Association of children's toothbrushing and fine motor skills: a cross-sectional study

Fine motor skills (FMS) allow for the control and coordination of the distal musculature of hands and fingers, a skill required to brush teeth. The objective of this study was to investigate the association between FMS and toothbrushing efficacy. This cross-sectional study included 42 low-income Lat...

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Autores:
Mafla Chamorro, Ana Cristina
Benavides Ramiro José, Benavides RJ
Meyer Pierre, Meyer P
Giraudeau Nicolas, Giraudeau N
Schwendicke Falk, Schwendicke F
Tipo de recurso:
Article of investigation
Fecha de publicación:
2022
Institución:
Universidad Cooperativa de Colombia
Repositorio:
Repositorio UCC
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OAI Identifier:
oai:repository.ucc.edu.co:20.500.12494/52437
Acceso en línea:
https://hdl.handle.net/20.500.12494/52437
Palabra clave:
Niño
Habilidades motoras
Cepillado
Desórdenes de neurodesarrollo
Fuerza en la mano
Child
Motor skills
Toothbrushing
Neurodevelopmental disorders
Hand strength
Rights
openAccess
License
Atribución
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oai_identifier_str oai:repository.ucc.edu.co:20.500.12494/52437
network_acronym_str COOPER2
network_name_str Repositorio UCC
repository_id_str
dc.title.none.fl_str_mv Association of children's toothbrushing and fine motor skills: a cross-sectional study
title Association of children's toothbrushing and fine motor skills: a cross-sectional study
spellingShingle Association of children's toothbrushing and fine motor skills: a cross-sectional study
Niño
Habilidades motoras
Cepillado
Desórdenes de neurodesarrollo
Fuerza en la mano
Child
Motor skills
Toothbrushing
Neurodevelopmental disorders
Hand strength
title_short Association of children's toothbrushing and fine motor skills: a cross-sectional study
title_full Association of children's toothbrushing and fine motor skills: a cross-sectional study
title_fullStr Association of children's toothbrushing and fine motor skills: a cross-sectional study
title_full_unstemmed Association of children's toothbrushing and fine motor skills: a cross-sectional study
title_sort Association of children's toothbrushing and fine motor skills: a cross-sectional study
dc.creator.fl_str_mv Mafla Chamorro, Ana Cristina
Benavides Ramiro José, Benavides RJ
Meyer Pierre, Meyer P
Giraudeau Nicolas, Giraudeau N
Schwendicke Falk, Schwendicke F
dc.contributor.author.none.fl_str_mv Mafla Chamorro, Ana Cristina
Benavides Ramiro José, Benavides RJ
Meyer Pierre, Meyer P
Giraudeau Nicolas, Giraudeau N
Schwendicke Falk, Schwendicke F
dc.subject.none.fl_str_mv Niño
Habilidades motoras
Cepillado
Desórdenes de neurodesarrollo
Fuerza en la mano
topic Niño
Habilidades motoras
Cepillado
Desórdenes de neurodesarrollo
Fuerza en la mano
Child
Motor skills
Toothbrushing
Neurodevelopmental disorders
Hand strength
dc.subject.other.none.fl_str_mv Child
Motor skills
Toothbrushing
Neurodevelopmental disorders
Hand strength
description Fine motor skills (FMS) allow for the control and coordination of the distal musculature of hands and fingers, a skill required to brush teeth. The objective of this study was to investigate the association between FMS and toothbrushing efficacy. This cross-sectional study included 42 low-income Latino children aged 5 to 9 years from Pasto, Colombia. Toothbrushing efficacy was determined by the children’s dental plaque Quigley-Hein Index (QH-I) mean-score difference from before and after toothbrushing. FMS were evaluated using the 5–15R parent evaluation, the spiral drawing Archimedes test, and a neurodevelopmental assessment of movements and prehension patterns during toothbrushing. A descriptive analysis was performed to assess the characteristics of FMS and children’s toothbrushing, and a generalized linear model was used to determine associations between these skills and toothbrushing efficacy. Eighty-six percent of the children had at least one difficulty with FMS, and in 7%, they interfered with daily activities. Fourteen percent presented a moderate pattern in the Archimedes test, and 43% had inefficient prehension patterns. Toothbrushing reduced the QH-I by a mean of 1.45 (SD = 0.78–2.12) (p < 0.001). Toothbrushing efficacy was only significantly associated with age (mean-difference = -0.315, 95%CI: -0.481 to -0.148, p < 0.001). FMS and toothbrushing efficacy were not significantly associated. Other components of fine motor control should be analyzed to understand the kinetics of toothbrushing.
