1. Hand Development Dr. Deepa sharma(OT)
General Introduction
Hand Development
Dr. Deepa sharma(OT)

2. Postural Influences hand development
Posture
Human posture can be defined as, “the position of one or many body segments in relation to one another and their orientation in space” (Ham et al, p26). The head, trunk, pelvis, lower limbs and feet are known as body ‘segments’, while spinal joints, hips, knees, ankle and shoulder joints are considered the body ‘linkages’ (Pope 2002).
Human posture is influenced by a number of interconnected factors:
muscle tone (i.e. high or low)
body shape and size (i.e. height and weight)
gravity
the surface (e.g. uneven ground, slopes, sand, footwear)
the task in hand
length of time required to be in a particular posture
level of health, well-being or emotional state

3. How posture develops
When babies are born they have a predominantly flexed (C-shaped) posture with two primary spinal curves known as the thoracic curve (mid back) and sacral curve (bottom)
Image 1
In the usual sequence of events, babies move through developmental stages almost seamlessly
Thoracic curve
Sacral curve

4. Postural control requires achieving normal developmental milestones and includes the maturing of postural reactions (righting, protective and equilibrium reactions), the integration of primitive reflexes (asymmetrical tonic neck reflex, symmetrical tonic neck reflex, tonic labyrinthine reflex), as well as normal muscle tone, normal postural tone and intentional voluntary movements (Wandel 2000).
As they learn postural control against gravity their spines develop secondary extension curves
in the cervical (neck) region first (holding their heads up against gravity when on their tummy or hands and knees) and lumbar region (lower back) as they gain sitting and standing balance
Cervical curve
Lumbar curve

5. The Foundation Proximal Stability
Proximal is a term that means “towards the center” or the midline of the body. Trunk muscles work together to create an upright and stable posture so that the fingers have a solid platform to develop precision movements.
Distal Mobility
Distal means towards the extremities or ends of our body, like the fingers. When a student writes letters by moving the pencil with the fingers, they are demonstrating “distal mobility”. Distal mobility can not be achieved without proximal stability as a platform.
The Foundation
Proximal Stability

6. Sensory Processing Proprioception
proprioception is the ability to feel one’s own body position in space. There are a multitude of nerve endings in our joints called proprioceptors. These receive input when the joints are compressed from gravity, deep pressure or heavy work activities like jumping.
Vestibular
The vestibular sense is activated through our inner ear and helps us with balance, movement sense and allowing us to know where our body is in space. It is stimulated by swinging, riding a bike, jumping on a trampoline or any other movement that activates the inner ear. Our vestibular center helps us organize and interpret sensory information.
Tactile Discrimination
Tactile discrimination is the ability to feel and discriminate tactile qualities. The hands have many touch sensors in the palm. This sense of touch and the ability to interpret it accurately is integral to performing fine motor tasks.
Kinesthesia
Kinesthesia is the ability to feel one’s own body as it moves through space. Body awareness in space is integral to developing concepts such as boundaries and visual perceptual skills. .
Sensory Processing

7. Crossing Midline
This is the ability to cross over an imaginary line running through the center of our body. A child with midline problems will often switch hands depending on which side the marker or crayon is placed. The ability to cross midline is important in developing efficient motor patterns as well as being able to draw letters. A student with midline problems will draw a cross by drawing the horizontal line as two separate lines, one on each side of the vertical line Bimanual Hand Use
The use of both hands in a lead-assist relationship. Usually one hand stabilizes the task (holds the paper) while the other manipulates the task (cuts the paper).
Bilateral Integration
Bilateral integration is a sophisticated combination of sensory processing. If the student’s sensory processing is developed properly, the student will be able to coordinate the two sides of the body to accomplish functional tasks.
Motor Planning
Motor planning is the ability to perform a novel motor task without difficulties and transfer the learned movement patterns to a new task. Motor planning is required to learn and remember any new task.

