question

Patterns of Hand Function:

answer

- Reach - Grasp - Carry - Voluntary release - In-hand manipulation - Bimanual skills

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Reach

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extension away from the body and movement of the arm for grasping or placing objects

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Grasp

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attainment of an object with the hand; holding within the hand

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Carry

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transportation of a hand-held object from one place to another

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Voluntary release

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finger extension allowing intentional release of a hand-held object within the hand at a specific time and place

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In-hand manipulation

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adjustment or movement of an object within the hand after grasp

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Bimanual skills (bilateral hand use)

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coordinated use of two hands together sequentially or simultaneously to accomplish an activity

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Social and Cultural Factors

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SES gender role expectations

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Occupational therapists use what to understand development of inter-related performance areas. Through this lens, a child's performance reflects their innate developmental abilities and the contextual opportunities and barriers that affect performance. TOP-DOWN

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occupation-based models and dynamic systems theory

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Somatosensory Functions

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Critical in hand development especially for isolated movements of fingers and thumbs

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Haptic perception

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child's interpretation of somatosensory information (through active touch) for purposes of understanding object properties and characteristics

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Haptic perception

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Emerges around 6 months

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Full haptic perception

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doesn't develop until the child is 5-6 years old when the child can manipulate objects within the hand

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Full haptic perception

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object texture, shape, and hardness through active touch

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Initiating and sustaining grasp force requires what?

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tactile and proprioceptive input and integration

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tactile information

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anticipating the amount of force needed to grasp and lift an object

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Children w/ CP and DCD

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results in coordination problems, timing and speed of response, clumsiness, dropping items or excessive force

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Somatosensory functions

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- need for ability to hold manipulation and use proper force - many times tested by watching hand function

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vision

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- used as a guide for reaching and grasping - guides fine motor development

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visual perception and cognition

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hand use and cognitive development closely linked

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sustaining attention

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important with hand development

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4-month old reaching

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uses vision as a dominant sense to guide arm and hand movements in reaching for objects

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visual-motor development required for accurate reach matures by approximately

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6 months of age reaching

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9 months infant reaching

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guides hand movements using visual-somatosensory integration

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6-12 months of age (visual perception and cognition)

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object characteristics and spatial relationships

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9-10 months of age (visual perception and cognition)

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infants adapt their arm positions to horizontal vs. vertical object presentations and shape their hands appropriately for convex and concave objects

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2-year-old (visual perception and cognition)

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relate objects to one another with more accuracy and purpose

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Before 18 months of age (visual perception and cognition)

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infants modify their movement approach in anticipation of the weight of the object

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1½ -2 infant (visual perception and cognition)

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adjusts the actions of the hand in response to object characteristics (size, shape, & surface qualities)

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Preschool age (visual perception and cognition)

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the development of hand function allows for more complex interaction with objects and use of well-developed visual-perceptual skills to guide manipulation of objects in the course of play and social interaction

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10 months of age (cognition)

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Infant can attend to two objects at once while banging them together (cognition)

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15 months of age (cognition)

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stabilizes an object with one hand, manipulating with other (cognition)

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18-20 months of age (toddler) (cognition)

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manipulates two or more objects simultaneously (cognition)

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Musculoskeletal Integrity

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- the integrity of the hand's joint and bone structures - ROM

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congenital hand anomalies

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may be missing one or digits, a condition that significantly affects the variety of possible prehension patterns

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Limitations in ROM can occur from

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abnormal joint structure, muscle weakness, abnormal muscle tone, joint inflammation

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Aspects of muscle functions:

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muscle power, muscle tone, muscle endurance

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Underdeveloped hand arches

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- critical for in-hand manipulation & handwriting skills - assess arches in hand development - thenar & hypothenar eminences (developed, shallow, muscular structures solid, atrophy, or underdeveloped?)

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social & cultural factors

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influence development

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culture

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- can determine objects held (chopsticks vs. a spoon) - influences the perception of child's need for manipulative materials

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sensory integration

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- hypersensitivity can affect development of hand skills - motor planning deficits associated with limitations in somatosensation

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cognition

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influences fine motor interests, child's attention, interest in fine motor tasks

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strength

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limitations in strength and endurance

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muscle tone

answer

hypertonicity hypotonicity

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reach and carry

answer

important sequence in motor control is use of linear movements before controlled rotation patterns

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reach and carry

answer

- visual regard (first several days of life neonate) - midline orientation (3-4 months) - symmetric then unilateral (4-5 months) - increased smoothness, consistency, ability to adjust movement - increased shoulder rotation with supination

