“I used to have the most beautiful handwriting to write notes to my grandchildren with.”
“How am I ever going to be able to use a check if the bank cannot read my writing?”
These comments are just a few of many that I have heard from my clients who have experienced a stroke impacting their dominant hand. It can be extremely frustrating to not be able to write as legibly as one once did before the diagnosis. The good news though is the brain is capable of rewiring and recovering after sustaining a stroke.
Neuroplasticity is defined as the brain’s ability to reorganize and regenerate after experiencing a stroke, by constructing new neural pathways. Research has shown that mass amounts of repetition, specificity, and saliency are important to promote neuroplasticity during stroke recovery (Kleim and Jones, 2008). The following are some activities and exercises that can help you strengthen your hand and coordination to improve your writing legibility.
It is important to note that writing is a very complex activity that involves not only precise motor control, but also visual, perceptual, and cognitive skills as well. Difficulty with writing after a stroke can be due to a multitude of deficits, which is why consulting with a trained clinician can be significantly beneficial for your rehabilitation recovery. These activities are not designed to replace therapy, but merely provide further support in your therapeutic progress.
In-Hand Manipulation Exercises
In-hand manipulation, or the ability to use objects within one hand, is an essential component of writing. When you are writing, you are constantly using small hand muscles and movements to adjust the writing utensil in order to produce coordinated lines on the paper. There are different types of in-hand manipulation skills including translation, shift, and rotation.
Here are some simple in-hand manipulation exercises you can complete with a writing utensil. What is great about these exercises is that you can do them while watching television or talking on the phone. They also provide that mass amount of repetition needed to promote neuroplasticity and improve motor control.
I recommend starting out by completing 10-20 repetitions of each exercise a couple times a day. Functional activities are also included under each type of skill to further promote your motor coordination during everyday tasks.
Translation
Finger to Palm Translation
The easiest in-hand manipulation skill, which is developed first, is finger to palm translation. This skill involves moving an object from the pads of your fingers to the palm of your hand.
To complete this exercise, first grasp the pen between the pads of your fingers and thumb; then slowly use your fingers and thumb to move the pen to your palm.
Palm to Finger Translation
This skill is essentially the opposite movement pattern to the finger to palm translation. This movement involves moving an object from your palm to the pads of your fingers.
To complete this exercise start with the pen in your palm then slowly move the pen to the tips of your fingers.
Functional Translation Activity
A great functional task that combines both translation skills is moving a coin from your palm to fingers as if simulating the movement to position a coin into a vending machine. Also, for a challenge attempt to hold multiple coins in your hand, and alternate moving each coin to your fingertips.
Shift
This skill involves moving an object between the pads of your fingers. We use this movement when adjusting a pen in our hand to assume the correct writing grasp.
To complete this exercise start by grasping the pen so it is positioned vertically. Then move your fingers so you are grasping the top of the pen. Then complete the same movement only downwards to grasp the bottom of the pen.
Functional Shift Activities
Functional activities that involve shift in-hand manipulation including reading and playing cards. For reading, you use shifting when separating the paper to turn the page. Also, when playing cards such as Solitaire or Uno, you use shifting when grasping a card from the deck.
Rotation
Rotation involves two movement patterns simple and complex. For simple rotation, you turn an object that is grasped at your finger pads 90 degrees or less. For complex rotation, you spin an object positioned at your finger pads 180 to 360 degrees. You utilize complex rotation when you rotate a pencil to use the eraser (Case-Smith & Clifford-O’Brien, 2015).
For this exercise, begin with grasping the pen with your fingers and thumb so the pen is positioned horizontally. Then, use your fingers to turn the pen so it is positioned vertically. As, you get good at doing that movement pattern, increase the challenge by rotating the pen first 180 degrees then 360 degrees. It is important to note that this is a very hard skill because it involves coordinating your fingers and thumb to move independent for each other. So it may be challenging at first to complete this exercise.
Coloring
Aside from the in-hand manipulation exercises, coloring is a great activity that improves the strength and coordination in your small hand muscles for writing. Coloring provides repetition and simulates grasping and coordinating the pen similarly to writing. There are many adult coloring books you can find at your local convenient store and also many free templates you can print out from online.
Tracing
There is actually conflicting opinions on using tracing sheets for teaching kids handwriting skills due to impacting the child’s ability to develop the appropriate motor patterns without visual stimuli. However, our purpose of using tracing sheets is to improve the fine motor control in an adult who already has developed the motor planning and sequencing for writing. The tracing sheets merely provide visual support while practicing forming words in order to restore the motor coordination needed for writing freely. There are also many free tracing worksheets you can find online and inexpensive books you can purchase in the preschool section of bookstores.
Writing Activities
Out of all the activities and exercises listed above, the most important activity to incorporate into your daily routine to improve your writing after a stroke is to actually write. As mentioned above, the research for neuroplasticity states that specificity matters. This means that in order to promote motor recovery for a certain task you need to engage in the activity itself (Kleim and Jones, 2008). The above activities and exercises are a great “warm up,” but you should always follow them with practicing writing. With this, it is not only important to incorporate writing into your daily routine, but also writing activities that are meaningful to you. Saliency matters in relation to neuroplasticity. So the more you incorporate activities that are meaningful to you during your stroke recovery, the more likely you are to promote motor return and plasticity (Kleim and Jones, 2008).
Some meaningful writing activities can include copying favorite cooking recipes, journaling, writing a note to a loved one, or creating your grocery list.
If you are struggling with writing on blank paper, you can always begin with using lined paper. It may be frustrating and discouraging at first, but the more you practice the better your writing legibility will become.
Remember that brain recovery is a journey and to try to see small improvements as large victories as you regain your autonomy after a stroke.
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Reference: Case-Smith, J. & Clifford-O’Brien, J. (Eds.) (2015). Occupational therapy for children and adolescents, (7th ed.). Maryland Heights, MO.: Mosby Elsevier.
Reference: Kleim, J. M. & Jones, T. A. (2008). Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage. Journal of Speech, Language, and Hearing Research, 51, S225-S239.
