The Importance of the Hands

Our hands are complex tools which we take for granted much of the time. We use them in combination and on our own command, using our brain to control them. They do not function on their own but are dependant on our trunk and arm stability. We can use our hands to initiate movements of our trunk by pulling or pushing ourselves e.g. when sitting up from lying. The hand does not just provide motor control but also provides a vast amount of sensory feedback.

The movement of our hands/arms:

• Fingers
  Abduction/Adduction spreading and closing fingers away from and towards middle finger
  Flexion/Extension Curling and straightening fingers
  Opposition of the thumb The ability to take the tip of the thumb to the tip of the other fingers
• Wrist
  Flexion/Extension Moving palm of the hand towards forearm/back of hand towards forearm
  Deviation Moving side of hand towards forearm (thumb or little finger)
• Forearm
  Supination/Pronation Rotating forearm from elbow palm up or down
• Elbow
  Flexion/extension Bending or straightening arm at elbow

Normal Development

A normally developing baby will find their hands and learn to control them firstly by chance and later through experimentation. All babies are born with a grasp reflex; if you put your finger in the palm of a newborn baby’s hand the fingers close tightly around it. The baby does this without any conscious control and it is difficult for them to let go. As a baby becomes more alert and moves more they will start to see their hands moving around in front of their face; through normal interaction and games with adults they become aware that their hands belong to them. As the grasp reflex begins to diminish a baby discovers that they can exert more and more control over opening and closing their hands.
Gradually, through a combination of watching their hands and playing with the toys they are given, young children develop finer and finer control over the many and varied movements of their hands. By the time they reach school age most children will have developed intricate control over their fine motor skills.

So what is different for children with Cerebral Palsy(CP)?

Children with CP may have a variety of difficulties which disrupt the use of their hands. Often they will not lose their grasp reflex. This makes it much more difficult for them to open their hands in order to hold or let go of e.g. toys. This reflex may be so strong that it overides their active control over their hand movements.
In addition, the children’s muscles in their hands, arms and fingers will be affected by CP in the same way as the rest of their body. This can result in tight muscles which can be slow to respond to the child’s ‘commands’; their movements will generally be poorly co-ordinated.
Many children will find it difficult to abduct their thumbs; they tend to remian adducted in the palms of their hands, exacerbating their difficulties in grasping, holding and letting go.

Grasp and Release:

Achieving grasp and release will have a very positive influence on a child’s development:

Fixation By grasping and holding a child can stabilise his body, enabling him to move other parts of his body more efficiently, safely and with increasing independence.
Mobility Grasping enables a child to actively change position and hold on to equipment in order to balance more efficiently.
Balance A child who has difficulty developing balance reactions can use his grasp to enable them to balance.
Function Hands are used in all functional tasks with a variety of different holds and manipulations

The ability to let go is key to achieving greater independence

So what can we do to help?

The first thing children with CP need to learn is to become familiar with their hands. They need to be encouraged to look at their hands throughout all tasks. Encouraging the children to clasp their hands together and stretch them out in front of them not only breaks some reflex patterns but also allows the hands to come together in midline.
Practising grasp and release in many situations will assists the development of these skills.
By gently flexing the wrist the fingers can be encouraged to release and by encouraging wrist extension the grasp can be strengthened.
One hand and one arm can be used to prop, offering stability at the trunk and encouraging elbow extension whilst the other can be used to compete an activity.

Above all the children need to have as many opportunities as possible and to use their hands to handle and explore a wide range of different objects of different size, texture etc.
This will give the children vital opportunities to become familiar with their hands, to develop control over their actions and to gain a variety of sensory information.