The document discusses the anatomy of the human hand, including its bones, joints, functions, grasp patterns, and developmental milestones. It outlines the importance of hand-eye coordination and the screening and assessment of hand function disorders, especially in individuals with intellectual disabilities. Additionally, it describes therapeutic programs and the use of splints in correcting hand function disorders.

1. RAVI RANJAN KUMAR
(OCCUPATIONAL THERAPIST)
MOT(JAMIA HAMDARD) NEW DELHI
BOT (NIOH)KOLKATA

2. Hand
• The part of the fore limb which extends
beyond the wrist joint including palm,
finger and thumb, is understood to be
the ‘hand’.
• The hand has 27 bones forming various
joints.
• 14 of which are
the phalanges (proximal, intermediat
e and distal) of the fingers and
thumb.
• The metacarpal bones connect the
fingers and the carpal bones of
the wrist.
• Each human hand has
five metacarpals and eight carpal
bones.

3. Hand bones
• It contains eight short carpal
bones of the wrist are
organized into a proximal row
(scaphoid, lunate, triquetral an
d pisiform) which articulates
with the bones of the forearm,
and a distal row (trapezium
, trapezoid, capitate
and hamate ), which articulates
with the bases of the
five metacarpal bones of the
hand.
• The fourteen phalanges make
up the fingers and thumb.
• The four fingers each consist of
three phalanx bones: proximal,
middle, and distal.
• The thumb only consists of a
proximal and distal phalanx.

4. Hand joints
• Major joints of hand are:
1. Interphalangeal (IP)
articulations of
hand (the hinge joints
between the bones of the
digits). There are two types
of IP joint Distal
Interphalengeal (DIP) joint
and Proximal
interphalengeal (PIP) joint.
2. Metacarpophalangeal (MCP)
joints (where the digits meet
the palm)
3. Carpometacarpal
articulations(where the
palm meets the wrist)

5. Major functions of hand
1. Reaching
2. Grasping
3. Transporting
4. Release
• Object manipulation is the main outcome of the
function of the hand. Among all these functions,
reaching and transporting are done with the
arm and forearm. Whereas grasping and
releasing are done entirely by hand.

6. Grasp patterns
• Grasp is the position in which
an object is held by the hand.
It is defined as a position of
the hand that facilitates
contact of an object against
the palm and the palmar
surface of partially flexed
digits. Some of the common
grasp patterns are as follows:
1. Spherical grasp:
This type of grasp is used for
holding spherical objects like
ball or apple. In this type of
grasp object remains in
complete contact with palm,
fingers and thumb.

7. Cont......
2. Cylindrical grasp:
Such type of grasp is used
for holding cylindrical
objects like pipe, glass etc.
The object remains in
complete contact with
fingers and partial contact
with palm.
3. Hook grasp:
This type of grasp is used
for holding objects with
handle like suitcase,
bucket etc. The object is
held by flexing the fingers
at IP joints.

8. 4. Opponance grasp/Intrinsic
plus grasp:
This pattern is used in
grasping and holding
large, flat objects such as
books or plates. In this
grasp the object is held
between tips of fingers
and of thumb which is
positioned opposite to
fingers.

9. Prehension
• Prehension is defined as a
position of the hand that
allows finger and thumb
contact and facilitates
manipulation of objects. Major
types of prehension are as
follows:
1. Lateral prehension:
• In lateral prehension, the pad
of the thumb is positioned to
contact the radial side of the
middle or distal phalanx of the
index finger. This pattern of
prehension is used in holding a
pen or eating utensil, and in
holding and turning a key.

10. Cont...
2. Palmar prehension/ 3-jaw
chuck:
The thumb is positioned in
opposition to the index and
long fingers. The important
component of motion in this
pattern is thumb rotation,
which allows for pad-to-pad
opposition. This prehension
pattern is used in lifting
objects from a flat surface,
in holding small objects, and
in tying a shoe or bow.

