Hand skills

 Our hands are vital in so many of the tasks that we do each day. Hands help children to communicate, play, participate in school-work and carry out the everyday things they need to do. These tasks can be more difficult for children with physical disabilities. This page provides practical information about how Novita Children's Services occupational therapists help such children to use their hands in the best possible way.

On this page

Issues children have using their hands

There are many different reasons a child may have difficulty using their hands. Their skill in using their hands not only depends on their physical ability, but also on their ability to think, plan and organise what they want to do.  In other words, a child must understand the task, know what to do and how to do it. They must also be physically capable of doing it.

Difficulties with hand skills can be due to:

Top of page contents

How occupational therapists help

Occupational therapists help children to use their hands to the best of their ability in a number of ways that depends on the nature of the problem and what the child wants to be able to do. Occupational therapists are able to analyse tasks and observe a child’s actions to discover which part of a task the child is having difficulty with and why. Occupational therapist's may ask  questions such as:

  • What does the child need to do?
  • which hand do they prefer?
  • what do they do with their non-preferred hand?
  • does the child understand what to do?
  • can they plan what to do?
  • can they organize to do tasks with the right tools and in the right order?
  • do they have the physical skills?

Some children will have the physical ability but limited understanding, others may know exactly what to do but are physically restricted.

Occupational therapists recognise that some difficulties can be overcome with correct training and practise. Other physical difficulties cannot be overcome in this way and instead, modifications need to be made to the child's environment or the task for the child to succeed.

Disclaimer: General information only - you should consult with the relevant professional before using it with a particular child.  See disclaimer details.

The following are some ways a therapist may get involved to help improve a child’s hand skills:

Positioning

Occupational therapists and physiotherapists help to position children so that they can best use their hands for their various daily activities. For example, a seat that provides good support and a table at the right height is a vital part of ensuring that a child can use their hands well.

Top of page contents

Improving skilled use of hands

Girl and boy fingerpaintingOccupational therapists work on improving the hand skills a child already has. For example, occupational therapists may recommend activities and ideas aimed at improving the strength and co-ordination of children's hands. These might include things like pinching play dough, finger painting and squeezing sponges to help increase pinch strength.

 Read Sarah's story

Helping the child to get the best use of their hands

Occupational therapists often do this by using hand splints to prevent deformities that may occur or provide a more functional position for the hand. They can also help to organise appointments for the child to see specialists if it is thought that surgery or other medical support might be of value. If surgery to improve hand function is undertaken, the majority of rehabilitation is carried out by the occupational therapist.

Suggesting new ways of doing things

Often the occupational therapist will suggest some new and clever ways that the child can do the things that they want.

Providing equipment

Sometimes equipment can assist with difficulties that the child may have with fine motor skills.

  • A computer keyboard or small word processor may be tried to see if it is quicker and easier than handwriting at school
  • Velcro fastenings may be tried to see if they are quicker to use than shoe-laces
  • A hand splint could help someone to pick up small objects.
  • Adapted tools may assist children to be able to draw, paint, eat with cutlery and dress themselves.

Top of page contents

Hand splints

Hand splints may be suggested by occupational therapists for the following reasons:

  • To lessen deformitiesDeformities are caused when the muscles and tendons become permanently shortened. This causes the hand to become fixed in a set position, making it hard to use to do every day things such as playing or dressing. They can also lead to skin breakdown in skin folds, due to poor air circulation. A hand splint may be used to prevent this and to increase the movement of the joint and the muscle lengths around the joint. This may help to keep the skin healthy and may also help to make the hand and wrist rest in a more natural position.
  • To improve the way the hand works -  for example, a splint may help to position the thumb and wrist so that the child is better able to pick up and hold objects.

Disclaimer: General information only - you should consult with the relevant professional before using it with a particular child.  See disclaimer details.

