Upper Limb and Fine Motor Difficulties

Cat 1 · 30 days

appointment within 30 calendar days. - No category 1 criteria

Cat 2 · 90 days

appointment within 90 calendar days. - Asymmetry: Subtle, moderate and significant differences between use of, or tone, or strength between right and left sides of body, specifically upper limbs. - Decreased movement: Young infant who moves upper limbs less than expected (this is a gestalt observation usually noted by a Child Health Nurse) or doesn’t move fingers and thumb or limited range of movement not explained by a known orthopaedic or neurological abnormality. - Increased tone in upper limbs impacting on reach, grasp and movements required for play expected for age. - Pain associated with fine motor skills (e.g. related to hypermobility that isn’t due to acute neurological or medical deterioration). - Children less than 18 months of age that meet criteria for this referral reason. - Movement quality issues in the upper limb at any age (i.e. tremor, jerkiness, awkward looking grasps/holds, slow, shaky movements, stiffness, exaggerated opening or closing of hands). - Infants with significant difficulties reaching, grasping, and other upper limb movements required for play expected for their age. - Examples include: - 5-month-old who can’t maintain hold, or doesn’t attempt to reach for or grasp a toy presented - 6-month-old who has fisted hands, or is not reaching or grasping toys, or doesn’t reach for objects in midline, or can’t hold one object with two hands - 7-month-old who doesn’t use forearm or upper arm movement, or doesn’t reach to side for objects - 9-month-old who cannot transfer toys, or who cannot release a toy such as into carer’s hand - 18-month-old who has no container play (i.e. controlled release) - Severe fine motor skill delays impacting on participating in play or ADLs (e.g. feeding - using cutlery, and dressing – using fasteners). - Examples include: - 12-month-old who cannot finger feed or hold their own bottle/cup - 18-month-old who does not assist with dressing by moving limbs - 2-year-old who cannot spoon-feed independently - 4-year-old who cannot undress independently (where there has been opportunity provided to do so)

Cat 3 · 365 days

appointment within 365 calendar days. Recommended to be seen within 90 - 180 calendar days - Severe delay in fine motor skills, impacting on participation in pre-academic tasks (e.g. use of pencil and scissors). Examples include: - 2-year-old who does not scribble (where there has been previous opportunity provided to develop this skill) - Pre-prep child who cannot cut along a line, hold scissors in a functional way, holds a pencil in an “awkward” grasp, controls the pencil with their wrist or whole arm, gets tired with drawing/colouring, holds a pencil in a fist grip, or can’t imitate vertical and horizontal lines, circle, cross (+) - Moderate developmental delay in fine motor skills, impacting on participation in pre-academic tasks, play or ADLs - 2 to 3-year-old who has difficulty manipulating small objects such as blocks - 4-year-old who does not draw recognisable pictures, colour within the lines (where there has been previous opportunity provided to develop this skill) or imitate a square - 3-year-old who can’t unscrew a lid from a jar (where there has been previous opportunity provided to develop this skill)