Fine Motor & Hand Function

• Cultural/Social - Different social and cultural experiences leads to earlier or later development

• Somatosensory - Perception about qualities of objects; can lead to difficulties with coordination, timing/speed, use of force​

• Visual Perception - integrating visual and tactile perception (eye-hand coordination) leads to spatial relationships​

• Musculoskeletal - Joint and bone structures, ROM, strength, tone, endurance impact function

• random & uncontrolled reach & contact

• symmetric bilateral reaching

• unilateral reaching

• accuracy, grading, consistency

In-hand manipulation: refers to the ability to move and control small objects using only one hand

Comprehensive Hand Function Evaluation

• fine motor

• visual motor

• hand function

• postural stability & alignment

• musculoskeletal

• neuro-motor functions

• gross motor

• cognitive/perceptual

• sensory

• socio-emotional skills

Assessment Options

• BOT-3

  • tests fine motor & gross motor skills

  • ages 4.0-21.11

Interventions

• Positioning

  • gravity-assisted v. unassisted

  • sidelying - helps with CP reach to midline with gravity-assisted

  • prone - builds shoulder stability, co-contraction, weight-bearing (using props, swing, bolster, wedge, etc)

  • supine - helps with infants reach against gravity to midline

  • standing - promotes postural tone & attention

• seating equipment (or supports)

  • wedge cushion

  • foot block - 

  • arm rests

  • slant board (20-30 degrees promotes wrist extension)

• NDT - 

  • deep pressure, quadruped weight-bearing, weight-shifting

  • enhances postural alignment & tone

  • weight shift & equilibrium

  • transitioning between movements

  • isolated & dissociated movements

• motor learning practice

• P-CIMT - pediatric constraint-induced movement therapy

  • can use splints, casts, mitts, gloves, etc

• AT

Equipment Considerations to Enhance Hand Fx

all supports provide proximal stability to enhance distal mobility

• back support - enhances shoulder stability

• pelvic strap - keeps hips at 90 degrees for upright trunk

• foot support - neutralizes tone, stabilizes pelvis

• lateral supports - supports symmetry & midline

• lap tray - supports arms & hands

• harness - supports upright & symmetric position

Hand Therapy (Clinic or Hospital)

• can be acute or chronic conditions

• Congenital differences in hand/arm

• UE impairments

  • brachial plexus birth palsy (BPBP) - 

  • preserve function & ROM to prevent deformity

• Injuries of the hand/arm

• conditions can be related to an injury or issues stemming from an underlying disorder

  • CP, TBI, SCI, DMD, SMA 

  • rheumatic conditions - juvenile idiopathic arthritis & connective tissue disorders

Hand Therapy Assessment

• Pain

• condition of skin

• edema

• sensation

• muscle tone

• ROM

• strength

• FM/prehension skills

• occupational function

Hand Therapy Interventions

• pain management/PAMS

• orthotics & casting

• activity mods, joint protection, & energy conservation strategies

• wound care, scar management, & edema control

• sensory desensitization & re-education - hypersensitivity to tactile input (light touch, deep pressure, textures) and temperature… so systematic exposure and tolerance

• ROM, strengthening, & endurance

• reducing muscle tone

• fine motor & bilateral coordination activities

• mirror therapy - reduces phantom limb pain, increases function, increases motor and sensor function, increases hand strength and ROM

• occupational functioning

Interventions for Trauma-induced Conditions

• Promote positive family experiences

• interprofessional team collaborat