Children are often told to hold their pencil “the right way,” but is there only one right way? While the dynamic tripod grasp is traditionally viewed as the most effective and most mature grasp, variations of this are often seen which are still functional and do not necessarily require modification. Children modify their grasp on writing implements for numerous reasons; fatigue, underdevelopment of wrist and hand muscles, and comfort are only a few. The following is a list of developmental grasps.
Palmar Grasp This is the most immature grasping pattern and is seen from birth to approximately 4-5 months of age. Here, the hand appears fisted with the palm supporting the object and the fingers moving together as a unit.
Palmar Supinate Grasp This grasp is seen around age 12-15 months and is slightly more mature than the palmar grasp. Here, the hand is still fisted however the wrist begins to flex and supinate away from a midline position. While coloring or scribbling the child’s whole arm moves as a unit. Supination is when the palm faces up, as if you were going to ‘cup’ your hands.
Digital Pronate or Pronated Grasp From about age two to three we see this grasp pattern emerge. The writing implement is slightly diagonal, held within the hand with the tips of the fingers, wrist straight and pronated with only the forearm moving as a unit. Pronation is opposite from supination which means it is a palms down position.
Static Tripod Grasp Between three and four years of age we see this close approximation to a mature grasp. Implement is held crudely with thumb, index, and middle fingers. The ring and little finger is usually only slightly flexed and the opposite hand will often make small adjustments. We begin to see an open web space meaning that the continued on page 36 ‰‰‰ GET A GRIP from page 35 thumb and index finger form a circle. Precise, localized movements of digits is not yet seen and the hand moves as a whole unit.
Dynamic Tripod Grasp Most mature grasping pattern. Here we see the implement grasped with the middle finger and the pads of the thumb and index finger. The ring and little finger are flexed to help form a supportive and stable arch and web space is open and clearly visible. Precise movements of the joints of the digits are seen, for example, when drawing tiny circles.
As stated previously, we can see variations of these grasping patterns. We can see a quadrupod grasp where the middle finger rests on the ring finger for added control and support. We can also see an adapted or D’Nealian grasp where the implement does not rest within the web space but rather between the index and middle finger, held by the tips of the thumb and index finger and resting on the middle finger. Although these may appear to be immature and incorrect, they are both fully functional. That is not to say that there aren’t inefficient grasping patterns to watch for. The following are common inefficient grasps.
Five Finger Grasp This is where the child holds the implement with the tips of all five fingers. The hand usually moves as a whole and writing is mostly on the fifth finger side of the hand rather than from the thumb and index finger.
Thumb Tuck Grasp This grasp appears similar to the dynamic tripod or quadupod grasp except that the thumb is tucked under the index finger, closing the web space.
Thumb Wrap Grasp Similar to the Thumb Tuck except that the thumb is now wrapped over the index finger, often closing the web space.
Just as there can be variations of functional grasping patterns, there can be variations of inefficient grasping patterns. We can see differences with wrist position or with digit and thumb placement. These grasps can result from a number of reasons, such as when children are required to participate in writing activities before they are developmentally ready. Research has shown that poorly established hand preference has been linked to developmentally immature grasps. It is though that this impedes the refinement of manipulative skills needed for good control on a writing implement. There have also been positive trends to emerge linking joint laxity to failure to develop a dynamic tripod grasp.
So, what can we do if we see these ineffective grasping patterns? One option is utilizing pencil grips. They assist by providing children with a larger area of contact for the fingers to rest and are shaped specifically to position fingers ‘correctly’, rather ideally, while keeping the web space open. For a grip to be an effective tool, a child must play an active role. Working with a professional such as an Occupational Therapist to identify and understand issues needing modification can assist with grasp development. Although pencil grips may assist in modification of grasp, it is most important to determine the cause of the ineffective grasp, be it lack of strength, lack of endurance or lack of development. The following are activities that can help strengthen children’s hands and assist with developing hand skills.
• Wheelbarrow walk: The child’s hands are on the floor, feet are held up while the child ‘walks’ on his/her hands • Floor activities: Floor puzzles, coloring while lying on their stomach on the floor • Working on a vertical surface: Activities can be taped to a chalkboard/easel or held up by a clip board. Try activities such as coloring, painting, writing, using a Lite Brite or Magna Doodle. • Play with squirt bottles, squeeze sponges for water games • Play Dough/silly putty activities • Pop bubble wrap • Pushing/Pulling/Carrying: Have children carry a heavy, yet manageable, tote bag, pull a loaded wheelbarrow, or play tug-of-war.
References: http://books.google.com/books www2.ccsd.ws/k4/ot/pencil_grasp.htm www.cem.msu.edu/~leej/development-prewriting.html
Anna Wright, OTR/L is on staff at Chautauqua PT, OT & SLP Professionals in the Riverwalk Center. She completed her BS and MS in Occupational Therapy at Springfield College in Massachusetts. Anna resides in Frewsburg, NY with her husband Scott. Anna tells us the most rewarding part of her job is, “Hearing someone say that I’ve made a difference in their life, or in the life of someone close to them.”