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Prevention begins with small steps
1. Use and move both sides of the upper body
2. Smart bodies rest and stretch
3. Teach and model strong posture habits
4. Tools make tasks easier
5. Build core and upper body strength together
A note about consistency
Free resource
Learn more

Prevention begins with small steps

If you’re raising a child with an upper limb difference, you’ve likely already noticed how creative, determined, and capable they are. Children are remarkable problem-solvers. They figure out how to do what they want to do, often in ways adults would never think of.

That adaptability is a strength. But it can also mean that their bodies work harder in subtle, cumulative ways.

Children with upper limb differences often rely more heavily on one side of their body or use compensatory movement patterns that place extra strain on muscles, joints, and connective tissue. Over time, this can contribute to fatigue, discomfort, or overuse injuries. The good news is that overuse risk isn’t about doing less, it’s about building habits that support balance, recovery, and long-term strength.

These five daily habits are simple, realistic actions you can start using right away. They’re designed to fit into everyday life and work best when practiced as a family so that your child doesn’t feel singled out. The goal isn’t perfection. It’s consistency, awareness, and helping your child’s body stay strong and sustainable as they grow.

1. Use and move both sides of the upper body

Encourage your child to involve their limb-different side in daily tasks whenever possible. This might include brushing teeth, carrying lightweight items, stabilizing objects, or helping turn faucets on and off.

If your child is engaged in one-sided activities such as screen time, crafting, or sports, build in regular pauses. After about 30 minutes, take a short break to stretch, change positions, or switch activities. These small resets can help reduce fatigue and support balanced muscle use.

2. Smart bodies rest and stretch

Rest and recovery protect growing muscles and joints.

Instead of waiting for pain or soreness, normalize short breaks as part of daily routines. Replace “push through” messages with language that values listening to the body, such as “do, rest, and stretch.”

Create a predictable rhythm: activity, pause, stretch, then return to play. Even if your child says they don’t feel sore, their body still benefits from rest and recovery.

3. Teach and model strong posture habits

Posture matters, especially during sitting, screen use, and homework.
Encourage upright positioning and minimize prolonged slouching, rounded backs, or “tech neck.” Use book stands, screen risers, or pillows to bring work to eye level rather than bending the body down to the task.

Family stretch breaks or short yoga moments can reinforce the idea that posture and movement care are normal parts of daily life.

4. Tools make tasks easier

Introduce adaptive tools early and use them as a family so no one feels singled out.
Show children how tools can make everyday tasks easier and more efficient. Start with small, practical changes at home, such as replacing round door knobs or faucets with lever handles. These changes benefit everyone and reduce strain on hands and wrists.

Universal cuffs and similar tools can help a shorter arm or smaller hand grasp objects more easily, supporting participation without extra effort.

5. Build core and upper body strength together

A strong core helps protect the arms and shoulders, and it’s never too early or too late to start.

• For children under 8-10 years, focus on playful strength-building: climbing, swimming, tummy play, animal walks, and rough-and-tumble movement.
• For children over 8-10 years, add simple strengthening such as planks (wall or floor) and using resistance bands. When appropriate add adapted weightlifting under guidance.

Strong bodies are more resilient, and strength-building works best when it feels empowering rather than corrective.

A note about consistency

Overuse prevention isn’t about doing everything perfectly. It’s about building awareness and routines that support your child’s body over time. Think of these habits the way you think about brushing teeth: small daily actions that protect long-term health.

If you’d like a quick reference to keep on your refrigerator or share with teachers, coaches, or therapists, download the free printable handout below.

Free resource: 👇Download the free “5 Daily Habits to Reduce Overuse Risk” handout

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For more education on overuse prevention, adaptive tools, and supporting strong, balanced bodies, follow on Instagram and subscribe to our newsletter. To access more overuse syndrome information, visit the overuse syndrome hub.

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post 5 Habits to Reduce Overuse Risk for Children with Upper Limb Differences appeared first on On The Other Hand.

A helpful way to think about this: brushing teeth
Why body care works best as a routine
Starting the conversation at different ages
Make it a whole-family practice
Language matters
Supporting lifelong habits
Free resource
Learn more

Before we talk about how to reduce overuse syndrome risk, it helps to talk about how to talk about it with your child.

Children with upper limb differences don’t need complicated explanations or heavy conversations about future pain. What they benefit from most is age-appropriate language that frames body care as a normal part of everyday life — something the whole family does together.

A helpful way to think about this: brushing teeth

Many parents find it useful to think about overuse prevention the same way we think about dental care.

We do not wait for cavities to teach children to brush their teeth, and we do not scare them with worst-case outcomes. We explain, matter-of-factly, that teeth need regular care to stay healthy. When children are young, we brush with them or for them. Over time, they take on more responsibility as they are ready.

Overuse prevention works the same way.

Instead of teaching children to be afraid of their bodies, we help them build simple habits that protect their bodies over time.

Why body care works best as a routine

Parents often ask whether they should check in with their child by asking if they are in pain or if they want to take a break. While this may feel respectful, it is often not the most effective approach for young children.

There are several reasons for this:

• young children may not have the body awareness to notice early fatigue or strain
• they may not want to interrupt an activity they are enjoying 
• they may say that they are not in pain to avoid worrying the adults around them

Because of this, body care works best when it is built into the routine rather than treated as a decision children must make in the moment. This is why adults play an important role in guiding and modeling these habits early on.

As children grow into adolescence, this guidance naturally shifts toward collaboration and independence.

Starting the conversation at different ages

Body care conversations do not need to be formal or scripted. Small, repeated messages are often the most effective.

For younger children, language can be simple and playful:

• “Let’s help both arms/sides get strong.”

For school-age children:

• “Your body did a lot today. A short break helps it stay strong.”
• “Let’s stretch because your muscles worked hard”
• “Stretching helps your muscles recover.”

For tweens and teens:

• “Let’s do planks together to strengthen our shoulders!”
• “Breaks help you keep doing what you love.”

Make it a whole-family practice

When body care habits are something the entire family participates in, children with limb differences are less likely to feel singled out.

Stretching together, taking movement breaks, and talking out loud about rest and recovery helps normalize body care for everyone. It sends the message that caring for our bodies is something all people do, not something only one child needs.

Language matters

The words adults use shape how children think about their bodies.

While you are having conversations with your child about overuse syndrome, it’s best to choose neutral, descriptive language such as “limb different side,” “shorter arm,” or “helping arm” to support confidence and reduce comparison. Avoiding terms like “bad,” “weak,” or “normal” can help children develop a sense of acceptance, rather than judgment, about their body.

Supporting lifelong habits

These conversations are not about limiting activity or watching for problems. They are about planting seeds.

Children who grow up with routine body care habits are better prepared to notice fatigue, respect their bodies, and advocate for themselves later in life. This matters because many adults with limb differences report experiencing overuse pain, often without having had the language or framework to understand what was happening.

Early awareness and supportive routines can make a meaningful difference over time.

Free resource

To support these conversations at home, you can download a one-page handout that summarizes:

• why routine matters
• age-appropriate language examples
• how to make body care a whole-family practice

👇 Download the free handout: “How to Talk to Your Child About Body Care & Overuse”

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If you would like to continue learning about overuse prevention, strength, and sustainable movement for children with upper limb differences, follow on Instagram and subscribe to our newsletter. To access more overuse syndrome information, visit the overuse syndrome hub.

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy

The post How to Talk to Your Child about Limb Difference Overuse Syndrome appeared first on On The Other Hand.

This post is the first of a three-part reflection on bullying; be sure to read
👉 Bullying Part 2: Practical Guidance for Parents and
👉 Bullying Part 3: Is It Bullying, Curiosity, or Something Else?

