The Dynamic Tripod Grasp

Handwriting is influenced by the development of appropriate sensorimotor, perceptual and cognitive skills. One of the most common problems occupational therapists in the school are consulted about is improper pencil grasp. While the most efficient way to hold a pencil is the dynamic tripod grasp (figure 1) many other patterns are commonly seen in children and it does not always require intervention or modification. In the dynamic tripod grasp, the pencil is held between the thumb and index finger, with the pencil resting on the middle finger.

There are variety of reasons why children hold their pencils in patterns other than the dynamic tripod. One common reason is participating in a lot of writing before their hands are developmentally ready for this activity. This is becoming more and more common as parents try to start preparing children to school with writing activities at an earlier stage.

It is important to try to modify the pencil grasp as early as possible, since many students seem to have developed bad habits even before entering kindergarten. Adaptive pencil grips may be helpful in teaching students to modify their grasp and are used to faciliatate an optimal pencil grasp (figure 2). There are many different types of grips available. For a pencil grip to be effective, the student needs to be involved in choosing the grip and to understand the importance of using it.

The most optimal position for writing includes the ankle, knee and hip at right (90 degrees) angles with the forearms resting on the desk. The top of the desk should be approximately 2 inches above the elbows when the arms are at the student's side.

Pencil Grasp Patterns

Functional Grasp Patterns
Tripod grasp with open web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb and index finger form a circle.
Quadrupod grasp with open web space: The pencil is held with the tip of the thumb, index finger, and third finger and rests against the side of the fourth finger. The thumb and index finger form a circle.
Adaptive tripod or D'Nealian grasp: The pencil is held between the index and third fingers with the tips of the thumb and index finger on the pencil. The pencil rests against the side of the third finger near its end.

Immature Grasp Patterns
Fisted grasp: The pencil is held in a fisted hand with the point of the pencil on the fifth finger side on the hand. This is typical of very young children.
Pronated grasp: The pencil is held diagonally within the hand with the tips of the thumb and index finger on the pencil. This is typical of children ages 2 to 3.

Inefficient Grasp Patterns
Five finger grasp: The pencil is held with the tips of all five fingers. The movement when writing is primarily on the fifth finger side of the hand.
Thumb tuck grasp: The pencil is held in a tripod or quadrupod grasp but with the thumb tucked under the index finger.
Thumb wrap grasp: The pencil is held in a tripod or quadrupod grasp but with the thumb wrapped over the index finger.
Tripod grasp with closed web space: The pencil is held with the tip of the thumb and index finger and rests against the side of the third finger. The thumb is rotated toward the pencil, closing the web space.
Finger wrap or interdigital brace grasp: The index and third fingers wrap around the pencil. The thumb web space is completely closed.
Flexed wrist or hooked wrist: The pencil can be held in a variety of grasps with the wrist flexed or bent. This is more typically seen with left-hand writers but is also present in some right-hand writers.

Activities to Improve Pre-Writing Skills

• - Playing jump rope
• - Volleyball-type activities where hands, paddles, or rackets are in palm-up position
• - Squirt bottles
• - Slinky-shift back and forth with palm up
• - Bead stringing/lacing with tip of finger against thumb
• - Pouring from small pitcher to specific level in clear glass. Increase size of pitcher as strength increases.
• - Ich a pencil or chopstick positioned in tripod grasp toward and away from palm. The shaft should rest in open web space.
• - Practice screw and unscrew lids
• - Pop bubble wrap
• - Playdough/silly putty activities
• - Use a turkey baster or nasal aspirator to blow cork or ping pong balls back and forth. These can also be used to squirt water to move floating object/toys.
• - Tier pieces of construction paper into small pieces and paste the different colors of paper on simple picture from a coloring book, or make your own design.
• - Floor activities - large mural painting, floor puzzles, coloring when lying on stomach on floor.
• - Dot-dots, color by number, mazes.
• - Wheelbarrow walking-child's hands are the large ones from Bed Bugs game or kitchen tongs.
• - Finger plays/string games such as Cat's Cradle.
• - Use tongs/tweezers to pick up blocks/small objects.
• - Pennies into piggy back or slot cut in plastic lid. Coins can also be put into slots cut in foam.
• - Working on vertical surface, especially above eye lelve. Activities can be mounted on a clip board or tapes to surface or chalkboard/easel. Examples: pegboards, Lite Brite, Etch-a-sketch( upside down), Magna doodle, outlining, coloring, painting, writing.
• - Clothespins/pinching. Put letters on clothespins and spell words by clipping on edge of shoe box. Use a clothespin to do finger "push-ups" by using the pads of the thumb and index finger to open a clothespin and count repetitions.
• - Squirrel objects into palm (pick up with index finger and thumb, move into palm without using the other hand)
• - Squeeze sponges to wash off table, clean windows, shower, etc.
• - More activity ideas are available here http://www.OTPlan.com.

Update: Pencil skills, and particularly handwriting, is a more complex skill than we often realise. A child's ability to colour within the lines, trace over a shape and draw simple pictures forms the building blocks for writing letters and words. Mastery of these skills enables children to focus on the content of their writing rather than the mechanics of pencil control, pencil grasp, speed and movement. However, given society's emphasis on, and haste to commence, 'academics' earlier now than ever before, we sometimes overlook the vital role these seemingly basic skills play in developing writing skills. Yet we expect children to demonstrate their knowledge on paper in order to assess their academic abilities. The video on the right was taken at a workshop that provides parents and professionals with an awareness of when a child is struggling to master pencil skills (even as early as Kindergarten), as well as some easy strategies to overcome these difficulties.

More resources:
OTPlan: find a therapy activity online
AGAPE Learning Group
Chappaqua Central School District Occupational Therapy Website