To address concerns of hand and upper body strength in children we have to zoom out a bit to look at the whole picture! Usually weakness that presents in the child’s fine motor skills has more global implications, and we can locate its origin more proximally. When treating children with fine motor concerns it is important to evaluate postural control, trunk strength and stability, upper extremity alignment, as well as shoulder strength, shoulder stability and specific fine motor abilities.
There are many great ways to evaluate the origin of a child’s presentation of hand weakness or difficulty with fine motor skills. Here are some ideas:
- Assess child’s posture and postural reactions.
- Assess child’s trunk strength and dynamic standing and sitting abilities.
- Assess upper body weight bearing, alignment of shoulders, elbows and hands, if they hyperextend at elbows to lock in, if they are able to weight shift over one side vs. other, etc.
- Assess child’s fine motor skills while seated vs. standing.
- Assess child’s fine motor skills while seated in optimal position with feet on floor, ankles/knees/hips at 90/90/90 angles.
- Assess child’s tactile perception of hands.
- Assess child’s bilateral coordination.
This post will highlight the components of my treatment plan for children who present with upper body weakness. All children should be evaluated and an individualized exercise and activity plan should be compiled based on their specific needs. If you have concerns speak directly to a Pediatric Physical Therapist or Occupational Therapist!
Trunk Strength and Stability
A strong trunk provides a stable base of support allowing the child’s upper body to activate efficiently with precision and control.
1. Therapy Ball Exercises
3. Seated Dyna-Disc Activities
4. Tall Kneel Activities
5. Incline Ramp Sit Up
A child’s upper body strength and fine motor skills are inherently linked to their posture and postural support (from chair, table, etc). Finding optimal positioning for a child will lead to improvements in hand strength and fine motor skills as they are able to interact with environment more freely.
1. Optimal Sitting Position at Desk or Table with feet on floor, ankles/knees/hips at 90 degree angles.
2. Vertical Surface
Working at vertical surface such as a chalkboard or white board allows children to use bigger arm movements that encourage strength and input throughout the joints and muscles of the upper extremities. Upright surfaces also promote bilateral coordination, midline crossing, visual attention, hand eye coordination, and activation of trunk musculature to promote improved posture!
3. Slant Board
The angled position of the slant board promotes improved posture, as it brings line of vision higher and encourages wrist flexion, which provides better support to hold writing instruments with more efficient and functional grasp.
4. Alternate Sitting Options
Sitting on Therapy Ball as opposed to a standard chair encourages weight shifting, allowing opportunities for trunk musculature activation, promoting better postural awareness. Experiment with Therapy Ball, Therapy Ball Balance Chair, Peanut Ball, Dyna-Disc on Chair or Wedge Cushion on Chair to find the best fit for each individual child.
Upper Body Weight Bearing
Bearing weight through the hands stimulates and strengthens shoulder girdle, upper extremity and the muscles of the hands to allow for improved fine motor skills.
1. Prone Play Activities
2. Prone over Dyna-Disc Wedge
3. Prone over Bolster
4. Plank Position
5. Yoga Poses which promote upper body weight bearing like Downward Dog!
6. Animal Walks (Crab Walk, Donkey Kick, Bear Crawl)
7. Crawling Through Tunnels
8. Wheelbarrow Walking
9. Prone Scooter Board Activities
10. Pushing/Pulling Activities
Fine Motor Strength
We can target fine motor skills with specific activities to improve hand and finger strength, functional grip, dexterity, in hand manipulation, and bilateral integration.
4. Tweezer/Tong Activities
5. Pull Tubes
6. Pop Beads
8. Lite Brite
9. Suction Ball
More Activity Ideas
I am extremely lucky to be a part of a wonderful network of Pediatric Clinicians and Therapy Bloggers. I have included links to their specific posts with more information about Upper Body Strengthening and Fine Motor skills.
Hand Strength: 35 Fun Activities for Kids from Inspired Treehouse
Upper Extremity Weight Bearing Tip from Pink Oatmeal
Ten Activities to Work on Hand Strength from Your Therapy Source
Favorite Activities to Work on Shoulder Girdle Strength from Therapy Fun Zone
Core Strengthening Exercises for Kids from Inspired Treehouse
Motor Skills and More: Working at a Vertical Surface from Inspired Treehouse
Fine Motor Strength Activities from Therapy Street for Kids
25 Fine Motor Activities Using Household Items from MamaOT
Learn more about Dinosaur Physical Therapy!