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

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

Background
Practice Makes Permanent
Mischievous “Motor-Memory”
Mouse Use
Dvorak vs. QWERTY Keyboard Layouts
What keyboarding options are available for children with hand differences?
Should children with hand/arm differences use an alternative layout?
Ergonomics
Taking breaks from computer use
Additional resources
Quick Summary on Keyboarding/Typing: links from this article
Important Takeaways

Complete the form below to download a free printable copy of Adaptive Tech Options for Children with Upper Limb Differences (ULD)

Background

While there is now a body of research on children using computers, unfortunately I am not aware of research specifically on computer use and adaptations for children with ULD. So what follows are recommendations based on my personal experience, the experience of families and adults with whom I’ve worked, and research involving typically developing children. 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. 

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 will focus on laptops. But please note that much of the following also applies to home desktop use, which has the advantage of being more configurable. 

Practice Makes Permanent

It used to be that children learned how to type on a typewriter in a formal typing class in the 7th or 8th grade. Now, children often begin to play on a computer keyboard almost as soon as they can point a finger. While many kids still take typing classes in their middle and high school years, by that time they have already typed hundreds (maybe thousands) of emails and other stuff. In so doing, many of them have adapted their keystrokes to typing on the standard “QWERTY” keyboard layout that they find at school, home, and library computers. At a minimum, many of them already have developed the good old “hunt and peck” strategy for typing at the computer keyboard using anywhere from 2 to 10 fingers (index fingers on up).

The problem, or potential problem, with this scenario is that “practice makes permanent,” as the saying goes among occupational therapists. Many children who learn to type on their own without formal instruction set “motor-memory” patterns that are difficult, if not impossible, to undo later. To provide an illustration of the role that “motor-memory” plays both in performing and learning familiar and novel tasks, grab a sneaker with laces and read on.

Mischievous “Motor-Memory”

So let’s explore an example of what I call mischievous “motor-memory.” I bet that if I were to ask you to tie your shoelaces with your eyes closed, you could do it, really easily. Your fingers have a “motor-memory” for tying shoelaces, following some pattern that you learned when you were little. This pattern is called a “motor plan.”

Now, suppose that I asked you to try tying your shoelaces with a slight variation – reversing the roles of the left and right hands. You’d probably notice that your fingers seemed like they were moving through peanut butter, way more clumsy and awkward than usual. If you were to continue tying your shoelaces like that for the rest of your life, you would need to think through that motor plan each time you tied your shoelaces until that new pattern had become rote like before.

Learning how to do something unfamiliar that requires a complicated motor plan is tough enough, but re-learning the motor plan for an activity that you already know how to do is even more difficult. In the first instance, you are learning through repetition until it “clicks.” In the second instance, you’re doing all that and also trying not to do it the way you had before.

What does this have to do with children with hand differences typing on a computer keyboard? The problem is that these children are at greater risk of developing overuse syndromes if they don’t learn balanced motor plans.

Human beings developed bilateral hand use for a reason: you have a ready-made backup, should anything happen to one arm. When you have a hand or arm difference, you’re already on your back-up. You don’t have much leeway. Children with hand/arm differences would benefit from learning how to type using an efficient and muscularly healthy motor plan right from the start. Since they already are at heightened risk for developing overuse and overcompensation syndromes due to the muscle and usage imbalances that are characteristic of their different anatomy, learning good typing hygiene is essential. They don’t have the luxury of misusing their bodies!

As a parent, you have the opportunity to help your child with a hand difference learn how to navigate the computer keyboard layout safely, to avoid having to re-learn it later. All of us know that if it’s too hard to re-learn something, we stick with the more familiar routine, even if we jeopardize our health sometime down the line. Overuse syndromes don’t develop overnight, just as tooth decay and cavities aren’t the result of one missed night of brushing teeth. The habits that children set when they are young catch up to them when they are adults. You are the most important player in helping your child to avoid developing a nasty, painful overuse syndrome by explaining to him why his typing hygiene is important and assisting him in making good choices about his posture and typing habits.

