Pencil Grips

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Many children we see at the clinic have difficulty assuming and maintaining a functional pencil grasp, which impacts their ability to write. What do we mean by “a functional pencil grasp”? Here are a few grasp patterns that we encourage:

Tripod Grasp – this is often seen as the “gold standard” for pencil grasp, however it is not the only functional and efficient way to hold a pencil. The pencil is held between the thumb and index finger and rests on the side of the middle finger. The ring and pinkie fingers are tucked into the palm while the shaft of the pencil rests in the open webspace formed by the thumb and index fingers. This pattern requires strong intrinsic hand muscles and good stability at the joints.

Quadrupod Grasp – this pattern is closely related to the tripod grasp, however, the pencil is held by the thumb, index and middle finger and it rests on the side of the ring finger. The pinkie is tucked into the palm and the pencil shaft rests in the open webspace just like a tripod grasp. This pattern provides slightly more stability but does not sacrifice control or joint positions.

Modified Tripod Grasp – Although this pattern looks quite a bit different than a standard tripod grasp pattern, the pencil is held the same way by the tips of the thumb and index finger. The difference is that the shaft of the pencil rests between the index and middle fingers. This pattern may be beneficial for children who lack stability of their webspace and arches of the hand. The movement of the pencil remains unimpeded and the joint positions are ergonomically correct.

Chances are if you are reading this article, your child does not use one of the patterns listed above. Some children tuck their thumbs under their index fingers, which is referred to as a thumb tuck.

Others place their thumb on top of their index fingers for added stability, which is referred to as a thumb wrap.

Then there are a wide variety of other dysfunctional grasp patterns like this one:

Perhaps a teacher or other professional has suggested the use of a pencil grip but with so many different grips available, how do you know which one is right for your child? Speak with your occupational therapist to investigate the need for a grip. Here are some of the common grips available. Click on the pictures below for a larger image.

GROTTO GRIP — GOAL: Promotes a tripod grasp pattern and helps prevent incorrect thumb placement PROS: Easy to place the fingers correctly on the grip; Can also be used by a child with a quadrupod grasp pattern; Blocks thumb wrap and thumb tuck ; Promotes an open webspace and supports the arches of the hand; Used by righties and lefties without changing the orientation of the grip CONS: It is rather large and children who are reluctant to stand out in the classroom may not accept the grip; Relatively costly at about $2 each

STETRO GRIP — GOAL: Promotes a tripod grasp pattern without adding bulk to the pencil; PROS: Small and inconspicuous, therefore it may be accepted by older children who do not want to use a “therapy tool” in the classroom; Inexpensive at about $0.25 each CONS: Does not prevent thumb wrap or thumb tuck; Can be confusing to place fingers correctly – arrow on grip points down for righties and up for lefties, thumb is placed on the star

THE PENCIL GRIP — GOAL: Supports an ergonomically correct grasp pattern; PROS: Soft, comfortable material; Wider at the top to promote an open webspace; Can work for children who prefer a quadrupod grasp; Available in many colors, including glitter, which may act as a motivator for use; CONS: Does not prevent thumb wrap or tuck; Fingers can be placed incorrectly; Material is hard to clean; Relatively costly – about $2 each

TRIANGLE GRIP — GOAL: Creates a broader shaft of the pencil and encourages a functional pattern in an unobtrusive manner; PROS: Easy to place on the pencil, since the uniform shape has no appropriate up vs. down and fingers can be placed on any of the sides; Supports an appropriate grasp pattern without extra features a child with a mild grasp issue does not need; Inexpensive at about $0.25 each; CONS: Does not prevent thumb wrap, thumb tuck or other less functional patterns

CUSHION GRIP — GOAL: Decreases pressure on joints; PROS: Can help alleviate pain for children who grasp their pencil too tightly; Inexpensive at about $0.20 each; CONS: Does not actively assist with finger placement or prevent less functional patterns; Does not “fix” the problem of holding the pencil with excessive force

PENCIL WEIGHTS — Although pencil weights are not actually an adaptive grip, they can be useful for children with decreased body awareness or mild hand tremors GOAL: Increase stability of the pencil; PROS: Improves awareness of the movement of the hand; Offers stability for mild hand tremors; CONS: May lead to fatigue in children with poor hand strength; O-rings may be a choking hazard to younger siblings

A Word of Caution Regarding Any Pencil Grips:

• Whenever exploring the potential use of a pencil grip, the following must be considered:
  • Does the grip support participation in handwriting tasks or does it cause more of a distraction?
  • Can the child consistently place their fingers correctly on the grip or do they need assistance each time they pick up the pencil?
  • Is the child willing to use the grip or will they hide it in their desk or “lose” it?
  • Is the child working to develop the intrinsic musculature of the hand in order to transition away from needing a grip?
  • What are the other factors impacting their writing? How is their trunk control? Are the seat and desk heights appropriately matched for the child? How is their proximal stability at their shoulder? What is their wrist position? Does the child efficiently separate movement between the two sides of the hand? How do their visual perceptual skills impact their writing? How does their regulation impact their attention and ability to sit long enough to master grip and graphomotor skills?

• Before a child enters Kindergarten, there is little need to use pencils or grips. Encourage the use of short crayons or pieces of chalk instead. A child’s grasp patterns continue to develop into a “mature” pattern around the age of 5-6 years old, so it is not uncommon to see a child alternate between functional and less functional grasp patterns up until this time.