publishDate 2022
dc.date.issued.none.fl_str_mv 2022-07-11
dc.date.accessioned.none.fl_str_mv 2023-08-14T22:01:44Z
dc.date.available.none.fl_str_mv 2023-12-31
2023-08-14T22:01:44Z
dc.type.none.fl_str_mv Artículos Científicos
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dc.identifier.bibliographicCitation.none.fl_str_mv Mafla, A. C., Benavides, R. J., Meyer, P., Giraudeau, N., & Schwendicke, F. (2022). Association of children's toothbrushing and fine motor skills: a cross-sectional study. Brazilian oral research, 36, e103. https://doi.org/10.1590/1807-3107bor-2022.vol36.0103
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10.1590/1807-3107bor-2022.vol36.0103
Mafla, A. C., Benavides, R. J., Meyer, P., Giraudeau, N., & Schwendicke, F. (2022). Association of children's toothbrushing and fine motor skills: a cross-sectional study. Brazilian oral research, 36, e103. https://doi.org/10.1590/1807-3107bor-2022.vol36.0103
url https://hdl.handle.net/20.500.12494/52437
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dc.relation.ispartofjournal.none.fl_str_mv Brazilian Oral Research
dc.relation.references.none.fl_str_mv 1. Bruininks RH, Bruininks BD. BOT2 Bruininks-Oseretsky Test of motor proficiency. Minneapolis: NCS Pearson; 2005.
2. Kelly DP, Natale MJ. Neurodevelopmental and executive function and dysfunction. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2020. Chapter 48.
3. Pienaar AE, Barhorst R, Twisk JW. Relationships between academic performance, SES school type and perceptual-motor skills in first grade South African learners: NW-CHILD study. Child Care Health Dev. 2014 May;40(3):370-8. https://doi.org/10.1111/cch.12059
4. Carlson AG, Rowe E, Curby TW. Disentangling fine motor skills’ relations to academic achievement: the relative contributions of visual-spatial integration and visual-motor coordination. J Genet Psychol. 2013 Sep-Dec;174(5-6):514-33. https://doi.org/10.1080/00221325.2012.717122
5. Wehby GL, Prater K, McCarthy AM, Castilla EE, Murray JC. The impact of maternal smoking during pregnancy on early child neurodevelopment. J Hum Cap. 2011;5(2):207-54. https://doi.org/10.1086/660885 » https://doi.org/10.1086/660885
6. Patil SP, Patil PB, Kashetty MV. Effectiveness of different tooth brushing techniques on the removal of dental plaque in 6-8 year old children of Gulbarga. J Int Soc Prev Community Dent. 2014 May;4(2):113-6. https://doi.org/10.4103/2231-0762.138305
7. Kumar S, Tadakamadla J, Johnson NW. Effect of toothbrushing frequency on incidence and increment of dental caries: a systematic review and meta-analysis. J Dent Res. 2016 Oct;95(11):1230-6. https://doi.org/10.1177/0022034516655315
8. Trinh VA, Tarbit E, Do L, Ha D, Tadakamadla SK. The influence of family socioeconomic status on toothbrushing practices in Australian children. J Public Health Dent. 2021 Dec;81(4):308-15. https://doi.org/10.1111/jphd.12477
9. Gill P, Stewart K, Chetcuti D, Chestnutt IG. Children’s understanding of and motivations for toothbrushing: a qualitative study. Int J Dent Hyg. 2011 Feb;9(1):79-86. https://doi.org/10.1111/j.1601-5037.2010.00442.x
10. Colaizzi LR, Tomar SL, Urdegar SM, Kass SH. Does the structure of dental hygiene instruction impact plaque control in primary school students? J Dent Hyg. 2015 Jun;89(3):180-9.