Introduction
Bullying can take many forms
What does and does not count as bullying
When bullying isn’t obvious: relational aggression
Cyberbullying and digital spaces
Why children with visible differences are often targeted
Bullying is not just an individual coping issue
Why self-advocacy alone is not enough
Why adults often miss what is happening
Friendship fit matters
A note to parents
Free resource
Learn more

Introduction 

Bullying does not always look the way we expect it to.

For children with visible differences, including upper limb differences, social harm often exists on a spectrum, from overt teasing or name-calling to subtle exclusion, joking, or story-making that is framed as “funny” or “no big deal.”

Bullying can take many forms

When parents think of bullying, they often imagine name-calling or physical conflict. But bullying can also be subtle and understated.

Bullying and social harm can:

• Be obvious or very subtle
• Come from strangers or close friends
• Happen multiple times in close succession or unfold slowly over time

For many children, the most painful experiences are not with strangers, but with friends who begin to treat them differently. This may happen when:

• A peer wants to fit into a new social group
• A child tests social power by aligning with peers who bully others
• Differences between children become more noticeable with age

Teasing or exclusion that comes from someone a child trusted can feel confusing and deeply hurtful, especially when dismissed as “joking.” Some of the most painful experiences children face happen through subtle social exclusion or friendship manipulation, patterns especially common among girls.

What does and does not count as bullying

Bullying is typically defined as a repeated pattern of behavior that is intended to harm, exclude, intimidate, or humiliate, and that involves a real or perceived power imbalance.

This may include:

• Repeated teasing or mocking
• Ongoing exclusion
• Name-calling or threats
• Targeting a visible difference

Not all unkind behavior meets this definition. A single hurtful comment, a misunderstanding, or a conflict between friends, while still painful, is not necessarily bullying.

That said, one-time incidents still deserve attention, especially when they involve a child’s body, disability, or identity. What matters most is watching for patterns over time and how the experience is affecting the child.

When bullying isn’t obvious: relational aggression

It can be hard for adults to recognize some forms of bullying.

Among girls in particular, bullying often takes the form of relational aggression. Instead of direct insults or physical conflict, it may involve social manipulation designed to damage a child’s relationships or sense of belonging.

This can look like:

• Excluding someone from a friend group
• Whispering or talking about someone behind their back
• Spreading rumors
• Rolling eyes or exchanging looks meant to humiliate
• Telling others not to play with a particular child
• Being friendly one moment and suddenly cold the next

Because these behaviors are subtle, adults may miss them entirely. A teacher might see a group of girls quietly working together and assume everything is fine, while one child feels deeply isolated within that group.

For children with visible differences, such as a hand or arm difference, these dynamics can become particularly painful. The bullying may not focus directly on the difference. Instead, the child may be pushed to the edges of social groups, left out of games, or treated as “different” in ways that are difficult to name.

Parents sometimes hear things like:

• “They said I couldn’t sit with them today.”
• “They’re having a party but I’m not invited.”
• “They were whispering about me.”

These experiences can be just as damaging as more obvious bullying, even though they are harder to document or intervene in.

Understanding relational aggression can help parents recognize that bullying is not always loud or visible. Sometimes it happens quietly, in the subtle social dynamics of childhood friendships.

Parents who want to understand these dynamics in more depth may find the book Queen Bees and Wannabes by Rosalind Wiseman helpful. It explores how social hierarchies and exclusion can develop among girls during the school years.

Cyberbullying and digital spaces

For many children and teens, bullying does not stop at the school door. Cyberbullying can include:

• Hurtful messages or comments
• Group chats used to exclude or mock
• Sharing images, videos, or private information
• Ongoing harassment through social media or gaming platforms

Because cyberbullying often happens privately, children may hesitate to tell adults, especially if they fear losing access to devices or social connection. Parents can support by:

• Keeping communication open about online spaces without immediate punishment
• Treating online harm with the same seriousness as in-person harm
• Documenting patterns (screenshots, dates) if intervention becomes necessary
• Involving school staff when online behavior intersects with school relationships

As with in-person bullying, greater focus should be on patterns and impact than on isolated moments. 👉 Visit Part 2: Practical Guidance for Parents for cyberbullying resources.

Why children with visible differences are often targeted

Noticing differences is a typical part of children’s development. Problems arise when curiosity is not guided by adults and turns into repeated comments, teasing, or exclusion.

Importantly, the issue is how differences are handled within the social environment, not the child’s body.

When children are not supported in learning how to engage respectfully with difference, harm can occur even without malicious intent.

Bullying is not just an individual coping issue

Bullying is often framed as something a child should learn to handle on their own. This framing misses a critical truth:

Bullying is not just an individual coping issue. It is a systems issue that requires different responses depending on the child’s age, capacity, and environment.

Expecting a child to self-advocate in an environment that does not support them places too much responsibility on the child and too little on the system around them.

Why self-advocacy alone is not enough

Self-advocacy is a skill that develops over time. Younger children, in particular:

• May speak up and still be ignored
• May be mocked for asserting boundaries
• May lack the social power to change peer behavior

This does not mean self-advocacy is unimportant. It means adult support remains essential, especially in childhood.

Why adults often miss what is happening

Bullying and exclusion often:

• Happen when adults are not present
• Are hidden behind humor or charm
• Appear inconsistent or hard to “prove”

Children who engage in bullying may behave very differently around adults, which can make children who are targeted feel doubted or unsupported.

Friendship fit matters

Learning to notice how someone treats you and how you feel in their presence are lifelong skills.

Not every peer or peer group will be a good fit, and recognizing that a relationship is no longer supportive does not represent social failure. It reflects growing social-emotional awareness and self-respect.

Children benefit when adults reinforce that:

• Being included should not require tolerating repeated unkindness
• Friendship quality matters more than social status or convenience
• Moving toward healthier relationships is a strength, not a loss

This framing helps children understand that social change is part of development, not a reflection of their worth.

A note to parents

Many parents reading this may recognize situations that have already happened or patterns they wish they had understood earlier. These dynamics are rarely explained to families in advance, and most parents are doing the best they can with the information they have at the time. Wherever you are in your journey, it is never too late to reflect, adjust, and support your child in ways that foster safety, confidence, and belonging.

Free resource

👉 Download the free handout, Supporting Your Child Through Bullying & Social Exclusion

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👉 In Bullying Part 2: Practical Guidance for Parents we explore what parents can actually do: how to talk with their child, when to step in, and how to support social and emotional well-being over time.
👉 In Bullying Part 3: Is It Bullying, Curiosity, or Something Else? we cover how it can be hard to know what’s happening when a child stares, asks questions, says something hurtful, or touches your child’s limb difference. We’ll try to tease out the difference between curiosity, social behavior, and true bullying, so you can support your child with clarity and confidence.

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post Bullying Part 1: Understanding Exclusion and Social Systems appeared first on On The Other Hand.

I never had a toy with a limb difference like mine – until just recently. Growing up with a partial hand, I tried so hard to adapt to the limb typical world that it didn’t occur to me that toys with limb differences like mine could be possible. I can only imagine how much my 5 year old self would have loved one of these dolls! 

But of course they’re not only possible – there now are so many incredible options available! Here are the dolls and toys I know about; please message me additional ones through social media so that I can add them to the resources page.

