This section focuses on the practical, day-to-day aspects of supporting children with upper limb differences so they can move through the world with comfort, confidence, and capability.

The goal is not just participation, but sustainable participation — helping children do what they love while also protecting their long-term physical health.

Here you will find guidance on topics such as:

• Keeping hands and arms comfortable in different environments
• Building strength and endurance
• Supporting movement, exercise, and physical participation
• Adapting everyday routines in simple, effective ways

Each child is different. Take what is helpful, adapt what you need, and let your child’s interests and experiences guide you.

Quick links

👉 Winter Care for Partial Arms and Hands: Skin, Circulation, and Warmth
👉 Upper Body Strengthening Tools for Upper Limb Difference
👉 Exercise: Building a balanced body for children with hand & arm differences
👉 Life Stages

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

The post Start Here: Everyday Living Tips for Children with Upper Limb Differences appeared first on On The Other Hand.

Why partial arms and hands are more affected in winter
Preventing cracked skin
Handwashing and skin health
Managing cold extremities
Teaching children to protect their bodies
A lifelong skill
Learn more

Many families assume these issues are unavoidable, but fortunately they are not.

Why partial arms and hands are more affected in winter

ULD can be associated with circulation differences. Reduced circulation may contribute to colder extremities, slower skin healing, and increased sensitivity to temperature changes.

Body parts with reduced circulation often require proactive protection.

Preventing cracked skin

Consistent moisture is the foundation of winter skin care.

• Apply a thick lotion or ointment nightly to the partial arm or hand
• Use cotton gloves or soft sleeves overnight to seal in moisture
• Use liquid bandage to close painful skin cracks and reduce reopening during use

Many adults with ULD recall improvising solutions before products like liquid bandage existed. Thankfully, today we have safer and more effective options.

Handwashing and skin health

Winter often brings increased handwashing to prevent illness. While necessary, frequent washing strips natural oils from the skin.

A simple strategy helps: dermatologists recommend applying lotion immediately after washing while the skin is still slightly damp.

This single habit can significantly reduce cracking.

Managing cold extremities

Cold sensitivity is common in partial arms and hands.

Helpful strategies include:

• Microwavable stuffed animals or heat packs
• Warm layers that do not restrict movement
• Pre-warming before outdoor transitions

Always monitor temperature carefully, especially if sensation is reduced.

Teaching children to protect their bodies

As children grow, they may resist warm clothing for social reasons. This is a normal developmental stage.

Parents can help by explaining:

• The partial arm or hand may get colder faster
• It may be more vulnerable to frostbite
• Protection supports comfort and long-term health

When children understand the reason behind self care routines, their willingness to protect their skin may improve and they may even carry these habits into adulthood.

A lifelong skill

Winter care for upper limb differences is not just a childhood concern. Many adults report learning these strategies only after years of discomfort.

Early education supports comfort, participation, and long-term skin health across the lifespan.

Learn more

👉 How to Talk to Your Child about Limb Difference Overuse Syndrome
👉 Understanding Upper Limb Difference Overuse Syndrome
👉 The Overachiever Trap
👉 Typing/Keyboarding with an Upper Limb Difference (or two!)

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

The post Winter Care for Partial Arms and Hands: Skin, Circulation, and Warmth appeared first on On The Other Hand.

Introduction
Weighlifting Hooks
Active Hands Grip Aid
Loop Resistance Bands
Multi-Loop Stretch/Strength Strap
Hook-and-Loop Closure Wrist Weights
IRONWEAR® Hand Weights
Resistance Tubing with Handles
Final notes and transparency
References
Learn more

Introduction

Strengthening the upper body can be challenging for people with upper limb differences, especially when equipment is not designed with different anatomies in mind. Many families tell me they want to build strength safely, but they aren’t sure which tools to choose or how to adapt them.

This guide includes the tools I use in my own workouts with a partial hand. I have included products that are appropriate for children, teens, and adults.

