How to Measure Progress with Your Child’s Manipulation Skills

What is in-hand manipulation, anyway?

In-hand manipulation is the ability to manipulate objects in the fingers and hand or adjust an object within the hand after grasping it.

There are three types of in-hand manipulation:

1) Translation – the ability to move an object from the fingers to the palm or from the palm to the fingers.  An example of this would be picking up a penny and moving it into the palm of the hand, and then manipulating it back to the thumb and fingers to put it in a bank. This skill starts to develop between the ages of 1.5 to 2.5 years old.

2) Rotation – the ability to rotate or turn an object in the pad of the fingers. Simple rotation could be turning a bead so you can put something through the hole. More complex rotation might be making “meatballs” with playdough within one hand using the thumb and fingers.  (This is one is always a challenge for my kids!)

3) Shift – the thumb and fingers manipulate an object in a linear movement after it’s been grasped.  Think of picking up a pencil near the eraser and then “shifting” or “walking” the fingers up toward the point.  (developing between 4 to 5 years)

What to Look For:

When you’re looking at a child’s in-hand manipulation skills, it’s important to note their speed and accuracy. I find that a lot of my kids drop things or “stumble” through in-hand manipulation tasks. Their speed and accuracy improve with natural development but lots of fine motor and manipulation activities are always helpful in pushing these skills along!

Kids who still haven’t developed in-hand manipulation often use compensatory strategies to accomplish the task in front of them. For instance, if they are trying to manipulate a peg into a pegboard, but it’s upside down, they may touch it to their chest to turn it. This is because they don’t have the higher-level manipulation skills to turn it within their hand.

Other compensatory strategies to look for:

  • -dropping the pegs or coins to pick them up in a different way
  • using their other hand to turn the object
  • picking up one object at a time

How do you know if they are making progress?

I like to use progress monitoring sheets to keep track of my kids’ manipulation skills.  These allow me to easily check off what activity I used, what goal I targeted, AND how my student did! 

Progress monitoring and keeping data are an important way to measure how and if your students are making progress. 

This printable Manipulation Activity Packet includes a simple tracking sheet that allows you to keep data while staying focused on your child and the exciting fine motor challenge at hand. 

fine motor, manipulation skills, progress monitoring, data tracking,
The Manipulation Dot Activity Packet is perfect for home or the classroom. Get 25 pages of fine motor activities and countless ways to address your goals. Use the progress monitoring sheet to track your child’s improvements.

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An “Old O.T.’s” Advice for other “School O.T.s”

Forward from Miss Jaime, O.T.:  When I first graduated from OT school, I got a job working as a contract therapist in a public school.  I had no supervisor, no mentor, and no one to ask questions.

Thank goodness, I ended up placed in a school with such a large caseload that there was also another (more experienced) OT.   She took me under her wing and offered me informal mentorship and much invaluable advice as a colleague and friend.

I left that agency very soon to get a district job, but I am forever grateful to my first mentor, Diane Fine, Occupational Therapy Extraordinaire.  Twenty years later, Diane still works for that agency in that building and has generously offered to share her experiences and advice to new school OTs in the field.

I am an old OT.  I don’t know when that happened.  I mean, I don’t feel like an old OT and I don’t look the way I think old OTs are supposed to look.  Certainly not like the old OT that was supervisor on my first clinical affiliation. Now that was an old OT (although she was most likely younger than I am today).  She was cranky and mean and told me I would never contribute much to our profession. She knew “my kind,” she said.

Young, pretty, newly married to a doctor. “You won’t work much,” she said.

 Well, here I am today. No longer young and pretty and certainly no longer married to that doctor.

But I have been a working O.T. for 39 years and counting.

So being an “old OT”, I have the ability to reflect on my past experiences as well as my present practice with a certain degree of wisdom that can only come from years and years of work in this field.  

For the past 22 years, I have been a contracting occupational therapist in a public school district on Long Island.  I came to this purely by accident. I had been working in adult rehab in an outpatient clinic. The hours were long and the vacations few.  I had three children. My youngest was three. I wanted the opportunity to choose my days and hours and have off when my kids’ schools were closed.  So I answered an ad in the newspaper (see how old I am? No internet search) and thus began my life as a contract therapist.

I came from a medical model.  As far as I was concerned, I was bringing this frame of reference into the schools.  I had no idea how my “treatments” were going to enhance the student’s academic success. Over the years, with the help of some wonderful teachers I’ve had the pleasure of working with, I began to learn how to combine my knowledge of neurodevelopment with the goals of the education model.   Classroom teachers and I would talk briefly between sessions or in the hallways. They would tell me about their student’s difficulties, such as their behaviors in class. I would share with them possible explanations and solutions. This became a collaborative effort that benefitted the classroom teachers and more importantly, their students.  