8. Visual processing Visual Acuity
Visual acuity is the ability to see things clearly. It includes distance and close vision as well as depth perception.20/20 vision?
Visual Perception
Visual perception is the ability to see, discern and recognize shapes visually. If a student does not accurately perceive a square, then he can not draw a square. The student uses visual perception to recognize subtle differences between letters such as an “f” versus a “t” or a “t” and an “x”.
Visual Motor
Visual motor skills are the ability to draw or reproduce what one sees. Visual motor skills are also involved in activities such as copying block configurations, tracing along a maze, and cutting along a line. Without visual-motor skill development, the student can not be expected to write letters.
Visual processing

9. Writing Readiness (Pre-Writing) Skills:
what are writing readiness (pre-writing) skills?
Pre-writing skills are the fundamental skills children need to develop before they are able to write. These skills contribute to a child’s ability to hold and use a pencil, and the ability to draw, write, copy, and colour. A major component of pre-writing skills are the pre-writing shapes. These are the pencil strokes that most letters, numbers and early drawings are comprised of. They are typically mastered in sequential order, and to an age specific level. These strokes include the following strokes: l, -, O, +, /, □, \, X, and ∆.
Why are writing readiness (pre-writing) skills important?
Pre-writing skills are essential for a child to be able to develop the ability to hold and move a pencil fluently and effectively and therefore produce legible writing. When these skills are underdeveloped it can lead to frustration and resistance due to the child not being able to produce legible writing or keep up in class due to fatigue. This can then result in poor self esteem and academic performance.

10. Building blocks necessary to develop writing readiness (pre-writing) skills:
Hand and finger strength: An ability to exert force against resistance using the hands and fingers.
Crossing the midline: The ability to cross the imaginary line running from a person’s nose to pelvis that divides the body into left and right sides.
Pencil grasp: The efficiency of the manner in which the pencil is held, allowing age appropriate pencil movement generation.
Finger isolation
Hand eye coordination: The ability to process information received from the eyes to
control, guide, and direct the hands in the accomplishment of a given task, such as handwriting or catching a ball.
Bilateral integration: Using two hands together with one hand leading (e.g. opening a jar lid; with the other and helping - e.g. stabilising the jar).
Upper body strength: An ability to exert force against resistance using the upper body and arms.
Object manipulation: The ability to skilfully manipulate tools, including the ability to
hold and move pencils and scissors with control, controlled use of everyday tools such as a toothbrush, hairbrush, cutlery.
Visual perception: The brain's ability to interpret and make sense of visual images seen by the eyes.
Hand dominance: The consistent use of one (usually the same) hand for task performance, which allows refined skills to develop.
Hand division (just using the thumb, index and middle finger for manipulation, leaving the fourth and little finger tucked into the palm not participating).

11. Has an awkward pencil grasp.
Has difficulty controlling a pencil for drawing.
Shows a tendency to use their whole hand to manipulate objects rather than just a few fingers.
Has poor endurance for pencil based activities.
Displays messy and/or slow handwriting.
Has difficulty staying within the lines when colouring.
Applies inappropriate pressure to the paper for pencil based activities (either too heavy and frequently breaks the pencil, or too light and ‘spidery’).
Has poor upper limb strength.
Has difficulty coordinating both hands for two handed tasks.
Has poor hand-eye coordination.
Is verbally skilled but has difficulty showing this on paper (i.e. writing, drawing or colouring).
You can tell there are problems with writing readiness (pre-writing) skills if the child:

12. Pre-writing Expections
Age
Pre-writing expectation
1 – 2 years
Randomly scribbles
Spontaneously scribbles in vertical/horizontal and/or circular direction
Imitates a horizontal/vertical/circular direction
2 – 3 years
Imitates a horizontal line
Imitates a vertical line
Imitates a circle
3 – 4 years
Copies a horizontal line
Copies a vertical line
Copies a circle
Imitates a cross
Imitates a right/left diagonal
Imitates a square
4 – 5 years
Copies a cross
Traces a line
Copies a square
Copies a right/left diagonal
Imitates an X
Imitates a triangle
Grasps pencil in writing position
5 – 6 years
Copies an X
Copies a triangle
Recognises between a big and small line or curve

