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Primary education

Join our Primary Education forum to discuss starting school and helping your child get the most out of it.

Mrz I need your help!!! Need to strengthen muscles in DD's hands.

26 replies

simpson · 03/04/2012 18:28

Hi

My DD (4) had an OT assessment today as she is hyper mobile although she has not been seen since 2010.

Basically they have said that her hand muscles are very weak, which is why her pencil grip is so poor Sad

I do remember a thread a while ago where you gave some ideas on how to strengthen muscles in the hand & for finger strength. I just cannot find the thread Sad Blush

Just wondering if you could give me some ideas???

Thanks!!!

OP posts:
Dustinthewind · 03/04/2012 18:31

I remember the thread, and it was so useful I saved the post.

mrz Fri 24-Jun-11 17:25:19
Fine Motor Skills
Things to remember:
Upright working surfaces promote fine motor skills. Examples of these are: vertical
chalkboards; easels for painting; flannel boards; lite bright; magnet boards (or
fridge); windows and mirrors; white boards, etc. Children can also make sticker
pictures; do rubber ink-stamping; use reuseable stickers to make pictures; complete
puzzles with thick knobs; use magna-doodle and etch-a-sketch as well. The benefits
for these include: having the child's wrist positioned to develop good thumb
movements; they help develop good fine motor muscles; the child is using the arm
and shoulder muscles.
Fine Motor Activities
Moulding and rolling play dough into balls - using the palms of the
hands facing each other and with fingers curled slightly towards the palm.
Rolling play dough into tiny balls (peas) using only the finger tips.
Using pegs or toothpicks to make designs in play dough.
Cutting play dough with a plastic knife or with a pizza wheel by holding
the implement in a diagonal volar grasp.
Tearing newspaper into strips and then crumpling them into balls. Use
to stuff scarecrow or other art creation.
Scrunching up 1 sheet of newspaper in one hand. This is a super
strength builder.
Using a plant sprayer to spray plants, (indoors, outdoors) to spray snow
(mix food colouring with water so that the snow can be painted), or melt
"monsters". (Draw monster pictures with markers and the colours will run
when sprayed.)
Primary
Picking up objects using large tweezers such as those found in the
"Bedbugs" game. This can be adapted by picking up Cheerios, small cubes,
small marshmallows, pennies, etc., in counting games.
Shaking dice by cupping the hands together, forming an empty air space
between the palms.
Using small-sized screwdrivers like those found in an erector set.
Lacing and sewing activities such as stringing beads, Cheerios,
macaroni, etc.
Using eye droppers to "pick up" coloured water for colour mixing or
to make artistic designs on paper.
Rolling small balls out of tissue paper, then gluing the balls onto
construction paper to form pictures or designs.
Turning over cards, coins, checkers, or buttons, without bringing them to
the edge of the table.
Making pictures using stickers or self-sticking paper reinforcements.
Playing games with the "puppet fingers" -the thumb, index, and middle
fingers. At circle time have each child's puppet fingers tell about what
happened over the weekend, or use them in songs and finger plays.
Place a variety of forms (eg. blocks, felt, paper, string, yarn, cereal,
cotton) on outlines
Match shapes, colour, or pictures to a page and paste them within the
outlines
Primary
Self-Care Skills
Buttoning
Lacing
Tying
Fastening Snaps
Zipping
Carrying
Using a screwdriver
Locking and unlocking a door
Winding a clock
Opening and closing jars
Rolling out dough or other simple cooking activities
Washing plastic dishes
Primary
Sweeping the floor
Dressing
Scissor Activities
When scissors are held correctly, and when they fit a child's hand well, cutting
activities will exercise the very same muscles which are needed to manipulate a pencil
in a mature tripod grasp. The correct scissor position is with the thumb and middle
finger in the handles of the scissors, the index finger on the outside of the handle to
stabilize, with fingers four and five curled into the palm.
Cutting junk mail, particularly the kind of paper used in magazine
subscription cards.
Making fringe on the edge of a piece of construction paper.
Cutting play dough or clay with scissors.
Cutting straws or shredded paper.
Cutting
Use a thick black line to guide cutting the following:
A fringe from a piece of paper
Cut off corners of a piece of paper
Cut along curved lines
Cut lines with a variety of angles
Primary
Cut figures with curves and angles
Sensory Activities
The following activities ought to be done frequently to increase postural muscle
strength and endurance. These activities also strengthen the child's awareness of
his/her hands.
Wheelbarrow walking, crab walking
Clapping games (loud/quiet, on knees together, etc.)
Catching (clapping) bubbles between hands
Pulling off pieces of thera-putty with individual fingers and thumb
Drawing in a tactile medium such as wet sand, salt, rice, or "goop".
Make "goop" by adding water to cornstarch until you have a mixture similar
in consistency to toothpaste. The "drag" of this mixture provides feedback to
the muscle and joint receptors, thus facilitating visual motor control.
Picking out small objects like pegs, beads, coins, etc., from a tray of salt,
sand, rice, or putty. Try it with eyes closed too. This helps develop sensory
awareness in the hands.
Midline Crossing
Establishment of hand dominance is still developing at this point. The following
activities will facilitate midline crossing:
Encourage reaching across the body for materials with each hand. It
may be necessary to engage the other hand in an activity to prevent
switching hands at midline.
Primary
Refrain specifically from discouraging a child from using the left hand
for any activity. Allow for the natural development of hand dominance by
presenting activities at midline, and allowing the child to choose freely.
Start making the child aware of the left and right sides of his body
through spontaneous comments like, "kick the ball with your right leg." Play
imitation posture games like "Simon Says" with across the body movements.
When painting at easel, encourage the child to paint a continuous line
across the entire paper- also from diagonal to diagonal.

