EM494: Workshop - The Hand in Action: From Global Organisation to Selective Function

Recovery of hand and upper limb function remains one of the greatest challenges in neurorehabilitation. Following stroke, traumatic brain injury, spinal cord injury and other central nervous system disorders, limitations in reaching, grasping, releasing and manipulating objects can have a profound impact on independence and participation. These difficulties cannot be fully understood by examining the hand, individual muscles or muscle strength in isolation.

Skilled hand function emerges from the interaction between descending motor control, flexible hand synergies, sensory information, previous experience and the intended goal of the action. Direct corticospinal and corticomotoneuronal control contributes particularly to fractionated finger movement, force modulation and dexterity, while tactile and proprioceptive information continuously shapes both anticipatory and reactive adjustments. Action intention, task demands and affordances influence hand posture and grasp selection.

Selective hand activity is never completely isolated from the rest of the upper limb or the body. Hand posture, carpal alignment, wrist and forearm orientation, shoulder girdle organisation and postural control all influence the ability to reach, grasp and manipulate. As the demand for force, stability or speed increases, broader motor organisations and reticulospinal contributions become increasingly relevant. Following central nervous system injury, these global organisations may support function, but they may also dominate the movement and restrict distal selectivity.

This three-day workshop adopts an original distal-to-proximal perspective. It begins with the selective organisation of the fingers and hand and progressively builds towards pronation and supination, proximal upper limb activation, the shoulder girdle, the trunk and whole-body postural organisation. Current neuroscience will be integrated with clinical reasoning, hands-on practice, live demonstrations and the presentation of a clinical case using the Model of Bobath Clinical Practice. The aim is to help participants understand how selective and global motor organisations interact and to translate this knowledge into individualised treatment strategies for functional reach, grasp and manipulation.

Learning Objectives

By the end of the workshop, participants will be able to:

• explain the contribution of corticospinal, corticomotoneuronal and reticulospinal systems to selective and global upper limb motor control;
• describe hand synergies as flexible motor solutions and distinguish adaptable selective synergies from stereotyped or inflexible movement organisations;
• explain how tactile and proprioceptive information, predictive and reactive control, action intention, affordances and task goals influence hand shaping, grasp and manipulation;
• analyse the relationship between selective finger activation, functional pinch, intrinsic muscle activity, hand posture and carpal alignment;
• identify the contribution of pronation and supination to hand orientation, grasp and manipulation within the organisation of the whole upper limb;
• analyse how grip force, effort and task demands influence proximal activation, shoulder girdle organisation and postural control;
• recognise when broader upper limb and whole-body motor organisations support function and when they interfere with distal selectivity;
• develop clinical hypotheses and treatment priorities based on the interaction between motor, sensory and postural impairments affecting hand function;
• apply hands-on strategies and functional practice to facilitate selective finger synergies, hand posture, forearm orientation, reach, grasp and manipulation;
• design treatment progressions that integrate distal selectivity with proximal and whole-body organisation