Hand Play Therapy
Page content created by parents of
CHASA
and Jeanne Ross, OT, MT
A child with hemiparesis sometimes has
excess muscle tone in the hand. They may have problems
isolating finger movement, turning their hand over
(palm up),
holding their wrist at a proper angle, and grasping and
releasing objects. The following exercises and activities have
been gathered from parents and occupational therapists. They
are meant to be a supplement to your child's current therapy.
You should consult your child's physician or therapist before
trying these activities.
Pincer Grasp
Picking M & M's out
of an egg carton
Water bottle fun,
using clear plastic pop bottles. Using tweezers and chop sticks,
have the child place items in the empty bottle (we had removed
the label and washed them first) Items can be anything that will
tolerate being in water such as plastic flowers, glitter, metal,
confetti, etc. Then fill the bottle with water which is colored
or plain. If you are concerned about the child opening it, you
can tape or glue the lid on. This engages the hands and is
visually appealing.
Finally, for kids
working on pinch/fine motor, place stickers on the non-affected
hand/arm. This way the child has to use the affected hand to
remove the sticker. My preschoolers love stickers and love to
make pictures with them.
A word of caution: to
lessen the hold of the sticker, place it on a shirt, etc to
minimize the adhesive before placing it on the child. Some of
the adhesives are really strong.
Tissue
paper scrunching is a really low tech exercise. Have the child
crumple up bits of soft paper and then throw them round the
room. Then they have to chase them by walking or crawling and
pick them up with their toes. This helps with hands and feet.
Supination
Ideas
(Turning the hand over, palm up)
Ringing water out of
a towel by twisting it.
Turning pages of a
book.
"guess which hand"
games, where something is hidden in one hand, the partner
guesses which by tapping the guessed hand and the hider turns
both palms up and opens her hands if correct the guesser gets a
point. If not the hider gets point and so on.
A simple "Slinky" is
a great toy to encourage supination.
Build with
cones
( I use
discarded spools from textile factories)
We build towers or set them up for "bowling", etc. If you place
or the child grasps the cone closest to the thumb, the child has
to actively supinate at least to neutral to effectively place
the cone.
For older kids,
grasping a magnet
(adapt type and size to the child's needs)
and guiding a magnetic "car" along a path
(the path is drawn
on oaktag or similar thin but sturdy paper).
the path is held with the non-affected hand and the child holds
the magnet in the affected hand, under the path to guide the
car.
Benik splints with
supinator straps, especially for children with some active
supination.
Another idea is
sand or water play. Scooping up sand or water and pouring into
another container, or sand/water wheel toy
(Discovery Toys has
a good one)
Making sand castles,
etc use the pronation/supination.
Using a snack
activity such as scooping and eating pudding.
Placing stickers,
stamps, ect on the inner arm. Turn to look at it.
Playing with money
and reaching for charge.
"give me five"
Fill plastic Easter
eggs with varying items, the easier it is to make a sound, the
easier the child needs to work. Things that don't make sounds
easy make the child work harder. You can actually do a number of
motions with these. Supination to pronation, flexion to
extension of either the wrist or elbow, crossing the midline.
Hiding little
stickers on the bottoms of large pegs in a pegboard.
Sensory Activities
Playing in rice, sand, different
textures.
Weight bearing
provides sensory input
Be sure to include
lots of bilateral activities so she is actively using both hands
together.
Not alot of two year
olds tolerate direct handling to an affected side, so you need
to be creative and fun. You may also want to consider a neoprene
splint if she continually rests her hand in a fisted position.
A tray full of
chocolate pudding, whipped cream, whipped cream, jello makes a
great place to "paint" with two hands. Also nice to lick the
stuff off both hands.
We also do the
pudding on a marker board easel to help with her wrist.
The classic
containers of rice, beans, sand for weight bearing
.Just have them
get a small Tupperware container and bury treasures in it.
Weight bear on
the affected hand into the container while she searches for
treasures or search with the affected hand.
Also works for toes and feet)
Paint fingernails
wild colors to stimulate interest in her hand.
Colored handsplints
and rings and bracelets.
Bugs, so we let those
rollie pollie bugs crawl on her affected arm. She thought it was
very funny. She often painted her arm with washable markers. I
think seeing stimulation, and we let her do this.
