Losing hand function after a spinal cord injury (SCI) can feel overwhelming, making everyday tasks more challenging and impacting independence. However, the nervous system has an incredible ability to adapt through rehabilitation and neuroplasticity. In other words, with the right combination of targeted exercises, therapy techniques, and assistive tools, it is possible to regain strength, coordination, and mobility.
In this guide, we will explore 7 proven strategies to help you regain hand function after spinal cord injury, including the MusicGlove which combines music with hand-based therapy for an engaging exercise experience.
Let’s jump in!
Understanding Hand Impairment After Spinal Cord Injury
The extent of hand function loss after an SCI depends on the level and severity of the injury. High level cervical injuries typically result in more severe hand and arm impairment. Lower cervical or high thoracic level injuries may allow for better hand movement, but can still cause weakness and coordination challenges. Generally, hand and arm function remain intact in individuals who have a T2 SCI or lower.
The most severe spinal cord injuries, referred to as complete SCIs, result in the loss of all sensation and motor function below the level of injury. Therefore, hand functions may be completely lost after a high-level spinal cord injury. However, many spinal cord injuries are incomplete, meaning some neural connections are left intact at the level of injury. Individuals with incomplete spinal cord injuries may lose some sensation and/or some motor function, but are likely to make improvements with therapy.
Common Hand Impairments After SCI
- Weakness or Paralysis: Loss of strength in the fingers, thumb, and wrist.
- Spasticity: Muscle stiffness and involuntary contractions that can limit movement.
- Loss of Sensation: Reduced ability to feel temperature, pain, or pressure.
- Poor Coordination: Difficulty with precise movements like gripping and pinching.
While these impairments can be challenging, targeted therapy, adaptive strategies, assistive devices can help restore function over time.
The Role of Neuroplasticity in Regaining Hand Function After Spinal Cord Injury
The spinal cord and brain have the ability to rewire themselves through neuroplasticity, meaning that repetitive movements and consistent training can help create and strengthen neural pathways. To take advantage of this, rehabilitation should focus on:
- Repetitive Movement Practice: Performing specific exercises consistently to reinforce neural connections.
- Task-Specific Training: Practicing real-life tasks, such as picking up objects, writing, or using utensils.
- Bilateral Training: Using both hands together to encourage the affected hand to regain movement. This is especially important when one side of the body is more affected than the other.
Recovery outcomes may vary depending on how many neural connections are left intact at the level of injury. More neural connections spared allows for more opportunity for neuroplasticity to occur, and therefore more potential for improvements.
Since individuals with complete spinal cord injuries do not have any spared neural connections, they are unable to improve below their level of injury through neuroplasticity. However, they can use adaptive strategies to improve their functional independence. Furthermore, researchers are currently examining alternative recovery methods, such as stem cell therapy, to allow sensation and motor improvements even below the level of injury in individuals with complete SCIs.
7 Proven Strategies for Regaining Hand Function After Spinal Cord Injury (SCI)
1. Passive and Active Range of Motion Exercises
Enhancing flexibility in the fingers and wrists is key to restoring control and preventing long-term stiffness. In other words, keeping these joints mobile supports overall hand function and recovery. Incorporating regular range of motion (ROM) exercises helps maintain flexibility, prevent stiffness, and encourage natural movement.
Two common forms of exercise include:
- Passive ROM Exercises or exercises where the hands and fingers are moved without exerting the muscles. For example, these exercises could be done by a therapist or caregiver, or by using an unaffected extremity to move the hand and fingers to maintain flexibility.
- Active ROM Exercises or exercises where the individual attempts to move their hand on their own to strengthen muscles and improve movement. An example of an active ROM hand exercise is fully closing the hand into a fist, then straightening the fingers back out.
Both have their place throughout your recovery and depend on your capabilities at the time. Passive ROM exercises are generally most effective when mobility is severely limited, while active ROM exercises are a great way to begin regaining movement and gradually building muscle strength.
2. Strengthening Exercises
Building hand and wrist strength is vital for regaining hand function after a spinal cord injury. Targeted exercises can help you restore lost strength which can make everyday activities like holding a cup or turning a doorknob easier.
Some effective strengthening techniques for your hand include:
- Grip Strengthening: Squeezing a stress ball or therapy putty.
- Finger Extensions: Using rubber bands around the fingers to practice opening the hand.
- Wrist Flexion and Extension: Moving the wrist up and down while holding light weights or resistance bands. If you don’t have any weights, consider holding a filled water bottle or canned goods during this exercise to gradually build up strength.
Try to work these exercises into your regular routine alongside active and passive range of motion to improve mobility!
3. Fine Motor Training
Fine motor training can improve your coordination skills and help with tasks like buttoning a shirt, writing, or handling small objects. Generally, the best way to retrain fine motor movements is to focus on small, deliberate hand movements that can improve coordination and refine control for detailed tasks.
Some ideas to help you get started include:
- Picking Up Small Items: Using tweezers or clothespins.
- Stacking Coins or Blocks: Encourages precise finger control.
- Tracing Letters and Shapes: Helps refine hand coordination.
There really is no limit except your imagination here. The key is to focus on activities that promote small, deliberate hand movements. Start with slightly larger objects, like puzzle pieces, and move to smaller items, such as dry beans, as your skills improve.
