Hands & Fingers – Our Versatile Tools

The functions performed by our hands are diverse and complex; ranging from holding and manipulating objects, to kneading dough, cutting foods, tying, and writing. 

Our hand is a manipulator of objects as well as a communicator. Hand is waved in bye-bye, or thrown up in anger, or used tenderly to pet a baby. Hand is a functional tool that we use for pressing, pushing, and pulling. And we use external tools with our hands such as scissors, hammer, and pestle. 

Most children seen at my clinic present with poor use of hands, sensitive hands, and weakness of hand muscles. These children have a range of diagnoses, such as autism, developmental delays, slow learner, and sensory processing difficulties. And there are a number of grade school children who present with difficulties in fine motor skills, handwriting, and attention. Regardless of the diagnosis, I find that children have a weak grasp of objects, a weak pincer grasp, and therefore have difficulty with using hands for a variety of functional tasks. 

Our finger tips contain the highest density of touch receptors, that help us appreciate and discriminate various textures, shapes, temperature, and pressure. Therefore, the tactile / touch input through the hands and fingers becomes crucial in the process of learning about the immediate environment in a child’s course of development.

Writing -- As parents of preschool and grade school children, it is common to have concerns about writing. However, before holding a pencil and starting to write, a child needs upper body strength, stability of multiple joints such as shoulder, elbow, wrist, strength of hand and finger muscles.  The hands should engage in climbing, digging, pinching, pressing, pulling, scrunching, and twisting with a wide variety of material.

All of these develop through prewriting activities of using hands in a variety of ways. Besides these, a child will be ready for letter formation only after they are able to copy prewriting lines and shapes such as vertical, horizontal, circle, etc. Also visual skills and cognition are required for writing. Hence, there is immense prep work needed prior to just giving a pencil and expecting the child to start making letters.

Fine motor skills are accomplished by using small muscles of the hand and fingers in coordination with the eyes. Young children need a lot of practice in manipulating objects of various sizes, shapes, and textures in order to develop finger strength and control.

 

Following are the videos that demonstrate many activities that are simple and can be done at home.  

Punching on paper – use 2 types of hole punchers to make holes on paper. The simple punching machine can be used in 2 ways as shown in the video.

https://www.youtube.com/shorts/fuyv61UHb70

 

Paper tearing --Have your child practice tearing a variety of paper that you are going to discard. These can range from regular paper to thin tissue paper to slightly thicker sheets. Your child can tear and crush the paper pieces.

Tearing paper is a simple, but important exercise in improving bilateral coordination.  It also improves hand-eye coordination, precision grip, intrinsic hand muscle strength, and shoulder stability. Moreover, it provides proprioceptive input to the hands and fingers.

 https://www.youtube.com/watch?v=xX1TWIFSWHU&t

https://www.youtube.com/watch?v=YSsw-2Iuy1g&t

Pincer grasp - use toothpicks and a small spice bottle to work on your child's pincer grasp. 

https://www.youtube.com/shorts/39ljmd--NPY

 

Rubber band activity – working with rubberbands provides tactile and proprioceptive input. It involves complex movements of the hands and fingers.

https://www.youtube.com/shorts/QDEepN3oTXI

https://www.youtube.com/watch?v=Mxg9sWG2Bt0

 

Various finger movements using small objects, paper, and bubble paper to work on pincer grip.

https://www.youtube.com/watch?v=hL1NdUiSC8s

 

Variety of fine motor activities are shown in this video, that can be done with material found at home.

https://www.youtube.com/watch?v=EyjHNmxGRoY&t=10s

 

Translation of small objects and coins within the palm. This occurs in 2 directions – from fingertips to palm or viceversa. This activity contributes to arch development and strengthening intrinsic muscles of the hand that are so important in all fine motor skills.

https://www.youtube.com/shorts/UXAPsKob8Tg

Have Fun with your child!

Movement – misunderstood & under rated

We have children with special needs where the primary concern of parents is ‘lack of sitting tolerance’ i.e. the child is always moving and walking around. Except for the sitting tolerance, the parents feel that their child is active and there is no problem with moving. As a sensory-motor therapist, my observation is that the child is moving around the room aimlessly and without any purpose or meaningful exploration. Most of the children demonstrate clumsiness of movement. And there is no variation in movement; either the child walks around or tries to climb short furniture in the therapy room frequently.

These atypical behaviors of moving around aimlessly and frequent climbing indicate that their vestibular & proprioceptive systems are not functioning adequately and optimally.  