Multisensory Handwriting Practice

Research has shown that a multisensory approach to learning is beneficial for a wide variety of children, particularly with teaching handwriting and reading skills. Many children who struggle with the formation of letters will show reluctance to complete class work or homework and may write the shortest answer possible rather than demonstrating their full grasp of the concept.

In the clinic, we see children who glaze over at the thought of practicing letter formation and other handwriting skills but are willing to participate in novel multisensory activities such as those listed below.

• Write or print out letters that take up an 8×11 piece of paper. Place a sticker or other indicator for where to start the letter.  Have your child drive a car or walk a stuffed animal along the letter’s path.
• Use the same printed letters from the first activity and place them on a cork board.  Have your child press push pins (with close supervision) into the start and end points for the strokes, then stretch elastics over the pins to create lines for the letter.
• Assemble a rainbow salt tray.  In short, glue colored construction paper into the lid of a shoe box and pour a thin layer of salt on top.  Your child can form letters with her finger or use a paint brush or other tool to write.  For complete step-by-step instructions, visit http://www.learning4kids.net/2012/06/05/rainbow-salt-tray/
• Shaving cream is a tried and true OT modality. Squirt a small amount of shaving cream on a cookie sheet, or right onto the tabletop if you don’t mind the mess. As with the salt tray, your child can use her finger or a tool to write and draw in the shaving cream.
• Pour finger paint on a plastic plate or small tray. The paint won’t adhere to the surface and provides the opportunity to practice letters repeatedly and correct errors easily.
• If you have a child who is over-responsive to tactile input, and therefore would run for the hills if you asked him to touch shaving cream or finger paint, try squirting hair gel in a sturdy zipper bag. Double bagging is probably the best approach.  You can add glitter or food coloring for extra visual appeal. Here is a great example: http://playathomemom3.blogspot.com/2011/07/squishy-bag-tactilemultisensory.html
• Roll play-doh or other modeling clay into “snakes” and form them into the letters.  Encourage your child to build the letter in the correct stroke order, for example, to make a “T”, start by forming the vertical line and then place the horizontal line on top.
• Wiki Sticks are a fun tool for learning letter formations.  They are a combination of yarn and food grade, non-toxic wax that can be bent into any shape you wish.  They will stick on a piece of paper, a sliding glass door, a smooth easel or the tabletop.  Start by having your child bend the Wiki Sticks to “trace” on top of a printed letter.  Then have him copy the letter by looking at an example and work up to forming the letter on his own. http://www.wikkistix.com/
• To work on letter identification, play a mystery letter game by tracing on your child’s back with your finger.  For extra motivation, give your child 100 points for every correct guess.  Please note:  this would likely not be an appropriate activity for children who are over-responsive to light touch and tactile input.
• Many kids have difficulty sitting long enough to practice letters and reading and need movement to stay regulated.  So you can print out letters or sight words and tape them firmly to the floor, or write with sidewalk chalk on the driveway.  Call out a letter or sight word and have your child jump on the correct answer.  Make this a little harder by giving instructions such as “Jump on the letter that makes the sound ‘sss’”, or “What does ‘lion’ start with?”.
• For a spin on the jumping activity listed above, try the same activity but give your child a (clean) fly swatter to smack the words or letters.
• Children who naturally have a low arousal level and children who seek intensity may benefit from using a wiggle pen. Their legibility may decrease with this pen, but it is great for repetitive assignments such as writing out spelling words.  These same children may enjoy using scented markers as well.

Handwriting Practice for the Summer Months

Children work very hard on handwriting skills each day during the school year. Don’t let the summer months slip by without encouraging handwriting practice. Here are some ideas to incorporate handwriting into vacation without bringing out the structured workbooks.

• Play games that include handwriting in the activity, like the board game Scattergories Jr. or have your child complete Mad Libs.

• Alter the rules of board games or card games to include a handwriting component. Have your child write their questions to play Guess Who, or write the new color after using a “Wild” card in Uno.

• Create a fortune teller. Put your child in charge of writing the words for the inside flaps. Here is a link with instructions. There are also templates for math-themed fortune tellers. We like to make ours with sensory activities written in them, such as jumping, catching a heavy ball, etc. Check out our indoor proprioceptive activities post for more ideas.

• Have your child write out a shopping list of his favorite groceries that you will be buying at the store. During the shopping trip, have him cross off the items as you place them in the cart.

• Take a picture of a family activity each week and have your child write about it. Young writers could simply label the picture, while older children could write a journal entry.

•  Here are some more ideas from Handwriting Without Tears: http://www.hwtears.com/files/HWT-Summer-Writing.pdf

Apps We Love for OT – Letter School

App Name: Letter School

Why We Love It: This app provides stroke by stroke instruction for uppercase letters, lowercase letters and numbers. Options include Handwriting Without Tears, D’Nealian and Zaner-Bloser stroke styles. Each letter or number is presented in 4 phases:

1. Identify

2. Touch the correct dot to start each stroke

3. Trace

4. Independently write

The best part about this app (other than the creative visuals) is that it provides extra cues as needed. For example, if the child repeatedly taps the wrong dot, the right one “jumps” and makes a sound, or if the child repeatedly attempts the stroke in the wrong direction, arrows will appear to help guide the child.

Why Kids Love It: This app makes letters come alive with soap bubbles, caterpillars, trains, lawnmowers and more. The visuals are very engaging without being a distraction, and this brings the kids back to this app over and over, without groaning about practicing handwriting.

Available: Itunes store – Lite version is free, Full version is $2.99

Check out the Letter School Website for more info.