What causes it?
Multiple sclerosis can impact hand dexterity, coordination, and strength because of the effect it has on the brain and spinal cord, the two interconnected regions that together are called the central nervous system (CNS). The function of the central nervous system is to receive sensory information, such as smells, tastes, sounds, sights and tactile information, through special receptors and respond to this information with a thought or an action or both.
What does this mean with regard to hand dexterity, coordination and strength? A simple example is the complex reflex that occurs when you encounter something painful. If you touch a hot stove, the nerve endings in your hand send a message to your central nervous system (spinal cord and brain) telling your brain that you need to remove your hand quickly. Your brain (central nervous system) takes over and automatically sends messages back to the parts of your body that will quickly remove your hand from the hot stove before you are even fully aware of being burned. In this example it is clear that the action (the hand removal from the stove) is directly linked to the pain you feel.
In fact, all movements and actions require different forms of sensory input or feedback to accomplish the action well. This is particularly true of movements in the hands and fingers that require a high level of dexterity and complexity. If the messages sent to or from your brain (central nervous system) are impaired, there will be a loss of sensation, strength, dexterity or a combination of these problems. An example of this impairment for someone with MS might be developing a tremor when trying to touch their nose with a finger. In MS this tremor can be dramatic, and the person’s arm will go up and down significantly as they attempt to touch their nose.
All of these problems are caused by MS interfering with either the incoming sensory signals, the coordinated response to these signals between different parts of the central nervous system, the outgoing signals to your muscles to create a movement, or a combination of these problems. How does MS create these problems in your CNS? First, understand that a nerve is composed of a bundle of neurons. Neurons are specialized cells with elongated processes called axons that process information and communicate with other neurons and muscle. These neurons need to work properly for your central nervous system to function effectively. When someone has MS, inflammation can either damage the neuron or axon directly or strip off the myelin sheath (which is like a protective coating, like the skin of an orange) around the axons and cause the neuron and axon to stop functioning normally. Specifically, when the myelin sheath is damaged but the axon remains, the electrical conduction of the neurons is changed. It is like getting a fuzzy signal on a television set. When this happens, the nerves cannot conduct messages to your brain as well as they should because either some or all of the neurons within the nerve have been damaged or are not functioning optimally.
MS does not affect your peripheral nervous system like diabetes or other conditions, although your peripheral nervous system is required for normal sensation and movement. The peripheral nervous system consists of the nerves after they leave your spinal cord and travel in nerve bundles to either your muscles or sensory receptors in the skin and organs. At times it can be difficult to determine if a symptom is being caused by problems in the central or peripheral nervous system and special evaluations may be required to sort this out.
What happens and what might I feel?
Conduction of the signals to and from your brain are slowed or halted by the lesions described above, producing symptoms such as tingling, numbness, pain, problems with hand-eye coordination, tremors and/or muscle weakness in your hands. These problems may start slowly and worsen as nerve damage progresses.
Loss of Dexterity
One major symptom of MS in the hands is a loss of dexterity. Fine-motor skills may regress or disappear. You might have difficulty with activities such picking things up, maintaining a hold on items, have difficulty writing or buttoning clothing, or have trouble controlling eating utensils. It may be even be painful to do so. These symptoms occur when MS affects the pathways in the central nervous system that control coordinated fine hand movements.
Involuntary Movements in the Hands
Some patients with MS will also experience involuntary movements in their hands, often described as ticks, spasms, tremors or twitches. The patient is unable to control the movement, which can be distracting. Muscle contractions can be painful.
Multiple sclerosis can impact hand dexterity, coordination, and strength because of the effect it has on the brain and spinal cord, the two interconnected regions that together are called the central nervous system (CNS). The function of the central nervous system is to receive sensory information, such as smells, tastes, sounds, sights and tactile information, through special receptors and respond to this information with a thought or an action or both.
What does this mean with regard to hand dexterity, coordination and strength? A simple example is the complex reflex that occurs when you encounter something painful. If you touch a hot stove, the nerve endings in your hand send a message to your central nervous system (spinal cord and brain) telling your brain that you need to remove your hand quickly. Your brain (central nervous system) takes over and automatically sends messages back to the parts of your body that will quickly remove your hand from the hot stove before you are even fully aware of being burned. In this example it is clear that the action (the hand removal from the stove) is directly linked to the pain you feel.
In fact, all movements and actions require different forms of sensory input or feedback to accomplish the action well. This is particularly true of movements in the hands and fingers that require a high level of dexterity and complexity. If the messages sent to or from your brain (central nervous system) are impaired, there will be a loss of sensation, strength, dexterity or a combination of these problems. An example of this impairment for someone with MS might be developing a tremor when trying to touch their nose with a finger. In MS this tremor can be dramatic, and the person’s arm will go up and down significantly as they attempt to touch their nose.
All of these problems are caused by MS interfering with either the incoming sensory signals, the coordinated response to these signals between different parts of the central nervous system, the outgoing signals to your muscles to create a movement, or a combination of these problems. How does MS create these problems in your CNS? First, understand that a nerve is composed of a bundle of neurons. Neurons are specialized cells with elongated processes called axons that process information and communicate with other neurons and muscle. These neurons need to work properly for your central nervous system to function effectively. When someone has MS, inflammation can either damage the neuron or axon directly or strip off the myelin sheath (which is like a protective coating, like the skin of an orange) around the axons and cause the neuron and axon to stop functioning normally. Specifically, when the myelin sheath is damaged but the axon remains, the electrical conduction of the neurons is changed. It is like getting a fuzzy signal on a television set. When this happens, the nerves cannot conduct messages to your brain as well as they should because either some or all of the neurons within the nerve have been damaged or are not functioning optimally.
