Peds Ch. 21- Functional Task at School: Handwriting

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Handwriting
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A functional task required of a child in his or her occupation as a student; the most important means by which a student expresses knowledge of the material being taught; used to summarize information taught in class, complete assignments, take tests, and interact with others for noneducational purposes; a tool teachers use to measure academic comprehension.
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Areas that affect the legibility of handwriting
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1. letter formation 2. horizontal alignment 3. size 4. spacing 5. slant
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Handwriting Program- A Reason for Handwriting (A Reason For)
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Siloam Springs, AR – Program uses a simplified version of Zaner Boser’s handwriting program and is based on Scripture verses and Christian content. It gives students a practical reason for using their very best handwriting can be highly motivated.
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Handwriting Program- Callirobics (Laufer)
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Chartlottesville, VA – This program consists of exercises that are repetitive simple writing patterns done to music. Callirobics can be beneficial to students who are auditory rather than visual learners.
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Handwriting Program- D’Nealian Handwriting (Thurber DN)
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Reading, MA – This program is developed to ease the transition from manuscript to cursive writing because most of the manuscript letters are the basic forms of the corresponding cursive letters. This program can be confusing to children who have directionality and orientation difficulties because they do not know in which direction to put the \”monkey tail.\”
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Handwriting Program- First Strokes Multisensory Print Program (The Handwriting Clinic)
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Plano, TX – This program was designed by an occupational therapist and provides a multisensory approach to teaching printing.
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Handwriting Program- Getty-Dubay Handwriting (Continuing Education Press)
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Portland State University – This program, developed by Barbara Getty and Inga Dubay, is an italicized handwriting program that promotes efficient, simple movements. Exercises to strengthen hand muscles and improve coordination are provided in the book Write Now: Comprehensive Guide to Better Handwriting.
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Handwriting Program- GUIDE-write Raided Line Paper
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Pompano Beach, FL – Provides products such as raised-line letters and raised-line paper that can be helpful when teaching a student to form letters.
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Handwriting Program- Handwriting Without Tears
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Cabin John, MD – Uses a developmental approach toward prewriting through cursive writing. The letters are grouped by difficulty in formation of the letters. In addition, the letters are formed with a simple vertical line rather than a slanted line. In this program, there are only two writing lines, a baseline and a center line, which are visually less confusing for children with visual figure-ground deficits. This program was created by an OT for her son and is very user friendly.
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Handwring Programs- Loops and Other Groups
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Randolph, NJ – Curriculum is a kinesthetic program that combines cursive connectors with manuscript letters for a more efficient writing style. The letters are taught in groups that share a common movement pattern. These motor and memory cues are used to help the student visualize and verbalize little experiences the \”feel\” of the letters. Mary Benhow is an OT and provides suggestions for handwriting remediation. Her program is very helpful to students in Grades 2 and higher, who have been taught cursive handwriting but have difficulty with letter formation.
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Handwriting Programs- Palmer Method (Palmer, A.N. The Palmer Method of Business Writing)
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New York – Has been traditionally used in schools for many years and has been the foundation for handwriting styles. The program begins with the letter \”a\” and goes through to \”Z.\” It uses a \”all and stick\” method, causing the child to lift the pencil as the letters are created. This program is really not used anymore, but teachers tend to teach the \”ball and stick\” method anyway.
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Handwriting Programs- Zaner Bloser Handwriting
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Columbus, OH – Is based on the Palmer method but has simplified the material. This program can be easily purchased by schools and has literature and easy-to-use materials to support the handwriting program.
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Prewriting strokes
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Foundation for making shapes and letter formation – 2 to 3 yrs: vertical and horizontal lines – 3 to 4 yrs: circles and intersecting lines – 4 to 6 yrs: diagonal lines and the ability to form shapes
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Compensatory Strategies
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adaptive techniques to improve function
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Classroom observation
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valuable means to assess handwriting; allows OT practitioner to view the functional task in the context in which it occurs; provides valuable information on the factors that may be interfering with function in the classroom.
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Developmental assessments
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examine the developmental level of a child’s handwriting ability
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visual perception
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the ability to organize and interpret what is seen
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Handwriting requires children to ______ ______ the organization of letters, the spacing between words, and the direction of the letters.
