Neuromuskuloskeletal componenets of hand work



In Occupational Therapy, you have neuromuscular components of activities and motor components of activities, including such things as range of motion, muscle tone, strength, endurance, postural control, gross and fine motor co-ordination, crossing the midline, bilateral integration, praxis, and visual motor education) – according to how I learned 10+ years ago. I know that terminology is dynamic and has no doubt changed in concept since I studied.
In order to be able to sit and knit, you need a good posture. You need to have enough core strength to be able to stabilize your trunk, shoulders and elbows, with your wrists and fingers doing most of the movement. Of course this is not 100% necessary, as you can adapt the position of the knitter depending on their physical strength, but ideally, you want to be making small movements with the hands. (adapting the position or technique is something that is relevant to people with special needs who are interested in knitting.)
Small, isolated movements with the hands are possible when the trunk and larger joints (shoulders and elbows) are stabilized either by core muscle strength or positioning with support pillows/wedges. Ideally, the pelvic is neutral, and the spine is straight/neutral and the shoulders relaxed.
Fingers and hands can get fatigued with all the work, and for this reason, it is helpful to know a variety of ways to hold the yarn while knitting. Repetitive motions can cause strain over time.
The hands work together, using reciprocal movements. Instead of the non dominant hand needing to secure the page so that it doesn’t move when the dominant hand is writing, for example (asymmetrical movements), or both hands doing the same movement simultaneously as in rolling out dough with a rolling-pin (symmetrical movements). This is a wonderful activity for bilateral integration, with the hands using reciprocal movements. Fine motor co-ordination is integral. As is motor planning (praxis), certainly in the initial learning stages.
In the initial learning stages, visual motor integration is required as you follow the movements and interpret the positions of the yarn, needles and fingers and plan the movements based on the visual information coming in. Once your hands know what to do, the visual perceptual components are confined to being able to recognize or identify a mistake. (Patterns of stitches, orientation of stitches requires visual attention to discern mistakes/irregularities).
In short, knitting requires and challenges a variety of physical components together with cognitive and psychological components. The integration of physical and cognitive and psychological components in the working with hands is what makes it so important, in my opinion. The creation of beautiful garments, toys, useful objects is less the goal when working with children. Their experience of challenging themselves and mastering a new skill is where the focus is.


I have two blogs, and I somehow posted a blog post from my personal family blog to this blog.

Sorry for that.

Anyway, I am wanting to get back to this blog. And have been knitting socks as my recent challenge. I am enjoying the results and will have socks for next winter and as presents. I can experiment with different stitches and challenge myself on projects that do not take weeks and weeks.

I need to figure our how to upload pictures on my computer and then I will post some evidence of my own personal handwork.

And continue building articles here on how handwork and the brain interconnect.

Perceptual Processing

I really enjoyed learning about the development of perception when studying OT. And I found it interesting that there is a known progression of acquiring and strengthening perceptual concepts (in, on, over under etc).
Initially children learn about their bodies and how their bodies relate to the environment through movement. Or kinesthesia. Then they start to relate to other objects and the relationships between them in 3 dimensions, for example, the candle is on the table, the matchbox is next to the candle and the matches are inside the matchbox. And then the concepts become strong enough to understand them in 2 dimensions, on paper or a screen. And perceptual processing becomes clear in reading and writing, with concepts or left, right, over, under, next to, in front, behind etc all crucial for mastery of reading and writing.
Using tools such as knitting needles is drawing on perceptual concepts of over, under, behind, in front, through. Certainly learning to master knitting requires a working understanding of these concepts, as well as sensation, fine motor control, attention etc.
It really is remarkable that based on sensory information, the brain is able to process sensory input, makes sense of it (process the perceptual concepts), and direct the hands to make the necessary movements to manipulate the tools and do the knitting (sewing, crochet, felting etc).
I am of the opinion that these perceptual concepts require a firm establishment through movement and play with props, before they are transferred to pages and screens. Generally. There are always exceptions. But from what we know today, the brain is wired to learn through movement. Not by sitting and working on a page or a screen (although these options certainly offer opportunity for learning, especially for children who are movement impaired, for whatever reason.
So run, dance, skip, hop, swing, bounce, slide, certainly if you are a child. And use your hands to build and create with lego, yarn, sand, water, playdough, cookie dough, bread, working in the garden. The list is endless.

Sensory Processing as it relates to hand work / fiber crafts

Sensation is a big deal these days, with a lot of attention being paid to helping children integrate their senses.

While knitting is not primarily a sensory activity, it does require sensation in order to do it, just like any motor skill. Only with sensory feedback, can the brain plan the motor activity and bring it to execution, making necessary adjustments based on sensory feedback. And of course the pleasurable sensation of soft and comforting fibers on the skin and rich, satisfying colours in the yarns themselves are part of the sensory experience.

