environment and age
appropriate toys

how do OT's help?
-By providing environments rich with opportunities
that provide the just right challenge for motor
development
-By using evidence-based techniques that promote
motor learning and motor control
-By providing supportive devices that enable
participation in occupation
-Through the use of technology to enhance muscle
power and control 
-By intentional engagement and developmentally
appropriate activity

criteria for referral
1. Referral from a physician maybe necessary 
2. medical developmental social or environmental
situations that limit the child's ability to participate in
normal daily routine 
3. physical limitations that affect the child's ability to
be mobile within the environment or there is on the
impaired upper extremity function 
4. developmental level of performance and self
maintenance skill or work related skills that is less
mature than expected given cognitive ability to acquire
those skills
5. Qualitative difficulties in the performance of daily
living skills like contribute to problems with frustration
attention motivation behavior organization or social
interaction
6. Parents or caregivers need for assistance in learning
strategies to encourage the child's independence daily
living

Evaluation process
OT is responsible for the initial valuation COTA can
administer portions or the full assessment under the
supervision of OT after establish service competency

Components of an assessment
Reason for assessment 
review of records 
other information pertinent to referral interview 
observation 
test administer score interpret communicate findings
and recommendations

Factors in using test
Reliability validity 
age appropriateness 
cultural bias 
practical considerations 
qualification of user 
ethical considerations 
adaption of test 
interpretation of test

CI
Cognitive impaired

PI
Physical impaired

ASD
Autism spectrum disorders

EI
Emotionally impaired

LD
Specific learning disability

HI
Hearing impairment

VI
Visual impairment

SLI
speech and language impairment

TBI
Traumatic brain injury

ECDD
Early childhood developmental delay

SXI
Severe multiple impairment

OHI
Otherwise health impaired

Referral process in school
1. child study: teacher brings attention 
2. observation & data collection 
3. parent premission to evaluate 
4 multidisiplinary evaluation team
5. IEP

Types of Services
1. early intervention
2. preschool- early childhood special ed 
3. school based program 3-26 yrs 
4. transition IEP: 14-17 yrs

Prerequisites for scissor skills
Ability to open and close the hand ability to use both
hands 
thumb movement 
ability to coordinate arm hand 
being able to look see and do what other people are
doing

Early Stages
18-24 mo. 
grasp: Both hands to hold handle sticking fingers and
loops but not sure where they belong

Cutting strategy: Open and close scissors wide opening

of scissors

intermediate stages
24-36 mo. 
grasp: So I'm in top loop in fingers and bottom lip
scissors held closer
to the base of the hand uncontrolled opening of the
scissors overflow movement

Cutting strategy: Short snipping


advance stages
36+ mo. 
grasp: Tom and Topelo fingers and bottom loop
handles are held closer 
to that DIP joints ring and little fingers remain on the
outside of loops

cutting strategy: Initially cut straight lines using

dominating in the help hold paper scissors open half
way

Developmental sequence for developing scissor skills
1. Needs to show interest in cutting 2. needs to be able
to hold them and manipulate scissors appropriately
3. student opens and closes and more controlled
fashion 
4. student can cut short random strips 
5. able to bring scissors up in forward motion 
6. coordinates lateral direction of scissors 
7. being able to cut a straightforward line being 
8. able to cut out simple geometric shape 
9. cutout simple figure shapes
10. Complex figures shapes
11. Can they cut out non-paper items

Peabody developmental motor skills cutting
sequence
2 yrs: can snips with scissors
2 1/2 yrs: Cut across a 6 inch piece of paper
3-3 1/2: cut on a line that is 6 inches long
3 1/2 -4 yrs: cut out circle 
4 1/2-5 yrs cut out square 
More complex cutting skills develop between six and
seven years

Interventions to develop opening and shutting of the
hand or scissors
Isolating finger movements 
develop arches and hand 
encourage lead in 
promoting stabilization a body part

Activity ideas for developing scissor skills
Tongs or tweezers 
water guns 
tearing paper

Adaptation
Hand the scissors by holding onto the blade to the
child as their fingers will automatically go in the right 
adjust wrist for correct direction 
hold the paper for the child or to the edge of the table
as here she learns how to manipulate scissors 
wrap rubber bands around clothspins to make them
more difficult to open as a child skills increased great
activity up by introducing materials are more difficult
to cut

beery VMI-4
The developmental test of visual motor integration,
Fourth edition is the most highly acclaimed measure of
students visual motor skills. The primary purpose of
VMI-4 is to help prevent learning and behavioral
problems through early screening identification.

bruininks- oserestsky test of motor proficiency
This test thoroughly assesses the motor proficiency of
able-bodied students With serious motor dysfunctions
and developmental handicaps. Gross motor skills-
Running speed and agility balance bilateral
coordination strength. Gross and fine motor
development of upper limb coronation, fine motor
development- response speed, visual motor control,
upper limb speed and dexterity

gardener social (maturity) developmental scale
the scale measures the following social development
skills: fine motor, gross motor, locomotion, cognative,
eye- hand coordination, receptive language, expressive
language, reflexive acts, intrinsic behavior,
educational, self help, and social.

