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Normal Development of the Hand and Upper Extremity

presented by Mary Faussett, MOTR/L, CHT and Jill Peck-Murray, MOTR/L, CHT

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Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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A pediatric patient is constantly growing and changing. Therapeutic intervention should be tailored to meet the needs of the child at their developmental level. The therapist must have a solid understanding of normal hand and upper extremity development in order to effectively treat any pediatric patient, especially one with hand involvement. This course will describe the normal development of the hand and upper extremity starting in utero and continuing through teen years. By remembering the developmental progression of hand skills (grasp/release, in-hand manipulation, pencil grasp), a therapist can provide and advance the intervention to encourage the child's potential for maximal hand use, despite their diagnosis/condition.

Meet Your Instructors

Mary Faussett, MOTR/L, CHT

Mary "Peggy" Faussett is an occupational therapist and certified hand therapist. She graduated with a master's in occupational therapy in 2001 from Chatham University. She became a certified hand therapist in 2012. Peggy currently works at Children's Hospital Colorado as the program coordinator for the pediatric hand therapy program. She enjoys treating children of all…

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Jill Peck-Murray, MOTR/L, CHT

Jill Peck-Murray, MOTR/L, CHT, is a pediatric hand therapist. She worked as an occupational therapist/hand therapist at Rady Children's Hospital in San Diego, CA from 1982 through 2017. During her 35 years, she gained expertise, with special skills in creative splinting/orthotic intervention, and developed the hand therapy program for the hospital. She is currently devoting…

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Chapters & Learning Objectives

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1. Components of Hand Skills

This chapter will describe the complex components of hand use. It will have the viewer analyze their own hand use to observe that multiple muscles, bones, and soft tissue work together in harmony. The child’s primary occupations of play, education, and activities of daily living are all dependent upon adequate hand skills. The hands are critical for interacting with the environment and influence the development of cognition, language, and sensory integration.

2. Development of the Hand and Upper Extremity in Utero

This chapter will discuss the normal process of embryonic growth for the hand and limb from the first stages of limb bud development through development of the individual parts. It will describe the initial movements of the limb and child’s first in utero hand use.

3. Development of Hand Skills From Birth to 12 months

This chapter will present the development of hand skills chronologically from birth to 12 months. During the first few months, foundation skills are developing, which will allow for progression to weight-bearing, grasp, release, and bimanual skills in later months. It will highlight how a child begins to interact with toys, utensils, and his environment.

4. Development of Hand Skills From 1 Year to 5 Years

This chapter will present the development of hand skills chronologically from 1 to 5 years. The toddler shows improving proximal control, which allows for beginning of controlled arm movements for distal use, including grasping, releasing, and enhanced manipulation of objects. As the child grows, he develops tool use, in-hand manipulation, and refined control.

5. Development of Hand Skills From 5 years and Older

This chapter will present the development of hand skills chronologically from 5 years to teenage years. The child’s in-hand manipulation improves and allows for complex rotation of objects. Mature pencil grasp patterns allow for development of good handwriting speed and legibility. Reaction times, hand-eye coordination, and complexity of bimanual skills increases, which allows the older child and teen to participate in sports, playing musical instruments, and use of computers.

6. Review of Bone Changes and Developmental Progression

This chapter will review the bony ossification of the hand and arm and its ramifications for therapy. Bones are also lengthening in the growing child, but this can be disrupted by acquired or congenital issues. To summarize the hand skills development, there is a review of the developmental progression of grasp, release, in-hand manipulation, and pencil grasp.

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