"As a physical therapist, I initially questioned my qualifications to review Fine Motor Skills for Children with Down Syndrome, by Maryanne Bruni, BScOT. I was also skeptical about its relevance to physical therapists. I was pleasantly surprised not only by the amount of information I learned, but also by the number of suggestions and activities that could be incorporated into pediatric physical therapy practice.
Without question, fine-motor development, activities of daily living and sensory processing fall primarily under the domain of an occupational therapist. These are major themes of the book as they apply to children with Down syndrome. However, fine-motor skill development is described in terms of 'building blocks,' the foundation of which includes stability, bilateral coordination and sensation; areas that are also important for gross-motor skill development.
Progression of early development with suggested activities and positioning is appropriate for both PTs and OTs as well as home programs. For all levels of development, functional activities along with activities to help the child progress to the next stage are described with strategies that can be used at both home and school. There is even a list of suggested toys or gift for children at various stages of development.
Medical and physical characteristics of children with Down syndrome are described along with the ways these characteristics can impact motor development. It is recognized that many skills, both within and between domains, develop simultaneously and that children with Down syndrome progress at varying rates. While there are no concrete age-appropriate norms for development in Down syndrome, development ranges for achievement of specific skills are provided.
Description of the progression of abilities can help the reader determine if a child is developmentally ready for a particular activity. Knowing a child's current fine-motor abilities and understanding the progression of fine-motor development can help a physical therapist choose appropriate and motivating functional activities to incorporate into a gross-motor tasks. This can make the therapy session more fun and purposeful for the child while providing additional practice with his currently developing fine-motor skills.
Of particular interest to me was Chapter 11, which included a concise explanation of sensory processing difficulties (SPDs), medical conditions or sensory impairments that could have similarly associated behaviors to those seen in children with SPDs, and basic strategies to help children with SPDs pediatric physical therapists commonly treat children (with and without Down syndrome) with SPDs and most have very limited education in this area. Even the basic information contained in this chapter can make a physical therapy session more effective for those children.
As an occupational therapist and parent of a child with Down syndrome, Bruni offers a realistic and comprehensive approach to this subject matter. She is able to give helpful suggestions for motivation, adaptation of an activity or the environment and recognition of the most important functional skills needed to foster a child's independence. This text is primarily written for parents, but is an excellent resource for anyone who works with or cares for a child with Down syndrome."
-ADVANCE for Physical Therapists & PT Assistants, December 31, 2007
"Fine Motor Skills for Children with Down Syndrome, part of the celebrated Topics in Down Syndrome product line from Woodbine House, is the ultimate fine-motor sourcebook for parents, caregivers, and therapists. In clear language, Ms. Bruni covers every aspect of a child's fine-motor development, from birth through adulthood. She explains the building blocks that are necessary for developing these skills and, especially helpful for new parents, demystifies the language and techniques that occupational therapist use. The book offers activites that can be done to help children strengthen their bodies and reach various milestones, along with ideas for adapting the child's environment and positioning so that they can be more successful. While Ms. Bruni acknowledges that parents cannot always be in 'therapy mode,' she suggests incorporating these activities into children's daily routines including their play time. She gives suggestions for developmentally, appropriate toys in her 'Grandma's and Grandpa's list' for each developmental stage. Additionally, there are extensive chapters on building self-help skills and on sensory processing (and the behaviors associated with them), as well as visual motor worksheets, a glossary, and resources.
Ms. Bruni's wealth of knowledge has been supplemented by her experiences raising her daughter Sarah, who also has Down Syndrome."
-NDSS Update, Spring 2006, Volume XXII, No. 1
"This is one book in a series, Topics in Down Syndrome, published by Woodbine House. The second edition, similar to the first edition, is well organized and easy to read. It was written to serve as a practical resource for both professionals and parents. Professionals can use the information to explain to parents what a child with Down syndrome can do at different stages of development, and to provide parents with activities to do at home that will help the child master emerging motor skills. Parents will be able to use the book to understand how the development of fine motor skills is affected by the characteristics of Down syndrome, how to identify when their child is ready to learn a new activity, how to choose toys and activities that develop the basic components needed to accomplish a motor skill, and the approximate age they can expect their child to master various skills.
