Appendix: Ways to Improve Hand Strength and Dexterity

  • Sharpen a pencil in a hand-held sharpener. Rotate the pencil in your hand for erasing. Rotate it back for writing. Repeat.
  • Twirl 5 to 10 times in each hand.
  • Crawl your fingers up and down the pencil. Pick up the pencil and adjust it in your hand for proper use.
  • Complete “mazes” on paper—stay between the lines.
  • Shuffle, place on the table one at a time, flip, pass and hold
  • Pick up a die, place it in the palm of your hand, shake it and roll it.
  • Rotate two dice around one another in one hand.
Paper clips
  • Hold paper clips and secure them to papers.
  • Pick up a specific coin from a bunch of coins (e.g., pick up the dime from among the other change) in your wallet.
  • Use a piggy bank or cut a small slot in a container lid, and place the coins in the slot.
  • Buckle a belt.
Shoe with laces 
  • Lace a shoe.
  • Tie shoelaces.
Dough (e.g., Play-Doh) 
  • Using toothpicks and Play-Doh, assemble a structure.
  • Roll, make a ball and squeeze the Play-Doh
Nuts and bolts 
  • Place nuts and washers onto bolts.
Ziplock-type bags 
  • Seal a ziplock bag.
Twist ties
  • Close a bread bag using twist ties.
Key ring with keys
  • Hold key ring and select one key for use (e.g., to open door).
Puzzles and games
  • Connect Four and Rubik’s Cube, for example.
  • Place bingo chips on game card.
  • Make a puzzle.
Tongs, tweezers or chopsticks
  • Use tongs, tweezers or chopsticks to pick up items.
  • Pick out a specific colour of button from a bag or container of buttons (e.g., pick out all the blue buttons).
  • Sort out buttons according to size and colour.
Rubber bands or elastics
  • Place around thumb and forefinger. Stretch the rubber band as far as you can.
  • If applicable, braid or use elastic to tie your hair.
Thread beads
  • Thread beads onto a shoelace or use them to make a small necklace


Remember: You can alternate four to five items at a time (e.g., every two weeks) depending on the activity your family member wishes to work on that day or week.

Patients should pace themselves, for example, two or three sessions a day for 10 minutes a session.