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the goal of reach

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to transport the hand to the target, with precision in both time and space, and therefore requires control of the hand's movement toward the object and the preparation of the hand for grasp

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12 and 22 weeks of age (reach development)

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reach with extended arm to contact object with hands is likely to occur

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Carrying

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- (moving and lifting) involves a smooth combination of body movements accompanied by stabilization of an object in the hand - uses shoulder rotation movements with should flexion and abduction to orient the object during carry

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Precision grasps

answer

- involve opposition of the thumb to fingertips. - uses the extensive sensory feedback available through the fingertips and the fine control of intrinsic muscles

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Power grasps

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- involve the use of the entire hand - Thumb is held flexed or abducted to other fingers

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Sequence of grasp patterns

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Radial palmar, raking, radial-digital, tip pinch

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Patterns of grasp development

answer

- Ulnar fingers show activation before radial fingers and thumb - Palmar grasp(proximal) patterns before finger grasp (distal) - Extrinsic muscle activation dominates before intrinsic muscle activation

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Within the first 3 months (grasp sequence)

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the automatic traction response and grasp reflex decrease and voluntary palmar grasp emerges

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By 6 months (grasp sequence)

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the infant exhibits a radial palmar grasp when prehending objects

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7 months (grasp sequence)

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crude raking of a tiny object is present

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9 months infant (grasp sequence)

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holds tiny object between finger surface and the thumb

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9-12 months (grasp sequence)

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- refinement occurs in the ability to use thumb and finger pad control for tiny and small objects. - More precise preparation of the fingers before initiation of grasp, more inhibition of the ulnar fingers, and slight wrist extension and forearm supination

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1 year infant (grasp sequence)

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further refines grasp patterns and more sophisticated patterns emerge

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15 months infant (grasp sequence)

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infant can hold crackers, cookies, and other flat objects increasing control of intrinsic muscles

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Between 18 months to 3 years (grasp sequence)

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most children acquire ability to use disk grasp, cylindrical grasp, and a spherical grasp with control

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Preschool (grasp sequence)

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control of power grasp continues to develop

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3 years (grasp sequence)

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pattern for lateral pinch may be present, but power may not be present until later

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3-5 years (grasp sequence)

answer

refinement of patterns, strength increases. Strength for palmar grip, key (lateral) pinch, and tripod (three point) pinch increase

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12 years (grasp sequence)

answer

strength continues to increase in grip, pinch, palmar pinch, and tip pinch

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power grasp

answer

- used to control tools or other objects. - used with hand strength is required in activity

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hook grasp

answer

used to carry objects such as a purse or briefcase

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spherical grasp

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used to hold a small ball

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cylindrical grasp

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used to hold a glass, cup, or can with hand around the object

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disk grasp

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used to hold a disk such as a jar lid

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lateral pinch

answer

used to exert power on or with a small object

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pincer grasp

answer

used to hold and handle small objects and precision tools (e.g., a pencil)

question

three-jaw chuck or tripod grasp

answer

used to hold and manipulate a writing utensil or eating utensil

question

tip pinch

answer

used to prehend and hold tiny objects

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5 Types of In-Hand Manipulation Skills

answer

Finger-to-palm translation Palm-to-finger translation Shift Simple rotation Complex rotation

question

Finger-to-palm translation

answer

child grasps the object with the pads of fingers and thumb and moves it to the palm 1. Example: picking up a coin with the fingers and thumb and moving it into the palm of the hand

question

Palm-to-finger translation

answer

reverse of finger to palm, requires more isolated control of the thumb. Begins with finger flexion and moves to finger extension 1. Example: Moving coin from palm of hand to the finger pads before placing coin in a vending machine

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Shift

answer

linear movement of the object on the finger surface to allow for repositioning of the object on the pads of the fingers. The object usually is held solely on the radial side of the hand 1. Example: separating two pieces of paper a. Moving a coin into position against the volar aspect of the DIP joint to a finger position closer to the fingertips b. Adjusting pen or pencil after grasp so that the fingers are positioned close the writing end of the tool - Used a lot in dressing tasks such as buttoning, fastening snaps, lacing shoes, and putting on belt through loops

question

Simple Rotation

answer

- child turns or rolls an object held at the finger pads approximately 90 degrees or less. Fingers act as a unit, without differentiation of action and thumb is in an opposed position 1. Examples: a. Unscrewing a small bottle cap b. Reorienting a puzzle piece c. Picking up small peg and rotating it from horizontal to vertical

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Complex rotation

answer

- child rotates small object 180 degrees to 360 degrees once or repetitively. Fingers and thumb alternate in producing the movement and the fingers typically move independently of one another. 1. Turning a coin or peg over. 2. Turning a pencil over to use an eraser

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With stabilization

answer

- refers to use of an in-hand manipulation skills while other objects stabilized in the hand.

