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Writing hypermobile finger splints(88 Posts)
Ds has hypermobile middle knuckle joints in each of his fingers and probably very loose connection across the knuckle joints. They cause him a lot of pain and he finds writing difficult. If I support his hand he writes surprisingly well. Soft pens and slippery surfaces help too.
I wonder if any of you have tried splints or supports. I was thinking something like this
I'm worried about the level of pain he experiences and if damage is being caused long term. I would also love him to be able to write unaided, not least because it looks lik I am doing the writing IYKWIM and he definitely is!
zzzzz How old is DS and what is his diagnosis?
AFAIK finger splints such as those are most commonly used for Rheumatoid Arthritis.
Using some form of splinting wouldn't be the usual first step in helping a child with hypermobility.....things like increasing the girth of the writing pen (like this ), using a writing slope, reducing the amount demanded by school, using a typewriter instead.
Have you tried any of those?
I use a wrist splint for writing and typing. It is hard to use at first and you need to get used to it but it helps a lot with pain in my hand. I was given mine by the hospital.
With DS I use big pencil grippers at the moment which seem to be working.
porridge he has other sn but no formal dx yet, he has a severe language disorder but high IQ.
We have used larger pencils, whiteboards slopes etc. ds is HE and I want to facilitate his writing, not look for an alternative (he uses other methods of producing text routinely). He is 7.
I am aware finger splints are not the normal route, but wonder if anyone has used them. The other thing that looks promising cups the lower half of the hand in hard plastic. I think this might work as he could pivot on it to write.
Most of the pain seems to be in his little finger. His control is very good with support.
Ds's education is tailored entirely to him. He is unlikely ever to be able to write for long, but I would like him to be able too, if possible independently.
Hi zzzzz, my ds has very hypermobile fingers too, our OT did a session just testing out a huge range of aids for writing, and actually found that noodle doodles were best for him. They are just soft tubes which make the pen less slippery and softer. The difficulty with writing with hypermobile fingers is the tendency to grip the pen rigidly to compensate for the lax joints, which then causes strain. Using a soft rather than hard grip can be better. Also don't worry about how he holds the pen, let him find his own hold which is comfortable for him (although actually I can't imagine you forcing anything )
OK at 7 I would expect that yes, you would continue to work on handwriting.
In handwriting, the hypothenar eminence, at the base of the little finger provides most of the stability to the hand. This allows the rest of the hand to be mobile for handwriting.
Pain there would suggest 2 things to me 1) that he is pressing hard to get more stability (which is not there due to the hypermobility) and 2) to wonder how stable the rest of his upper limb is.
When he is writing, can you have a look at his posture? Does he find it easier to write sitting or standing? Does he wrap his legs around his chair legs, is he 'falling' onto the table surface?
Sorry, lots of questions, but in handwriting, it's rarely a question of just looking at the hand in isolation.
polter (you are beginning to know me far too well) yes soft tubes are helpful and I must try a bit harder with them. The young man in question is quite writing adverse but I have identified a chink in his armour and intend to take full advantage of his oversight. . Those tubes look good. I will buy some.
porridge. Oooh how technical. Fair warning I am pretty shameless in milking experts for useful strategies.
1) he doesn't press at all really. His hands are soft and have very little strength unless he is tantruming. He won't rest on the page at all, but will rest in the cup of my hand (warm and soft?) and this also helps with hieght/ finger placement. He finds making hard marks type pressure almost impossible.
2) posture is not something we are going to be able to address directly with any ease or hope of success. Best writing is done in my lap at table with hand round hand help. Historically he has written well standing on a chair at the white board (slippery pen/surface, larger scale, focus of standing on chair so less fidget, fatter pen, desirable activity/performance).
He couldn't wrap a leg round like that, or at least I have never seen him behave like that. He sits up straight from choice but too far back from the table.
He would hold in a fist if left to his own devices and use the pen like a wand. He holds things all the time (small toys lego etc). I believe this is because it stops his hands brushing against things and hurting.
He writes best on a vertical surface (whiteboard)?
He holds things in a fist? (see here)
Both of these would suggest that developmentally he is not ready for tabletop writing. Now, I realise that in age terms, he needs to be learning letter formation and possibly DS is ready intellectually for that but in motor terms, this suggests not.