Important note

Every body is unique. A tool that works well for one person may need to be modified for someone else. Trial-and-error is normal, and it’s okay if you adjust, or customize tools.

This guide is educational only and not medical advice. Always check with a clinician before starting new exercise routines.

1. Weightlifting Hooks

What they are:
Hooks that attach to the wrist and wrap around a bar to assist with pulling movements

Why they’re helpful:

• Reduce reliance on grip strength
• Great for rows, pull-downs, and deadlifts
• Work well for partial hand differences and other grip-related challenges

Use cases:
(Teens & adults) Gym workouts, cable machines, barbell exercises

Link:
👉 Weight Lifting Hooks

2. Active Hands Grip Aid (Adapted Version)

What it is:
A strap system that secures the hand around a handle (must have a wrist to use this version). I adapted mine to fit my hand more comfortably.

Why it’s helpful:

• Excellent for light dumbbells and cable & machine handles

Use cases:
(Teens & adults) Dumbbells, cable & machine handles

Link:
👉 Active Hands Limb Difference Aid
Note: I modified the product to improve the fit for my partial hand

3. Loop Resistance Bands

What they are:
Closed-loop elastic bands great for warm-ups and strengthening

Why they’re helpful:

• Inexpensive
• Loop enables easy on/off and reduces need to grip
• Excellent for gentle shoulder and upper-back strengthening
• Great for home workouts for children or adults

Use cases:
(Children, teens, & adults) At-home programs, warm-ups, low-resistance strengthening

Link:
👉 Mini Band Resistance Loop | also typically available at FiveBelow stores

5. Hook-and-Loop Closure Wrist Weights

What it is:
Weights that can be fastened to wrists or arm

Why it’s helpful:

• Inexpensive
• Adjustable weight models offer flexibility (shown in photo)
• Comfortable options available
• No need to grip weights because of hook-and-loop closure

Use cases:
(Children, teens, & adults) At-home programs, warm-ups, low-weight resistance strengthening

Link:
👉 Weights for Women, Men, and Kids – note that this link is for non-adjustable weights; they’re often sold as ankle/wrist weights, so check the length because they may be too large for small wrists

6. IRONWEAR® Hand Weights

What it is:
Weights that can be fastened directly to hand (need a wrist)

Why it’s helpful:

• Pricey but durable
• Allows partial hand to hold weight
• Easy on/off with hook-and-loop straps
• Multiple weight options

Use cases:
(Children, teens, & adults) At-home programs, warm-ups, low-weight resistance strengthening

Link:
👉 Knuckle Irons™ (Champion Series) – 1/2 pound each (1 pound pair) or 1 pound each (2 pound pair); could be used for 6-9 year old children

👉 Hand Irons™ Champion Series – 2 lb. to 7 lb. each; also an adjustable option; great for ages 10+

Note: Reebok® no longer sells IRONWEAR® weights

Coming Soon:

How I modify adaptive equipment: what I change and why
I often need to adjust tools (yes, even adaptive ones) to work for my partial hand. I’ll share exactly how I modify:

• Active Hands grip aid
• Household items
• Exercise straps
  …including easy ways families can safely customize equipment at home

Final Notes and Transparency

I do not receive commissions or kick-backs for any of the products mentioned here. Some companies occasionally send items for me to try.

References

Long, C., Ranellone, S., & Welch, M. (2024). Strength and conditioning in the young athlete for long-term athletic development. HSS Journal: The Musculoskeletal Journal of Hospital for Special Surgery, 20(3), 444–449. https://doi.org/10.1177/15563316241248445

Learn More

👉 Check out “How to think like an OT”: how we engage in and adapt everyday activities with upper limb differences
👉 Explore Typing/Keyboarding with an Upper Limb Difference (or two!)
👉 Read Start Here: Overuse Syndrome in Upper Limb Differences

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

The post Upper Body Strengthening Tools for Upper 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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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!