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visually perceive
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______ _______ is required to know where to start writing on the page, sequence the strokes of letters, and space words.
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visual perception
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Skills determined by visual perceptional assessments:
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1. Discrimination 2. Visual Memory 3. Form Constancy 4. Sequential Memory 5. Figure Ground 6. Visual Closure
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Visual perceptual skill- Descrimination
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The ability to detect a difference or distinction between one item or picture and another, for ex., the ability to identify which picture is not like the others.
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Visual perceptual skill- Visual Memory
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The ability to remember a shape or word and recall the information when necessary. With handwriting, children must remember how to form letters, numbers, and shapes. In later school years, this skill is used when remembering how to form the letters to spell words or form multi-digit members.
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Visual perceptual skill- Form Constancy
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The ability to realize and recognize that forms, letters, and numbers are the same or are constant whether they are moved, turned, or changed to a different size. This means that a square is always a square no matter what size or color. A daily example of this is when a person recalls the shape of the \”yield\” sign.
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Visual perceptual skill- Sequential Memory
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The ability to remember a sequence or chain of letters to form a word. With handwriting, children need motor as well as cognitive sequencing. Therefore, they need the ability to remember how letters make words and sequence them according to their motor abilities to make those words. For example, when taking a spelling test, the child need to be able to recall what the word \”dog\” looks like and remember that it is d-o-g and not g-d-o.
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Visual perceptual skill- Figure Ground
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The ability to identify the foreground from the background. When looking at pictures, people, or items, it is essential to separate important visual aspects from the background. When writing, children identify written words on lined paper. An example of this is the game of finding hidden objects in a drawing.
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Visual perceptual skill- Visual Closure
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The ability to identify a form or object from its incomplete appearnance. This enables a child to figure out objects, shapes, and forms by finishing the image mentally, for example, finding a jacket when it is partially covered by others. This ability id required when a letter may not be completely formed.
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The Test of Visual Motor Integration- Revised (1995): TVMI-R
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Combines both the developmental sequencing or geometric shapes and visual motor integration.
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The Motor-Free Visual Perception Test- Revised (2002): MFVPT-R and The Test of Visual Perceptual Skills-nonmotor: TVPS-R (2006)
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Measures nonmotor visual perception in children by testing visual perception without requiring a motor response.
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Developmental Assessment: The Peabody Developmental Motor Scale-2
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Evaluates copying and writing readiness skills and provides an age-equivalent score on grasp development
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Developmental Assessment: The Hawaii Early Learning Profile- HELP
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Can be used to examine pre-handwriting skills in children O-3 years of age. This developmental checklist is helpful in tracking the development of hand skills.
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Developmental Assessment: The Bayley Scale of Infant Development
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Assesses the motor development of children from 1 to 42 months of age
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Developmental Assessment: The Bruininks-Oseretsky Test of Motor Proficiency-2
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Measures the gross and fine motor proficiencies of children 4.5 to 14.5 year old, testing such areas as response speed, upper limb speed, and visual motor control.
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Developmental Assessment: The Erhardt Developmental Prehension Assessment
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Measures the components of arm and hand development in children.
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Examples of Personal Context
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Is client easily distracted? What is her temperament and attitude? Is she nervous during assignments?
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Examples of Temporal Context
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What time of day is best for the client? How is the client managing her time?
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Examples of Cultural Context
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How organized is the teacher? Are Accommodations a natural part of the classroom? Is the classroom too busy for a child who requires a quiet environment? Is the child able to interact easily with her peers?
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Handwriting Assessments: The Children’s Handwriting Evaluation Scales- CHES-S & CHES
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Measures the speed and quality of the child’s handwriting skills
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Handwriting Assessment: The Evaluation Tool of Children’s Handwriting – ETCH
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Evaluates legibility and speed in six areas of handwriting: 1. Alphabet production of lower and uppercase letters from memory 2. Numeral writing of 1 to 12 from memory 3. Near-point copying 4. Far-Point copying 5. Speed 6. Sentence composition in both manuscript and cursive formation * The ETCH provides legibility scores for the child’s age level
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Handwriting Assessment: The Print Tool
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A non-standardized assessment from Jan Olsen’s Handwriting Without Tears Curriculum. \”The Print Tool focuses on the eight key components of handwriting: memory, orientation, placement, size, start, sequence, control, and spacing.\” In addition to being an assessment, The Print Tool also \”helps pinpoint the cause of difficulty and provides guidance for a remediation plan specific to the child’s needs.\”
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______ and ______ distractions in the classroom may interfere with visual attention to handwriting tasks.
