Pencil Grasp - When to be concerned
Pencil Grasp - When to worry?
This is a common issue in 'OT-Land'! Parents frequently bring their children along with a number of concerns, and often pencil grip is in there somewhere. There can be a number of factors contributing to this........
* Children these days are often expected to use a mature grasp when they're very young and their muscles aren't yet ready, so they adopt all sorts of awkward positions, which end up as habit. Developmentally, 3 year olds use a dagger grasp pattern because that gives them enough strength! We need to let them. At 4 years they start to move their fingers down into a more mature position, but they still often need to use all their fingers and haven't developed the ability to isolate the little muscles in their fingers for finer control. Occasionally children haven't been shown how to hold their pencil, or they've been modelling their parents creative grip styles!
* However, often there are other reasons contributing to non-functional grasps, e.g. poor isolation of finger movements, not able to separate the two sides of the hand, low muscle tone, decreased sensory awareness, etc. OT's can assess and identify these factors and children will then benefit from opportunity to develop via the specific activities recommended. We are always encouraging activities on vertical surfaces as this helps in most of these instances. We have a whole section of our website just for this! See Vertical Surface Activities
When children adopt a functional pencil grip they:
* Are efficient in their writing
* Their writing becomes more effortless
* They have more endurance
We want children to be able to write automatically, so that they can concentrate on what they're writing. This is the goal and the reason to assist.
The following table shows the type of grip patterns which we worry about. All of the recommended grips can be seen by clicking here.
Five finger grasp: The pencil is held with the tips of all five fingers. The movement when writing is primarily on the fifth finger side of the hand.
Recommended: The Handiwriter helps to separate the two sides of the hand. Often good to use in combination with The Pencil Grip or The Pinch Grip to support finger positioning. The Pediatools Key is also an option here.
Thumb tuck grasp: The pencil is held in a tripod or quadrupod grasp but with the thumb tucked under the index finger.
Recommended: The Pencil Grip, The Pinch Grip, Solo grip - will help support re-positioning of the thumb and keep the index finger properly on top of the pencil. Children will have individual preferences in regard to how comfortable the different grips feel - this applies in most instances!
Thumb wrap grasp: The pencil is held in a tripod or quadrupod grasp but with the thumb wrapped over the index finger.
Recommended: There are a few options including the Grotto Grip, The Crossover Grip, The WriteRight, the StartRight - all of these grips prevent the thumb from wrapping around. The C.L.A.W is another option.
Tripod grasp with closed web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb is rotated toward the pencil, closing the web space.
Recommended: This is a tricky one and often requires more trial and error. Try a Jumbo grip to support the thumb webspace. The WriteRight has also been successful as have the options for the thumb wrap as above.
Finger wrap or interdigital brace grasp: The index and third fingers wrap around the pencil. The thumb web space is completely closed.
Recommended: This is a fairly atypical pattern and calls for a more radical response! Have a look at the Pen Again range after trialling some more basic options like The Pencil Grip.
Flexed wrist or hooked wrist: The pencil can be held in a variety of grasps with the wrist flexed or bent. This is more typically seen with left-hand writers but is also present in some right-hand writers.
Recommended: This is where Handiwriters and Sportwriters really come into their own as they really help get the wrist into a better position. The WriteRight is also very good. Angled boards are a good idea too.
The common theme is that the pattern inhibits the small movements of the fingers, making children use bigger muscles which aren't designed for fine tasks. They therefore lack control and are quicker to fatigue with sustained effort. Often children end up holding on tighter, which adds to pain and fatigue. We want to see an open webspace (where the thumb and index finger form a circle), a relaxed grip, and a slightly extended wrist.
When children hold on too tight and press too hard, but their positioning is OK, you can consider: Ribie Foam Grip, Massage Grip, Squishy Jelly Grip, The Bumpy Grip.
When children have a tremor, think about weighted pens and pencils.
All of these options can be seen at Pencil Grips
My child needs to move!
Research indicates that a student's academic performance is directly related to whether he/she is able to attend long enough to learn the information presented. Sitting in one position for long periods of time can be a real struggle for some children (and adults!) By providing children with opportunities to move and change position we increase a child's ability to pay attention by increasing the sensory input he or she is receiving.
There have now been a range of studies investigating the effectiveness of dynamic seating options on attention in class. They have all found that children demonstrated increased attention to task and improved academic performance by being permitted to move while still seated. Dynamic seating is a simple, practical, and relatively inexpensive strategy. There are a range of options available, all having different features:
* Move'n'Sit Cushion - We usually recommend this option when children need movement and they also have poor postural muscle tone. The wedge shape assists by tilting their pelvis, therefore assisting children to maintain better sitting posture. Available in blue. $56.85
* Disc-o-sit Cushion - This is a favourite as it gives the option of extra tactile input on one side, and none on the other. It can also be inflated by mouth, so it's easy to adjust the level of inflation to suit the child. Available in red. $55.50
* AllCare Air Cushion - At $36 this is a cheaper option. It has the tactile option on one side, but not the adjustable inflation. Available in blue.
* Stability Disc - This option has a smooth surface on both sides and comes in a range of colours. $51.50
* Sensory Seat Tactile Mat - This is an option that only provides tactile input, no movement - This time for the tactile seekers/movement avoiders! $31.00
* Howdahug Seats - These are much loved! They are ideal for mat time, where the other options above can be used for mat time as well as at the desk. The howdahug seats allow children to move while being fully supported and 'hugged' - the extra sensory input providing the calming some children need to focus. $89.95
* Senseez Vibrating Cushions - These are new and now come in a vinyl range (4 colours and shapes $66.50) and a delightful Touchables range (4 fluffy designs $73.50). This time the sensory input is gentle vibration and this can be just the thing to help some children settle. We've only had these a couple of months and they've been very popular!