4. Electrical Stimulation Therapy
Electrical stimulation therapy is a powerful technique that uses gentle electrical pulses to stimulate nerves, helping to activate weakened or dormant muscles. This therapy can be particularly beneficial for individuals recovering from neurological injuries, such as stroke or spinal cord injuries, by reawakening muscle activity and promoting strength recovery.
One common form of this therapy is functional electrical stimulation (FES), which delivers targeted electrical pulses to the nerves, triggering muscle contractions that mimic natural movement. When combined with hand exercises, FES can enhance neuromuscular re-education, improve coordination, and encourage the brain and muscles to work together more effectively.
While you can get electrical stimulation devices to use at home, it is recommended to consult with your therapist regarding which device and parameters may be most effective for you.
5. Mirror Therapy
Mirror therapy is an innovative and effective rehabilitation technique that leverages visual feedback to help retrain the brain and restore movement in an affected hand. It can be especially beneficial for individuals trying to regain hand function after spinal cord injury, particularly if only one hand was affected such as in cases of Brown-Sequard syndrome.
The process involves placing a mirror in front of the unaffected hand while concealing the affected hand behind it. As the individual moves their unaffected hand, the mirror creates the illusion that the affected hand is also moving. This visual trick helps the brain perceive movement in the affected limb, activating mirror neurons and stimulating neuroplasticity—the brain’s ability to reorganize and form new connections.
Over time, repeated practice with mirror therapy can lead to improved motor control, reduced pain, and increased confidence in hand movement. If both hands were affected, motor imagery, where you mentally visualize moving the hands, can also be an effective way to promote neuroplasticity.
6. Constraint-Induced Movement Therapy (CIMT)
Constraint-Induced Movement Therapy (CIMT) is a highly effective rehabilitation technique designed to encourage use of the affected hand by limiting reliance on the stronger hand. This approach, which is most appropriate for individuals with impairments primarily in only one hand, is based on the principle of neuroplasticity—the brain’s ability to rewire itself by forming new neural connections through repeated use and practice.
CIMT involves restricting movement of the stronger hand using a mitt, sling, or other constraint while requiring the affected hand to perform daily tasks and functional activities. This forces the brain to engage the weaker hand, gradually improving strength, coordination, and motor control.
One of the key benefits of CIMT is that it helps overcome learned non-use, a condition where the brain “ignores” the affected hand due to prolonged inactivity. By continuously challenging the weaker hand, CIMT strengthens neural pathways and restores movement patterns that may have been lost.
7. MusicGlove: A Fun and Effective Hand Therapy Solution
Merging music with therapy, the MusicGlove provides a fun, engaging and gamelike experience that keeps users motivated. Designed for individuals recovering from stroke, spinal cord injury, or other neurological conditions, this interactive therapy device helps improve hand function, coordination, and dexterity through music-based exercises.
How does it work exactly? The MusicGlove uses built-in sensors that track finger movements. Users wear the glove while participating in therapy exercises that are synchronized with an interactive rhythm-based game. As they tap their fingers in time with the music, they perform high-repetition hand movements essential for stimulating neuroplasticity and rebuilding strength.
The major benefits of the MusicGlove include:
- Encourages High Repetition: Users complete thousands of functional hand movements in a single session, reinforcing brain-muscle connections critical for recovery.
- Increases Engagement: The interactive music-based gameplay makes therapy enjoyable, motivating users to stay consistent with their exercises.
- Proven Results: Clinical research has shown that regular use of MusicGlove can lead to significant improvements in hand strength and dexterity within just a few weeks.
For individuals recovering from SCI, MusicGlove offers a structured and engaging way to enhance hand rehabilitation at home or in a clinical setting.
Regaining Hand Function through Adaptive Strategies
While the techniques above focus on regaining functional motor control and sensation, there are a number of adaptive strategies that may be used to improve use of the hands after a spinal cord injury. These are ideal for those with complete spinal cord injuries, since they may not be able to restore motor control and sensation below their level of injury.
Universal Cuff
This versatile and affordable assistive device can be very beneficial for those who are unable to grasp items effectively, but can still move their arms. It consists of a band that can be fitted around the palm of the hand, as well as a holder that can support various utensils.
Universal cuffs can be used to help individuals hold a number of items, such as a spoon, pencil, or toothbrush. Using a universal cuff can greatly increase independence, as it provides a way to to hold everyday utensils that individuals would otherwise would be unable to use.
Similarly, individuals who have some use of their hands but are unable to grasp small items may benefit from adding built-up handles to commonly used utensils.
Tenodesis Grip
Spinal cord injury survivors who have lost control of their hands and fingers, but are still able to extend the wrist, may benefit from learning how to use a tenodesis grip. This is an adaptive technique that allows the fingers to passively close when the wrist extends, and open when the wrist is flexed.
Learning how to use a tenodesis grip can improve independence with daily tasks, allowing individuals to grasp items they otherwise would be unable to. Talk with your occupational therapist to learn more about whether you’d be able to use tenodesis to improve your hand function, and how to perform it.
Final Thoughts to Regaining Hand Function After SCI
Regaining hand function after a spinal cord injury is a gradual process that requires dedication and the right exercises. With consistent therapy, neuroplasticity can help restore movement and strength.
Tools like MusicGlove can make the rehabilitation journey more engaging and effective. By staying committed to recovery, individuals can regain greater independence and improve their quality of life.
