Manual skills are essential in child development, in their participation in daily activities as well as their school performance. There is a high incidence of children with developmental disorders and it seems to be (give evidence) increasing. Difficulties in manual skills are a frequent sign of developmental delay. Some of the constraints we can observe are difficulties in handwriting, inaccuracy with buttons and ties or a general lack of strength. This is particularly evident in children with DCD (Development Coordination Disorders) Physiotherapists have to observe and assess manual function in order to identify issues and to plan the appropriate intervention to improve the development of manual skills.
But, what is the best approach in the assessment of manual skills in pediatric physiotherapy?
First of all, it is important to understand that two complementary assessments must be integrated: the clinical assessment and the objective assessment using scales and questionnaires. The first one, the clinical assessment allows us to understand the hand function in relation to the children whose constraints have been reported by parents. A complete clinical assessment clearly shows the way for the intervention. The weakness is the subjectivity and the difficulty of sharing with other professionals. On the other hand, the tests provide a measure of manual function in standard conditions. This alone, however doesn’t offer a complete understanding of the global situation of the child nor etiological factors. So, both assessments must be carried out together.
In children’s manual skills there are other limitations to the assessment. There is not only a single scale with all requirements for hand function assessment, but there are scales and questionnaires which should be combined for a comprehensive assessment, considering the ICF-CY framework.
There are five key points in the assessment of manual skills in children. The following is a brief extract of the complete hand skill assessment in PIMT:
- Observe carefully the manual function of your little clients while they are painting in the waiting room, undressing (especially buttons and ties) or even while they are resting. In any action you could identify some hand patterns that indicate deficient manual skills: for example, hands with low tonicity (floppy hands), thumb adduction or fifth finger in more extension at the metacarpophalangeal joint than others.
- Make the child crawl on all fours and observe the hand support on the floor. It is an easy way to evidence dysfunctional and surprising hand patterns.
- Measure hand strength , clinically or with HHD (Hand Held Dynamometry), in static and dynamic conditions (Bieber et al. 2016).
- Always test handwriting. The Systematic Detection of Writing Problems (SOS-2) can be used but it is only available in English and Dutch versions (Bieber et al. 2016).
- Some coordination tests could be very useful. We recommend some tests with repeated and quick finger movements with both hands wide open.
Manual function outcome measures in children with developmental coordination disorder (DCD): Systematic review.
Bieber E, Smits-Engelsman BC, Sgandurra G, Cioni G, Feys H, Guzzetta A, Klingels K.Res Dev Disabil. 2016 Aug;55:114-31.
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