Factors That Impact Hand Use
Children with severe cognitive and motor disabilities usually demonstrate limited hand use due to decreased visual attention, motivation, hand strength, range of motion and motor planning deficits. However, environmental and activity adaptations can maximize their abilities, helping to promote success and motivation to increase hand use.
Proper Positioning Promotes Hand Function
The first consideration in promoting hand use in the profoundly multiply handicapped student- is positioning. Students who use wheel chairs will likely already be positioned with the necessary support for trunk stability- enabling them to use their hands most effectively. Children who sit at a desk should have a chair with arm rests, with the desk about two inches above the height of the elbows and feet positioned flat on the floor. A box can be placed below the child’s feet to achieve optimal positioning. Many children with multiple disabilities use their hands best when lying on their sides in a positioning device or propped with wedges and pillows. The side-lying position makes it easier for a child to see her hands and use them together to clap or manipulate objects.
Positioning Work Materials
The next consideration is the height of materials. Providing activities that are large or raised (i.e. on top of a box) promotes visual attention because they are right in front of the student’s eyes. At the same time, reaching upward strengthens the upper extremities. Suggested activities to promote these skills:
Pulling objects attached with Velcro off a box, then inserting them inside. (See the “Take apart” box shown in photo to the right.)
Placing rings over tall ring stacks.
Placing large magnets on a cookie sheet positioned on a raised vertical or angled surface.
Provide Large and Stimulating Objects to Grasp
Students who have difficulty grasping smaller objects benefit from using materials that have large handles so that they fit inside the palm. Objects such as a hair brush or music shaker can be adapted by taping foam around the handles. Small bottles or other objects that fit inside the palm can be used during insertion and placement activities. In addition, these objects can be adapted to provide sensory stimulation in the following ways:
Cover bottles with bright colors.
Fill bottles with sand or bells to make sounds when shook.
Use objects that vibrate such as part of an electric toothbrush.
Provide objects that are weighted (such as a bottle filled with water). The weight may increase body awareness and attention to tasks.
Promoting Bilateral Hand Use
The profoundly multiply handicapped student will often avoid using the two hands together and activities should be designed to encourage bilateral hand skills. This can be done by using materials that:
Are heavy (i.e. pushing socks filled with sand into a box opening).
Large, long or awkward (i.e. placing shapes over two dowels, shown in photo).
Require stabilizing with one hand (i.e. removing shapes from a bottle that are attached with Velcro).
As students with severe cognitive and motor disabilities get older it becomes increasingly important to use activities that meet their learning needs, yet are not babyish. Sometimes this involves the occupational therapist or teacher fabricating the activities. However, many schools have vocational students eager to help with such projects and may have woodworking equipment and other supplies readily available.
Adapting activities to enable simple reaching, grasping and insertion tasks will help students develop basic cognitive skills while also promoting visual attention, upper extremity strength, bilateral hand use and coordination.