By the age of three, most children will have developed the full range of hand grips and manipulation skills, which are then only developed further with age, by increasing in speed and combinations of complexity.

Many disabled children will be delayed in the acquisition of these skills; as well as being limited by the range of hand movements they are able to perform effectively.

In order for children to use their hands precisely, they require good shoulder and upper arm strength and stability to hold and position their hands, both close to and away from their body, and at different height levels.

In order to grip an object with precision the hand muscles need to be sufficiently developed for the palm and fingers to move around the object and to sustain and adjust the grip as necessary.

Children with abnormal tone, neurological conditions and learning difficulties will experience difficulties with this type of precision task. To be motivating and enjoyable, toys need to be appropriate for the age and skills of the child, for them to succeed with minimal assistance.

Toys with large operating buttons will be easier to use for children with all types of disabilities. Dycem mats are useful to stabilise toys for visually impaired and/or physically disabled children and keep them within reach.

Toys which incorporate clothes fastenings are only able to teach a manipulation skill in isolation to the real situation of dressing. This may make the task harder for children with visual and/or learning difficulties, who often learn the skill in a realistic context more easily, rather than learn it twice over.

Using dressing-up clothes, fastening waistcoats or ordinary clothes with large simple fastenings are often more effective teaching methods.

Construction toys teach spatial skills in three dimensions. Larger sized pieces are easier to grip and fit together initially. Interlocking pieces will be more difficult than magnetic or velcro attachments to fit together and pull apart.

Scissor skills can be difficult for children to learn, particularly opening the blades ready for cutting. Using scissors with spring assisted opening blades or with linked/loop handles may help initially.

Children's scissors should have rounded tips to the blades and be made of quality stainless steel and preferably be able to be used equally effectively by both left and right handed children.

Children with limited/no use of one hand may be able to do some cutting with table top scissors with flat handles to push down on to produce a cutting action.

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