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!

Name Email

Name *

First

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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!

© 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.

Introduction

This is my story, and it certainly does not apply to all children (or adults!) with limb differences. In fact, your child likely has a very different personality. But in talking with many adults with limb differences, I have met a shocking number who match this personality profile. Coincidence? Unclear. I would be delighted to hear from anyone out there for whom this resonates.

Taking Advantage of Opportunities

Most parents want their children to have every opportunity to develop their capacities to the fullest extent possible. Parents especially want to give their children opportunities that were not available to them when they were children themselves: playing a musical instrument, going to sleep-away camp, traveling to Europe. Usually, parents want to share these experiences with their children because they build character, help to make them “well-rounded,” forge bonds that last a lifetime – or all of these.

Parents of children with limb differences are no different in wanting opportunities for their kids. But they often worry that their children’s differences will prevent them from taking advantage of the same experiences as other children. These parents often try extra-hard to make sure that their children take full advantage of opportunities to improve their innate capacities so that they are as bright and fulfilled as possible.

Fulfilling one’s potential is wonderful. Extra pressure upon a child to achieve because of parents’ fears is not.

Overriding Limitations

All children have limitations. Some children prefer sports to music or math to writing. When “normal” children reveal a skill or deficit in a certain area, their experience is validated. A boy’s parents may tell a friend, “Oh, Johnny decided not to join the swim team because swimming isn’t his forte; he much prefers playing chess with his sister and his friends.” A parent of a child with an difference, however, may fear that the difference has shaped his preference. So instead of letting the child gravitate towards something he prefers and away from something he dislikes, the parents may unwittingly encourage him to “stick with it” – to prove to himself that he can.

Proving Self-Worth

Children with physical limitations subconsciously are aware of their physical limitation long before they ever “know” about it consciously. Children with disabilities often put pressure upon themselves to prove their self worth, to themselves, to their peers, and to their teachers. Without anyone instructing them to do so – in fact, without anyone particularly noticing – these children may internalize a self-diminishing message about themselves from a very young age: “I have this body part that is different and people automatically think that I am unable to do things (e.g. ride a bicycle, tie my sneakers, dress myself) as well as they can. I’ll show them. I can do those things just as well.”

In the process of trying to prove that she is “equal” to other children, the child may actually strive to be “better” than them. She thinks to herself, “Sarah can make jewelry. She says I can’t do that. I’ll show her. I’ll do it better than she can. Then she’ll be impressed.” Ironically, where the child is only trying to be “normal,” she instead becomes an overachiever. To measure a child’s worth by her achievements encourages her to measure herself in those terms. The child hopes to prove that she is “normal” by overcoming her physical limitations. In fact, from an early age, children who are wired this way develop incredible determination, strength, and willpower that enabled them to master tasks independently that even “normal” children find challenging. Each achievement may provide some temporary gratification, but only as a stepping stone to the next, bigger achievement. The moment the child ceases to achieve, the child may again doubt her competence.

The child’s parents, who may find themselves frequently defending their child’s capacities in the face of their peers’ questions, may also feel the need to prove their child’s worth to others. “My Betty, you know what she did? She was the first one in her kindergarten class to zip her jacket – all by herself!!” Unfortunately, while Betty’s parents are ecstatic that their daughter is able to dress herself independently with two fingers on her hand, they may unwittingly reinforce feelings of inadequacy in their child. Long after the child has proved herself to her parents, she may continue to prove her competence to herself.

Trying to Earn Love

Children rarely question our expectations; instead, they question their personal adequacy.