11. 3. Tip-to-tip prehension:
The IP joint of the thumb
and the DIP and PIP
joints of the finger are
flexed to facilitate tip-
to-tip prehension.
These motions are
necessary for picking up
a pin or a coin.

12. Grip:
While grasp is the pattern of holding an object,
grip is the strength with which and object is
held. It is measured by two methods. The first
method is simple but is subjective. In this
method it is noted if the grip is adequate and
effective for a given task. The second method
is objective and measured by an instrument
called dynamometer.

13. Development of hand functions
Age Developmental milestones
0 – 6 months •Reflexive grasp (at birth). Ulnar side fingers are more active in grasp.
•Global ineffective reach for objects (3 months)
•Voluntary grasp (3 months)
•2 handed palmar grasp (3 months)
•1 handed palmar grasp (5 months). Squeezes objects with the fingers and palm.
•Controlled reach (6 months)
6 – 12
months
•Reaches, grasps, puts object in mouth
•Controlled release of objects
•Static Pincer grasp (thumb and one finger)
•Picks things up with pincer grasp (thumb and one finger)
•Radial side fingers become more active.
•Transfers objects from one hand to another
•Drops and picks up toys
1 -2 years •Builds tower of three small blocks
•Puts four rings on stick
•Places five pegs in pegboard
•Turns pages two or three of a book at a time
•Scribbles
•Turns knobs
•Paints with whole arm movement, shifts hands, makes strokes
•Self-feeds with minimal assistance
•Able to use signing to communicate
•Brings spoon to mouth
•Holds and drinks from cup independently

14. Age Developmental milestones
2- 3 years •Strings four large beads
•Turns single pages of a book
•Snips with scissors
•Holds crayon with thumb and fingers (not fist)
•Uses one hand consistently in most activities
•Imitates circular, vertical, and horizontal
strokes
•Paints with some wrist action, makes dots,
lines, circular
•strokes
•Rolls, pounds, squeezes, and pulls playdough
•Eats without assistance
3 – 4 yrs •Builds tower of nine small blocks
•Copies circle
•Imitates cross
•Manipulates clay material (rolls balls, makes
snakes, cookies)
•Uses non-dominant hand to assist and
stabilise the use of
•objects
•Snips paper using scissors

15. Age Developmental milestones
4 -5 yrs •Cuts on line continuously
•Copies cross
•Copies square
•Writes name
•Writes numbers 1-5
•Copies letters
•Handedness is well established
•Dresses and undresses independently
5 – 6 yrs •Cuts out simple shapes
•Copies triangle
•Colours within lines
•Uses a fingered grasp of pencil and uses
fingers to generate
•movement
•Pastes and glues appropriately
•Can draw basic pictures

16. Eye hand coordination
• Eye hand coordination is the ability of the vision
system to coordinate the information received
through the eyes to control, guide, and direct the
hands in the accomplishment of a given task,
such as handwriting or catching a ball. It uses the
eyes to direct attention and the hands to execute
a task.
• It is an important aspect of hand function.
Accurate reaching towards an object, grasping
effectively in required pattern with required
strength, carrying to desired position and
releasing the object, all require proper
monitoring of eyes.

17. Development of eye- hand coordination
Birth to three years of age, an infant:
• starts to develop vision that allows them to follow slowly moving objects with their
eyes
• begin to develop basic hand-eye skills, such as reaching, grasping objects, feeding,
dressing
• begin to recognize concepts of place and direction, such as up, down, in
• develop the ability to manipulate objects with fine motor skills
Between three and five years of age, little children:
• Continue to develop hand-eye coordination skills and a preference for left or
right handedness.
• Continue to understand and use concepts of place and direction, such as up, down,
under, beside.
• Develop the ability to climb, balance, run, gallop, jump, push and pull, and take stairs
one at a time.
• Develop eye/hand/body coordination, eye teaming, and depth perception.
Children between five and seven years old:
• Improve fine motor skills, such as handling writing tools, using scissors.
• Continue to develop climbing, balancing, running, galloping, and jumping abilities.
• Continue to improve hand-eye coordination and handedness preference.
• Learn to focus vision on school work for hours every day.

