Tired of correcting a pencil grasp over & over again?  Do this instead.

The 2 main issues with teaching a proper pencil grasp are 

a) it takes forever (especially if you are trying to fix old habits) and 

b) it does not always generalize into the classroom setting i.e. students tend to revert back to old grasping habits. 

In this article we will take a look at how the science of fluency and super simple data collection can help us address these two chronic issues in OT. 

But before we do that, take a look at this pencil grasp…  doesn’t it make you cringe !?!?!  

Now before you make an assumption….  Take a look at this student’s handwriting… Surprised???  So was I.  

What is also surprising is that this student never complains of fatigue despite his highly unusual pencil grasp pattern.

The research on the impact of pencil grasp is also surprising.  Studies indicate that “while a child’s awkward pencil grasp is commonly blamed for handwriting difficulties, this implication is actually not evidence based”. ((Graham et al., 2008; Rigby & Schwellnus, 1999; Rosenblum, Dvorkin, & Weiss, 2006). 

Also, five peer reviewed studies (Schwellnus et al. 2012; Ziviani & Elkins 2006; Koziatek & Powell 2003; Dennis & Swinth 2001; Chang & Yu 2005) also found that differences in a child’s pencil grasp had no statistically significant effect on handwriting legibility and/or speed.

So should we not bother fixing pencil grasps?  The answer is, yes and it depends.

When NOT to fix a pencil grasp?

Throughout your career as an OT, you will undoubtedly encounter many students who present with non-conventional pencil grasps, especially older students who may have developed very specific fine motor habits and pencil grasp patterns.  

While these ‘non- traditional’ pencil grasps may seem visually aversive and awkward, it is important to dig deeper to see how they manifest.  The question we need to ask ourselves is, if these non conventional pencil grasps are functional and sustainable for long tern use?  That is……..can fatigue and joint integrity become a barrier at some point?

However in reality it is very difficult to change a grasp once it has been established, especially one that seems to be working and especially for older students.

Now if the pencil grasp looks funny AND there are handwriting difficulties AND/or if there are apparent physical/ sensorimotor differences, that’s when we may pursue the task of teaching a proper pencil grasp.  But again there are considerations such as age, diagnosis and other client factors.

What is the benefit of teaching a proper pencil grasp?

The benefit of teaching a proper (mature) pencil grasp is that it promotes a posture for optimal finger dexterity necessary for effective coordination, and reduces the stress on the joints for sustained motor coordination activities like writing. 

The common belief is that only the tripod Pencil grasp is the ‘proper’ mature pencil grasp, however according to an article published by Koziatek & Powell in 2003, there are 4 types of mature pencil grasp patterns that can also promote speed and legibility in handwriting.

1) The Dynamic Tripod Pencil Grasp.

The main reason this is the most widely accepted pencil grasp is not just because of its notoriety, but it is actually the most efficient pencil grasp that “facilitates fluid and fine movements of the three fingers as they flex and extend to form vertical and curved letter strokes.”(Elliott & Connolly, in 1984; Tseng, in 1993).   This pencil grasp also provides a greater base of support than any other pencil grasp, which is essential for visual motor control, stability and long term sustainability. 

2) The Dynamic quadrupod pencil grasp

Now this pencil grasp is awfully similar to the dynamic tripod pencil grasp, with one noticeable difference: the 4th digit provides an increased surface area to grasp the pencil, but this also decreases the dynamic movement of the pencil and provides less stabilization in the base of the hand.    

3) Lateral tripod pencil grasp

4) Lateral quadrupod pencil grasp

In both these types of lateral grasps, “the thumb is adducted and the web space is closed more tightly around the barrel of the pencil, which restricts the pencil’s movement, eliminates thumb opposition, and further compromises balance.” (Dennis & Swinth, 2001). 

One important consideration of these lateral pencil grasp patterns is that while they can be functional and are considered mature pencil grasping patterns, they tend to cause earlier hand fatigue when writing. (Stevens, 2008).

Since the dynamic tripod pencil grasp is the gold standard of pencil grasps, that is the pencil grasp most OTs teach students in the early years.

Case Example:  Jenna is a Kindergartner who holds her pencil like this….

Jenna does not have a functional grasp by any means.  Jenna may be able to scribble but she will not be able to imitate any pre-writing strokes with control or precision using this grasp. 

How to teach a pencil grasp using the grip & flip method to fluency.

Now I am sure you have heard of this method, but what you probably have not heard is how exponentially effective it is when you add a fluency component to it. 

So let’s start with the basic steps….   

1. Place the pencil with the tip facing you.
2. Pinch the pencil close to the tip with the first 2 fingers and the thumb.
3. Flip the pencil with a quick wrist extension so that the pencil barrel rests in the web space.
4. Practice practice and practice!

This last step is one of the most important components of teaching a pencil grasp, because it is actually how we develop motor memory.

It is widely known that practice is how athletes and musicians master their art and skill to perfection.  Not only do they practice, but they practice a lot (4-5 times weekly).  That’s because practice helps develop motor pathways / motor representations ( i.e. motor memory).  And by repeating these movements over and over again, they do become permanently stored in our brains, so that the practiced skill becomes effortless and easy. 

So why don’t we apply this principle to teaching a pencil grasp?

Just imagine if we had our students practice this grip and flip pencil grasp 10-15 times, 2-3 days a week?  What would happen?  I can tell you from first hand experience… it would expedite the learning curve exponentially, because that is how we learn.

In an article by Binder (1999) on Fluency development, the learning process involves 3 stages: acquisition, practice and application.

