Occupational therapists are trained to identify difficulties associated with the hands.  Fine motor skills include coordination of hands, dexterity of the fingers, muscle grading (using the right amount of force through objects), object manipulation, finger isolation, hand/finger strength and using both hands simultaneously. Although fine motor skills are typically associated with the use of the hands, development in other parts of the body affect the ability of the hands to work with good coordination and accuracy. Shoulder strength and stability, trunk control and stability, and the ability of the child to use his/her eyes efficiently can also affect fine motor skills.

Problems often associated with fine motor difficulties may include handwriting difficulties; hand fatigue with hand use; difficulty holding objects or placing them accurately; difficulty manipulating buttons, knobs and zippers; difficulty coordinating eye-hand movements; difficulty copying words or sentences in an efficient amount of time; difficulty opening packages and containers; difficulty with keyboarding skills; and difficulty picking up objects with hands.

Therapists use a variety of treatment strategies to address the underlying problems associated with fine motor delays. Working on larger groups of muscles such as those in the abdomen, shoulders, back and neck helps to develop refined skills with the hands. Activities may include weight bearing activities through the hands and shoulders, resistant exercises to help strengthen muscles in the hands and shoulders, abdominal and back strengthening for better posture in sitting needed for handwriting and keyboarding, repetitive activities that help rehearse specific skills and timed motor tasks to work on time efficiency for dexterity.

Different tools may be used depending on the child's need.  Most fine motor tools are associated with helping the child to enhance handwriting skills. Tools may include pencil grips, weighted writing utensils and vibratory pens. Alternate seating may also be added to help the child stay upright and balanced for better posture and attention. Different types of seating during handwriting or tabletop activities may include using a T stool or an air cushion, therapy ball or pillow in the child's seat.