HOW TO EXECUTE THE HALF ARM RAISE Upward Reach Initiated by Elbow Flexion or shoulder shrug. Game co-developed with a stroke survivor and informed by neurorehabilitation research into upper limb motor primitives. This exercise was designed for severe hemiparesis and supports early-stage movement toward the functional “reach and grasp” sequence, using the XBox adaptive controller. Aim To initiate a partial upward reach using available motion in the paretic arm — primarily through the existing elbow flexion or shoulder/scapular compensations — guided by music and visual cueing. This movement builds a foundation for functional reaching and forms part of the reach and grasp sequence critical to activities of daily living. Objectives To activate a partial upward movement using elbow flexion or shoulder shrug. To enable a stroke survivor with severe hemiparesis to engage in goal driven movement using his own musical preference and switches. To improve awareness, initiation, and control of arm movement. To encourage return-to-lap control and observe and reduce reliance on momentum-based compensation. Type of Reach: Upward Reach Initiated by Elbow Flexion (caused by spasticity) This exercise facilitates a partial upward reach initiated through (existing) elbow flexion, not full shoulder elevation. The forearm is lifted vertically toward a switch positioned at midline height (chest or upper abdomen), either through active or supported movement. Though this is not a full forward reach, it is a component of the “reach and grasp” functional primitive — a sequence required for activities of daily living such as raising a fork to the mouth, the initial movement to opening a door or putting on a jacket. Overview The Half Arm Raise game is suited for individuals with severe hemiparesis or limited range of motion. It can be played in multiple ways depending on the user's movement pattern: Using elbow flexion to raise the forearm Using scapular elevation (shoulder shrug) to lift the whole arm The game can beplayed using an inverted adaptive switch or Xbox Adaptive Controller clamped securely to a table or support surface at waist height. How to Perform the Half Arm Raise Sit upright on a chair Place the switch (XAC or adaptive button) securely inverted on a clamp at waist height. Rest your paretic arm in your lap. Initiate the movement by: Elbow flexion to lift the forearm Supported motion or shoulder shrug Momentum or trunk lean to assist in early stages Reach upward to activate the switch in time with the music. Lower the arm slowly and with control back to your lap. Repeat the cycle as guided by the game level. Key Movement Considerations The paretic arm may remain in a flexed position due to spasticity. Elbow flexion is not always actively generated, but movement is encouraged within the available range. Scapular elevation and trunk movement was used by the stroke survivor in the example as compensation. It is worth noting that the return-to-lap arm control in this example showed greater voluntary control than the upward movement. Gaming and Musical Integration • The game is set to “Another One Bites the dust. The strong beat of this track facilitates a repetition every 8 counts. • Three game levels allow stoke survivors to change the repetitions within the game and tempo as they progress. Technical Setup • Attach the switch to a clamp, secured to a table or stable surface at waist height. • Adjust height and distance to suit the stroke survivor's movement range and ability. Tips for Best Results • Begin with assistance or support if active control is limited. • Ensure the switch is reachable without strain — the goal is to promote repetition, not overexertion. • Pay attention to the lowering phase — encourage controlled return. • Practise with the music demo to internalise the rhythm. • Stop if you experience pain — muscle fatigue is expected and will reduce with practice. Clinical Application The Half Arm Raise supports reach initiation and can be used in early neurorehabilitation for: • Functional primitive re-training (Schambra et al., 2019) • Developing motor awareness in severely impaired limbs • Supporting sensorimotor integration and proprioceptive feedback (d’Avella & Lacquaniti, 2013) • Enhancing grip and reach capacity, which is linked to independence in ADLs (Bae et al., 2015) Music: Queen – Another One Bites the Dust Gaming Platform: Stepmania Exercise Level Design: RColclasure