All About Hands and Handwriting Part One: Understanding Your Hands
By The Better Learning Therapies Motor Department
The aim to improve a child’s handwriting is a common reason children receive occupational therapy. Handwriting is an advanced skill and daily occupation of children that requires the coordinated application of visual, cognitive, motor, and sensory abilities. Occupational therapy can help improve motor, sensory, postural, or perceptual skills involved in handwriting.
In this three-part blog post series, we will explore how hands work, issues that can prevent legible handwriting, and how occupational therapists and parents can work together to improve a child’s handwriting.
First, we will take a look at our hands and try to understand how they work in handwriting and other fine motor tasks. Hands are something we often take for granted, but they are remarkable and help us do so much!
Palmar Grasp Reflex
“The grasp reflex begins in the womb and continues until a baby is about 6 months old. You can see this reflex very easily when you place your finger inside a baby's hand: they will automatically wrap their fingers around yours.” (Hand Dominance Development in Children) At around 6 months, OTs and PTs are looking for this automatic response to “integrate” or become more purposeful and functional , creating a motor pattern that lays the foundation for voluntary fine motor use. The main bond between infant and adult motor patterns is rooted in the grasp reflex and it plays a significant role in handwriting.
If it is not yet integrated in a child, an OT can work to integrate it through different exercises. One way to do this is squeezing some soft putty or a softball and then following that up with squeezes between each digit and the thumb, moving from index to pinky.
Once integration occurs, skills such as handwriting, utensil and scissor grasp, and hand-eye coordination tend to improve!
From the time your child starts grasping for objects with their hands, they are developing grasps. For even more information on early skill development, check out our resource on Pre-Writing Skills!
Sides of Your Hand
Did You Know That Your Hand Has Two Sides?
Not many people realize the two sides of the hand have different attributes. The precision side includes the thumb, index, and middle digits while the power side includes the fourth and fifth digits. The power side provides stability to the hand while the precision side moves to manipulate objects.
Think about handwriting and how you hold your pencil. Typically, we use our thumb, index, and middle digits to hold the pencil, while the fourth and fifth digits are tucked inside the palm, offering stability.
The ability to use the two sides of the hands separately is usually referred to as dissociation of the hand.
How Do I Know if My Child Lacks Dissociation?
Something we encounter very often in therapy is a lack of dissociation between the two sides. This leads to difficulties with fine motor tasks such as cutting, handwriting, using feeding utensils, etc. Some signs that your child needs further help in developing dissociation between the two sides of their hand include:
Difficulty manipulating paper to turn as they cut
Inability to hold a buttonhole with one hand and a button in the other
Moving the whole hand across the paper when writing, slowing down the process
Trouble tying shoelaces
Activities to do At Home
A few activities that can help with the development of dissociation include:
Unscrewing small caps/lids
Using squirt guns or spray bottles
Holding a pompom or cotton ball under the fourth and fifth digit while writing
Using jumbo tweezers to pick up small items
Threading activities
Placing coins in a piggy bank
Playing with stickers
Try this fun and inexpensive idea for using sponges to improve the separation of the sides of the hands. For more information and ideas check out this blog post: Easy Ideas for Motoric Separation of the Hand in Fine Motor Skills.
Hand Dominance
Hand preference or dominance is the consistent favoring of one hand over the other for the skilled part of an activity.
“Human hand preference emerges very early in an infant’s life, where genetics and environmental influences are believed to play a key role in development. Some researchers suggest that direction of hand preference is fixed at age 3, further explaining that degree increases between the ages of 3–7 and more gradually until the age of 9. Based on this idea, an individual’s hand preference cannot be reliably assessed until 4 years of age.” (Hand preference, performance abilities, and hand selection in children)
Why is hand dominance important?
One primary reason is that a lack of hand dominance results in difficulties performing fine motor tasks. For example, a child that has established hand dominance with cutting will use their “helper” hand to hold the paper while their “doing” (dominant) hand manipulates the scissors. With practice, the child will demonstrate increased precision with cutting, leading to their ability to cut more detailed and complex shapes.
When children are switching hands, they will struggle to achieve refined and precise fine motor movements. The more a child uses a specific hand for a task, the more efficient the child becomes at that task and the movement becomes more automatic. Something we see often with toddlers is a lot of switching of hands when performing fine motor activities and parents can’t quite figure out which hand is preferred.
Determining Hand Dominance
If your child doesn’t use one hand as their preferred, don’t force them to choose or use one hand. Instead, carefully observe what hand the child uses to start an activity. Also, pay attention to which side you are presenting and offering items. Does your child reach for an item with the left hand when it’s presented on the left? Do they reach for an item with the right hand when it’s presented on the right? Try placing items at midline and observing which hand goes for the object and making note of right or left consistency.
