Exercise

Building a Balanced Body for Children with Hand & Arm Differences

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

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!

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 videos or books. Since there are many on the market now, visiting your local library may save you some money and allow your child to choose one that appeals to him. Yoga Kids is a 30 minute video geared for children ages 3-6 by yoga teacher Marsha Wenig, who promotes self-esteem while developing healthy, strong, and flexible bodies. Also check your local library or bookstore for a picture-filled book on yoga, like Yoga for Children by Mary Stewart and Kathy Phillips or I Can’t Believe It’s Yoga for Kids! by Lisa Trivell.

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. You can also check out these sites to learn more about yoga for children:
http://www.yogamovement.com/resources/kidyoga.html
http://www.yogaconnection.com/kidyoga.htm
http://www.childrensyoga.com/

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