First move

Some children may require specific support to develop their motor skills at some point of their development (by motor skill, we mean movement, fine hand skills and self-help skills). Children may need support due to lack of early experience, opportunity to develop motor skills, delayed development or motor difficulties.

1st Move is a resource intended for use both by parents/carers and in nursery/schools by teachers and support staff.

It is written to be a ‘child friendly’ approach focussing on skill development. 1st Move emphasises functional skill development. The emphasis is on quality movements and it is important that time is invested early on to promote these good quality movement patterns.

• Key ideas:
• Quality (quality movements count – keep it short and focused)
• Regular practice (short, regular practice will make a difference)
• Big to small (all movements start big before refining to small - allow children to develop increasing precision by allowing them to start with big actions on a big area)
• Utilising existing skills (each child will have a range of existing skills – allow the child to use them)
• Teach new skills ( teach new skills – be specific)
• Minimise frustrations and develop coping (whilst the child is learning and practising new skills, support them to have some coping strategies in place until they have mastered the new skills)
• Generalise (use the new skills in a growing range of situations and practise them in a functional manner)
• Environment (where is the skill going to be introduced/ practised?)
• Use appropriately sized equipment (using appropriately sized and working equipment makes a difference to the success of children’s acquisition of certain movement skills)
• Make it interesting!

POINTS OF NOTE: Many children are confused about the right and left sides of their own bodies creating difficulties for them in everyday life. Children need to be able to internalise the knowledge of right and left so responses become automatic and instantaneous.

Equipment

• Sticker or stamp
• Hoop: red
• Beanbag: red

Preparation

• Stamp or stick red sticker on back of right hand
• Use reminder – “This is the right hand and this is the one that’s left”

Activities

Physical and verbal cueing

• Adult touches the right arm of the child and instructs the child to take two steps sideways to the right. Repeat, but this time on the left
• The child holds a bean bag in each hand. The adult cues the child to throw by touching the right arm with a verbal cue ‘throw with your right hand’. Repeat but with the left hand

Verbal cueing only

• Repeat as with the physical cueing but only use verbal cues
• Rhythms: Tap out rhythms with right hand eg. “Baa baa black sheep”
• Throwing: Throw red beanbag in red hoop, placed to the right of child
• Hokey Cokey song – ‘Right hand in…’

Movement from left to right

POINTS OF NOTE: Gross motor movements from left to right will help reinforce the movement patterns required for writing. These exercises should be carried out using the child’s writing hand.

Equipment

• Bench
• Hockey stick
• Quoits, beanbags

Activities

Move quoits

• The child is placed behind a line 1m away from a bench and the child lifts each quoit with a hockey stick and puts it over the bench. The child starts at the left and works down the line to the right

Progress:

• As above but pushes off bean bags
• Child sits in a hoop and carries out the above
• Skittles placed in a row and the child rolls a ball to knock each one over starting at the left and working down the line to the right
• A ball is placed on a bench at the left hand side and the child is instructed to move the ball along the bench to the right using a hockey stick

Move along children

• A line of children side by side passes objects along the line starting at the left and passing to the right. The one at the end runs to the beginning of the line and starts again

POINTS OF NOTE: For a child to plan and organise his/her movement he/she must have good understanding of his/her body in space.

Equipment

• Bean bags
• Hoops
• Skittles
• Ball

Activities

Distance practice

• The child throws bean bags into hoops placed at varying distances in front of him/her
• The child throws bean bags into hoops placed at points 360° around him/her
• Mix distance and direction
• With a bean bag, knock skittles down placed at different distances and directions

Dodge the hoops

• Place six hoops around the gym/hall. Have the child run in and out of the hoops, putting red beanbags into red hoops, yellow into yellow etc.
• Lay a path of hoops in a line and have the child jump (or step) from one to another without touching them (the greater distance being the child’s height)

Roll along the wall

• The child stands facing a wall with a ball between the wall and child’s stomach. Child rolls self along the wall, keeping the ball between body and wall

Knowledge of shape

Equipment

• Bean bags
• Hockey sticks
• Skipping ropes
• Ribbon

Activities

Making shapes

• Help the children make large shapes on the gym/hall floor using skipping ropes. Use the bean bags to identify the beginning and end of the shape or points for changing direction eg. the corners of a shape. Have the child walk around the shape, forwards or backwards
• Draw the shapes on large white board
• Draw the shapes in the air with a ribbon
• Have the child lay out shapes on the gym/hall floor from memory, using a collection of beanbags, hockey sticks and skipping ropes
• Have the children make shapes with their own body eg. a T shape or circle
• Have the child walk a shape, or move to form a shape from recall

Handwriting is perhaps the most complex perceptuo-motor skill that children have to acquire. It requires the simultaneous processing of a range of visual and often auditory inputs (eg. dictation) whilst producing controlled, complex movements using tools. See? We said it was complex.

