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Graduate students in �Ͼ�Ʒ��’s Occupational Therapy program have developed a fine motor skills training program that draws on exercises often used by boxers in order to help people living with Parkinson’s Disease (PD) carry out simple – yet essential – tasks that become difficult as the disease progresses. Preliminary results show the program significantly improves the ability of PD patients to carry out tasks such as buttoning shirts and writing.

PD is a neurological degenerative condition that impairs physical function over time by making overall movements slower and smaller, which leads adults with PD to have more and more difficulty in producing their desired movements.

For adults living with PD, there are several established programs that emphasize big and vigorous gross motor movements and exercises. However, none of these programs offer fine motor training, says Dr. Kitsum Li, Occupational Therapy (OT) program director and associate professor in the School of Health and Natural Sciences.

Rock Steady Boxing (RSB), a national nonprofit with a program in Marin County, is one of the organizations offering programs targeting gross motor movements. RSB works with people living with PD to improve their quality of life through a boxing-based curriculum. RSB contacted Dominican’s OT Department to collaborate on a project to add a fine motor skill training program to its curriculum.

“Currently, there is a gap in evidence that shows specifically how fine motor skills, such as repetitive motions of the fingers, can improve movement and function for people living with PD,” Li says.

Li saw this as a perfect opportunity to involve Dominican’s OT students in developing and then evaluating a new program. Li then obtained a grant from the California Endowment to support the development and assessment of the new program.

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Four graduate students in �Ͼ�Ʒ��’s OT program in the class of 2020 developed a fine motor skills training program, the “Knockout PD” program, that draws on the movements mimicking daily activities in order to help people living with PD carry out simple fine motor movements that become difficult as the disease progresses.

“We focused on finger movement in order to improve a patient’s ability to use fine motor skills,
 Li says. “This is because adults with PD have difficulty buttoning their clothes, writing, opening jars, and tying shoe laces.”

The Knockout PD program focuses on upper extremity movements and proximal control, incorporating four fine motor activities including buttoning, handwriting, opening a jar, and keyboarding. The students developed 12 30-minute sessions of fine motor skill training, working with RSB clients via Zoom due to the pandemic. Each session covered one set of fine motor skill exercises related to one of the fine motor activities – and each set contained two-four movements.

To assess its effectiveness, Li recruited five OT students from the class of 2021 to implement a mixed-methods study.  All members of the team completed LSVT BIG certification, another program that focuses on larger motor skills and PD patients. In addition, team member Mia Do was also awarded with the 2020 LSVT Global Student Grant to support their study.

When the program concluded, the students qualitatively investigated the habitual practice of fine motor activities in adults with PD in their daily life by interviewing the participants to understand how fine motor control affects the participants’ lives, their motivations for doing the exercises, barriers to doing the homework, what benefited them in the program, what they were struggling with in their activities of daily living as related to the fine motor movements prior to participation in the fine motor skill training program and after the program.

Preliminary results of the Knockout PD program show that the 12-session program improved the ability of the participants with PD to carry out tasks requiring finger movement, including buttoning clothes and writing. One participant said that he had been concerned that he would not be able to sign his name while casting a ballot. After the exercises, he reported that his signature was almost like it was pre-Parkinson’s. Also, the participants noted improvement in other areas that were not practiced in the program such as pulling out their wallet from their pocket or putting on a seatbelt in the car.

The improvements, however, start to diminish three months after the training ends – showing the need for participants to make the exercises part of their regular routine.

“Immediately after the training, the participants with PD found it easier to button their clothes and write,” Li says. “It is such a fantastic outcome, but three months after they finished the program the improvements were not sustained – we believe because they were not continuing with the exercises.”

Another cohort of four OT students from the class of 2022 will continue the project, repeating the study but focusing on the teaching aspect to see if they can instill a teaching strategy that will make the exercises a habit so that when the clients complete the 12 sessions, they will continue with the exercises. The students will follow up with interviews in the spring. 

“I am so excited that we can involve OT students from multiple years to continue with this project”, Li says. “I hope that we can find a way to make the improvements last and truly knockout PD one movement at a time.”