Being a contractor for over two decades was not my initial intention. The years sort of snuck up on me.  I enjoyed the independence. I determined my treatment plans and techniques. No one was looking over my shoulder in that area.  I’ve had the pleasure of working with some very talented OTs and PTs over the years. I like to think they were able to learn from my expertise as I know I have from theirs.  Many times there was just me. No department, no union, no peers. I have spent 22 years in one district – mostly in one school. Now that I am nearing retirement, I have no pension.  I am still getting almost the exact same fee for service I got in 1997. I knew about this all along and still decided to stay, but I would not advise this as a model to follow. I often tell my younger peers not to stay with the agency for too long.  “Get out while you can”, I half joke.

So what happens as a result?  A lot of unpaid time I spend tending to these student’s needs. I’m in a difficult position. I want to collaborate with the teachers and ultimately help these kids learn. But my time as an experienced professional is worth something.  

 As an aside, this year the principal decided to place every teacher and teacher assistant’s photo outside their classroom.  The other OT, PT and I were never photographed.

The theme book for the school year is “The Dot”. A lovely story about the creativity in all of us and how we can make a mark on this world.  A colored dot was hung up with the names of every student, teacher, aide, and custodian. In short, every human being in the building – except the OTs and PT. When I questioned this, the response was “Oh, you’re not on the list.”  

Exactly! We are not on “the list”, or the email chain or in the secret santa group or the super bowl pool. Even though I have been at that school longer than almost every other staff member.

Now if I can be this detached after 22 years in one school,  imagine how a contracting therapist traveling to multiple schools in multiple districts feels.  

(“Actually, I’m not even in the staff photo” reports Diane Fine, Long Island contract therapist in the same building for 22 years)

More important than feelings, however, is the difficulty this poses for those therapists that need to collaborate with the educational team. 

Public schools today are filled with students who have varying degrees of learning and physical disabilities. OTs are the unique professionals who have the educational background to help teachers understand and approach these challenges in a way that can help kids do their job – get educated.  It has taken me over 20 years of sharing my knowledge and clinical expertise with the educators in my school. I know I am respected and trusted by the teachers I work with.

However, I know that as a contractor who is not employed by the district, I am considered an outsider in many ways.  I have to ask to be invited to team meetings concerning student’s IEPs.  I’m expected to put forth work without being compensated  – It’s part of the territory when navigating this position.  

I’m not ready to quit yet. This old OT may have a few more years in her. But it’s up to you younger therapists to continue to educate the educators and administrators so that they understand the vital role we play in the successes of our students.

Miss Jaime, O.T.:  I am so honored that Diane, my first mentor, shared her wisdom and experience with my readers.  I have been advocating for equal rights for Occupational Therapists within New York state.  Because what’s been going on for so long JUST ISN’T right.  If you’d like to learn more about advocating for OTs, click here! 


About the Author:

Diane Fine is an occupational therapist with 38 years experience as a clinician.  She is a graduate of New York University.  Diane began her professional career in inpatient adult rehabilitation with rotations on stroke, spinal cord, and cardiac units.  She then worked in a private physiatrist practice specializing in hand injuries.  Following this, Mrs. Fine worked in an outpatient adult rehabilitation center where she was the student clinical coordinator.  For the past two decades, she has been working in the public school setting as a contracting therapist in Long Island, NY.

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Miss Jaime, O.T.’s Favorite Sensory Gifts 2018!

Sensory kids can be tricky. 

Different kids can like or dislike different sensations.  I like to recommend weighted things because I find that they can be calming and grounding for children who are sensory seeking, anxious, impulsive, or hyperactive. They can also be used as “heavy work” for kids who need to “wake up” or get moving.

Picking out a gift can be so frustrating.

This year I thought I’d make a quick list of my top favorite NEW sensory toys – ones that are unique and probably not already in your child’s toy box.

Affiliate links have been included for your convenience.

A Weighted Teddy Bear

This weighted teddy bear is too adorable.  It looks like a typical toy but provides a weighted sensation which can be comforting.  Check it out!



A Weighted Cap

This weighted cap is so cool! I love that it looks just like a regular hat, but it is weighted to provide extra input to the head.  Such a brilliant idea! Learn more here.