Your Child’s Self-Esteem: Step-by-Step Guide for Raising Responsible, Productive, Happy Children, by Dorothy Corkille Briggs, 1975

Children are very sensitive, intelligent beings who pick up a great deal of information about and from their surroundings. Children with physical differences often are especially attuned to reading subtle cues, such as whether anyone is looking at them or talking about them. In addition, they bear an unfortunate burden of knowing that they are not the perfect children that their parents dreamed of and prayed for (even if their parents tell them frequently that they are perfect just the way they are, it can be difficult for a child to hold onto to that once they go out into the world). Not that their parents don’t love them. Just that if their parents could have had a “normal” child, it stands to reason that many parents would have chosen that if given the chance – if only to save their child from unnecessary difficulties. So many of these children develop a barometer that measures how loved they feel.

For example, a child – let’s call her Alice – develops a pattern of behavior in which she tries to “be good” to ensure her parents’ love. She knows that she can’t change the circumstances of her birth or her difference, both of which have affected her parents profoundly. Instead, she decides to be the best child that she can be. She tries to please her parents however possible, by being helpful, cheery, or at least not causing them more difficulties, as her hand/arm condition has already created so much trouble. When her parents congratulate her on her good behavior, her helpfulness, or her constant positive attitude, they reinforce those behaviors. When Alice arrives at school, she instinctually transfers this behavior toward her preschool and kindergarten teachers. Again, the internal message that Alice carries is: “If I didn’t have this hand/arm thing, it would be so much less trouble for everyone. So I’ll try to hide it and not draw a lot of attention to it, and at the same time I’ll be really good and friendly so that people will like me.”

“Just Like Everyone Else”

Once at school, a conflict arises. The child – this time let’s call him Billy – wants desperately to be accepted, so he hides his hand/arm difference to avoid questions and stares. To be “just like everyone else,” Billy needs to participate in all of the activities in which his peers engage. But when he participates, some activities may be difficult for him, like art projects that require the functional use of two hands. Wanting to appear normal, Billy tries extra hard to accomplish tasks independently, because asking for help draws unwanted attention to his hand and reinforces that he has limitations. Often he is successful, adopting a creative problem-solving approach.

When he is not successful, Billy tells himself not to cry or admit to failure, but to just try harder next time. He handles these struggles silently, as he has no peers who share the same frustrations and challenges. Over time and without any instruction, Billy, like many children with physical limitations, learns how to use his asymmetrical body in amazing ways to accomplish the most challenging of tasks.

Dependence on External Validation

Billy earns a lot of praise and recognition for pushing himself beyond his natural limitations – from his parents, other relatives and family, and his community. But the irony is that this only draws more attention to the difference. When a “normal” child excels at football, his community lauds him for his prowess as a wide receiver. When a boy with no hands does the same, the newspaper blasts the headline “Handless Boy – Football Wonder!” Contrary to dispelling the child’s feelings of inadequacy, this process instead exacerbates them. The child cannot think of himself in terms of his success alone, but instead in terms of his success despite his limitations.

Moreover, the child begins to depend upon external validation to give him a sense of self. When he achieves and succeeds, he receives great praise, which feels good. So he seeks more, investing a good deal of energy in impressing the people in his environment. But what is happening to the child inside? Does he feel special and talented when he’s not in the limelight?

Stages

The process typically follows these stages:

• The child wants to be “normal” by not having others notice her difference. This in part means drawing attention away from herself, so she can blend in with other children.
• The child also wants to be “normal” by overcoming any limitations imposed by her difference.
• To prove that she is not limited, the child feels pressured to overachieve.
• Once she has overachieved, she gains recognition for her successes. The recognition is generally in the form of, “Look at what Megan has achieved, despite missing four fingers on her left hand!”

Athletics and Music

I have noticed that the Overachiever Trap often manifests itself in the form of competitive athletics and music performance; a strange phenomenon, since these are two of the most physically challenging activities for anyone, with or without a hand/arm difference. Both of these extracurricular activities require hours of physically-demanding practice to achieve success. Parents, teachers, and coaches swell with pride when the child with one “normal” hand excels as a trumpet player or baseball pitcher. Mastering these skills provides definitive proof that the child suffers no ill effects from the difference – right? But have these children chosen sports and music as outlets for their creativity, or are they, indeed, trying to “prove” that they can do what their peers can do?

