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Dexterity with Parkinson's Disease

Written by Kristi Riker OTD, OTR/L


Parkinson’s and Dexterity or ‘Fine Motor Control’:


Fine motor control is the skillful use of the hands and fingers to perform tasks that require coordination, precision, and control. What are some everyday tasks that require these skills? Buttoning a shirt, tying your shoes, writing/typing, using utensils, playing instruments. And the list goes on. This is a skill that is essential for daily life and unfortunately, it is also a skill that tends to decline with the progression of PD.


Why is My Fine Motor Control Declining?


Studies reveal that we can attribute this decline to dysfunction in the basal ganglia-thalamus-cortex loop (Lorek, 2024). Quite the mouthful! In short, this loop includes a series of brain circuits required for movement planning and execution. And due to the dopamine depletion caused by PD, this loop gradually struggles to run smoothly. Quite frustrating when you’d like to tie your shoes and the circuits in your brain say, ‘not today!’ It’s a good thing we’re fighters. SO, what can we do about this??



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Basal ganglia

-thalamus-cortex loop



Dexterity Programs

Completing fine motor exercises daily can be a great way to fight back. Research indicates home-based dexterity rehabilitation programs are particularly promising due to feasibility, convenience, and potential for real-life functional benefits. These ‘dexterity programs’ are fine motor exercise routines created by an occupational or physical therapist. Here is an example of an exercise protocol designed for someone with PD.



Frequency:

  • 5–6 days/week, ~20–30 minutes/day

  • Best if done when medications are “on”



Warm-Up (2–3 mins)

  • Hand stretches: open wide and close fists × 10

  • Wrist rolls: slow circles, both directions × 10

  • Finger taps: tap thumb to each finger sequentially × 10



 Daily Core Exercises (Choose 4–5 per session)

Activity

Duration/Goal

Tools Needed

Therapy putty squish & roll

3–5 minutes: alternate pinching, squeezing, rolling

Therapy putty or Play-Doh

Purdue-style peg task (see link at bottom)

Insert/remove 20 pegs, 3 rounds

Pegboard or DIY (toothpicks + sponge)

Button & zipper board

(see link)

Fasten/unfasten 5 times

Button board or old shirt

Spoon transfer

Move small beans between bowls

Spoon + 2 bowls + dry beans

Coin stacking

Stack 5–10 coins as fast as possible

Coins

Handwriting practice

Trace letters, copy a sentence

Pen and paper or calligraphy workbook

Playing cards task

Shuffle, deal, sort cards

Deck of cards

Clothespin pinching

Place/remove clothespins on edge

10–15 clothespins

Beading or threading

Thread 10 beads in a row

Beads + string or shoelace




Cool-Down (1–2 mins)

  • Shake out the hands

  • Gentle hand massage

  • Deep breathing × 3



Side note: here are some fun activities to exercise your dexterity:

  • Music rhythm tapping: Tap out rhythms to your favorite song

  • Art tasks: Watercolor painting, coloring books, calligraphy

  • Jenga or stacking games: Use small blocks for challenge and focus

  • Puzzles!


Technology-based interventions

New technology is constantly being developed and used in innovative ways. While sometimes intimidating, technology can actually be an amazing resource for improving fine motor skills. Research studies are using advanced technology such as virtual reality to assist in supporting physical needs. Virtual reality (VR) is a technology that simulates a 3 dimensional environment, allowing users to interact with a computer generated world. Some VR systems include the use of special gloves to complete fine motor control tasks, such as hand tracking, object manipulation, and finger movement coordination. These simulations allow fun, repetitive, and adjustable-difficulty training, which helps build dexterity, coordination, and reaction time. 


Here is a video of an individual using VR to make cookies: 

If virtual reality is not accessible for you, smart phone apps are a much more accessible way to use technology for fine motor support. Here are some smart phone applications that can help with dexterity: 

  • Dexteria

  • Touch Trainer

  • Blob Opera

  • Guitar Hero



Adaptive Equipment:

If fine motor tasks have become a large barrier for you, here are some adaptive devices that may make every day tasks much easier:


Utensils: These handles eating utensils are great for arthritis pain and tremors;




Plates: These lipped plates have silicone one the bottom to prevent sliding and a high rim to prevent spills off the side of the plate.



Button/zipper aids: A button/zipper aid has a loop to pull buttons through your shirt holes and a hook to latch and pull zippers




Slip on shoes: These sneakers essentially have a built in “shoe horn” to more easily slip shoes on without the use of your hands;





References:


Vasu DT, Hui Lim M, Fong WH, Choong PK, Chou LW. Evidence-Based Physiotherapeutic Interventions Enhancing Hand Dexterity, Activities of Daily Living and Quality of Life of Parkinson's Disease Patients: A Systematic Review. Can J Neurol Sci. 2024 May 30:1-13. doi: 10.1017/cjn.2024.53. Epub ahead of print. PMID: 38812333.


Lorek K, Mączewska J, Królicki L, Chalimoniuk M, Markowska K, Budrewicz S, Koszewicz M, Szumowski Ł, Marusiak J. Motor cortex activation mediates associations between striatal dopamine depletion and manual dexterity in Parkinson's disease. Parkinsonism Relat Disord. 2024 Aug;125:107049. doi: 10.1016/j.parkreldis.2024.107049. Epub 2024 Jun 27. PMID: 38955097.


Yau CE, Ho ECK, Ong NY, Loh CJK, Mai AS, Tan EK. Innovative technology-based interventions in Parkinson's disease: A systematic review and meta-analysis. Ann Clin Transl Neurol. 2024 Oct;11(10):2548-2562. doi: 10.1002/acn3.52160. Epub 2024 Sep 5. PMID: 39236299; PMCID: PMC11514937.


Links:




 
 
 
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