Mouse Use

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

Research has shown that having acclimated to using a regular mouse, many people later are resistant to switching to an adaptive mouse. So introducing a mouse from a young age that works well is ideal – except almost no adaptive mice are designed for children!

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 or vertical mouse or trackball. While there are few adaptive mouse options specifically designed for children, some do 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 a small regular mouse, the elec Space Mini Small Wireless Mouse is designed for children 3-7 years old
  • For trackballs, the most highly rated are by Kensington and Logitech, but these versions are for adults
  • For vertical mice, there are options at various price points; Logitech Lift Vertical Ergonomic Mouse is designed for smaller hands

Some children with ULD might benefit from using the Microsoft Adaptive Accessories, which is a family of customizable input devices. One of the options is the Microsoft Adaptive Mouse, for which several free 3D printed designs are available

Dvorak vs. QWERTY Keyboard Layouts

You may know that when typists used to use 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. The “QWERTY” typerwriter layout gets its name from the letters of the top row of a standard typewriter, which spells QWERTYUIOP. The QWERTY layout became standard for typewriters, and when computers arrived, the layout remained. The problem is that computers don’t jam the same way as typewriters once did, so using the QWERTY layout no longer makes much sense. And with the rise of repetitive use injuries, many people are looking for alternatives to the QWERTY system, which allegedly contributes to their incidence.

“Dvorak” refers to an alternate keyboard layout which is purportedly more “finger-friendly” than the standard QWERTY layout. August Dvorak invented a layout in 1932 based upon studies of language usage patterns and typing habits. In the Dvorak layout, keys are arranged so that all 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 you extend your fingers less often, which really 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, where most typing occurs on the top row. Some proponents claim that the Dvorak layout reduces the incidence of repetitive use injuries. As of right now, there are no large-scale research studies that measure outcomes of using the Dvorak and QWERTY layouts.

One great thing about the Dvorak system is that there are two ready-made layouts for one- handed typists. So if your child has a “normal” right hand, he could use the right-handed Dvorak layout, and vice-versa.

What keyboarding options are available for children with upper limb differences?

Probably the most common keyboarding solution is simply to learn to type on the standard QWERTY keyboard with only one hand. This option is certainly convenient, since it requires no special accommodations. However, this option is likely to cause strain in the dominant hand, especially if it is necessary to stretch awkwardly to reach the buttons, or to execute a “click and drag” maneuver. According to ergonomic research, stretching the fingers to reach high frequency letters that are placed inconveniently and/or executing frequent “click and drag” maneuvers greatly increases the risk of repetitive stress injury for the dominant hand. For typists with repetitive stress injury, it may exacerbate the problem.

Two good free options are the left- and right-handed Dvorak layouts. The advantage of these is that they are included with the Windows operating system, and it takes less than two minutes to configure your computer to use it.

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

If your child has one typical hand and one partial hand, or if both hands are affected, then you also might consider making your own custom layout. There are several keyboard mapping programs available for download that can be used for this purpose. Since I have a thumb on my left hand, I wanted the keyboard layout that I used to enable me to type some low-frequency letters with my left thumb. My husband used Microsoft Keyboard Layout Creator to create a custom layout according to my specifications. 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.

You don’t need to purchase an expensive new keyboard to use the Dvorak or a custom layout. But I do recommend either that you purchase labels to cover the key names or that you purchase a cheap ($10) keyboard that has removable keys at any of the large computer mega-stores. Note that to be able to rearrange the keys on a keyboard, all of the keys must be the same size (on some keyboards, the keys are “graded”, meaning that the keys on the higher rows are deeper), and not all of the keys will switch. On my keyboard, all but 4 of the keys were movable. I put labels on the 4 keys that weren’t moveable. If more than one person uses the computer, you should have one keyboard that is arranged in the Dvorak layout for your child and one standard QWERTY layout keyboard. Just exchange them when your child needs to use the computer.