Cultural Expectations

The Overachiever Trap is not solely the result of parents’ high expectations and childens’ feelings of inadequacy. Our culture places a large premium on overcoming obstacles, whether socioeconomic, racial, or physical. As a young child, a boy with a hand/arm difference can expect to be deluged with stories of the one-handed Tennis Wonder. If this boy is not naturally gifted in tennis, he is then more likely to feel demoralized by his limitations. If the boy does succeed, the newspapers will compare him to other one-handed sensations who have preceded him. When he applies for college, he will be rewarded by writing an essay on how he has overcome adversity. Are these comparisons helpful to the child, or do they remind him, yet again, that there is something that he needs to prove to others?

“You Need to Work Extra Hard”

Parents may encourage their daughter to surmount any obstacle because they anticipate that she will be disadvantaged by her difference. They may try to teach her that through perseverance and hard work, all things are possible.

On the one hand, most people would agree that perseverance and hard work are desirable traits in young people, and that parents who successfully instill these traits are praiseworthy.

On the other hand, there can be unintended consequences if the child internalizes these messages: “You need to work extra hard – more than everyone else – because the odds are stacked against you. Of course it’s not your fault; nonetheless, if you want to succeed in life, you will need to make things happen.” All children need to learn to draw boundaries. They eventually need to learn to ask themselves – not others – “How hard should I work for this? If I still can’t do it – is it okay to stop?”

The other downside to the “all things are possible if you work hard enough” message is that sometimes the costs of pushing oneself beyond reason are too great. We all know friends who were able to push themselves to pull an all-nighter to study for a college final exam and others who would try, but just couldn’t make it through the night. Did the latter folks not try hard enough? Did they care less? Or had they learned to respect the limits of their bodies?

The Parents’ Role

How can parents avoid their children falling into the overachiever trap? Shouldn’t parents encourage their children to express their natural talents? Isn’t it good for children who face differences to develop determination and willpower?

On the one hand, it is a parent’s responsibility to expose children to a wide variety of experiences and be their source of support in attempting even those activities that may appear to be challenging or difficult. Trying and succeeding at new and more challenging tasks builds children’s competence and self-esteem. This may be even more important for children who are naturally shy and hesitant than for children who are extroverted and outgoing.

On the other hand, development of the child’s sense of self-esteem and self confidence is ultimately more important than proving self-worth. Parents can help in this process by gently probing their children’s choices non-judgmentally. Here are some examples:

• Let’s talk about why you want to take tennis lessons
• Are you curious about learning to play tennis?
• Does it look like a fun game?
• Are your friends taking tennis lessons?
• Do they talk about playing tennis when you get together with them?
• Do you ever feel excluded?
• Would taking tennis lessons with your friends allow you to feel part of the group?
• Let’s think about how that will work for your body …

Almost every religious path emphasizes that children are lovable human beings simply because they have a soul and bear any number of aspects of the divine. Helping your child to learn to define herself apart from external measures of her worth is important for all children and especially important for children with limb differences.

Recap: What Can Parents’ Do?

• Starts with awareness about this issue
• Take your child’s personality into account – do they need push or to hold back from diving into everything?
• Start conversations with your child from a young age, probing choices non-judgmentally so you understand their motivation for various pursuits (see question examples above)
• Look at the limb differences books with a critical eye – are they reinforcing the “You need to work extra hard – more than everyone else” message?
• Role model asking for help
• Narrate aloud your thought processes about your choices to engage vs. refrain; e.g. “Daddy was invited to join the school PTO but he decided not to do that right now because he wants to spend time with us and take care of his body by going to the gym”

Quick Links

👉 Learn how to prevent, reduce, & treat Overuse Syndrome – and download the free infographic handout!
👉 Learn how to set you or your child or client up for Typing & Technology success – and download the free handout!

