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Fine Motor Activities for Adults in Occupational Therapy 

Adult Place Settings

For better or for worse, many areas of practice within the medical model equate occupational therapy with the upper body. For this reason, occupational therapy practitioners really need to make sure that we are designing our treatments to incorporate our knowledge of anatomy, healing, and occupations. How do we incorporate occupations? We ask what our client is struggling with and we use activity analysis to break it into its structures, functions, and performance skills so that we can clearly define which aspect of the occupation is being impacted….and why

 

This is the part where people get lost. Occupational therapy practitioners become so caught up in making sure it looks like an ADL or IADL that we forget that this is not always the way to restore or maximize function being impacted by the impairment or deficit! You must use activity analysis to rebuild the human function required to perform the activity or task (using all domains of occupational therapy!) 

 

So what does this mean? 

 

In order for you to understand what this means, I need to first address what it does not mean. If someone comes to you and has fine motor range of motion and strength deficits caused from an exacerbation of an arthritic diagnosis, there is no that you can restore that function by having your patient cap and uncap toothpaste, turn the faucet on and off, use a windex bottle and have them wash their hospital room windows. PLEASE STOP DOING THIS. Instead, what should you do?  You would refresh your foundational knowledge on your patient’s diagnosis, you would interview your patient to discuss their daily lifestyle and pinpoint what they are doing that is exacerbating their condition. You know the exacerbating factors, because you know the condition, the prognosis, the mechanism of injury and healing, and you have done activity analysis on all of the referenced activities. At this point you provide patient education before engaging in a restorative plan of care to decrease symptoms manifesting from the exacerbation so that you can begin incorporating appropriate therapeutic exercise (which includes stretching/AROM) to maximize this person’s hand mobility. If you did what so many of these blogs and pinterest articles are telling you to do, you could perpetuate the dysfunction. If you always default to your arsenal of occupations before you do the work of a medical professional, you can hurt your patient, and decrease respect for the occupational therapy profession and process. Remember you are not an activity leader or companion care aide, you are an analyst with a medical license. 

 

Task Oriented (TO) Training, Motor Learning Strategies, and remaining within the OT Scope of Practice

 

With that said, it is important to note that occupation-specific or occupation-proximal treatments are warranted and necessary to master as an occupational therapy practitioner.

There is much supportive literature and research that discusses the value of task oriented training when a patient requires remediation in of neuromuscular behavior. Using a task close to or exactly the same as the components of movement, strength, power, coordination, and executive function required for the defined occupation yields faster and more lasting results than tasks that are reduced to one part of the activity. Even still, this can’t always be achieved if the person lacks the ability to safely and effectively perform a multi-faceted task. As an OTP, we need to know when to put it together and when to take the activity apart for the achievability and safety of our patient’s performance.

As a reminder: Make sure you are looking at The Bridge (If you have bought this CEU Course) for instruction on the most common pathologies impacting the upper extremity (shoulder, elbow, wrist, and hand).

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Assessments for Fine Motor Goals

Always make sure you have fine motor goals if you are going to be working on fine motor skills within your treatments. In order to ensure that fine motor goals are appropriate, you need use objective based assessments. They don’t all need to be standardized, but you absolutely should have a quantifiable or qualifiable number to measure success or non-success of your treatments! (You are a medical professional not an activity leader, you must do activities from goals that are measurable). 

 

If you are a BOT Portal member., use this very large list of occupational therapy assessments to find a good one! 

 

I personally like to use the following fine motor assessments for occupational therapy

  • Quick Dash
  • 9-Hole Peg Test
  • Dynamometer 
  • Pinch Gauge
  • Anecdotal-based revolutions of baoding balls for a 2-minute time constraint
  • Anecdotal-based 50 bead in-hand manipulation bead sort (looks at cog and FM!)

 

Fine Motor Activities for Adults

HANDWRITING ACTIVITIES WITH METRONOME FOR ADULTS

THERABAND : INTRINSIC AND EXTRINSIC HAND STRENGTH

Preparatory Methods: 

  • Paraffin Bath
  • Moist Heat
  • Vibration

 

Modifications: 

  • Use metronome
  • Change type of resistance band (different color)
  • Increase isometric contraction at end-range
  • Increased number of concentric contractions
  • Increase number of sets and repetition knowing that progressive overload is something you must abide by if doing therapeutic exercises 
  • Hang from the doorway and have client stand/balance during performance of this fine motor activity for adults.

 

Occupations:

  • Closing baggies
  • Sealing envelopes
  • Using nail clippers
  • Changing Diapers
  • Maneuvering sheets when changing the bed

BAODING BALLS : IN-HAND MANIPULATIONS

(Another resource on baoding balls) 

 

Preparatory Methods: 

  • Self-guided AROM routine isolating digits prior to coordinating grossly
  • Paraffin Bath
  • Moist Heat
  • Vibration

 

Modifications: 

 

  • Increase the # of desired revolutions
  • Modify the time-oriented goal (i.e. How many revolutions can you achieve in 2 minutes — increase from there for endurance). 
  • Increase the size/weight of balls
  • Increase environmental distractions
  • Provide a cognitive remedial component to make it a dual tasking activity

 

Occupations:

In-hand manipulation tasks

 

