Piano Playing as a Hobby for Children With Problem Hands

LORRAINE B. ERICKSON


Providing a child with an opportunity to learn to play the piano as a hobby and to enjoy music can bring a lifetime of pleasure. While music will enrich any child's life, we have found that children with serious hand and arm problems especially amputations and severe deformities and deficiencies? can derive even more benefits, happiness, and satisfaction from playing the piano than the average child. Therefore, we are eager to share our experiences and ideas in the hope that other children may be helped.

A Variety of Disabilities

The little girl pictured in Fig. 1 is five-year-old Susan, who plays the piano with her own right hand and the hook of her left above-elbow prosthesis. She was fitted with her first prosthesis when she was eight months of age and is now very much a two-armed and two-handed individual. She loves her prosthesis and has great fun playing the piano with it. This she does with her prosthetic elbow locked at about 90 deg. of flexion. A heavy rubber arrowhead slipped over her inside hook finger makes a firm "finger" to play with ( Fig. 2 ). Susan began taking piano lessons at the age of five years and within a few weeks had learned to play three of her favorite songs well by rote and had played for her class at preschool.

Susan began taking baton lessons at the age of four and is a two-handed twirler. She recently won first prize in a baton-twirling contest in Wyoming ( Fig. 3 ), and now has won three trophies competing with non-handicapped children. She can tie her shoelaces and bows, enjoys cooking, sewing, and embroidery, and is a good ice skater. She is a very friendly girl, has a good sense of humor, and enjoys demonstrating her prosthesis for people.

The boy pictured playing the piano with his below-elbow amputation stumps in Fig. 4 is ten-year-old Buddy, a quadruple amputee who lost both hands and part of both legs from a rare blood disease at the age of 13 months. He can play the piano beautifully and is very proud of his accomplishment. He loves to amaze people with his skill and dexterity and the "grown-up," full-sounding music that he plays. He is always delighted to be asked to play, and has played at school and elsewhere many times. His mother is very enthusiastic and says that learning to play the piano is the best thing that ever happened to Buddy.

Buddy wears prostheses and can play the piano with his hooks ( Fig. 5 ). However, he himself decided that he preferred to play without them so that he could feel what he was doing and have more freedom of movement. In playing with his stumps Buddy must hit single white keys on the very edge as shown in the picture. This takes great accuracy but is easy to do after a little practice. He has no problem in hitting single black keys which are raised and separated by considerable space. He has his own anatomical right knee and can use the damper pedal even though he cannot feel his prosthetic foot on the pedal.

Buddy is a very well-adjusted, sociable boy who has always gone to regular public school and taken part in all school activities. He has a good sense of humor and is one of the most popular boys in school. Life is a real challenge to him, and he probably does more things than the average boy, as he loves all sports, arts, crafts, and music and will try anything. He has become a real expert at finding ways to do all the things he wants to do, and is very confident, self-sufficient, and proud of all his accomplishments. He is especially proud to have qualified to drive a quarter-midget racing car and to be able to race in regular competition with children of his own age and win his share of trophies.

Shown playing the piano with her own right hand and a cosmetic left hand in Fig. 6 is 14-year-old Rhonda, who lost her left hand and about half of her forearm in a power meat grinder at the age of 13 years. She had had five years of piano lessons and thought she would never be able to play again. Five months after her accident we began her piano lessons. With a rubber arrowhead over the inside hook finger she played the piano well with it immediately, using her prosthesis readily and with surprising control for a recent amputee ( Fig. 7 ). Her below-elbow prosthesis is of the so-called Münster type.

Playing with good liming and expression is emphasized and Rhonda says she is playing the piano better and having more fun now then she ever did before her accident. She enjoys playing for all her relatives and friends and is now piano accompanist for the junior choir at church. She is interested in many sports and is active in her school athletic program where she is a member of the track team.

Although it is much heavier than her hook, Rhonda always wears her Dor-rance No. 3 functional-cosmetic hand to school and for social occasions. We therefore felt it was worthwhile to find a way for her to play the piano with it also. She tried holding a rubber-tipped pencil but found that it would slip after a while even through the hand holds it quite firmly. Since the middle finger extends slightly below the others, we tried slipping various things over the end of that finger to extend it further.

