Everyday Activities
The following activities are intended to encourage the use of both arms/hands at home in activities that a 2-4 year old child may already be doing within a day. Not every child will be doing these activities in their day, however choosing even just a few to incorporate into daily routine will be beneficial to the child's carryover of bimanual skills at home.
The everyday activities are divided into the following categories:
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Below are ways that use of both hands can be encouraged during meal or snack time.
Meal Time
Eating
Helping Set the Table
Give the child a role at dinnertime and have them set out the silverware. They can either hold silverware in their affected hand and place it on the table with their unaffected hand or hold a handled basket with their affected hand and place with their unaffected hand.
Grasp/Finger Flexion
Shoulder Flexion
Eating from a snack container
Having the child use one hand to hold a snack bag or cup while using the other to retrieve the food is an easy way to encourage use of both hands at the same time.
Grasp/Finger Flexion
Elbow Flexion
Shoulder Flexion
Eating from a handled dish
Give the affected hand a job by having it hold a handled dish while using the unaffected hand to retrieve the food.
Grasp/Finger Flexion
Elbow Flexion
Shoulder Flexion
Eating finger foods
Foods that are cylindrical or long are easy items for your child to practice grasping. Then, either on their own, or with assistance, the child can practice maintaining that grasp while bringing the food to their mouth to take a bite.
Grasp/Finger Flexion
Elbow Flexion
Shoulder Flexion
Eating foods with utensils
Utensils with a cylindrical handle are easier for your child to practice grasping. Then, either on their own, or with assistance, the child can practice maintaining that grasp while bringing the food to their mouth to take a bite.
Grasp/Finger Flexion
Elbow Flexion
Shoulder Flexion
Helpful Items
Two-handled snack cups
Handled Dish
Drinking
Drinking from a two-handled cup
As the child tries to drink, encourage them to use two hands to hold the handles of the cup. The handles on the cup will make this a more appropriate challenge for a child that struggles with grasp.
If the child needs more of a challenge for keeping their hands open, have them hold a cup with no handles, placing both hands around it to drink.
Grasp/Finger Flexion
Elbow Flexion
Shoulder Flexion
Below are ways to encourage use of both hands during your morning routine.
Morning Routine
Getting Dressed
Choosing an Outfit
Choose two pairs of pants and have your child reach for the one they would like to wear with their affected arm. Cues such as "Right hand show me which pants! Blue or yellow?" may be helpful. Do the same for the shirt, etc.
Elbow Extension
Shoulder Flexion
Closing Drawers
Have the child push clothing drawers closed with both hands, assisting as needed while they have both hands placed on the drawer.
Finger Extension
Wrist Extension
Elbow Extension
Shoulder Flexion
Putting on Pants
Have your child try to help you pull up their pants using both hands. They may require cues to place the affected hand on the pants.
Grasp/Finger Flexion
Elbow Flexion
Shoulder Extension
Shoulder Flexion
Putting on a shirt
Have your child put both hands up above their head to put their shirt on or place the shirt on their head and have them pull it over with two hands.
Option 2: Get the shirt started on the child's affected arm and have them push their arm straight to get the sleeve on. Then have them place their head in, and lastly their unaffected arm.
Main idea:
Affected arm
Head
Unaffected arm
Grasp/Finger Flexion
Elbow Flexion
Elbow Extension
Shoulder Flexion
Main idea:
Affected arm
Head
Unaffected arm
CHASA's Dressing Techniques for Kids with Hemiplegia Resource
Excellent resource for further advice on dressing.
(includes skills for older kids such as buttons and zippers)
CHASA's "I Can Do it Myself!" Booklet
Resource with photos and step by step for putting on and taking off shirt and pants.
(includes skills for older kids as well)
Below are ways to encourage use of both hands during your evening routine.
Evening Routine
Taking off Pants
Have the child try to help you pull down their pants using both hands. They may require cues to place the affected hand on the pants.