 Why should we move frequently and variedly?

Humans were designed to move in space, just like we did so until 3-4 decades ago, prior to the advent of conveniences in life. In the first 5 years of life, children engage in active exploration of their surroundings, that leads to problem-solve and learning. They are required to move their head and body in various ways so as to provide input to their vestibular system. Variety of movements include bending down to pick up objects, getting down on all-fours, transitions between stand and squat, look up to reach and retrieve an object, climb up on different heights, walk on uneven surfaces, and the list goes on. Movement should also include effortful work such as push, pull, lift, carry, and drag.

 All such movements should be frequently done, not just on occasion. Let your child carry their own backpack, climb stairs, pull a small wheelie bag during travels, clear the table after a meal, wipe the table, make your bed, pull out wet clothes from the washing machine. Such tasks lead to increased visual-spatial awareness, problem-solving, and learning. These are skills that the child will need throughout their life; it is work that boosts self-esteem and self-confidence. When a child learns a new task, although with some struggle, the process of learning entails ‘figuring it out’ that consequently leads to neuroplasticity and better cognition as well.

https://sensoryintegrationbangalore.blogspot.com/2015/09/movement-part-1.html

https://sensoryintegrationbangalore.blogspot.com/2015/12/movement-part-2.html

As a course of development, gross motor movement leads to fine motor abilities. In order for our distal muscles to work, our proximal larger muscles need to be strong and efficient. If we expect a child to perform fine motor skills such as cutting, coloring, buttoning, and writing, they also need to have strength and control of the muscles surrounding the elbow, shoulder, upper body, and the core muscles. This strength and control of larger proximal muscles comes from using the body in various ways other than only walking.

The following video shows some ways in which opportunities for meaningful movement are provided at Activ Kaarya during therapy sessions—

https://www.youtube.com/watch?v=oFfTgbIFweQ

 It is a little paradoxical that meaningful movement is needed to improve attention, engagement, and participation in tasks.  Attention cannot develop while doing table-top tasks. Rather, attention improves when a young child actively moves through space, explores, and meaningfully interacts with their environment.

As an adult, think about how good you feel when you play a game of tennis, or go for a brisk walk, or clean up your room. This is because you have engaged in movement and exercise that release good neurochemicals in the brain. If you engage in various movements and exercise frequently and regularly, you will find yourself sleeping better, and will have more focus and attention towards your work. The same is for our children. Young children do need physical exercise in the form of activity and function.

 

Contemporary way of life

In our chase for convenience and the coverup of fast living, we forget to move our body in ways it should. Many of us rarely climb a ladder, or squat down to the floor, or sit on the floor even briefly. If adults moved frequently and in various ways, they become a role model for their child. Eg. climb 1-2 flights of stairs daily. It is good for you and your child.

https://sensoryintegrationbangalore.blogspot.com/2021/12/the-humble-staircase.html

 

 

In my clinical experience, I have seen children from grade schools who have anxiety, difficulty following instructions, struggle with attention in the classroom, become upset easily, and show aggression frequently. All of these issues are rooted in their vestibular, proprioceptive, and visual systems not developed adequately to help them cope up with the external world outside of home. As soon as we provide them with meaningful movement, effortful work, and functional visual activities in therapy sessions, their behavior and performance in classroom improves. My consistent suggestion to all parents has been to involve your child in age-appropriate house chores – making their own bed, folding clothes, sweeping and mopping, setting the table. Such tasks boost the child’s visual-spatial awareness, working memory, sequencing and organization of actions. More importantly, such chores allow body movement in a variety of ways that provide input to the vestibular system, that further boosts self-regulation and behavior.  

 

https://sensoryintegrationbangalore.blogspot.com/2024/08/moments-of-learning-in-natural.html

 

https://sensoryintegrationbangalore.blogspot.com/2016/10/home-choresessential-functional-training.html

 

 

All parents need to seriously reflect on ‘how much’ and in ‘what ways’ is your child moving throughout the day.  A child’s routine involves traveling to school and back, attending 1-2 structured classes, doing homework, and the day is over. Structures sports and activities are good, however, they do not provide the cognitive benefits of free play and unstructured tasks such as house chores. In my experience, children who are occupied in too many activities after school demonstrate fatigue and irritability. Therefore, it is wise to minimize multiple structured activities after school, and replace them with free play, house chores, and spending quality interactive time with your child.