Hand splints are different in how they look and the way they are made, depending on their purpose. They can be moulded to fit the child’s hand from special materials such as:

  • Thermoplastic™
    Thermoplastic splint - photo
  • Lycra
    Lycra hand splint - photo
  • softer materials, such as neoprene, leather and denim
    Soft wrist splint - photo

Top of page contents

Hand surgery

In some special cases, hand surgery may be looked at to help to improve hand and arm function. This choice is usually considered only after a number of other things have been tried. Types of surgery vary, depending on what the child needs and the hand skills that the child has at the moment. Families can be supported by the Novita occupational therapist in the Physical Rehabilitation Program to make the sometimes difficult decisions about whether or not hand surgery or other medical methods may be helpful.

The Upper Limb Clinic at the Women’s and Children’s Hospital

At the clinic, a paediatric orthopaedic surgeonpaediatric rehabilitation physician and the occupational therapist from the Physical Rehabilitation Program can talk over with the parent and their child all the details about possible surgery and how it might help. Clinic appointments are usually booked through the senior ccupational therapist in the Physical Rehabilitation Program.

Ways of managing problems (such as increased muscle tightness and improving hand function) that avoid surgery can also be discussed.

Top of page contents

For further information

Send an on-line message to a Novita occupational therapist or contact one of the occupational therapists based at each of the Novita regional offices.

The Novita Toy and Resource Centre has a range of books with information on hand function. Ask your regional occupational therapist for more information on resources and ideas for particular activities to develop hand skills.


Disclaimer Detail: The above information on is of a general nature only and does not constitute advice. Novita Children's Services makes no representations, express or implied, as to the accuracy, usefulness, suitability or application of the information to a child's particular circumstances. Use of the information above is at your sole risk, and you should seek professional advice before acting or relying on the information. Novita Children's Services accepts no liability for any damages or loss that may arise from the use of, or any omission from, the information provided. In using this site, you are agreeing to the Terms and Conditions of Use for the site. 

Glossary

Ataxia

Inability to balance, that may affect walking, talking, hand use and speech.

Deformity

Abnormal position of any part of the body due to shortening of the muscles and tendons. Deformities may be fixed or may change to different positions.

Dexterity

Ability to coordinate fine movements of the hands and fingers.

Fine motor skills

The ability to use hands and fingers, for example, reaching for, picking up, holding and exploring objects with the hands, using a pencil or other writing tools, using scissors, managing zips, buttons and shoelaces.

Intellectual disability

An intellectual level significantly below average (assessed IQ less than 70), occurring before the age of 18 years. This must be combined with related limitations in two or more of the following areas: communication, self-care, home living, social skills, community awareness, self-direction, health and safety, functional academics, leisure & work.

Motor planning

The ability to plan and carry out a movement in the correct order and timing when doing a task. Motor planning is critical in learning a new movement or skill, such as riding a bike. Eventually new skills can become automatic, like writing or catching a ball.

Muscle tone

The level of tension in the muscle.

Neurological

Having to do with the body’s nervous system.

Paediatric Orthopaedic Surgeon

A doctor who has had 4 to 5 years of full-time training in diseases and injuries to bones, joints and muscles, has passed the examination for the Royal Australasian College of Surgeons and who has additional training in children’s problems.

Paediatric Rehabilitation Physician

A paediatrician who has had a further 3 years full-time training in disability rehabilitation for children and young adults, and who has passed the written and clinical examination of the Faculty of Rehabilitation Medicine.

Physical disability

A restriction or lack of ability that limits the person’s physical functioning.

Spasticity

The increased stiffness or ‘muscle tone’ experience by children with cerebral palsy. Muscle spasm can often be felt when such a child’s limbs are moved. The limbs are hard to bend or straighten because of the spasticity of the muscles. The doctor usually finds increased tendon jerks in a child with spasticity.

Splint (hand)

A custom-made or ‘off the shelf’ support which is worn on the hand to hold it in a fixed position - usually made from materials such as low temperature thermoplastic (plastic material which is mouldable when heated), neoprene and lycra.

Tendon

Structure that joins muscle to bone.

Top of page contents