This chapter will present the anatomical, biomechanical and patient-centered challenges that therapists are faced with when setting goals and designing rehabilitation interventions for the upper extremity.

This chapter will present an evidence-based algorithm therapists can use to predict upper extremity recovery, establish an appropriate treatment plan and set appropriate goals. The algorithm will be applied to case examples along the recovery continuum.

This chapter will introduce an algorithm that can be used to design appropriate interventions for patients across the recovery continuum. Examples of intervention options will be provided.

This chapter will cover the process of neurological and functional recovery for persons who have acquired brain injury or stroke and their implications on the rehabilitation process. Dr. Bondoc will also explain the nature of spasticity and its impact on movement, functional recovery, and the development of secondary impairments.

This chapter will review neurophysiology of the motor unit and discuss the definition of spasticity and its impact on movement and posture of the arm and hand.

In this chapter Salvador Bondoc will review the somatosensory system and sub-modalities of somatosensation and describe pain and sensory impairments associated with the neurological UE following brain injury.

This chapter will provide an overview of the ICF Model while integrating the ICF Model with a systems approach to assess the neurological upper extremity.

This chapter will continue the review of the ICF Model while demonstrating and explaining the use of certain physical tests and measures specific to the neurologic upper extremity.

Using assessment findings from a demonstration, this chapter will help the viewer recognize different patterns of the neurologic upper extremity and describe corresponding approaches to treatment.

This chapter describes neuroplasticity, including basic physiologic mechanisms of cortical reorganization post-stroke. It will cover use-dependent plasticity, learned non-use, and their impact on UE function post-stroke.

This chapter describes P.R.A.C.T.I.C.E. Principles and generally how they can be integrated into clinical therapies.

This chapter covers transcranial direct current stimulation. Rationale for tDCS use in UE motor function will be briefly described, as well as tDCS mechanisms for anodal versus cathodal approach.

This chapter describes the clinical presentation of the neurological upper extremity classified as having mild tomoderate neuromotor impairments.

This chapter identifies various impairment-focused and function-based interventions appropriate for the mild to moderately impaired upper extremity and describes the indications and scientific and theoretical bases for specific interventions.

This chapter describes the use of orthotics as a way to circumvent or support specific hand limitations to enable improved performance and increase engagement in task-oriented training.

This chapter provides a description of the different levels of bilateral hand use and describes specific tasks for each level of bilateral functioning as a critical element of task-oriented training.

Participants will be presented with treatment approaches for the post-stroke upper extremity with little to no movement. Risk factors for shoulder pain will be discussed as well as appropriate range of motion and positioning techniques for this population.

This chapter will present treatment approaches for the post-stroke upper extremity that presents with proximal movement, but which the patient considers “non-functional” secondary to lack of distal control.

This chapter will present treatment approaches for the post-stroke upper extremity that has regained movement but remains slow and poorly coordinated in daily living skills. Keys to developing skill in these patients, as well as the development of an independent practice program, will be presented.

This chapter will define neuroplasticity and learned non-use. It will describe the importance of neuroplasticity and reptitive, task-specific training to neurologic UE treatment.

This chapter will cover the different kinds of electrical stimulation. The rationale and components of electrical stimulation in neurorehabilitation will be described.

This chapter explains the rationale and components of portable upper extremity robotics. The rationale and benefits of the Myomo myoelectric brace will be discussed.

This chapter will describe the clinical presentation from the flaccid/ “non-assistive” upper extremity to emerging motor control.

This chapter will identify various impairment-focused and function-based interventions appropriate for the flaccid/non-assistive upper extremity while discussing the indications and scientific and theoretical bases for specific interventions.

This chapter will identify and incorporate evidence-based strategies to address the painful and subluxed shoulder, with a particular view of interventions at motor recovery Level Three.

This chapter discusses the mechanics of impairment in the hemiplegic shoulder and reviews of the healthy shoulder anatomy and pathomechanics associated with hemiplegia.

This chapter identifies and incorporates evidence-based strategies to address the painful and subluxed shoulder.

This chapter will provide an operational definition of neuroplasticity and present the principles of “Use it or Lose It,” “Use it and Improve It,” and “Specificity.” These will be presented using examples from animal and human research with clinical examples on their implementation for patients post-stroke.

This chapter will present the principles of repetition and intensity using evidence from clinical trials. Examples from trials that can be translated into clinical practice will be provided.

This chapter will discuss the role patient-specific factors, such as age and time post-stroke play in recovery. Clinical interventions that may interfere with neuroplasticity will also be discussed.

This chapter provides an overview of neuroplasticity, learned non-use, basic mechanisms of TMS, and how TMS is used for assessment and treatment. There is a brief introduction to tDCS and how to differentiate between tDCS and TMS.

This chapter summarizes the physiological basis for tDCS, including interhemispheric imbalance, long-term potentiation, and long-term depression. Mechanisms for both anodal and cathodal stimulation techniques are described, as well as the established tDCS safety guidelines.

This chapter covers tDCS evidence and use in various diagnoses, including neurodegenerative diseases, spinal cord injury, and stroke. tDCS evidence and use in post-stroke upper and lower extremity motor function is also discussed.

This chapter covers the supplies needed to administer tDCS, including electrodes, electrode sponges, and machine. A demonstration shows the electrode placement for both anodal and cathodal stimulation, as well as usage of the tDCS device.