The author clearly explains why a child needs to develop stability, bilateral coordination, and sensation before they can master finger and hand skills. Detailed guidelines tell parents how to facilitate the development of these basic building blocks by incorporating the exercises into day-to-day activities.
It is generally accepted that children with Down syndrome take longer to learn. The second edition contains new information on how children with Down syndrome learn and a chapter on sensory processing, in chapter 2, Building on What is There: Step by Step, the author proposes that in order for the child to learn, 4 questions must be considered:
(1) Is the child 'ready'? ('Ready' means adequate neurological, cognitive, and motor control development).
(2) Can the child pay attention to the task long enough to learn the task?
(3) What combination of sensory cues should be used to promote learning?
(4) How much repetition does the child need to learn a new activity?
Chapter 11 explains how difficulties with sensory processing can negatively affect learning and behavior in children with Down syndrome. This chapter also provides strategies that can help a child manage various sensory problems in order to facilitate learning.
One notable feature is that this book contains many clear and appropriately placed pictures that enhance the text. It also has a glossary of terms and 2 appendixes. There are visual motor worksheets in appendix 1 and a list household items that can be used for hand activities in appendix 2. References in the bibliography have expanded from 36 in the first edition to 72 in the second edition. The list of resource companies and support organizations also has been expanded.
Fine Motor Skills for Children With Down Syndrome is an excellent resource for both parents and professionals unfamiliar with Down syndrome. It is a good companion to the book Gross Motor Skills in Children With Down Syndrome, which also is in Woodbine House's Topics in Down Syndrome series."
-Physical Therapy, Volume 87, Number 1
"The challenges faced by caregivers of children with Down syndrome are numerous and diverse, but Bruni guides parents and professionals with expertise and compassion. A winning guide, helpfully revised and updated."
-Kirkus Reports, May 2, 2006, Vol 3/Issue 4
"This book is highly recommended for pediatric consumer health collections as well as for collections in hospitals that provide specialized clinical services for patients who have Down syndrome."
-CAPHIS Consumer Connections, October 2006
"Fine Motor Skills for Children with Down Syndrome is part of the Topics in Down Syndrome series from Woodbine House and is indeed a classic that deserves a place on the bookshelves of all parents of a child with Down syndrome. As well as information on fine motor skills, perhaps more important is the added insight that comes when a therapist is also a parent."
-New Zealand Down Syndrome News magazine, Volume 29, Winter 2006
"Maryanne Bruni is an occupational therapist who is also the parent of a child with Down syndrome. The tone of her book is one of theory, understanding and compassion as only who experiences a child with Down syndrome on a daily basis could express. It is well organized and easy to read.
She explains fine motor development in terms of building blocks emphasizing the foundation blocks required to achieve control and dexterity. This analogy works well in explaining the developmental process. She describes motor milestones emphasizing the progression of development and the importance of accepting and understanding that each child programs individually. She describes what can facilitate development and recommends many activities that are broken down into steps emphasizing activities of daily living and play.
The section on goal setting for the child's Educational Program Plan (EPP) gives examples of clear, measurable, achievable goals. The Developmental Chart for Preprinting Skills is excellent in explaining the progression to printing readiness. The chapter on Sensory Processing is interesting and analogy is skillfully used to explain modulation. Several charts cover examples of sensory processing difficulties and strategies. However I feel that the role of the occupational therapist in identifying areas of dysfunction in sensory processing and developing a program is underplayed.
This resource is valuable for parents, teachers and therapists. It will help every team member develop a better understanding of fine motor skill development and therefore facilitate collaboration when working with a child with Down syndrome. It offers therapists insight into the experiences of parents and ways to help parents understand the process."
-Canadian Journal of Occupational Therapy, December 2007
