Hand therapy

Hand therapy works on forming and developing the function of the upper limb: not only the physical side, but also hand sensitivity, proprioceptive and kinaesthetic sense, eye-hand coordination, bimanual skills and the differentiation of manipulation for different tasks. The aim is to involve the child as actively as possible in play, productive activity and daily life, so the therapist chooses activities individually to keep the child interested and at ease.

Grasp is one of the hand's key functions. It is formed in the cerebral cortex and requires motor, sensory and cognitive coordination that is still developing in a child. Grasps fall into two groups: fine grasps, where the object is held between the fingertips and thumb, and power grasps, where the fingers wrap the object and press it against the palm. Grasp quality depends on muscle strength, speed, coordination, endurance, motor initiative, sensitivity, swelling, pain, muscle tone, range of motion and practice, and it strongly affects the child's motivation to act. Impaired grasp is most common in children with neurological conditions.

Grasping an object is a sequence: intention, locating the object visually and judging its size, shape and orientation, reaching it with enough antigravity control to guide the hand without wobbling, shaping the hand before contact, and then judging weight and texture by touch so the object does not slip. Somatosensory information guides each finger, and with practice this becomes automatic. Selective finger movement also requires adequate intrinsic hand muscles and good postural control that balances stability with the ability to dissociate movements.

If these motor skills are missing and complex grasps are trained too early, the child develops compensations that get in the way of learning proper hand use. The therapist therefore assesses the child's developmental stage and test results and builds an individual programme to develop, restore or modify grasp in line with the child's age, interests and environment.