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The All In One Magic Magnetized Shoe-Tying Miracle

“How am I supposed to teach him to tie his shoes?”
The Occupational Therapy student’s cheeks were pink.  A concerned look creased her face.

Self-doubt was creeping in. I understood.

Sometimes you get a child on your caseload that seems to have a lot of obstacles to face, just to live a normal independent life.

This little boy was no exception.  Charlie was born with amniotic banding, a rare condition caused by fibrous strands of the amniotic sac entangling the limbs or other parts of the body, which can cause deformities in utero.  In Charlie’s case, he was born without his left hand.

How do you teach bilateral skills like cutting, buttoning, and tying to a child with only one hand?  

You adapt.   And you teach them to adapt.  There’s always a way.

    • Every child deserves to live a full and happy life.
    • They deserve to be independent.
    • And they deserve to accomplish typical milestones, such as tying their shoes for the first time.

I love to use adaptive tools to make these mountainous challenges just a bit easier for my little guys.    So I was super excited to tell my OT student about Zubits.

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“Cookie Cutter Therapy”- Why it’s OK with me….

The other day I did an autumn arts and crafts project with all of the students on my caseload.

Every. Single. One.

Kindergartners as well as fourth graders.

Very often we hear about the problem of a “cookie cutter therapist”.

Meaning – a therapist that does one thing with every single student regardless of their goals or deficit areas.

A lot of people have a problem with this and so do I – sometimes.

I might sound like I’m contradicting myself because I said I’m OK with doing the same activity with every single student but here’s the thing:

One of an occupational therapist’s best and greatest qualities is creativity and flexibility. Teachers have this gift, too!

Every single child has different goals – so tweak that activity to work for them!

Change it Up!

Here are some ways to tweak this simple fall craft.

  • For really weak fine motor skills, take one piece of tissue paper in each hand. Hold the student’s hands up in the air like a “Y”. Crunch the tissues into little balls without using his other hand or his chin or even his belly to help with the crunching.
  • To work on mid crossing midline; place the paper to the other side of the student’s body.  Put the helping hand on vacation (meaning behind his back). His dominant hand has to crossover in order to glue on the leaves of the tree.
  • My student with weak grip strength had to use a clothespin to pick up each tissue ball and place it on the tree.
  • My student with really poor scissor skills had to cut the tissue before he crunched. He also cut a piece of green construction paper to make grass for the bottom of his picture.

So – if you were a random person standing at the door of my occupational therapy room, you’d see every student come out with a picture of a tree with different colored fall leaves on it.

It might look like I’m doing cookie cutter therapy but I’m not.

It’s ok to re-use an Idea

My point is – give yourself a break! It’s OK to do the same or similar activity with different students.

Just use your creative mind to tweak it to work for that student and the needs of that student.

For teachers, this may mean creating groups of students who will complete the task in a different way. For example, the red table will use clothespins to pick up the leaves and the blue table has to crunch with two hands in the air in the shape of a Y.

Once you give yourself permission to do one activity with all the kids; you’ll see how easy it is to change it up.

Need an AMAZING Activity to do with your kids this week?

For a limited time, get a FREE E-Book of Sensory Recipes!


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It’s only available this week, so don’t miss it!


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For the Hardworking Therapists Who Work With Children with Special Needs

therapist guilt, fine motor skills, primitive reflexes

I’m sure you’ve heard of Mom guilt, Daughter Guilt, and Irish Guilt, but have you ever heard of Therapist Guilt?

I may have invented it…

You’ve probably read letters and blog posts written toward the parents of children with special needs; talking about how strong they are and how hard they work to help their children.

It’s true.  But many of those selfless parents still have “The Guilts”.


When you have “the guilts”,  there is always something you feel guilty about.   It could be about not having a spic-n-span house, not being able to go to loud family events, or losing your patience with a child with special needs.  The guilt is always there.

It’s often there for therapists, too.

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6 Things You Should Know about Primitive Reflexes

I’m still buzzing from all the amazing things I’m learning in the Primitive Reflexes E-course. As an affiliate for the program, I can whole-heartedly recommend this course – not just for therapists but parents and teachers, too!

*This post contains affiliate links for your conveinence

Starting TODAY, there’s an early bird special for this course.

 The course is $97.00 until October 3rd, then it goes up to $127.00.

I’m the first to admit I didn’t know a lot about retained Primitive Reflexes – the school-based framework is more about “fixing what’s in front of you” rather than digging deep for the underlying causes of certain behaviors.

But I have to admit- I’m hooked.

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