The Children’s Hand Skills Framework (CHSF) is used as a conceptual guide to analyze and describe children’s hand skills in the assessment and intervention process. The CHSF divides children’s hand skill use into six major categories, based on the extent to which the hands contact objects/parts of the body or not. The first two categories are manual gesture and body contact hand skills that do not contact specific objects. The following three categories are object-related hand skills that involve arm-hand use (including the skills of reaching, turning, carrying, throwing, catching, moving and stabilizing of objects), adaptive skilled hand use (including the skills of grasping, holding, in-hand manipulating, releasing and isolated finger movements), and bimanual use (including transferring, using both hands together simultaneously, and using both hands cooperatively). The final category describes the general quality (including accuracy, pace, and movement quality) of children’s hand skills. The CHSF is conceptually compatible with the International Classification of Functioning, Disability, and Health, providing a holistic view when considering assessment and intervention of the impact of hand skill problems/difficulties in children. In evaluation, therapist can analyze and establish children’s initial hand skill profiles by using the CHSF in combination with a test battery of appropriate standardized and non-standardized instruments. Therapists can also further use the CHSF to choose appropriate facilitation or compensatory interventions/programs/techniques, based on the hand skills that children need to improve or adapt.
Domain of occupation
There is a hand skill assessment (i.e., the Assessment of Children’s Hand Skills) that has been developed specifically based on this framework.
Chien, C. W., Brown, T., & McDonald, R. (2009). A framework of children's hand skills for assessment and intervention. Child: Care, Health and Development, 35, 873-884.
The Framework of Occupational Gradation (FOG) focuses on one’s active movements with the more involved upper extremity. There are two versions of FOG, one for young children (C-FOG) and one for older children and adults (A-FOG). Both aim to provide occupational ideas in preventing learned non-use of the more involved upper extremity for clients with neurological impairment. These ideas can be incorporated into daily lives to increase use of the extremity. Appropriateness of task for each client is determined by hand dominance and perceived meaningfulness.
The Infant Space Theory describes four primary aspects of how infants develop interactions with objects and space in their home environment. The first aspect is through gaze and visual play. Between 2 to 6 months, the emergence of gaze path, gaze search, and gaze alignment allows infants to use gaze path to search, scan for their mother and objects, and to align and direct gaze. They explore out-of-reach objects like moving contrasts and aircrafts, through vision.
The Hand Function Evaluation Model (HFEM) aims to guide assessment of the impairment and disabilities for preschool-age children presenting hand dysfunction. In the HFEM, hand function is evaluated at three levels: 1) sensorimotor performance, 2) developmental progress, and 3) hand function performance. At the first level, assessment of sensorimotor performance includes grip strength, dexterity, and stereognosis of the child. In particular, the evaluation of the grip strength includes four subtypes: power, tip pinch, three point chuck, and lateral pinch grip.
The Neuro-Developmental Treatment (NDT) frame of reference is used to analyze and treat posture and movement impairments based on kinesiology and biomechanics. To identify difficulties and plan for intervention, the following concepts are to be considered in NDT, including planes of movement, alignment, range of motion, base of support, muscle strength, postural control, weight shifts, and mobility. NDT assumes that posture and movement impairments are changeable. Thus, it utilizes movement analysis to identify missing or atypical elements.
The Client-centred Strategies Framework (CSF) aims to help clinicians in creating environments and contexts that facilitate client-centered practice. This framework consists of five categories; personal reflection, client-centered process, practice settings, community organizing, and coalition advocacy and political action. Each category provides strategies that can be used by clinicians in facilitating client-centered practice. The personal reflections category is the clinician’s process of gaining insight from clinical and individual experiences.