Hand-under-Hand Part 2

Slide 15
So let's talk about some major considerations. I have a total of five of them. The first three appear here. There are five major considerations that I would suggest you think about when you first are going to give hand under hand strategy a try. You want to, number one, guide the learner's hands from underneath. This really offers her an invitation to join an interaction with you. You're saying, hey, I'm here, I'd like to tell you something, I'd like to show you something. Are you ready? You want to do this with me? I want to do this with you. This is safe. Come on, let's try it. Let's try this thing together. It's that softer approach. Again, leaves control with the learner, and you're making an offer to her to say, hey, I'd really like you to interact with me right now.
If when you try and from underneath you come up underneath the child's palms or underneath the fourth and fifth fingers of her hands and she pulls away from you, in my estimation the worst thing in the world would be to grab that kid's hands and try it again. You don't want to do that. You want to somehow pat the kid's leg, pat the kid's forearm. If she has hearing, say something like, that's okay. Let her know it's okay if she doesn't want to interact with you right now. Wait a little bit, try it again. You might say, how long do I wait? I would have to say to you, I don't know, because every learner is different. It might be that if you wait even as little as four or five seconds. Maybe if you pat the kid's leg or you rub the kid's forearm, or you turn on some music that the kid likes, that could be soothing if the kid has the hearing to process that, you could again try and come up under her hands to invite her to interact with you. With some kids you may need to wait a minute. With some kids you may need to come back in ten minutes. It's just a very individual consideration, but you make the invitation.
You notice every time I say hand under hand and I'm trying to explain, I say, you move your hands under the child's hands, and you put your hands under the fourth and fifth fingers. You do this simultaneously with both your right and left hands. It's a two-handed technique. It's not one hand at a time, and who knows what your other hand is doing? Both of your hands come up underneath both of the learner's hands.
Point number one. You offer the invitation to interact. You're offering the invitation for the learner to join you out in the world.


Slide 16
The second consideration I would suggest to you is kind of in line with what I was saying when I was introducing the Hands Up, Hands Down queuing system. I think it's really important to leave the learner's hands free to the greatest extent possible. Now of course, if you're assisting her to use her hands as a tool, if she has washed her hands in the bathroom and you need to help her find and retrieve a paper towel so she's not dripping water all over herself and the floor, yes you need to assist. Or if you're in a cafeteria at a school and the child is learning to self-feed but needs your assistance to help scoop food onto a spoon, well then you need to help [laughter] get the food on the spoon so the kid can feed herself. Anything that's going on when you are providing needed assistance to use some tool or to use her hands as a tool, then of course, you need to provide that assistance. Put your hands, slide them gently hand under hand, and help. Otherwise, you want to
 
leave the learner's hands free to the greatest extent possible because those hands are her ears, her eyes, her tools, her voice, her way to relieve stress, and she ought to have the right to engage in any one of those functions when she wants to.


Slide 17
Number three. A second thing that you can do, if you choose to use this palms up - palms down cuing system, is you can invite the learner to "watch" while you, as the partner, are doing something with your hands. Let's say that you got a new work task that you're going to introduce to a class of secondary students, that you run a free enterprise business. You may do some piecework for pay. You may run a store for your high school, or you have a new product you're going to sell in the school store. Something like that. It's a brand-new item. It's a brand-new item with which you're going to work in the classroom. It's a brand-new item you're going to sell in the store. Maybe for families at home, it's a brand-new toy that was just purchased for either this learner or a younger brother or sister. For a teenager, maybe it's a brand-new iPod or something that you're going to connect, iPad, something that you're going to try to make available to this learner with the appropriate accommodations.
Well, when you are going to first be exploring this thing, the learner gets a chance to watch you. I think if you have children of your own, as parents, how many times do we say, no, wait, wait, wait, let mama look at it. Let mama figure it out, and then you can try it. Well, that's what we're doing with this third consideration, is you're inviting the learner to watch while you explore something and figure something out with your hands. And she's watching by laying her hands-on top of yours and exploring it with you, but still you, as the partner, are doing the manipulation. Your hands are the ones in direct contact with the object, the new store item, the iPad, the work pad, the work materials, whatever it is. And the kid is watching you by becoming familiar through her hands laid on top of yours.


