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• Bilateral integration
  
• Shoulder and postural stability
  
• Wrist extension stability
• Arches of the hands
• Thumb opposition/open webspace
• Separate function of the two sides of the hand
• In-hand manipulation skills
• Hand and finger strength

Bilateral Integration
For a discussion of what this is and why it is important, click here

• Shifting weight between two hands, such as when swinging between monkey bars or trapezes, or wheelbarrow walking, crab-walking, bear-walking, doing the "inchworm" (walk hands forward, then hands stay still and feet walk up to hands, repeat), etc.
• Positioning-plus-activity to elicit crossing midline. For example: have the child sit backwards on a chair, straddle a bench or bolster, or sit on a hippity-hop. Or just tell them that their feet have to stay "glued in place" to the floor while standing. Now have them throw beanbags at targets located far to the sides. Or bat at balloons hung to each side, roll balls in bowling game with pins located to the side, etc. You are looking for rotation through the body and needing to switch objects between hands.
  
• In a group, have children sit in a circle cross-legged or on chairs. Pass a ball around with two hands by twisting the body to the right and left to take the ball and then pass it. This can be elicited through positioning the players just right. Make it more interesting by speeding up the pace or pairing it with having to count down by 3's as you take the ball, or spelling words out loud one letter per person as you pass the ball, etc.
  
• Make circles and shapes in front of body with streamers
• Anything hand-over-hand to pull a rope (pull something to self, or pull self along a rope while on scooterboard, or while on a swing, or climb rope, etc)
• Wear a catcher's mitt or velcro mitt while playing catch; child has to catch with mitted hand, then transfer to other hand to throw or roll it back
• Fishing games where the child needs to pull the "fish" off the "line" with one hand while holding the line with the other hand.
  
• Drumming with both hands. Try to listen and copy each others' rhythm patterns.
• Pull-apart and push-together building materials and toys (Duplos, zoob/accordion tubes, toy accordion, zoom ball)
• Stringing beads - match the size of beads and string to ability level of child: easiest is pipe cleaners and large square wooden beads, hardest is thread and tiny beads.
  
• Penny flipping! Line up a row of pennies from left to right so that the row reaches from in front of left shoulder to in front of right shoulder. Cross midline by using one hand to flip them all over in line without leaning to right or left. Try using both hands at once by starting simultaneously at left and right ends of row and flipping pennies until hands meet at the middle. Or make an oval race track and race around it by flipping pennies in turn.
  
• Any toy that has to be held in one hand while the other manipulates! Just arrange the situation so that the toy can't be stabilized by leaning against it or some such, but that other hand is really actively holding it.
  

Postural and Shoulder Stability
If you want a discussion of why this is important, click here

• Weight-bearing through the arms and shoulders -- swinging between monkey bars or trapezes, or wheelbarrow walking, crab-walking, bear-walking, doing the "inchworm" (walk hands forward, then hands stay still and feet walk up to hands, repeat), etc.
  
• All the usual abdominal exercises we know from the gym! (Sit-ups, crunches, leg lifts, oblique or twist sit-ups, etc.) Use caution in younger children to avoid back strain or overdoing it. Children's muscles are more easily torn and strained than adults'.  DON'T add weight or do incline sit-ups unless a therapist or doctor has OK'ed it.
  
• For back exercises, maintaining an extended position while lying on tummy is good. In the clinic we use scooter boards, various swings (a hammock is useful, with adult supervision), and therapy balls. Just lying on tummy and propping up to read or color is a good way at home.
• Standing on your knees forces you to use abdominal/postural muscles more than does standing on feet or sitting. Try playing a game of catch while "tall kneeling" (don't sit back!).  I have had good results with making any time spent playing Gameboy, X-box, or watching favorite TV show conditional on standing on knees while doing it. Harder than it looks!
  
• Mirror arm patterns: in pairs, facing each other, one person raises hands and moves them slowly while the other person tries to copy them exactly as if they are a mirror image
• Pouring from a pitcher or watering can (keep going or repeating for several minutes overall per session).
• Shooting baskets with basketball or playground ball, or playing volleyball
  
• Rope turning for jumping rope
• Carrying a ball or small rock at arm's length on a wooden spoon
• Zoom ball! If motor planning this is too difficult at first, attach the handles at one end to something up high and have the child lay down on the floor. The ball will return to them via gravity anytime they don't have their arms spread apart.
  
