Grasp patterns

The 5 Types of Grasp Patterns: Everything You Need to Know

Do we really need to know the types of grasp patterns? In our day–to-day lives, we pick up and handle a variety of items without having to think about what grasp or pinch to use. Imagine if we had to reach for our hairbrush and think, “activate cylindrical grasp!”

However, when your patient or client has a new injury or medical condition affecting their hand (no matter the setting) it can be challenging and very effortful for a person to try and form the grasp needed to hold or manipulate the item.

Having knowledge of the different types of grasp patterns enables us to help our patients grasp items needed in daily functional activities. We can therefore see the importance of knowing the variety of hand grasps. 

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What are Grasp Patterns?

Grasp patterns are coordinated movements that we do with our hands to facilitate contact of an object against the palm and partially flexed digits (1).

In simpler terms, it is the different movements we do with our hands to hold an object. These grasp patterns allow a person to interact with the world and their level of independence while participating in everyday activities. 

What are the Different Types of Grasp Patterns?

1. Cylindrical Grasp

cylindrical grasp

What finger movements are needed? Thumb opposition, finger flexion, and object stabilized in the palm.

Example: Holding a can, broom handle, drinking glass, tennis racket, handhold on a walker or crutch.

Activities it would affect: Feeding and drinking, domestic tasks, mobility, and leisure.

Splinting: Positioning the wrist in extension provides greater stability to the hand to form the cylindrical grasp.

Fun fact: This is the most common static grasp pattern.

2. Spherical Grasp

spherical grasp

What finger movements are needed? Same as cylindrical, but the difference is in the 4th and 5th digit, with greater extension at the metacarpal to allow for a more open hand posture (1).

Example: Holding a ball, apple or orange.

Activities it would affect: Leisure and self-feeding

Splinting: When splinting the splint must be trimmed proximal to the distal palmar crease to allow for obliquity of the 4th and 5th metacarpal heads (1).

Fun fact: It is also known as the ‘ball grasp.’

3. Hook Grasp

hook grasp

What finger movements are needed? The only grasp pattern that does not include the thumb for opposition. The metacarpophalangeal joints are in extension, and the proximal and distal interphalangeal joints are in flexion.

Example: Holding a briefcase, shopping bag, or pail.

Activities it would affect: Work and productivity, grocery shopping.

4. Power Grasp

power grasp

What finger movements are needed? The fingers are in the same position as the cylindrical grasp, but the thumb is not opposed. This is to be able to stabilize the shaft of a tool when exerting effort.

Example: Holding a hammer, pulling a rope, using a screwdriver, or a drill.

Activities it would affect: Work and productivity, home maintenance.

Fun fact: Power grasps are more about the force of the grasp and arm movement, than the precision of the movement.

5. Lumbrical Grasp

lumbrical grasp

What finger movements are needed? Metacarpalphalangeal joints are in flexion, and proximal and distal interphalangeal joints are in extension. The thumb is opposed to the 3rd and 4th fingers (1).

Example: Holding a book or stack of papers or paper plates.

Activities it would affect: Education and work.

Splinting: This movement is often impacted by median or ulnar nerve dysfunction, so a figure-eight splint would assist with this (1).

Fun fact: Some people don’t include this as one of the official grasps.

What can affect the ability to form a grasp?

  • Poor muscle strength: Decreased hand strength will result in difficulty forming or maintaining the grasp needed. Different grasps may require more strength than others, depending on the object being held. Cylindrical and spherical grasps are often easier to achieve as they are mass grasps, and can be used to hold light items, such as can or a ball. Power grasp, on the other hand, requires a lot of strength to hold a hammer while repeatedly hitting a nail, as well as good endurance to hold the tool for a prolonged period of time. 
  • Diminished or absent sensation: Sensory feedback is used to determine the shape, weight, and size of an item, and therefore the brain decides what is the best grasp to form. Sensation is needed to determine how hard an item is being grasped. You will often find people with diminished or absent sensation holding an item too loosely (and it falls out) or too strongly and they’re crushing the item. 
  • Decreased range of motion in the fingers and thumb: Decreased range in the metacarpophalangeal or interphalangeal joints will result in difficulty getting the fingers in the correct position to form the grasp needed. 
  • Pain: Acute and chronic pain can affect your patients’ abilities to form grasps. They may be fearful of moving their fingers again, especially if they sustained a traumatic injury to their hand. 
  • Missing digits: People with amputated fingers may struggle to form certain grasps, in which case they rely on their occupational therapist to teach them compensatory strategies. 

Interventions for Impaired Grasp Patterns

Assessing the underlying impairment impacting grasp formation as well as the activity it is impacting on plays a huge role in shaping an occupational therapist’s intervention. Intervention can include:

  • Strengthening the hand: Stress ball with various resistances, Theraputty, targeted resistance exercises
  • Targeting sensory education or sensory re-education, depending on what caused the altered sensation. 
  • Increasing range of motion in the digits: Active and passive range can be targeted, with active range of motion being preferable. Educate patients on isolated finger movements and targeting the specific movement needed for that grasp. For example, thumb opposition is important in spherical grasp but not in power grasp. Furthermore, increased DIPJ flexion is needed in hook grasp in comparison to the other grasps. 
  • When it comes to pain, there are many ways to address it. Educate the patient on wound healing, the benefit of active movement, and teach them how to gradually expose themselves to more challenging activities over time.  You may also want to address some incorrect beliefs that your patient has about their injury that can contribute to their pain. 
  • Use activities to provide mass practice to form the grasp. Analyze what grasp is needed for the activity they are struggling with, and then provide an activity with an opportunity to repetitively form the grasp. For example, making lemonade to strengthen spherical grasp, or using large wooden pegs and a peg board to target cylindrical grasp. 
  • Teach them compensatory movements or provide adaptations to items needed in the activity. For example, using cutlery with built up handles, or using foam tubing on a toothbrush. 

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We know that was a lot of information! Now, take this opportunity to take a deep breath, close your eyes and name the different types of grasp patterns. Okay, now open and see if you remembered all five: cylindrical, spherical, hook, power, and lumbrical grasp. Great!

We hope that you now feel a bit more confident in naming and assessing the different types of grasp patterns, as well as treating them. 

Reference:

Pendleton, H. M., & Schultz-Krohn, W. (1995). Pedretti’s Occupational Therapy (7th ed.). Mosby.

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