Bridging Sensory and Motor Components in Pediatric Therapy

Dr. Ushma Goradia discussed the critical importance of bridging sensory and motor components in pediatric physical therapy, emphasizing the pyramid of learning framework developed by Kathleen Taylor and a special educator. This framework identifies eight sensory systems as the foundation, with particular focus on the “power senses” of vestibular, proprioception, tactile, and visual perception, which work together to influence motor output, behavior, and cognitive responses in children.

The integration of sensory and motor components requires a holistic treatment approach where therapeutic activities like prone weight-bearing, trunk rotation, and gait training provide dual benefits by addressing both motor skills and vestibular function simultaneously. Physiotherapists must recognize that movement is crucial for development across multiple domains and should consider sensory integration when treating children with neuromotor impairments, distinguishing between sensory issues that show observable physiological responses and purely behavioral problems.

Parental involvement, particularly from mothers, emerges as a critical success factor in pediatric therapy, helping to build trust and comfort while addressing potential child discomfort due to touch hypersensitivity. Parents need education about therapeutic processes to support their children effectively throughout treatment. Clinicians should watch for specific red flags in conditions like hemiplegia and cerebral palsy, including asymmetrical posture, balance issues, body awareness problems, vestibular and proprioceptive concerns, and tactile defensiveness.

Treatment strategies for sensory processing issues involve gradual exposure to different textures, emphasis on movement therapy, systematic approaches to tactile defensiveness, and holistic methods that combine sensory and motor elements. The fundamental clinical insight is that physiotherapists must understand how sensory processing impacts motor development, as this connection is essential for creating more effective pediatric interventions that address the whole child rather than isolated symptoms -- Dr. KD Mallikarjuna, PT

Ushma ma'am, your emphasis on adding sensory integration gives the exact perspective to paediatric Physiotherapy needed. Humans are sensory beings. So taking into account all their sensory experiences and understanding their implications on therapy was well explained -- Dr. Vidhya Venkatesh, PT

Dilemma of the Dominant hand

The right hand holds a significant importance in Indian culture. Not only the right hand, but also the right foot. Giving money to a vendor or an autodriver, accepting ‘prasad’ at a temple, to making the first step in a new home are all done with the right side of the body. Some regions of the country call the right hand as ‘seedha haath’ meaning correct side and the left hand as the ‘ooltaa haath’ or the wrong side.

Being a physical therapist and having lived in the USA, the right hand being sacred and the left believed as unholy truly baffles me. The USA has a much larger number of people who are left dominant. In contrast, in urban areas of India, the left dominant child catches negative attention and is perceived as something wrong. My son is left-handed; he writes and eats with his left hand. During his preschool years, many people asked me to correct his dominance! But I taught my son to remain cool!!

A 7 years old girl was brought to my clinic due to behavioral and anger issues. (A diagnosis of autism was doubted by parents and past professionals at the time). She was also emotionally distraught in that she would cry without any reason, hit another child, and had poor sitting tolerance. Careful history revealed that parents were unsure about their daughter’s dominant hand. The child’s grandmother insisted that she use her right hand for eating, and hence the parents tried to insist on the same. Besides the sensory-motor therapy that was indicated for this little girl, my first priority was to educate parents on not forcing use of a particular hand and to let the child just ‘be’. In a few weeks, the child started calming down, following verbal instructions fairly well, and more importantly participating in fine motor skills and using the left hand for writing. Therefore, I strongly urge parents to not force your child into using the right hand only. 

I have had several children with delayed speech and poor fine motor abilities, who were forced to hold a crayon and eat their food using the right hand because the grandmother said so. 

Beginning at age 6 -12 months, a child uses 2 hands together and gradually shows preference for either hand around age 3-4 years. Dominance is generally established by 6 years of age. 

The other important point for parents to realize that we perform majority of tasks such as buttoning and tying shoelaces using both hands together in various ways (bilateral integration). Tasks such as opening or closing a bottle requires that you hold the bottle with 1 hand (non-dominant) and open or close with the other  hand which is the dominant one. You hold the paper with non-dominant hand and cut using the dominant one. So the non-dominant hand becomes the helping hand that provides stability, while the dominant hand is the working hand that performs the task. As you go through your day, try to consciously think when and how do you use your hands. 

I am trying to emphasize that development of both hands is crucial as the development of a child progresses from the first year of life to school years. As parents, offer objects to your young child somewhere in the center of their space and let them pick it up with any hand. Observe during many occassions as to which hand the child advances to pick up or pull something first. But do not force or insist on using the right hand only.