11. Mescher KD, Brine P, Biller I. Ability of elementary school children to perform sulcular toothbrushing as related to their hand function ability. Pediatr Dent. 1980 Mar;2(1):31-6.
12. Berzinski M, Morawska A, Mitchell AE, Baker S. Parenting and child behaviour as predictors of toothbrushing difficulties in young children. Int J Paediatr Dent. 2020 Jan;30(1):75-84. https://doi.org/10.1111/ipd.12570
13. Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344-9. https://doi.org/10.1016/j.jclinepi.2007.11.008
14. Colombia. Resultados censo nacional de población y vivienda 2018. DANE. 2019 June 26 [cited 2021 Feb 1]. Available from: https://www.dane.gov.co/files/censo2018/informacion-tecnica/presentaciones-territorio/190726-CNPV-presentacion-Narino-Pasto.pdf
15. Minsalud (CO). Balance proceso reglamentario. 2017 [cited 2020 Oct 5]. Available from: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/PS/documento-balance-1618-2013-240517.pdf
16. Quigley GA, Hein JW. Comparative cleansing efficiency of manual and power brushing. J Am Dent Assoc. 1962 Jul;65(1):26-9. https://doi.org/10.14219/jada.archive.1962.0184
17. Turesky S, Gilmore ND, Glickman I. Reduced plaque formation by the chloromethyl analogue of victamine C. J Periodontol. 1970 Jan;41(1):41-3. https://doi.org/10.1902/jop.1970.41.1.41
18. Bass CC. An effective method of personal oral hygiene. J La State Med Soc. 1954 Feb;106(2):57-73.
19. Fones AC. Mouth hygiene. 4th ed. Philadelphia: Lea & Febiger; 1934.
20. Boyce W, Gowland C, Rosenbaum P, Hardy S, Lane M, Plews N, et al. Gross motor performance measure manual. Kingston: Queen’s University; 1999.
21. Kadesjö B, Janols LO, Korkman M, Mickelsson K, Strand G, Trillingsgaard A, et al. The FTF (Five to Fifteen): the development of a parent questionnaire for the assessment of ADHD and comorbid conditions. Eur Child Adolesc Psychiatry. 2004;13 Suppl 3:3-13. https://doi.org/10.1007/s00787-004-3002-2
22. Korkman M, Jaakkola M, Ahlroth A, Pesonen AE, Turunen MM. Screening of developmental disorders in five-year-olds using the FTF (Five to Fifteen) questionnaire: a validation study. Eur Child Adolesc Psychiatry. 2004;13(S3 Suppl 3):31-8. https://doi.org/10.1007/s00787-004-3005-z
23. Rodríguez-Pérez C, Nicasio García J. Validación y utilización empírica de un instrumento de diagnóstico en una muestra de niños con el Trastorno por Déficit de Atención con y sin Hiperactividad (TDAH): el cuestionario Five to Fifteen (FTF). Int J of Dev Educ Psychol. 2008;1(3):241-9.
24. Beltrán-Ortiz MF, Barra HT, Franzani P, Martinich C, Castillo RD. [The Five to Fifteen Questionnaire (FTF) for a comprehensive assessment of development: psychometric properties and characterization of a sample of Chilean children]. Ter Psicol. 2012;30(3):31-47. Spanish. https://doi.org/10.4067/S0718-48082012000300004
25. Trouillas P, Takayanagi T, Hallett M, Currier RD, Subramony SH, Wessel K, et al. International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. J Neurol Sci. 1997 Feb;145(2):205-11. https://doi.org/10.1016/S0022-510X(96)00231-6
26. Hoogendam YY, Lijn F, Vernooij MW, Hofman A, Niessen WJ, Lugt A, et al. Older age relates to worsening of fine motor skills: a population-based study of middle-aged and elderly persons. Front Aging Neurosci. 2014 Sep;6:259. https://doi.org/10.3389/fnagi.2014.00259
27. Schneck CM, Henderson A. Descriptive analysis of the developmental progression of grip position for pencil and crayon control in nondysfunctional children. Am J Occup Ther. 1990 Oct;44(10):893-900. https://doi.org/10.5014/ajot.44.10.893
28. Dennis JL, Swinth Y. Pencil grasp and children’s handwriting legibility during different-length writing tasks. Am J Occup Ther. 2001 Mar-Apr;55(2):175-83. https://doi.org/10.5014/ajot.55.2.175
29. Exner CE. In-hand manipulation skills. In: Case-smith J, Pehoski C, editors. Development of hand skills in the child. Bethesda: American Occupational Therapy Association; 1992. p. 35-40.
