Occupational Therapy

Gross Motor Functions

Gross motor functions are the skills where large muscles of the body are being used to do big movements of body in space. These skills include standing, walking, running, jumping etc. muscle tone, posture, muscular strength plays vital role in developing these skills in children. The children will typically learn head control, trunk stability, and then standing up and walking (Humphrey). Any hindrance in gross motor development sequence can cause a gap in growth cycle leading to dysfunction.

How can you detect your child has problems in Gross Motor Function:

If your child:

Has not achieved/or is late in achieving the age appropriate gross motor milestones(i.e. sit, crawl, walk, run and hop).

Move stiffly and lacks fluid body movement or alternatively looks awkward and appears clumsy.

Avoid physical activity.

Participate in physical activity for only short periods (have low endurance).

Cannot maintain an upright posture when sitting on a mat or at a table top.

Be unable to perform the same skills as their peers (e.g. catch, kick, hop and jump).

Appear less skillful than their peers in sports.

Be unable to follow multiple step instructions to complete a physical task (e.g. obstacle course).

Be unable to plan and correctly sequence events or steps in a process (e.g. step forward before throwing).

Fail to perform movements safely (e.g. climbing).

Need to put in more effort than their peers to complete a task.

Tire frequently with physical activity.

Lose previously mastered skill if they do not keep practicing them.

Be unable to ‘generalize’ or transfer a skill (use the same skill in a different setting/way) (e.g. can easily change between throwing a big/heavy ball to a light/small ball).

Occupational Therapy determine the block/delay in these skills and provide intervention to help child develop skills to achieve these milestones and catch up with the chronological growth sequence. OT also helps in early intervention to identify the dysfunction as it appears, to minimize the effect it will have on the development of the kid.

Fine motor skills

Fine motor skills are involved in smaller movements that occur in the wrists, hands, fingers, and the feet and toes. They participate in smaller actions such as picking up objects between the thumb and finger, writing carefully, and even blinking. These two motor skills work together to provide coordination. As grown-ups our need for doing fine motor skills increases with increasing life challenges. And we build our foundations for these skills in childhood. Children use their fine motor skills when writing, holding small items, buttoning clothing, turning pages, eating, cutting with scissors, and using computer keyboards. Mastery of fine motor skills requires precision and coordination. Fine motor skills develop after gross motor skills, when the child has developed skills such as catching, throwing, swinging of arm, indicating core muscles strength, which help the kid stabilize the arm and move the forearm, wrist, and fingers effectively in space.

How can you detect your child has problems in Gross Motor Function:

If your child:

Have messy, slow or laborious drawing, coloring or writing skills, not coloring within the lines, too light marks on the paper….

Have an immature pencil grasp for their age.

Have difficulty using scissors.

Have difficulty performing age appropriate self-care tasks independently.

Have difficulty mastering new fine motor tasks.

Not using both hands while doing an activity, such as; not stabilizing tower while adding another block, do not stabilize paper while writing etc.

Have difficulty performing precise manipulation tasks (i.e. doing up buttons, threading, or tying shoelaces).

Tire easily when engaged in fine motor tasks.

Dislike precise hand and eye coordination tasks (e.g. construction).

Tire quickly when typing or using a mouse on a computer.

Occupational therapy helps in recognizing the area causing deficit. Hand muscle strengthening, activities to improve and develop various grasps, giving a nurturing and learning environment for the kids to unlock his potential, teaching ADL tasks, provide various strategies to develop these skills in a healthy learning environment.


Pre writing skills are the ones which kids develop before they start writing. They develop naturally through course of development with play. These skills includes: in-hand manipulation, thumb opposition, pincer grasp, scissoring skills: making snips on the paper, cutting along a straight line, cutting various shapes, scribbling with proper grasp and grip on crayon/pen, coloring within lines... They also include: drawing “/,|,U,~,V”, imitating simple shapes, copying shapes, coloring of small objects, regards of the lines in cursive, using proper upper case and lower case etc. How can you detect your child has problems in pre writing skills:

If your child:

Doesn’t hold the pencil age appropriately

Scribbling is too light/spidery/dark

Cannot move an object within hand

Do not stabilize/hold paper while writing/cutting

Have difficulty using scissors.

Tires easily at writing task

Does well in retaining information verbally but not in writing

Avoids writing in class/home

Cannot make straight/steady lines with pencil

Cannot color small picture

Occupational therapy help your child to explore the age appropriate and correct ways, in a fun learning experience. Worksheets, activities, board plays , group activities, painting etc. can help your child bring out the best in them, as well as develop endurance, strength, attention and skills to carry out the writing tasks.

Visual perception: Visual perception allows a child process, identify and make sense of what he sees in the environment around him. These skills include:

Visual discrimination: the ability to discriminate form, color, position and shape.

Spatial relationships: the ability to recognize one object in various orientation (reversal/rotation). Visual memory: the ability to recognize an object after a brief interval.

Figure-ground: the ability to recognize an object in a cluttered background.

Visual closure: the ability to recognize the whole object even when fragments of it is visible. Making sense of what you see is vital for school skills such as reading, writing and math, as well as life skills such as reading signs and maps, finding objects in a busy space, and taking part in hobbies or crafts. Recognizing letters and numbers, matching shapes, recognizing a face, finding a toy in a messy cupboard, reading a road sign – these are all examples of how visual perception can be used in everyday life.

How can you detect your child has problems in pre writing skills:

If your child:

Difficult for the child to plan actions in relation to objects around him/her

Results in inconsistent symbol reversals and transposing numbers or letters

losing place on a page

difficulty finding what is being looked for

ability to sequence letters or numbers in words or math problems,

remember the alphabet in sequence,

copy from one place to another (e.g., from board, from book, from one side of the paper to the other),


problems in dressing (i.e., matching shoes or socks),

correcting errors in school work,

distinguishing similarities and differences in the formation of letters (i.e., letter reversal) or objects,

matching two dimension to three dimension such as alphabet letters.

would make reading difficult as the child might not recognize familiar letters when presented in different styles of print (fonts, size, or color);

result in being slower to master the alphabet and numbers;

lead to difficulty recognizing errors;

complete dot-to-dot worksheets or puzzles,

identify mistakes in written material,

perform mathematics (including geometry),

solve puzzles.

may have difficulty attending to a word on a printed page due to his/her inability to block out other words around it,

difficulty filtering out visual distractions such as colorful bulletin boards or movement in the room in order to attend to the task at hand,

difficulty sorting and organizing personal belongings (may appear disorganized or careless in work)

Occupational therapy can help by improving ability in persistence to visual tasks. For the tasks of reading and writing, visual discrimination is critical for seeing letters or words as different, recognizing letters or words in different contexts. For example, a child must know that the word “the” is the same whether they see it written in a text book, on a marker board, or in a magazine article. A child has to remember what they read and recognize a word from one page to the next. Difficulties with this skill can also make copying from a board or book so much more challenging. Visual closure is important for reading and comprehending what we see quickly. That whole left/right concept plays a big part in this skill as well.

In fine motor terms, visual spatial relations are important for appropriate letter orientation and avoiding reversals. After all, “b” and “d” are essentially the same shape, just pointing in different directions. Difficulties with these skill can leave kids lost as they look for specific information on a busy worksheet. Occupational therapist uses strategies to help child identify and cope up with the challenges environment provides.


TVPS-3 : test of visual perceptual skills-3


Sensory profile

PDMS-2: Peabody developmental motor scales-2

BOTMP-2: bruininks-oseretsky test for motor proficiency

GMFM-88: gross motor function measure -88

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