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

The post The Overachiever Trap 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!

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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.

Playing sports
An athletic child is NOT necessarily a muscularly-balanced child
Imbalance & assymmetry in upper body musculature
Developing balance & symmetry
But my child already uses their “different” hand/arm!
Trunk stability and balance
Shoulder stability
Choosing a sport
Yoga
Learn more

Playing sports

Loads of children with hand/arm differences participate in athletics and sports, whether individually or on a team. Playing a sport can improve self-confidence and self-image, provide a fantastic outlet for energy, strengthen the body, and be a great avenue for meeting other great kids like your child – among many other great reasons for playing a sport. Luckily, there are many athletic activities that children with hand/arm differences can participate in without having to make any accommodations at all, as well as others which require significant adjustments. In the first category are sports like soccer, swimming, volleyball, rollerblading, ice skating, gymnastics, martial arts, and track and field. In the second category are sports that involve using the hands to grasp, such as baseball, skiing, tennis, field hockey, lacrosse, or football. Of course, if goalies in soccer and gymnasts who do handstands of course use their hands and arms quite a lot!

I still can remember how my 7th grade gym teacher wanted me to be able to participate in field hockey so badly that he sawed off about a foot of an old field hockey stick so that I could hold it with just my (unaffected) right hand. I was still awful at the game, but every once in a while I made a decent hit! I wound up finding my niche as a varsity distance runner on the cross-country and track teams (I ran the 1 and 2 mile) in my high school years instead. But thankfully there are now many accomplished athletes with hand and arm differences who are truly amazing at sports that require a lot of hand use. They have learned how to hold a baseball glove with their “little” hand, or they ski without poles (like I did), or they hold a tennis racquet with just one hand – the possibilities are endless. The bottom line is that children who want to play a sport, for any reason at all, should be encouraged to do just that, of course with support, mentoring, and whatever adaptations are needed.

An athletic child is NOT necessarily a muscularly balanced child

Congenital upper limb differences can cause imbalance and assymmetry in the muscles of the upper body. This can be exacerbated when children with upper limb differences try to play sports without looking different or making adaptations. Some parts of their bodies may be strong, but if a physical or occupational therapist or physician looks carefully, they may notice more than the different hand or arm. They may notice that the musculature of the upper body on the side of the body with the hand/arm difference is underdeveloped: the trunk, the shoulders, the upper arm, and the forearm usually are smaller from less use.

Imbalance & assymmetry in upper body musculature

When the limb difference affects the right hand or arm, often the whole right upper body is affected, and the same often is true when the limb difference affects the left hand or arm. Having two upper body limb differences can affect the entire upper body’s development. When left uncorrected, the body is more vulnerable to developing overuse syndrome and overcompensation patterns that can lead to considerable pain, weakness, and restriction in muscles as the person ages. Once overuse syndrome has developed, rehabilitation can be lengthy and costly. The effects from the muscle imbalance can begin to appear when children are school age; others begin to notice the effects when they reach their teenage or college years, or even later when they begin working full time or caring for children of their own.

While this may all sound like doom and gloom, the amazing fact is that overuse conditions are about 99% preventable. Please read on for some important suggestions for helping yourself and/or your children to develop a healthy, strong, and balanced body that can serve you (and/or them) for life.

Developing balance & symmetry

What parents and even well-intentioned therapists and physicians who work with kids with hand/arm differences frequently overlook is that the single-most important predictor of a child’s overall functional ability is how they use their body as a whole, not just how they use their unaffected or even their limb different side. So many times, parents worry about whether their children with limb differences will have friends, be able to tie their own shoelaces, and generally do things like their “normal” peers. Children often internalize a desire to prove that they can, in fact, do the things that their “normal” peers can do. As a result, children with limb differenceus tend not to focus on whether they are developing balanced musculature in their upper body. It falls to parents to explain to their children why it is important for everyone to pay close attention to how they use their body and how stretching and strengthening can help to create balance. It is important to remember that an athletic child is not necessarily a muscularly-balanced child!

