Dorsiflexion and Palmar flexion are one joint motor activities of the hand (Fig. 10.2). The wrist is the used joint. While exercising Dorsiflexion or/and Palmar flexion, the forearm lays on a table. In basic position one, the forearm is in position 0° without gravity. Dorsiflexion is the activity in the back of the hand direction. Palmar flexion is the activity in the palm of the hand direction. Basic position two with forearm on a pack allows to train movements over a wider range of motions.

Radial abduction and ulnar abduction are one joint motor activities of the hand. The wrist is the used joint. Radial abduction goes in thumb direction. Ulnar abduction goes in cubital direction. While exercising radial abduction and/or ulnar abduction, the forearm mostly lays with the palm on the table, basic position one shown in Fig. 10.3 without gravity. Basic position two: forearm on a pack, position of the wrist in pronation/supination direction 0° and in Dorsiflexion/Palmar flexion 0°, shown in Fig. 10.4 with gravity.

Finger flexion and finger extension are simple motor activities of the hand using multiple joints. All small finger joints are the used joints. Needed joints are metacarpophalangeal joints (knuckle joints), proximal interphalangeal joints and distal interphalangeal joints. Finger flexion is making a fist. Finger extension is to open the fist. While exercising finger flexion or/and finger extension, the forearm lays on a table. Basic position one (supination/pronation 0°, dorsiflexion/palmar flexion of the wrist 0°) and basic position two (palm of the hand on a pack and finger extension with gravity) are shown in Fig. 10.5.

Thumb abduction and thumb adduction are one joint motor activities of the thumb. The metacarpophalangeal joint of the thumb is the used joint. Thumb abduction direction goes away from hand. Finger adduction direction goes close to hand. While exercising thumb abduction or/and thumb adduction, the forearms and the palm of the hand lay flat on a table (Basic position one, without gravity). Basic position two: forearm and ulnar side of the hand lay on the table (shown in Fig. 10.6 without gravity and in Fig. 10.7 with gravity).

Finger abduction and finger adduction, also called “finger spread”, are motor activities of the metacarpophalangeal joints of all five fingers. Basic position one, forearm and palm of the hand lay flat on a table, as shown in Fig. 10.8 without gravity.

Pinch grip (shown in Fig. 10.9) is a motor activity of the hand using different fingers selectively. Two fingers are used. The thumb is in opposition to one of the other fingers (digit II to digit V). The finger pulps need to contact. Used joints are all small finger joints (metacarpophalangeal joints, proximal interphalangeal joints and distal interphalangeal joints). While exercising pinch grip, the forearm and the ulnar side of the hand lay on a table (Basic position one).

Repetitive training of simple movements is monotonous. Even increasing success will not keep the motivation of the patient on a high level. Serious gaming may increase the attention and motivation of the patient. Each “level” of a game is reached when specific tasks are fulfilled. In our context, fulfilling of tasks is defined by moving in a certain direction, with a minimal movement speed, with a specific number of repetitions and so on. In other words, we can define the sequence of tasks by modifying the shaping variables of the trained movements. For each movement, a sequence of shaping variables needs to be developed. In the following sections, we describe the principle shaping possibilities for each movement.

This subset of training intervention is employable for patients with mild to moderate impairments. It is advisable to exercise highly repetitive (many repetitions during a training session) and often (many training sessions during a week). We proposed seven objects and their correlating tasks.

The goal of each task is to get better grip force, steadiness, coordination, dexterity, aiming, strength endurance and speed of hand and finger movements. Training should stimulate the patient to involve the paretic upper limb more extensively in the activities of daily living. See the described distal movements below for further details. Each exercise needs to be adapted to the rising performance limit as well. Shaping possibilities will be described for each object in detail. General shaping possibilities include: speed, weight and level of difficulty.