Chapter 9: Management of the Impaired Upper Extremity

INTRODUCTION

Man by the use of his hands, as they are energized by mind and will, can influence the state of his own health (Riley, 1962).

Having read about the basic structure and theory behind movement and function, the reader’s clinical eye can now turn to a study of the upper extremity. It is difficult to list many functional activities that do not require upper extremity use. From self-care to vocation to play and leisure, the upper extremity plays an integral role in an individual’s successful ability to interact within the environment. Development of skillful use of the upper extremity relies on the coordinated efforts of a multitude of different systems and the ability of these systems to adapt to changes within the environment.

This chapter will examine the functional components of upper extremity (UE) use and the systems that support them. This description of components will be followed by an exploration of the developmental tasks of the upper extremity as they change throughout the life span. Common neurological problems and their effect on UE function will be explored. A discussion of useful intervention strategies enhancing upper extremity function and control will follow. The chapter will conclude with pediatric and adult case studies, illustrating some of the key management concepts discussed in this chapter.

FUNCTIONAL COMPONENTS OF UPPER EXTREMITY FUNCTION

The complex task of upper extremity control is accomplished through the coordination of postural control, vision and visual perception, somatosensory function, cognition/volition, and fine motor skills. Each of these components will be discussed separately, but remember that successful use of the upper extremity is made possible through the coordinated efforts of these many systems.

In Chapter 8, the functional implications of postural control were discussed. During fine motor activities, postural control through the trunk and shoulder girdle allow for distal mobility. This proximal stability afforded from the trunk provides a stable base from which distal movements can occur. Refer to Chapter 8 for more detail on postural control and stability, which serve as prerequisite skills for many upper extremity movements.