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


Leanne Suero

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:

Universal cuff

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.

Sock aid

Assists a person with only one useful hand in putting on a sock without having to reach down to their foot.

Button hook

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.

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Stroke Rehabilitation

Making the Best Decisions at Discharge After Stroke

The type of rehabilitation and support systems a survivor receives at discharge can strongly influence health outcomes and recovery. In this, the first part of a two-part series on stroke rehab, we offer guidance for the decision-making process required when it’s time to leave the hospital.

What to Expect from Outpatient Rehab

After stroke, about two-thirds of survivors receive some type of rehabilitation. Outpatient therapy may consist of Several types of therapy. Whether a patient is referred to inpatient or outpatient therapy depends on the level of medical care required.

What to Expect in Stroke Rehab

Following a stroke, about two-thirds of survivors receive some type rehabilitation. In this second of our two-part series, we want to alleviate some of the mystery, fear and anxiety around the inpatient rehab part of the stroke recovery journey.
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AHA-ASA Resources

The Support Network

When faced with challenges recovering from heart disease or stroke, it’s important to have emotional support. That is why we created a network to connect patients and loved ones with others during their journey.

Caregiver Guide to Stroke

The Caregiver Guide to Stroke is meant to help caregivers better navigate the recovery process and the financial and social implications of a stroke.

Stroke Support Group Finder

To find a group near you, simply enter your ZIP code and a mile radius. If your initial search does not pull up any groups, try

Tips for Daily Living Library

This volunteer-powered library gathers tips and ideas from stroke survivors, caregivers and healthcare professionals all over the country who’ve created or discovered adaptive and often innovative ways to get things done!

Stroke Family Warmline

The Warmline connects stroke survivors and their families with an ASA team member who can provide support, helpful information or just a listening ear.

Let's Talk About Stroke Patient Information Sheets

Let's Talk About Stroke is a series of downloadable patient information sheets, created by the American Stroke Association, that presents information in a question-and-answer format that's brief, easy to follow and easy to read.

Request Free Stroke Information Packets

Fill out this online form to request free information about a variety of post-stroke topics.
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Stroke & Parts of the Brain

When Stroke Affects the Occipital Lobe

Our occipital lobe, the smallest of the four lobes of the cerebral cortex, controls how we visually interpret our world.

When Stroke Affects the Cerebellum

The cerebellum contains 80 percent of our neurons. Its job seems to be to make things better. We talked with neuroscientist Jeremy Schmahmann about how stroke affects the “little brain.”

When Stroke Affects the Parietal Lobe

The parietal lobe helps us make sense of sensory information, like where our bodies and body parts are in space, our sense of touch, and the part of our vision that deals with the location of objects.

When Stroke Affects the Frontal Lobe

Of the four lobes that make up the cerebral cortex, the frontal lobe is the largest. It plays a huge role in many of the functions that make us human — memory, language, movement, judgment, abstract thinking.

When Stroke Affects the Temporal Lobe

The temporal lobe has several functions, mainly involved with memory, perception and language.

When Stroke Affects the Brain Stem

The brain stem serves as a bridge in the nervous system. It sits at the top of the spinal column in the center of the brain. When a stroke happens there, it can cause a few different deficits and, in the most severe cases, can lead to locked-in syndrome.

When Stroke Affects the Thalamus

The thalamus can be thought of as a "relay station," receiving signals from the brain’s outer regions (cerebral cortex), interpreting them, then sending them to other areas of the brain to complete their job.
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Stroke Notes

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Everyday Survival

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Simple Cooking

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Helping Others Understand

Stroke affects people differently and many of the effects of stroke can be complicated. Helping friends and family understand how a stroke is affecting a survivor can help everyone involved.

Support Showcase

Our new department highlighting the good work being done by stroke support groups from around the nation. If you are part of a successful support group we should consider featuring, let us know!