The thing that works best for her is a 10c rubber fingertip (available at office supply stores and worn by office workers for sorting papers). Into the end of this tip we drop a cylindrical piece of heavy rubber 3/8 in. to ½ in. thick, and then slip the top of the rubber finger over the end of the middle finger of the cosmetic hand ( Fig. 8 ). This adaptation extends the finger far enough below the others to permit her to strike a single piano key with it and also to see where she is playing. The rubber fingertip must fit tightly over the end of the middle finger after the piece of rubber has been dropped into the end. For Rhonda's prosthetic finger the smallest size rubber fingertip (#11) works perfectly.

Pictured in Fig. 9 playing the piano with just her left hand is 8-year-old Barbie, who is one of only about 20 thalidomide children born in the United States. She was born with her right arm and part of her right shoulder missing (amelia). Her left arm is fused at a slight angle at the elbow, and there are some limitations in her wrist and fourth and fifth fingers. She developed a severe scoliosis so that her spine was bent into a "C" and her lung capacity was reduced to one-third of normal. At the age of 6½ years she had drastic but extremely successful surgery to straighten her spine with an 8-in. steel rod inserted to hold it straight. Thus she also has limited movement in her spine.

We never teach a child to play the piano with just one hand if she can use a prosthesis, her stump, or hold something with which to play. However, Barbie's doctors do not recommend a prosthesis for her at this lime, so as soon as they would permit it we started her piano lessons using just one hand. People hearing her play are always amazed that it sounds like she is playing with two hands.

Should Begin Early

To have something beautiful and creative like piano playing to talk about and share with others and to take pride in his prowess can give a tremendous lift to a child and his parents, and contribute greatly to the development of a positive, healthy attitude toward a serious hand problem. Therefore, it can be very helpful for such a child to start playing the piano as soon as he can understand the relationship between the black and white keys. Depending upon his maturity, a child as young as five years, or possibly four, should be able to have fun learning to play many favorite songs by rote even before he can read music. My youngest student started lessons at the age of 4½ years and plays the piano with her own left hand and her prosthetic right hook. Both she and Susan were already learning to read music at the age of five years, which is very young for this accomplishment.

The piano is an excellent instrument for hand problems because it can be played by hitting the keys in any manner that the child can manage. A pedal can be used to sustain the sound of some notes while others are being played, thereby making it possible to spread the notes out over a wide area of the keyboard. Thus a beginner can produce music that is surprisingly full-sounding and satisfying by playing just one note with each hand, or using only one hand if absolutely necessary.

If direct contact by any finger or part of the hand or arm is not possible, the child may be able to hold an object like a pencil and hit the keys with it. As long as he can hit the keys with sufficient strength and control this is all that is needed. A child using prostheses well need not even have his own elbows or much upper arm. A piece of heavy rubber tubing or a rubber arrowhead slipped over the tip of the inside hook linger (the one nearest the body) makes a soft but firm "finger" with which to play. Junior small-game rubber arrowheads (these kill by impact rather than by penetration) are available from sporting-goods stores in a box of six for $1.75. These arrowheads will slip over the tip of any size hook from Susan's baby hook to adult size, and will also fit the end of a pencil, dowel stick, or drum stick. Since the original arrowheads are a little too wide (5/8-in. diameter) to strike the keys properly, we grind them down to about ½-in. diameter ( Fig. 10 ).

Playing the piano with a prosthesis is not only great fun for the child, but it also helps to develop good coordination and encourages him to use his prosthesis easily and readily so that he will be truly bimanual.