Handwriting can be supported through handwriting specific activities but there are a number of components parts to help develop handwriting skills. If any of these skills are absent or poorly integrated, a handwriting difficulty may occur.

Below are the components which give the child a base to develop their handwriting skills. It is worth investing time to check these skills and use the programmes outlined below to develop these component skills. A child doesn’t necessarily need to have a pencil in their hand to work on skills to aid handwriting

Development of grasp

The dynamic tripod grip (see below) is often seen as the model grip, but look around you, how many adults don’t show this precise grasp?

Lots of perfectly functioning adults exhibit far from model tripod grips, therefore apply this model sensitively, we want to empower children to mark make effectively and not be frightened because their grip isn’t ‘just so’. It is important to know the typical stages of pencil grip development. The decision about this should relate to what age and stage the child is at. Do they have other recognised difficulties that need to be considered?

Normal development of drawing skills

Drawing is a learned skill. Most children also follow a general order of skill development of drawing shapes. This follows an imitate, copy, drawing sentence.

Teaching handwriting

Imitation precedes copying prepared examples. Model it!

Pencil/pen grasp

It is a good idea to teach how to grip the pencil, as this will avoid the need for remedial action later on. It is important to show the child how to hold the pencil – model it! If you are teaching a left handed grip, use your left hand and for a right handed grip, use your right hand.

Development of pencil control

As children develop pencil control, the movement changes from large shoulder movements to controlled finger movement with the forearm resting on the writing surface. This is only achieved effectively when shoulder stability is established.

Remember, the control moves down from the shoulder to the wrist; to the hand; to the fingers. Static tripod grip (not moved by fingers) is often mistaken for a dynamic tripod where the movement comes from the end of the fingers and thumb.

• Shoulder 
• Wrist 
• Hand 
• Fingers

Principles underlying good handwriting

Good sitting

Good sitting forms the basis of good handwriting.

Ensure the table and chair is the correct height. Taller or shorter children may need additional furniture or adaptation to existing furniture.

The principles of good sitting:

• Feet on floor (use footrest if necessary)
• Bottom to back of chair
• Forearms resting on table

Paper position

Many children will place their paper in such a way it prompts them to work in awkward positions. It helps to teach a good way to position the paper. Paper positioning is important to allow a view of the writing and to help prevent the development of a hooked grasp, since the writing hand will be below the line of writing.

Left-handed children should be encouraged to position their paper slightly turned to their right, with the left corner high. Right-handed children should be encouraged to position their paper slightly turned to their left, with the right corner high.

Letter formation

For most children the aim of writing will be to develop an efficient cursive script (joined up writing style). Incorrect letter formation can prevent this by stopping the pen/pencil where it cannot join with the next letter. It is important to observe the child’s writing process since letter formation is difficult to judge from the finished writing, as some children produce neat printing which is formed incorrectly and it is only picked up when they fail to join or are excessively slow. Others may sometimes print their letters and put the joins in afterwards – not a very efficient approach to writing!

Therefore, whilst the finished product of writing is important – the skill of handwriting is best observed as a process rather than the finished product. For some children, the development of fluency in cursive writing may be limited due to muscle tone, tremors or coordination – and for these children we may have to consider printing as the most effective way of writing.

Don’t judge a child’s handwriting by the product – watch the process of writing, it will tell you much more!

‘Left-handedness’

Left handed people make up approximately 10% - 15% of the population. They are generally

confronted by techniques and equipment designed by and for right-handed people. This can make life unnecessarily complicated for left-handed children.

There are a few key principles to keep in mind to help left-handed children:

• It is ok to be left-handed! Reassure the child – he/she may worry they are different
• Identify the left-handed children as early as possible. The best time is to do this as soon as they are being taught to hold a pencil
• Cursive writing was designed with right-handed people in mind. For left-handed children to succeed with writing, they need to learn correct paper position and pencil grip early on when learning to write, or they may develop a compensatory hooked grip which enables them to see what they are writing
• When demonstrating to a left-handed child use a left-handed style
• Left-handed materials are available and for some tasks they are vital for the child to achieve eg. left-handed scissors
• The direction of work may be different, eg. when cutting with scissors a left-handed child should be enabled to cut in a clockwise direction, where a right-handed child should be enabled to cut in an anticlockwise direction
• Be aware that some children will be using their left hand as a result of difficulty with their dominant side (eg. hemiplegia, and this needs appropriate and different consideration).
• Consider desk positioning within the classroom when accessing white board etc.