In the “Show Me” game, the child can be asked, “Show me how you brush your hair.” The child can demonstrate with an imaginary brush how they’d complete the activity. By using an imaginary brush, the child does not have to worry about picking up the tool. They will automatically brush without thinking about it.
Pencil Grasp Development
Parents are often concerned about all the interesting and inventive ways their children hold a pencil. Children typically progress through pencil grasp development in a predictable manner, from primitive, transitional, to mature.
Primitive grasp: Pincer Grasp, Whole Hand Grasp/Palmer Supinate Grasp, and Digital Pronate Grasp/ Pronated Wrist Grasp. In these beginning pencil grasps, the whole arm moves the pencil.
Transitional grasp: Four Fingered Grasp, Static Tripod Grasp, others. The grasp patterns in this stage all involve the child’s forearm and/or wrist moving the pencil.
Mature grasp: Dynamic Tripod Grasp, Lateral Tripod Grasp, and others. In a mature grasp, the child holds and maneuvers the pencil using mobility in the fingers or the hand.
“There are other grasps that can be considered “functional” in which the child holds the pencil differently than described here, but can also write in an efficient manner. These can include (but not be limited to) a thumb wrap grasp, thumb tuck grasp, inter-digital brace grasp, or a finger-wrap grasp.” (Pencil Grasp Development - The OT Toolbox)
Further reading on grasp development:
Less Functional Grasps
“Children with poor fine motor skills will often find an alternative way to hold onto their pencil. This is usually because their fine motor skills are not mature enough when they first start holding onto a pencil. The reason these grasps are not ideal is that they don’t allow for optimal finger movement and control of the pencil.” (Handwriting - looking beyond the tripod pencil grasp - GriffinOT)
Tablet Grasp
A tablet grasp is considered a non-mature grasp pattern. This grasp pattern can be tricky to modify and often requires the implementation of skills to make the grasp more functional rather than changing the grasp completely to look more like a tripod. Oftentimes, these children present with weakened forearms, creating the need for increased wrist extensor muscle exercises, or with a general low tone and hypermobility in the hand, requiring strengthening from proximal to distal muscles of the upper extremity. These exercises must be done often and utilized within a home exercise program because it is common that with minimal intervention or practice this grasp pattern will revert back.
Implementation of activities that involve pincer grasp can be beneficial because these children can typically be seen grasping small objects with their thumb and middle plus ring fingers instead of thumb and pointer.
There are grasp modification tools that can be used, with a common one being the HandiWriter, designed to facilitate the correct positioning and holding of a writing tool. It is recommended for use with children of any age who have inappropriate grasp patterns. Talk to your child’s occupational therapist about possible tools for correcting grasp.
Should I Correct My Child's Weird Grasp?
An unusual pencil grasp is not a problem by itself. However, parents may feel pressure to correct a grasp from other family members or teachers. Do parents really need to worry about this?
First, it is important to determine whether or not the child is getting fatigued with their current pencil grasp. If they are getting fatigued then it may be helpful looking into how to minimize that. Another component that we would consider is legibility. Are you able to read what they write? Are their peers able to read what they write? Is their teacher able to read what they write? Finally, we would also consider time and efficiency. Are they able to complete writing assignments within an expected time frame or are they taking longer than they’d like or their teacher would like? If there is no strain or fatigue and writing is legible and efficient, then a child’s grasp is considered functional.
If you're seeing any of the following red flags, then we recommend an occupational therapy assessment to help figure out why your child is struggling. An occupational therapist can collaborate with parents and teachers to make a plan to work on the skills that are missing.
Very slow handwriting speed
Pencil pressure that is too light or hard
Lack of control and stability
Illegible writing
Hand fatigue
How can we work on fine motor skills besides handwriting worksheets?
There are so many ways to work on fine motor skills that don’t involve handwriting. An important component of handwriting is developing a functional grasp when manipulating writing utensils. To assist in developing an age-appropriate grasp that will translate over to handwriting the child can engage in various activities. These include, but are not limited to:
Using tweezers or tongs to pick up and transfer objects
Threading and lacing activities
Crafts with eye droppers and food coloring
Slime, kinetic sand, or dough
Legos and Duplo blocks
Parents can even incorporate fine motor skill development into day-to-day activities, such as using a spray bottle to water plants or to clean, practicing zippers and buttons, opening snack packets, and twisting the lid off a drink.
Through these activities, the child will work on skills such as strength, dexterity, and coordination, all of which translate to handwriting.
For other ideas, check out these resources:
