In-hand manipulation is one of the most complex fine motor skills. It involves moving an object within the hand. Usually, this manipulation is used to complete a functional task. A few examples of in-hand manipulation include: 

• Manipulating a pen or marker to hold effectively for coloring or writing

• Adjusting a piece of paper in one hand when using scissors with the opposite hand

• Adjusting an eating utensil (fork, spoon, knife) in order to hold appropriately for eating

• Moving shoelaces in the hand(s) in order to tie shoes

• Moving a coin or small object from the palm to the fingertips

At what age do in-hand manipulation skills develop? 

Typically these skills develop between the ages of 2 and 4 years. The first manipulation skill is finger to palm translation, then palm to finger translation, then rotation, and finally shift. By ages 6-7, typically, children are able to manipulate multiple objects within the hand, and they are able to use these skills more purposefully. 

Types of manipulation skills

1. Translation: Allows you to move objects from the tips of the fingers to the palm and from the palm to the tips of the fingers

2. Rotation:

   1. Simple rotation: Rolling an object between the thumb and fingertips (ex. Using the thumb and fingertips to twist/open a bottle)

   2. Complex rotation: Turning an object end over end (ex. Flipping a spoon over if given the wrong end for use)

3. Shift: Moving objects between the fingers (separating two pages in a book in order to turn the page)

Activities to improve in-hand manipulation skills: 

Improving Translation: Placing coins in a piggy bank, crumple paper using one hand, eat a small snack placed in the palm (like raisins), and have the child move the food to fingertips to eat (all in the same hand)

Improving Rotation: Practice screwing and unscrewing nuts and bolts, opening and closing water bottle with a cap, playing with shape sorter (having to move and rotate the shape in order to fit in the correct space), completing puzzles.

Improving Shift: Turning pages of a book, sorting currency (bills), playing a game that requires sorting through or flipping cards (card matching game, Monopoly, flashcards, etc.), walking fingers up or down a pencil. 

For additional questions about in-hand manipulation skills and how to address your child’s specific needs, talk to your child’s occupational therapist.