Figure 1

Shape discrimination exercise (a) and height discrimination exercise (b). The therapist first shows all the options to the participant. In (a) the therapist shows letters “H” with different widths of horizontal and vertical bars. Then the participant closes his or her eyes and the therapist guides the participant’s finger along the edged contour of one of the letters “H” to identify which letter “H” the therapist has chosen. The movement is felt in the shoulder joint. Through reflection and attention on associated shoulder movements, the patient feels the width and length of the horizontal and vertical bars and identifies the correct letter “H”. This kind of exercises provides an integrating of attention, sensory integration, reflection and awareness of body positions, movements, and feelings. Later in the session, this increased awareness of shoulder and arm movements will be evaluated during daily tasks that involve reaching. The latter will be done with eyes open. In (b) the wooden stabs have different heights. The participant first sees all the options. Then the participant closes his or her eyes and the therapist guides the participant’s finger along the edge of the wooden stab and stops at the top of the wooden stab. The participant has to feel the movement and position in the metacarpophalangeal joint of the finger while keeping the fingers relaxed, in order to identify the correct height of the wooden stab. Later in the session, this learned position and movement will be evaluated in a real-life situation in which, e.g., the participant integrates what was learned by opening the hand correctly to grasp a bottle.