• An old-fashioned toy called a button or buzzsaw. Requires timing, motor planning, and grading of force skill so not for everyone, but a good work out! And works on control at midline too.
  
• Play with a yo-yo
  
• Making big circles on a blackboard (or white board, or butcher paper taped to wall), or erasing/washing a blackboard
• Any work with hands at eye level, such as writing, etc. on a vertical surface (see wrist extension activities, below)
• Donkey kicks: in push-up position, keep both ankles together while jumping feet from right to left and back again. For that matter, push-ups!
  
• Ball tapping: this is one of the only ways to work the serrates anterior, a muscle that is important for stabilizing the shoulder blade. Hold a dowel braced between the two flattened palms and gently tap a ball suspended by a string between waist and shoulder level. The ball should be hung at a level that will require as full elevation of the arms as the child is capable of controlling. Gentle tapping will better develop stability and control.
  
• Holding a dowel between flat palms, hit a balloon and see how many times you can hit it before it gets away and touches the ground
  
• Have child sit on rolling chair or scooterboard with feet up while you sit on stable surface. Child grabs your wrists or a dowel that you stabilize and pushes and pulls to scoot forwards and backwards.
  

Developing stability in wrist extension:
If you want a discussion of why this is important, click here

• Work on an elevated (tilted towards you) or vertical surface. Use an easel, blackboard, desk easel or slantboard, or just tape some paper up on the wall or window. Many common activities can be positioned to promote wrist extension. For example: Colorforms or felt boards; chalkboard activities; Magna doodle; Lite-Bright; painting, drawing, coloring, mazes, dot-to-dot, or stencils; magnetic letters or shapes; sticker art; stamp art, or my pencil obstacle courses!
  
• Activities involving weight-bearing on the hands, such as wheelbarrow or crab walking
• Leaning on one open hand on floor while working on a large picture, with sidewalk chalk, floor puzzle, or anything else that can be worked on while leaning over it on the floor
• With therapy putty -- hang hand over edge of a table with palm down. Hold therapy putty with other hand beneath the exercising hand. Grab the putty and stretch it by bending wrist back.
  

Developing stable arches within the hands:
For a discussion of why this is important, click here

• Clay or play dough, especially rolled on table or between two hands with cupped palms (see putty exercises)
• Knife for cutting play dough with "proper" knife grasp
• Use a rolling ravioli-maker or dressmaker's wheel to cut snakes of therapy putty
• Small beads or games requiring holding a handful of objects in cupped palm.
  
• Pour rice or sand into child's hand and "see how much you can hold before it spills"
• Paper-tearing, e.g. for collages
• Large, whole-hand spray bottles: spray the plants or make art by spraying tissue paper over white paper so it bleeds its color when wet
  
• Tongs or large tweezers (games include Bedbugs, Operation, and Zoo sticks or Rookie Sticks)
  
• Dice games - must shake dice in cupped hands, "so you can hear them click"
  
• Chinese hand balls
  
• Tennis ball with mouth: buy one here, or make your own here.
  
• Massaging palms
  
• The Taco Game - group game where you have to hold a foam "taco" closed with one hand while rolling dice and adding pieces with the other
  
• Touch each finger to thumb. For extra challenge, have someone else use their pinkies, hooked, to try to pull apart the circle of your thumb-to-finger. You should be able to resist until they get to your ring and pinky fingers.
  
• Use chisel erasers (the old-fashioned erasers you can put onto the end of pencils) to pick up small items. Hold the erasers between thumb and index finger of each hand and use the flat/round edge to pick up dice or cubes or dominoes or Jenga pieces, or whatever and arrange them. You can pretend that the pieces are electrically charged, and if you touch them directly you will get a shock!
• Spider on the mirror: place fingertips of one hand against like fingertips on other. Make the "spider" and its mirror image move different legs in different ways

Strengthening Thumb-Index Webspace:
For a discussion of why this is important, click here

• Tennis ball with mouth: buy one here or make your own here
• Clothespins or clips. As with tongs and tweezers, monitoring may be necessary to make sure that the child maintains a rounded and opposed grasp rather than using a lateral pinch or avoiding use of thumb altogether by bracing one side of clip in palm of hand
  
