Information provided by Paediatric Neurology Service and Occupational Therapy Service from KK Women's and Children's Hospital (KKH), a member of the SingHealth group.

Bimanual or bilateral hand use refers to the use of two hands in holding and manipulation of objects. It is an important component of fine motor skills development which begins when infants learn to bring their hands together at midline. As children develop, they learn to use both hands in a coordinated manner to carry out skilled tasks in play or daily activities.

Children with neuro-developmental conditions may experience difficulties in using both their hands in daily living activities. Some children may develop a strong hand preference for one hand and a developmental disuse of the other hand, particularly in children with unilateral cerebral palsy, whereby one hand is likely to be more skilled than the other.

You may be able to help your child enhance his bimanual hand skills through some common play activities at home. Some of these activities are listed below.

If your child presents with neuro-developmental concerns affecting his/her bimanual hand use, please consult your occupational therapist for specific hand function goals and relevant recommended activities before getting started. Your occupational therapist will also be able to advise on the suitability of activities in accordance to your child’s developmental level.

Safety precautions

  • Ensure your child is well supported and seated/standing in a stable position.

  • Start with an easy task before progressing to something more challenging.

  • When introducing a new activity, demonstrate the task especially during the first few attempts. Provide hand over hand assistance or consider breaking up the activities into simple steps where necessary.

  • Allow your child time to practise and feel comfortable in the presented activity.

  • Praise your child for his attempts and successes to reinforce his efforts and encourage participation!

Provide supervision during activities to ensure safety, especially when learning to use tools or sharps, or when introducing small manipulatives. If your child is in the mouthing phase, choose larger-sized, developmentally appropriate toys and manipulatives.

Activities to encourage use of both hands

1. Play-dough and therapeutic putty play

  • Pull dough/putty apart with whole hand or fingers   

  • Create shapes or figures with dough/putty

  • Find hidden objects such as pegs, marbles, coins, beads by squeezing, pressing, or pinching dough/putty

  • Use familiar tools like cookie cutters, scissors, fork, spoon or plastic knife in putty play

2. Stringing and lacing activities

  • String large rings through shoelace

  • String large wooden beads

  • String small beads

  • Lace board or cards

3. Craft activities

  • Paper folding or origami (e.g. into a fan, boat, box, paper chain, etc)

  • Tearing of paper to form collages

  • Stickers play

4. Constructional toys

  • Create structures with Lego/Duplo, bolts and nuts, magnetic tiles

  • Fix up 3-D constructional puzzles

5. Sports activities/games:   

  • Use of two hands in beanbag/ball tossing activities

  • Use of larger balls in rolling or bouncing to include use of two hands

  • Modified racquet games to involve the use of two hands in play

6. Daily activities at home

  • Dressing up and managing clothing fasteners such as buttons, zips, drawstring, shoelaces, on self or on dolls

  • Wringing out sponges or washcloths during bath-time

  • Baking fun: Using rolling pin, stirring batter with spatula in mixing bowl, shaping cookie dough

  • Food preparation: Spreading butter/ jam on bread, stirring drinks, grating cheese/ carrot, peeling fruits, making meatballs, fishcakes or anything that has to be rolled/ shaped

  • Opening a snack wrapper, ziplock bag or food storage container/cookie jar

  • Carrying a tray with both hands

Ref: K21