Here are some ways that your child can build a strong, balanced body:

• Encourage symmetry by involving the limb difference side as much as possible in every day activities such as opening doors, turning on faucets, eating, brushing teeth, and carrying items
• Educate yourself about good posture, particularly when using techonology such as laptops, tablets, and phones
• Seek professional help from an OT who works with children with upper limb differences
• Listen to your child if they complain about pain in either the dominant or affected side

But my child already uses their “different” hand/arm!

Without particular prompting, children with hand/arm differences usually will begin to use their different hand/arm as their “helping” hand from a young age, just like their peers who use their non-dominant hand to grasp, stabilize, and position objects. Obviously, the nature of the child’s hand/arm difference will affect their ability to grasp, stabilize, and position objects. A child who is able to make their fingers meet (regardless of how many fingers there are) will be able to grasp items with their different hand more than a child whose fingers don’t “oppose.”

However, while children with hand/arm differences usually are able to manipulate some objects with their different hand, somtimes grasping, lifting, and carrying heavy, bulky, or large-handled items is particularly challenging. So opening doors, carrying a 2 liter bottle of soda, or swinging a tennis racquet can be rather difficult with the different hand. It is the large muscles of the shoulder complex, trunk, and back that assist with those movements, including the rhomboids, trapezius, latissimus dorsi, deltoids, biceps, triceps, and pectoralis major and minor. Without performing the tasks that involve those large muscles groups, the muscles of the shoulder complex, trunk, and back often remain underdeveloped and underused.

So children with hand/arm differences who can grasp and especially those who can’t grasp with their different hands may benefit from giving some extra attention to strengthening these large muscles. They can do this pretty much the same way that limb typical children strengthen their trunk and shoulder muscles: by spending time bearing weight on their arms and hands. Read on for activities that you can try with your children at home to develop trunk and shoulder stability and balance.

Here’s a suggestion: Have your child who has a congenital hand difference and one of her/his friends who is about the same age as your child each put on their bathing suit. Then stand the two children next to each other and look at their backs. What do you notice? You probably will notice that the side of the back where the arm of the affected hand/arm attaches is underdeveloped compared to the side of the back with the “normal” hand. Now look at the other child’s back, and you probably will notice that the child’s back looks fairly symmetrical. Then take a picture of your child from the back to show the child’s occupational therapist or physical therapist to explain the difference in musculature. If you would like to contribute to this site, you could email me the picture of your child so that I can post it to this page. You could also ask the permission of the parents of your child’s friend so that both children could be represented.

Trunk Stability and Balance

All children need to develop trunk stability (also known as “core strength”), as a foundation for performing lots of different activities, including sitting upright at a desk, playing a sport or a musical instrument, and doing arts and crafts. Children with congenital hand differences especially need to develop trunk stability to lessen the heavy toll that using the one typical hand/arm takes on the body. Children with poor trunk stability fatigue quickly when using their hands and begin to overcompensate for their weakness by recruiting other muscles that aren’t the prime movers for a particular activity. Bearing weight on hands and arms, such as positioning in tummy-down on the floor, strengthens the trunk and the muscles of the arm.

Try these activities:

• Tummy-down position for almost anything! Encourage your child to lie tummy down for 20 – 30 minutes each day, to do puzzles, read, color with crayons, etc.
• Animal Walks: slither like a snake on the floor using arms only. Crab walk and wheelbarrow walk.
• Try different body positions while playing board games or doing puzzles, such as side sitting, legs criss- crossed, kneeling, and standing on one foot.
• Balance activities, such as walking on curbs/beam with arms extended to the side.
• Maneuver a scooter board in tummy down position or crawl on all 4’s like animals around an obstacle course of plastic cones, laundry detergent jugs filled with sand, or stacks of books. Make it fun!
• Sit on a peanut or therapy ball and practice sitting balance while playing balloon volleyball. Reach for items on the floor or nearby table, by shifting body weight without losing balance.
• On verbal command (such as “go” or “get ready … jump!” or count to 3), jump up from the floor or down from a step or higher surface at least ten times each day. This helps the child to develop his reflexes, incorporate the concept of starting and stopping a movement, and build strength.

