Optimising Upper Limb Recovery: A Clinician’s Perspective on the Challenges and Solutions.
- Tim Walton
- 2 days ago
- 3 min read
Tim Walton (BBTA tutor)
Helping patients recover arm function after neurological injury remains one of the most challenging—and rewarding—parts of my work.
While encouraging patients to complete tasks with the right number of repetitions is essential, we all know it’s not as simple as “just keep doing the task.” If it were, rehabilitation would be far less complex. The real difficulty lies in addressing the wide range of presentations, underlying impairments, and barriers to movement that each patient brings to therapy.
In this post, I’ll explore two key challenges I face in my clinical practice—and how the Bobath Concept (BC) and principles of motor learning guide my approach.
Challenge 1: The Assessment
A “one size fits all” approach is rarely effective. The reality is that most of my patients do not present with the same movement profile—or the same degree of recovery.
Some have profound motor weakness with very low tone and inactive arms. Others present with increased tone and stiffness. Some cannot initiate voluntary movement, struggling to conceptualise or ideate moving their arm away from their body.
This variability means individualised assessment is essential. My approach includes:
Detailed movement analysis to identify missing key components.
Linking findings to the nature of the neurological damage and resulting impairments.
Applying the Model of Bobath Clinical Practice (MBCP) to shape my clinical reasoning and inform targeted interventions.
As Stockley et al. noted, “Accurate assessment of impairment and function forms the bedrock of treatment planning.” Skilled clinicians begin by analysing movement to uncover musculoskeletal, neurological, and non-motor limitations.
In my assessments, I not only observe movement patterns but also use my hands to guide and facilitate movement. This “hands-on” approach:
Gives me critical information about posture, selective movement, and muscle activation.
Provides the patient with valuable somatosensory input, which can enhance muscle activation (Bolognini et al., 2016).
Challenge 2: The Intervention
Designing an effective intervention goes far beyond prescribing exercises. It requires:
Identifying key impairments and understanding their impact on function.
Deciding which components to focus on—postural control, movement patterns, or the task itself.
Choosing the most appropriate tasks and activities for the patient’s stage of recovery.
Motor learning literature supports this complexity.
McLoughlin (2020) outlines 10 movement training principles, incorporating impairment-based activity, sensory integration, task-specific practice, and real-life application. Similarly, Boccuni (2022) describes the process of preparing for an activity, shaping it, and rehearsing the task—principles that align perfectly with the MBCP.
In practice, I may:
Work on individual components or the full task.
Use a mix of “hands-on” and “hands-off” approaches.
Adapt interventions in real time to suit patient needs.
Integrate other modalities such as NMES alongside active movement practice.
I absolutely encourage my patients to translate improved movement into functional tasks—but I also address the underlying postural and selective movement issues that limit performance. This dual focus allows for meaningful and sustainable improvement.
Conclusion
Upper limb recovery after neurological injury is a complex process with no quick fixes.
By combining the principles of motor learning with the Bobath Concept’s emphasis on postural control, selective movement, and the integration of sensory input, I can create tailored interventions that meet each patient where they are—and help guide them toward improved movement and function.
The real art lies in knowing what to do, when to do it, and with whom—questions the Bobath Concept equips me to answer.
Would you like to develop your knowledge and skills for your patients arm recovery? Do you have some of these same challenges in your clinical practice? Sign up for one of our clinically based hands-on courses, embedded on up to date neurophysiology and move your practice forwards. www.bbta.org.uk | info@bbta.org.uk.
References:
Boccuni, L., Marinelli, L., Trompetto, C., Pascual-Leone, A. and Tormos Muñoz, J.M., 2022. Time to reconcile research findings and clinical practice on upper limb neurorehabilitation. Frontiers in neurology, 13, p.939748.
Bolognini, N., Russo, C. and Edwards, D.J., 2016. The sensory side of post-stroke motor rehabilitation. Restorative neurology and neuroscience, 34(4), pp.571-586.
McLoughlin, J., 2020. Ten guiding principles for movement training in neurorehabilitation. OpenPhysio J, 10, pp.1-17.
Stockley, R.C., Clark, L. and Kelly, K., 2025. Revisiting the core principles of physical rehabilitation after stroke: Recapping the guidelines and underlining the importance of assessment. British Journal of Occupational Therapy, p.03080226251330756.
Wingfield, M., Hughes, G., Fini, N.A., Brodtmann, A., Williams, G. and Hayward, K.S., 2024. Considerations for developing complex post-stroke upper limb behavioural interventions: An international qualitative study. Clinical Rehabilitation, 38(9), pp.1249-1263.
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