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Hands Down: Hands Rock

One of the first tasks I do, in an early childhood setting, is to assess the level of independence. This, of course, really boils down to functional use of hands, which is why most early childhood settings are full of tactile manipulatives and gooey substances for hand use.

The hands are great for zipping and buttoning clothes, as well as opening and shutting doors and small containers. This also covers dressing, feeding and ambulatory manipulation of the classroom environment. All of these hand-tool skills are precursors to drawing and then handwriting. I often have a goal saying, “student will write their first name,” but find that the student cannot manipulate objects or has tactile defensiveness with different substances (like play dough, silly putty, shaving cream, clay). I have to go backwards developmentally and address hands as a tool.

I often marvel at a new born/infant when they discover their hands. They look at them in awe as they realize the potential of their amazing tool. Their first cognitive grasp of an object is magical. Hand use (scooping, raking, finger dexterity, sensory, etc.) and strength are quick assessments to direct the next level of a goal or objective. Hands are critical components to tool manipulation, but "hands down" (sorry, I couldn’t resist) the hands come first.

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Comment by Cecilia Cruse on May 2, 2012 at 4:02pm: Ok. Thanks for sharing this. It may help some of our other members as well and/or they may have other suggestions. Sounds to me like you are doing all the right things and she seems to have had very thorough therapy. CVI is often a challenge as it is difficult sometimes to determine what she is seeing and/or what other sensory systems to tap as an alternative. The only thing I would add (if you are not doing so already) would be vibration toys/activities. This also may help activiate the proprioceptive system which helps build body awareness and motor planning. Here is a link to some of our vibration solutions: http://catalogs.schoolspecialty.com/3420_ssi_sn12_10021/t1.asp?page=22

Also, are you using any switch reward toys for cause/effect? You could try a swtich interface that would activate a small portable fan that would gently blow on her if she pressed the switch for example. Here is an interface that would work for an electronic device: http://store.schoolspecialty.com/OA_HTML/ibeCCtpItmDspRte.jsp?secti...

Hope this is helpful! As stated, perhaps some of our other members may have some other suggestions as well. Our best wishes for her success!

Comment by Kelli McCoy on May 2, 2012 at 1:14pm: My baby girl has been diagnosed with being legally blind, and unofficially diagnosed as hypotonic. The blindness is currently being called CVI, although no one seems sure at this point. Like Kelli R's son, she uses her feet to explore, reach out, and find her boundaries. We are doing the sensory brushing. Therapists try to get her to prop on her hands (she isn't sitting or crawling). They have tried all kinds of food that she likes. Vision places her hands on the light box and IPAD. She will leave her hands where placed -- it's not like she pulls them back like she doesn't like it -- but when they fall away, she doesn't replace them. And she would never reach out to put them somewhere on her own. She occasionally puts them up on her bottle now. She is still fisted probably 40-50% of the time. Up until recently, that was more like 90% of the time. One of the therapists told me a few weeks ago that she is out of ideas. She has tried everything she can think of to get her to use her hands, but nothing has worked.

Comment by Cecilia Cruse on May 2, 2012 at 12:29pm: Kelli R: Also thanks for your input. Great ideas for tactile input that you are already using! I don't see your son's age listed, but based on the info you have provided, I would suggest adding and/or increasing proprioceptive (deep touch pressure) input to the repertoire. Activities like wheelbarrow walking, pulling a heavy wagon, carrying a weighted object ( heavy book or grocery bag etc). are all good ways to activate this sensory system which may in turn help with fine tuning development of good hand strength/fine motor skills. Hope this is helpful! Keep us posted on his progress.

Comment by Cecilia Cruse on May 2, 2012 at 12:19pm: Kelli M: Thanks fo your note. Would need to know more about the diagnosis/cognitive level of your 1.5 year old and what therapists have already tried before commenting further. Look forward to hearing from you. You can post to share with all or use my FB account to message:http://www.facebook.com/people/Cecilia-Cruse-Ssi/100001292707248

Comment by Kelli Reynoldson on May 1, 2012 at 7:20pm: My son has always struggled with his hands. He used his feet as an infant way before ever even reaching for an object. We still work with play dough, silly putty and shaving cream almost weekly. This summer I am finally giving up on buttons for now and have ripped all the zippers out of his shorts and replaced them with velcro :) It seems having to exert any pressure with his fingers is aggrivating. :( ?????

Comment by Kelli McCoy on May 1, 2012 at 4:26pm: And what do you do with the infant -- actually 1 1/2 year old -- who doesn't use her hands at all, for anything? Well, OK, she chews on one of them. We have therapists working to no avail. Any suggestions?

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