30. Exner CE. Content validity of the in-hand manipulation test. Am J Occup Ther. 1993 Jun;47(6):505-13. https://doi.org/10.5014/ajot.47.6.505
31. Case-Smith J, O’Brien JC. Occupational therapy for children. 6th ed. Missouri: Mosby Elsevier; 2010. p. 275-312.
32. American Psychological Association. Fine motor. Washington: American Psychological Association; 2021 [cited 2021 Feb 20].Available from: https://dictionary.apa.org/fine-motor
33. Forsman L, Eliasson AC. Strengths and challenges faced by school-aged children with unilateral CP described by the Five To Fifteen parental questionnaire. Dev Neurorehabil. 2016 Dec;19(6):380-8. https://doi.org/10.3109/17518423.2015.1017662
34. Louis ED, Garcia WE, Rauh VA. Tremor in a population-based cohort of children in New York City. Pediatr Neurol. 2015 Feb;52(2):187-91. https://doi.org/10.1016/j.pediatrneurol.2014.10.017
35. Louis ED, Cubo E, Trejo-Gabriel-Galán JM, Villaverde VA, Benito VD, Velasco SS, et al. Tremor in school-aged children: a cross-sectional study of tremor in 819 boys and girls in Burgos, Spain. Neuroepidemiology. 2011;37(2):90-5. https://doi.org/10.1159/000330352
36. Collett BR, Huebner CE, Seminario AL, Wallace E, Gray KE, Speltz ML. Observed child and parent toothbrushing behaviors and child oral health. Int J Paediatr Dent. 2016 May;26(3):184-92. https://doi.org/10.1111/ipd.12175
37. Bowens A, Smith I. Childhood dyspraxia: some issues for the NHS. Nuffield Institute for Health; 1999. Nuffield Portfolio Programme Report No: 2 Leeds.
38. Gibbs J, Appleton J, Appleton R. Dyspraxia or developmental coordination disorder? Unravelling the enigma. Arch Dis Child. 2007 Jun;92(6):534-9. https://doi.org/10.1136/adc.2005.088054
39. Farmer M, Echenne B, Drouin R, Bentourkia M. Insights in developmental coordination disorder. Curr Pediatr Rev. 2017;13(2):111-9. https://doi.org/10.2174/1573396313666170726113550
40. Colombia. DNP. Primero las niñas y los niños: desarrollo integral desde la primera infancia hasta la adolescência. 2019 [cited 2021 Mar 2]. Available from: https://www.dnp.gov.co/DNPN/Plan-Nacional-de-Desarrollo/Paginas/Pilares-del-PND/Equidad/Primero-las-ninas-y-los-ninos.aspx
41. Galler JR, Koethe JR, Yolken RH. Neurodevelopment: The Impact of Nutrition and Inflammation During Adolescence in Low-Resource Settings. Pediatrics. 2017 Apr;139 Suppl 1:S72-84. https://doi.org/10.1542/peds.2016-2828I
42. Burr P, Choudhury P. Fine motor disability. StatPearls. Treasure Island: StatPearls; 2021.
43. Lin YC, Chao YL, Wu SK, Lin HH, Hsu CH, Hsu HM, et al. Comprehension of handwriting development: pen-grip kinetics in handwriting tasks and its relation to fine motor skills among school-age children. Aust Occup Ther J. 2017 Oct;64(5):369-80. https://doi.org/10.1111/1440-1630.12393
44. Liutsko L, Muiños R, Tous Ral JM, Contreras MJ. Fine motor precision tasks: sex differences in performance with and without visual guidance across different age groups. Behav Sci (Basel). 2020 Jan;10(1):36. https://doi.org/10.3390/bs10010036
45. Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology (Bethesda). 2015 Jan;30(1):30-9. https://doi.org/10.1152/physiol.00024.2014
46. Silvestrini Biavati A, Gastaldo L, Dessì M, Silvestrini Biavati F, Migliorati M. Manual orthodontic vs. oscillating-rotating electric toothbrush in orthodontic patients: a randomised clinical trial. Eur J Paediatr Dent. 2010 Dec;11(4):200-2.
