Two Models of a Low-Temperature Writing Device for a Child with Finger Deficiencies

Toni Thompson, MA, OTR/L, BCP Pediatric Occupational Therapist; (Photos by Penny Rogo Bailes); Shriners Hospitals for Children – Tampa, FL

A child with short digits on both hands often stabilizes and maneuvers writing tools by holding the tool with the distal aspects of both hands. This method does not leave one limb for age-appropriate tasks, such as stabilizing or moving the paper or writing surface, or raising a hand to ask a question. Commercially-available devices tend to accommodate to the one thickness of writing tool, allowing the use of a standard pencil, but do not incorporate thicker markers, thinner crayons, or various sizes of paintbrushes.

A graphic designer, the father of four-year old conceptualized several ideas for a writing tool that attaches to the forearm. The occupational therapist collaborated to fabricate a device with the goals to:

  1. Hold a writing tool with one hand,
  2. Allow the non-dominant hand free to stabilize or move the paper or writing surface,
  3. Accommodate to various thicknesses of writing tools,
  4. Allow for easy and quick changes of writing tools in the device,
  5. Provide ease of donning and doffing,
  6. Be accepted by a pre-school and school-age child,
  7. And be aesthetically pleasing.

The original model employed a dorsal-based forearm component of low-temperature splinting material attached with two Velcro straps for ease in donning and doffing the device. The therapist chose1/8" thick Aquaplast® Watercolors™ because of the ability to adhere the tool holder extension, a thin Aquaplast® rod to the distal aspect of the forearm base. The rod curved superiorly five inches and curved distally and then downward. The rod fit into a piece of cylindrical foam three inches long. The rod and foam held the writing tool and accommodated to various sizes of tools. Teacher or parent can easily remove and replace the writing tools in the cylindrical foam without doffing the device from his forearm. (photos 1 , 2 , 3 , 4 )

Tanner and his family named this device the Tanner-Saurus. With his love of dinosaurs, Tanner more readily donned his namesake device. After one year of use, Tanner's father went back to the drawing board and conceptualized a more low-profile device with a more stable support rod. The Aquaplast® rod was very flexible and allowed excessive movement, making it "too wiggly" according to Tanner.

The therapist fabricated the updated forearm base of Aquaplast® Watercolors™ Opti-perf with 19% perforations. With the perforations, the forearm base was more ventilated to decrease sweating. The rod, fabricated out of Aquaplast® material, was thicker than the commercially available rod and curved superiorly about three inches rather than five inches to maintain low-profile status. With Aquaplast® used to form the support rod, the component stabilizing the writing tool was more stable and less flexible when Tanner wrote or colored. The low-profile status made the device more appealing to Tanner, now in Kindergarten, and he calls it his Tanner-Saurus Two. (photos 5 , 6 , 7 , 8 )

CONCLUSION: The team of parent, child, and occupational therapist collaborated to design and fabricate a way for the pre-school child with finger deficiencies to perform the age-appropriate tasks of manipulating crayons, markers, pencils, and paintbrushes. The initial model of the Tanner-Saurus met the basic criteria of the process, but presented only minor difficulties with its high profile and overly flexible elements. The second model of the Tanner-Saurus evolved into a more streamlined device. Collaboration of all team members contributes to the development of appropriate orthotic devices to enhance the functional activities of children with limb anomalies.