Activities and tools to promote good writing

Choice of writing implement can be important. Is the child using suitable writing implements that are matched to their stage of development? A chunky pencil for a younger child is usually a preferred choice. Remember the principle of big to small (thick pencils to thin pencils). Where possible, offer a choice of writing implements. Some children will prefer something which glides smoothly such as a gel pen; some children need the sensory feedback of a soft lead pencil.

Therefore, when promoting good handwriting, it may be worth considering:

• Shape, size and colour
• Comfort
• Effect on pencil control and writing
• Social acceptance (clearly a chunky, early years pencil may be less socially acceptable in an older age class)

Do:

• Try different types of pencils or pens
• Try pencil grips
• Use quality resources

Do:

Consider the writing surface as well. Blackboards give good sensory feedback; whiteboards provide very little sensory feedback. Different types of paper give different degrees of sensory feedback.

Many children will benefit from using an angled writing board/ surface, these can be bought or a simple homemade equivalent can be made.

Do:

Have a tool box of games which also promote good motor skills such as; cards games, construction toys, magnetic mazes, dressing dolls, lacing games.

Handwriting practice

Remember, quality movements, short and focused are key. Writing practice can seem boring, especially to those children who need most practice. Try to keep the work to small amounts and help the child to see progress. Give rewards – stickers, smiley stamp. The Lucky Letters Programme from Rainbow Road Resources supports this (see reference).

Never use handwriting as a punishment (this can devalue handwriting and demotivate pupils) – this sounds obvious but historically, this has not always been the case).

Remember:

• Make activities fun and enjoyable
• Catch their attention/interest
• Start with big movements i.e. painting onto large sheets or large pieces of paper, painting with water, mark making in sand or salt with sequins or cornflower. Be creative!
• When colouring, remember to start by colouring big areas before moving to smaller objects to colour. (If we move too small too soon, we may inhibit precision)
• Stabilise the paper using blue tac or masking tape if the child is not yet able to use the other hand effectively
• Use quality resources for writing
• Classroom organisation - ensure child is seated appropriately/ comfortably i.e. left/right-handed children. Ideally avoiding a clash of elbows
• Draw lines in straight or curved path – build it in to art sessions too
• Practise hand skills and pencil control in other ways such as colouring books, peg boards, threading activities, play dough, tracing paper. Some of these can be incorporated into the handwriting session eg. as part of a ‘warm up’.

Structuring the handwriting session

A handwriting session could consist of:

1. Preparation activity
2. Fine motor activity
3. Pencil/pen activity

Starting position

• Good sitting position, feet flat
• Bottom back on chair
• Back straight, head tall

Getting ready or preparation activities

If a child finds handwriting difficult, it is a good idea to do some preparation activities to help with body awareness and posture before starting the handwriting.

Example 1

1. Push ups on the desk
2. Push hands together
3. Sit straight; bottom back; reach arms into air above head
4. Stamp/press feet down
5. Massage/rub your writing hand with your helping hand

Example 2

1. Sit on hands – sit on one, wave the other
2. Hold edge of chair (two hands)
3. Shake hands with a neighbour
4. Push self up – lean right and lean left
5. Lift (shrug) two shoulders
6. Shake two hands in the air, then shake writing hand
7. Shake up, down, fast, slow, one hand still, one hand shake
8. Hands on table, talk about them
9. Name them, name the thumb, fingers eg. index finger etc
10. Touch them, rub fingers as you name them

Example 3

1. Make two flat hands (thumbs out palm down)
2. Spread fingers (thumbs touching)
3. Close fingers and thumbs
4. Turn them over (touch little fingers). Stand flat hands up (thumbs up)
5. Put one on the other and cross them
6. Lift flat hands and straighten arms
7. One higher, one lower, one up, one down
8. Make a V with two flat hands
9. Rest chin in it
10. Make an inverted V with hands, put on head
11. Clap hands to rhythms (with increasing complexity)
12. Clap hands then, clap hands on thighs or table or rhythms
13. Increase complexity

Fine motor activity

A fine motor activity may be used as part of the handwriting session. This may be particularly useful in developing coordination and hand and finger control.

