Page 19 - A Guide to Physical and Occupational Therapy for CMT

The ability to interpret peripheral sensory stimuli, carry out appropriate motoric
responses and continually perform this cycle of sensorimotor adaptation
throughout a task is essential for efficient and effective task completion. Due to
the sensorimotor impairments discussed above, the completion of ADL tasks
can be quite challenging. Tasks requiring bimanual (both hands) manipulation
such as buttoning clothing, fastening zippers, managing jewelry and tying
shoes tend to be the most challenging. These tasks require a steady hand,
the ability to interpret important sensory stimuli and the use of the fingers to
reposition, manipulate and accurately release small objects with the dominant
hand while the non-dominant hand serves as a stabilizing force or functional
assist. Other tasks such as opening jars, removing container lids and tearing
open food packaging can be challenging due to muscle weakness. Decreased
thumb mobility can limit the ability to use a pincer grasp, which uses the thumb
to index finger tip, stabilize objects against the fingers for grasp like hold a
water bottle and complete manipulative tasks. As a result, lifting small things
such as coins, food, writing implements, etc., off a table surface can be very
difficult. Limited thumb mobility can also affect the use of the thumb for text
messaging, writing, stabilization of the computer mouse and joystick operation
for gaming.

STRATEGIES TO DISCUSS WITH YOUR OCCUPATIONAL THERAPIST

STRETCHING: Maintaining joint integrity is crucial for preventing joint
contractures and soft tissue shortening. Daily stretching may help with hand
cramping as well as reduce pain and joint deformity. Remember, a stretch
should never be painful!
Wrists
Flexion/extension range of motion stretches prevent stiffness and tightness.
Fingers
Stretching may help prevent proximal interphalangeal (PIP) flexion patterns
and thumb stiffness due to muscle imbalance.