Slide 18
The last two general considerations for using hand-under-hand strategies-- and I don't know why I put this fourth in the list because in my mind it's the most important. I've already mentioned this to you, so I guess this is the time to say, "These five considerations are not listed in order of priority."
Number four, if the learner pushes the partner away. If the learner rejects the partner's hand. If you as a partner, lift your hands, gently guide them under the learner's palm, and she lifts her hands away, pushes yours away, honor that request. We did talk about that before, but now it appears in my list, and it's important enough to say one more time. This last consideration is a point that spans that last notion we were just talking about. Some children with deaf-blindness who might have very high, very strong tactile defensiveness who are not accustomed to being touched, who are not comfortable with being touched, it can be a longer haul to get those children to allow you to touch them or at least to be comfortable with your touching them and touching her hands and manipulating her hands. So even if you were to come back in 30 minutes or an hour, it may be a really slow learning curve and a long time.
So the way that you can kind of gauge this is if a learner - child, teenager, whoever - pushes you away or draws her hands away from you, move further back from the learner, just a little bit at a time. And you're sort of trying to find where that learner's line in the sand is. What you're looking for is trying to find the edge-- is the way I've explained it here-- the edge of the space where she is comfortable allowing the partner to be. It could be she'll be very comfortable with letting you manipulate her hands, but she doesn't want her knees touching your knees, if you're sitting across from each other. Or if you're sitting side by side, she doesn't want your chair bumping her chair or your shoulder touching her shoulder. Or she doesn't want you close enough to her that when you talk she can feel your breath on her face. It may not be the hand thing at all. It might be, but it might be all of these other variables. So you want to strategically and in some kind of structured fashion, move away from the learner just a little bit at a time, till you find an edge where she seems to be comfortable with
 
your body and yourself being in relation to her, and then, again, take your two hands, slide them up under her hand or under just the fourth and fifth fingers, and give it another go and invite her, see if she will engage with you in some activity.




Slide 21

Three final points. I think from using hand-under-hand strategies, there are three major outcomes we can accomplish. There are three major outcomes we can help the learners whom we teach - the children whom you're raising, the family member - we can help them accomplish, we can help them master three very important skills. The first one we can develop a mutual understanding. We can develop an understanding of the hands of the learner who is deaf-blind. All I can say about this is I warned you. I told you I was going to say this a lot. So here we go. A learner who experiences deaf-blindness must not only use her hands as tools, but also in a much, much broader sense. In particular, to this learner, her hands are her eyes, but they are also her voice, her ears, her tool, her stress reliever. A learner with deaf-blindness must also use other parts of her body to gather information about the world. And you will see that sometimes. Some kids with deaf-blindness will want to just get right up, body-to-body contact. And Van Dijk theory calls this collective movement or resonance. If the child is plastering her body up against yours and moving with you, it's the resonance stage of Van Dijk's movement theory. Kids will do things with their feet, with their legs. They will do things with their tongue. They're trying to get information for a body that is sensorially deprived if their hearing and vision losses are pretty significant. So try to interpret those things as a search or as a request for information. And if you use hand-under-hand strategies, you can in a very structured way help that learner find out and gather a whole lot more information in ways that are more typical will be less likely to call negative attention to her in the public and community.


Slide 22
A second thing that is a very, very important outcome for learning is that, through using hand-under-hand strategies with a learner, you can help that learner develop what's called mutual tactile attention. What is mutual tactile attention? Through Project SALUTE, which is a fabulous project that has all kinds of resources on the website, so check out Project SALUTEs website, Deborah Chen and June Downing have this project. They have wonderful applications about tactile tools, tactile learning activities, tactile instructional material. Wonderful, wonderful resource for families, as well as school teams. Project SALUTE defines mutual tactile attention as involving joint attention and sharing an activity, sharing an object, through non- controlling mutual touch. A lot of big words in there. But if we put it back into our world where we have vision, mutual tactile attention is really the equivalent of children developing a pointing gesture.
So if you'll think with me, if you have your own children, or if you've been around young children who are just learning to communicate and learning those niceties of social interaction, one of the first most powerful things that kids learn is to point. They'll point at things before they actually touch them. They'll walk around, or crawl around, cruise around a room, and they'll touch everything, and they'll point. They'll touch a refrigeration then go, "What's that?" And the mom or the dad says, "Refrigerator." "What's that?" "It's the cabinet." "What's that?" "That's the table." "What's that?" "That's the floor." The kids point, and they get you to give them information because they're sharing joint attention with you. As they develop a more sophisticated point, they're pointing at things all the way across the room, or they're pointing at things in the distance, and they're wanting you to look. They're like, "Look momma. Look at that balloon." Look at that dog. Look at grandma. Look at whatever to look at. And when they're saying, "Momma, look at. Daddy look at. Teacher look at," that involves mutual attention.
Kids with deaf-blindness who have significant vision impairment, they can't use those distance points, and so their mutual tactile attention is by sharing exploration tactilely. Going to share an activity tactilely. It assists the learner to focus all the senses she has, whatever residual sense she has, whatever vision she still has available, hearing, touch, taste, smell - maybe,
 
