
Developing fine motor skills is one of the most crucial aspects of a child’s growth. These skills enable children to carry out daily tasks, such as feeding themselves, dressing, and writing, fostering independence and self-confidence. However, fine motor development doesn’t occur in isolation—it relies on a solid foundation known as “proximal stability.”
Proximal stability refers to the strength and stability of the core and shoulders, which provides the support needed for fine motor precision in the hands and fingers. A child without this foundation may struggle with tasks requiring coordination, endurance, and dexterity.
Occupational therapy (OT) plays a pivotal role in helping children achieve proximal stability. Therapists assess, treat, and guide children through exercises and activities that strengthen their core and shoulder muscles, ultimately improving their ability to perform fine motor tasks.
Table of Contents
Why Proximal Stability Matters in Motor Development
1. Core Stability as a Foundation
Proximal stability begins with the core muscles, which stabilise the spine and pelvis. When these muscles are strong, children can sit upright, maintain good posture, and use their arms and hands effectively. Occupational therapists often start by addressing core stability when working with children who have fine motor challenges, as poor trunk control can hinder hand function.
2. Role of Shoulder Girdle Stability
The shoulders act as the “base” for the arms, supporting movements required for tasks like writing, colouring, or cutting. Without stable shoulders, children may compensate by using their whole arm for tasks that should only involve the hands and fingers. Occupational Therapy interventions often focus on strengthening the shoulder girdle to prevent these compensatory patterns.
3. The Key Muscle Groups Involved
Occupational therapy focuses on strengthening proximal muscles, including the core, shoulders, and upper arms, which work together to stabilise the trunk and arms. Therapists also incorporate exercises that target these areas to create a stable foundation for fine motor activities.
Developmental Stages: From Stability to Mobility
Children naturally develop motor skills in a sequence that prioritises proximal stability before distal mobility. Occupational Therapists use these developmental milestones as a framework when assessing and treating motor delays.
1. Infancy
During infancy, babies develop trunk and head control, which are prerequisites for reaching and grasping. Activities like tummy time and supported sitting encourage core strength and stability. Occupational therapists might recommend activities to help infants with delayed milestones strengthen these areas.
2. Early Childhood (Toddler Stage)
Crawling is a key activity at this stage, as it builds strength in the shoulders, core, and arms. Occupational therapy interventions for toddlers often include crawling-based games to support core and shoulder development, as these are critical for later fine motor skills.
3. Preschool Age
By preschool, children are beginning to use their hands for more complex tasks, such as drawing and cutting. Proximal stability allows them to focus on refining their hand movements without being distracted by poor posture or instability. Occupational Therapists often incorporate play-based activities like climbing and balancing to strengthen these foundational skills.
4. School Age
School-aged children are expected to sustain postural control for longer periods while engaging in fine motor tasks like writing. If a child struggles to maintain stability, they may experience fatigue or poor handwriting. Occupational therapy at this stage might include exercises that target both endurance and precision.
The Role of Occupational Therapy in Proximal Stability
Occupational therapy is instrumental in helping children develop the stability needed for functional mobility. OTs take a holistic approach, addressing both the physical and environmental factors that influence a child’s ability to build proximal stability.
Assessment
Occupational therapists assess a child’s proximal stability through observations of their posture, movement patterns, and fine motor performance. For example, an OT might note whether a child leans heavily on one arm when writing or frequently shifts in their seat, which could indicate poor core stability.
Customised Treatment Plans
Based on the assessment, Occupational Therapists develop tailored interventions. These may include exercises targeting specific muscle groups, activities designed to improve endurance, and strategies to enhance coordination and body awareness.
Play-Based Therapy
To keep therapy engaging, Occupational Therapists often use play-based approaches. Activities like crawling through tunnels, climbing playground equipment, or pretending to be animals (e.g., bear or crab walks) are fun for children while strengthening their core and shoulders.
Collaboration with Families
Occupational therapists work closely with parents and caregivers, providing guidance on how to incorporate stability-building activities at home. For example, they might suggest games that involve pushing and pulling heavy objects or creating obstacle courses in the living room.
The Link Between Proximal Stability and Functional Independence
Proximal stability isn’t just about physical development—it’s also essential for fostering independence in daily life.
Daily Living Skills
Children with strong core and shoulder stability find it easier to perform self-care tasks like buttoning shirts, tying shoelaces, and using utensils. Occupational Therapists work on these skills directly, integrating proximal stability exercises into functional activities.
Academic Success
In school, tasks like writing require stable posture and shoulder control. An Occupational Therapist might support a child struggling with handwriting by addressing their underlying stability challenges, ensuring they can sit upright and use their hands effectively for extended periods.
Participation in Play
Play is a child’s primary occupation, and proximal stability plays a vital role here too. Activities like building with blocks, throwing a ball, or riding a bike all require a strong core and shoulder stability. Occupational therapy helps children develop these skills, enabling them to participate in play more confidently and interact with their peers.
Addressing Proximal Stability Challenges in OT
Impact of Weak Proximal Stability
Children with poor proximal stability often struggle with fine motor tasks, showing signs like a weak grip, hand fatigue, or difficulty sitting still. Occupational therapists identify these issues and provide targeted interventions.
Compensation Patterns
Some children compensate for weak proximal stability by relying on larger muscle groups or leaning heavily on surfaces. Occupational Therapists work to correct these patterns, teaching children how to use their core and shoulders effectively without overcompensating.
Conditions Impacting Proximal Stability
Children with developmental conditions like cerebral palsy, Down syndrome, or low muscle tone often benefit from Occupational Therapy, which can address their unique challenges and build foundational strength.
Conclusion
Proximal stability provides the foundational strength and control that children need to perform fine motor tasks efficiently. When children have a stable base, they can focus on honing their fine motor skills, allowing for greater independence in daily tasks and academic achievements. With patience, targeted exercises, and supportive environments, children can develop the stability they need for confident, controlled movements, setting them up for success in fine motor tasks and beyond.
Next Steps: If you would like support with your child’s communication skills, it may be helpful to have consult with one of our Occupational Therapists for a formal evaluation and intervention support.

Transform Life is a NDIS registered organisation that provide support for you and your family.
Book your consult with an experienced Therapist at Transform Life to explore how OT, PBS and Speech Therapy can support you and your family.