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Pencil Grasp - When to be concerned

Sunday, January 11, 2015

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