Tag Archives: fine motor

The Hypermobile Hand

 

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I just received another referral for a kid with “weak’ hands.  Can’t hold a pencil correctly, can’t make a dark enough mark on paper when he writes or colors.  But his mom says he has quite a grip on an object when he doesn’t want to hand something over.  He plays soccer without problems and otherwise functions well in a regular classroom.  Could it be that hypermobility is his real problem?

Some children display problems with fine motor skills due to low muscle tone alone.  Many times, their low tone is significant enough to create poor joint alignment and stability, resulting in joint hypermobility as well as low muscle tone.  But kids can have joint laxity with typical muscle tone.  Assessing the difference between tone, strength, alignment and endurance is why you get an evaluation from a skilled therapist.  And even then, it can be tricky to determine etiology with the youngest children because they cannot follow directions or answer questions.  Time to take out your detective hat and drill down into patient history and do a full assessment.

With older kids, both low tone and joint laxity can lead them over time to develop joint deformity.  Like a tire that you never rotated, inappropriate wear and tear can create joint, ligament and tendon problems that result in worse alignment, less stability and endurance, and even pain.  And yes, weakness is often observed or reported, but it often is dependent on posture and task demands, rather than being consistent.

What does the classic hypermobile hand look like?  Here are some common presentations:

  • The small joints of the fingers and thumb look “swaybacked”, as the joint capsule is unstable and the tendons of the hand exert their pull without correct ligament support.
  • The arches of the hand aren’t supported, so the palm looks flat at rest and during grasp.  By late preschool, the arches of the hand should be evident in both states.
  • The fleshy bases of the thumb and pinky ( for all you therapists, the thenar and hypothenar eminences) aren’t pronounced, due to the lack of support reducing muscle development during daily use.
  • Grasp and pinch patterns are immature and/or atypical.  A preschooler uses a fisted grasp to scribble, a grade-school child uses two hands to hold an object that should be held by one hand and a “hook” grasp on a pencil.
  • Grasp and pinch may start out looking great, and deteriorate with the need for force.  Or prehension begins looking poor and improves for a while, until fatigue sets in.

Don’t forget that hypermobility creates poor sensory processing feedback loops.  Reduced proprioception and kinesthesia will result in issues grading force and controlling movement without compensation such as visual attention and decreased speed.

For ideas to address the difficulties children face when they have hypermobility in their hands, take a look at For Kids With Sensory and Motor Issues, Add Resistance Instead of Hand-Over-Hand Assistance and Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility?.  Depending on the age and skill level of the child, adaptations and education can be just as important as therapeutic exercise.

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Want Pincer Grasp Before Her First Birthday? Bet You’ll Be Surprised At What Moves (Hint) Build Hand Control!

The image of a baby popping cereal into her mouth and grinning is commercial genius.  But what if your child is still raking them with a fist at 8 months?  Is that late or just right?  Is there a way to promote early grasp without offering a baby something tiny that she can choke on?  Only if you know the many ways grasp is developing in those first months of life.

Motor skills do not appear out of the blue.  There isn’t a switch that goes on to suddenly release the ability to roll or the ability to hold a bottle.  That’s true for my clients in Early Intervention as well.  Some have serious medical challenges, and some have yet to be diagnosed with ASD or a genetic disorder.  But no skills just pop out without foundational abilities first.

Motor skills start developing in the womb, folks. A premature arrival has medical consequences, but it also deprives a child of the motor and sensory development that naturally occurs while floating in a very active and progressively smaller apartment.  Some children catch up quickly and some do not.   What happens after birth will make a huge impact on the way movement skills are acquired and refined every single day after birth.

If you go shopping at a baby emporium, you would think that they sell toys that are absolutely essential to development.  Reading the labels, you’d think that hand control just couldn’t happen without a Whoozit or a Taggie toy.  Guess what?  Human beings have been developing pincer grasp long before Toys R Us came along, and as far as I know, infant development did just fine without them.  What makes a difference is what exposure and encouragement a child has to build his skills.  Fun toys can motivate a child, but they aren’t the most powerful tool I know to develop grasp.

Here are the great hidden things that build early fine motor skills:

  • Crawling:  I know, there is a big internet debate about whether crawling is necessary for walking.  Here is what I do know:  it is great for developing arm strength and control through the wrist.  It is amazing for building the arches of the hand that allow a child to curve the palm and bring fingers together.  Bonus Round:  crawling with objects in the palm.  Your baby will eventually move the toy toward the thumb-side of her hand so that she can put her weight on the pinky-side while crawling.  One hand, two different uses = better refined control.
  • Reaching While in Tummy Time:  Big-time hand skills develop in this position, especially when babies have to push way up while reaching.
  • Reaching Up While Lying on the Back:  All that abdominal strength is core, core, core stabilization, plus hand control without any arm support.  I make first-graders do exercises in this position before we work on handwriting.  It works.
  • Pivoting around on the Belly.  I love the pivot!!  I took a training course from a PT about 15 years ago that transformed my understanding of this move.  Your little one will be working arms, legs, core, neck, and I saved the best for last.  As she reaches and pivots, she will be using her hand in all directions as she leans on one side of her hand first the front, then the heel of her hand, etc…  Magic can happen for so many other skills using this move, but the biggest secret is how it develops hand control!

Good luck, and have fun developing great hand control before that pincer grasp emerges!!