Weightbearing Hands Explained

As OTs we are often promoting activities that encourage weight bearing on the hands. This means that weight is transferred from the rest of the body and the child supports their own weight through their upper bodies (shoulders, elbows, wrists and hands).  There are wonderful benefits to weight bearing on the hands including increasing proprioceptive and vestibular input (the last few blogs have focused on this) and building upper body strength (shoulder, elbow, wrist and hands). 

But what does this look like? What are we aiming for? Can we be doing it wrong? 

Can you spot the differences in the photographs above? 

1. Arms extended, hands forward, wrists extended, palms flat. (Top left photograph)

This is a great way to build strength and provide sensory input through yoga poses, animal walks, prone activities, crawling, etc. This is what we are aiming for when we are encouraging weight bearing. 

2. Arms extended, supination of forearm leading to external rotation of wrists, fingers pointing away from midline. (Top right photograph)

Things to check: ability to support forearm and wrist on table during writing, extension of wrist for writing, wrist stability. 

Some children will rotate their forearms to use their shoulder and/or elbow muscles for stability.  This is often a way to compensate for weak wrist muscles.  However, suspending one's whole arm can become tiring and also means that only big movements are possible.  Finer more controlled movements of the hand (fine motor skills) are best achieved with the dynamic movement of the hand and finger muscles. 

3. Arms extended, wrists extended, fingers curled at DIP joints. (Bottom left photograph)

Things to check: tactile defensiveness, low tone, shortening/tight finger extensors, retained reflexes (palmar, STNR), wrist strength and stability, development of palmar arches.

This is not a fully fisted hand.  Rather the fingers are curled over at the Distal Interphalangeal Joint of the fingers (the joint closest to the palm). 

In my practice as an OT, I'm observing an increasing number of children with this presentation.  Some say that it is due to less active children with less exposure to gross motor movements.  Some say that retained primitive reflexes need to be addressed as they have not been integrated.  Some say that it is an over use of devices that leads to shortening and tightening of the finger muscles. 

We need to remember that in all movements, children are seeking stability.  They do things automatically to protect themselves and to be comfortable. 

4. Arms extended, wrists extended, fingers and palms slightly arched.

This could be normal protective reflex patterns. This could also reflect strong palmar arches needed for fine motor skills. If so, no change needed.

Also check: tactile defensiveness, wrist strength, elbow strength or collapses.
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Recommended:
✅Try hand stretches such as pushing both hands together (fingers, palms and wrists touching) or pushing against a wall.
✅Try weight bearing activities through hands on different surfaces and predictable movements for your child.
✅Try moving from commando crawling to four point crawling to static weight bearing (eg. Yoga pose - downward dog).

So when you ask your child to do animal walks, push along a scooter board, do a yoga pose.. watch what is happening with their hands, wrists and forearms! 

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​Cindy is a registered occupational therapist practising in Sydney, Australia.  She has two growing children who are a constant source of inspiration and learning.  Cindy loves working creatively to help children to reach their potential, finding opportunities in everyday living and making learning fun. She is also addicted to making printables (even when they take a long time to complete).  Cindy is the author of the Occupational Therapy blog Your Kids OT.  Read more articles from Your Kids OT at https://www.yourkidsot.com/blog

Cindy is a contributing author of the Functional Skills for Kids Therapy Team.  They have together published THE HANDWRITING BOOK, THE SCISSORS SKILLS BOOK and THE TOILETING BOOK.

​The information on this site is general in nature. The activities are safe for most children, however, you should consult an Occupational Therapist or health professional to address specific movement, sensory or other medical conditions. Affiliate links are used throughout this website to promote recommended products. Your Kids OT receives a small commission if any purchases are made through these links. Please see my disclosure policy for more details. ​​​
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