Shoulder Extension
Grasp/Finger Flexion
Elbow Extension
Taking off Shirt
Have the child put both hands up above their head to take their shirt off or help them get the shirt off of their arms and then allow them to lift it over their head with two hands.
Grasp/Finger Flexion
Elbow Extension
Shoulder Flexion
Brushing Teeth
Have the child open the toothpaste by using their affected hand to hold the tube while using their unaffected hand to manipulate the top. Have the child maintain a grasp with their affected hand while you help them brush their teeth.
Grasp/Finger Flexion
Elbow Flexion
Shoulder Flexion
Reading – 2 ways
Using a board book, lift the page slightly and then have the child use their affected arm to turn the page.
Shoulder Adduction
Shoulder Abduction
Elbow Flexion
Elbow Extension
Shoulder Flexion
Using a board book, turn the book vertically so the page will be turning toward the child. Lift the page slightly and have the child use their affected arm to bring the page down.
Elbow Extension
Wrist Extension
Shoulder Flexion
Opening Bottles
Allow child to open bubbles and other bottles by using their affected hand to hold the bottle while using the unaffected hand to manipulate the top. They can then use both hands to squeeze bubbles into water.
Elbow Flexion
Finger Flexion/Grasp
Shoulder Flexion
Getting Cleaned Up
Encourage child to use both hands to scrub their head and “lather up” their soap by rubbing both hands together.
Elbow Flexion
Finger Extension
Finger Flexion
Shoulder Flexion
Wringing out a washcloth
Have the child help clean up at the end of bath time by grabbing each end of a washcloth and twisting it to squeeze out the water.
Elbow Flexion
Finger Flexion/Grasp
Shoulder Flexion
Pronation/Supination
Potty Training
Miscellaneous
Shopping Cart
While you're grocery shopping have the child either push a kid-sized grocery cart (if the store has these available) or help push the big grocery cart with two hands.
If the child is unable to walk independently, have them sit in the front and encourage them to place both hands on the handles. Race car carts could be especially motivating for kids to place both hands on the wheel to "drive" while you shop. They can even indicate when it is time to "go" by lifting both hands above their head.
Elbow Flexion
Wrist Extension
Finger Flexion/Grasp
Shoulder Flexion
Washing Hands
Encourage child to stretch out arms and open both hands to scrub them together.
You can also sneak in a supination stretch during hand washing by holding the child's forearms to guide them into a palms up (supination) position.
Elbow Extension
Finger Extension
Shoulder Flexion
Pushing Doors Open/Closed
When going from room to room or entering a building, allow child to attempt pushing open the door with both hands, helping them as needed.
This can also be done with only the affected hand, especially for kids who are being carried. Line the child up so that their affected hand is closest to the door.
Elbow Extension
Wrist Extension
Finger Extension
Shoulder Flexion
Raising up Both Hands to Request Being Picked Up
When your child wants to be picked up, encourage them to raise both hands before you pick them up.
Elbow Extension
Wrist Extension
Shoulder Flexion
Sign Language
Sign language is a great way for your child to communicate with you while also incorporating both hands.
“All done”
Elbow Flexion
Wrist Neutral
Pronation/Supination
Finger Extension
"More"
Elbow Flexion
Wrist Neutral
Finger Flexion
Gardening
Have the child help with gardening tasks. These could include:
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Holding a soil bag open with the affected hand and scooping dirt out of it with the unaffected hand.
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Supporting a pot with the affected hand while scooping dirt into it with the unaffected hand.
Elbow Flexion
Finger Flexion
Shoulder Flexion
Zipping Baggies
Have the child hold a baggy of items with their affected hand and zip it up using the unaffected hand during cleanup time.
Pushing Items off a Surface
Have the child sit on the couch and help clean up by pushing items off the couch into a container.
Elbow Extension
Wrist Extension
Holding a Bucket to Clean Up
Have the child hold a handled bucket with their affected hand while cleaning up or collecting toys with the unaffected.
