Upper Limb Exercises
Boxing Series
Left or Right Hook
Assisted Shoulder Flexion with Horizontal Adduction Across the Chest
Jab
Assisted Forward Reach
Upper Cut
Self-Assisted External Rotation of the Shoulder and Forearm
The Left Hook, Jab and Upper Cut are standing or seated upper limb games. Sitting and standing boxing programs have positive effects on upper limb function including balance, gait, core strengthening, stability, balance, motor coordination, shoulder strength, elbow extension, neuroplasticity and quality of life in stroke patients (Park et al., 2017, Ersoy & Iyigun, 2020).
Stroke survivors explored the gamification of boxing punches as upper limb exercises, mapping 3 boxing arm moves to 3 upper limb exercises: the Left Hook - cross body adduction, Jab - assisted forward reach, and Upper Cut - Self-Assisted External Rotation of the Shoulder and Forearm
These games have original music and instructions on how to play are below!
Left Hook
Game Download
Switch Placements
Here a stroke survivor is holding a bluetooth switch in his non-paretic hand as he did not have a suitable clamp, Be mindful not to twist the trunk if you use a switch in this position.
Alternatively, position a switch using a clamp to facilitate the assisted or unassisted movement.
HOW TO: LEFT HOOK! CROSS-BODY REACH (ASSISTED) Assisted Shoulder Flexion with Horizontal Adduction Across the Chest Game co-designed with a stroke survivor and developed to support upper limb motor control, range of motion, and coordination. Aim To facilitate shoulder (glenohumeral joint) and scapular movement (shoulder blade) across the torso by guiding the paretic arm in a diagonal motion across the body using the non-paretic arm for support. The game encourages movement synchronisation with rhythmic (guitar stabs) and visual cues (arrows). Objectives To enable cross-body reaching in stroke survivors with limited arm control. To safely execute active assisted range of motion. To facilitate an affective number of exercise repetitions using musical and visual cues. Overview The assisted version of the Cross-Body Reach involves using the non-paretic arm to guide the paretic arm across the chest to press a switch. The game provides visual prompts and a 2-part musical cueing structure to guide the timing of the exercise pacing and promote a smoothness the movement. How to Perform (Assisted) Preparation Sit or stand with your paretic arm with palm inward (ulnar position) and clasp or support it with your non-paretic hand. In time with the music move your paretic arm across the chest toward the opposite shoulder, and press the switch timing the movement so that the switch press aligns with the arrow on the screen. Guide the arm back to the starting position. Gaming and Musical Integration Two guitar cues support the movement: Guitar Cue 1: Reach and press Guitar Cue 2: Return to starting position Match movement to the arrow cues for accuracy. Adjust game speed between 25% and 75% to accommodate different ability levels. Tips for Best Results (Assisted) • Support your paretic arm but allowing it to move as freely as much as possible. • Focus on smooth symmetrical motion. • Potentially practise without the switch first • Keep trunk movement minimal Remember this is a game and exercise, the priority is effective exercise movement. However, the gaming element may also cause you to want to hit the target quickly! This is also ok at the beginning but recognise that combining effective movement shaping with improving game scores is the motivation :) Clinical Application • Early-stage and ongoing stroke rehab with severe hemiparesis, • Bilateral motor coordination training • Neurologic Music Therapy (NMT) using PSE and RAS • Midline crossing and proprioceptive feedback work
HOW TO: LEFT HOOK! CROSS-BODY REACH (UNASSISTED)CROSS-BODY REACH (UNASSISTED) Unassisted Shoulder Flexion with Horizontal Adduction Across the Chest Aim To facilitate shoulder (glenohumeral joint) and scapular movement (shoulder blade) across the torso by moving the paretic arm in a diagonal motion across the body. The game encourages movement synchronisation with rhythmic (guitar stabs) and visual cues (arrows). Objectives To develop independent control of shoulder and upper limb movement. To improve cross body movement and accuracy, and reaching ability. To reinforce motor planning using the game to provide visual (arrows) and auditory timing (guitar stabs) cues. To build endurance, good execution of movement Overview This version involves an independent cross-body movement, where the paretic arm lifts and moves across the chest to a switch positioned at the opposite shoulder. This switch activates the click to arrow press within the game in time with a guitar sound. How to Perform Sit or stand with your paretic arm with palm inward (ulnar position) Lift the arm independently and