Within the body, for all actions, we gain skill and mobility from a stable base. This is true whether we are hitting a ball with a bat, riding a bike, eating or handwriting. In order for the small muscles of the hand, fingers and thumb to gain the mobility necessary to complete the intricate and speedy actions required for handwriting, they need to be provided with a stable base from which to act. This means stability within the hips, core, shoulders and wrist, which I’ll explore further in upcoming blogs, but it also means a stable base within the hand itself. When handwriting, the ideal grip includes hand division – flexion of the little and ring fingers into the palm to stabilise the palmar arch – and resting the little finger side of the hand onto the table top thereby using the table as part of the stability. The little and ring fingers even share a tendon to make it easier for them to act together for this purpose. This combination allows for stability to be provided through one side of the hand while the other side – the middle finger, index finger and the thumb – complete all of the skilled movements required for the handwriting.
Forming letters with a pencil involves translation movements – small in and out movements of the fingers – blended seamlessly with rotational movements which are controlled by the thumb. In order to allow for these patterns to be smooth and fast, grasp on the pencil needs to be firm without being tight, thereby allowing the joints of the fingers and thumb to move with ease, and the web space – formed by the index finger and the thumb – should be circular in shape, which allows the thumb to have a full range of movement. Developmentally this is achieved through a tripod grasp which involves the thumb and index finger holding the pencil and the pencil resting on top of the first joint of the middle finger.
Providing a child with a diverse range of play involving both gross and fine motor activities throughout birth to preschool years will see most children spontaneously developing the underlying skills necessary to transition to first a static (non moving) tripod grasp and then to a dynamic (moving) tripod grasp. In future blogs I will explore the types of play activities that will support this development. For some children however a little extra help is required, either to transition to a tripod grasp or to modify a grasp if a problematic or less functional grasp pattern has developed. In some instances a pencil grip can help with this process for children if issues remain by the time they are around five years of age. It should be noted however that I would never suggest that the pencil grip be seen as the solution, rather it might be an additional aid while the underlying skills are developed with some therapeutic intervention or as a longer term support if underlying issues cannot be resolved.
Each different pencil grip provides a different level or type of support and so an understanding of these features might help you choose which grip you might try out with your child, client, yourself or your student. There are often a number of grips that are possible solutions for each different issue and a process of trial and error will always be required to find the one that suits the physical and sensory needs of each person.
Collapsing web space
As I’ve discussed above the muscles and joints of the web space should ideally be able to work under pressure, maintaining an open round web space. If these joints and/or muscles are unable to work under pressure then they can collapse resulting in the web space looking more like a teardrop than a circle, a half circle where the thumb is flat but the index finger is curved or the thumb may wrap under or over the index finger. For grasps that involve the half circle or teardrop webs space then I would start with The Pencil Grip (if the instability is mild); The Jumbo Pencil Grip; The Pinch Grip; or the Butter Grip (being aware that the fingers are not positioned on the Butter Grip rather it just sits behind the fingers to purely stabilise the web space.
Thumb wrap over and Thumb wrap under index finger
As noted above this is also as a result of instability within the web space but once it develops as a habit it is hard to change and the grips listed above don’t necessarily stop the thumb from wrapping over or under the index finger and so a grip with greater guidance to minimise the thumb wrap can be needed. The CrossOver grip and The Ring Grip provide the greatest guidance but then transitioning to the Pinch Grip or the grips noted above as the habit is changed and/or as more stability is developed can be useful.
Index grasp or difficulty transitioning
When there is persistence of a more immature grasp such as a pronator grasp, or an abnormal pattern such as an Index grasp, some additional support can be required. These are all situations where division of the two sides of the hand hasn’t developed and so a grip that encourages the use of the skilled side of the hand can be supportive. These are pencil grips like the Writing Claw (small, medium or large depending upon finger size), the Pointer Grip, the Two Finger grip, the Ring Grip or the Stetro grip, or The Pencil Grip. Grips that involve the child putting their fingers into designated sections like the Claw, Pointer, The Ring Grip and Two Finger tend to provide greater guidance and mean that the child has to think less about finger positioning making the transition easier. The other support that can be very helpful with these grasp patterns are the Handithing or Sportithing which give the little and ring fingers something to hold into the palm to encourage the hand division that is sought therapeutically. You can also just get them to hold a mini pom pom or a little piece of screwed up paper or BlueTac.
This is a grasp where the middle and index fingers are placed upon the top of the pencil and the ring finger tucks underneath. This is a fairly functional grasp and for many children doesn’t cause long term issues, however it does mean that the palmar arch is left with less stabilising support so can result in pain and hand fatigue when writing for longer periods of time such as what will be required in later school years. Pencil grips that are supportive in making change with this are those listed above in reference to the hand division having not developed, with particular emphasis on the Ring Grip as it provides a clear guide as to where to position the middle finger. As noted above the Handithing or Sportithing may also provide some additional support here.
Flexion at the wrist
This pattern is seen often in left handers so that they can see their writing in cultures where we write left to right across the page, but is also seen in children who haven’t yet developed enough stability at the wrist. A wrist positioned in neutral or flexion decreases the range of movement available to the fingers and thumb. The Handithing or Sportithing while not pencil grips are useful supports to guide the wrist back into extension, while also supporting hand division development. Doing writing and drawing activities on a vertical surface also encourages this position so are a great environmental modification.
Pain or callosing at the first joint of the middle finger
This is most typically as a result of too much pressure being put through the grasp or tightness within the grasp being used. Grasps that provide some padding can help ease this. There are a range from those with simple foam, silicone or rubber through to others that provide additional tactile feedback such as bumps or soft spikes to give more feedback as to how tight the person is grasping the pencil.
As with all issues relating to hand development if you are not seeing the change required with a little home or school support, or you are seeing the issue impact upon other skills such as their learning then I would encourage you to seek out professional support from an Occupational Therapist.