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General Developmental considerations

answer

- Development of movement patterns from mass to specific - Proximal to distal - Ability to combine patterns of stability and mobility - Joints must be able to stabilize at any point in normal range of motion - Straight movement patterns emerge before controlled rotational patterns

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In-hand Manipulation Skills Developmental considerations: Motor skill prerequisites

answer

- Active forearm supination with stability and movement - wrist extension with stability - dynamic thumb opposition - Fingertip prehension with control of fingertip forces - Isolated thumb and radial finger movement - Stability with mobility of the transverse MCP arch - Dissociation of the radial and ulnar sides of the hand

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12 to 15 months (in-hand manipulation skills)

answer

- infants use finger-to-palm translation to pick up and hide small pieces of food in hand

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object characteristics

answer

influence the in-hand manipulation pattern used

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voluntary release

answer

To place an object for release, the arm must move into position accurately and then stabilize as the fingers and thumb extend. - Object release requires precise coordination of fingertip forces and timing for predicting accurate object placement

question

volitional control release emerges

answer

as the infants proprioceptive perception, eye hand coordination, and cognitive development improve

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5 to 6 months (voluntary release)

answer

infant transfers the object from one hand to the other by fully opening the releasing hand

question

9 months (voluntary release)

answer

- infants begins to release objects without stabilizing them with the other hand

question

voluntary release

answer

-Child initially stabilizes on surface to release -Learns to release w/o stabilizing -Release pattern is refined -Learns to modulate force-demonstrates stacking

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7 to 13 years (voluntary release)

answer

- children acquire effective modulation of fingertip force when grasping lighter and heavier objects accurately time their release and placement

question

Bilateral hand use

answer

-Symmetric patterns dominate initially -Bimanual action emerges in 10-12 months -Reciprocal and alternating hand movement -Simultaneous manipulation -Differentially uses two hands

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Bimanual skills

answer

As skilled use of symmetrical hand and arm patterns is refined, the infant begins to use the two arms independently of one another to perform different roles in an activity

question

Ball-throwing skills

answer

-Fling -Child learns to dissociate trunk and arm movements -Can control direction with shoulder stability -Accuracy and distance increase

question

Ball-throwing skills

answer

reflect the child's ability to use shoulder strength and control with release skills (tells a lot a/b UE function)

question

Ball-throwing skills

answer

-child must sequence and time movements throughout the entire UE -overhand throwing develops later than underhand throwing

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2 years (ball-throwing skills)

answer

can throw the ball forward and maintain balance so that his body does not fall forward

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5 years (ball-throwing skills)

answer

child can use overhand throw to consistently hit a target at 5 feet

question

5 years and older (ball-throwing skills)

answer

child use underhand throws to contact a target

question

Tool use

answer

-development of scissor use -development of spoon and fork use

question

Tool use

answer

-essential for participation in a variety of self-care, play and leisure, and school and work tasks. -purposeful, goal-directed manipulation of a tool to interact with other objects or materials -highly relates to cognitive development -Used for eating -Good for grading activities -competence for eating and play typically emerges during the 2nd year

question

6 years of age (tool use)

answer

-child demonstrates a mature grasp with the ulnar two fingers flexed and the radial fingers within the top scissor hole to provide the cutting action

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Hand preference (dominance)

answer

-continues to develop up to 8 years of age -infants less than 7 months only use one hand -left hand develop later than right hand -boys take longer to develop

question

Children's occupations

answer

Play ADLs School functions

question

play

answer

-can hinder social engagement if child cannot play w/ peers in the same fashion their peers are playing with objects

question

early exploratory play

answer

-infant learns object properties through manipulating them -the interaction of touching, grasping, and manipulating allows the infant to integrate sensory information and to learn that objects remain the same regardless of visual orientation

question

play

answer

-with increasing age, depends on hand function and fine motor skill competence

question

ADLs

answer

dressing bathing and hygiene eating -cognitive-perceptual function

question

Hand functions for ADLs

answer

-Precision and power grasps of objects and materials -Complementary and reciprocal bimanual skills -Hand movements, including in-hand manipulation with and without vision -Complex action sequences -Development of automaticity

