Steps in the Developmental Process of Grasping
In her book The Comprehending Hand, Dr. Lilli Nielsen lists the various steps in the developmental process involved in the ability to grasp:
- hand to mouth
- hand to hand
- objects held in hand
- objects held in hand put to mouth
- losing objects
- objects transferred from one hand to the other
- reaching out for objects
- knocking objects on the table
- handling of objects
- throwing objects
- knocking two objects against each other
- pincer grasp — for beginners
- pointing to objects
- taking objects apart
- putting objects inside each other
- building with objects
Learning to reach and grasp takes time to develop. (You may want to download “Promoting Comprehending Hands Through Active Learning” by Patty Obrzut, M.S., O.T.R/L). Learn more about various activities that support your child in learning to grasp.
- Entangling fingers
- Opening hands to grasp
- Grasp and let go
- Grasp and manipulate
- Pincer grasp
- Taking apart and putting together
Children are typically born with a grasp reflex, but it takes time for the development of a functional grasp that allows the child to explore and manipulate various objects. A voluntary grasp and release develops out of activities of scratching, banging, patting, and so forth. You may want to review Scratching, Batting, Banging ideas on Active Learning Space to learn more. There are several pieces of “perceptualzing aids” or equipment that provide great opportunities for a child to learn grasp. These include various Position Boards and the Little Room.
Reaching is another skills that ties in with grasping. Children need to have activities included in their day that encourage reaching. You may want to review Reaching on the Active Learning Space website to learn more about these activities.
Activities for Developing Finger Movements and Finger Strength
Here are some ideas for activities to develop finger movement and strength from Dr. Nielsen’s book, The Comprehending Hand.
- Crumpling large pieces of paper (newspaper, brown paper)
- Crumpling small pieces of paper (tissue)
- Squeezing an ear-syringe (with and without water)
- Zipping zippers
- Flattening balls of clay with hands, fists
- Flattening balls of clay with a flat piece of wood
- Rolling out balls of clay with a pastry roller
- Pressing on push-buttons (which can give different sounds)
- Turning keys in locks
- Taking tops off tins
- Making holes in lumps of clay with fingers
- Putting matches, different kinds of sticks, in clay
- Pushing thumb-tacks into cardboard, flamingo, softer/harder pieces of wood)
- Cutting with scissors — first in the air, then drinking straws, paper, cardboard
- Using a perforator, stapling machine
- Opening and closing files
- Putting clothed pegs on cardboard, wooden slats, lines
- Winding elastic between and around pegs, hooks, legs of stool, etc.
- Winding elastic around objects (cardboard rolls, boxes)
- Putting rubber bands on cardboard rolls, tubes, etc.
- Matching stockings, turning them inside out
- Opening and shutting purses, bags with different kinds of clasps, snap fasteners, etc.
- Fastening and unfastening belts
- Breaking macaroni, twigs, ice-cream sticks
- Playing tiddlywinks
- Opening small packets of raisins
- Opening small face-cream bottles, yubes, jars and rubbing contents on fingers, legs, face
- Scrubbing with brushes
- “Sewing” wire through holes in hard board
- Sewing with needle and thread through holes in hard board
- Putting things in pockets and taking them out
- Turning pepper mill (use salt), musical boxes, ratchet toys, parsley rollers (empty, later full)
- Using dustpan and brush
- Inflating inner tubes or balls with a pump
- Plucking grass
- Wringing water from sponges, cloths (wash-, floor-, etc.)
- Watering with toy, small and large watering cans
- Peeling oranges
- Grating carrots, apples
- Screwing and unscrewing large and small nuts and bolts (start with wing nuts)
- Winding up kitchen timers, alarm clocks
- Pulling paper off kitchen paper rolls (paper towel), etc.
- Using rubber bulb-horns
- Ringing bicycle bells
- Winding up musical toys
Nielsen, Lilli. The Comprehending Hand. SIKON: 1994.
When a child begins to be able to reach and scratch various surfaces, introducing items that allow the child’s fingers to become entangled helps the child practice grasping. You might begin with loops of yarn, bundles of elastic hair ties or scrunchies, ribbons and bows, crocheted or macramé fabrics, Slinkys, chains, and other objects that allow a child to entangle his or her fingers easily.