I also use a Busy Finger Box in the classroom but you could easily find most things at home

  1. Pegs ?
You need pegs of different sizes, clothes pegs, small bulldog clips, stationery clips etc. Get the children to use one hand only at a time. I usually get them to peg about 10 pegs of different sizes onto the sides of a gift bag. They might put them on with their left hand and take them off with their right. They can also try squeezing the pegs between the first finger and thumb (on each hand) then the middle finger and thumb and so on.
  1. Elastic bands ?
Elastic gymnastics! ? Start by putting 2 elastic bands (the same size) around the thumb, first and middle fingers, ask the child to open and close the fingers. Then add another 2 elastic bands and so on. The more you have on, the harder it is to move your fingers. These exercises help to develop the muscles which make the web space when writing.
  1. Beads ?
Get beads of different sizes and thread. Ask the children to thread some beads onto their string. The smaller the hole obviously the harder it is to thread. Develops hand/eye coordination.
  1. Ball bearings and tweezers ?
Put the ball bearings in one little box and ask the child to try and pick one ball bearing up at a time with the tweezers and place in a second small box. If this is too tricky try using Hama beads and tweezers.
  1. Floam / Playdough ?
These products are great for squeezing and rolling which provides necessary sensory feedback and helps to develop hand strength. Ask the children to squeeze the dough and roll it with the palm of their hand.
  1. Doodle board ?
The Doodleboard is just a way of children practising handwriting patterns or letters without having to commit them to paper. Provide some patterns and shapes to copy.
  1. Gummed Shapes ?
Give the children a sheet of plain paper and ask them to make patterns or pictures with the gummed shapes. Just picking up on shape at a time, licking it and then sticking it down all help to develop hand/eye coordination and the pincer grip.
  1. Hama Beads ?
Hama beads are good for pincer grip and hand/eye coordination. The children have patterned sheets to copy and peg boards to put them on.
  1. Lacing cards ?
Also good for hand/eye coordination. Just give each child one card to lace.
  1. Bean bags ?
    Give a child 4-5 bean bags and place a container about 3 feet infront of them. Ask the child to try and get as many beanbags in the container as possible. (Hand/eye coordination)

  2. Chalk and blackboard ?
    If you can, try and wedge the blackboard between two tables and provide the child with a piece of chalk in each hand. Ask them to draw the same pattern with both hands at the same time on both sides of the board. This helps develop bilateral movement.
    Allow the children to draw patterns, shapes and letter shapes on the blackboard. The chalk gives sensory feedback and sound simultaneously.

  3. Stencils ?
    Children can use the stencils to make a picture. Helps develop pencil control and special awareness among other things.

