Fine motor skills are what we use when we do up buttons, unscrew lids, cut with scissors, thread string, put lego together, manipulate puzzle pieces or coins, tie our shoelaces and write with a pencil.

Fine motor skills consist of a variety of different areas including: bilateral coordination(using both hands together), hand and finger strength, palmar arch development,  grasp and manipulation,  and hand-eye coordination.

Children with fine motor difficulties also often have underlying poor gross motor difficulties such as poor body proprioception (awareness of where their body is in space), core strength and relating poor balance and difficulty crossing the midline.  Hand writing and copying difficulties  are also often seen in conjuction with Visual Motor integration (VMI) and Visual Perception (VP) problems.

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Constantly dropping their cutlery,  fumbling with buttons, or writing illegibly or very slowly can be a sign of poor hand control or strength. 

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Children with fine motor deficiencies can struggle to keep up with school work or they may avoid or refuse to do activities they find too challenging e.g. writing, cutting, buttoning their shirt.  Handwriting skills are needed to keep up in class and to progress in learning.

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Constantly dropping their cutlery,  fumbling with buttons, or writing illegibly or very slowly can be a sign of poor hand control or strength. 

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Other children with  poor fine motor skills may complain of pain in their hands when completing fine motor tasks. This is likely due to poor hand strength and sensory modulation. (They may be squeezing too hard in order to compensate for weak muscles or they may have an underlying joint problem as as laxity in their ligaments).

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Children with poor fine motor skills may struggle with self esteem and frustration that they can not do 'simple' tasks. They can fall behind their peers as they are reluctant to engage in table top activities.

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Older children who struggle with handwriting may have difficulty expressing their thoughts on paper, completing exams legibly and within the time frame and struggle with maths due to overcrowding their page and the effort required to correctly write out numbers.

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Therapy will start by looking the underlying skills needed for fine motor skills and ensuring the child has the core strength, sensory regulation, propricoception, balance and shoulder stability to be able to sit at a desk and concentrate.

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Sometimes children who rush their work or have difficulty copying, present as having fine motor problems but are actually struggling with visual perception difficulties or poor balance. The iniitial assessment will determine the correct treatment approach. 

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Children with poor fine motor skills may struggle with self esteem and frustration that they can not do 'simple' tasks. 

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We work with a range of tools to strengthen their hands and upper limbs and improve their hand manipulation skills. We do this through a range of fun activities.  We encourage parents to continue prescribed activities at home in between sessions.

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We also look at providing tools or allowances for the student to help them better keep up at school. For example, using a slope board where the child has poor shoulder stability and poor visual motor integration skills. 

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We might use the Handwriting Without Tears program when the child has adequate fine motor strength but struggles with handwriting legibility.