306 OCCUPATIONAL THERAPY - SEPTEMBER, 1982

Children's Prehension
while Writing.
A PILOT INVESTIGATION
by
Jenny Ziviani, B.App.Sc. (O.T.), B.A.
Lecturer, Department of Occupational Therapy, University of Queensland

INTRODUCTION Procedure
Occupational Therapists have worked with children in special All children were asked to do a series of pencil and paper tasks.
school settings for many years. More recently they have also At the same phase of each task children had their pencil grip
become involved with children who have specific learning photographed from the ventral and sagittal planes. Photographs
disabilities in regular schools. Here, because of their traditional were then enlarged to 5" x 3" and grips were analysed in the
concern with upper limb function, Occupational Therapists, have followingways:
been sought when children demonstrate poor hand function. The 1. Degree offlexion ofindex finger:
classic manifestation of this difficulty in fine manipulation is in poor By use of graphed overlay, a measure of grip tension was
handwriting. determined by analysing the angle of flexion of the index finger
Fundamental to the treatment of poor handwriting skills is an while holding the pencil. If the proximal interphalangeal (P.I.P.)
understanding of the evolution of prehension from early reflexive joint was flexed at 90 degrees or more with or without hyper-
behaviour. A number of workers (Halverson 1931, Sheridan 1960, extension of the D.I.P. joint, it was given a grade of 1 (Fig. la). If
Twitchell 1970, Erhardt 1974) have comprehensively presented the the P.I.P. joint was less than 90 degrees flexion it was given a grade
neurodevelopmental basis. However, less emphasis has been given of2 (Fig. Ib).
to later aspects of manipulative development directly related to
handwriting performance. Gesell in 1940 presented the first
detailed description of maturational changes in prehension. The
earliest grasp seen in young children is a cylindrical supinated
approach. This is then followed by a increase in pronation and the Figure la Figure Ib
development of opposition between the thumb the first two fingers.
From about two and a half years a gradual progression occurs in the
quality of the opposition until the thumb comes into precise
opposition with the distal phalanx of the index finger while a pencil
or crayon is secured between them and the radial border of the
terminal phalanx of the middle finger.
Rosenbloom and Horton (1971) looked more specificallyat what
Wynn-Parry (1966) called the "dynamic tripod. grip". They
identified two phases of this grip - the first was the tripod posture
in which there was little or no intrinsic muscle activity and. the
second was the dynamic tripod in which intrinsic muscle activity was
present. After observing 128 children between the ages of 1 and 7
years they confirmed that the developmental trend was for tripod 2. Fingers used:
posture to precede dynamic tripod and that, in normal children, this Literature suggests that a child of 7 years or more is able to
commenced at about two and half years of age. employ the dynamic tripod grip when writing (Rosenbloom and
Little subsequent research has examined the developmental Horton 1971). However clinical experience reveals that some
tendency in handwriting grips. Yet it would seem important to any children use thumb, index and middle fingers on the pencil barrel
remedial Occupational Therapy programme for children with and support the pencil on the radial aspect of the fourth finger.
handwriting problems that grips be identified as age-appropriate When this was observed a grade of 1 was given (Fig. 2a). Where the
and the sequence to their attainment be recognised. It was for this child gripped the pencil with the thumb and index finger and rested
reason that the following pilot investigation was carried out. The the pencil on the radial aspect of the middle finger a grade of 2 was
aim was to look at school aged children and identify various given (Fig. Ib).
components of handwriting grip to see if they changed over time.

METHOD
Subjects Figure 2a
Participants in the study were fifty six children (equal numbers of
boys and girls from the same school) ranging in age from 7 years 4
months to 13 years 1 month with a mean age of 9 years 8 months.
These children were randomly selected from their respective grades
with 10 children from each of grades 3 to 5 and 13 from each of
grades 6 and 7. Since all children were attending a regular state
school, average intelligence was assumed.

