Skip to Main Content


Chapter Outline

Biomechanics of Functional Skills

  • The Shoulder

  • The Wrist

  • The Hand

  • Functions of the Hand

Examination and Evaluation of Functional Skills

Task Analysis Guidelines

  • Body Function Performance (Lead-up) Skills

  • Activity Analysis of ADL Tasks

Treatment Strategies and Considerations

  • Neuromuscular Facilitation

  • Proprioceptive Neuromuscular Facilitation

  • Compensatory Training

  • Motor Learning

  • Modified Constraint-Induced Movement Therapy


Student Practice Activities

This chapter is written from the perspective of the practicing occupational therapist and addresses how impairment of the upper extremity (UE) is treated within the context of daily living skills. The chapter is designed to provide the therapist with information to (1) provide effective interventions to improve UE function, (2) understand the unique contributions of the occupational therapist in UE functional skill training, and (3) communicate with occupational therapy colleagues about comprehensive interdisciplinary patient management.


Practitioners must possess a thorough understanding of normal upper limb movement as a foundation for skilled observation of the neurologically involved upper limb. In this chapter, the kinesiological principles of the shoulder complex, from proximal through distal control, are described. It is important to understand how active isolated movement, beginning with shoulder stabilization through the use of the hand, may potentially be affected by a variety of musculoskeletal or neurological injuries. Additionally, the upper limb may present with changes in soft tissues, joint integrity, muscle tone, and the ability to initiate active voluntary control. Neurological changes when coupled with biomechanical impairments will present a challenge to the patient during the rehabilitation process, particularly when the therapist attempts to facilitate the return of isolated active movement patterns. Keen observation of dysfunctional movement patterns is also necessary to fully understand how the patient may be best supported when facilitating the return of upper limb function.

The Shoulder

The shoulder complex is designed for mobility at the expense of stability in order to provide proximal support in all planes of movement for distal hand use. The upper extremity (UE) is linked to the thorax through the clavicle, scapula, and humerus. Three major joints will be described beginning with the sternoclavicular (S-C) joint, which serves as the only structural attachment of the UE and shoulder complex to the axial skeleton. The acromioclavicular (A-C) joint serves to attach the scapula to the clavicle and orients the glenoid fossa for optimal position in scapular upward/downward rotation in relation to the humeral head. This allows the scapula to rotate in three dimensions during UE movement to achieve required active motions and provides stability of the scapula on the thorax. Dysfunction is present if there is internal rotation of the scapula, which leads to “winging” of the scapular vertebral border as the medial border moves away from the thorax and the glenoid fossa orients anteriorly. The scapulothoracic (S-T) joint is formed by the articulation of the scapula with the thorax. This is not a true ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.