by Marci Revelli, MS, CCC-SLP (Speech-Language Pathologist); NWACS Board Member

From time to time, we SLPs may encounter a child with communication challenges who is also blind, low vision or has a cortical vision impairment. Prior to using symbols for communication, a child with a vision impairment has to learn to trust and reach out with their hands to explore their environment. This is where hand under hand support comes in.

What is hand under hand support? The strategy of hand under hand is useful for different populations who may not be able to see you or your hands well (https://www.wsdsonline.org/hand-under-hand/). Hand under hand support helps a child experience how others’ hands move independent or together, including direction, speed and tempo. Hand under hand use helps a child learn to reach out and explore what is around them. If your hands are on top, you are in control and the child follows passively. Hand under hand use helps the child be more active and promotes their own hand use to reach out and explore their environment. This strategy also prepares the child for using tactile signing. The child learns to reach out to another’s hands to seek information. I invite you to scroll through this presentation from OHOA Deaf-Blind Intervener Learning Modules developed by the National Consortium on Deaf-Blindness (NCDB). It has great short video clips for what hand under hand support looks like.

Why do SLPs need to know this? A child with a vision impairment who is also not developing speech may require AAC strategies. Hand under hand support sets up the foundation for learning tactile sign language. In some cases, a child who learns to reach out and explore their environment can then learn to reach out to explore an AAC system such as a tangible symbol system or use of tangible symbols on a voice output device.