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Neuro-rehabilitation-for-the-upper-limb | Blog | Physio.co.uk | Leading physiotherapy provider in Liverpool and Manchester.

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Neuro Rehabilitation for the upper limb

The upper limb, which consists of the shoulder girdle, the elbow and the hand, is an essential part of the body to complete everyday functional activities. There are 32 bones in each upper limb with multiple muscle attachments. Some of these muscles attach across more than one joint and have multiple uses.

The upper limb is unique in its combination of large gross, multi-directional movements at the shoulder to its fine precise movements of the fingers. This makes it ideal for complex task accomplishment in reaching, prehension, and manipulation for objects.

The muscles of the upper limb are innervated by the corticospinal tract.  The corticospinal tract is a motor pathway starting at the motor cortex in the brain and terminates on lower motor neurons in the spinal cord and it controls movements of the limbs and trunk.   If a brain suffers an injury in this area then it is unable to communicate with the muscles in the upper limb and ultimately results in a loss of function within the upper limb.

Upper limb weakness can be a result any of the below conditions:

  • Multiple Sclerosis
  • Traumatic Brain injuries
  • Cerebral Palsy
  • Guillain Barre
  • Spinal injuries
  • Strokes
  • Parkinson’s

Studies have shown that therapy including physiotherapy and occupational therapy are effective in utilising the potential for recovery.

Upper limb therapy input is important for the following reasons:

  • To maintain muscle length and prevent contractures. This can lead to disuse of a limb and also problems with personal hygiene e.g. a closed hand is very hard to clean.
  • To reduce pain
  • To reduce tremors
  • To increase muscle strength
  • To prevent further deterioration
  • To increase functional potential.

Below is a list of potential upper limb interventions that are supported by evidence-based rehabilitation:

  • Splinting

There are numerous splints on the market. These can range from resting splints to dynamic splints to rehabilitation splints. The type of splint required is dependent on your level of function, your goals and any increased tone you may have within your upper limb.

  • Electrical Muscle Stimulation

This modality uses electrical impulses to elicit a muscle contraction. This can be used to provide both sensory feedback and strength training to a weak upper limb. The variation in the setting will be dependent on your tolerance to the impulse, the make of your machine and your current level of upper limb function.

  • Constraint-induced Movement Therapy (CIMT)

CIMT is a specialised therapy that involves restraining the stronger arm whilst providing functional intensive rehabilitation to the weaker arm. CIMT is provided by specialist therapists and involves rehab sessions for a few weeks.

  •  Repetitive task training

There is a strong body of evidence that shows regular repetition of a task can promote neuro recovery through a process known as neuroplasticity. Repetitive task training can be small finger lifting, pinching movements to gross reach, grasp release movements.

  • Strength training

Strength training is based on the basic principle that loading a muscle, will in turn make it stronger. Strength training must be graded and appropriate to your upper limb weakness. Strength training can range from using your own body weight to lifting household items or weights.

We would advise that none of the above treatments are started without first receiving a full assessment from a qualified physiotherapist.

Our neuro therapy team at physio.co.uk are able to offer advice on all the above treatment options. For more information please visit our website or arrange an initial assessment with one of our qualified therapists:


0330 088 7800