Awareness of Helper Hand

Children with hemiplegia can often forget to use the helper hand and can be seen to play with toys using mostly one hand. You may find you need to remind your child to use the helper hand in activities and your child may seem to generally lack awareness that the helper hand is there. 

Dominant hand

This refers to the more skilled hand and is usually the hand that is used for writing.

Hand function

This is the ability to perform tasks with the hands. As a general rule it is easier to do everyday things such as fastening buttons and zips if we use two hands together. 

Helper hand or Affected hand

This is the hand on the affected side of the body.


Hemiplegia, also known as unilateral cerebral palsy is the commonest form of cerebral palsy and is a condition which affects movement on one side of the body (the affected side). For more information about hemiplegia please visit


This is simply the ability to keep hold of an object. This is particularly helpful if the dominant hand needs to do something more precise with an object and the helper hand holds it steady. We often use holding in everyday activities. Some examples are holding a toothbrush while applying paste with the other hand or holding a bottle while the dominant hand screws/unscrews the lid.

This video clip shows some examples of the helper hand holding toys during play:

Holding Toys and Games.

Large arm movements

This involves movements of the shoulder such as stretching the arms out to the sides or above the head.


Here we mean situations where the helper hand must stretch away from the body to reach an object. To make reaching with the helper hand motivating, your child must have the ability to grasp.

Here is an example of reaching:

Reaching Toys and Games.


Releasing is simply the letting go of objects but often this can be quite difficult for the helper hand. It is often easier for the helper hand to release objects to the dominant hand than it is to release them directly to the table.

Here is an example of releasing an object to the table:

Releasing Toys and Games.


Supination is a forearm movement which can be particularly difficult for people with hemiplegia. Supination is where the palm of the hand faces upwards. Examples of situations when we need to use supination are when being given coins and when taking food to our mouths.

This photograph shows supination:

t4 test



Thumb / finger grasping

This is where the thumb and index/forefinger are used together to pick up a small object. Some children find it easier to use the thumb and middle finger to do this. Objects may be picked up using the tip of the thumb and the tip of the index/forefinger, like this:

or your child may find it easier to use the side of the index/forefinger like this:

Thumb / finger grasping is usually more difficult than whole hand grasping.

Thumb / finger grasping Toys and Games.

Two-handed play

Two-handed activities, often called bimanual activities, require the use of the two hands together. Most of the toys and games we have chosen encourage the use of both hands together – two-handed play. Often the helper hand is used to hold a toy steady while the dominant hand does the more skilled movements.

Whole hand grasping

Whole hand grasping, sometimes known as palmar grasping is used for larger objects and usually involves all the fingers. Here is an example:

Whole hand grasping Toys and Games.

Wrist and forearm movements

This covers a variety of movements from having the palm of the hand facing the floor (pronation) or the ceiling (supination) or anything in between. 
This video clip shows forearm pronation and supination:

Wrist and forearm movements also include bending the wrist up (wrist extension) and down (wrist flexion). 
This video clip shows wrist extension and flexion:

We usually use a combination of wrist and forearm movements when we are using our hands but it is important to remember that wrist extension and supination are often quite tricky for people with hemiplegia.

Wrist and forearm movements Toys and Games.