Typing/Keyboarding for Kids, Teens, and Adults with Hand/Arm Differences

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.

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 S yndrome).

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:

My custom keyboard layout,
designed for right hand and left thumb

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

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