Evaluation and training of upper extremity control from a systems perspective in the patient with neurological...

Three phases exist for using the arm in a functional activity, namely, localization of the target in the environment, transportation of the arm to the target, and grasp release or in-hand manipulation of the object. According to the systems model of motor control, functional use of the arm requires the integrated activity of the musculoskeletal, sensorimotor integration, commanding, comparing, regulating, and environmental systems. Comprehensive retraining of upper extremity control in the client with neurological dysfunction should include restoration of postural alignment range of motion and strength, elimination of pain, reduction of shoulder subluxation, training postural control and orientation, optimizing sensory processing and organization, training the shoulder elbow coupling needed to transport the arm to the target, reeducating grasp release and manipulation of objects, developing the predictive central set needed for environmental adaptation, developing the patient's intrinsic error detection skills, and maximizing the ability to use knowledge of results and performance for generalization of learning.