reach diagonally across the chest. Press the switch positioned at the opposite shoulder at the same time as the arrow cue appears on the screen. Return the arm back to the starting position. Repeat the movement in time with the music. Gaming and Musical Integration • The music provides two distinct guitar notes: Guitar Stab 1: Initiate and complete the reach (hit the switch) Guitar Stab 2: Return to starting position • Visual arrow prompts guide timing and placement. • Speed adjustments (25%–75%) are possible to adjust speed of the arrows within the game. Tips for Best Results (Independent) • Keep movement in time with the music, do not rush to hit the switch. • Use the music to pace the reach and return phases. • Minimise trunk compensation — aim for isolated arm movement. • Practise regularly according to your required dosage. Remember this is a game and exercise, the priority is effective exercise movement. However, the gaming element may also cause you to want to hit the target quickly! This is also ok at the beginning but recognise that combining effective movement shaping with improving game scores is the motivation :) Clinical Application • All stages of stroke recovery • Cross body reaching and scapular control training • Motor learning through entrainment • Neurologic Music Therapy techniques for upper limb re-patterning
Jab
Game Download
Un/Assisted Forward Reach
Novice Level: 11 Repetitions per game..
Switch Placements
HOW TO: FORWARD JAB (UNASSISTED) Unassited Forward Reach Aim To promote active forward reach and shoulder control through an independent, rhythmically guided jab. The movement targets shoulder flexion, elbow extension, and upper limb activation in response to timed cues. Objectives To support functional reaching patterns in the paretic or recovering limb. To reinforce muscle activation, motor planning, and reach consistency. To build endurance through repeated, rhythm-based switch pressing. To improve postural control during standing or seated reaching. Overview In the unassisted version, the user reaches forward independently with one or both arms (without clasping). The switch should be positioned at a comfortable distance to allow full reach with active control. The game uses musical prompts and arrows to regulate timing. How to Perform the Forward Jab (Unassisted) Stand tall (or sit, if needed) with a straight spine and relaxed shoulders. Position your paretic or active arm in front of your chest. Extend the arm forward toward the switch, either fully or partially, depending on ability. Press the switch when cued, then return your arm to the starting position with control. Repeat in rhythm with the music and arrow prompts. Gaming and Musical Integration • The game includes two guitar cues: Cue 1: Jab forward Cue 2: Return to start • Visual arrows support auditory cues for sensorimotor integration. • Speed is adjustable to accommodate fatigue or to promote faster reps as progress improves. Tips for Best Results (Unassisted) • Ensure posture remains upright — avoid leaning or shrugging during the jab. • Focus on matching movement to the arrow and music cues. • Practise the reach at slower speeds to develop confidence and control. • Maintain a steady rhythm — the goal is smooth repetition, not speed. Remember this is a game and exercise, the priority is effective exercise movement. However, the gaming element may also cause you to want to hit the target quickly! This is also ok at the beginning but recognise that combining effective movement shaping with improving game scores is the motivation :) Clinical Application • Mid- to late-stage stroke rehabilitation • Upper limb activation in one or both arms • Motor control retraining through music and game-based structure • Functional reach exercises integrated with Neurologic Music Therapy (NMT) principles Music: RColclasure Gaming Platform: Stepmania Exercise Level Design: RColclasure
HOW TO: FORWARD JAB (ASSISTED) Assisted Forward Reach Game developed in collaboration with a stroke survivor Aim To support bilateral reaching and shoulder protraction by guiding both arms forward in a controlled, rhythmically cued movement. In this version, the non-paretic arm supports the paretic side. Objectives To encourage forward reaching using both arms together. To develop proximal control, shoulder mobility, and using rhythm to practise exercising in time. To build confidence and practise precision through hitting a switch in time with the beat (auditory cueing). To provide a safe bilateral exercise for those with limited active reach and with severe hemiparesis. Overview In the assisted version, both hands are clasped together, and the non-paretic arm helps guide the movement. The arms are extended forward to activate a switch placed at a distance suited to the user’s comfort and range. Music and arrow prompts guide the rhythm