When I started working at an institution for individuals with developmental disabilities in the 1990s, I realized that many clients avoided using their hands together (bilateral hand skills). This was more often due to a sensory processing disorder than a neurological disorder such as hemiplegic cerebral palsy or a stroke. Staff often adapted activities so that clients could more easily perform them with one hand. After I was hired, I went to work training the staff on how to encourage using both hands together, even if only to stabilize materials.
I also realized that many clients were bored with ring stacks, so I began adapting activities that were similar such as stacking cardboard or wooden pieces with 2 holes in them such as shown below. These are extremely difficult to perform using only one hand! Folding or unfolding stiff paper such as contact paper (these were abundantly available at the program) added a step to make the task a bit more challenging. Some clients were able to fold these in half or in quarters to stack on the dowels. Other clients were able to unfold the pieces to use on a four dowel activity. I love this versatility…..