Download the free 2025 Inclusive Toys + Dolls Guide with hot links to the inclusive limb different toys listed below

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For children with limb differences, these toys can …
These toys can ALSO …
For children with typical limbs, these toys can …
Where do these toys belong?
How can people who are raising or work with “limb typical” children be allies?
Who makes limb difference toys?
At what age can children benefit from playing with inclusive dolls? 
Transparency
Links

For children with limb differences, these toys can: 

• boost self-esteem – encourage them to embrace their differences
• offer belonging, comfort, & connection – remind them they aren’t alone
• provide representation – help them see themselves positively

These toys can ALSO:

• foster imaginative play that includes their differences
• offer opportunities to practice responding to questions about their limb difference
• open conversations with peers & siblings

For children with typical limbs, these toys can:

• normalize disabilities & differences in body shapes/sizes
• promote acceptance, empathy, & understanding of differences
• serve as powerful tools for inclusion

Where do these toys belong?

Wherever children live, learn, play, & visit, such as:

• daycares
• extracurricular activities
• homes of peers & loved ones
• public libraries, recreational & after care centers
• schools & educational facilities
• summer camps

How can people who are raising or work with “limb typical” children be allies?

• promote inclusive toys with educators, librarians, & program staff
• encourage children to role play asking kind questions

Who makes limb difference toys?

• Plushies + soft dolls
  • A Doll Like Me – custom plush dolls customized to the child’s difference
  • Budsies – custom plush dolls customized to the child’s difference                     
  • Crochet-ABLEs – custom crocheted dolls and animals matched to any limb difference
  • Kikilishop – personalized cloth rag dolls featuring upper and/or lower limb differences
  • Mayana & Friends – a collection of animal plushies representing diverse limb differences
  • Uniquely Me – companion doll to Trace Wilson’s book Uniquely Me
  • Vermont Teddy Bear with theAmputee Coalition – plush bears with limb differences   

• 18″ “realistic” dolls
  • Customized American Girl dolls by A Step Ahead Prosthetics 
  • The Doll for All – boy and girl 18” realistic dolls with 10 upper limb difference options and 4 lower limb difference options
    
• Action figures + character toys
  • Disney® – Nemo has a smaller “lucky fin”
  • LEGO® – Autumn (Friends line) has a partial arm and her sets come with adaptive gadgets
  • Mattel® – Barbie® with a prosthetic leg; part of the Fashionista line

At what age can children benefit from playing with inclusive dolls? 

• the younger the better!
• it’s never too early to make the world kinder & more inclusive

Transparency

I do not do not receive any commissions or kick backs for toy recommendations. Occasionally companies send me free products to try; Mayana & Friends sent me their adorable “Dougie” doll.

Please note that I can no longer find these products that previously were available; they may still be available on Ebay or used:

• “My Life” as a gymnast with prosthetic leg by Walmart
• “Our Generation” with prosthetic leg by Target

Many thanks to the families for sharing photos of their children with their dolls: @kimberly_gallagher and @thehandweredealt

Links

• Links for all of the toys and dolls are on the resources page.
• See this post on Instagram.
• See this post in the “H2L Innovation Station” column in the Hands to Love newsletter.

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post Limb different toys & dolls matter – here’s why appeared first on On The Other Hand.

Complete the form below to download a free printable copy of the Upper Limb Difference (ULD) Overuse Syndrome: Prevent, Reduce, Treat infographic

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Want a personalized consultation to discuss how to help your child avoid overuse syndrome? Schedule a consult with me (limited to Ohio)!

The amazing human body
What is overuse syndrome?
Causes of overuse syndrome
Why are people with upper limb differences at higher risk?
When does overuse syndrome usually start?
How does overuse syndrome develop?
What parents and practitioners can do
Final thoughts
Free resource
Quick links
Learn more

The amazing human body

The human body — with typical or atypical limbs — is incredible. Although bodies are designed to be symmetrical, they can and do adapt in marvelous and ingenious ways. Every day, children and adults with upper limb differences (ULD) are living their lives to the fullest: playing sports, cooking, creating, and so much more. 

At the same time, when a child has one hand or arm that functions differently, the unaffected side often does more. This may not cause problems at first, but over time, the extra strain adds up. This can lead to a painful condition called overuse syndrome, which can last for months or even years. From the time children with one-sided limb differences are young, we need to pay close attention to how much they use the unaffected side of the body.

What is overuse syndrome? 

Overuse syndrome is when pain or fatigue sets in because of repeating the same motions over and over. It’s also called:

• Repetitive strain injury (RSI)
• Repetitive motion disorder (RMD)
• Cumulative trauma disorder (CTD)
• Occupational overuse syndrome (OOS)

It often starts in the hands or arms and can spread to the shoulder, back, and neck if not addressed.

Causes of overuse syndrome 

• Repeating the same movements often
• Using high force or awkward postures
• Not enough rest
• Weak or tired muscles
• Poor posture or body mechanics
• Stress or untreated mental health challenges

Why are people with upper limb differences at higher risk?

People with one-sided upper limb differences often rely heavily on one side of their body. Over time, that side can become overworked, especially if the limb-different side isn’t used as much.

A recent research study of adults with congenital one-sided ULD by Jenkins, 2025 found:

• 82% reported overuse symptoms
• 60% said the pain began by age 25
• 41% said the pain began by age 20

Compare that to the general population, where upper limb pain affects only about 16–24% of people under age 45. That’s a big difference!

When does overuse syndrome usually start?

We used to think that overuse syndrome started in middle age. But we now know that the condition often begins in childhood or young adulthood, but it can be missed or ignored for years. That’s because physically active children and teens with upper limb differences may not realize that the aches they feel are not “typical” or they may be so used to compensating for their difference that they push through discomfort.

How does overuse syndrome develop?

Overuse syndrome develops in stages over time. Catching overuse syndrome early in either arm or hand can prevent symptoms from worsening. Because it‘s easy to ignore pain, learning to recognize the stages for oneself or a loved one (child, spouse, friend) and noticing patterns of ignoring or pushing through pain can help reduce the risk of overuse syndrome.

The four stages of overuse syndrome

• Stage 1: pain occurs after activity:
  • Pain or tiredness after activity, goes away with rest
  • Example: pain and/or fatigue after cooking, playing sports, or typing one-handed
    
• Stage 2: pain occurs during activity — but doesn’t affect performance
  • Pain starts during activity, may last into the next day; rest and over the counter anti-inflammatory medication bring relief
  • Example: pain and/or fatigue during cooking, playing sports, or typing one-handed
    
• Stage 3: serious aching, fatigue, pain — and limits performance
  • Pain limits participation; rest and over the counter anti-inflammatory medication offer limited relief
  • Example: pain and/or fatigue limit ability to cook, play sports, or type one-handed
    
• Stage 4: chronic pain even at rest
  • Constant pain, aching, fatigue, and pain, even at rest. Muscles may weaken. Sleep and daily life are affected.
  • Example: constant pain and/or fatigue in either hand/arm, back, neck, shoulder

What parents and practitioners can do

You’re already doing so much to support your child. Here are a few more ways to prevent overuse syndrome:

• Encourage use of both sides during daily tasks
• Use tools and assistive devices that make using the limb-different side easier
• Support strength, posture, and endurance through safe movement
• Watch for signs of fatigue or pain and respond early
• Adapt technology and activities — not your child — to reduce strain
• Work with a pediatric occupational therapist who understands limb differences
• Teach your child about listening to their body and taking breaks

Final thoughts

Children with upper limb differences are capable, smart, and strong. Let’s support them by protecting their bodies, not just now, but for the long term.

By making small changes early and being aware of the signs of overuse, we can help them grow healthy, confident, and balanced bodies.