A more expensive option is to purchase a specialized keyboard. The Little Fingers keyboard by DataDesk Technologies is worth considering for any child. Although it is not specifically designed for one-handed typing, it is designed for children with small hands. If you intend to use the Little Fingers keyboard with a layout such as Dvorak, then please note that I do not know whether its keys are moveable, nor am I aware of keyboard labels designed for the smaller sized keys. The Little Fingers is available with a track ball or standard numeric key pad. Children can graduate to a standard keyboard when they are big enough to use one. In addition, a number of specialized one-handed alternative keyboards are listed here. The preferred choice will depend on the precise nature of the hand difference. If in doubt, your local occupational therapist can help determine the best option for your child.

Finally, you may want to consider voice recognition software. My personal experience with such software has been mixed. Strain on the hand is replaced by strain on the eyes and voice, from carefully watching the screen for typos, and from the frequent necessity for repetition. Still, the quality of the software does improve with each new generation, so I am hopeful that it will eventually provide a more consistent advantage.

Should children with hand/arm differences use an alternative keyboard layout?

While alternate keyboard layouts such as Dvorak may be a smart choice for two-handed typists, it is even more important to consider such alternatives for people with hand/arm differences. One-handed typists already are at a serious disadvantage, in that they must type every key using just 4 fingers (the thumb really can’t type more than the space bar). That means a lot of wear and tear on the dominant hand, which is doing almost every other task as well. Now, if you happen to be lucky enough to have a large hand, then maybe you don’t need to worry quite as much, but you still may want to consider an alternative layout designed for one-handed typists. If you happen to have a small or even an average size hand, then it is strongly recommended to consider using an alternative layout. The reason is simple: typing one-handed on the standard QWERTY layout, your fingers naturally rest on the home keys F G H J — not the most important keys to have at your fingertips! In contrast, you must stretch awkwardly to reach frequently-used keys such as A, S, O, and L.

I must acknowledge that the topic of alternative keyboard layouts is somewhat controversial. For example, aboutonehandtyping.com advocates that the Dvorak layout never be used, and that the standard QWERTY layout be used instead, if possible. The main argument is that the ability to type on a standard keyboard is an essential skill for school, libraries, the workplace, or other places where it may not be convenient or possible to reconfigure the keyboard. It is important to factor that when aboutonehandtyping.com was written, children did not have their own laptops, so they would have to use keyboards out in the world. Since in many school systems children these days are assigned a laptop in kindergarten, there is much less concern about frequent use of other computers that have the standard keyboard layout.

Another argument from this author is that children with differences should not be given additional reasons to feel self-conscious. While it is certainly important to take into consideration your child’s self-esteem, it also is important to consider your child’s long-term health. In my personal experience, I learned in 8th grade to type using the one-handed QWERTY technique. When I hit college, I developed a severe repetetive use injury that took years to heal. I believe that the injury was either caused or exacerbated by my use of the QWERTY layout. The years of suffering caused far more damage to my self-esteem than any accommodations. In fact, I eventually required more accommodations because of it. When I switched to a custom keyboard layout, my typing endurance increased significantly.

Ultimately, this is a decision between you and your child, perhaps with the assistance of an occupational therapist. Every solution does carry drawbacks as well as benefits. I recommend that you carefully examine all options, to determine which is the best for your child.

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

Additional resources

Two excellent books that can give you 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 stretches that are useful at home or in the office. Available through amazon.com.

Quick Summary on Keyboarding/Typing: links from this article

  • Keyboard labels are great for covering the key names if you set up your own keyboard layout for your child
  • The Little Fingers keyboard by DataDesk Technologies is worth considering for any child because it is ergonomically designed for smaller hands
  • A number of specialized one-handed alternative keyboards are listed here
  • aboutonehandtyping.com advocates that the Dvorak layout never be used by people who type with one hand, and that the standard QWERTY layout be used instead, if possible
  • Left- and right-handed Dvorak layouts are relatively easy to configure on your computer
  • 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, and 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.
  • Fingers should not hurt or ache from using a computer
  • Research on typically developing children using laptops suggests that an external mouse is ergonomically preferable to the trackpad on a laptop
  • There currently is no research specifically on computer use and adaptations for children with ULD
  • 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 possibly returning) several mice 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

©2024. Laura Faye Clubok, MS, OTR/L, On The Other Hand Therapy

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