Music Must Be Satisfying

We feel that it is easier to start playing the piano when we do not have to be concerned with coordinating ten perfect fingers. We can then concentrate on the music and from the first lesson play full-sounding, satisfying arrangements of the child's favorite songs. We believe the sound of the music a child with serious hand problems learns to play is of great importance. The child with hand problems may feel inadequate and become discouraged if the music he plays is thin and beginner sounding. Most children love to play folk, traditional, and popular songs which they and their friends know. Each child's music-is arranged to fit his own abilities so that nobody ever sounds like a beginner. My students love the sound of their music and can hardly wait to learn something to play for their family, friends, and at school. Often they have enough confidence and ability to play at school after only two or three lessons.

A beginner should be able to learn to play the song on page 13, which is well known to everyone. Both 5-year-old Susan and Barbie (then 7) played this music for their classes at school after only two lessons. If one holds a pencil in each hand and plays with the eraser end, pressing the damper pedal down at the beginning of each measure and holding it down throughout the measure, it will be noted that this music sounds full and satisfying even though only one note is played with each pencil at any one time. Any note too low for a very limited reach may be played an octave higher. This music can also be played with one hand if necessary.

We have read articles about children with thalidomide birth defects who have very short arms and several fingers (phocomelia), and have examined their photographs with great interest. We feel that children with these and other deficiencies and deformities could learn to play the piano well and derive great pleasure and many benefits from it. To insure good posture we suggest that they might hold something in their phocomelic hands with which to reach the keyboard and hit the keys?possibly a drumstick or a longer and lighter-weight stick, with the playing end rubber-lipped. Those whose arms are long enough might also try silting on a lower stool so they can extend their arms to the keyboard comfortably. Although their range would be more limited, they would have the advantage of playing with their own fingers.

One of my students has one normal arm and hand, and one tiny arm with two small but quite strong fingers which cannot be seen even when she is wearing a short-sleeved blouse. Her deficiency (phocomelia) looks very much like those of the thalidomide children. She has never been able to wear a prosthesis without great pain, so she plays the piano by holding a dowel stick (a three-foot-long dowel stick 5/16 in. in diameter costs 10c at the lumber yard) about two feet long and the diameter of a pencil, with her two small fingers. This stick is light weight and strong, and a rubber arrowhead is placed over the playing end ( ). This keeps her back straight and her shoulders level, which is especially important since she has had surgery for double scoliosis. A piece of foam rubber could be wrapped around the top end of the stick and secured with a rubber band to make it easier to hold. If more support is needed to hold and control a stick, the top end could be held under the arm or propped on the child's shoulder.

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Many Possibilities

No problem is too great. A child who does not have any arms or cannot use his own or prosthetic arms could even hold something in his mouth with which to play, or use his toes, and have fun playing a melody. If he cannot sit at a piano, he could play a small inexpensive electric chord organ (cost about $15 on sale at discount stores) placed across his wheelchair, or the chord organ could be placed on the floor and played with the toes.

The man pictured is playing an electric piano with the eraser end of two pencils attached to a tongue depressor held in the mouth, giving him a range of about two octaves ( Fig. 11 and Fig. 12 ). Although he is completely paralyzed below his neck from polio, he is the leader of a country and western band and a gospel-singing group, and plays and sings many professional engagements with them. He has composed over 100 songs and made recordings. He has freed himself from a respirator by mastering glossopharyngeal breathing, which he does while playing or singing.

To prepare a tongue-depressor-and-pencil mouth stick for playing the piano or electric organ, place the unsharpcned ends of two pencils about 1 1/4 in. from one end of a tongue depressor and attach them firmly with a rubber band. Spread the eraser ends of the pencils so that the left one strikes the center of a white key. Skip the next white key to the right, and center the right pencil in the middle of the next while key. Tape the two pencils in this position across the bottom of the tongue depressor and again in the middle. Wrap large, plain gauze bandaids, or slip a piece of rubber tubing, around the top end of the tongue depressor to cover any splinters and make it easier to hold in the mouth

For a beginner, tape a single unsharpened pencil down the middle of a tongue depressor in this same way.

More and more we read statements by educators and psychologists who believe:

  1. There is a definite correlation between coordination and motor-learning ability in children.
  2. Children who are learning to do things with their hands have a better feeling about themselves and are more confident in starting school.
  3. Children who are learning to read music read their school books better, as music is good preparation for both reading and mathematics. Learning to play music also improves concentration and teaches perseverance.