I would suggest taping paper to a wall and encouraging writing while standing (for some of his work). I would work on writing in LARGE letters to encourage use of his shoulder girdle while also encouraging correct letter formation and 'encoding' motor patterns around letters.
Some of the other stuff you have mentioned would suggest that he may have difficulty with sensory processing esp in his hand (not uncommon with hypermobility).
Is he ok with messy play e.g. smearing shaving foam on a table and doing 'writing' in the foam?
Would he be ok with playing pat-a-cakes? walking as a wheelbarrow? did he crawl?
He knows all the letter formation. He can read and write. He likes messy play. His problem is not the feel of the table on his hand, more the strength needed to maintain the position and his bottom finger being squished out of place (bones are quite fluid in flesh).
From what you've said here, then I would work on hand strength.
Do you have OT locally?
Sounds as if he needs lots of weight bearing through his hands (promotes strength, increases muscle tone, helps integrate sensory information).
Then work on the intrinsic muscles of the hand ....see here, here and here.
If he has hypermobility in his hands, I presume he has it through his body. So any activities that increase whole body strength, in particular core strength will also help e.g. swimming, horse-riding.
Hi porrige, I was interested to read what you said about wrapping legs around the chair. Dd3 does this and she lies across the table. She rarely uses both hands as she is usually leaning on one.
We have been doing the exercises set by the OT ' s for ages and she had 3 months of phsio but we dont really seem to have seen any improvement.
Do you have any advice?
Sorry for the hijack zzzzz
Those links look brilliant. Thank you, lots of fodder for strengthening. Have added them to the ever growing list of things to research and do. I honestly don't know how we ever had time for school.
I'm not sure how many joints are effected and these issues are perceived to be very minor by professionals in the grand scheme of things. They do impac his quality of life though and also hold him back academically. I am very flexible myself so it is probably an unwanted gift from me. We playdough daily and will be able to think about swimming again soon.
When you say weight bearing with hands does it matter if it is pushing (eg handstand, pushing trolley) or pulling (eg carry weight, dragging), I'm a bit worried about introducing things like that and going too far. Ds is not always able to tell me very accurately about pain.
One of our OT exercises is called person push and it is exactly that, we stand facing each other with our hands palm to palm and Dd3 tries to push me backwards, I have to watch that she doesnt lock her elbows though as she has a tendency to twist the joints.
She also does tug of war with a teatowel and one where she rolls the gym ball up and down the wall. I think these are meant for shoulder stability but I think they work her hands too.
Dd3 is hypermobile in all her joints and as I said she has been seen by OT and physio.
Has your Ds never had an OT assessment zzzzz, if he hasnt it might be worth getting him on a list somewhere.
I agree that it isnt a minor thing, it affects Dd3 everyday.
zzzzz, does ds draw? My ds's writing skills didn't really develop until he'd become more proficient at drawing IYSWIM? With hindsight I'd say he needed the space to freestyle before he could develop any technique if that makes sense. We used to play a lot of drawing games and one was a letter monster game, so we would take turns to draw a letter and the other one would turn it into a monster, again, you probably do stuff like the anyway!
Ineed, 3 months isn't long, do give it more time. Ds took ages to get the hang of writing and then it just happened.
zzzzz...re pushing and pulling activities..both are good. The thing with hypermobility is that the proprioceptive receptors in the joints are not receiving sufficient 'strength' of information during movement (we think...thats why for instance, if you have sprained your ankle, the proprioceptors can be 're-set' to think that the extra degree of mobility is now 'normal' and you are more likely to sprain again).
It is important to grade the movement and monitor. If you are having fun, your brain is switched 'on' to learn. So, it's balancing the safety vs the learning/benefit. Activities where he 'grades' himself are the best way to go. So for instance, you might get him to hold a plank position for 5 seconds today and tomorrow he aims for 6. Then he's pacing himself, but improving IYSWIM.
I dont know your son's medical history (and this isnt the place) but you say his hypermobility is minor in the scheme of things. So core strength is probably the place to focus for most benefit.
