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Hand, Arm, Shoulder Rehabilitation Service

Neurological conditions that affect the shoulders, arms and hands can be complex and often have a significant impact on everyday function, independence and quality of life.

At Neuro Alliance, our Neuro Shoulder, Arm and Hand Service is delivered by our team of Occupational Therapists and Physiotherapists with specialised experience and a strong clinical interest in neurological upper limb rehabilitation.

We support people with a wide range of neurological conditions, including (but not limited to) stroke, acquired brain injury (ABI), spinal cord injury (SCI), multiple sclerosis (MS), Parkinson’s disease (PD), cerebral palsy (CP), amputation and limb difference, functional neurological disorder (FND), rare genetic conditions, and brachial plexus injuries.

For every client, we complete a comprehensive neurological upper limb assessment, taking the time to understand your medical history, previous interventions, current abilities, and what is most important to you. Based on this assessment, we work collaboratively with you to develop an individualised intervention plan aimed at improving strength, coordination, sensation, movement and functional use of your arm and hand.

We offer a range of evidence-based upper limb interventions, delivered through both individual therapy and structured group programs, allowing therapy to be tailored to your goals, needs and funding pathway.

Interventions Offered

Goal-directed therapy focuses on helping you work towards specific, meaningful goals that are important in your everyday life.

If you want to improve a particular task such as reaching, grasping, dressing, eating, or using technology – it’s important to practice that task directly. This approach takes advantage of neuroplasticity, the brain’s ability to adapt and change with targeted practice.

Your therapist will carefully analyse how you move and design individualised, task-specific interventions to support improvement. We use a combination of remedial approaches (aimed at improving movement quality, strength and control) and adaptive strategies (finding new or supported ways to complete tasks), depending on your needs and goals.

Focus areas may include:

  • Improving functional use of the arm and hand

  • Increasing strength, coordination and control

  • Reducing effort or fatigue during tasks

  • Supporting independence in daily activities

Spasticity and other changes in muscle tone are common following injury or damage to the brain or spinal cord. These changes can cause muscles to feel stiff, tight or difficult to control, and may impact comfort, movement, positioning and everyday function.

While there is no single ‘cure’ for spasticity, we work closely with you to manage symptoms and reduce the impact on your daily life. Management is always guided by your goals and may focus on improving movement, comfort, ease of care, or functional use of your arm and hand. Our therapists work collaboratively with the wider multidisciplinary team, including rehabilitation specialists, to support pre- and post-Botox assessment and intervention where appropriate.

People with neurological conditions may also experience other changes in tone and movement, such as dystonia, tremor or clonus. We take a comprehensive approach to assessment and work with you and the broader team to identify the most appropriate strategies for your situation.

Neurological upper limb splinting is always prescribed with clear, client-centred goals in mind. Splinting is not used routinely, but considered carefully where it can support comfort, function or care.

Depending on your needs, we may recommend resting splints and/or functional splints to support your goals. These goals may include improving comfort and positioning, supporting hygiene and skin care, reducing pain, or assisting with specific functional tasks where joint support or alignment can improve hand use. Our therapists assess whether off-the-shelf splints are appropriate or whether custom-made splinting is required. For individuals with more complex upper limb presentations, we can fabricate individualised thermoplastic splints to ensure optimal fit, comfort and function.

Splinting is always reviewed regularly and adjusted as your needs, goals or function change.

Constraint Induced Movement Therapy (CIMT) is an evidence-based, intensive upper limb rehabilitation program designed to improve functional use of the affected arm and hand by harnessing the brain’s ability to change and adapt (neuroplasticity).

We offer both a full CIMT program (delivered five days per week) and a modified CIMT program (mCIMT), which runs three days per week in clinic with a structured home program. Programs typically run over a two-week block, depending on individual needs and circumstances.

Both programs focus on high-intensity, task-specific practice. A mitt is used to temporarily constrain the stronger arm, encouraging the affected arm and hand to complete meaningful tasks that are tailored to your goals.

CIMT and mCIMT have strong evidence in selected neurological populations. To be considered, you generally need to have some active movement in the affected arm (for example, the ability to pick up and release a light object). Your therapist will assess your eligibility and discuss whether this program is appropriate for you.

Neuro Arms is a small, therapist-led upper limb group program that provides a cost-effective and motivating way to access our specialised Upper Limb Lab.

Before joining the group, your therapist will develop an individualised upper limb program based on your functional goals. During each session, a therapist supervises the group while you complete your personalised program using a range of equipment and technology available in the Upper Limb Lab.

Neuro Arms runs in a semi-supervised environment, offering the benefits of structured therapy alongside peer support from others working towards similar goals. Group sessions run at scheduled times throughout the week and are listed on our Clinic Group Timetable.

Changes in sensation are common following neurological injury and can have a significant impact on hand use, safety and daily function. This may include altered touch, reduced awareness of the hand, or difficulty judging objects during tasks.

At Neuro Alliance, we provide specific assessment and intervention for upper limb sensory changes, with a focus on improving functional use of the arm and hand in everyday activities.

Where appropriate, we utilise evidence-based sensory re-education approaches, including the SENSe approach, which is designed to improve sensory discrimination and support functional outcomes. Sensory intervention is always guided by your goals and integrated into meaningful tasks, rather than isolated exercises.

Your therapist will discuss whether sensory-specific intervention is appropriate for you and how it may form part of your broader upper limb rehabilitation program.

Functional Electrical Stimulation (FES) is a therapy technique that uses small, controlled electrical impulses to activate muscles and nerves that are not working effectively following neurological damage.

FES can be used to support movement, improve muscle activation, and assist with functional tasks, such as opening the hand, reaching, or maintaining joint alignment during activity. It may also be used to support motor re-learning when combined with active, task-specific practice.

Our therapists assess whether FES is appropriate for you and integrate it into your upper limb rehabilitation program where it aligns with your goals. FES is always used as a tool to support functional outcomes, rather than as a standalone treatment.

Technology can make therapy more engaging, motivating, and effective, helping you complete more repetitions and practice tasks in a meaningful way.

At Neuro Alliance, we integrate a range of interactive and sensor-based technologies into upper limb rehabilitation to complement hands-on therapy. This may include:

  • LusioMate = interactive hand and arm exercises

  • Blaze Pods = reaction and coordination training

  • Smart Fit systems = gamified, task-based exercises

These tools are used alongside your program to support your goals, track progress, and make therapy more enjoyable (and fun!). Technology is never a replacement for skilled therapy, it is a way to enhance outcomes and help you achieve functional improvements faster.