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Visual and Auditory
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Asking teachers and families what ______ have been used in the past and using or _______ those ______ to the classroom is effective.
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Strategies, matching, strategies
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___________ occurs through the learning, experiencing, and acquisition of the skills.
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Development
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_______, ______, and _______ systems must work together for success in pre-writing
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Motor, cognitive, and sensory
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Children with handwriting difficulties show:
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– less mature grasp – immature pencil grip – inconsistent hand preference
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Most mature grasps include:
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– dynamic tripod -lateral tripod
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Tripod grasp
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Three fingers are used for holding the writing utensil. The thumb is bent, the index finger points to the top of the writing utensil, and the writing utensil rests on the side of the middle finger. The last two fingers are curled in the palm and stabilize the hand.
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Quadropod grip
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Four finger grip. The thumb is bent, the index and middle finger point to the top of the writing utensil, and the writing utensil rests on the ring finger.
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_________ or ________ can be fatiguing and painful but offer more stability and power.
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a. Cross-thumb, or thumb wrap b. static tripod grasps
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___________ grasps limit the variety of movements and make smooth, flowing motion difficult.
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Tight * Writers using tight grasp often press hard on the paper, which results in the formation of dark, sometimes smeared letters.
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Appropriate pencil for preschoolers
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short crayons and small pencils for writing/coloring.
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Table 21-1: Prewriting Skill Development Stirring Spoon
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12 months
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Table 21-1: Scribbling- 1 scribble 1 inch long
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12 months
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Table 21-1: Imitating vertical line 2 inches long
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23-24 months
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Table 21-1: Imitating horizontal line 2 inches
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27-28 months
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Table 21-1: Copying circle- end points within half inch and each other
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33-34 months
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Table 21-1: Copying cross-intersecting lines within 20 degrees of perpendicular
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30-40 months
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Table 21-1: Tracing line- deviates <2 times
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41-42 months
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In-Hand Manipulation
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refers to the precise and skilled finger movements make during fine motor tasks; correlated with handwriting legibility.
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In order to perform _________, the child needs to be able to adjust objects within the hand while maintaining the grasp on the object.
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in-hand manipulation tasks
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Example of in-hand manipulation tasks
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1. working coins from the palm of the hand to a pincer grasp to deposit the coins into a piggy bank. 2. During writing, a child rotates the pencil to use the eraser 3. Manipulating the pencil to write dynamically with a tripod grasp while the ring and little fingers remain still to stabilize the hand.
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In-hand manipulation requires ______, ______, and _____.
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strength, timing, and coordination
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In-hand Manipulation: Shifting
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working items from the palm of the hand to the tips of the fingers without dropping items
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In-hand Manipulation: Translation
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using only the fingers, the student \”walks\” his or her hand from the lead end of the pencil to the eraser end without the aid of items for stabilization
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In-hand Manipulation: Rotation
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turning the pencil from the lead end to the eraser end without putting the pencil down on the table or using the chest to stabilize the pencil while turning it
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Children with _______ _______ tend to use their third finger and thumb to pick up small objects because their thumb does not curve, or oppose, enough to reach the index finger.
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Downs Syndrome
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Motor skills necessary for writing
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-Upper extremity range of motion -Trunk, upper body and upper extremity stability -limb integrity -muscle strength and endurance
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The inability to perform mid-line crossing may indicate:
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an immature nervous system
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mid-line crossing
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the ability to continue a motor act without switching hands at the point in front of a person’s middle.
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eye-hand coordination
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refers to the control of eye movement coordinated with the control of hand movement, the processing of visual input to guide reaching and grasping, and the use of proprioception of the hands to guide the eyes
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motor planning
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figuring out how to move their bodies and then actually doing it
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motor memory
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remembering the motor pattern and being able to repeat them
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proprioception
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awareness of muscle and joint postions
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Grasp Pattern
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Palmer>>>static tripod>>>dynamic tripod

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