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Development of Reach & Grasp
Development of Reach & Grasp
Reach develops before grasp
Perfecting the previous phase of grasp overlaps with the development of the new phase of reach develops
Exploratory: swipes - cannot combine reach with a grasp
Around 2-3 mons, squeezing begins with 2-5th digits (ulnarly), no thumb
No control for release (grasp)
do not have coordinated grasp & release at early phases
Perceptual Learning: more accurate reaching, reaching towards midline (e.g. a bottle)
Around 6 mon can reach & grasp with 2 hands
Radial palmar & radial digital grasping patterns with the thumb now involved
Smoother release, but cannot grasp small objects fluidly yet
Skill Achievement: accurate, smooth reaching, where they can carry things as they move
Around 12 mons, pincer grasp develops, using more distal grasping & precise, voluntary release
***PROXIMAL STABILITY LEADS TO DISTAL MOBILITY
Infant Grasps
4 mons - Ulnar raking & grasping develops first
5 mons - Grasp then shifts to medial hand
6 mons+ - Grasping with radial side develops
18-24 mons
stacking 1" blocks
distal grasping of a crayon to make simple strokes
bimanual use to string large beads
completing 4-5 piece inset puzzles
exploring scissors, and using two hands to open & close, but unsure of the exact use
Inset puzzle
2-3 years
begins snipping (visual-motor skills) to work on squeezing/releasing, but not cutting fully
digital pronate grasp on crayon, drawing circles & tracing other shapes
builds higher towers to do simple constructions
complete simple interlocking puzzles with visual cueing behind
Digital Pronate Grasp
3-4 years
begins cutting along straight lines, curved lines with fair accuracy, beginning to stabilize with the opposite hand, but thumb is usually down
precision grasp on writing instruments to copy simple shapes & letters (uppercase of name first) - more movement from fingers rather than wrist
simple constructions like bridges, emerge
Interlocking puzzle skills emerge better, benefiting from visual behind
hand preference emerges
4-5 years
hand dominance emerges (by 5 yrs)
using dynamic tripod grasp
interlocking puzzle skills with 12+ pieces
can cut simple shapes like squares/triangles with thumb up position for opposite hand
Grasping Patterns
Grasping Patterns
Cylindrical grasp: e.g. holding bottle, glue stick, fork
develops functionally after 12 mons
Tip pinch: more tip of the fingertip than fine pincer grasp, e.g. using really fine beads
Hook/Snap grasp: e.g. opening cabinets/drawers/doors
Palmar grasp: item is tucked into the palm,
Lateral grasp: e.g. keys/cards
Spherical: e.g. door knob, throwing a ball
Handwriting = visual motor skill
Combines a motor element (grasping, hand skills, etc) with a visual perceptual element (letter formation, drawing, etc)
Continue to develop beyond age 5
Evaluation & Assessment
Evaluation & Assessment
Battelle (Motor Section)
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HELP (Fine Motor)
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M-FUN
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Peabody (Fine Motor Scales)
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Erhardt Developmental Prehension Assessment (EDPA)
Erhardt Developmental Prehension Assessment (EDPA)
Erdhardt.pdfIntervention
Intervention
Strengthening is important!!
Proximal stability leads to distal mobility
evaluate hyperextension of joints, tone, hand muscle strength
Examples to promote strength & stability of digits
Spray bottles
Mr. Hungry (tennis ball made into a face & feed coins, beads, etc.
Tongs (resistive or regular)
Clothespins
Theraputty (risk of getting eaten or making a mess)
McKie Splint
provides stability at the MCP joint
helpful for those with hypotonia or joint laxity
utilized during fine & visual motor interventions to provide stability
continue strengthening!
Constraint-induced Movement Therapy (CIMT)
splinting the unaffected limb to encourage use of affected limb
true treatment course is intensive - multiple hours each day
utilize a modified approach
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