Play
Below are ways to encourage use of both hands during play time.
Bimanual Play
Reading
Allow the child to hold the book with the unaffected hand and turn the pages with the affected hand or vice versa.
Blowing Bubbles
Have the child hold a small bubble container with the affected hand while using the unaffected hand to dip the wand and blow bubbles.
Pulling items apart, pushing them together
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Pull tubes
-
Snap blocks
-
Pulling apart tissues
Crafts
-
Stringing
-
Ripping paper (tissue paper is an easy material to grasp)
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"Do a dot" or scribbling with a marker
The photo to the right shows how you can help the child hold the marker upright if they struggle with wrist supination. Holding the marker not directly over their hand helps them feel like they are doing it themselves.
-
Snipping paper
Have the child hold the paper with the affected hand and use scissors with the unaffected hand.
"Making Music"
Have the child explore different instruments, whether these are instrument toys or something as simple as two pans or a spoon and a pan. For example, the child can hold one part of the instrument (the pan acting as a drum) with their unaffected extremity while holding the lighter weight spoon (acting as a drumstick) with their affected extremity.
This video shows the strategy also used in feeding, where the caregiver holds the end of the drumstick to assist the child rather than placing their hand over the child's. This gives the child a sense of independence.
Play with Salad Spinner
Give the affected hand the job of pushing down on the button to make the salad spinner go. Then the child can open it up with either the affected or unaffected hand and take out the toys. It can be fun to pretend like figures are "getting clean", "taking a bath", or going for a ride as they spin.
Elbow Flexion
Elbow Extension
Wrist Extension
Finger Extension
Songs with Hand Motions
Many popular kids songs have two-hand motions associated with them. Have fun singing along while modeling the hand motions for the child to encourage them to imitate you.
These songs might include:
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Wheels on the Bus
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Old MacDonald
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Itsy Bitsy Spider
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Twinkle Twinkle Little Star
This is a video with all 4. Below, songs are available in separate videos.
Old MacDonald
Itsy Bitsy Spider
Twinkle Twinkle Little Star
Wheels on the Bus
Holding onto Swing with Both Hands
While the child is on the swing, have them put their each hand around the chain on both sides.
Finger Flexion/Grasp
Elbow Flexion
Shoulder Flexion
Riding a Balance Bike or Tricycle
Riding a balance bike lends easily to the use of both hands by placing a hand on each handlebar.
Yoga
There are a wide variety of poses in the world of yoga. Below are several examples of yoga poses that require two hands or require weight bearing through the arms. Weight bearing is especially beneficial for the development of the child's shoulder, elbow, and wrist (particularly wrist extension).
Cat & Cow
Downward Facing Dog
Warrior 1 and 2
Rainbow
Tree
Upward Facing Dog
Animal Walks
Animal walks or poses can be a fun way to practice use of two hands or weight-bearing which is especially beneficial for the development of the child's shoulder, elbow, and wrist (particularly wrist extension). Animal walks can also provide proprioceptive input (knowing where their body is in space), and increased body awareness for motor planning.
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Bear
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Dog
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Cat
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Crab
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Elephant
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Donkey
Play with Siblings
Passing big ball back and forth, pushing with both hands
Encourage the children to sit on the ground and push a larger ball that requires 2 hands. Make it more fun by challenging them to see how many passes they can get in a row without the ball going out of bounds.
Charades
Play a game of charades, using animal walks or other actions that require two hands.
Simon says
Play a game with one child as Simon or both children as followers and include movements like “simon says lift both hands above your head” or “simon says wave both hands”. You can incorporate yoga poses or animal walks into this as well.
Ring Around the Rosie
With this game, children will naturally have to use both hands to make a circle and then sing the song before all falling down.
Twister
With this game, children will be told which hand/foot to put where on the mat. This will not only encourage use of both hands/feet, but also weight bearing through the arms, as they often end up in positions on all four extremities.
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