question

8 years and older (ADLs)

answer

children are independent in self-care skills and manipulation skills required to perform ADLS

question

School functions

answer

-Manipulative activities -crayons, paper, pencil -scissors -building with materials -FM & perceptual issues (handwriting)

question

Biomechanical approach

answer

-Used primarily to assess and provide intervention activities that improve a child's ROM, strength, or endurance. -Focus on postural alignment, joint stability and relationships, and musculoskeletal problems focus is on stability, postural alignment, level of motor skill performance, effects of gravity, effects of the supporting surface and the most efficient postures for functional performance -proximal - stability -distal - control - Used for children with musculoskeletal and neuromotor disorders associated with prenatal or perinatal central nervous system lesions or anomalies

question

Biomechanical approach

answer

-ROM -Base of support -Alignment of the body -Muscle strength and postural control -Mobility

question

Neurodevelopmental approach

answer

-Uses range of handling and positioning techniques that promote motor function in children with cerebral palsy. (Bobath) -Inhibit spasticity, encourage normal muscle movement patterns -Work toward obtaining postural alignment and postural tone that allows fluid transitional movements, postural stability for optimal hand function, efficient weight shift and equilibrium responses in upright positions, control of isolated and dissociated extremity movements, enhanced mobility and dynamic stability within and between body positions -Normalize tone -Outcomes include improved control of isolated arm, hand, and finger movements required for manipulation and bimanual activities

question

Occupation-Based Approaches

answer

-Emphasize the interaction of the person, environment, and occupation and use holistic methods to support the child's skill development. -Considers the child's motivation and interests, the context of performance including activity demands, constraints, and natural supports, and the child's performance strengths and limitations. -Include: motor learning, pediatric-constraint induced movement therapy, Cognitive Orientation to daily Occupational Performance (CO-OP), occupational therapy using sensory integration (OT-SI)

question

Motor Learning Practice Model

answer

-everyday activities, motivating and meaningful activities that help children achieve motor goals using problem solving, practice with reinforcement, whole task activities and refinement of skill in everyday activities. Use encouragement and specific feedback on performance is used. Repetitive practice. -children engaging in naturalistic environment -setting up environment correctly, providing feedback, & great encouragement

question

Motor Learning Practice Model Children w/ disabilities

answer

•Children with CP require more practice and it takes longer in the learning stages •ASD and DCD have trouble with in-hand manipulation skills and hand writing

question

Foundational motor learning theories

answer

-Schema theory -Dynamic systems theory -Stages of learning

question

Schema theory

answer

defines how a child learns movement patterns by building new based theories movements on established motor patterns

question

Dynamic systems theory and occupation-based theories

answer

recognize how multiple variables in the child, the activity, and the environment influence performance

question

Stages of learning

answer

-Cognitive -Associative -Automatic

question

Cognitive stage

answer

child is highly attentive to the activity, learning how to approach it, often using trial and error to develop a strategy for accomplishing the activity goal

question

Associative stage

answer

movements are less variable and the child refines the movements that accomplish the goal

question

Automatic stage

answer

child practices his or her skills with less cognitive effort and less attention required

question

Pediatric constraint-induced movement therapy

answer

-restrain non-effected extremity and engage child in meaningful activities -used for children with hemiparetic cerebral palsy and hemiparesis caused by acquired brain injury

question

Pediatric Constraint Induced Movement Therapy

answer

-Constraint of the child's less impaired upper extremity -Selection of activities and techniques to elicit specific movements of the more impaired arm and hand -High intensity intervention with repetition of targeted movements -Sessions in the child's natural environment -Systematic reinforcement that directs the child to attempt higher level skills or demonstrate increased strength and endurance -Transfer of the intervention program to caregivers and the child's daily routines -3-6 hours for 2 - 4 weeks

question

Developmental disregard

answer

refers to a pattern observed in children with congenital hemiparesis in which they neglect their affected arm and hand

question

Activity Adaptation

answer

-Children that benefit from adaptation models are children who have neuromotor or musculoskeletal disorders with hand function impairments that remain limiting despite interventions focused on remediation. -Congenital orthopedic disorders -Trauma resulting in permanent hand impairments -Severe neuromotor disorder such as cerebral palsy

question

Adaptive Equipment for FM

answer

dycem, built up spoons, weighted spoons, switches, touch screens, elastic waste bands, Velcro, pencil grips, adapted mouse, large zipper pulls on backpacks.