Free resource: 👇download the free printable copy of the Upper Limb Difference (ULD) Overuse Syndrome: prevent, reduce, treat infographic

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Quick links

• Want a personalized consultation to discuss how to help your child avoid overuse syndrome? Schedule a consult in Ohio with me!
• Technology is a big contributor to overuse syndrome. Learn how to adapt technology to your child’s upper limb difference – and download the free handout!
• Learn about the Overachiever Trap
• Learn about Occupational Therapy for children with upper limb differences
• To learn more about overuse syndrome, follow our series on Instagram

Learn more

For more education on overuse prevention, adaptive tools, and supporting strong, balanced bodies, follow on Instagram and subscribe to our newsletter. To access more overuse syndrome information, visit the overuse syndrome hub.

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post Understanding Upper Limb Difference (ULD) Overuse Syndrome appeared first on On The Other Hand.

Complete the form below to download a free printable copy of the Mother’s Day Letter to my Mother

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I wrote this letter to express empathy for all my mother went through raising a child with a hand difference — and to thank her for all the support and love she gave me over the years.

Growing up with a limb difference, there were so many things left unsaid between my mother and me — not out of neglect, but because we didn’t have the words. In this letter, I reflect on what I imagine she felt, what I’ve come to understand, and what I’ve always wanted her to know. Whether you’re a parent or an adult with a limb difference, I hope it resonates with your own journey.

I want to celebrate all the mothers raising children with disabilities and limb differences in particular. I know sometimes your labor goes unseen. Thank you for everything that you do on behalf of your children that goes above and beyond loving, caring for, helping, listening, and sharing yourself, your time, and your energy:

• advocating for your child’s needs in school and extracurriculars
• connecting with other families to ask questions and set up get togethers
• including siblings whenever appropriate/helpful to enable them to develop strong bonds of empathy and connection
• problem solving with your child how they can cook, sew, play an instrument or sport, or a million other things
• researching the right camps and programs
• taking your children to medical providers

💭 Adults with limb differences, have you written to your mother — even if you didn’t share it? I found the process offered clarity, healing, and space to explore what I wish she knew.

Here’s the letter ….

Dear Mom, 

When I was born, I imagine you felt a wave of emotions: 
– awe – confusion – fear – joy – relief – shock  … and probably many more! 

So many things were difficult for you

• You didn’t expect to have a child with a hand difference
• You blamed yourself — no one told you otherwise
• No one offered support or guidance on how to raise a child with a limb difference
• My pediatrician never asked how you were doing or mentioned my hand (!)

You worried so much

• You feared people would be unkin.
• You worried I wouldn’t be able to do things like everyone else
• You questioned whether I’d have enough strength to deal with everything
• You felt distressed that I would suffer from something I didn’t choose
• You wondered if I would find love

Everything you felt made sense

• In the world we lived in, my hand was seen as “defective” and disability was viewed negatively
• Of course you couldn’t predict how my life would turn out
• You didn’t yet know how strong I am and would become — how could you?

While I sometimes questioned, I never blamed you for my hand difference – it wasn’t your fault

I have experienced challenges, yes

But I also have been blessed with an incredibly joyful and fulfilling life

What mattered most to me was knowing you loved me exactly as I am — and you’re proud of who I’ve become

And one more thing … what I learned from my experiences has helped shape who I am. Every day, I use:
– advocacy – creativity – empathy – perseverance – problem solving – strength
in my life as an occupational therapist, wife, mother, daughter, sister, and friend

What none of us could have imagined that changed my life is discovering the beautiful community of people with limb differences where I feel accepted, connected, understood, and warmly welcomed

So on this Mother’s Day — and every day — thank you for all you did to help make me who I am

Thank you for your constant support and encouragement to try everything I dreamed of

And thank you for the millions of things you did for me that I will never even know about

I love and appreciate you with all my heart

Your loving daughter,
Laura

Complete the form below to download a free printable copy of the Mother’s Day Letter to my Mother

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Read the other posts in this series:

• Letter from a Parent to their Child with a Limb Difference
• Letter to my Parents, Teachers, and Coaches from my Younger Self
• Letter to my Younger Self

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. © 2026. All rights reserved.

The post Mother’s Day Letter to my Mom appeared first on On The Other Hand.

Complete the form below to download a free printable copy of the Letter from a Parent to their Child with a Limb Difference

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• If you are a parent/guardian of a child dealing with any kind of difference, it absolutely is ok to need and seek help – and totally encouraged! Where did you seek (and find) support? What was most helpful? If you had difficulty finding support, what do you wish you had been able to find?

• If you are the person with a difference (limb or otherwise): did you hear this as a child? What might it have been like for you if you had?

Please feel free to share your comments how this letter resonates for you here.

Read the other posts in this series:

• Mother’s Day Letter to my Mother
• Letter to my Parents, Teachers, and Coaches from my Younger Self
• Letter to my Younger Self

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post Letter from a Parent to their Child with a Limb Difference appeared first on On The Other Hand.

Download a free copy of the Fortune Teller for Children with Upper Limb Differences!
What is overuse syndrome?
Becoming a body sleuth
Hands-on learning: the Fortune Teller craft
Tips for parents & caregivers
Final takeaways
Let’s stay connected!

Download a free copy of the Fortune Teller for Children with Upper Limb Differences!

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Sarah Tuberty, OTD, OTR/L and I teamed up to present a workshop session for families on how to guide children to become “body sleuths” so they can recognize how their bodies feel during and after activities. 

As parents, caregivers, and practitioners, we want our children to feel confident, capable, and comfortable in their bodies. That’s why understanding overuse syndrome and how to prevent it is so important — especially for children with upper limb differences. 

Let’s dive into what we covered and how you can apply it at home or in practice!

What is overuse syndrome?

Overuse syndrome happens when we put too much strain on certain muscles or joints, leading to discomfort or pain. Daily activities can put extra stress on the bodies of children with upper limb differences because the dominant side is always working. In addition, asymmetries on the limb different side(s) can lead to compensations in hands/arms that can cause strain or fatigue in other muscles. The goal is to develop strategies early on so children can move, play, and learn with less strain and pain and more ease. Learn more about overuse syndrome here.

It’s easy to focus so much on accomplishing a task that adults may not realize that children may strain themselves by how they adapt to doing an activity. Encouraging children to tune into their bodies is key! 

Becoming a body sleuth

Most of the time, children with upper limb differences learn how to do new things from people who have ten fingers and two hands, not from other people with limb differences. Think about when your child first learned how to ride a bicycle, brush their teeth, play baseball, tie their shoelaces – they probably learned from people who have all their limbs!

Every time your child tries a new activity, they have to figure out how to adapt their body. Asking these questions can help your child start thinking like a body sleuth:

• Observe: How does your body feel while doing an activity? Afterward?
• Think: How will you be able to do this in your body? Have you done something like this before? What worked well? What other activities or skills can you use here?
• Plan & Adapt: Can you do the activity as shown, or can you adapt? Would different tools or a different approach help, such as:
  • more information or instructions
  • different materials or tools
  • extra time
  • help from others

Hands-on learning: the Fortune Teller craft

At our workshop, we practiced these ideas with a fun Fortune Teller Craft Activity! This hands-on experience empowers children to explore how they use their bodies when trying to learn how to do a new activity. Once your child has made the fortune teller, you can use it as a resource with your child as they build their body sleuth skills. You can use this fun and playful tool when you want to ask your child about doing a new activity at school, sports practice, extracurricular activity, camp – whenever! 

You can try it at home:

1. Download the Fortune Teller for Children with Upper Limb Differences template (above).
2. Demonstrate folding the fortune teller (watch this video or view these visual instructions if you need guidance!) while your child copies step by step.
3. Once they’ve finished folding, it’s time to use the fortune teller!
4. Use the reflection questions inside the fortune teller: What felt easy? What needed adjusting?

