HOW TO COMPLETE THE SEATED ARM-TO-TABLE REACH (Functional Reach to Table Surface or Equivalent) Game developed in collaboration with a stroke survivor. Though compensation is visibly present (at this early stage of exercise trial), the long-term aim is to enable the stroke survivor to be more confident in using his paretic limb in ADL's. Aim To encourage repeated attempts to lift and place the paretic arm onto a table surface from a resting position on the lap. Objectives To initiate intentional movement in the paretic limb, even if incomplete or with compensation. To gamify the integration of the upper limb in basic functional movement: bringing the hand or forearm to rest on a tabletop for dinner or when working on a laptop. To promote motor planning, spatial awareness, and proprioceptive feedback through repetition. Encouraging Everyday Use This exercise encouraged the participant to involve his paretic upper limb in daily activities. Previously, he would move the paretic arm using his non-paretic hand. By introducing this movement as a gamified, cued task, the goal is to create habitual opportunities for the paretic arm to be used independently, whenever possible. Type of Reach: This movement uses a forward reach to a surface where a switch is placed. The movement is driven by a combination of trunk lean and shoulder elevation. Placing the hand on a table for stability How to Perform the Seated Arm-to-Table Reach Sit upright in a chair with your feet flat, back supported. Rest your paretic arm in your lap. Begin the movement when cued by the music: Use available motion (e.g. elbow lift, scapular elevation, trunk lean) to bring the arm forward. Attempt to place the hand, wrist, or forearm onto the table surface. After the switch or surface is touched, return the arm slowly back to the lap. Repeat with each musical phrase or cue. Gaming and Musical Integration • This level uses pitch-based movement synchrony, with an 8-note ascending scale to signal the movement from lap to table, and an 8-note descending scale to guide the return from table to lap or this could facilitate another arm raise (this game is still in development). • The 8 note scale creates a structured and intuitive sequence that supports guides the stroke survivor in the movement and gamifies the action. • Visual arrows appear on-screen to prompt the start of each reach. • A switch is positioned on the table to activate as the game control, • Repetition and timing increase in frequency and speed across 3 game levels. Technical Setup • Attach the switch to a clamp, secured to a table or stable surface at waist height. • The clamp should be adjustable to suit the stroke survivor's range and ability. Visual Description and Movement Analysis The video above shows a stroke survivor trialling the Seated Arm-to-Table Reach task using a black adaptive switch placed on a flat surface. The movement begins with his paretic arm resting on his lap. The stroke survivor then lifts his torso, raises his arm upward, forward and down to make contact with the switch, guided by the 8 note scale and arrow visuals. This movement is limited by spasticity in his hand, flexion in his elbow and reduced range at his shoulder. Compensation Patterns Observed The stroke survivor's hand remains clenched as he has spasticity and hypertonia. His movement is achieved through a combination of trunk lean, shoulder elevation, and minimal elbow extension. The upward motion is compensatory, but the return to lap phase shows greater control. Functional Relevance and Everyday Application This exercise was specifically co-designed to support the stroke survivor in reintegrating his paretic arm into activities of daily living, with the key goal is to encourage the independent movement of the arm from the lap to the table, such as during mealtimes — a task the participant previously completed by lifting the paretic arm with the non-paretic arm. Through repetition, cueing, and gamification, this activity builds the awareness, and confidence needed to reduce reliance on the non-paretic arm to assist his paretic arm in some activities. Clinical Application This exercise increases: • Awareness and use of the unassisted paretic arm in ADL's. • Motor intention and reinforcement of goal-directed reaching • Engagement with hemiparetic side towards neuroplasticity Important Note: Compensation may be present — such as trunk lean or shoulder hiking potentially with time, repetition, and cueing, a stroke survivor may gradually recruit more appropriate motor patterns and reduce reliance on compensatory strategies. Music: RColclasure Gaming Platform: Stepmania Exercise Level Design: RColclasure