Just as an aside.....In a 2014 clinical trial with 23 families involved, Senseez Pillows showed that:
-70% had an increase in their child’s attention span
-67% found Senseez helped to soothe and calm their children
-72% said Senseez helped in their daily living activities and tasks
-86% said they would recommend Senseez Pillows to other families
Low Muscle Tone
Muscle tone is the amount of tension in the muscles, achieved by a continuous partial contraction of the muscles. This helps us to keep our bodies in a certain position. Muscle tone is different to muscle strength. Strength is more so a component of physical fitness. For example, if we pick up something heavy, our muscles exert force that gives us the strength to pick up the item.
There are a number of signs that can indicate low muscle tone:
- Does your child seem to tire very easily?
- Does your child sweat more than other kids during physical activity?
- Does your child seem “floppy” or “double jointed”?
- As a baby, did your child take their weight when you picked them up or were they a “heavy” baby?
Certain activities can be beneficial if you think your child may have low muscle tone:
- * Animal walks
- Bear: walk on hands and feet with bottom in the air
- Bunny hops
- Frog leaps
* Wheelbarrow walks
- Support your child at the hips while he places his hands on the floor and walks forward
- Support just above the knees as your child becomes stronger
* Scooter boards and balance boards are fun and help build core strength
* Swimming or jungle gym play
* Fun obstacle courses (set up your own in the backyard) using various combinations of witches hats, bean bags, foot pods, and other gross motor products. Be creative!
Because of the fatigue that is often related to low muscle, you may have noticed difficulties with fine motor activities such as writing, drawing, colouring or cutting. Improving these skills can increase participation at school and prevent your child from falling behind. If you suspect that your child may need extra help in this area, seeking the assistance of an occupational therapist can be beneficial.
Concentrating in the classroom - What works?
We have daily phone calls from parents identifying concentration at school as a problem for their child. There can be all sorts of contributing factors, which is why a proper assessment of the situation is always a good idea. Mat time is often a tricky time as kids may have issues with:
* touch (eg hypersensitive to other kids touching them, constantly seeking tactile input for calming),
* movement (eg need movement to stay alert, difficulty maintaining their postural control),
* auditory or visual processing (eg easily overwhelmed in a more confined area)
* and there are more reasons as well, eg language comprehension.
Tactile avoiders are better with a small stool or a carpet square so they have their own space with less 'risk' of them being touched.
For children who are easily overwhelmed by noise you can try setting up a quieter place for them to go, eg a beanbag a little bit separate from the group but still within vision and hearing distance from the teacher.
These are just some simple, quick strategies which can give instant improvements and can be considered 'first line of defence'. The important thing is to identify the underlying issue and this is best done by watching the child during mat time with your 'sensory processing hat' on. This means watching carefully how they react to different sensory stimuli. There are many more factors at play and strategies to consider, and this is where you would call on an OT to give you a hand.
Getting ‘Home Programmes’ done!
"Our therapist has recommended some daily activities to help our child. I know it needs to be a priority, but how on earth do we fit anything extra into our family’s hectic schedule?"
As a parent of kids who have needed to follow several home programmes, as well as a therapist, I feel very familiar with just how challenging this can be. At one point there we were working on a strengthening programme with one child and an articulation programme with another. Our family has had Speech Therapy, Physio and Occupational Therapy goals to work on at different times with each of our children. In my experience there are lots of ways to tackle this and. Like many things, it’s never a one-size-fits-all approach. A big determining factor is the nature of the therapy goal and the tasks themselves, then you’ve got variable like parenting style, your child’s personality, resources/equipment available, other children’s needs, etc, etc. Some of the options below may work for you with a bit of tweaking……
- TEACHABLE MOMENTS – this is about looking for ways to build therapy goals into your regular daily routines. This can work well for families who have regular routines! I think this is the way to go for general developmental areas, eg muscle tone, bilateral coordination – where you might get your child to bear walk from their bedroom to breakfast each morning to develop muscle tone, and have some fun 2-handed games with the bubbles in the bath each night to work on bilateral coordination.
- SCHEDULED PRACTICE TIME – This worked best for our family! I found if I didn’t set a specific time it just didn’t happen. It also works well when you need to do specific, prescribed activities, eg literacy tasks, specific handwriting activities.
- SETTING UP A BOX OF ACTIVITIES AND LETTING YOUR CHILD GO FOR IT. This can be brilliant! Work on finger strength, dexterity, pencil skills, sensory processing, oral motor activities can all be achieved by your child with minimal support if you set them up with fun activities. This is part of the reason we’ve made up the therapy kits you can see on the Skillbuilders website. These kits give parents (and teachers) a simple, practical option for helping kids develop specific skills. They provide a good starting point that’s easy to build on.
- A COMBINATION OF ANY OF THE ABOVE. Sometimes you need a combination, eg when you’re working on specific muscle stretches along with general work on muscle tone, and sometimes you just need a change of approach to re-charge your enthusiasm.
A point on maintaining enthusiasm…..
For yourself – Ask yourself – “What will it look like when my child has sorted out this developmental glitch?” eg Toby will be able to use scissors as well as his peers, then break this skill down into VERY observable steps so that you can really see his progress and not be vague about it. This will help you be clear about his progress and this motivates you to keep up your efforts.
For your child – FUN FUN FUN – try really hard to incorporate fun at every opportunity. Kids will practice the activities spontaneously if they enjoy them.