Isolation of index finger in grasp

After doing "heavy work" activities for development of proprioception in the hands, then it's time to move on to activities which encourage isolation of individual fingers, especially the development of pincer grasp with the index finger and thumb.  

Using the miniature Connect Four game, we can encourage the use of a pincer grasp by the use of a little cup to hold the tiny checkers.  Now the child can't grasp the checker with a gross grasp or with all his fingers; he has to isolate the index finger to reach down into the cup to get a checker.

You can change the activity slightly by asking the child to hold the cup in one hand, while grasping and placing the checker with the other.  Now it is an activity which also requires bilateral coordination with differentiation of function of the two hands, that is, the use of both hands with each hand performing a different function.

Gee, it's a geoboard

Remember those mittens? Here's a good example of an older kid who still uses his hands as if he's wearing mittens. He uses his four fingers together to pick up a small checker, rather than using a more precise pincer grasp with the index finger and thumb. That's what is called poor differentiation of the two sides of the hand and of the fingers. The thumb, rather than forming a nice rounded space between it and the index finger, pulls in towards the palm. That indicates underdevelopment of the thumb's webspace. This kiddo needs more proprioceptive input to increase that internal awareness of each finger and its movement and position in space.


Another activity that provides proprioceptive input to the fingers is playing with a geoboard. The board has a grid of pegs on which the child can stretch rubber bands to make shapes and designs. Stretching the rubber bands usually encourages the child to isolate the index and middle finger, or just the index finger alone. The stretch provides traction to those fingers, which provides proprioceptive input.



Using a geoboard does require a moderate degree of coordination and motor planning, but if the child is having difficulty, you can help stabilize the band on a peg or two to prevent them from slipping off.



The geoboard also provides reinforcement of shapes and colors. You can ask the child to copy your shape, or you can ask if he can make a yellow square, green triangle, etc. For more advanced play, you can even print diagrams of the board and see if the child can copy the design from the printed example.



Geoboards are available at educational supply stores.

Pig in the putty

An activity that is frequently used by OTs is working with therapy putty. Small objects such as marbles or miniature toys can be hidden in the putty and the child must squeeze and pinch the putty to find the objects. It is important to vary the activity to sustain the child's interest. You can hide different objects each time. You can also make a game out of the activity by dividing the putty in half and both you and the child can search for the objects in one of the two wads of putty; whoever has the most objects wins. Or you can have the child select one object to be the winning object (for example, the "magic pig") and whoever finds that object wins.

The purpose of working with therapy putty is twofold. First, it provides proprioceptive input to the hands and fingers. Proprioception is "the normal awareness of one's posture, movement, balance, and location based on the sensations received by the body's proprioceptors" (Webster) located in tendons and joints. "Heavy work," such as moving against resistance, pounding, pushing, stomping, and pulling, all provide proprioceptive input which increases the child's awareness of position and space. So squeezing and pinching the putty provides proprioceptive input to the fingers, which helps the child develop awareness of the movement and position of individual fingers. The second purpose of the putty activity is to improve the strength of the small muscles of the hand and fingers.

Please note that, while putty is non-toxic and does not contain latex, it sticks to clothing and is hard to get out. So it's a good idea to work at a table with it and to use a painting smock.

Discard those mittens!

In a typically developing child, the development and refinement of grasp is incredibly swift. In a few short months, the baby moves from this

to this.

But children who have various developmental problems usually develop these skills more slowly and need some intervention to facilitate their progress. Delays in the refinement of grasp and fine motor function may occur due to spasticity, lack of stability in the trunk and shoulders, poor sensory processing, weakness, or poor coordination.

Some of these older children may still be using the gross grasp the baby is using in the first picture. It is almost as if they are trying to grasp and manipulate objects with mittens on. Imagine performing any fine motor task, such as putting pegs in a board or buttoning your shirt, with mittens on your hands! You would not be able to use fingers individually nor would you be able to adequately feel the objects in your hands. This is how many of our children are trying to accomplish what they want or need to do.

So what we want to do is help them discard those mittens. We want to improve their inner awareness of their hands and fingers (proprioception). We want them to improve their ability to accept and discriminate tactile input. We want them to have adequate hand and finger strength to accomplish age appropriate tasks such as taking Legos apart or pulling the cap off a marker. We want them to use each finger individually so they can pick up that last crumb of cookie or hold a pencil correctly.

Whew! We want a lot, don't we? But it doesn't have to be done overnight and it doesn't have to be drudgery. You also don't have to run out and buy a lot of expensive toys. As a home health therapist, I had to provide all of my own materials for therapy, so I usually tried to find inexpensive toys or devise my own games which would help my patients develop the desired skills. I don't claim that all of the ideas I'll present here are original, as I've drawn on the expertise of others, too. I hope the ideas I share here will be helpful to you and your child or patients.