Tips for parents & caregivers

• Finding the balance – help your child develop strategies and consider their long-term health 
• Encourage exploration – your child may find that trying different ways of doing things helps their body; they don’t have to go with the first solution
• Avoid pressure to “keep up” or be “amazing” – each child moves at their own pace. The goals are comfort, competence, and confidence, not speed
• Support their creativity and problem-solving – they may enjoy having a thinking partner, but not someone to do it for them! 
• Reflect together – Talk about what worked, what didn’t, and what could be different next time
• Watch out for over analyzing – while it’s not necessary to review every activity with your child, checking in every so often lets them know you care

Final takeaways

For children:

• Do the things you want to do, while also paying attention to how your body feels!

For parents & caregivers:

• Trust that children are resilient and adaptive
• Celebrate small wins and problem-solving efforts
• Support reflection and self-awareness

Let’s stay connected!

We love sharing resources and learning together! Please share your experiences using the fortune teller activity here and follow us for more tips and activities!

• @ontheotherhandtherapy
• @aerials.and.airplanes; Sarah Tuberty’s Website

A huge thank you to Helping Hands Foundation for hosting us! Let’s keep learning, adapting, and growing together!

Many thanks Aiden Plaziak, who volunteered to demonstrate using the fortune teller during the presentation and Joss Hunt, who took photos!

We also wish to thank the amazing pre-OT student interns who contributed to our presentation:

• Zoey Blagrove, sophomore at the University of Pittsburgh, recorded making the fortune teller
• Tiffany Chaplin, junior at University of Connecticut, took photos of the presentation at the Helping Hands Winter Outing
• Maria Chesko, junior at The Ohio State University, assisted with the slides
  

Download a free copy of the Fortune Teller for Children with Upper Limb Differences!

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© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post “How to think like an OT” appeared first on On The Other Hand.

Adapt the technology to the child, not the other way around

Background
Advocating for Your Child
Practice Makes Permanent
Looking Different Can be Hard
Adaptive Technology Options
Keyboard Layouts: QWERTY vs. DVORAK
Mouse Use
External Keyboards
Typing with One Hand
Typing with One Hand and a Partial Hand
Typing with Two Partial Hands
Typing without Hands
What About One-Handed Keyboards?
Custom Keyboard Layouts
My Typing Journey Story
Accessible Accessories
Try Before You Buy
Voice to Text Options
Ergonomics
Taking Breaks from Computer Use
Additional Resources
Quick Links
Important Takeaways

Complete the form below to download a free printable copy of the Adaptive Tech Options for Children with Upper Limb Differences (ULD) handouts, featuring an overview page and a chart with adaptive tech options. You will receive two versions of the chart: digital (with hot links) and printable (less color, so less toner used!). Both handouts link to an Amazon list with recommended products; recommendations for products are for educational purposes only; we don’t endorse or profit from them.

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Want to save time? Schedule a consult with me to individualize a technology set up that is best for your child!

Background

While there is now a (limited) body of research on children using computers, there is no research yet specifically on computer use and adaptations for children with upper limb differences (ULD).

So what follows are recommendations based on:

• my personal experience with overuse syndrome
• the experiences of families and adults with whom I’ve worked and spoken
• ergonomics research involving typically developing children and adults

Most of the information below applies regardless of age; however, because upper limb differences can be so varied, unfortunately there is no one-size-fits-all recommendation. Because most children these days use laptops much more often than desktop computers, we focus mostly on laptops. But note that much of the following also applies to home desktop use, which has the advantage of being more configurable. If your child works with an occupational therapist, sharing this information would be helpful.  

Advocating for Your Child

I have heard regularly from parents over the past two decades that there weren’t any specialists with expertise on adaptive tecnology within their school system or school district. Unless your child’s school or district has an assistive technology specialist on staff, you likely will need to be the expert on technology adaptations and advocate for your child. Knowing what grade children begin using technology can be very helpful, as is implementing adaptations as young as possible. But even if your child is older, it’s never too late to reduce strain on their arm(s) and hand(s)!

The most important principle when choosing technology for your child is: as much as possible, adapt the technology to the child, not the other way around. 

Practice Makes Permanent

Most adults with upper limb differences with whom I have spoken report that they were given no accommodations when they learned to type. The same is true of most of the parents of children with ULDs. Those parents who report that their child’s school district offered an “adaptive strategy” for typing with a limb difference all mention the same plan: type the entire keyboard with whatever digits the child has, whether one hand or several digits on either hand.

Can children and adults type with one hand or even several fingers? Absolutely! Some can even type as fast as – or even faster – than two-handed typists! However, the standard layout is much too wide for one hand (especially a child’s) to type on safely for many years, even with a smaller keyboard.

The standard keyboard layout (known as “QWERTY”) was designed for two hands – although it wasn’t designed well for minimizing strain even on ten fingered folks. This is why so many “limb typical” people develop repetitive use injuries such as carpal tunnel syndrome from typing. According to ergonomic research, stretching the fingers to reach inconveniently placed high frequency letters greatly increases the risk of repetitive stress injury for the dominant hand.

So with our children, who may use as few as one or two or fingers, we want to be especially mindful of the wear and tear on the dominant hand, which does almost every other task as well. One-handed typists must type every key using just 4 fingers (the thumb really can’t type more than the space bar). Setting our children up for a lifetime of good bodily health typically requires making some technology accommodations. Because “practice makes permanent” and it is hard to relearn how to type, children with hand/arm differences benefit from learning how to type using an efficient and muscularly healthy motor plan right from the start. The best plan is to consider all of the available options and make the choice that seems best for your child.

Looking Different Can be Hard

But before we even start delving into adaptive technology options, it is important to acknowledge that some children may reject these options. Parents of children with ULD who do not share the difference with their children may feel frustrated or confused when their children reject adaptations that can reduce strain and improve body positioning. Your child’s stage of development and personality can and likely will affect their willingness to try adaptive equipment. It may help to keep in mind that our society rewards “fitting in”, and children who already experience negative attention from their difference may not want to increase the number of ways that they stand out.

For these reasons, introducing adaptations early in a child’s life as a normal part of how they are raised may make them more willing to adopt them. For all of these reasons, the best strategy for children who don’t want to look different may be a more typical computer set up at school and an adaptive set up at home. Of course if your child accepts and even welcomes these options, by all means encourage them to use them at school as well as home!

Adaptive Technology Options

Depending on what your child’s ULD is, there are multiple adaptive techology options to consider for your child, including:

• alternative keyboard layouts + keyboard stickers:
  • one-handed right- or left-handed Dvorak layout
  • two-handed Dvorak layout
  • custom layout
• external ergonomic mouse
• external keyboard
• adaptive accessories
• voice to text

We will explore these options in detail below with a summary of recommendations for the more common types of ULD.

Keyboard Layouts

Here is some background information on the two major keyboard layout options:

• QWERTY:
  The “QWERTY” typewriter layout gets its name from the letters on the left top row of a standard typewriter, which spells “QWERTYUIOP”. When typists used mechanical typewriters, keys would jam if they typed too fast. In the late 1860s, Christopher Sholes of Milwaukee designed a layout that would allow typists to type as fast as possible without jamming the keys by spreading out the high frequency letters across the keyboard. The QWERTY layout became standard for typewriters, and when computers arrived, the layout was transferred to computer keyboards. In the QWERTY system, only 32% of all keystrokes take place on the home row. Computer keyboard keys don’t jam the same way as typewriters once did, so using the QWERTY layout no longer makes much sense, particularly given the prevalence of repetitive use injuries.
  