Refrigerated cookie
dough is a wonderful play with both hands is wonderful for play
with both hands.
"Indoor
bean sandbox". Take a shoebox sized Tupperware and fill it with
all kinds of raw beans and macaroni noodles,etc. Use it just
like a sandbox with shovels and pails, etc.
Different thoughts on hand therapy for
children with hemiplegia
Bilateral upper extremity weight bearing
activities and unilateral reach to both sides (works
on lengthening the involved side)
trunk rotation
(both ways)
bilateral activities
where both hands move together and where one hand stabilizes and
the other manipulates.
bilateral and
unilateral reaching in different planes in a variety of
positions.
holding large light
objects when walking such as a ball
In terms of grasp try
to stabilize the arm as much as possible when grasping. eg: rest
forearm on the table initially.
Need to work on wrist
extension also for a good grasp. Keep in mind that you may only
get to a functional assist on that side.
A soft thumb
abduction splint will probably help with grasp.
Wheelbarrow walking
is great for weight bearing.
Bilateral
coordination tasks: pushing a swing with both hands, scooter in
prone propelling with both hands, and waving bubble wands in the
air with the affected hand is a good way to make it fun!
To encourage reaching
with the involved hand, position the child so that the involved
side is close enough to reach to touch a lamp which would turn
on and off by touch.
Cozy coupe cars are
great for children with left hemiplegia. Encourage the child to
open the door by pushing with the left arm. It also helps
develop lower extremities to power the car.
Use squishy balls to
squeeze or toys that required gripping in 2 hands. McDonald's
Happy Meal toys often require two hands (I know you love this
idea as much as I do!)
Finger foods like
pizza and burgers were also helpful in getting the hand
involved. Have the child pick up every other potato chip with
the involved hand with assistance.
Try to incorporate
these activities into everyday play and routines.
In the kitchen
Have the child hold onto the mixing bowl
with the affected hand and stir with the other hand.
Help unload the
dishwasher with the affected hand pulling out all of the
silverware.
Putting up boxes of
cereal, etc. when unloading the groceries.
Pouring just
about anything. hold cup with affected hand
(find one that's the right size)
For the wrist
Finger painting on easel.
Shaving cream on the
wall of the bathtub
Colorforms on a
mirror. put on and pulls off with the effected hand.
Leaning into the wall
with the affected hand while she paints a picture.
Batting a
lightweight ball or balloon
(like volleyball)
Play dough
activities, pretend cooking
(flipping pancakes)
and the
shaker bottles with corn syrup and glitter, plastic confetti,
etc.
(can
make your own with water bottle, or small plastic bottle)
Toys with the keys
your turn, toy oven knobs, etc
.... playing
'waiter'
(hold the tray under the bottom side with one hand)...
turn keys in a treasure chest to open it...
Weight bearing
Wheel barrowing
Side sitting and
weight bearing while we play board games or do puzzles.
Pretending
we're animals and crawling through the jungle
(I mean house!).
Take the cushions off the sofa and chairs - jumble them up and
hide toys
underneath - have child crawl up and over cushions and weight
bear on hand while reaching for toys.
Bilateral activities
Catching balls.
Carrying containers
of toys when we clean up.
Opening
packages of CANDY
(much motivation) and
baggies of food.
Lots of two
handed baby toys
those popping beads, duplos/legos.
Dressing Barbies.
Emptying the trash cans.
Clearing the
dinner table
(buy non-breakable dishes)
Zoom football that's
on a string.
Trapeze bar swing in
the backyard.
Stringing
beads.
Sewing - get a embroidery hoop and place
fabric in this - hold onto hoop with affected hand and sew with
other hand.
Holding paper down
with affected hand and drawing
Holding paper with
affected hand and cutting -
Pushing a
laundry basket with two hands on the floor (fill
with heavy phone books, cover with a baby blanket and then put
baby doll inside)
- do it on
knees and get in some leg work also.
Balance
There's a toy called a jump-o-lene
that's inexpensive and great for helping with balance.
Walking on curbs with
arms extended.
Wrestling for fun.
Lots of swinging at
the park.
Music and hand play
Percussion instrument like the marimba
might be a good one,
The
glockenspiel
A
tambourine is also a great instrument to use for supination/pronation
because it is so visual. Get one of those cute animal ones for
children that has a handle in the middle. The weight is more
easily distributed.
