I've made quite a few noters for "special needs" hands...Instead of the usual 3/8 diameter, using thicker and sometimes longer noters help a lot. I have some customers that have found a great help by sizing up to 7/16, and some that are even using 1/2 inch diameters. Varied lengths as well to help in the holding and leverage. A thumb/ finger notch is also an added help.

 The thicker noters can be a bit more tricky as you go down the fret board, but the trade off of being ABLE to play seems to be worth it...

Was just now on Reddit and had a person pop up in the Mountain Dulcimer community there with questions about playing the Mountain Dulcimer with health issues in his hands that he’s working on a diagnosis for. I wanted to share the answer I gave him here, and would welcome any other insight folks might have for future reference:

” I’ve got some kind of general connective tissue disorder that runs in my family that resembles hypermobile Ehlers-Danlos syndrome but comes with a side of Dupuytren’s contracture, which I have in my right hand, so far not in my left but I suspect it will arrive eventually. I also have congenital MCP joint lock in the thumbs of both hands. So, my hands have reduced strength and flexibility all around and yet dulcimer is a dream instrument because it matches my ergonomic needs better than any other instrument I’ve tried. Some info I’ve figured out as a still beginner player:

Picking/strumming hand: I’ve got a whole collection of different picks as I’ve tried to find what works for me, as my hand flexibility decreases over time. I find I like a pick with good flexibility as it compensates for my lack of same. Dunlop nylon .46 mm are my go-to for flat picking, but they might be too small for some folks. Blue Mountain blue thumb picks for finger picking are great, and I’ve been playing around a bit with Oud picks for fast strumming, which isn’t something I do much of, as their length and flexibility makes for less hand/wrist strain for me.

Chord/noter hand: Set up of the instrument is key. I had a previous dulcimer with high action, among other problems, and it was a complete life changer when I got a dulcimer with lower, easier action. Depending on your playing style you might find a three string (no doubled melody string) easier to manage. VSL is also key - don’t overstrain your hands by trying to play an instrument that’s VSL is just too long. My dulcimer at the moment has doubled strings and it’s VSL is a little too long for me to chord easily so it’s going to be my noter/drone dulcimer and I’ll be getting a New Harmony Pudge Pro soon, which has the VSL and three string setup I need, on the advice of my dulcimer teacher.

Hope this helps!”