Hand-Under-Hand Guidance

Two young girls who are deafblind, explore pumpkins using their hands.
Two young girls who are deafblind, explore pumpkins using their hands.

A person who cannot see or hear or who lacks significant amounts of these senses must be given a way to compensate for the missing information these senses usually provide. In the words of Harlan Lane, he must be given “modality-appropriate stimulation” (1997). Most commonly it is the hands that take over the function of the eyes and ears for the person who is deafblind. Fortunately, as both Harlan Lane and Oliver Sacks have reminded us, the brain is extremely plastic. When a sense is used a great deal, the brain is able to process information from that sense more efficiently. People who use their fingers extensively, such as Braille readers and string players, “give evidence of increased cortical representation of the fingers.” (Lane, 1997). What is more, areas of the brain previously devoted to visual or auditory processing can be reallocated to processing tactile information, providing the hands with even more brain power. In this way, the hands of a person who is deafblind can become, in addition to their usual role as tools, useful and intelligent sense organs, allowing people without sight and hearing to have access to objects, people, and language that would otherwise be inaccessible to them. It is important to note here that the brain is most plastic, most adaptable, when a child is young, and therefore, the earlier a child who is deafblind can learn to use his hands as finely tuned receptors, the more likely he will be to make optimum use of his hands to get information.

Talking the Language of the Hands to the Hands

Barbara Miles

National Center on Deafblindness Factsheet, 2003

A teacher and young man work in a raised flower bed using hand-under-hand guidance.
A teacher and young man work in a raised flower bed using hand-under-hand guidance.

Hand-under-hand guidance and interactions are critical to the development of hand use for children who are deafblind and visually and multiply impaired. Hands are used as tools for exploring the world, for literacy (tactile symbols, braille, etc.), for communication (both receptive and expressive), for social engagement and connection.

    • Use hand-under-hand guidance to show a child an action or object. Invite the child to engage with your hands.
    • Offer your hands to the child to do with as they please. Play hand games and let the child explore the details of your hand, such as the rings you wear or the hair on the back of your hand.
    • As the child begins to trust you, offer objects under his/her hands and let him explore objects as he will.
    • Bringing your activity and/or object up and under the hands of the child. If a child pulls away, continue to do what you are doing and re-invite his/her exploration.
    • Begin to slide your hands under the child’s hands and bring them to your mouth or other parts of your face as you make movements, eat or drink.
    • Encourage him to put his hands on top of your hands or along side your hands to feel what you are doing in all activities.
    • Cue her to reach out and see that you are doing something by touching her shoulder or elbow and allow her to connect with your hands.
    • Be respectful of the things the child can do with his/her hands such as scratching, grasping, throwing, banging, etc. This is how the child learns about the properties of the objects he/she encounters and builds important skills for interacting with objects. If throwing things is problematic, consider making a Position Board for the child to practice throwing in a controlled way that will not hurt him/her or anyone else. Also give the child plenty of opportunities to throw things appropriately outside and in the gym.
    • If a child does not reach out to feel what you are doing because their hands are shy or because of motor limitations, bring the activity very near to the child and perform it while in light physical contact.

“While the child is young, or developmentally young, the connection between her and the world needs to be almost always hands-on, involving close physical, auditory, or visual involvement with whatever she is experiencing. Often she will need help to reach out and explore her environment. Helping her will entail using skillful touch in order to invite her hands outward. Gentle touch, the teacher’s hands under the child’s, never controlling, always coaxing, is the best kind. Even though we may be tempted to put our hands on top of the child’s hands in order to guide them, we need to remember that the more freedom we give her hands, the more she will be encouraged to exercise that freedom.”

(p. 74, Remarkable Conversations, Miles and Reggio, © 1999, Perkins School for the Blind, Watertown, MA)


Reflections on Deafblindness: Hands and Touch

Here is a YouTube video from Perkins School for the Blind where Barbara Miles discusses the importance of hands and touch in learning.

Landscape of Touch Video

This video talks about the importance of touch in a broader sense, beyond just the hands. It is equally important to recognize for many students who are born deafblind or blind, their sense of touch is the way they learn and understand the world and what happens in their lives. Landscape of Touch is a co-production of Perkins International, Sense Scotland, and Signo Dovblindesenter.

Hand Under Hand Strategy – Idaho Children and Youth with Deaf-Blindness

Hand Under Hand Strategy  is viewable below and on the Idaho Children & Youth with Deaf-Blindness channel at:  www.youtube.com/watch?v=DcERQWPnc2Y

Read more: http://www.cadbs.org/videos/


Hand-Under-Hand Cooking Routine

In this video a teacher and a student who has multiple impairments (including visual) are performing a cooking routine, making muffins. The teacher has the materials set out for the student and performs the steps of the routine. The student participates by touching items or the teacher’s arm or hand to observe, but only briefly. The teacher respects the level at which he can successfully participate.


Barbara Miles. Talking the Language of the Hands to the Hands

Barbara Miles, The Importance of Hands and Touch. Perkins School for the Blind.

Barbara Miles and Marianne Riggio.  Remarkable Conversations , Perkins School for the Blind.

Barbara Miles, Emma Nelson, and René Pellerin.  CDCI Research Into Practice – Talking the Language of the Hands to the Hands, University of Vermont

Jude T. Nicholas, Annika M. Johannessen, Trees van Nunen, 2019.  Tactile Working Memory Scale – a Professional Manual. Nordic Welfare Centre, DEAFBLINDNESS, DISABILITY ISSUES 14 Jan 2020

Tactile-Bodily Perspective, Texas Deafblind Project Website, Deafblind Interaction.

Developing Hand Skills, Fact sheet from Colorado Services to Children with Deafblindness

Topic in Deafblindness – Instructional Strategies from Georgia Sensory Assistance Project

Hand-Over-Hand Guidance: What Lesson Do We Teach? By Andrea Story

Hand-Under-Hand Video Examples from Washington Sensory Disabilities Services