Hand Under Hand And Why We Love It!

By Jessica Jordan, MS, OTR/L

What Is Hand Under Hand?

Hand under hand, yes you heard that right. I see many providers use hand over hand assistance, so this reframe is quite the shift, but it’s a must and needed in our society.  What do I mean by hand under hand?  Well it’s quite simply the act of the therapist/provider/adult placing their hand under the individual’s in order to allow that individual more control and influence over the movement. It should be anyone’s right to have autonomy over their body so this should apply to those who are neurodivergent too, not to mention other high-risk populations such as children and the elderly.

Encouraging Autonomy

When neurodivergent individuals are not moving their body in the way that we expect, it doesn’t and shouldn’t give us the right to take their hands and move their bodies for them (unless, of course we receive their consent in some shape or form).  For example, one of the clients I am working with is learning to cut.  He verbalizes and asks for me to practice this skill with him by using the scissors together. 

Letting Go Of Compliance Based Strategies

Now yes, the task we are trying to achieve may not be the “just the right challenge” for the individual, however that is not by any means the client’s fault or shortcoming, but one of the many discoveries we make in treatment in order to see our clients unique talents, diverse skills, and special interests. Another reason why we hear that the individual may not be participating and hand over hand techniques may be “justified” is because the task may not be motivating for the client.  If the task is not motivating then how can we adapt it to make it motivating to the client? And why are we practicing a skill that may not be of importance to the individual themself in the first place?  These are the questions we should be asking ourselves and letting go of compliance-based strategies to honor connection more than compliance.

By using hand under hand during sessions, we are prioritizing the individual’s autonomy and allowing their own self-determination to be respected!  As an occupational therapist, autonomy is principal listed in our practice framework in order to guide ethical treatment guidelines. I hope all practitioners and those supporting the neurodiversity community can consider incorporating more principles of autonomy into their treatment sessions. 

We speak a lot about this in our online course for parents of autistic individuals, especially those who are have apraxia! Learn more about this topic and many more that many OTs aren’t fully aware of or implemting in their practice (but will soon!!) and how you can support your autistic loved one by clicking below.