  4. Feathers ?
    Ask the children to try and balance a feather on different parts of their body. This helps to develop balance and coordination.

  5. Handhugger pens ?
    Hand hugger pens are the triangular shaped pens. These help the children to establish a better pencil grip.

  6. Tissue paper strips ?
    Place the child?s palm (at the wrist) on the end of a strip of tissue paper. Ask them to only use their middle finger to get the paper to scrunch up under their hand.
    Repeat, but this time place the side of the child?s hand on one end of the tissue strip and ask them to only use their thumb to scrunch up the paper and bring it under their hand.
    These activities really help to develop the hand arch, web space and muscle tone of the hand.

  7. Stickers ?
    Children love stickers. Just peeling them off provides an opportunity to develop fine motor skills and hand/eye coordination.

  8. Peg boards ?
    These can be peg boards where the child has to place pegs in the holes, maybe copying patterns.
    They can be the boards with plastic pegs already on where they have to stretch elastic bands between them to make patterns.

mrz · 03/04/2012 18:36

Squeeze a soft sponge ball in the palm of your hand, or sponges while in the bath. (hold for 30 seconds increasing to 1 min)

Wringing out wet cloths using 2 hands.

Pinch and seal zip locks bag and close it.

Turning pennies from heads to tails.

Practising isolated finger movements when playing with play dough by pinching it with the thumb and index and middle finger. Also poking the play dough with individual fingers.

Using a spray gun get to play games, spray at a target or help with the cleaning!

Put an elastic band around the fingers and thumb. Open and close fingers to stretch the band. (double the band to increase resistance)

Opening and closing clothes pegs.

Practise touching the pads of each finger to the thumb of the same hand.

Using the thumb, index and middle fingers only, spin a coin sideways and towards the palm. Or spin a small spinning top with these fingers.

Playing with therapeutic putty or play dough - squeezing, prodding &, rolling.

Put an elastic band around a pair of scissors, this will keep the tension constantly tight and encourage working the hand muscles.

Using a toy tool kit with screwdriver or a hammer.

Scrunching paper to make a collage or flick into a goal (finger soccer!)

Tearing paper - increase the thickness of paper up to coagulated cardboard

Pencil tug of war with another person. Hold pencil with thumb, index and middle fingers.

simpson · 03/04/2012 18:43

Thanks both Grin

Some fab ideas. She is left handed too which I don't think helps Sad

We have got some OT putty to use. She is on the easiest one but they will change it each week

OP posts:
blackeyedsusan · 03/04/2012 23:27

hey, here did you get your ot putty? Envy

and don't forget to bookmark the page....

I can see I am going to be busy over Easter...

blackeyedsusan · 03/04/2012 23:28

Where

simpson · 03/04/2012 23:40

The OT gave it to us and said its the easiest one to use but hopefully with time each week they will give her a harder one.

DD seems very keen on it and has already had one session on it this eve, despite playing with it in the OT session for 15mins Grin

LOL have book marked this thread Grin

OT mentioned pegs actually and said its a good thing to do whilst she is watching TV etc etc so will try that (amongst other things).

OP posts:
EBDteacher · 04/04/2012 07:08

You can buy therapy putty on amazon. We have it at work and find that the adults rather like it too. Grin

mrz · 04/04/2012 07:22

In class I give the children a bag of pegs (I have lots of fancy ones) a paper plate and an egg timer and they race to see who can peg the most around the edge in a minute. We also make flowers by the same technique.
www.amazon.co.uk/Butterfly-Design-Wooden-Craft-ST1581A/dp/B003N29BVQ/ref=sr_1_12?ie=UTF8&qid=1333520477&sr=8-12

www.amazon.co.uk/PEGS-BRIGHTLY-COLOURED-WOODEN-PACK/dp/B000XQ6NWK/ref=sr_1_17?ie=UTF8&qid=1333520526&sr=8-17

OhChristFENTON · 04/04/2012 07:31

Sorry to jump in here - what is 'OT' please?

My DS has always been quite 'shaky' when doing fine work, lego, modelling and at the last parent/teacher consultation they asked if I had ever mentioned it to the Doctor (I had to the HV but was told that it wasn't unusual and if he could complete the tasks he was working on it wasn't really a problem) - I did go to the Doctor and am awaiting a "children's services" appointment in May but have no idea what they will do or say about it Confused

He is also left handed btw and struggles with handwriting, - what's all this about then?

