Fine Motor Symptoms in Parkinsons


What are fine motor skills?

Fine motor skills refer to all the manipulation and precision tasks we do with our hands. From gripping, pinching and twisting to isolating individual fingers, opposing the thumb and opening the hand into a full wave position.

Relying on a highly developed sensory feedback system, our brains respond to sensory input to assess the size, shape, texture and weight of an object and decide how the hand should respond to produce appropriate grip, power, movement and accurate fine motor control.

Our hands are one of our finest features!

What is Parkinson’s disease?

Parkinson’s disease is a neurological condition where there is a significant loss in the dopamine-making cells in the substantia nigra in the brain, resulting in the transmission from nerve cell to nerve cell being slow, delayed, or incomplete.

Dopamine is a neurotransmitter, working in delicate balance with other neurotransmitters to help coordinate the millions of nerve and muscle cells in the body systems including controlled movement, cognitive functions, and emotional activity.

Parkinson’s disease is typically associated with 4 key motor symptoms:


      • Tremor

      • bradykinesia (slow movements)

      • rigidity (stiff muscles producing smaller movements)

      • postural instability (balance problems)

    These motor symptoms can result in shuffled walking, loss of arm swing and trunk rotation, risk of falls, and reduced fine motor control.

    Does Parkinson’s disease affect fine motor skills? 

    Simply put – yes! Fine motor issues are one of the key motor symptoms of Parkinson’s and can impact every activity you do, every day.

    Fine motor control is an often-unnoticed motor control loss for people living with Parkinson’s disease, with focus often being on the larger body movements that other people notice, such as a shuffling gait or facial masking.

    Working with people with Parkinson’s disease for many years, it is the loss of fine motor control that is possibly the first, and largest, contributor to loss of independence that I see. From no longer being able to write clearly, to difficulties with brushing teeth, doing up buttons and laces and using cutlery.

    How does Parkinson’s affect fine motor skills?

    To produce controlled movement, the brain relies on receiving sensory information to make sense of the task at hand. From touching an object with your hand, your brain is able to ‘make sense’ of it through sensing temperature, texture and shape and then producing the exact amount of muscle power, grip and movement needed to pick something up, with control.

    With reduced dopamine levels, this sensory information sent up to the brain and the motor output sent back down from the brain is slowed, delayed or incomplete. This can result in the typical Parkinson’s disease motor symptoms including fine motor skill loss.

    Top 5 Tips for managing fine motor symptoms

    1 – Early Intervention

    The best time to start working on your hand and fine motor control is now. If you haven’t yet noticed any difficulties with completing fine motor tasks, like doing up your buttons or writing, then don’t let that stop you from focusing on keeping the strength and dexterity that you have.

    Our Fine Motor Control ideas below are just a handful of ideas to get you going.

    2 – Hand Exercises

    Whether you have noticed some weakness in your hands or not, start your daily hand exercises today! It really is a case of “use it or lose it” and, as unglamorous as hand exercises are, they are one of the best investments you can make in your own future independence. Guaranteed.

    Hand exercises should focus on strength, amplitude and coordination. Below are some hand exercise ideas to get you started on your daily practice.

    3 – Adapting the task

    As Occupational Therapists, we are masters of adaptation, with a passion for independence, to improve your quality of life.

    We assess the way you do a task, in your own environment, to see where your unique challenges are.

    We then provide you with education, training, strategies, exercises, assistive devices, and ergonomic advice to make how you do that task easier.

    Our goal is always to make you as independent as possible. Whether that is adapting the way you complete a task, the tools you use or the environment around you – we are skilled in finding ways for you to keep doing the things you love to do.

    4 – Optimising medications

    Medication is a critical component of Parkinson’s disease management. The most common medications used to manage Parkinson’s symptoms is levodopa – the precursor to dopamine.

    Working closely with your neuro-specialist team, including your neurologist, PD-specialist nurse and therapists, to find the best regimen for you in managing your Parkinson’s is crucial to maximising symptom management and ensuring you are able to get the most out of your exercises and management strategies provided by your therapy team.

    5 – Lifestyle factors

    Lifestyle factors are the foundations to living well, with or without Parkinson’s disease.

    Addressing the four pillars of a healthy lifestyle – exercise, nutrition, sleep and stress – will have a positive impact on your health and wellbeing, physically and mentally.

    I would also suggest a fifth pillar, of social connection, which has proven links to lower rates of anxiety and depression, improved self-esteem and contentment, better sleep, improved brain health and lowered blood pressure.

    Stress impacts motor symptoms and can lead to uncontrolled symptoms of freezing and falls when walking. Practicing relaxation techniques and developing your parasympathetic responses can improve the management of your motor symptoms, including tremor, freezing and fine motor control.

    How can NeuYou Rehab help you with your fine motor symptoms?

    At NeuYou Rehab, we take a holistic approach to our work, including addressing difficulties with fine motor skills.

    We will assess your unique difficulties and provide you with effective solutions to your issues, including fine motor control.

    We use a combination of physical rehab, exercises and movement education, sensory integration to better ‘talk’ to your brain, symptom management strategies and assistive technology to help you manage fine motor symptoms in Parkinson’s disease to improve your functional skills and independence.  

    Regain. Retain. Live well.



    Fine Motor activities for Parkinson’s

    Hand exercises don’t have to be like a gym prescription. Having a few items on the coffee table to pick up and play with whilst you’re watching TV is an easy, no-excuses way of getting in your daily dose of hand strengthening and coordination challenges to keep your hands and fine motor skills top-notch.

    In-Hand Manipulation


        • Rotate items in you palm such as Chinese medicine balls, golf balls, ping-pong balls etc (make sure you rotate both clockwise and anticlockwise)

        • Roll a ball up and down your arm

        • Move a coin across your hand, weaving under and then over your fingers

      Finger Isolation


          • Place your hand and fingers flat on the table and lift one finger off of the table at a time

          • A-OK exercise – touch your thumb to each fingertip, one at a time, and squeeze

          • Place a cloth on the table and place your flat palm on top. Then, one finger at a time, crumple the towel into a ball

          • Playing paper football or marbles

          • Playing the piano, keyboard or any string instrument

        Dynamic Movements


            • Sewing, knitting and cross stitching

            • Jewellery making or stringing beads

            •  Manipulating small nuts and bolts

            • Picking up small items off of a table (such as buttons, coins, etc.) by lifting off of the table versus pulling off of the table

            • Use pegs to pick up small items

            • Playing cards – flipping them over, playing Solitaire, or playing card games with friends

            • Connect 4 and other board games


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