Palmar Grasp – Get a Grip: Understand and Recognize the Influence of Palmar Grasp, Persistence and Integration Treatments

Check off list - Identification of obligatory and persistent palmar grasp:

• Hand clasped without release to extension
• Poor manual dexterity
• Poor independent thumb and finger movements in fine motor tasks
• Palm or hand may remain sensitive to textures or pressure
• May have related mouth movements while writing or working with fine motor due to additional primitive reflexes
• Relation to Babkin response may reduce development of anterior mouth control and may affect articulation
• May have poor use of thumb
• Restrictions in rotation movements of upper extremity and hand
• Lack of fingertip prehension and coordination with holding crayon, pen, small toys
• Any evidence of cortical area omission, injury or trauma

Emerges: 11 weeks in utero
Birth: Present
Typical integration: 2-3 months of life
Full integration and transition: 4-6 months old to voluntary grasp, finger dexterity and “let go” of objects.

The hands are key to exploring the environment. The hand and fingers are in the top five most populated by sensory endings in the body. The hands are important for developmental skill attainment, reaching and grasping food then releasing it in the mouth, protective responses in balance and manual dexterity.

Palmar Grasp is stimulated by pressure in the palm but does not possess the motion of opening the hand or release of an object.

We need 2 eyes to allow binocular vision for 3-D realization of space. We need both hands with neural connections to reach bilateral hemispheres and effectively feel 3-D objects in our world. We work to develop eye-hand coordination for ball handling, and reaching grasping toys. Feedback from various types of grip are necessary for holding food, crayons, pens and holding paper steady for writing.

The challenges of obligatory palmar grasp are significant in learning, coordination and development. If the reflex is not integrated adequately, the child may have a gross grip on pencils, pens, scissors and with the use of spoon and fork. Handwriting will be poor in form and mealtime will be messy. Larger muscles of the arm and shoulder girdle will be used instead of the muscles controlling individual finger movements.

Testing: Light touch to the palm will demonstrate closure of the fingers with persistent grip and difficulty with opening the hand. This can be done in supine, sitting or standing. One may observe complete grip or slight flexion of fingers/thumb depending on level of neural integration. If you find a significant difference in the Palmar Grasp of right hand compared to left hand, please seek additional medical testing.

Brain connection challenges
What does a positive Palmar Grasp tell you if positive or obligatory after 6 months old? Further investigation and evaluation of the nervous system is warranted. The sensory system is the way the brain learns. Primitive reflexes are integrated through incoming information from the sensory system.

If there is damage to higher midbrain or cortical centers, the palmar reflex may still be obligatory. When there are lower center connections available in brainstem, the primitive reflex will still be a response to touching the palm of the hand. A neurological connection between palmar grasp and sucking occurs to keep the baby close to the bottle or breast for feeding. One may note involuntary movement of the hands while eating or talking as well as movement of the mouth and tongue while writing or performing fine motor tasks.

This circuit of neurological pattern serves for nourishment, safety and security. When the child is relaxed (not in fight or flight), the reflex will continue to decrease in need. If there are threats to security or safety, the child may again clasp hands, hold on and flex the upper extremities, neck and trunk.

Neurological pathway formation is necessary for integration of the reflex, placing the primitive reflex in the background of the nervous system motor response. Thereby not interfering with active fine motor movements, and allowing good dexterity and intricate skills.

Palmar Grasp Reflex is sometimes confused with Babkin Palmomental Reflex. The demonstration of this reflex is somewhat similar in that the hand and mouth are neuro-loop connected. This information of object from hand to mouth stimulates multiple sensory pathways to wire them together. For example, the hand grasps a piece of banana and brings it to mouth. The hand feels the texture and softness of the banana. The nose smells the banana. The mouth tastes as well as detects the feel of the banana on the tongue, teeth and cheeks in preparation for swallowing.

Palmar Grasp Reflex appears in the 9th week in utero and goes in the background of the nervous system around 4 months old. When the palm is stimulated, the mouth opens. Also, the mouth may open with index finger pointing. The reflex is foundational for the higher-level connections and motor skills related to eating, sucking, swallowing, biting, chewing and speech development.

The Palmar Grasp can also be called upon when needed, and it lives below the level of conscious thought. When we are on a ride at the fair or a baby is walking on uneven ground for the first time, Palmar Grasp may reappear.

Integration: This sensation is driven by touch or pressure on the palm. Vibration, brushing or hand rubbing on the palm and fingers numb and dumb the response. Have the child look superiorly (extension of eyes and neck) to reverse the flexion synergy pattern involved in Palmar Grasp. This will promote elbow extension and hand and finger extension. Once this is done add fine motor activities with small legos or toys.

Handwriting, drawing, finger painting with chilled pencils, pens and cool paint will assist in forming new pathways in the nervous system. Use of clay or theraputty will increase voluntary motion as well as strength in the small muscles of the hand and forearm. Also, adding smells such as orange, lemon, lime or grapefruit will make new stem cells for connections to higher brain levels. (NIH 2014).