• DVORAK:
  The “Dvorak” alternate keyboard layout purportedly is more “finger-friendly” than the standard QWERTY layout. August Dvorak invented this layout in 1932 based upon studies of language usage patterns and typing habits. In the Dvorak layout, keys are arranged so that most of the highest-frequency letters are located on the home row, which is the centered position for the fingers. The lowest-frequency keys are positioned farther away, so that typists extend their fingers less often, which significantly cuts down on finger strain. In the standard two-handed Dvorak system, 70% of all keystrokes take place on the home row (compared with 32% for QWERTY (as we saw above). Some proponents claim that the Dvorak layout reduces the incidence of repetitive use injuries.
  • One of the reasons that there has been little research to date on the potential benefits of the Dvorak layout is that most people already know the QWERTY layout. Here is a study that controlled for previous experience with QWERTY comparing speed for one-handed typing using a one-handed QWERTY and one-handed Dvorak layouts. It found that “a clinician working with clients who have lost, temporarily or long term, the use of one hand, would best serve their clients by encouraging them to learn an alternative keyboard layout. Because the layout is built-in to modern operating systems, the cost of provision is minimal, and the time to adapt the computer, and to switch between layouts is a matter of seconds.”
  • The Dvorak layouts are included as standard keyboard settings options on both Mac and Windows operating systems, making them easy to access, and it takes less than two minutes to configure your computer to use them.
  • The Dvorak system includes two ready-made layouts for one-handed typists. So if your child has a limb typical right or left hand, they can use the one-handed layout that corresponds to their hand. Take a look at the Dvorak layouts here.
  • You can purchase labels to cover the key names, which you can easily attach to a laptop or external keyboard.
  • This arrangement is particularly good if the child uses a single assigned laptop at school, so that the child can have the operating system configured to the Dvorak layout.

Mouse Use

Turning to the mouse, it’s important to distinguish between desktop and laptop computers. People typically use an external mouse on desktop computers while on laptops, a touchpad or trackpad is the built-in control for the screen cursor. Research on typically developing children using laptops in schools suggests that an external mouse may be ergonomically preferable to the trackpad on a laptop. However, historically computer mice haven’t had optimal biomechanical design, so frequent mouse use still can lead to strain and pain as people age. While pain or strain usually wouldn’t be so much of a concern for young children, it is more important to be mindful of how children with ULD use their dominant hand – whether or not that hand has a limb difference – because of the additional wear and tear on that limb. If at any point, your child develops overuse pain or strain on either side, it is important to take it seriously and pursue treatment (read about Overuse Syndrome). 

Research has shown that having acclimated to using a regular mouse, many people later are resistant to switching to an adaptive mouse. So introducing a mouse from a young age that works well is ideal, even if the child uses it inconsistently. Some children with ULD use the laptop touchpad or trackpad at school and an external mouse at home.

Depending on your child’s hands, it may be possible to operate the mouse with the affected hand(s), and there are multiple potential options worth considering for an external mouse, such as a small mouse, a vertical mouse, or a trackball. While there are few adaptive mouse options specifically designed for children, some have smaller versions. In order to prevent strain to your child’s arms/hands, it may be worth the hassle of potentially purchasing (and possibly returning) several mice to find a good match for your child’s hand size, range of motion, and personal preference. It also may be worth trying to find two comfortable mice, for example one for home and one for school, to alternate muscle usage in your child’s hands. 

Here are some options: 

• For younger children, miniature mice designed for children 3-7 years old should fit their hands better than larger mice
• For trackballs, many of the the most highly rated versions are for adults
• For vertical mice, there are options at various price points and some are designed for smaller hands
• The free printable copy of the Adaptive Tech Options for Children with Upper Limb Differences (ULD) handout(available at the top and bottom of this post) features a link to an Amazon list I’ve compiled of recommended adaptive technology options that include these mice

External Keyboards

In general, it is worth taking the time to find a keyboard that is comfortable for your child. While some children with ULD prefer the feel of shallow laptop keys, others find them uncomfortable. For children who find laptop keys uncomfortable, I recommend ordering several external keyboards with different depths of keys to find a good fit and returning whatever doesn’t work. When you download the free printable copy of Adaptive Tech Options for Children with Upper Limb Differences (ULD) (above), you will be able to access an Amazon list of recommended adaptive technology options. Here are some of the considerations to keep in mind:

• For children who type one-handed, a smaller external keyboard may cause less strain than on the laptop keyboard
• An 87-key keyboard (no number pad) allows an external mouse to sit closer to the body
• Some keyboards have macro keys that can be assigned to keystrokes that require typing multiple keys simultaneously
• Some children with two-sided limb differences may do better with a split keyboard, where the keyboard is split into two halves, with each arm/hand typing on one half
• Some one-handed typists find that tilting the keyboard makes typing more comfortable
  • A right-handed typist would tilt the bottom left edge of the keyboard down towards the body and the top right edge away from the body
  • A left-handed typist would tilt the bottom right edge of the keyboard down towards the body and the top left edge away from the body
• If your child uses an external keyboard, a simple adjustable laptop stand can ensure that the screen is at the right height for their eyes and encourage upright posture
• Your child may adamantly refuse to use an external keyboard at school but be willing at home; please see section below

Typing with One Hand

If your child has one full (or mostly full) hand available for typing, here are some specific recommendations:

• Two good free keyboard layout options are the left- and right-handed Dvorak layouts, especially if the laptops they use are assigned to them and/or have a dedicated home laptop
• Keyboard labels for whichever layout
• External mouse: ergonomic if possible, at home and possibly at school
• External keyboard: at home if they prefer

Typing with One Hand and a Partial Hand

If your child has use of both one limb typical hand and a partial arm or hand, or if there are some fingers on each hand, there are some additional considerations:

• The two-handed Dvorak layout may be most helpful, especially if your child is assigned their own school or home laptop (see section above), and keyboard labels for the layout
• In addition to the options above, a custom keyboard layout may best optimize their ability to use all their fingers
• Using the Microsoft Adaptive Accessories may enable the partial hand or arm to simplify keystrokes, for example, the Adaptive D-pad button enables a typist to assign “shift + ctrl + V = paste” to a button (see below under Accessible Accessories)
• External keyboards with programmable macro keys offer some of the same functionality

Typing with Two Partial Hands

If your child has one or several fingers on each hand available for typing, here are some specific recommendations:

• Consider the two-handed Dvorak layout, especially if your child is assigned their own school or home laptop (see section above), and keyboard labels for the layout
• External split keyboard (which has separate left and right sides) at home and possibly school
• External mouse: ergonomic if possible, at home and possibly at school

Typing without Hands

As for the previous sections, adaptations will depend on the length of the arm and presence of fingers. With short arms, an external split keyboard may be helpful, attached to a shelf that can rest close to the face to eliminate the need to bend over to reach the keys. Voice to text is a good option. Some individuals may be able to use their feet to type, but special care should be given to ensuring that the screen is enlarged since the keyboard may be at a distance from the body.

What About One-Handed Keyboards?

A number of specialized one-handed alternative keyboards are listed here or you can search for “one handed keyboard”. In addition to their high cost, for many of the them, your child needs to learn a keyboard layout that will not transfer to a standard keyboard. This makes them less generalizable.

Custom Keyboard Layouts

There are several keyboard mapping programs available for download that can be used for this purpose.

CAVEAT:

• It is important to note that unlike the Dvorak layouts above, a custom layout that you design with or for your child will NOT be included as one of the standard keyboard settings options on Mac and Windows operating systems. This means that this custom layout will need to be installed on the operating system every time your child switches computers.
• If it seems that using a custom layout is too risky, it may be worth considering whether it would be possible for the child to type on the one-handed Dvorak layout with the limb typical hand and control the mouse with the partial arm or hand.