Iineedmorepatience the posture you describe is typical of a child seeking more support during writing.
What have your PT and OT said re core strength and endurance?
Time and again (totally outing myself here) I get children referred to me with handwriting problems. And I point out that handwriting is at the top of a 'pyramid' of skills. Its very high level fine motor, visual, perceptual all rolled together. If you have problems in any one of those areas, its going to become evident around 6-7 years as the child is expected to produce fluent handwriting.
So, the initial assessment should be looking not only at the handwriting but also the child's sensory processing, gross and fine motor development, perception, visual-motor integration.
How is your DD at skills like bike-riding, skipping, holding postures e.g. stork. (sorrry about the links but I am doing a quick google so you know what I am talking about).
ooops needed to read the thread before posting, Ineedmorepatience.
If they are already working on muscle strength and joint stability, perhaps DD would benefit from some postural support while writing. That would be a more supportive chair, a tilted writing surface, modified writing implements.
I would also recommend Therapeutic Listening for core strength <ducks> <runs away>
Have you tried testing out different pens to try to find one which causes the least amount of pain? Gel pens are better than pencils/biro's as they only require the lightest touch to make a mark on the paper. I don't think finger splints are the best way to go, it's a lot like sticking a plaster on a bleeding wound. It's still going to bleed, you're just controlling it for a little while. We found pilates a great help.
My DS 5 (6 in feb) has extreme hypermobility in his hands and writing is so difficult for him. The OT discharged him without a thorough assessment after declaring the hypermobility in his hands was the most extreme she'd seen in 15 years! Barely any advice for school etc, said will beed to switch to IT support asap and that its up to school to deliver any intervention, so really not happy. The physio hadn't done an assessment either as I didn't have concerns over his gross motor skills (the OT and physio saw him as part of a multi disciplinary assessment at the CDC)!
I've now gone out of area to the rheumatology dept at a children's hospital and I'm hoping that the physio/OT there will be more supportive.
This noodle doodle pen grips look perfect for him as he has a strange pen grip but the OT said not to correct it as he holds it like that to stop his thumb joint popping out!
A very interesting thread.
Ds saw an NHS physio once. She fell off her horse, the next appointment was cancelled and I didn't hear from them again. By the time I called to see what was going on they had discharged him (without telling or contacting me). The orthopedic doctor's plan of solving ds's ankle pain was surgery to break and reset ds's femurs (thank god that the gait assessment proved he didn't need this). Provision for patients with hypermobility syndrome within the NHS is a joke (as is the DWP's DLA form but I fear I'm starting to rant now).
It can be difficult to understand ds as he is all out of sinc with the norm.
He can write, but it hurts him to write so he doesn't like it. He wouldn't draw for pleasure in the same way you wouldn't use your hand if it was injured. He can pedal a bike with stabilisers, is graceful on a trampoline and can balance, catch a ball. I would say his gross motor skills are good.
We have similar problems with cutlery. His preference is for plastic handles, light cutlery, and fatter handles. He can't use a knife, but is working on it.
I am extremely sneaky by nature and can given time and space can get him to do most things. But he would not tell me if something hurt, or rather it would be impossible to tell how much it hurt. Given his hands are so floppy and sore, I am concerned about doing more damage than good.
He is on the list for OT (over a year) but how much they can help (and when we will get to see them) will be very dependant on how they perceive him. It's been my perception that most people think its not worth worrying about for him because he appears so do lally.
I have rather different expectations which is why he was able to write a note asking to go to the aquarium yesterday. <fails totally to hide shameless smuggery>
Thanks, porrige, Dd3 uses a stabilo pen/pencil at school but not a writing slope.
We have been doing the exersises on and off for 2 yrs now but we are having a real push on them at the moment since she was ill and spent 2 weeks lying on the sofa.
She really struggles with the exercises, hates doing them and often just lies on the floor wailing.
Consequently we have made little progress, she does them once a week at school without any trouble but obviously thst is not enough.
I am working really hard atm to build it into her routine and I am going to start taking her to a trampolining class after the hols, she loves canoeing which is great for core strength and shoulder stability but it is just too cold for her atm.
Thanks for the advice and keep it coming
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