Hand-under-hand

Also called Hand under hand guidance, Hand-under-hand support

The person rests their hand on top of yours while you move. They feel what you're doing, they can lift off whenever they like, and they stay in charge.

What it is

Hand-under-hand is a way of showing someone how to do something with their hands without taking their hands over. Your hand goes underneath; theirs rests on top. You touch the symbol, turn the page, pick up the cup, and the person feels the movement through your hand and follows it if they want to. If they don't want to, they lift their hand away, and nothing has been done to them.

The approach came out of work with deafblind children, where the hands are the eyes, and it has spread through AAC because it solves the problem that hand-over-hand creates: it teaches without taking control.

Who it can help

People who need to feel a movement to learn it: people with deafblindness, people with profound and multiple learning disabilities, people with a visual impairment learning tactile symbols or objects of reference, and anyone for whom watching a demonstration isn't enough.

It is also for the many people who find an adult's hand clamped over theirs distressing. If a person pulls away from touch, hand-under-hand is the version to try before deciding physical guidance is off the table altogether. It is not needed at all for a person who can watch and copy, and it's not a way of making someone select a symbol they haven't chosen.

How it works

The physics is simple. When your hand is underneath, the person's hand is free. They can press down to feel more, follow your movement, or lift off. Their fingertips are on the back of your hand, not on the symbol, so at first they're feeling you touch it rather than touching it themselves. Over time they slide their fingers forward past yours and make contact. Later still, you take your hand away and they carry on.

It also keeps the message honest. With hand-over-hand, nobody can tell whether the person meant to select that symbol or their hand was put there. With hand-under-hand, a selection is always the person's own movement. That's why it matters for yes and no and for anything that touches consent.

Go slowly, tell the person what you're doing, and offer your hand rather than reaching for theirs.

Getting started

Offer your hand palm-down next to the person's and wait. If they put theirs on top, you have consent to start. If not, model with your own hand in their view and try again another time.

Narrate each move: "I'm touching DRINK. Now I'm touching MORE." Say the word the symbol says.

Do it with real activities, not drills. Turning the page of a book together, feeling a spoon go into a bowl, finding the object of reference for bath time. The learning is in the doing, not in the sitting at a table.

Where to get help

Sense is the organisation with the deepest practice in hand-under-hand and works with deafblind people of all ages. Deafblind UK supports adults. PMLD Link shares practice for people with profound and multiple learning disabilities. A speech and language therapist or a specialist teacher for multi-sensory impairment can show you the technique on a real task, which is far better than reading about it.