Tying your shoes. Opening a jar. Picking up a coin from the counter. Texting. The everyday tasks that were once automatic can become slow and frustrating when CMT impacts your hands.
CMT affects the longest nerves in your body first, which is why symptoms usually start in your feet and hands. The small muscles inside your hand, called the intrinsic muscles, do the work of refined finger movement. They tend to be hit hardest. The forearm muscles that open and close your fingers and move your wrist (the extrinsic muscles) can also weaken.
Sensory changes in the hands, including burning, tingling pain, numbness, and a loss of sensibility (the ability to feel size, shape, texture, and temperature) are common CMT symptoms. Proprioception, your sense of where your hand is in space, can fade too. To add to the picture, people with CMT may experience stiff, cold fingers, hand cramping and tremors.
Enter the occupational therapist. OTs are licensed health professionals trained to help you keep doing the things you want and need to do at work and at home. For CMT, that might mean a care plan built around your hands, tailored to your challenges and goals.
Start with an evaluation
A good OT plan begins with an honest look at where your hands are today. Your OT will test your strength, sensation, and range of motion, and discuss with you, which tasks are giving you trouble. From there, your OT builds your customized plan.
Your plan may include stretching and exercise, splints, adaptive equipment, home modifications, ergonomic changes, tremor-reduction techniques, and pain relief. OTs use both remedial methods to restore or maintain function, and compensatory methods to work around a deficit, by modifying the task or adding a tool.
Ask about splints
The right splint, worn at the right time, can protect a joint, prevent deformities, or give your thumb the stability it needs to grip something.
Your OT will show you options. Resting hand splints worn at night provide a long, gentle stretch and reduce morning stiffness. Thumb splints come in several brands and styles, and they stabilize the base of your thumb so you can pinch, write, and grip. Silver Ring and figure-8 splints help with finger hyperextension. A cock-up or wrist immobilizer splint supports a neutral wrist position and improves your grasp.
Stretch every day, but never to the point of pain
Daily stretching keeps your joints moving, prevents soft tissue from shortening, and can ease cramping and pain. Remember, a stretch should never hurt.
As part of your plan, your OT may recommend stretches that target the joints most likely to stiffen with CMT, including the middle knuckles (the proximal interphalangeal joints) and your thumb.
For your wrists, focus on flexion and extension. Flexion is the bending movement of joint that decreases the angle between two body parts, while extension increases the angle. To do this exercise, slowly bend your wrist down and hold for a few seconds, then bend up, then hold.
For thumb mobility and manual dexterity, try these two classic OT exercises. Roll two golf balls or Chinese medicine balls in one hand, clockwise and then counterclockwise. Drop a few coins or dice into your palm and bring them up to your fingertips one at a time, then drop them on to a tabletop. These are the same movements you use to fish out a key, hold a pen, or turn a credit card around to swipe it.
Strengthen the right muscles the right way
Resistance training for the hand and wrist can help maintain the strength you have. For people with mild to moderate weakness, it can improve strength too. The trick is knowing which muscles you are working.
For the small intrinsic muscles inside your hand, practice pinching with different patterns: tip-to-tip, side pinch, and pad-to-pad. Spread your fingers apart and squeeze them back together. Try the “intrinsic plus” position, with your knuckles bent and the rest of your fingers straight.
For the larger extrinsic muscles in your forearm, work on making a fist, bending your wrist up and down, and turning your palm up and down. Tools like this hand exerciser <<link to Gadget Store>>, hand webs <<link to Gadget Store>>, and flex therapy bars <<link to Gadget Store>>, can help.
Talk to your OT before adding weight as CMT muscles can be more sensitive to overwork. Your therapist can help you find the right intensity.
Practice the way your hands actually work
Coordination, fine motor skills, and hand dexterity also can improve from regular activities like playing an instrument, cooking (especially measuring and pouring) and crafts such as stringing beads or needlepoint.
Change the task when you need to
When stretching, strengthening, and splinting won’t get you all the way there, your OT can help you change the task itself. Button hooks, weighted utensils, jar openers, dictation software, ergonomic keyboards, modified car controls, easy-grip tools: all of it helps.
Resources to help you
You don’t have to wait for things to get worse. The earlier you start OT, the more options you have.
To find an OT experienced in treating CMT, visit a CMTA Center of Excellence near you.
Visit the CMTA Gadget Store to shop tools and devices for people with CMT, tested by people with CMT.
Watch our “Move with Natalie” series to learn simple hand exercises you can do at home, taught by a person with CMT.