it depends - to explore some new activity, to explore some new touch. And it keeps the partner's hands available for use by the learner. You'll remember what I said to you about palm up, palm down. When your palms are up, you're telling the learner, "I'm ready to listen to you, so keep your palms up," while you're doing mutual tactile attention activities. After you've explored, you've manipulated the object, you've let her feel it, you've felt it, maybe if it is a new food from a [inaudible], you've each tasted it, you've smelled it, you've crackled the plastic bag, then your palms are up to say to her, "Okay. I'm ready to listen. What did you think about this? Do you want to look at it again?" Look in quotes. Do you want to look at it again? Do you want to taste it again? Do you want to throw it away and go eat something else? After the mutual exploration, you're cuing the learner, "Okay. Your call. Where do we go from here?"


Slide 25
The final point, touch can help develop construct a very important foundation for language. And you saw a little bit of that, I hope, in my last examples about the contact point. Young children, typically developing children, use points to get their family members and their preschool teachers to tell them the names of things. The same thing has to happen for kids with hearing and vision loss to be able to move their communication development forward. It's not going to be them touching and saying, "That," and hearing you say, "Refrigerator, floor, cabinet, table." But as they explore with your hands, your hands are going to move in a certain way to give them the sign for refrigerator, or cold, to give them the sign for table, or plate, or eat, or whatever you're going to match with that, to give them the sign for floor or carpet, to give them the sign, or gestures, or whatever it is that matches that individual child or teenager's learning level, in regard to communication ability, so that you can provide that same manual sign, that same kind of gesture, that same touch repeatedly. Because how many times does your child have to touch a refrigerator and you go, "That. What that?" and you say, "It's a refrigerator. That's a refrigerator." It doesn't take once. It takes lots of repetitions. The same thing is happening here.
So exposure to language through touch and repeated exposure to language where the touch comes back to that learner in the same way, in the same form, it's going to help give that certain kind of touch, that certain kind of hand movement, that certain kind of hand shake. It will give it meaning, and that meaning is how the learner can further develop language and communication skills.
By using touch, it will encourage the learner's expressiveness. If she touches things, moves objects in a certain way, taps on something three times, you tap on it three times. And with your hand under her hand, so she feels you and "sees you" tapping on it three times. If she moves it from one hand to the other and back, you put your hands under her hands and show her, "I'm copying you. I'm imitating you," and moving it back and forth between your two hands. Incorporate manual signs as these can be, again, depending on the child's level of symbolization and language development.
And you want to say or sign the word at the very moment that your tactile attention is first shared on an object. You can't delay it by five seconds, or three seconds, or any longer. It's when that child's hands come in contact with a certain object, or a certain tool that represents a certain activity, or a certain texture that you're going to use to represent an activity, bang. You give the sign. You say the word. You give the gesture at that very moment. So you got that paired association that you're then going to repeat and repeat and repeat in exactly that same way to further the child's language development.


Slide 26

On this slide and the final one, there are two resources that give you great written information. If you're a reader, you want to read about Barbara Miles. I love the title of this chapter, Conversation: The Essence of Communication. It's in a fabulous book, Remarkable Conversation. It's an old book now, but it's a fabulous resource. This is available for checkout through the Kansas State DeafBlind Project. And the second resource is available through the National Consortium on Deaf-Blindness, DB Link.
 
Barbara Miles many years ago wrote a little perspective, Talking the Language of the Hands to the Hands. Isn't that a great title? The Language of the Hands to the Hands. It's an entire little publication on hand under hand strategy, and I encourage you to request that as well. I thank you for your time. I thank you for your attention. Thank you so much.