He might
be able to develop the fine muscle movements needed for writing
by doing exercises on the keyboard/piano geared for
strengthening. There are some great books available, and he can
do the exercises whether or not he knows how to play the piano.
The key thing is that he gets feedback-he makes sound when he
plays.
In terms
of the right brain/left brain ability, music is one of the only
activities that a person can do that requires the whole brain.
Development of hand function among
children with cerebral palsy: growth curve analysis for ages 16
to 70 months. July 2003.
Ontario, Canada.
Excess muscle tone in
the arm and hand of children with Hemiplegia is very common.
The pattern for most children is one of extension. Occupational
therapists may recommend hand splints for the children to help
with stretching the muscles, keeping the hand in a more
functional position, and providing sensory input. This page
contains hand splint information that has been provided by
therapists and parents.
American Society of Hand
Therapists
Grasp Study
- Spastic Cerebral Palsy
Relation between clinical measures and
fine manipulative control in children with hemiplegic cerebral
palsy Journal article, 1999
FirstFlex™
manufacturer of custom bracing and neuromuscular stimulation
treatment for spasticity reduction in children who have
Hemiplegia
McKie Splints affordable
pediatric splinting products
The
Joe Cool Company manufacturers
of soft pediatric thumb abduction splints and gloves
Benik Corporation pediatric
hand splints
and
pediatric wrist supports
TruGrasp Hand
Splint - website no longer available - check with your child's
therapist for this product
Pediatric
Comfy Hand Splints
The
Medi-Kid Company pediatric
immobilizes
Splinting Basic Lecture
Second Skin Splint
A Second Skin Splint in made
out of lycra and specially measured to fit the child's arm or
hand, and sometimes both. It puts pressure on certain parts of
the arm or hand, depending on where needed, to create awareness
of the arm/hand and a certain amount of resistance.
You
can finds photos of the Second Skin Splint at:
http://www2.eis.net.au/~joelsmum/family.html
In this child's case,
the arm band helps to keep his arm down by his side and the hand
one helps to keep his thumb out, wrist at neutral and isolate
certain fingers.
They are made in
Australia, not available in the US at the moment, but are
available in England.
Constraint-induced
(CI)
movement therapy, also known as forced use therapy has been used
in the adult stroke population for years. Recently, this type
of therapy has gained the attention of therapists who work with
children who have Hemiplegia.
Constraint-induced
therapy focuses on regaining movement on the affected side of
the body. More specifically, in children with Hemiplegia, it
focuses on regaining movement of the affected arm and hand.
CI consists of
restraining the non-affected arm, thus forcing the child to
learn to move the affected arm. The thought is that this
treatment may overcome the effects of learned non-use of the arm
and will also ensure that the affected arm has increased
practice or use.
Psychological
concerns about restraining movement in a child is an issue that
need to be considered. Depending on the amount of time in the
restraint, there could be the potential to severely limit the
developing child's already limited ability to explore and
experience his or her environment. Frustration may also be a
major issue.
Pediatric Constraint Induced Therapy
at the University of Alabama at Birmingham Pediatric Neuromotor
Research Clinic
Plastic changes of motor network after
constraint-induced movement therapy.
April 2004. Korea.
Efficacy of
constraint-induced movement therapy for children with cerebral
palsy with asymmetric motor impairment
Feb. 2004. Alabama.
Pediatric constraint-induced movement
therapy for a young child with cerebral palsy: two episodes of
care. Nov. 2003. Alabama.
DeLuca, Echols, Ramey, Taub.
'Clinical experience of constraint induced
movement therapy in adolescents with hemiplegic cerebral
palsy--a day camp model'. May
2003. Eliasson, Bonnier, Krumlinde-Sundholm. Letter.
Constraint-induced therapy
for a child with hemiplegic cerebral palsy: A case report
Home forced use in an outpatient
rehabilitation program for adults with hemiplegia: a pilot study.
Dec. 2003. Philadelphia.
Forced use treatment
of childhood hemiparesis, 2002
Forced use treatment of childhood
hemiparesis, July 2002. 12
participants, ages 1 to 8 years. Louisiana.
Constraint-induced therapy for stroke:
more of the same or something completely different?
2002
Stroke patients' and therapists' opinions of constraint-induced
movement therapy
