Motor skills are the movements we use to produce actions (sitting, walking, eating, dressing, writing, dancing, swimming, etc.). Gross motor skills are larger movements usually involving the whole body (climbing stairs, running, etc.). Fine motor skills involve manipulations of the hands and fingers (picking up items, writing, tying laces, etc. Motor skills are controlled by the central nervous system and the brain and improve with practice.
Children with Down syndrome develop their motor skills in the same sequence as their typically developing peers, but with some degree of delay. Balance can be an area of relative difficulty compared to other types of motor skills. Children with Down syndrome tend to need more practice and repetition of motor skills than their typically developing peers, to achieve mastery and embed the pattern of movement in the brain, but with appropriate practice and encouragement, most can make good progress. Hypotonia and lax ligaments can be physical features of Down syndrome, but there is no conclusive evidence to suggest that this impairs motor skill development, which is controlled largely by the central nervous system. Encouraging daily activity and play will help motor development, and use of visual supports and prompts wherever possible (diagrams, modelling, etc.) is recommended. Sports and other activities that promote strength and balance (yoga, gymnastics) are also beneficial. In school, the following suggestions may be helpful:
- In the classroom, good seating is important to support the child during fine motor activities: the chair and desk should be the correct size for the child. If feet are not touching the floor, a box or some form of foot rest will help stabilise the child.
- Writing on a slanted surface can help the child during longer written activities, and improve the quality of handwriting.
- As the child with Down syndrome may find writing and other fine motor tasks more tiring and difficult than their same age peers, it may help to give them a smaller amount of work to complete, or else allow short movement breaks during longer activities. If the class are copying from the board, choose and mark a section of the text for the child with Down syndrome to copy.
- Check vision regularly to ensure eyesight difficulties are not impeding fine motor work
- Hand exercises: a ‘hand gym’ is a box of activities for improving hand control and fine motor skills. An occupational therapist or physiotherapist can suggest items to include in it, such as clips and pegs, etc. It can be used as a fun activity to develop fine motor skills.
- Pencil grips, larger pencils, a sloped writing surface or other assistive equipment may help – consult an occupational therapist for details.
- Strengthening tasks include: playing with márla, tearing paper, using finger puppets, opening and closing jars, lego, pegs and beads, squeezing pegs and clips, ‘hanging clothes up’ or clipping pegs onto a piece of cloth, wringing out cloths, etc.
- Tasks to develop hand-eye coordination include: painting, jigsaws, touch screen computer activities, building bricks, using chalkboard, threading beads, tracing patterns, dot to dots, mazes, magna-doodle boards, and peg boards.
- Provide plenty of support and practice in the use of scissors
- Handwriting should progress through a graded series of steps: tracing →copying →writing, starting with patterns, followed by individual letters, and then whole words and full sentences.
- Handwriting Without Tears is a programme designed by occupational therapists for teaching handwriting. It has been used successfully in Ireland with children with Down syndrome.
- Provide opportunity for lots of practice, use praise, and encourage as much independence in dressing, eating, etc. as possible.
- During summer holidays, ensure the child has daily opportunities to maintain and develop their fine and gross motor skills through play activities or games.
- Try to balance the need to develop motor skills with the need for independence and school inclusion. For example, wearing Velcro shoes to school may mean the child can remove/close their own shoes quickly, but at home, when there is less time pressure, lace up shoes could be worn to develop lace-tying skills. When the child can competently tie their lace, they can then wear laced shoes to school.
- If a child has difficulty learning handwriting, balance opportunities to practice and develop handwriting with the need to access the curriculum (the child can work on handwriting at certain times, but if completing a written task where writing is not the main focus, consider a support such as a scribe, computer, or plastic letters, so the child can still produce and share their written message. Also, if assessing understanding of a topic, multiple choice or cloze worksheets can be used as a more accessible alternative to lengthy written comprehension pieces.
- Provide foods at lunch time that the pupil can manage themselves. Avoid items that require careful eating and are easily spilled. For example, instead of yoghurt in tubes or with fruit sauce on the side, give a regular potted yoghurt. With oranges or bananas – put a score or slice in the peel with a knife so child can grip and peel it easier.
(Adapted from Down Syndrome Education International, Down’s Syndrome UK)