MS does not affect your peripheral nervous system like diabetes or other conditions, although your peripheral nervous system is required for normal sensation and movement. The peripheral nervous system consists of the nerves after they leave your spinal cord and travel in nerve bundles to either your muscles or sensory receptors in the skin and organs. At times it can be difficult to determine if a symptom is being caused by problems in the central or peripheral nervous system and special evaluations may be required to sort this out.
What happens and what might I feel?
Conduction of the signals to and from your brain are slowed or halted by the lesions described above, producing symptoms such as tingling, numbness, pain, problems with hand-eye coordination, tremors and/or muscle weakness in your hands. These problems may start slowly and worsen as nerve damage progresses.
Loss of Dexterity
One major symptom of MS in the hands is a loss of dexterity. Fine-motor skills may regress or disappear. You might have difficulty with activities such picking things up, maintaining a hold on items, have difficulty writing or buttoning clothing, or have trouble controlling eating utensils. It may be even be painful to do so. These symptoms occur when MS affects the pathways in the central nervous system that control coordinated fine hand movements.
Involuntary Movements in the Hands
Some patients with MS will also experience involuntary movements in their hands, often described as ticks, spasms, tremors or twitches. The patient is unable to control the movement, which can be distracting. Muscle contractions can be painful.
What can I do about it?
The good news is that the damage to myelin sheaths is able to repair itself early in the course of the disease. This is one of the reasons for the spontaneous improvement that occurs after relapses; remember we call this stage of the disease “relapsing remitting” for a reason (emphasis on remission or improvement after worsening). The key is to prevent further worsening that can result in more permanent damage. But even with the permanent damage that can occur at any time, other areas of the brain can be trained or coaxed into taking over lost functions. This ability to take over lost function (what is referred to as plasticity) seems to work best when the retraining is initiated shortly after injury.
Traditionally, hand exercises are used to promote plasticity responses and improve hand function over time. Other experimental approaches include the use of transcranial magnetic stimulation (called TMS) in combination with these rehabilitative approaches to promote more successful responses.
The exercises below can help improve fine motor skills that have deteriorated. Please note that some activities may be too easy or too hard depending on the extent of impairment. It helps to work with an occupational therapist to assist with your recovery, if the loss of function is limiting your activities.
The good news is that the damage to myelin sheaths is able to repair itself early in the course of the disease. This is one of the reasons for the spontaneous improvement that occurs after relapses; remember we call this stage of the disease “relapsing remitting” for a reason (emphasis on remission or improvement after worsening). The key is to prevent further worsening that can result in more permanent damage. But even with the permanent damage that can occur at any time, other areas of the brain can be trained or coaxed into taking over lost functions. This ability to take over lost function (what is referred to as plasticity) seems to work best when the retraining is initiated shortly after injury.
Traditionally, hand exercises are used to promote plasticity responses and improve hand function over time. Other experimental approaches include the use of transcranial magnetic stimulation (called TMS) in combination with these rehabilitative approaches to promote more successful responses.
The exercises below can help improve fine motor skills that have deteriorated. Please note that some activities may be too easy or too hard depending on the extent of impairment. It helps to work with an occupational therapist to assist with your recovery, if the loss of function is limiting your activities.
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Tips From MS Patients To Manage Loss Of Hand Dexterity And Coordination
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Tip #1: Use a Beer Chicken Stand as a drink stabilizer. No, this isn't a joke but a great tip. If you sometimes knock over drinks, a beer chicken stand will make your drink much more stable. There are many places to buy it on the web and sometimes in stores. There is a link to buy one at the bottom of this page. It is designed for cooking chicken, but can also be used at the table to keep your drink from being knocked over.
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Tip #2: iPhones have accessibility settings that enable the touchscreen to produce button icons. AssistiveTouch allows you to use your iPhone if you have difficulty touching the screen. This means you don’t have to press any of the hard buttons (like the Home button, volume buttons, etc. on your phone. Instead, you can lightly touch the touchscreen. DIRECTIONS: On the iPhone, go to Settings, then General, then Accessibility, then AssistiveTouch. Press the button to enable the AssistiveTouch. See http://support.apple.com/kb/HT5587 for more information.
Tip #3: Physical and visual challenges can make typing difficult for some living with MS. There is software for your computer that can do the work for you via voice commands. Check out programs like Dragon NaturallySpeaking or MacSpeech Scribe (see links to these products at the bottom of this page)
Tip #4: Using silverware can be a challenge for those with hand dexterity/coordination problems. A lot of people shy away from the built-up cutlery because it looks so different from regular cutlery. Check out the link at the bottom of this page for the Knork 5 piece flatware set. You will see that there is a company that makes adapted cutlery that looks quite nice and doesn't stand out. It makes me feel less self-conscious especially when I'm having friends over.
Tip #5: Active Hands Gripping Aids (http://www.activehands.com/us/shop.html) are very helpful for a wide range of tasks - at home, in the gym or out and about. They work by tightening a strap in the upper section, which gently pulls the hand into a fist shape, adjusting to hold items in the palm. The wrist strap is also adjustable and the aid is padded to reduce chafing. These grips can help with things like:
Read a blog from Lizzy about how she used these grips to use a rowing machine...http://www.healthcarejourney.com/7/post/2014/01/ms-and-exercise.html
- Working out in the gym (e.g. holding free weights, using a rowing machine)
- Playing on the Nintendo Wii
- DIY at home (using a saw or hammer)
- Holding a pool or snooker cue
- Rowing or Kayaking
- Gardening
- Holding a glass or bottle
Read a blog from Lizzy about how she used these grips to use a rowing machine...http://www.healthcarejourney.com/7/post/2014/01/ms-and-exercise.html
PLEASE NOTE: The medical information on this site is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.
