OBJECT

The following three exercises strengthen the ability to sort out (differentiate) small muscles in the hands and fingers from the large muscles of the arms and trunk. In doing this, the exercises strengthen the muscles themselves and increase their range and flexibility of movement. Perhaps more importantly, they increase the brain's ability to focus attention on the task at hand, to organize incoming information and to execute planned activities. They also inhibit unintended movements.

WHO CAN BENEFIT

This exercise is highly recommended for most people who have histories of inadvertently knocking things over or crumpling corners of their papers. It also helps many people who have difficulty writing fluidly. It is particularly helpful to individuals diagnosed with Tourette's Syndrome and some other disorders of movement.

MATERIALS

All three versions of the exercise are performed preferably on a table or similar surface, but can be performed spontaneously almost anywhere (e.g., with elbows resting on knees, or steadied in sand, or on the edge of the counter at the supermarket). The equipment necessary to perform these exercises includes a small rubberband (the size that binds green onions in most produce departments), a marble or bead not smaller than half-inch in diameter, and a partner. Let’s assume that a table will be used, for the sake of clarifying the instructions.

Note: We will use the word "child" to describe the person doing the exercise, even though the exercise is equally appropriate for an adult whose neurodevelopmental Systems require this level of work.

PROCEDURES

The child is to sit close to the table and place both elbows on the table, with both forearms extending upwards, and both hands hanging somewhat floppily from relaxed wrists. This basic posture already separates the larger muscles from the smaller ones. This ensures that the exercises will be working on very fine motor differentiation and on the development of awareness of each body side as distinct, one from the other.

 

The child should begin each exercise with his/her dominant hand. After performing the exercise once with the dominant hand (e.g., right hand), the exercise should be performed again, this time with the non-dominant hand (e.g., left), and then, in conclusion, the dominant hand should perform one more time.

The partner’s role is to watch the hand that is not performing the given task, and also to observe the child's mouth. The non-performing parts should be still and relaxed. If the partner notices that there is movement, the child should be made aware of this, and encouraged to quiet the undifferentiated response. If the child cannot find the means, the partner should advise the child to trust the performing hand to do its job, and concentrate on the non-performing hand, telling it to rest. If this technique does not work, then the partner should place one of her/his hands under the child’s non-performing hand, and gently rub the back of the child's hand. Against this foil, the child will generally feel any unintentional hand movements. If this is not sufficient, the partner should gently restrain the non-performing hand. Each session, and for each of the three activities, the child should be encouraged to try three times to move the desired hand only, at whatever level of assistance is required.

 

Regarding mouth movements, the child might use a mirror to monitor visually (as in step one of monitoring the non-performing hand). However, some children engage in silly behaviors when seated in front of a mirror, so know your child. Engaging the child in purposeful oral-motor movements (e.g., conversation, singing, chewing gum, etc.) may be helpful to quiet over-flow movements to the mouth.

So much for general directions. Now for the specifics of the Differentiation Triad

BEAD TRANSFER

With the hands in their starting position, and beginning with the dominant hand, the child is to pick up the bead, using only the tips of the thumb and forefinger. S/he should grasp the bead firmly enough so that the partner cannot pull the bead from her/his fingers. Maintaining this same grasp, the child should roll the bead for approximately five (5) seconds, and then transfer it to be grasped and rolled between the thumb and middle finger; next to the ring finger; and finally to the little finger. No additional fingers or body parts should be employed during the transfer. The partner should monitor the performance in a humorous fashion, expecting some attempts to improve performance, but not requesting more than three trials. Whether or not the hand was truly successful, the task passes to the non-dominant hand; and in conclusion, back to the dominant hand.

For young children (under six years old) and for others with very immature fine motor control, this exercise can be adapted. Instruct the child to perform the task with only the index finger and then the middle finger. Isolating the movements of the ring finger and the little finger is more demanding.

Note: Faceted beads do not roll when they slip away from fingers, so they might be preferable.

RUBBERBAND TANGLE

With the hands in their starting position, the dominant hand is to reach out and pick up a small rubberband from the table. By flexing and extending the fingers in a planned movement pattern, the child should try to stretch the rubberband enough to bring it over her/his fingers. The goal is to have it encompass the fingers at approximately the point where the knuckles join the hand. If the rubberband goes beyond this point, closer to the child's wrist, the partner should move it back to position around the knuckles. Now the child should try to remove the rubberband, and place it back on the table so the other hand can perform. Don't forget to remind the child to turn any rings so that projections (such as stones) are on the palm side. Otherwise the rubberband will catch on the ring.

FIST OPENING

In this exercise, we focus on power and tension, learning to apply them only when and where intended. With her/his hands in the starting position, the child should make a tight fist with the dominant hand. The partner should enclose the child's fist in his/her hand. (For children with large hands, the partner may need to use both hands to enclose the fist.) The partner should hold the fist tightly enough to offer resistance to the child's attempts to open her/his fingers without pulling her/his hand away. If the partner feels the child's fingers moving and trying to open, he/she should decrease the resistance ever so slightly to allow the child to succeed. This exercise is frequently the most difficult, and the one in which the mouth is most likely to get into the act. Be mindful, and monitor extra movements for the child, to help him/her gain control.

The fist opening version of this exercise is usually the easiest one for young children to begin with. Do not pay too much attention to unintended mouth movements in a child younger than 8 years old.