question

Arthrogryposis multiplex congenital

answer

abnormal fibrosis of muscle tissue, causing contracture of upper and lower extremity joints. Often the child's elbow is locked in extension with forearm pronated, creating difficulty in eating, and activities that require bringing hand to face

question

school setting

answer

use adaptive approach

question

clinic setting

answer

use remedial approach

question

children who benefit from adapted techniques and assistive technology

answer

-orthopedic conditions that restrict UE function -neuromuscular disorders with significant weakness or loss of movement -cerebral palsy with severe spasticity and limited ROM

question

Motor Problems associated with Impaired Hand Skills

answer

-Inadequate isolation of movements -Poorly graded movement -Lack of ability to use the middle ranges of movement -Insufficient force -Poor timing of movements -Limited variety of movement patterns -Disorder in bilateral integration and control -Trunk instability or abnormal posture -Compensatory patterns of movement

question

Adaptation Models

answer

-Contextual features of the environment and activity are modified to increase the child's participation in play, school functions, social interaction and ADLs.

question

Somatosensory problems

answer

-Poor tactile discrimination can result in less feedback from the hand's movement. -Children with cerebral palsy may have tactile discrimination problems. -Degree of tactile impairment is not always associated with degree of motor impairment. -Can relate to motor planning problems. -Children with developmental coordination disorder can have limited somatosensory perception.

question

Learned non-use phenomenon in children with hemiplegia

answer

Children with hemiplegic cerebral palsy can have learned non-use: They do not use the weaker arm because it is easier to only use the fully functional arm.

question

Hand skill problems in children and adolescents with various developmental disabilities

answer

-Visual impairment/blindness -Attention deficit-hyperactivity disorder -Autism spectrum disorders -Development coordination disorder

question

Difference in developmental trends between children with and without disabilities

answer

-Hand skills may increase at a slow rate -Hand skills may decrease over time in children with quadriplegic cerebral palsy -Hand skills may develop over a longer course than in typical children. -Problems with coordination may persist.

question

Screening for Hand Skill Problems Evaluation content

answer

1. Measurement of active and passive ROM 2. Evaluation of strength 3. Evaluation of tactile functioning 4. Assessment of posture 5. Administration of a standardized developmental test 6. Administration of a developmental motor test 7. Administration of a test of fine motor skills for older children and adolescents 8. Classification of manual skills to document outcomes 9. Administration of a visual motor integration test 10. Assessment of hand skills in prevocational and work tasks.

question

John is a 3-year-old boy who breaks his toys often. His mother states he drops things and crushes them. Which explanation seems most possible for his poor hand skills?

answer

Poor proprioceptive or tactile awareness

question

According to biomechanical principles, what is the optimal position for functional tasks?

answer

Sitting with head, arms, hands in midline

question

8-9 months

answer

radial digital grasp

question

12 months

answer

tip pinch

question

poor proprioceptive or tactile awareness

answer

may result in breaking objects or dropping them frequently

question

Optimal position for most functional tasks

answer

Midline position of the head, arms, and hands. Sitting with slight flexion is best.

question

Hypertonicity

answer

characterized by limited range of motion and decreased range of motion

question

Gray cannot fully extend his fingers. He has limited range of motion at wrist, forearm, and fingers. What does this describe?

answer

Hypertonicity

question

Hypotonicity

answer

the joints may be hypermobile and the hand lacks stability. Over time, joints stiffen owing to limited or minimal joint movement.

question

Muscle weakness

answer

The hand may not have sufficient force to hold or move heavy objects. The hand may not generate appropriate forces to hold and use writing utensils, scissors, eating utensils.

question

Sensory feedback

answer

Tactile, kinesthetic, and proprioceptive feedback is limited; is not available to guide precise hand and finger movements

question

Scott is able to move the penny from inside his hand to his fingertips without using his other hand. What hand skill pattern does this represent?

answer

Palm to finger translation

question

Seating characteristics considered optimal for hand function in children with cerebral palsy (spastic quadriparesis)?

answer

-The pelvis is supported on a solid surface. -The chair promotes symmetric weight bearing on thighs. -A lap tray is used to improve shoulder position. -Pelvic strap holds the pelvis in place. -Knees and ankles are positioned at 90-degree angles. -Lateral trunk supports can provide lateral stability and increase midline alignment of trunk.

question

The therapist evaluating a 4-year-old child observes the child changing hands quickly, transferring objects to one hand, and stabilizing an object on a table surface to re-orient its position. What do these observations indicate?

