I'm Michelle, and I have a different way of designing.
I try and use my arms as little as possible, and for that reason, I've developed several techniques that allow me to create images and illustrations without straining my hands. I use the tip of my nose to draw in a trackpad, but I also perform certain gestures using my lips. I've been doing this now for several years, and I can achieve the same level of accuracy as with my hands.
There are certain techniques that are easier for me, such as the drawings, and this has also influenced my design style since last few years.
I hope this video gives someone else inspiration.