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Universidad Cooperativa de Colombia, Programa de Odontología, Pasto, Colombia
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Universidad Cooperativa de Colombia, Programa de Odontología, Pasto, Colombia
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spelling Mafla Chamorro, Ana CristinaBenavides Ramiro José, Benavides RJMeyer Pierre, Meyer PGiraudeau Nicolas, Giraudeau NSchwendicke Falk, Schwendicke F36:e1032023-08-14T22:01:44Z2023-12-312023-08-14T22:01:44Z2022-07-11N/A1807-310710.1590/1807-3107bor-2022.vol36.0103https://hdl.handle.net/20.500.12494/52437Mafla, A. C., Benavides, R. J., Meyer, P., Giraudeau, N., & Schwendicke, F. (2022). Association of children's toothbrushing and fine motor skills: a cross-sectional study. Brazilian oral research, 36, e103. https://doi.org/10.1590/1807-3107bor-2022.vol36.0103Fine motor skills (FMS) allow for the control and coordination of the distal musculature of hands and fingers, a skill required to brush teeth. The objective of this study was to investigate the association between FMS and toothbrushing efficacy. This cross-sectional study included 42 low-income Latino children aged 5 to 9 years from Pasto, Colombia. Toothbrushing efficacy was determined by the children’s dental plaque Quigley-Hein Index (QH-I) mean-score difference from before and after toothbrushing. FMS were evaluated using the 5–15R parent evaluation, the spiral drawing Archimedes test, and a neurodevelopmental assessment of movements and prehension patterns during toothbrushing. A descriptive analysis was performed to assess the characteristics of FMS and children’s toothbrushing, and a generalized linear model was used to determine associations between these skills and toothbrushing efficacy. Eighty-six percent of the children had at least one difficulty with FMS, and in 7%, they interfered with daily activities. Fourteen percent presented a moderate pattern in the Archimedes test, and 43% had inefficient prehension patterns. Toothbrushing reduced the QH-I by a mean of 1.45 (SD = 0.78–2.12) (p < 0.001). Toothbrushing efficacy was only significantly associated with age (mean-difference = -0.315, 95%CI: -0.481 to -0.148, p < 0.001). FMS and toothbrushing efficacy were not significantly associated. Other components of fine motor control should be analyzed to understand the kinetics of toothbrushing.1. Introducción 2. Metodología 2.1 Study design, settings, and sample 2.2 Measures and procedures 2.3 Fine motor skills 2.4 Statistical analysis 3. Results 3.1 Fine motor skills 3.2 Toothbrushing 3.3 Fine motor skills and toothbrushing efficacy 4. Discussion; 4.1 Limitations 5. Conclusionshttps://scienti.minciencias.gov.co/cvlac/visualizador/generarCurriculoCv.do?cod_rh=0000676616https://orcid.org/0000-0002-2805-7901https://scienti.minciencias.gov.co/gruplac/jsp/visualiza/visualizagr.jsp?nro=00000000002911ana.mafla@campusucc.edu.cohttps://scholar.google.com/citations?user=MSFc5YoAAAAJ&hl=es1-12Saul Martins PaivaUniversidad Cooperativa de Colombia, Programa de Odontología, Pasto, ColombiaOdontologíaPastoN/Ahttps://www.scielo.br/j/bor/a/6ySrdNtRtd9GmP7BnDF5wkp/?lang=enN/ABrazilian Oral Research1. Bruininks RH, Bruininks BD. BOT2 Bruininks-Oseretsky Test of motor proficiency. Minneapolis: NCS Pearson; 2005.2. Kelly DP, Natale MJ. Neurodevelopmental and executive function and dysfunction. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, editors. Nelson textbook of pediatrics. 