Working on Fine Motor Skills
Fine motor skills are how we use our hands and coordinate the small muscles that control our fingers. Those skills, along with other arm functions such as reaching and grasping, can be affected by stroke. The stroke’s severity determines the extent of this weakness.
A stroke may affect many upper extremity functions:
- motor control
- one’s perception of where their body is in space (known as proprioception)
- decreased sensation
- shoulder weakness
- weakness in the wrist and hand
These can have a serious impact on a survivor’s life, particularly on how they are able to manage many essential activities of daily living (ADLs).
Something as basic as putting on a shirt shows us the importance of fine motor skills. The survivor must pick up the shirt, orient it, put his/her arms through the sleeves. They must pull it into place and manage buttons, zippers or other fasteners. All of this can be challenging with impaired fine motor skills.
To maximize independence with ADLs and mobility, survivors benefit from rehabbing these skills with an occupational therapist.
Fine motor skill therapy may be either inpatient or outpatient, depending on the severity of the stroke and where the survivor is in their recovery process. Occupational therapists (OTs) in each setting determine their plan based on the needs and goals of the survivor.
Occupational therapy usually involves at least one of these types of interventions:
- Participating in ADLs: Things like buttoning a shirt, tying shoe laces, cutting food, opening food containers and performing toilet hygiene use fine motor skills and encourage their use in other everyday tasks.
- Functional tasks like combing your hair, feeding yourself or brushing your teeth.
- Therapeutic activities that are less functional, like stacking cones or threading beads on yarn. Typically, therapeutic activities help to address more specific aspects of fine motor skills deficit, like addressing specific grasps such as a lateral pincer grasp, which you use when turning a key, or a dynamic tripod grasp, which allows you to hold a pen.
- Many fine motor skill deficits involve muscle weakness. Therapeutic exercise can help. Performing bicep curls or chest presses and using free weights to build strength and muscle are examples. This helps maintain current strength and/or create gains in strength.
- Neuromuscular electrical stimulation involves using a device that delivers electrical impulses to nerves causing the muscles to contract. The goal is to regain movement and strength.
- Massed practice is long sessions with a lot of repetition performing a specific task, like stacking cones, during a specific interval of time. The idea being that “practice makes perfect.”
- Constraint-induced movement therapy: Based on the principle that movement in the affected hand or arm can be strengthened and increased by constraining the unaffected hand: a mitt on the “strong” hand, forces use of the affected hand. By focusing the use of the recovering hand or arm, constraint-induced movement therapy helps prevent “learned non-use,” which occurs when survivors prefer their unaffected hand to do things.
After rehab, it is important for survivors to keep doing things that encourage fine motor skills, like dressing and feeding, as independently as possible. Therapists also provide home exercise programs so survivors can use the skills and activities learned in therapy in their everyday routines. It is important to make every hour of the day count. These home exercise programs help maintain the gains made in therapy that enable survivors to become as independent as possible.
When fine motor skills are taking time to recover, an OT can also help find ways to compensate to encourage independence and function. It is important to find ways for a survivor to be successful in their everyday lives throughout their recovery process. There are hundreds of tools and strategies that can be used to compensate for impaired fine motor skills; here are some examples:
This piece of adaptive equipment lets the survivor hold a pen, an eating utensil, a toothbrush or other objects despite a lack of strength or coordination in the hand. The universal cuff wraps around the hand just below the fingers and has an insert where the object can be placed.
Assists a person with only one useful hand in putting on a sock without having to reach down to their foot.
Allows a survivor to button a shirt with only one hand.
A person’s home can also be adapted to allow more accessibility. Things as simple as changing a door knob or a handle on a cabinet can enable a survivor to open doors and lessen the need for assistance at home. Independence can be achieved in many ways, and it is our goal as occupational therapists to ensure that stroke survivors can live life to the fullest.