Rehabilitation of the upper limb after an stroke. Part 4. Dissociation and tone and tissue control.

The reality for the individual that has suffer from an stroke is visible in the text that an person with an severe stroke say: “Brilliant that I can move and managed my shoulder and elbow and have less difficulties with the ADL and no pain, but at the end of the arm is my hand and that is purpose of al that shoulder movement to bring my affected hand in an position that I can use him.” I was silent. He was right, I wasn’t capable to get an good hand-function. He was able to pick up something and open his hand but only with mass flexion and mass extension. And often when he don’t look to his hand was the object gone! The therapy remain on that level but when stop an while, he experience what he loss in an short time and his motivation was present again. Still it is never the treatment goal to hold that level!! After the treatment of the flexor attitude and movement synergy, now there is more dissociation possible and that can be through recovery but also through an good treatment. But that means don’t stop, go one with dissociation, also with the hand to get the highest possible level!