Patterns for Hand Under Hand
Johnny is an eight-year-old child with multiple impairments including vision and hearing loss. He
has some light perception and fairly good voluntary movement in his upper extremities although
he can't walk. He is about to engage in an activity designed to teach him to brush his teeth. The
brush suddenly appears in Johnny's hand. His teacher places her hand over his. The pressure
applied to hold the brush is hers. The thought processes to plan the movement of the brush is
hers. The spatial memory used to move and place the brush is hers. Finally, her hand and the
brush are gone. Toothbrushing is finished. What has Johnny learned? He has learned to be
passive and to tolerate having his hands moved for him.
This example demonstrates the use of hand over hand instruction. When this type of instruction
is implemented, with complete other-directed manipulation throughout a task, children lose
control of their hands and any potential they might have for learning through the tactual medium.
They risk becoming increasingly passive by pulling their hands away and rejecting objects.
These students may not actually be tactually defensive, but rather tactually selective. Instead of
using their hands as tools to interact more and more with the world outside their bodies, they
withdraw, turn ever more inward, and spend most of their time engaging in self-stimulatory
behaviors. Like Johnny, they have learned to be helpless.
It is crucial for educators, parents, and friends of people who are deafblind to become sensitive
to the hands; the hands of a learner with deafblindness must function as eyes. Information must
be presented so that it is accessible to the hands. One way to achieve this goal is to use hand
under hand instruction, which is a gentle touch under part of the child’s hand or directly
alongside of her hand. Such a touch establishes a mutual topic of conversation. Hand under
hand must be done carefully with three goals in mind.
Hand under hand touch:
is noncontrolling
allows the child to know that you share the experience of touching the same object or of
making the same kind of movements
does not obstruct the most important parts of the child’s own experience of any object he
may be touching
The teacher’s hand is slightly under the child’s as they explore together.
Ideas for applying this topic with beginning communicators:
Offer an object by making a sound with it close to the child or by using the object to
touch some part of the body less sensitive than the palm of the hand, usually the arm or
leg. Wait for a reach.
Engage in parallel play guided by the child. After the child does something with an
object, imitate his action. Try to prolong the interaction by taking turns, he with his object,
and you doing the same thing with a like object or a shared object.
Model new actions with the object of interest. Offer your hands to the child as you do
something with an object. Place your hands under the child's hands, but don't persist in
maintaining contact if he removes his hands.
Create safe, consistent, interesting object environments. The child should have total
control over these environments. No one should guide his hands or verbally direct his
activity when he is in these special environments.
Always ask permission before taking the child's hand. This can be done non-verbally by
placing your hand on top of the child's hand. If the child does not remove his hand,
proceed.
Always cue the child so that he knows what you are going to do before you take his
hand. For example, give the child a spoon to let him know it is time to eat.
If the child is resisting attempts to engage his hands, leave his hands alone and drop
back to reciprocal whole body interactions such as rocking, swinging, bouncing, etc.
Remember you are using these interactions to build trust so that the child will value time
spent with you. In these interactions, the child will use his body to signal when he wants
you to continue or stop. As he develops trust that you will respond to these signals, he
will be more likely to expand his contact with you to eventually include hands.
Ideas for applying this topic with more advanced communicators:
Use an invitation to touch by simply putting your hand gently under the hand of the
person who is deafblind and moving it toward the activity. If your hand is under the hand
of the one who is deafblind, she is free to move away, and the gesture feels like an
invitation rather than a direction.
Giving the person who is deafblind the opportunity to “overhear” signed conversations by
touching the signs of the persons involved is important and should be provided on a
regular basis. Being in literal touch with the conversations of others will help balance
experience and broaden the world of the one who is deafblind.
Model whatever hand skills you wish the child to acquire and allow her tactual access to
that modeling. Do things together with the child, rather than to the child. In a workshop,
for example, staff members who perform the same tasks alongside workers who are
deafblind, and who also invite the ones who cannot see to touch their hands as they
work, are communicating a great deal to the person who is deafblind. They are not only
modeling hand skills, but also are encouraging other work skills such as sustained
attention. In addition, they are affirming a sense of belonging in the person who is
deafblind, and this person becomes part of a “we” rather than feeling isolated or set
apart.
Now that you’ve learned about hand under hand instruction, how would you teach Johnny to
brush his teeth?
Taken from:
“Feelin’ Groovy: Functional Tactual Skills.” By Millie Smith, Educational Specialist, TSBVI VI Outreach with help from Roger Toy,
Occupational Therapist, TSBVI. Downloaded September 2009 from www.tsbvi.edu
“Talking the Language of the Hands to the Hands.” by Barbara Miles, M.Ed. Downloaded September 2009 from www.nationaldb.org
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