• Tongs or large tweezers (Bedbugs, Operation, Zoo sticks or Rookie Sticks). I especially like strawberry hullers, short and fat little tongs that tend to make kids automatically use a rounded webspace
• Wee Waterfuls games (only the tube-shaped ones; they can be hard to find for some reason but are excellent for thumb positioning)
• Shuffling cards while holding each half of deck with thumb at one end, index and middle fingers at other end, and arched palms
• Eye droppers (can make colorful designs on coffee filters with food color and water mixture)
• Disc shooters
  

Separating Motoric Function of the Two Sides of the Hand:
For a discussion of why this is important, click here

• Roll small balls of play dough or putty in fingertips
• Tear paper while keeping ring and pinky fingers tucked into palms
• Make things with small beads
• Color in small pictures or do page of sticker targets with small color dots (available at office supply stores). Especially when the picture is clipped or taped up onto a vertical surface, child will start to automatically stabilize on the side of the hand while using index and thumb to place stickers in precise places.
• Scissor cutting or writing or coloring or painting or eye droppers or tongs or tweezers... with a "magic penny" held against the palm with the ring and pinky fingers curled in (its magic like Dumbo's magic feather that helped him fly)
• Toothpick or thumbtack designs in play dough, clay, or putty spread out on flat surface (even better if it's a vertical surface!)
• Water guns or squirt bottles with one- or two-finger triggers. Keep other fingers tight around handle or neck
• Roll tissue paper into balls to glue onto paper for collages
• Penny flipping: line up a row of pennies and flip them all over one at a time as quickly as possible
• Finger pattern games: copy adult in positioning individual fingers as demonstrated, working on moving just one finger at a time
• Hold a tube of toothpaste or a small bottle in one hand and try to remove/replace the lid without using the other hand
• Use learning scissors to encourage separation while cutting
• Snapping fingers
• Place two pennies and two paper clips in palm of hand. Try to move one penny to fingertips and place on table without using other hand, then one paper clip, and so on. Increase number of items as it gets easy.
  

Improving In-Hand Manipulations Skills:
For a discussion of why this is important, click here

• Place two pennies and two paper clips in palm of hand. Try to move one penny to fingertips and place on table without using other hand, then one paper clip, and so on. Try it with more items as it gets easy.
• Bead stringing, especially when the lacing tip is shorter than the bead
• Pegs and pegboards, especially when several pegs are held in the hand while placing each one
• Place pennies or buttons into slots (cut one into the plastic lid of coffee can and draw a face so you are "feeding" the can)
  
• Lacing boards, sewing cards, beginner sewing kits (with yarn and felt, for example)
• Play finger tug'o'war with coffee stirs, plastic lace (gimp), or a marble
• Modeling clay or play dough, especially when making small objects
• Pencil walk and flip: hold a pencil as if you are going to write with it. Keeping the tripod position, walk your fingers up towards the eraser. When you get there, flip the pencil over without using other hand or a surface to brace it. Walk fingers back to the other end, still keeping the tripod position, and repeat.
  
• Flip a pencil or coin over and over in fingertips
• Hold a small plastic cup filled with water (the lid from liquid laundry detergent works well for this) upright in the tips of fingers. Turn the lid without spilling by turning it in fingertips.
• Several finger puppets on one hand or multi-finger puppet
• My product: Fasten-ator
  

Overall Strengthening of Hands and Fingers:
For a discussion of why this is important, click here

• Hole punches and staplers
• Clay or play dough -- squeeze, flatten with heavy rolling pin, use play-doh® extruding and squishing tools
• Cooking projects, especially with batter or dough
  
• Construction tools (hammer, saw, etc. at child's developmental level)
• Glue bottles, puffy paint, fabric paint, glitter glue in squeeze bottles
• Popbeads
• Clothespins, large tongs
• Stress balls and squeezy fidget toys
  
• Squeeze toys -- balloon pump, paint sprayer, large squirt gun or spray bottle
• Ziplok bags -- keep thumbtip and fingertip together rather than using a "key grip" (aka "lateral pinch").
  
• Buttoning, snapping
• Find some fun toys for this at this link. Check out the bear popper and squeeze flashlights.