  • Coins 
  • Playing with your children (legos, small pieces) 
  • Medication management 
  • Job-related requirements (factor, mechanist, office, nuse) 
  • Act of prehension like handwriting

BEADS : IN-HAND MANIPULATION

Preparatory Methods: 

  • Self-guided AROM routine isolating digits prior to coordinating grossly
  • Paraffin Bath
  • Moist Heat
  • Vibration

Modifications: 

  • Adjust the amount of beads used
  • Set a time-oriented goal (Collect and place 50 beads in 3 mins)
  • Change the item being manipulated
  • Increase environmental distractors
  • Provide a cognitive remedial component to make it a dual tasking activity (color sort, having a sheet of ‘Rx prescriptions’ they must complete)
  • Provide a smaller/resistive target for the placement of beads (example: rip off a corner of an envelope and ask patient to hold with opposite hand while placing the beads with active hand) 

Occupations:

In-hand manipulation tasks

  • Coins (taking them out and putting them back into the wallet)
  • Playing with your children (legos, small pieces) 
  • Medication management 
  • Job-related requirements (factor, mechanist, office, nuse) 
  • Act of prehension like handwriting

Example rationale: 

The patient engaged in a kinetic-based therapeutic activity requiring the gathering of 20 beads into palm of right hand (and then left in seperate repetition) with subsequent placement of each bead into a small target. The task elicited fine motor coordination, in-hand manipulation, and mm endurance of intrinsic muscles of the the hand. Task requires translation, shift, rotation and stabilization of the objects within the palm space by eliciting mm involvement of the ring and pinky fingers while isolating movement of the beads with the thumb, index and middle fingers.

MONTESSOURI ACTIVITY SORT : IN-HAND MANIPULATION, FUNCTIONAL MOVEMENT OF FOREARM, WRIST, AND HAND

Brief Explanation: 

This kinetic-based fine motor activity for adults in occupational therapy is unique because it is a goal-oriented task that encompasses executive function, high-order reasoning, shoulder internal and external rotation, forearm pronation and supination, wrist flexion/extension, radial/ulnar deviation, and in-hand manipulation skills. This bridges the gaps and puts all functional movement of the upper extremity together in one activity! 

 

Preparatory Methods: 

  • Paraffin Bath
  • Moist Heat
  • Vibration

 

Modifications: 

  • Adjust the amount of beads used
  • Set a time-oriented goal (Sort all beads without dropping any in 5 minutes)
  • Increase environmental distractors
  • Provide a cognitive remedial component to make it a dual tasking activity (verbally instruct a sequence of colors [purple-yellow-red-green-yellow] pause for 10 seconds and ask client to complete the activity in that order by first collecting all of them in one hand)

 

Occupations:

 

This is a multi-faceted activity that incorporates functional movement patterns of each

arthrokinematic joint of the  upper extremity while being Goal-driven and Task  Oriented (TO)

COINS AND BINDER CLIPS : TIP, KEY AND CHUCK PINCH

Preparatory Methods: 

  • Paraffin Bath
  • Moist Heat
  • Vibration

Modifications: 

  • Set a time-oriented goal 
  • Varying levels of resistance of binder clips / clothespins
  • Place targets at opposite sides of tables or across room to promote greater mobility

Occupations:

  • Clasps and Keys
  • Light Switches
  • Work-related functions
  • (Office, factory, mechanist, construction)
  • Lifting pans out of oven
  • Putting dishes away

POWER WEB AND LIDS : FUNCTIONAL GRASP STRENGTHENING

Preparatory Methods: 

  • Paraffin Bath
  • Moist Heat
  • Vibration
  • Self A/PROM stretching and lengthening of hand mm.

Modifications: 

  • Choose between lower and higher resistance
  • Provide multiple sized lids/caps
  • Increase isometric contraction at end range
  • Change the position of the power web in space to elicit different stabilizing muscles
  • Increase number of repetitions/sets

Occupations:

  • Opening jars, lids, and caps
  • Carrying boxes or containers
  • Grocery Shopping
  • Meal Preparation

MISCELLANEOUS FINE MOTOR ACTIVITIES FOR ADULTS

THERABAND & CLOTHESPINS : UPPER BODY STRENGTHENING AND PINCH STRENGTH

 

  • Number of clothespins
  • Environmental distractions
  • Label clothespins with #s 
  • Corresponding to a sheet of 
  • Financial management calculations
  • Standing Surface
  • Gaze-shifting requirements

 

FINGER LOOPS : EXTRINSIC HAND STRENGTHENING / EXTENSORS

 

  • Increase isometric contractions at end range
  • Increase # of reps/sets
  • Use rubber band instead
  • Use theraputty instead

 

DIGI FLEXOR : GRIP/GRASP STRENGTHENING

 

  • Increase isometric contractions at end range
  • Increase # of reps/sets
  • Digit isolation or Gross Grasp
  • Varying levels of resistance
  • Use Metronome
  • Use theraputty instead
  • Use FlexFixx Eggs

 

SCREW, BOLTS, AND WASHERS: FINE MOTOR COORDINATION AND MANIPULATION

 

  • Use a time-based goal
  • Use environment or conversational distractions
  • Require client copy pattern from one object to the other
  • Copy pattern and place each object in an obstructed plane