Hand Function in the Child

Assessment of in-hand manipulation by occupational therapists in paediatric practices in South Africa

“…When considering that 60% of a school-going child's day is concerned with the fine motor task of writing 18 , it is understandable that practitioners focus on these tasks, specifically when poor in-hand manipulation is suspected. The activity of cutting provides a good opportunity to observe the simple shift movement of the supporting hand as the fingers adjust the paper for cutting 2,4 . In-hand manipulation required to adjust writing utensils includes both complex and simple rotation when correctly orientating the pencil, and complex shift when positioning the fingers on the shaft of the pencil or crayon 3,14 .…”

“…In-hand manipulation is the complex skill of adjusting an object using different movements of the fingers for more effective placement. It enables a child to handle and place items, such as shoelaces or puzzle pieces, with more precision 2,20 as well as allowing an efficient pencil grasp needed for refined and controlled movements during drawing and writing 8,21 . The six components of in-hand manipulation as described by the Modified Classification System 3 , are finger-to-palm translation to achieve stabilisation, palm-to-finger translation, simple and complex shift, and simple and complex rotation.…”

“…This should include the assessment and treatment of poorly developed in-hand manipulation skills. In the context of paediatric practices, in-hand manipulation is inherently linked to the proficiency with which a child performs scholastic, self-care and play tasks [2][3][4][5] . Children with in-hand manipulation delays are often characterised as 'clumsy', with slow and messy fine motor skills 6,7 , or they present with handwriting difficulties 4,8,9 .…”