If we apply this process to the simple task of grasping a pencil, we could suggest that in the acquisition stage i.e. the student is likely to perform the skill with low accuracy and a high frequency of errors.

In the 2nd stage of practice, the student will perhaps demonstrate higher accuracy and now have a lower errors, but the coordination process may still be slow and deliberate.  

It is important to highlight that during this 2nd stage (when we see higher accuracy and lower errors) is when most of us tend to think that our job is done. 

In reality there is one more very crucial step we are often missing. It involves making sure the student is fluent in the process of grasping his/ her pencil.

Binder (1996) defined fluency as “the fluid combination of accuracy plus speed that characterizes competent performance” (Binder, 1996, p. 164).    

This missing step is also likely to be the reason we see students reverting back to their old pencil grasping habits in the classroom setting and never mastering the skill.  

Building fluency in the skill of proper pencil grasping means that the student will demonstrate (accuracy AND speed) i.e. he/ she will grasp the pencil accurately, quickly and without hesitation.  So, by adding a time component to practice, you will ensure that the student has truly mastered and is fluent in this skill.  This is the step that leads to retention of the skill, so you never have to re-teach this skill again.

Remember by building fluency, you are not only enhancing the neuronal connections in the brain, but you are also building fluidity in the coordination of fine motor movements in general.  

So the by-product of fluency building is a somewhat salient improvement in the component skills of other fine motor based activities like buttoning, shoe tying etc.  That is, now students can apply aspects of the fluent skill to novel tasks.  This is the application stage of learning and is considered the 3rd and last stage in the learning process. 

How do we find the fluency goal is for this ‘grip and flip’ pencil grasp method?

You can figure out the fluency goal by performing the task yourself or you can ask a peer to do this.  Turn the timer on for 15 seconds and pick up the pencil as many times as possible accurately in that timeframe.  Don’t rush, just do it at a very easy and comfortable pace.  Then multiply your correct responses by 4 (to get a per minute score) and that is your fluency goal.  

My grip and flip pencil grasp score was 7 in 15 seconds, which translates to a fluency rate of approximately 28/minute.  So this is the range for my fluency goal.

The OT goal:

Jenna will grasp a pencil with a tripod pencil grasp on at least 14 of 15 trials with accuracy in a 30 second timing, across a variety of settings.

Here is an example Jenna practicing her ‘grip & flip’ method during a 30 second timing.   

So is that it?  Once the student reaches their fluency goal, are they considered fluent in this new pencil gasp?  Well yes and no.

I am always cautiously optimistic at this point.  This is because a student may perform well in one specific setting, where there are limited distractions or competing expectations, but the true test is if they can generalize this skill and perform it just as well in novel (and distracting) settings. 

This is a very important question to consider and test out, because if the student is not able to generalize this newly learned skill to other settings……then they are not quite fluent in this newly learned pencil grasp and are likely to revert back to their old not-so-pretty pencil grasping habits.  

This is precisely why adding the criteria of ‘across various settings’ to the pencil grasp OT goal is ever so pertinent and relevant.  

Only when the student can use this newly learned pencil grasp consistently over and over again without fatigue or hesitation in any setting, no matter how distracting…. that’s when you can infer that they have truly mastered the skill, are fluent and have met their goal.

Another big bonus (freebie) of building fluency 

By now you know that building fluency can help students learn faster and perform skills effortlessly.  But the other bonus you may not have thought about is that fluency builds more than just speed. It develops automaticity of fine motor movements, which in turn saves cognitive resources for higher level tasks. (Werner et. al 2014) 

So instead of spending all the effort and mental energy on how to coordinate the muscles to assume a proper pencil grasp, students can use this cognitive energy to focus on more higher level skills like handwriting.  

How can we take data on a pencil grasp goal ? 

Let’s face it…OT’s are not known for their data collection, but in this case… gathering data could not be easier. 

Once you know your fluency goal then all you have to do is count the number of correct and incorrect responses during the 15 second, 30 second, or 1 min timing.  So here is an example of how you could take data on a fluency data collection sheet which is also a free resource downloadable here.

In the above data sheet, you can see that I started this student off with a 15 second timing because she demonstrated poor visual attention and endurance.  She simply could not attend for longer than that and I did not want to frustrate her by expecting more.

The highlighted portion indicates that is took her approximately 3 weeks to meet her fluency goal for a 15 second timing.  At this point I did increase her timing to 30 seconds and to help her build endurance for this skill.

The only other aspect you will notice in my data sheet…..is the frequency.  I tried to have her practice 2- 3 times a week.  This is a key feature.  Fluency is not so much about duration, as it is about frequency and consistency.  Since these practice trials are so short, it is really easy to do.

So for example, if Jenna receives OT 20 mins/ week.  You can spread out the sessions into three 10 min segments and work on 8 practice trials each session.  Since each practice trial is 15 seconds, so it will literally only take 2 minutes to do 8 trials and that totals up to less than half of the allotted time (6 minutes/ week).

Of course the option is to recruit paras, teachers and parents to practice this in the classroom or home too.  This not only helps with providing more opportunities to practice, but it also helps with ensuring generalization is occurring across various settings.

I am curious… did you try out the grip and flip method yourself?

How was your fluency?

Reference

Binder, C. (1999). Fluency Development. In D. G. Langson, K. S. Whiteside, & M. M. McKenna (Eds.), Intervention Resource Guide: 50 Performance Improvement Tools (pp.176-183). San Francisco, CA: Jossey-Bass/Pfeiffer.