In-Hand Manipulation

In-hand manipulation refers to the ability to use the fingers to perform precise actions on small objects. Some common examples include positioning a pencil in your hand, turning pages of a book, and opening small bottle caps. Certain skills must be obtained before being able to perform this specific actions.

Prerequisite Skills:

All skills require ability to control the arches of the palm
Movement into and stability in supination (palm up position)
Wrist stability
Opposed grasp with thumb opposition (bringing the thumb around to touch fingertips in index, middle, ring and pinky fingers)
Isolated thumb and index and middle finger movement
Ability to dissociate the radial (thumb) and ulnar (pinky) sides of the hand
Ability to grade force in fingertips

Finger to palm translation, 12-15 months

Linear movement of an object from the finger to the palm
Example: coin from fingertip to palm

Palm to finger translation, 2-2 ½ years

Linear movement of an object from the palm to the finger
Example: coin from palm to fingertip

Simple rotation, 2-2 ½ years

Turning or rolling an object held at finger pads, 90 degrees or less
Examples: Opening a water bottle cap, rotating a small peg to place in a pegboard, reorienting a puzzle piece in hand

Shift, 3-3 ½ years

Linear movement of object on the finger surface to allow for repositioning of object on the pads of the finger
Example: separating two pieces of paper, repositioning pencil, buttoning, fastening snaps, lacing shoes, putting a belt through loops

Complex rotation, 5-7 years

Rotation of an object 180-360 degrees once or repetitively
Examples: turning a pencil over to use the eraser, turning a coin over

In-hand Manipulation with stabilization, 6-7 years

Objects are held in the pinky side of the hand while the thumb, index and middle fingers are manipulating another object
Example: Holding a penny in the pinky side of the hand while the thumb, index and middle fingers pick up other pennies

Substitutions occur in children who do not have the prerequisite skill. When children realize that they need to reposition an object, they will switch it to the other hand and then back to their dominant hand in a new positions. Some children preplan for this by picking up object in non-dominant hand and then placing it in dominant hand in a different position. Sometimes children use a hand assist, where the item does not leave the hand, but other hand repositions it in the hand - object stays in original hand. Sometimes children will also use other parts of the body to help provide support for manipulation.

Strategies -
Help by supporting the object while the hand is trying to reposition it
Use items that are motivating
Have the other hand holding on to another object so it cannot assist the hand that is manipulation object


Fine Motor
Fine Motor Milestones (Grasping and Hand Skills)
Fine Motor Activities
OT Terms Defined