motor free visual perceptual test-3
Individually administered test designed to assess
overall visual perceptual ability. Perceptual tasks
include spatial relationships visual discrimination
figure ground visual closure and visual memory

Mullen: scale of early learning
a diagnostic tool designed to provide information that
describes a child's strengths and weaknesses and
motor and cognitive development, information useful
in developing programs and strategies for early
intervention in preschool education. Strong theoretical
base and it neurodevelopment and enter intarsensory
intersensory learning it assesses visual language
abilities both receptive and expressive level

peabody developmental motor scale
This package provides both in-depth assessment and
training or remediation of gross and fine motor skills
for children from birth through the 6 years six subtest
reflexes stationery, locomotion, object manipulation,
grasping, and visual motor integration

School function assessment
Help elementary school students with disabilities
succeed identifying their strengths and needs an
important nonacademic functional tasks. Helps
establish eligibility for special education.

vulpe assessment battery revised
Comprehensive process oriented, criterion- referenced
Assessment that emphasizes child's functional abilities.
It is appropriate for children and atopic typical
development patterns related to metal core social
conditions that affect their developmental potential.
Early intervention of those who may be at risk of
educational failure

primitive reflexes
1. mediated subcortically
2. presence beyond a certain age is a signal of possible
neurological dysfunction 
3. suppression occurs to allow for more advanced
motor behavior... reflex integration

suck/ swallow
28 wks gestation to 2-5 months
s: place finger or nipple into infants mouth
r: sucking movement of lips, tongue, and jaw
s: absence may indicate CNS depression. nutritional
needs

rooting
28 wks gestation to 3 mo
s: stroke finger over perioral skin at the corner of the
mouth moving laterally toward cheek
r: infant turns head toward stimulus and mouth opens 
s: absence may indicate CNS suppression

flexor withdrawal
28 wks gestation to 1-2 mo
s: apply noxious stimulus to sole of foot
r: stimulated leg reacts with flexion of knee, hip and
ankle to withdrawal extremity
s: required throughout life for safety

cross extension
28 wks gestation to 1-2 mo
s: hold one leg straight and apply firm pressure or
noxious stimulus to sole of foot
r: flexion, addiction, and then extension of opposite leg
s: foundation for reciprocal locomotion

Morro "startle"
28 wks gestation to 5-6 mo
s: support head and shoulders then allow head to drop
back 20-30 degrees 
r: abduction of UE with extension of the elbows, wrists
and fingers followed by addiction of arms at the
shoulders and flexion of the elbows 
s: indicative of neurological abnormality if absent

Plantar grasp
28 wks gestation to 9 mo
s: place firm pressure on volar aspect of foot, below
toes 
r: plantar flexion of toes 
s: indicates immature stability with the disappearance
with standing which works with mature posturing

palmar grasp
birth to 4-11 mo 
s: place index finger into infant's hand with pressure
over metacarpal heads 
r: finger flexion around examiners hand 
s: sign of immature reaching and grasping-unable to be
functional until integrated

spontaneous stepping
birth to 1-2 mo
s: hold infant in vertical position and touch feet at
support surface while slightly leaning infant forward to
elicit stepping 
r: alternate stepping pattern 
s: may be evident with hypertonicity or spastic
disorders

placing Response
birth to 1 mo
s: brush the dorsum of child's hand or foot against
table top 
r: limbs lifts into flexion followed by extension to place
onto surface 
s: may be evident with CNS damage

tonic labryinthine
28 wks gestation to 6 mo 
s: assess tone in supine and prone position
prone with head extension =flexor tone 
supine or pull to sit = extensor tone 
r: prone = flexor tone dominates and child will not lift
head; supine= extensor tone dominates and child will
not flex to sit up
s: may inhibit ability to roll and develop anti- gravity
behaviors if persists

labeyinthine righting reaction
birth throughout life
s: tilt child's body in all directions
r: head orients to vertical position to maintain proper
orientation with environment 
s: assists with antigravity behaviors

positive support
35 wks gestation to 1-2 mo
s: allow feet to make contact with support surface 
r: co-contraction of lower extremity muscles 
s: indicates normal muscle tone at that age; indicates
hypertonicity if persisting

asymmetric tonic neck (ATNR)
-37 weeks to 4-6 months
-Stimulus: Fully rotate infants head and hold for 5
seconds
-Response: Extension of extremities on the face side,
flexion of extremities on the skull side.
s: prevents symmetrical behaviors, not uncommon to
be seen in adults with CNS damage

symmetrical tonic neck reflux (STNR)
emerges 6-8 mo, integrated 9-11 mo 
s: lowering of head and raising head 
r: lowering head causes arms to bend and legs to
straighten. raise head causes arms to straighten and
legs to bend 
s: helps to integrate TRL, prepares for mobility,
facilitates development of vision

protective reactions
s: displacement of center of mass so body can't re-
center 
r: parachute reaction- arms extend to protect proximal
body parts, downward displacement first the anterior 
s: safety and contributes to balance

equilibrium reactions
stimulus: displace center of gravity by tipping support
surface,
response: righting of head/trunk/limbs
s: contributes to balance, prone develops first

landau reactions
appears by 6 mo 
s: suspends in horizontal prone position 
r: total antigravity extension