My Typing Journey Story

Like my peers, I learned to type one-handed on the standard QWERTY layout when I was in the 7th grade. Many years later, after I had developed and then mostly healed from the worst of the overuse syndrome in my full hand and arm, I knew that I needed to switch to a more ergonomically designed keyboard layout. Since I have a thumb on my left hand, I also wanted my keyboard layout to enable me to type some low-frequency letters with my left thumb. When I was 30 and newly married, my tech-savvy husband used Microsoft Keyboard Layout Creator to create a custom layout that I modeled on the right-handed Dvorak layout. Here’s what my layout looks like:

Unfortunately, as of the time of this writing, the Microsoft keyboard tool does not work with Windows 11. When I upgraded to the latest Windows, my husband recreated the layout using EPKL. This tool is more difficult to use, but once the layout is created, it has some nice additional features, such as displaying an image of the layout on the screen and much easier portability between computers. If you do not feel so computer-savvy but do want to accommodate the partial hand, consider a visit to your local occupational therapist to help design an efficient individualized keyboard layout, and then to a computer guru to implement it – or schedule a virtual consultation with me.

Just like with the Dvorak one- or two-handed layouts, it can be very helpful to use keyboard labels to cover the key names with a custom layout. Another option is purchasing a keyboard that will allow you to move the keycaps. In particular, most mechanical keyboards will allow you to do this.

Accessible Accessories

Some children with a below-elbow partial arm or hand might benefit from using the Microsoft Adaptive Accessories, which is a family of customizable input devices. These input devices enable keyboard shortcuts, such as replacing “alt-ctrl-V” with a simple button press. These can be used on their own or in addition to an external mouse. One of the options is the Microsoft Adaptive Mouse, for which several free 3D printed designs are available.

Try Before You Buy

The federal government has funded Assistive Technology Centers (ATC) in each state which offer “try before you buy” free adaptive equipment loans. This can be especially helpful for children with upper limb differences that don’t as easily fall into the categories outlined above as one-handed or one-handed plus typists. Depending on where the ATCs are in relation to where you live, you may be able to try the equipment with your child in person. Most ATCs cover shipping for the adaptive equipment to and from houses. Click to find your state/territory ATC.

Voice to Text Options

Many children with ULD benefit from using voice to text, and ideally it should be incorporated in whatever technology accommodations they are using, simply to reduce the amount of written content they need to produce. But it is also important to understand that these programs make mistakes, so it typically is necessary to proof read and use a spell check application to catch errors.

In the early 1990s during my college years, I beta-tested DragonDictate, one of the earliest speech recognition software programs. I was experiencing terrible overuse in my dominant arm and couldn’t type without pain. At the time, the program was glitchy and it made many mistakes. Fortunately, voice to text has come a long way, especially in applications such as smartphones. Microsoft and Google have built-in options for texting and dictation for Google documents, for example.

Ergonomics

By now, you surely are familiar with ontheotherhand.org’s focus on promoting good health for children with hand differences. Which is why we have devoted so much space to considering keyboard and mouse design issues. But underlying these issues is an even more fundamental issue: “ergonomics”, otherwise known as good body positioning. For several years corporations seeking to reduce carpal tunnel syndrome and other repetitive strain injuries among employees have buzzed about ergonomics. But computer ergonomics for children is just beginning to be recognized as essential for instilling in children an awareness of how to take care of their bodies, thereby helping to prevent a whole host of body aches and nasty conditions. Remember once again that children learn habits from a young age, and that children with hand differences need to focus on how they are using their whole bodies, not just their arms.

For excellent general discussions of computer ergonomics for children, visit the Cornell University Ergonomics Website and the Oregon Occupational Safety and Health Division website for great tips on computer station set-up, good computer posture, and practicing good work habits. These sites also have “before and after” pictures of children’s workstations that have been modified to fit their needs.

Taking Breaks From Computer Use

Two elements of working safely at the computer are taking breaks and relaxing tired muscles. Please see a great site with visuals of exercises and stretches for fingers, hands, arms, shoulders, and neck. Try doing these with your child to encourage him/her.

Here’s a list of apps that remind you to take a stretch break.

Additional resources

Two excellent books offer more information about healthy computer use:

Comfort at Your Computer: Body Awareness Training for Pain-Free Computer Use by Paul Linden, published by Pub Group West. This book, written by a black belt in Aikido and Karate with a Ph.D. in Physical Education, covers efficient breathing, improving body awareness, and balancing the muscles of the body while using a computer. Available through amazon.com.

Stretching in the Office by Bob Anderson. This wonderful resource has drawings of stretches that are useful at home or in the office. Available through amazon.com.

Quick Links

• Left-, right-, and two-handed Dvorak layouts are relatively easy to configure on your computer
  
• Microsoft Keyboard Layout Creator enables users to to create a custom layout according to their specifications
  
• Keyboard labels are great for covering the key names for Dvorak or custom layouts

• There are several keyboards ergonomically designed for smaller hands. Download the free handout below for access to a list of recommended adaptive technology options

• A number of specialized one-handed alternative keyboards are listed here. In general, these are not the best options for one-handed children because they require learning a specialized layout that usually doesn’t transfer well to typical keyboards
  
• Microsoft has an Adaptive Accessories line of products that can supplement – or replace – other kinds of input devices like a mouse
  
• Find your state/territory Assistive Technology Center to try options for free

• Cornell University Ergonomics Website and Oregon Occupational Safety and Health Division both have great tips on computer station set-up, good computer posture, and practicing good work habits. These sites also have “before and after” pictures of children’s workstations that have been modified to fit their needs.

• Here is a site with visuals of exercises and stretches for fingers, hands, arms, shoulders, and neck after keyboarding. Try doing these with your child.
  
• Here is a list of apps that remind you to take a stretch break
  
• Two excellent books that can give you more information about healthy computer use are:
  • Comfort at Your Computer: Body Awareness Training for Pain-Free Computer Use by Paul Linden, published by Pub Group West, available through amazon.com
  • Stretching in the Office by Bob Anderson, available through amazon.com
    
• A previous version of this article suggested purchasing an inexpensive device called a mouse bridge, which could be helpful for some folks with upper limb differences. The mouse sits on this raised platform over the numeric keypad. This allows the mouse to be much closer to the resting hand position on the keyboard, thus reducing unnecessary strain on the shoulder when using the mouse. Although this device may be useful for two-handed typists, it is more important for a right-handed typist, who would rest their hand in the middle of the keyboard. However, it may be preferable to purchase a keyboard that doesn’t have a numeric keypad, such as one like the NPET G20 Compact Gaming Keyboard

Important Takeaways

• As much as possible, adapt the technology to the child, not the other way around
• Be aware that some children may reject adaptive tech options because they don’t want to look different at school; encourage use at home
• Because upper limb differences vary so much, it may take some time to devise a set up that maximizes your child’s skills and minimizes strain
• There currently is no research specifically on computer use and adaptations for children with ULD
• The standard keyboard is too wide for one hand (especially a child’s) to type on safely for a lifetime
• For one-handed typing, consider the right- or left-handed Dvorak layout, which is a standard keyboard settings option on Mac and Windows OS operating systems
• For two-handed typing, consider the two-handed Dvorak layout, also standard keyboard settings option on Mac and Windows OS operating systems
• Fingers should not hurt or ache from using a computer; remember that everything your child does over their day is cumulative
• For optimal ergonomics, if using an external mouse, you may want consider an external keyboard & simple laptop stand
• Some children with ULD find typing easier and/or more comfortable on an external keyboard than on the shallow keys of a laptop; some children use a standard laptop at school and an external keyboard at home to reduce strain
• A smaller external keyboard can be easier for one-handed typing and an 87-key keyboard (no number pad) allows the mouse to sit closer to the body
• In addition to their high cost, one-handed keyboards typically require learning a specialized keyboard layout that will not transfer to a standard keyboard, making them less generalizable.
• Research on typically developing children using laptops suggests that an external mouse may be ergonomically preferable to the trackpad on a laptop
• While there are few adaptive mouse options specifically designed for children, some do have smaller versions, such as vertical mice
• In order to prevent strain to your child’s arms/hands, it may be worth the hassle of potentially purchasing (and returning) several mice and external keyboards to find a good match for your child’s hand size, range of motion, and personal preference 
• Alternating between two comfortable mice, such as a track ball and vertical mouse, that use different muscles in your child’s hands/arms can decrease strain; for example, one for home and one for school
• Microsoft has an Adaptive Accessories line of products that can supplement – or replace – other kinds of input devices like a mouse; there are external keyboards with programmable macro keys that serve a similar function

