Occupational Therapy and Functional Hand Use

In fact, on a neurological level, humans are not hard-wired to find the more challenging ways of doing things. Unless motivated by external sources, we will always look to perform our occupations in effective, efficient, and successful manners (Hoare & Greaves, 2017). And thinking back to our consideration of a child with Cerebral Palsy, this means that the evidence-based research is in support of finding alternative ways of achieving functional hand use that is: effective, efficient, and successful.

Role Differences

There is an emphasis on how the hands are used in activities. Understanding that while the hands may play very differing roles, we can learn to appreciate that such role differences are okay! (Krumlinde‐Sundholm et al., 2007).

Keeping in mind – What hand would you use to complete the following tasks?

• Brush your teeth
• Throw a ball
• Open a door
• Give someone a high-5

Functional Hand Use Can look like:

Using a dominant hand to…

• Handle & manipulate objects to engage in daily occupations

Using a non-dominant or affected side to…

• Stabilise or position objects against the body
• Help or assisting the dominant hand to complete tasks
• Hold objects while the dominant hand engages in the task

With functional hand use, we always come back to the three ingredients. Is the child effective, efficient, and successful in what they want to achieve given the environmental and task demands? Were their attempts completed with minimal effort? And if so, it is likely that the task only requires a dominant hand in achieving. In a situation where two hands are not required or relevant, a child with unilateral CP will never use their affected side or non-dominant side unless prompted to. Meaning, it is unlikely that this particular task or activity will be a natural progression to improving their bimanual skills.

How Can Occupational Therapy Support?

At Centre of Movement, our occupational therapists, use a theoretical framework for understanding the client, their environment, and the occupations that they want to, need to, or are expected to do. They foster a strengths based-approach to evaluate the client, while emphasising their strengths and capabilities which helps to empower and foster self-efficacy. Interventions are then able to be tailored, meaningful, and supported by enhancing motivation for participation.

Enhancing Outcomes!

Occupational Therapists may target a variety of areas to support a child’ functional hand use and bimanual skills, such as:

• Cognition (Executive Function)
• Perception
• Sensation
• Musculoskeletal systems
• Motivation
• Environment

Functional hand use is so much more than the motor skills and our occupational therapists can support your child to develop the skills required to promote effective, efficient, and successful hand use, including the bimanual skills in order to further enhance their independence within their activities of daily living.

“Children with disabilities may not do things nicely and ‘normally’ but they are still making developmental progress. I think there’s more than one path to success. And I would strongly encourage all of us to enable and support children to do things in whatever ways they can. Because the more they do, the more they practice. The more they practice, the better they get at it. If they never do it beautifully, that’s to me, not a big problem.”
-Professor Peter Rosenbaum.