Example

1. Using playdough
2. Roll a ball in both hands
3. Roll a sausage with both hands
4. Pinch the top of the playdough sausage and bend it to make a shape or even the back of a Loch Ness Monster!

Pencil activity

Depending on the child’s development and skill, this may be a handwriting task but may include tracing, dot to dot or copying shapes. If the pencil activity leads to a specific handwriting task, it is perhaps best that practising individual letters is applied to words the children will need to write rather than simply joining up a row of the same letter (children need to develop fluency in writing words not a row of letters).

Benefits of using an angled writing board

The 20-degree angle of a writing board is considered to be the optimum position for writing and also assists with improved reading.

An angled board provides positioning benefits for the eyes, neck, shoulders, trunk, arms and hands.

A non-slip writing surface on an angled board provides increased proprioceptive feedback, helping to reduce pen, pencil slippage.

Stable and effective shoulder, elbow, forearm and wrist control is required for drawing smooth, controlled lines. This can be promoted by the use of an angled writing surface.

An angled board promotes wrist stability as both the wrists and forearms are resting on the surface of the board. By putting weight through the wrists this helps to gain more control at the join. This in turn can improve pencil control.

Effective wrist extension can improve voluntary finger movements (essential for handwriting).

Resources and suppliers

1. Pre-writing Skills Skill Starters for Motor Development by Marsha Dunn Klein, M.Ed, O.T.R Therapy Skills Builders a division of the Psychological Corporation
2. Handwriting Without Tears by Jan Olsen
3. Write from the start: Unique Programme to Develop the Fine Motor and Perceptual Skills Necessary for Effective Handwriting
4. Loops and Other Groups by Mary Benbow M.S. OTR. Therapy Skills Builder
5. First Call: A Speech and Language Resource for Teachers by Lincolnshire County Council and Lincolnshire Community Health Service NHS Trust

Equipment suppliers:

• Homecraft
• LDA
• Nottingham Rehab

Dressing is a complex perceptual motor activity. It is best practised when in real situations eg. changing for P.E, swimming, dress up games etc. Clearly, this is a skill area that should be supported sensitively and in line with all health and safety and child protection guidelines.

Clearly, most children will increase their dressing skills if they have opportunity to practice using them regularly and with sufficient time and support to organise and dress in an effective way. Adults who do too much or too little can be inadvertently maintain a child at a lower level of independence.

Dressing skills can be supported through dressing specific activities but there are a number of component parts to help develop dressing skills. If any of these skills are absent or poorly integrated, a child may have difficulty trying to dress successfully.

Below are the components which give the child a base to develop their dressing skills. It is worth investing time to check these skills and use the programmes outlined below to develop these component skills. By practising component skills can facilitate better dressing skills when the are practiced.

Checklist

What to do next

When developing dressing skills, remember focus on:

• Regular practice
• Helping the child organise the sequence of dressing
• Helping the child organise the clothes
• Careful consideration of where to practice
• Giving sufficient time (it always takes longer than adults expect)
• Using it in real situations

Also:

• Allow for the child’s level of development
• Allow children to develop increasing precision
• Minimise frustration
• Use appropriately sized clothing
• Have sufficient space to get dressed (children need more space than adults sometimes realise)

Preparation

If the child has difficulty with organisation – give clear instructions. If the child has difficulty getting things in the right order,

try pictorial representations of the correct sequence as listening to instructions and doing, may be too difficult. Checklists and visual schedules are very helpful in supporting organisation and it may be helpful to teach a routine to help shape organisation.

Ensure they have all clothes together when going to change for P.E or back. Sitting down with back against wall prevents overbalancing or getting into other children’s body space.

If the difficulty is with getting things the right way round, mark back and front as necessary.

General ideas if a child is having a lot of difficulty

Suggestions:

• Avoid complicated garments
• Buy clothes on the large size
• Shirts, T-Shirts and jumpers with set in sleeves are more difficult than the raglan style
• Loose trousers with elasticated waists are easier to manage
• Use Velcro for fastening if necessary
• Tube socks with no definite heel require less manipulation to get a comfortable fit (but can be difficult to find/buy)
• Shoes that slip on or are closed with Velcro are easier to get on and off
• Elastic shoelaces are available; these are permanently tied but ‘give’ as the foot goes back into the shoe
• Try backward chaining (see below)
• Use visual organisers

Backward chaining teaching technique

Backward chaining is an approach which allows a child to achieve a goal. A task is split into steps (like the links in a chain) and the child is taught to do the last step of the task to achieve the goal. The child should always be experiencing success in finishing the task and developing the self-confidence required to learn.