Shoulder Stability

For the hands to be able to manipulate objects, all parts of the arm must develop stability, starting with the shoulder complex. The limb typical side will develop stability more naturally than the limb different one. To promote symmetry in the two sides of the upper body, encourage your child to incorporate both hands/arms when performing the following activities that strengthen the shoulder and give it stability:

• Balloon volleyball (you can use a light weight ball instead) or Zoom Ball.
• Engage in activities with vertical surface at shoulder height. Fingerpaint or place stickers/colorforms/magnets on vertical surface (mirror, window, chalkboard, easel, or bathroom tile). Cue the child to use helping hand to stabilize picture.
• Use shaving cream on the wall of the bathtub.
• “Donkey Kicks”: while on all 4s (quadruped or table position), shift weight forward onto palms and kick legs behind or side to side.
• Flatten play dough, clay, or silly putty, using the palm of the hand or a rolling pin on a flat table surface. Hands should be open on the pin rather than holding the handles.
• Vertically position toys by fastening to a wall, setting in a chalk rail or on the edge of an easel, such as pegboards, Etch-A-Sketch®, magnetic tray for magnet play, etc.

Choosing a sport

When your child is ready to begin playing a sport, your family should sit down and discuss the pros and cons of those that interest your child. You may want to encourage your child to try a sport like running, which emphasizes leg strength over arm coordination and strength. Some sports that develop musculature on the two sides of the body (left or right) and the two halves of the body (upper or lower body) evenly are swimming, some kinds of martial arts, weight lifting, yoga, and pilates. Should your child still choose to play sports such as tennis or basketball, you want to be sure that the child and the coach appreciate the fact that when training and in practice, focusing on whole-body conditioning that emphasizes balance and development of symmetry is very important.

Yoga

Yoga is an ancient art that focuses on balance and strength in the body through “asanas” or postures. Yoga can help your child to develop body awareness, flexibility, and muscle tone. In many sports, one side (left or right) or one half (upper or lower body) of the body predominates. For example, in tennis, soccer, baseball, and basketball, one arm or leg is most active, meaning that the muscles of the body are not used evenly. In contrast, yoga emphasizes strengthening and exercising both sides of the body equally. Also, yoga is different from other sports in that it is non-competitive, relaxing, and emphasizes integrating mind and body.

You can introduce your child to yoga at home through YouTube videos created by yoga teachers with upper limb differences.

Check out these upper limb different yoga teachers:

• Adapting Yoga: Accessible/Office Wellness Workshops with Melanie Waldman
• Adapting Together: Wellness events for women with limb-differences, including yoga retreats, run by:
  • Allie Redshaw @allie_redshaw
  • Sarah Belanger @adventure_bel
  • Madisyn Taute @madisyn.taute

Check out these upper limb different yoga YouTube videos:

• How Do You Do Yoga With an Upper Limb Difference? | Reach Charity – Yoga teacher Kim Hughes shares how she uses props to adapt poses
• Melanie Waldman Adaptive Yoga Forearm Balance – quick video of a forearm balance preparation sequence

If your child wants to try a yoga class, check listings of your local yoga studios, community centers, and parks and recreation departments. Many of these now offer yoga classes specifically geared for children.

Learn more

👉 5 Habits to Reduce Overuse Risk
👉 Understanding Upper Limb Difference Overuse Syndrome
👉 The Overachiever Trap

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

The post Exercise appeared first on On The Other Hand.