Normal and Abnormal Reach, Grasp and Manipulation

Question 1

Why is upper limb function important for ADLs?

Answer 1

Upper limb function is essential for fine motor skills needed for ADLs such as feeding, donning/doffing clothes.

Question 2

What gross motor skills are related to upper limb function?

Answer 2

Gross motor skills such as crawling, walking, regaining balance, and protecting the body from injury during a fall.

Question 3

Why is retraining upper extremity (UE) function important?

Answer 3

Due to the interrelation of UE control with both fine and gross motor skills, retraining UE function is crucial for PTs and OTs.

Question 4

How do reach, grasp, and manipulation fit into the ICF framework?

Answer 4

They fit into the ICF under body structure and function (neuromusculoskeletal and movement-related functions), activities and participation (mobility, carrying, moving, and handling objects), and self-care.

Question 5

What are the motor control principles involved in reach, grasp, and manipulation?

Answer 5

Control of reach, grasp, and manipulation requires both reflexive and voluntary movements and both feedback and feedforward processing.

Question 6

What is the role of feedforward processing in motor control?

Answer 6

Feedforward processing uses vision to anticipate where to move the hand to catch a ball, activating biceps, triceps, and wrist muscles.

Question 7

What is the role of feedback processing in motor control?

Answer 7

Feedback responses occur after the ball hits the hand, providing sensory information from the hand and eyes to compare planned and actual outputs.

Question 8

What are the basic requirements of reach, grasp, and manipulation?

Answer 8

Visual regard, reaching, grasping, and manipulation.

Question 9

What is visual regard?

Answer 9

Visual regard is locating the object in space and includes eye-head-trunk coordination.

Question 10

What are smooth pursuits?

Answer 10

Smooth pursuits are following a slowly moving target with the eyes only.

Question 11

What are saccades?

Answer 11

Saccades are rapid eye movements between two targets with the head stationary.

Question 12

What is the Vestibulo-ocular Reflex (VOR)?

Answer 12

VOR is keeping an object visually stable while moving the head and body.

Question 13

What is reaching?

Answer 13

Reaching is the transportation of the arm and hand in space, requiring postural support.

Question 14

How do postural support demands vary in reaching?

Answer 14

Seated reaching requires less postural support than standing, which may require extensive activation of muscles in legs and trunk.

Question 15

What is grasping?

Answer 15

Grasping is making contact with an object, including grip formation, grasp, and release.

Question 16

What are the types of grips?

Answer 16

Power grip and precision grip.

Question 17

What is a power grip?

Answer 17

A power grip involves finger and thumb pads directed toward the palm to transfer force to the object, using basic synergies of the arm.

Question 18

What is a precision grip?

Answer 18

A precision grip involves forces directed between the fingers and thumb, allowing manipulation of the object relative to the hand and within the hand.

Question 19

What is manipulation?

Answer 19

Manipulation is moving the object with grip-dependent dexterity and power.

Question 20

What are musculoskeletal components contributing to reach, grasp, and manipulation?

Answer 20

Joint ROM, spinal flexibility, and postural support.

Question 21

What are neural components contributing to reach, grasp, and manipulation?

Answer 21

Motor processes (coordination of eyes, head, and trunk), muscle strength, and coordination of reach and grasp phases.

Question 22

What are sensory processes contributing to reach, grasp, and manipulation?

Answer 22

Coordination of vestibular, visual, and somatosensory systems.

Question 23

What is the impact of abnormal reach, grasp, and manipulation?

Answer 23

It significantly impacts independence with ADLs and gross motor skills, contributing to increased healthcare costs.

Question 24

What are common problems with visual regard?

Answer 24

Eye movement problems (slow/inaccurate smooth pursuits or saccades), gaze stability problems, and visual field deficits.

Question 25

What are common problems with eye-head-hand coordination?

Answer 25

Coordination problems often seen with cerebral palsy, developmental coordination deficits, stroke, and cerebellar pathology.

Question 26

What are common problems with reach?

Answer 26

Sensory contributions (visual and somatosensory deficits), cognitive contributions (alertness, memory, attention), and motor contributions (timing problems, inter-joint coordination, abnormal synergies).

Question 27

What are common problems with grasp and manipulation?

Answer 27

Altered grip position, slower movements, less accuracy, altered forces, and problems with in-hand manipulation and release.

Question 28

How can target location problems be managed?

Answer 28

Training focus on eye movements while the head is stationary, progressing to gaze stability, and combining eye, head, and trunk movements.

Question 29

How can reach problems be managed?

Answer 29

Providing postural support, facilitating UE movement, using targets, and retraining task-dependent characteristics of reach.

Question 30

How can grasp and manipulation problems be managed?

Answer 30

Starting with simple grip patterns, progressing to more precision grips, using diverse objects in various positions, and working on release.

Question 31

What is Constraint-Induced Movement Therapy (CIMT)?

Answer 31

CIMT is a form of massed practice designed to improve function in patients with hemiplegia by constraining the less-affected limb.

Question 32

What are the benefits of CIMT?

Answer 32

Improved hand function, greater pinch strength, and less variability during precision grip tasks.

Question 33

What is bimanual training?

Answer 33

Bimanual training uses both upper extremities simultaneously to encourage interlimb coordination and is functional and recreational.

Question 34

What are smooth pursuits and their role in visual regard?

Answer 34

Smooth pursuits are following a slowly moving target with the eyes only, essential for visual regard.

Question 35

What is the significance of postural support in reaching?

Answer 35

Postural support is crucial for stabilizing the body while reaching, varying in demand based on the task.

Question 36

How does anticipatory shaping occur during reach?

Answer 36

Pre-shaping of the hand occurs during the transportation component of the reach, under visual control.

Question 37

What are the classifications of grasp patterns?

Answer 37

Grasp patterns are classified as power grips and precision grips.

Question 38

What are examples of power grips?

Answer 38

Hook grasp, spherical grasp, and cylindrical grasp.

Question 39

What is the role of tactile sensation in grasp?

Answer 39

Tactile sensation is important to adjust the forces during grasp.

Question 40

What are common motor contributions to reach problems?

Answer 40

Timing problems, over/undershooting the target, and inter-joint coordination issues.

Question 41

What are visual feedback deficits in reach?

Answer 41

Visual feedback deficits affect the accuracy of reaching movements.

Question 42

What are proprioception deficits in reach?

Answer 42

Proprioception deficits lead to less accurate reaching movements involving multiple joints.

Question 43

What is the impact of abnormal synergies on reach?

Answer 43

Abnormal synergies involve fixed patterns of movement, impacting reach accuracy.

Question 44

How can external trunk support improve reaching?

Answer 44

External trunk support can improve reaching kinematics for individuals with neurological pathology.

Question 45

What is the clinical implication of visual regard problems?

Answer 45

Lack of coordination of eye-head movements needed for visual regard may affect functional grasp.

Question 46

What are cognitive contributions to reach problems?

Answer 46

Cognitive contributions include difficulties with alertness, memory, attention, and dual tasking.

Question 47

What are common release problems in grasp?

Answer 47

Slower and less accurate/timely release of objects.

Question 48

How can visual modeling aid in reach training?

Answer 48

Visual modeling prior to active movement can improve proprioception and reaching accuracy.

Question 49

What is the importance of high repetition in grasp training?

Answer 49

High repetition helps in developing and refining grip patterns and manipulation skills.

Question 50

What is the role of CIMT in brain reorganization?

Answer 50

CIMT helps rewire the brain following neurological injury through intensive task-oriented training.