18. Between three and five years of age, little children:
• Continue to develop hand-eye coordination skills and a
preference for left or right handedness.
• Continue to understand and use concepts of place and
direction, such as up, down, under, beside.
• Develop the ability to climb, balance, run, gallop, jump,
push and pull, and take stairs one at a time.
• Develop eye/hand/body coordination, eye teaming,
and depth perception.

19. Children between five and seven years old:
• Improve fine motor skills, such as handling writing
tools, using scissors.
• Continue to develop climbing, balancing, running,
galloping, and jumping abilities.
• Continue to improve hand-eye coordination
and handedness preference.
• Learn to focus vision on school work for hours every
day.

20. Disorders of hand function
• In cases of person with intellectual disability (MR), there is
possibility of two types of hand function disorder
1. General delay in the development of hand functions.
2. Anomalies or deformities in structure of hand.
• In a person with MR the commonly found hand function
disorders are:
1. Delayed development of hand functions
2. Atypical functional grasps
3. Anomalies and deformities in the structure of hand
4. Contractures
5. Prolonged presence of grasp reflex
6. Weakness of muscles

21. Screening
• Screening of hand function can be done by testing:
1. If the person can do complete flexion of hand joints.
2. If the person can do complete extension of all the
joints of hand.
3. If the person can do any three of the grasps: spherical,
cylindrical, hook, lateral and opponance.
4. If the person can do a pincer grasp.
• Inability to succeed in any one of the above tasks is an
indicator of poor development and disorder of hand
functions. Complete assessment of disorder of hand
function includes collecting information regarding
range of motion, muscle strength, hand function and
coordination.

22. Therapeutic programme
• Therapeutic programme for correcting disorders of hand function is
very specialised and customised one.
• It is to be done under the direction of an experienced and qualified
therapist. Therapeutic programme depends on the particular
disorder but some important aspects which needs to be kept in
mind are:
 Exercises must be done gently within the tolerance of the person.
 Forced passive movements or painful actions may cause further
complications.
 Psychologically the person should not become fearful otherwise
they would not participate in therapy.
• Some of the activities to enhance hand functions used in
therapeutic programme are using plasticine, theraputty, clay work,
thread and bead work, rubber band activity, peg board, block
stacking, woodwork, finger painting, squeeze ball, pinching
clothespin, building blocks etc.
• For some therapeutic programmes, splints are also used with
activities, exercises and therapies.

23. Splints
• Splint is a rigid support given to any part of the
body. There are three main reasons for which a
part of the body may require such a rigid support
like a splint. These reasons are :
1. To protect the injured part and thus to reduce
pain.
2. To strengthen any weak muscle and thus assist it
to carry out its action.
3. To prevent formation of contracture and
deformities.
• Splints are made up of various material like
metal, wood, thermoplastic, plaster etc.

24. Some common hand splints
1. Wrist drop splint- Prevents wrist
flexion contracture and deformity.
2. Cock up splint-Providing better
extrinsic position of wrist for
better grasp. These are probably
the most commonly prescribed
type of orthosis for the upper
extremity. Indications for use
include sprains, strains, tendonitis,
arthritis, carpal tunnel syndrome,
wrist fractures following cast
removal, and other conditions
that cause pain.
3. Dorsal block splint- Prevents
unwanted extension of the finger
while permitting flexion.

25. 4. Finger extension spring splint-
Provides assistance in finger
extension.
5. Knuckle bender splint-
It is a finger flexion splint
designed for assisting in
simultaneously flexing the
MCP joints of all digits without
blocking IP joint or wrist
motion.