and spacing of each reach. How to Perform the Forward Jab (Assisted) Begin in a standing position with your spine upright and shoulders relaxed. Engage your core muscles gently to support posture. Clasp both hands together and position your arms in front of your chest with elbows slightly bent. Extend your arms forward toward the switch. You can adjust the switch position based on your reach — with either fully straightened arms or a slight bend. Press the switch with control, then reverse the motion to return to the starting position. Gaming and Musical Integration • The game uses rhythmic cues in a disco style to guide each jab forward and return. • Musical phrasing ensures consistent pacing. • Visual arrows will prompt when to extend the arms and when to bring them back. • The game level can be slowed by 25% to 75% if needed for better control. Tips for Best Results (Assisted) • Focus on smooth, controlled movement — don’t rush to hit the switch. • Allow the non-paretic side to guide and support, but engage the paretic side as much as possible. • Keep elbows soft (not locked) and maintain neutral shoulders. • Practise with the music demo to get used to the rhythm and pacing. Remember this is a game and exercise, the priority is effective exercise movement. However, the gaming element may also cause you to want to hit the target quickly! This is also ok at the beginning but recognise that combining effective movement shaping with improving game scores is the motivation :) Clinical Application • Bilateral movement re-education in early- to mid-stage recovery • Proprioception and shoulder mobility retraining • Neurologic Music Therapy (NMT) – Patterned Sensory Enhancement (PSE) • Stroke rehab strategies incorporating switch-based gamified goal targeting
UPPER CUT
GAME DOWNLOAD
Self-Assisted External Rotation of the Shoulder and Forearm
Novice Level: 8 Repetitions per game..
HOW TO: UPPERCUT Self-Assisted External Rotation of the Shoulder and Forearm Game co-designed with a stroke survivor and developed for functional external rotation through guided upward movement, integrated with musical and verbal cueing. Aim To activate external rotation and upward movement of the paretic arm through a guided “uppercut” motion, supporting motor control, range of motion, and coordination. The switch press marks the end range and provides feedback on reach success. Musical and verbal cues assist with motor planning and anticipation. Objectives To develop external rotation and elevation of the shoulder and forearm. To promote targeted reach through switch activation. To increase range of motion and functional independence in the paretic upper limb. To support rehabilitation with multisensory cueing and game-based repetition. Overview This exercise mimics an uppercut movement, where the paretic arm moves from the waist upward in a curved, externally rotated motion to activate a switch positioned above or in front of the user. Music and a voice-over assist with rhythm, direction, and timing of movement. How to Perform the Uppercut Exercise Start with the paretic arm positioned at the waist, elbow bent at a 90-degree angle. Keep the palm in a ulnar position, with the thumb pointing upward. Begin to lift the arm in an outward and upward arc, keeping the elbow close to your body. Reach toward the switch in front of you (or above you, depending on setup), activating it in time with the arrow on screen. Then, reverse the motion slowly back to the starting position. Repeat this upward rotation with music-guided pacing. Switch Connection and Placement • If using an XAC switch, it can be placed upside down or overhead depending on range of motion and user comfort. • Position the switch as high as the participant can safely and consistently reach to provide appropriate challenge. Gaming and Musical Integration • A synthesiser cue will guide the motion upwards. • Just before the arrow appears, a voice cue will say “hit the target!”, helping to anticipate the moment of switch press. • The arrow will prompt the movement peak — follow its lead to align timing. • This musical-verbal structure supports anticipation, rhythm, and sensory-motor engagement. Tips for Best Results • Focus on external rotation — let the forearm arc outward as it moves up. • Keep the elbow close to the torso throughout to avoid compensatory movement. • Practise with the verbal cue and music to internalise the timing. • Adjust switch placement based on fatigue, range of motion, or strength. Clinical Application • Supports external rotation re-patterning for shoulder and forearm • Appropriate for stroke rehab, particularly when retraining scapular and humeral mechanics • Integrated with Neurologic Music Therapy (NMT) principles — especially PSE (Patterned Sensory Enhancement) • Ideal for upper limb goal-setting and gamified task completion with feedback