Complete the form below to download a free printable copy of the Adaptive Tech Options for Children with Upper Limb Differences (ULD) handouts, featuring an overview page and a chart with adaptive tech options. You will receive two versions of the chart: digital (with hot links) and printable (less color, so less toner used!). Both handouts link to an Amazon list with recommended products; recommendations for products are for educational purposes only; we don’t endorse or profit from them.

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© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post Typing/Keyboarding with an Upper Limb Difference (or two!) appeared first on On The Other Hand.

Background
Before asking people about their differences …
Education is the key
Unkind/intrusive/demanding questions & statements
Invade privacy
Cause shame
Create a power difference
Questions often aren’t meant to be hurtful
Courteous/curious/kind/respectful questions & statements
Create connection
Encourage learning
Maintain peer equality
“No” is a complete answer
Their voice, their choice
Recommended reading
Questions to discuss with your child as you read
Download the free handout!

Complete the form below to download a free printable copy of Teaching Children How to Ask About Limb Differences!

Background

A parent recently asked me and other adults with upper limb differences: “Is there ever going to be a time when my child won’t be asked, ‘What happened to your hand/foot?’” 

One of the unexpected bright spots of the COVID shutdowns for me was that for almost 3 years, no one asked me about my hand! Although I didn’t go to new places for much of that time, I did meet many people on Zoom, where I was able to choose whether and when to disclose my hand to others. It was the first time in my life that I got to control when people found out about my hand – and it was incredibly freeing! 

Returning to the parent’s question from above – unfortunately, no, in real life we don’t get a break from the questions. But during the time when no one was asking about my hand difference, I pondered what I wish people knew before they asked. While we can’t control how people ask us about our limb differences, we can raise awareness in our communities about how we experience these questions.

Please share this blog post with anyone whom you think would benefit – friends, relatives, practitioners, etc. (keeping the original formatting and attribution)

Before asking people about their differences …

It’s important to teach children who do not have visible differences or disabilities and are old enough to understand that getting to get to know people first before asking personal questions is polite and respectful. People with limb differences are people just like everyone else; they do mostly the same things as everyone else, sometimes just in a different way or with different tools.

Education is the key

Children need to be taught how to ask questions and connect with people who have differences. Reading books about limb differences with your child can be a good first step. See below for some book recommendations.

So let’s dive into discussing two different kinds of questions and comments and their impacts on the person hearing them:

• Unkind/intrusive/demanding
• Courteous/curious/kind/respectful

Parents: most times, I really don’t mind answering questions from your children. But please after they have asked the same question 5+ times now would be a good time for you to kindly intervene and continue the learning/conversation at home

Gabriella Sanchez, parent of a child with a limb difference, @gab_riella25

Unkind/intrusive/demanding questions & comments

Children and adults sometimes ask questions and make comments that are unkind, intrusive, or demanding – and they can be difficult for a child with a difference or disability to hear. Like many other people with congenital limb differences, I have been asked all of the questions below (about hands) over my lifetime – some by children and some by adults. Let’s delve into these further.

Unkind/intrusive/demanding questions and comments have three consequences for children with limb differences, even if the person asking or commenting doesn’t mean to be hurtful:

1. invade privacy
2. cause shame
3. create a power difference

Invade privacy

Intrusive questions & comments put the person with a limb difference on the spot. For example, 

• did someone cut off your fingers?
• is your foot messed up too?
• your mother must have taken drugs when she was pregnant with you!

Cause shame

The person with a limb difference may feel deficient and embarrassed about their body when asked unkind questions or comments. For example, 

• hey you! you have no fingers/hand 
• your foot is so weird! 
• what’s wrong with you/your arm/your hand/your foot/your leg?

Create a power difference

The person with a limb difference may feel inferior, less than, or small when others make demanding questions and comments. For example, 

• let me see your hand/leg (said while the person grabs the different hand or leg) 
• you’ll never learn to ride a bicycle!

Questions often aren’t meant to be hurtful

Many children are curious but don’t know how to ask kind questions. For example, 

• kids can be impulsive and say the first thing that enters their mind 
• other children may script from video games or cartoons they watch

Courteous/curious/kind/respectful questions & comments

Children and adults should learn to ask questions and make comments that are courteous, curious, kind, and respectful because they: 

1. create connection
2. encourage learning
3. maintain peer equality

Here’s how to do that.

Create connection

The asker speaks to the child with a limb difference with warm curiosity. For example, 

• would you like to play together? 
• wow, your arm/leg is really cool! 
• do you like to … play games, ice skate, bake cookies, watch movies?

Encourage learning

The asker wants to learn how the child lives with their limb difference. For example, 

• does your hand/leg hurt?
• have you ever … done the monkey bars or gone on an amusement park ride?
• how do you jump with your prosthesis?

Maintain peer equality

The asker interacts with the child with a limb difference as an equal. For example, 

• is it ok if I hold your hand? 
• could you please show me how you … ride a bike, tie your shoelaces? 
• would you like help with that?

“No” is a complete answer

The person with a limb difference needs agency to say “no” to questions because… 

• they may not feel like talking about their difference at that moment
• they likely have answered the same questions many times
• it’s not their job to educate all the time

Their voice, their choice

The person with a limb difference needs agency to set boundaries on their responses because… 

• like all children, they probably prefer to keep playing, exploring, creating, etc.
• people can search online for information 
• educating others can be exhausting

Recommended reading

Many books are available at local public libraries and many book read alouds can found online. Here are some that depict interactions between children who do not have visible disabilities and child with limb differences:

• What Happened to You? by James Catchpole
• You’re So Amazing by James and Lucy Catchpole  
• Different is Awesome by Ryan Haack 
• She Kept Dancing by Sydney Mesher & Catherine Laudone
• Awesomely Emma: A Charley and Emma Story by Amy Webb

Questions to discuss with your child as you read: 

• how do others treat the child/adult with a limb difference?
• how do you think a child with a limb difference wants to be treated? 
• let’s name some feelings you might have if you had a limb difference
• what are some differences in the way the child/adult with a limb difference does things?
• what can you do to be kind to someone who is different from you? 
• what is a respectful way to ask questions of a child or adult with a limb difference?
• how are the children with limb differences the same/different as you? 

Complete the form below to download a free printable copy of Teaching Children How to Ask About Limb Differences!

Name Email

Name *

First

Last

Email *

By providing your email address, you agree to receive occasional email correspondence from On The Other Hand. Don’t worry: we will never share your email with any other entity and we will never spam you!

Download the free handout – Teaching Children How to Ask About Limb Differences

To see the original Instagram posts on Teaching Children How to Ask About Limb Differences, go to Part 1 and Part 2.

© 2026. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy. All rights reserved.

The post Teaching Children How to Ask About Limb Differences appeared first on On The Other Hand.