21st ed. Philadelphia: Elsevier; 2020. Chapter 48.3. Pienaar AE, Barhorst R, Twisk JW. Relationships between academic performance, SES school type and perceptual-motor skills in first grade South African learners: NW-CHILD study. Child Care Health Dev. 2014 May;40(3):370-8. https://doi.org/10.1111/cch.120594. Carlson AG, Rowe E, Curby TW. Disentangling fine motor skills’ relations to academic achievement: the relative contributions of visual-spatial integration and visual-motor coordination. J Genet Psychol. 2013 Sep-Dec;174(5-6):514-33. https://doi.org/10.1080/00221325.2012.7171225. Wehby GL, Prater K, McCarthy AM, Castilla EE, Murray JC. The impact of maternal smoking during pregnancy on early child neurodevelopment. J Hum Cap. 2011;5(2):207-54. https://doi.org/10.1086/660885 » https://doi.org/10.1086/6608856. Patil SP, Patil PB, Kashetty MV. Effectiveness of different tooth brushing techniques on the removal of dental plaque in 6-8 year old children of Gulbarga. J Int Soc Prev Community Dent. 2014 May;4(2):113-6. https://doi.org/10.4103/2231-0762.1383057. Kumar S, Tadakamadla J, Johnson NW. Effect of toothbrushing frequency on incidence and increment of dental caries: a systematic review and meta-analysis. J Dent Res. 2016 Oct;95(11):1230-6. https://doi.org/10.1177/00220345166553158. Trinh VA, Tarbit E, Do L, Ha D, Tadakamadla SK. The influence of family socioeconomic status on toothbrushing practices in Australian children. J Public Health Dent. 2021 Dec;81(4):308-15. https://doi.org/10.1111/jphd.124779. Gill P, Stewart K, Chetcuti D, Chestnutt IG. Children’s understanding of and motivations for toothbrushing: a qualitative study. Int J Dent Hyg. 2011 Feb;9(1):79-86. https://doi.org/10.1111/j.1601-5037.2010.00442.x10. Colaizzi LR, Tomar SL, Urdegar SM, Kass SH. Does the structure of dental hygiene instruction impact plaque control in primary school students? J Dent Hyg. 2015 Jun;89(3):180-9.11. Mescher KD, Brine P, Biller I. Ability of elementary school children to perform sulcular toothbrushing as related to their hand function ability. Pediatr Dent. 1980 Mar;2(1):31-6.12. Berzinski M, Morawska A, Mitchell AE, Baker S. Parenting and child behaviour as predictors of toothbrushing difficulties in young children. Int J Paediatr Dent. 2020 Jan;30(1):75-84. https://doi.org/10.1111/ipd.1257013. Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008 Apr;61(4):344-9. https://doi.org/10.1016/j.jclinepi.2007.11.00814. Colombia. Resultados censo nacional de población y vivienda 2018. DANE. 2019 June 26 [cited 2021 Feb 1]. Available from: https://www.dane.gov.co/files/censo2018/informacion-tecnica/presentaciones-territorio/190726-CNPV-presentacion-Narino-Pasto.pdf15. Minsalud (CO). Balance proceso reglamentario. 2017 [cited 2020 Oct 5]. 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Fine motor disability. StatPearls. Treasure Island: StatPearls; 2021.43. Lin YC, Chao YL, Wu SK, Lin HH, Hsu CH, Hsu HM, et al. Comprehension of handwriting development: pen-grip kinetics in handwriting tasks and its relation to fine motor skills among school-age children. Aust Occup Ther J. 2017 Oct;64(5):369-80. https://doi.org/10.1111/1440-1630.1239344. Liutsko L, Muiños R, Tous Ral JM, Contreras MJ. Fine motor precision tasks: sex differences in performance with and without visual guidance across different age groups. Behav Sci (Basel). 2020 Jan;10(1):36. https://doi.org/10.3390/bs1001003645. Haizlip KM, Harrison BC, Leinwand LA. Sex-based differences in skeletal muscle kinetics and fiber-type composition. Physiology (Bethesda). 2015 Jan;30(1):30-9. https://doi.org/10.1152/physiol.00024.201446. Silvestrini Biavati A, Gastaldo L, Dessì M, Silvestrini Biavati F, Migliorati M. Manual orthodontic vs. oscillating-rotating electric toothbrush in orthodontic patients: a randomised clinical trial. 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