Tools and Tips for Better Dexterity With MS
Symptoms from relapsing-remitting multiple sclerosis (RRMS) , the most common type of MS, often occur in the hands. This is the result of lesions, scarring, and inflammation from the disease appearing in parts of your brain or spinal cord that control your hands, explains neurologist Tirisham Gyang, M.D., who specializes in treating MS at The Ohio State University Wexner Medical Center in Columbus. “That can cause weakness, making many tasks difficult,” she says. MS also can cause tremors in the arms, which makes hand coordination difficult.
Motor Coordination Can Be Affected
Fine motor movement, like buttoning a shirt, may become impossible with MS. “Some people with MS never wear clothes that have buttons,” says Dr. Gyang. Tremors can be so bad that whenever you lift a spoon or fork, the food just spills off of it. “If you’re having difficulty feeding yourself, that’s not a trivial issue,” she adds. “Your hands are essential. You need them for activities of daily living.” The good news? Whether you struggle with getting dressed, writing, eating, or any task that require your hands, you can regain your abilities with exercises prescribed by a physical or occupational therapist.
Early Intervention Is Key
The first step is to recognize the problem. “Sometimes, symptoms are very subtle,” says Dr. Gyang. Catching signs of hand disability early and starting therapy right away may prevent difficult-to-treat contractures, which can cause a muscle to completely lock up. Regular exercises can greatly help, too—and when you work with a specialist these moves will be tailored to your specific symptoms. “Exercise will help you to utilize what you do currently have and to use it more efficiently,” says Dr. Gyang. “Go to a PT and learn what to do and how to do it the right way.”
Set Individualized Goals
You and your physical therapist will prioritize what’s meaningful to you to set tailored goals. And since MS often leaves you with limited reserves of energy, you may have to decide what you’re willing to let slide, says physical therapist Matthew Caraher, P.T., who specializes in neuromuscular diseases like MS at the University of Miami Hospital. If you’re an avid gamer, for example, nimble fingers for your Xbox controller may be more important to you than, say, handwriting holiday cards. “I can help you get a dictation app so you can save your energy for your Xbox,” explains Caraher.
Try Stress Ball Therapy
Your PT likely will recommend that you use a stress ball to help develop better grip strength in your hands. These balls come in different sizes and a variety of colors, each of which denotes a different degree of resistance, meaning the amount of grip strength required to squeeze. The right ball for you will depend on your current strength. Some are soft and easy to squeeze, while others are much firmer. “This is something that a lot of people use,” says physical therapist Grace Schaffner, D.P.T., an MS specialist who also works at The Ohio State University Wexner Medical Center.
Practice With Rubber Bands
While you work on grip strength, don’t neglect another critical ability. “Equally important is our ability to extend our fingers,” says Caraher. “A lot of things we do with our hands are a combination of flexion and extension.” He frequently recommends an exercise that employs something you probably have around your house in abundance: rubber bands. “Often, I’ll tell someone to find a rubber band, wrap it around your fingers, and practice spreading your fingers to open them up and get that extension of the fingers,” he adds.
“Playing” With Putty Helps Flexibility
Schaffner says that another helpful tool for finger flexibility is therapeutic putty. Like stress balls, putty comes in different resistances that offer varying levels of challenge. You can squeeze it, or press and roll it on a table with your fingers extended. Use it to practice flexing your fingers, either individually or all at once. Let your PT decide which exercises will provide benefits and which to avoid, as well as how much exercise you should do. “Hands can be very sensitive to over-stretching and over-mobilizing because they have so many small joints,” says Schaffner.
Finger Tap for Better Coordination
If you struggle with coordination, there are exercises to help you develop it. One example that Schaffner offers is a simple thumb tap. Tap your thumb with each finger, one at a time starting with your index finger. Work down to your pinkie and then reverse, moving back to your index finger. Your PT can tell you if this will help you and, if so, how often you should practice the movement. Repetitive coordination exercises like this help retrain your brain so that it makes new connections to do the work of brain parts damaged by your MS.
Train With Everyday Tasks
Grab a pen and paper! “One of the best things for working on hand coordination is practicing your handwriting skills,” says Caraher. “That’s an extremely coordinated task.” The simple act of picking up a cup can be helpful, too. Lift a cup just using your first and third fingers and thumb. That requires a different amount of coordination than grabbing it with your whole hand, says Caraher. And if you struggle with buttons? Practice with large buttons first rather than the size that gives you difficulty. As you improve your abilities, try smaller and smaller buttons.
Find Your Exercise Sweet Spot
Begin with the end in mind, Caraher advises. By this he means to work towards your goal, then work to maintain to your progress. “This will be a lifelong commitment, but lifelong commitment does not mean that you will always have to do these exercises every day,” he says. Eventually, you may be able to reduce the frequency of certain exercises. For example, if handwriting exercises four times a week gets you where you want to be, drop those exercises to once or twice a week. Unless your handwriting starts to deteriorate, you likely have found your sweet spot.
Keep in Contact With Your PT
Once physical or occupational therapy has ended, be sure to follow up with your therapist every three to six months. “It’s extremely important to have an ongoing relationship with your PT,” says Caraher. If your coordination in your hands starts to worsen, check in. You may not need an appointment or new exercises. You may simply need to boost what you’re already doing. And that might just take a quick email or phone call to get you on the right path again. “Be empowered by your own knowledge,” says Caraher.
Go at Your Own Pace
Don’t compare yourself—or your progress—to others. Work at your own pace to achieve your set goals. “Be kind to yourself, especially when just starting an exercise program,” says Caraher. “Give yourself the chance to grow.” You’ll also benefit physically by taking things at a deliberate rather than a rushed pace. Here’s a guideline from Caraher: If you still feel drained two hours after you exercised, you overdid it. “That’s OK on occasion,” he says. “But if you consistently and frequently overdo it, you won’t see progress because you’re continuously beating your body down.”
Multiple Sclerosis: Mayo Clinic. (2020). “Multiple sclerosis.” mayoclinic.org/diseases-conditions/multiple-sclerosis/symptoms-causes/syc-20350269
Multiple Sclerosis: National Multiple Sclerosis Society. (2020). “What Is MS?” nationalmssociety.org/What-is-MS