While it is absolutely required to establish competency through continuing education and optional certifications before treating your client to ‘do no harm’, every occupational therapy practitioner is a generalist which means you have the freedom to treat the diagnoses, conditions, or barriers affecting the upper extremity.  

Because of our holistic training on the human body that includes both medical science and social science, every occupational therapy practitioner must remember that the hand is the distal attachment of the entire upper extremity and the upper extremity is connected to the trunk by way of the shoulder complex. The muscles encasing the skeletal anatomy are connected through kinematic chains and therefore if the trunk or shoulder are experiencing dysfunction, this may manifest in the functional performance of ‘the hand’. Work proximal to distal! The shoulder complex drives the functional performance of the hand. 

As we know from Applied Kinesiology, the body wants to move and will find a way to do this REGARDLESS of whether or not it is a ‘safe and efficient movement pattern’. This desire for your body to engage in occupational performance will result in compensatory movements in the neck, shoulders or trunk to complete a task. We canNOT carry on with a treatment if our patient can not use their upper extremity in an activity without shoulder hiking, lateral trunk flexion, trunk rotation and flexion, neck lateral flexion or a combination of any of the above. Additionally, if you can see the client can not reach their arm above 90 -110˚, assess their scapular mobility and stability!  Are they winging? Do you see little movement within the shoulder girdle (Boney ring)? If this observed, this is a hands-on treatment and you will be providing stability for upper body exercises until you have helped your patient regain strength in those structures through therapeutic exercise and neuromuscular re-education. You can not achieve maximum occupational engagement by repeating the occupation over and over again. You must break it down and address the deconditioned body structures! 

A cross-crawl technique is used in movement and mobility training of both upper body and lower body. By recruiting both sides of your brain using opposite movement patterns we strengthen the communication across the two sides of your brain known as your corpus collosum.