Sorry for hijack Smile

mrz · 04/04/2012 07:36

Occupational Therapy

OhChristFENTON · 04/04/2012 07:46

Ah, thank you.

mrz · 04/04/2012 07:52

Ask if there is a children's occupational service in your area and ask for a referral and tell them the school has raised this as a concern it might help.

ILikeToMoveItMoveIt · 04/04/2012 09:01

Some great ideas here, many thanks.

Great timing too, i have just been reading through ds's (3.6yo) learning journey from pre school and I have noticed the staff have mentioned 'inferior tripod grip'. Ds is left handed and I have noticed he looks awkward when using a pencil, paintbrush etc, but I wasn't sure whether it seems awkward because I am right handed, and/or it is because he is still learning how to hold them.

I will speak to the staff to get their opinion, but any other opinions are most welcome Smile

mrz · 04/04/2012 09:12

inferior tripod grip is another name for immature or static tripod grip which I would expect in a 3.6 year old child

www.getreadyforschool.com/preschool/pencil_grip.htm

ILikeToMoveItMoveIt · 04/04/2012 10:08

Many thanks for the link Smile it has put my mind at rest. Inferior is quite an emotive word to use, especially when not backed by a spoken comment by the staff. If they had used inferior, but also said 'which is expected for his age', then I wouldn't have given it a second thought.

rabbitstew · 04/04/2012 11:59

I know lots of adults who still have a static (or "inferior") tripod grip. It works for some people, causes problems for others... Being hypermobile, I think anyone ever expecting me (or either of my dss) to develop a dynamic tripod posture was being naive. I've never had trouble writing quickly and neatly with a grip that feels more stable to me, though, which, being stable, is not hugely "dynamic" (except to the extent that it doesn't stop quick, neat handwriting....).

As for hand strengthening exercises, my ds1 hated doing ANYTHING with his hands when he was younger - try making opening and closing a peg fun when it hurts. He wouldn't even try to open his own birthday presents if the paper provided any resistance. However, whilst he couldn't see the point of going through the pain barrier in order to put pegs on a plate or to mould a piece of dough he didn't like the feel of and couldn't mould into anything remotely interesting, he did see the point in it when learning to play the piano. So, my advice to simpson would be not to completely despair, as I nearly did, if your dd takes against all the activities offered to her, because there will eventually be something she wants to do enough that she will put the effort in. Hopefully, however, she is more compliant than my ds1, who quite rigidly either refused to try any of the activities on offer that were supposed to help, or would look hugely pained when doing them and deliberately not try to do them properly!

mrz · 04/04/2012 12:02

Most people would find a static tripod grip painful but an effective grip doesn't mean the dynamic tripod grip there are a number of perfectly good alternative ways of holding a pen. Grip is only an issue if it is ineffective or painful.

simpson · 04/04/2012 15:47

She seems ok about doing some basic exercises although loses interest very quickly, but I guess that is down to being 4 Grin

She has the most bizarre pencil hold.

She hooks her thumb around the pencil and rests the pencil against her knuckles. OT said its because her finger strength is so bad so she is using muscles in her wrist/arm instead but is amazed she can write as well as she can Confused

We have a more detailed OT session next week so will find out more then I guess...

OP posts:
mrz · 04/04/2012 15:49

I'm sure you know that using wrist and arms muscles is the most common cause of fatigue when writing

simpson · 04/04/2012 20:50

Yes, she did 5 mins of colouring in and stopped saying her arm hurt Sad

I have been told she will need an IEP next yr (school yr, when she starts reception) which will help Smile

OP posts:
mrz · 04/04/2012 20:55

I would do things like wheel barrow walking (her being the wheelbarrow ) and monkey bars to strengthen shoulder girdle.

Can she stretch out her arms shoulder level and make large circles with her finger tips forwards and backwards?

simpson · 04/04/2012 22:25

Mrz - will try her with that tomorrow thanks Smile Although not sure if her arms are strong enough to support her weight even a small bit.