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 OCCUPATIONAL THERAPY -
3. Opposition
Finger opposition is an important component of fine prehension.
If fingers used by the children were not in pad to pad opposition
(Fig. 3a) a grade of 1 was given. If fingers were in opposition a grade
of2 was given (Fig. Ib),
. Figure3a
4. Degree offorearm supination:
While in early development the child progresses from supinated
cylindrical grasp to more pronated pincer grip, the transition from
print to cursive writing makes a slightly more supinated posture of
the forearm advantageous. Therefore if the forearm was
determined to be less than 45 degrees supinated a grade of 1 was
given (Fig. 4a), while if it was more than 45 degrees a grade of2 was
given (Fig. 4b). The angle was determined by using a graphed
overlay on the photographs.
Figure4a Figure 4b
RESULTS AND DISCUSSION
Resulting frequencies have been plotted in Figure 5. Index finger
flexion shows definite tendency towards relaxation with increasing
age. By the age of 10.5,32 percent ofthe total children were rated as
having less than 90 degrees of flexion in the P.I.P. joint ofthe index
finger. This compared to 17 percent maintaining flexion at 90
degrees or greater. Callewaert (1963) refers to this latter posture as
the "broken index finger" and suggests that it results in writing
which is generally perpendicular to the horizontal line or sometimes
backhanded. With the development of cursive writing this should
probably be modified. The fact that none of the younger children
scored a grade of 2 in this observation suggests that it is an age
related phenomena. The Fisher exact probability (Seigel 1959)was
calculated and the probability of such a result occurring by chance
was P< .001. The few children over the age of 12 who continued to
score grades of 1 were also described by their classroom teacher as
being particularly tense and prone to writer's cramp. This may
therefore be a reflection of a behavioural characteristic and not
purely motor skill development.
The only other category to show such a marked developmental
trend was the degree of forearm supination (P<.OI). The amount of
supination tended to increase with age and accompanied the
relaxation of pressure through the index finger. It was felt through
observation that this could result from the transition from print
script to cursive writing. As slope and speed are more easily
obtained when the forearm is more supinated then as children
become more accustomed to cursive writing so the trend for
increased supination should follow.
The remaining two categories - fingers used and opposition -
showed no specific developmental transition. Most children (91
percent) between the ages of 7 and 12 presented with the dynamic
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SEPTEMBER, 1982 307
tripod grip (grade 2). This is consistent with Rosenbloom and
Horton's (1971) findings that this is a preschool development
commencing at about 2.5 years and continuing to be refined as
motor control matures. The 5 children demonstrating the modified
tripod (grade 1), where thumb, index and middle fingers were all on
the pencil shaft which in tum rested on the distal phalanx of the
fourth finger, appeared to occur in no particular age grouping. This
could represent either poor writing habits or children who as a result
of poor fine motor control derive extra stabilization by using this
grip.
Opposition of fingers had no recognisable pattern with
approximately 32 percent not demonstrating pad to pad opposition.
This was distributed evenly throughout the age range and may
simply represent a habitual pattern which has not undergone
teacher correction. Writing as a motor skill is only actively taught in
most schools during grades 3 and 4. Thereafter there is opportunity
for children to lapse into poor habits as more emphasis is placed on
content and structure of writing.
CONCLUSION
This pilot investigation has suggested that certain aspects of
pencil gnp (index finger flexion and forearm supination) in children
between ages 7 and 12 undergo modification - possibly as a result
of motor skill refinement. Other aspects (fingers used and
opposition) appear more related to a child's specific motor abilities
or poor writing habits. The analysis of these factors in children who
present for Occupational Therapy is important in the understanding
of whether poor handwriting is a reflection of underlying problems
in motor coordination or simply something that can be remediated
by correction of poor writing habits. Extension of this study to
compare sensory motor functioning with handwriting grips is the
logical next step.
REFERENCES
1. Callewaert, H. For easy and legible handwriting, In Herrick, V.
E. (Ed). New Horizons for Research in Handwriting. University of
Wisconsin Press, 1963.
2. Erhardt, R. P. Sequential levels in development of prehension.
The American Journal ofOccupational Therapy, 1974,28,592-596.
3. Gesell, A. The FirstFive Years ofLife. London: Methuen, 1940.
4. Halverson, H. M. An experimental study of prehension in
infants by means of systematic cinema records. Genetic Psychology
Monograph 1931, 10.
5. Rosenbloom, L. and Horton, M. E. The maturation of fine
prehension in young children. Developmental Medicine and Child
Neurology 1971, 13,3-8.
6. Sheridan, M. D. The development of progress of infants and
young children. Reports on Public Health and Medical Subject. No.
102. London, 1960.
7. Siegel, S. Non parametic Statistics Japan: Me Graw Hill, 1959.
8. Twitchell, T. E. Reflex mechanisms and the development of
prehension. In Connolly, K. (Ed). Mechanisms of Motor Skill
Development London: Academic Press, 1970.
9. Wynn-Parry, C. B. Rehabilitation of the Hand (2nd edition).
London: Butterworth, 1966.
APPENDIX A
GRADE N 12-5 13 lH
-B
I I
A. INDEX FINGlR fLEXION
·8 luI II IIU .:::.1.1
B. fiNGERS USED
. !I
eEl I. I
..
C. OPPOSITION
DB FIGURE 3 Grip Components
I •.: • .11
D. FOREA. SUPINATION