answer

The child has limited in-hand manipulation skills.

question

Which practice model is the therapist using when she focusses on improving a child's postural alignment, joint stability, and hand strength for dressing?

answer

Biomechanical

question

Goals of therapy for infants with brachial plexus birth palsy

answer

-Preserve passive range of motion -Promote awareness of the affected extremity -Promote gross motor development

question

Molly is a 4-year-old girl with right hemiplegia who loves to play with "Littlest Pets." Which statement best reflects motor leaning principles and strategies to improve hand skills?

answer

Engage her in play with Littlest Pets, encouraging use of both hands and increasing the challenge.

question

Unstructured clinical observations are useful for the therapist to understand how a child uses the affected upper extremity. Important clinical observations to make are

answer

-The appearance of the child's affected arm -How the child holds the affected arm -How the child spontaneously uses the affected arm for play and/or self-care activities

question

Sensation can be tested using the following:

answer

-Two-point discrimination -Wrinkle test -Semmes Weinstein monofilaments

question

Preparation for hand skill development

answer

-Positioning the child -Attending to postural tone issues -Improving postural tone and control -Improving muscle strength

question

Development of hand skills

answer

-Promoting isolated arm and hand movements -Enhancement of reach and carry skills (Grasp skills, voluntary release skills, In-hand manipulation skills) -Facilitation of bilateral hand use skills -Generalizing skills (integration of hand skills into functional activities)

question

Positioning the child

answer

-Optimal positioning -Position to facilitate specific movements -Stable chair with adequate foot support -Appropriate size for good posture -Adequate support if posture is unstable -Use standing position

question

Improving postural tone and control

answer

-Child with spasticity may need inhibition of tone -Upper extremity weight-bearing to encourage co-contraction -Weight-bearing in prone position -Use splints during weight-bearing -Pressure on hand/palm to relax

question

Improving muscle strength

answer

-Strengthening programs -Use of neuromuscular electrical stimulation

question

Promoting isolated arm and hand movements

answer

-Focus on specific movement patterns -Embed movements in games and songs -Supination control is often a focus of activity

question

Enhancement of reach

answer

-May select sitting, prone, side-lying. -For children with severe involvement, use materials that are easy to activate and are easy to reach -Add structure to activity to promote reach in different planes -Present activity at different heights and angles -Reach forward, to side, behind -Reach with shoulder neutral then in external rotation.

question

Enhancement of carry

answer

-Trunk must be stable, may need to first improve trunk control -Facilitate carry at shoulder with gentle holding -For child with weakness, first carry using a table surface to stabilize elbows -For children with visual impairments, may need to use contrasting colors or objects that make sounds

question

Enhancement of grasp skills

answer

-For child with spasticity, first inhibit tone -For child with hypersensitivity, desensitize -For child with severe disabilities, try different positions, emphasize wrist extension with grasp, consider splinting, use built-up handles. -For child with moderate disabilities, select object shapes to match grasping patterns: begin with medium-size objects, place objects to vary patterns, combine grasp and lift -For child with mild disabilities, focus on using a variety of grasping patterns: focus on pincer grasps, elicit intrinsic muscle activity, develop power grasp

question

Enhancement of voluntary release skills

answer

-Begin with full finger release -Begin with release to the side -Consider splinting -Practice finger extension -Move the target for release close to the body so that child extends fingers while flexing arm -Practice release in bimanual activities

question

Enhancement of in-hand manipulation skills

answer

-Begin with finger-to-palm translation activities -Use tactile discrimination and proprioception activities to enhance awareness -Use small, not tiny, objects -Structure the presentation to elicit specific skills -Move from translation to rotation skills -For child with basic skills, emphasize speed and variety of skills

question

Enhancement of bilateral hand use skills

answer

-Begin with symmetrical bilateral skills -Promote stabilizing with one hand and manipulating with other -Use toys and materials that require both hands -May work on a slightly unstable surface to promote stabilizing with one hand -For child with mild disabilities, focus on simultaneous bilateral manipulation skills

question

Types of splints used with children

answer

Static Dynamic Neurophysiologically based Spasticity reduction Resting pan Volar Soft Weight-bearing Casting Dorsal Thumb

question

Normal hand

answer

prominent thenar & hypothenar eminences

question

Abnormal (Atypical) hand

answer

shallow arches, flat & thin thenar & hypothenar eminences, little musculature, difficulty w/ hand manipulation & dexterity

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