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Chapter Objectives

Upon completion of this chapter, the learner should be able to:

  1. Identify the effects of neurologically based illness or injury on the functional repertoire of the hand and arm related to the performance of daily tasks and engagement in life activities.

  2. Identify examinations, evaluations, and interventions at the basic function and skill levels for an upper extremity affected by neurologically based illness or injury.

  3. Choose appropriate evidence-based examinations, evaluations, and interventions at the occupational performance skill level for an upper extremity affected by neurologically based illness or injury.

  4. List the typical clinical pictures of neurological impairment characteristics of the hand and upper extremity, including impairments underlying abnormal neurological function, safety considerations, and lifespan influence.


Dana, a 58 year-old musician, had a right hemisphere cerebrovascular accident. She tells you that her “left arm feels tight and stiff, and it is difficult to move. I can’t do anything!” You observe that all left upper extremity movements are in the form of abnormal synergies with no isolated movements. In addition to other body function impairments, you detect spasticity in the left upper extremity. Because the patient has identified left upper extremity tasks as a priority problem, you will need to further explore all underlying impairments potentially contributing to the movement dysfunction, the specifics of the muscle tone examination, and precisely how each upper extremity function has been affected. We will learn more about Dana as the chapter progresses.

This morning, you may have pushed the snooze button on your alarm clock, reached for the blankets, and plumped your pillow for an extra minute of “shut-eye.” Or perhaps you threw back the covers, ran your hands through your hair, and faced the new day. As you prepared for the day, you ran a familiar upper extremity (UE) obstacle course that included manipulation and navigation of small items, such as a razor; toothpaste, shampoo, creams, or pill bottle caps; slippery soaps and lotions; tubes, pencils, and brushes for makeup; and buttons, zippers, ties, snaps, and Velcro for closures—not to mention remote controls and microwave buttons. You successfully met many challenges just to get ready for the day. Depending on the education, work, leisure, or other tasks scheduled in your day, you then carried out additional unique sets of coordinated hand and arm tasks. For the most part, all of these were accomplished with ease owing to the dexterity, coordination, and control of your hands and UEs.

Upper extremity (UE), a term generally used to describe all the muscular, skeletal, nervous, and soft tissues of the shoulder, arm, forearm, and hand, is inadequate for describing the importance of this portion of the anatomy in the performance of occupations or activities of daily living; these actions, which people engage in throughout their life, give them meaning and include care of their body, home, and family, as well ...

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