13. When you see difficulties with writing readiness (pre-writing) skills, you might also see difficulties with:
Behavior: May avoid or refuse to participate in fine motor tasks.
Self esteem: A person's overall sense of self-worth or personal value.
Academic performance: The ease with which a student is able to complete academic tasks.
Self care: Involves the everyday tasks undertaken to be ready to participate in life activities (including dressing, eating, cleaning teeth).
Avoidance: Preference to get others to perform fine motor tasks for them under their
direction, rather than actually doing themselves (e.g. “Daddy, draw me a house”, or “build me a rocket”, with refusal to do it themselves).

14. What can be done to improve writing readiness (pre-writing) skills?
Hand dominance: Determine which the dominant hand is and reinforce its frequent use in precision task performance.
Experience: Encourage participation in activities that involve grasping and
manipulating small objects such drawing, puzzles, opening containers, threading or other related tasks.
Poking and pointing: Practice tasks that use just one or two fingers (not all at once)
e.g. poking games.
Praise and encouragement when your child engages in fine motor activities, especially if they are persistent when finding an activity difficult.
Hand and finger strength (e.g. scrunching, paper, using tweezers, play dough, pegs).
Sensory play activities (e.g. rice play, finger painting) to assist the development of tactile awareness.
Hand-eye coordination: Practice activities that involve hand-eye coordination (e.g. throwing and catching) and crossing the midline (e.g. reaching across the body to pick up items).
Upper limb strength: Encourage play activities that develop upper limb strength (e.g. climbing ladders, wheelbarrow walking).

38. Activities that can help improve writing readiness (pre-writing) skills include:
Threading and lacing with a variety of sized laces.
Play-doh (playdough) activities that may involve rolling with hands or a rolling pin, hiding objects such as coins in the play dough or just creative construction.
Scissor projects that may involve cutting out geometric shapes to then paste them
together to make pictures such as robots, trains or houses.
Tongs or teabag squeezers to pick up objects.
Drawing or writing on a vertical surface.
Every day activities such as opening containers and jars.
Pre writing shapes: Practice drawing the 9 prewriting shapes (-, l, O, +, /, \, X, ∆, □).
Finger games: Incy wincy spider.
Craft: Make things using old boxes, egg cartons, wool, paper and sticky or masking tape.
Construction: Building with duplo, lego, mobilo or other construction toys.

39. Why should you seek therapy if you notice difficulties with writing readiness (pre- writing) skills?
To improve ability in and persistence with fine motor tasks.
Increase school readiness.
To help a child to complete self care tasks, such as doing up buttons and zips.
To avoid a child becoming disengaged in an academic environment due to difficulties completing fine motor activities (e.g. writing, cutting, drawing).
To avoid frustrations experienced by parents, teachers and children when a child is struggling to remain engaged in academic activities.
To help maintain and develop a positive sense of well being.
To ensure that a child doesn’t fall behind their peers in development of handwriting.

40. Left untreated, difficulties with writing readiness (pre-writing) skills can lead to:
Difficulties meeting academic criteria due to poor handwriting skills and rapid fatigue.
Difficulties mastering letter formation.
Excessive pressure and anxiety in a school-aged child due to difficulties keeping up in class.
Difficulties completing exams due to difficulty answering all written questions within the allocated time.
Poor self esteem when a child compares their abilities with their peers.
Difficulties filling in forms, such as job and rental applications.
Difficulty developing efficient typing skills.
Difficulty manipulating items for construction (puzzles, lego).

41. Non prehensile
Pushing
Touching
Pressing down
Tapping
feeling

42. Prehensile patterns Precision grips palmer pinch tip pinch
lateral or key pinch
three jaw chuck
Power grips
cylindrical grip
spherical grip
hook