Tactile sensation includes the stimulation of sensory receptors in the skin for light touch and pressure. This happens with the yarn moving through the hands and fingers, and the holding of the knitting needles while manipulating them.

Visual stimulation is initially relied on to guide the movements. Paying visual attention to the details of where needles are placed and the sequencing of the movements helps the learner  knitter to master the skill.

Proprioceptive stimulation is happening all the time, and becomes the sensation you rely on in conjunction with tactile stimulation once the skill has been mastered. You can work with your hands without looking at what you are doing.

There are handcrafts, such as paper making which involves working with wet mushy materials that is a great sensory experience for children.

For more reading on sensation as a broader topic, about being able to integrate sensory experiences so as to gain motor control, Jean Ayers wrote a very good book on her pioneering work on Sensory Integration. She was an OT who devoted her professional life to exploring and understanding sensation and how it affects function. She coined the term Sensory Integration.

Today more and more is discovered and understood about the different sensory systems and how they interact and what happens when they are not stimulated enough, stimulated too much and when individual children have problems integrating sensations, either by over stimulating themselves or avoiding stimulation.

Two books that are a fantastic resource for deepening your personal understanding of sensation as it is understood in child development are Sensational Kids and The Out of Sync Child has Fun. They go into more detail for the interested parent, teacher or therapist, way beyond the scope of sensation as it pertains to hand work.

Why handwork for the brain?

When studying Occupational Therapy,  Activity Analysis was introduced to us students as a tool for developing specific treatment intervention plans. It is a method of looking at an activity, and isolating the physical, emotional, cognitive, psychological and social components of the activity.

For example, if someone has difficulties with attention, activities that require attention are built into the intervention program, starting with a minimal expectation for attention, and slowly building the expectation as attention improves. Like-wise, someone could have difficulties with fine motor skills, and activities that require fine motor skills are introduced, slowly grading the difficulty, based on the improving ability of the child/person.

Here I am doing an activity analysis of knitting, using the Uniform Terminology  (from my 8th edition Willard and Spackman’s Occupational Therapy) that Occupational Therapists use to analyse activities. A similar analysis could be done for spinning, sewing or weaving, with the differences being in the specific movement required of the hands.

Sensory processing

  • Tactile – interprets light touch, pressure through skin contact/receptors
  • Proprioception – interprets stimuli originating in the muscles, joints and other internal tissues to give information about the position of one body part in relation to another
  • Visual – interprets stimuli through the eyes, including peripheral vision and acuity, awareness of colour, depth and figure ground.

Perceptual processing 

  • Stereognosis – identify objects through the sense of touch
  • Kinesthesia – Identify the excursion and direction of joint movement.
  • Right left discrimination – differentiating one side of the body from the other.
  • Position in Space – determine the spatial relationships of figures and objects to self or other forms and objects.
  • Figure ground – differentiate between foreground and background forms and objects.


  • Range of motion – move body parts through an arc
  • Strength – demonstrate a degree of muscle power when movement is resisted with weight or gravity
  • Endurance – sustain musculoskeletal exertion over time.
  • Postural control – core stability for refined distal movements.
  • Bilateral integration – using both hands together in a coordinated manner
  • Praxis – conceiving and planning a new motor act.
  • Fine dexterity – control of small muscle group
  • Visual Motor Integration – coordinating the interaction of information from the with body movement during activity.

Cognitive components:

  • Attention – focusing on a task over time
  • Memory – recalling information after a short or long period of time.
  • Sequencing – placing information, concepts and action in order
  • Spatial operations – mentally manipulating and position of objects in relation to each other.
  • Problem solving – recognizing a problem, defining the problem and fixing it, and evaluating the outcome.
  • Learning – acquiring new concepts and skills.
  • Generalization – applying learned concepts and behaviors to a variety of new situations.


  • Values – identifying ideas or beliefs that are important to self and others. (for example handmade, home-made, recycling, natural fibers, local crafts etc)
  • Interests – identifying physical or mental activities that create pleasure or maintain attention.
  • Self concept – developing the value of the physical, emotional and social self.


  • Social conduct – interacting by using manners, personal space, eye contact, gestures, active listening and self-expression appropriate for one’s environment.
  • Self-expression – using a variety of styles and skills to express thoughts, feelings and needs.

Self management

  • Coping skills – identifying and managing stress and related factors
  • Self-control – modifying ones own behavior in response to environmental needs, demands, constraints, personal aspirations, and feedback from others.

And I am adding in:

  • Emotional regulation
  • Executive function

That is a lot!

So many parts of the brain can be used when learning to knit and becoming a  skilled knitter. And each person will have different challenges and reasons to love knitting, their own unique mix of what their strengths and difficulties are.

I do feel it necessary to state that I am not aware of scientific studies done to demonstrate the therapeutic effect of knitting on the brain. My Activity Analysis here is based on personal experience and observation and discussion with other knitters. I am drawing on my OT skills of activity analysis and applying them to knitting.

