One of my most popular posts, Why “Hand-Over-Hand” Assistance Works Poorly With So Many Special Needs Children , explains how this common method of assisting children to hold and manipulate objects often results in rejection or even aversion. This post tells you about my most successful strategy for kids with low muscle tone and limited sensory processing: using graded resistance.
Why does making it harder to move work better? Because if the child is actively trying to reach and grasp an object, you are providing more tactile, kinesthetic and proprioceptive information for their brain. More information = better quality movement. Your accurately graded resistance is doing what weighted/pressure vests, foot weights and SPIO suits do for the rest of their body. Could you use a hand weight or weighted object? Maybe, but little children have little hands with limited space to place a weight, and weights don’t distribute force evenly. Did you take physics in school? Then you know that gravity exerts a constant pressure in one direction. Hands move in 3-D. Oh, well. So much for weighting things.
How do you know how much force to use? Just enough to allow the child to move smoothly. Its a dance in which you constantly monitor their effort and grade yours to allow movement to continue.
Where do you place the force? That one is a little trickier. It helps to have some knowledge of biomechanics, but I can tell you that it isn’t always on their hand. Not because they won’t like it, but because it may not deliver the correct force. Often your force can be more proximal, meaning closer to the shoulder than the hand. That would provide more information for the joints and muscles that stabilize the arm, steadying it so the hand can be guided accurately. If a child has such a weak grasp that they cannot maintain a hold while pushing or pulling, you may be better off moving the object, not the hand, while they hold the object, rather than holding their hand.
Still getting aversive responses from the child? It may be because the child doesn’t want to engage in your activity, or they don’t realize that you are helping them. They may think that adults touch them to remove objects from their grasp or otherwise stop them from exploring. Both can be true. In that case, make sure that you are offering the child something that they want to do first. Remember, we can’t force anyone to play. The desire to engage has to come from them, or it isn’t play. Its just adults making a kid do something that we think is good for them.