RJ and the Mini Massager
In this video we see RJ interacting with a mini massager that is being held in one place so that he has the opportunity to repeatedly explore the it. RJ is unable to grasp and hold onto an object. He has difficulty moving his hands and arms. In this video you will see him first push on the massager, then his thumb and finger begin to open up, which allows him to briefly grasp the massager. It is important to point out that RJ can move his head and mouth, and these are areas of strength for him. While he needs continued opportunities to practice moving these parts of his body, he also needs opportunities to address areas of weakness, such as difficulty moving his arms and hands. In both cases he needs many, many opportunities to repeat the movements before they will become incorporated into his personality and used automatically. For many children with motor challenges, this may take months or years. We have to learn to be patient and allow that child the time to practice these movements again and again throughout the day. So not only should he practice grasping the mini massager, but he should also have access to grasping in a Little Room, using a Scratch and Position Board, and trying to grasp in a variety of positions – prone, supine, in supported sitting, etc.
Position boards should be designed at various levels: Level 1 Scratching, Level 2 Grasp and Release, and Level 3 Grasp and Manipulate. If you child is not yet grasping, but using fingers to voluntarily attempt to grasp add items that are fixed onto the board. For example soap dishes made from rubber and metal, dish scrubbers, package bows, paper folded into a fan shape, and so forth. Keep the profiles low at first and gradually move to higher profiles like kitchen utensils, tools, toy cars, empty Altoid or other mint containers. When the child is demonstrating grasp while the object is in a fixed position begin to transition to objects placed on short elastic pieces. This allows the child to grasp and release an object, then be able to find it again. Though almost anything can be included in this type of Position Board, it is important to consider the size of the child’s hand. Once the child is able to easily grasp and release, then transition to a Grasp and Manipulate level by extending the length of the elastic holding the object to the board. You will need to thread the elastic tubing to reduce the chance of the child cutting of blood flow to finger should they get them wrapped tightly in the longer cords. This also helps keep the objects from tangling up with each other. Below are examples of Position Boards at these different levels.
Practicing Grasping Skills in a Little Room
Description: This child in a Little Room accidentally, or purposefully, grasps and keeps, or grasps and releases objects. On several occasions, he also grasps and brings an object to his mouth. All of these movements are increasingly higher developmental skills. This child’s pushing and batting motions, with increased opening of the hand, allow grasping to occur. Note that this Little Room is well equipped with materials that respond appropriately to pushing and batting.
Zain Exploring Kinetic Sand on a Mirror Tray to Develop Grasp
Description: This boy with cerebral palsy uses a raking motion to explore the objects in the kinetic sand in front of him. As an adult moves the objects, notice the slight changes in the way he uses his hands and fingers. The kinetic sand on the mirror tray allows the objects to stay in place, so that he can more easily find the objects.
Jervarius with the Rain Stick and Steel Drum
This video we see that the boy demonstrates difficulty rotating his wrist in order to activate the rain stick. In the second part of the video, notice how he compares the sound of dropping the beads in the steel drum versus the ping pong balls, and eventually puts the beads down to engage both hands in dropping ping pong balls in the steel drum.
Desmond Grasping While Drumming
Description: Desmond transitions from banging on noise-making surfaces with an open hand, to using a tool to bang on various drums. You will observe that whether or not he uses his hand or the end of a drum stick to contact the surfaces, often depends on the length of the stick, and where the stick is positioned in his hand, as he is still refining this skill.
Using a Massaging Brush to Develop Pincer Grasp
Description: In order for a child to isolate the finger movement necessary to develop a pincer grasp, the child must be given objects with grooves and contours to explore. Watch in this video as a child isolates a finger to find the hole at the center of a massaging brush. Using only the hand and fingers, the child also learns how to stop the brush or slow it down.
Isolating Finger Movement and Exploring Holes
Provide a variety of materials for your child to explore by poking his fingers inside. These can include both large and small items. Below are some examples of objects and materials that your child might explore by poking his or her fingers in the holes.
Taking Things Apart and Putting Things Together
Description: A young boy takes things apart, puts things together and bangs objects with two hands. If given the correct environment, he will start to use his hands for more and more constructive activity.