The Sensorimotor cortex of the human brain

The Sensorimotor cortex of the human brain.

Notice how much of the motor area  (red) is assigned to controlling movement in the hands.

A very brief history (herstory) of string

Why has the creation of cloth primarily been Women’s Work?

An answer that appeals to me is as follows:

Work that allowed women to contribute to subsistence living had the following requirements, as proposed by Judith Brown in 1970 – “Note on the division of Labour by Sex

the participant is not obliged to be far from home; the tasks are relatively monotonous and do not require rapt concentration; and the work is not dangerous, can be performed in spite of interruptions, and is easily resumed once interrupted.

In other words, relying on women to contribute economically, required that the work that they do meet the above requirements, so that they could provide childcare.

Spinning, weaving and sewing meet these requirements (and later knitting). Food preparation also meets the above requirements. Clothing and food having become the core responsibilities for women (with young children to care for).

The methodology of creating string/yarn was surprisingly similar, with little variation for thousands of years. Prior to the Industrial Revolution, women stuck with methods that were tried and proven. Deviating from time-honoured ways was not an option, as women could not risk failure of an already working system. It could spell out economic failure. Elise Boulding writes in her book, The Underside of History: A View of Women through Time:

The general situation of little margin of error leading to conservatism might apply to the whole range of activities carried out by women. Because they had so much to do, slight variations in care of farm or dairy products or pottery could lead to food spoilage, production failure, and a consequent increase in already heavy burdens.

The introduction of the Spinning Jenny (invented by a man), revolutionized the production of yarn.

At the core of cloth production is thread or yarn. Made from a variety of natural materials, such as flax, wool, silk and cotton. These fibers are prepared for spinning by brushing them and lying them side by side and then spinning them.

The first evidence of twisted thread/string is from a sculpture from 20, 000 BCE on a small Palaeolithic Venus figure that wears a string skirt (sculpted detail). For a more detailed and wonderful exploration of The String Revolution, Chapter Two in Women’s Work, the first 20, 000 years

Small Palaeolithic Venus Lespugue, France, 20, 000 BCE – in the Musee de l’Homme in Paris

Enter the spindle. Which is an ancient tool that allowed people to turn fibers to yarn for weaving and later knitting. It is becoming popular again as a low tech option for knitters to create their own yarn at home and on the move.

Spindle and distaff

Spun thread was then woven. By making a warp (threads laid parallel to each other under tension) and weaving the weft under and over at right angles to the warp threads. I will go into more details on how climate influenced the way people set up their weaving, in a later post. I am a bit of a geek for such details :D

Showing the warp (longitudinal string) and the weft (horizontal string)

Knitting only really became a method of creating cloth in the last millennium. It is far more portable than weaving. The first evidence of knitting is from Egypt, from +-1200 BCE, in the form of knitted socks.

I have drawn very heavily from the book Women’s Work, the first 20, 000 years for my content in this piece. It is a fantastic book! With Elizabeth Wayland Barber being an accomplished and respected expert on textiles, amongst other accomplishments.

How Integrative Fiber Arts came to be

My first memory of working with yarn is my mother teaching me to knit. I was about 5 or 6, and I remember her casting on for me, and showing me how to knit a row. I finished the row and asked her what happens next. It was magic for me that you turned the work around and started a new row, growing the knitted piece in length with each knitted row.

Another memory from a similar time period is of my mother spinning dog hair for a paying client. She was cursing having agreed to spin the dog hair, with very short fibers. I have a very clear memory of her seated and the rhythmical movement of her foot pushing the peddle and her hands feeding the fibers into the spinning wheel.

My mothers love of weaving and spinning is in part what brought her to England to study at Emerson College, meet my father and form her connection to Anthroposophy and Waldorf Education. This sets the background for me having grown up in a home with two Anthroposophists, attending a Waldorf school for my education and my personal connection to learning to create with my hands. Going on to study Occupational Therapy and then work in Hand Rehabilitation in orthopeadics and plastics.

My mother died very unexpectedly when I was just a new mother myself. I have worked through mourning her death and resolving the inevitable pain in the relationship between a mother and daughter, but without her. And a part of that has been me connecting to the positive qualities and skills she taught me, and integrating them into my life. This includes (but is not exclusive to) knitting and sewing and now I am learning spinning.

I took up knitting again while expecting my 1st child, in 2007. My last memory I share of my mother, the day before she died, was her showing me what she was knitting for my son. Over skype. I  showing her what I was knitting and we compared our work.  I have expanded on my skills, time allowing. I also have started sewing and making little toys from felt and cotton. I also enjoy making handmade gifts for friends and family, time permitting.

And now I find myself moving into a teacher role, sharing what I know about knitting, and also what I know about executive function, emotional regulation and child development. Integrating my knowledge as an OT with professional experience in Hand Rehabilitation, a passion for child development as well as personal development and my personal heritage of handwork passed on from my mother.


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