Put simply, the adult starts the task and the child finishes the task off. Gradually, the adult does fewer steps and the child does more until the child can carry out the whole task.

Adult starts the task (steps 1,2,3) eg. putting a coat on and half zipping it up. Child finishes the task (step 4) eg. pulls the zip up to the top.

The technique can be adapted to teaching a wide range of activities. The task can be broken down into small or as large steps as required.

 Backward chaining approach applied to dressing/undressing

 Example: Goal: Removing a T-Shirt

Backward chaining – adult supports/helps student through entire process leaving the last part or parts for the student to achieve:

• Student just removes t-shirt from head
• Student removes t-shirt from neck
• Student removes t-shirt with one arm in and one arm out
• Student removes t-shirt with one arm in and one arm half out
• Student removes t-shirt when both arms are in sleeves and t-shirt has been pulled up at the shoulders
• Student removes t-shirt

Example: Goal: Put on socks

Backward chaining stages:

• Student pulls up sock from just above heel
• Student pulls up sock from just below heel
• Student pulls up sock after toes have been placed in
• Student pulls on sock after handed to them with the heel in the correct position
• Student puts on sock with heel in correct position

Example: Goal: Tying shoelaces

Backward chaining stages:

1. Start to do up the laces: explain what you are doing, i.e ‘Cross the laces over, put the lace which is at the back around and through the hole, pull tight, make a loop/rabbit’s ear, put the other lace around the loop/rabbit’s ear and under the bridge/down the burrow to make another loop/rabbit’s ear. This story form may be helpful to a child by linking the parts together in a logical sequence
2. Ask the child to help you: ‘pull the loops/ rabbit’s ears’. Praise the child for helping to do up his laces. This is the first step taught
3. Once the child has mastered this, they may then ‘pull the loops/rabbit’s ears themselves, then ‘push the lace through to make loop/ rabbit’s ear’ and so on. Eventually, the child will be able to do their laces from start to finish.

General notes

• Do each dressing task the same way each time so a predictable series of steps is repeated
• Describe what you are doing as you are doing it, for example@ ‘Now I am putting your left leg in’
• Remember undressing is learned before dressing
• Give sufficient time to react

Visual support strategies

Visual support strategies can be used in a variety of situations to promote independence and prompt a child to remember sequences correctly. This is particularly relevant to developing self-care skills such as dressing, use of the toilet, getting ready for school and independent working habits in the classroom.

Visual timetables

A timetable of events can be a helpful reminder and promote understanding of the relationship between events over time. Put simply, knowing when things are going to happen. Drawings, pictures, photos and labels can be used effectively to simply list the events of the day.

Visual schedules

Activities and tasks that have a sequence or can be broken down into steps can be supported through visual schedules (just like a set of furniture assembly instructions). Using pictures and drawings to indicate each step of the task can simplify complex activities such as remembering which order to put clothes on, bathroom routines (including washing hands and flushing the toilet!). Not too many steps should be included and many will help all children eg. a hand washing schedule above the sink would act as a reminder for all children.  

Bunny ears method of tying laces

Skill: Fasten shoe by tying laces

Adapted technique: ‘Bunny ears’ or ‘two-loop tie’ method

The method requires less refined lead-assist action and fewer different steps than the standard approach.

Materials: Shoe and long shoelaces

Position: A comfortable, balanced sitting posture (remember some children are helped by sitting back against the wall)

Resources

Pre-Dressing Sills by Marsha Dunn Klein Skill Starters for Motor Development by Marsha Dunn Klein, M.Ed, O.T.R Therapy Skill Builders a Division of the Psychological Corporation.

Procedure

This has been presented as forward chaining (this is the child starting from the beginning of the task). Backward chaining could also be used.

1. Pick up shoelaces
2. Cross laces, laying them across the front of shoe
3. Put upper lace under the crossed laces through the cross created with the shoe in a toe-to-tongue direction
4. Grasp a lace in each hand and pull tight
5. Make one loop
6. Make a second loop with the other shoelace
7. Cross loops across the front of shoe, maintaining grasp on the loops (same action as step 2)
8. Put upper loop under crossed laces through the triangle created with the shoe, in a toe- to-tongue direction (same action as step 3)
9. Grasp a loop in each hand and pull tight