Besides the specific benefits to be gained of improved coordination, dexterity, confidence, and poise, piano playing encourages and challenges a child with serious hand problems to use what he has with imagination. A child who has one hand missing or disabled may tend to use his good hand only. Piano playing gives him something that is fun to do with both hands, thus encouraging him to use a prosthetic or deformed hand more easily and readily.

We do not worry about how others play the piano, or what they play. Instead we encourage the child to find a way he can play, to develop his own techniques, and have fun playing the things he likes. This should help him to realize that it does not matter if he cannot do things the way everyone else does, but rather what is important is to challenge himself to find his own way to do things. Children have a great deal of imagination and will enjoy finding ways to do things if adults will have confidence in them and encourage them.

Social Benefits

Piano playing can be especially helpful socially to a child with hand problems which attract attention, for it gives him something beautiful and creative that he can be proud to talk about and share with others. Since it is impossible to prepare the world to meet the child with understanding, ease, and intelligence, we must prepare the child to meet the world and handle any situations he may encounter. It is an unfair and unfortunate fact that the burden is on the child to make others feel at ease with him. Nevertheless, if he feels good about himself, others will feel comfortable with him, and will enjoy him tremendously. A good sense of humor is invaluable, needless to say. People find prostheses very fascinating and often will be rude enough to stare or even follow a child around in an effort to get a better look. The attitude of the child's parents is extremely important. With their help he can learn to explain what happened to him (whether accident, illness, or birth defect), to discuss his prosthesis with ease and confidence, and to be proud to demonstrate how it works and all the things he can do with it.

People who do not know him may think a child who has lost his hands or an arm can't do very much, so it can be very helpful for him to be able to talk about his piano playing and demonstrate his ability. Being able to play the piano for people can help the child develop a good feeling about himself and a great deal of poise, self-confidence, and pride in his own accomplishments. Piano playing should be helpful to him all his life?to help put people at ease, to entertain, and to demonstrate quickly how very capable he is. My students find it a great social asset to be able to play the piano for visitors at home and for their class at school. It also gives them considerable status with their friends who are probably having greater difficulty than they in coordinating ten fingers to play the piano.

Summary

Children are remarkable people and, given the opportunity and encouragement, can accomplish far more than seems possible. They can learn to consider their problems a challenge, rather than a handicap, and to take great pride and pleasure in finding their own ways of doing things. When they learn that they can play the piano so long as they can hit the keys, children with serious arm and hand deformities and children without fingers, hands, or even their own elbows, will have great fun and surprise you with how quickly they find ways to play their favorite songs. If it is necessary to play the piano with something held in a deformed hand, rubber balls, plastic bottles with narrow tops, erasers, handlebar grips, pencils, tongue depressors, or rubber-tipped drumsticks, arrows, or any length stick needed to reach the keyboard may be tried. A child using a prosthetic hook can play well by covering the tip of the inside hook finger with a rubber arrowhead, heavy rubber tubing, or even a pencil-eraser tip. Something can be attached to a hand that cannot hold anything, or the child can hold a pencil or padded stick in his mouth if necessary. It must be emphasized, of course, that the child should begin to learn to play the piano with the approval of his physician.

Instructional Booklet

A book of easy instructions with a collection of full-sounding, satisfying arrangements of songs everyone likes to play and sing is in preparation for use by therapists and parents of children with hand problems. Since developing a good piano technique and a beautiful playing style with two perfect hands is not a consideration, one need only to be able to read music and play the piano competently to help a child start playing and developing his own techniques. Anyone with a working knowledge of keyboard harmony should also be able to use the music in the book as a model to arrange other songs. In order to adapt to the widest variety of hand problems, the songs in the book will be "pencil pieces" for piano?that is, playable with a right hand and a left pencil (or hook, or whatever the child decides he can hit the piano keys with best), a left hand and a right pencil, or with two pencils if necessary. We welcome any inquiries and suggestions.

Boulder, Colorado