Not sure on the circle thing probably backwards but maybe not forwards Sad

OT told us to get her playing with clothes pegs whilst watching TV and she could not even move then pegs a small bit as her grip/fingers are so weak Sad

OP posts:
rabbitstew · 04/04/2012 22:46

Be careful about asking her to try swinging from monkey bars if you aren't certain about how hypermobile she is elsewhere in her body. Ds1 has Ehlers-Danlos syndrome, hypermobility type, and we were advised against ever swinging from monkey bars on the basis it might dislocate his shoulders. He can hang for a bit from the monkey bars now, though, but only after quite a bit of physio... And he can wheelbarrow walk, but it might be better to start with bear walking, where you sort of scramble along on hands and feet without letting your knees touch the floor, as then there is slightly less risk of falling onto your nose when your arms give way! If even bear walking is hard, crawling is a good place to start, as is going onto hands and knees (ie in crawling position) in front of a low table and picking objects up off the floor with one hand and transferring them to the table then back to the floor (so that the weight is on one shoulder for a short while). It quite rapidly gets tiring... Also, watch out if your dd is hypermobile elsewhere that when she puts weight on her arms, she isn't achieving this by letting her elbows bend the wrong way or letting her shoulder blades stick out like chicken wings, rather than using her muscles to ensure the joints do not hyperextend. Writing on a blackboard also helps with shoulder, hand and arm strength, as you are having to lift your arm up to write. If your dd is hypermobile other than in her hands, a physiotherapist might have a wider range of exercises, targeting particularly weak muscles, than an occupational therapist might have... ds1 benefited hugely from being given exercises by a physio, as she was targeting the particular muscles that were weak as a result of the hypermobility. We never got any helpful advice out of the OT for our ds1, except to make sure he learnt to touch type, as he was likely to find his hands tired easily when he was older and he was required to write a lot (ie at secondary level). His hand is now plenty strong enough to cope with the volume of writing expected of him at primary school and his handwriting has, in any event, always been legible, even if when younger, it was rather faint when he wrote with a pencil.

simpson · 04/04/2012 22:55

rabbitstew -thanks. Smile

She is hypermobile in her hips, knees, ankles, wrists and her hand muscles are very weak Sad

There is no way she could support her weight on monkey bars yet.

She has an OT session next week and the physiotherapist is going to pop in and look at her as she has not been assessed since 2010 and I suspect her ankles are much worse now. They just give way when she walks Sad

Her arms do not seem to pop out at all but I know she complains that her knees bend the wrong way when she has been on the trampoline or something.

OP posts:
rabbitstew · 05/04/2012 09:07

Hi, simpson. The physio gave us loads of exercises to help with ds1's hips. Apparently there is a very small muscle deep in the hip that is quite hard to strengthen, so you need to do particular exercises to try and get to it. Those and some shoe inserts called Sohlis really helped with his walking and running. Prior to that, he'd gone from having Piedros to support his ankles to nothing (except for me buying shoes as supportive as possible) for several years and his ankles pronated quite severely and he would constantly complain of tired legs and hips or legs that hurt. He's never complained about his knees bending the wrong way, but we did also do some exercises to strengthen the muscles around his knees. He still tends to stand with his knees bent the wrong way (his legs look like bananas, sometimes!), but he has never (yet) complained that his knees hurt and no longer walks with them like that... I expect he will complain they hurt, eventually, because bad knees run in the family. The Sohlis definitely helped lift his ankles a bit off the floor and improved his run, which had been very flat looking, because he couldn't spring off his feet at all.

However, we didn't do the intensive physio until ds1 was 6, as it was VERY hard work and he would have been resistant to putting in the effort when he was younger - we ended up doing about 45 minutes of physio five or six nights a week, and when I tried to do some of the exercises with him, I realised how uncomfortable and tiring the exercises were: it is not a fun process building up seriously weak muscles. However, the difference they made to his physical abilities and long term physical comfort made them worthwhile, as he does now use his body more efficiently, which helps him maintain most of the gains (although growth spurts can cause issues to arise again) and can run much faster and now enjoys playing in the playground with his friends at school.

My main piece of advice is, insist on maintaining access to the physiotherapist... even if she doesn't do more than offer a bit of extra support for your dd's ankles and a few tips, now, she could be extremely useful when your dd is a bit older and able to do something more structured.