Forearm Muscle Activity Research Articles

A wearable neural interface for detecting and decoding attempted hand movements in a person with tetraplegia.

We are developing a wearable neural interface based on high-density surface electromyography (HDEMG) for detecting and decoding signals from spared motor units in the forearms of people with tetraplegia after spinal cord injury (SCI). A lightweight, form-fitting garment containing 150 disc electrodes and covering the entire forearm was used to map the myoelectric activity of forearm muscles during a wide range of voluntary tasks of a person with chronic tetraplegia after SCI (C5 motor and C6 sensory American Spinal Injury Association Impairment Scale B spinal cord injury). Despite exhibiting no overt finger motion, myoelectric signals were detectable for attempted movements of individual digits and were highly discriminable. Motor unit decomposition was used to identify the activity of >30 motor neurons, active specifically during rotation, pronation of the wrist (4 units), and flexion of the elbow joint (7 units), and during attempted movements of individual hand digits (1-5 units). In addition, we performed a neural connectivity analysis based on the power of the common oscillations of the identified motor neurons in the delta (~5Hz), alpha (~6-12 Hz), and beta bands (~15-30 Hz). This analysis showed clear common synaptic inputs to the identified motor neurons in all the analyzed frequency bands. This neural interface offers a new potential for the control of assistive technologies, whereby the motor neurons spared after SCI may serve as a direct readout of motor intent that allows proportional control over several distinct degrees of freedom. Moreover, this framework can be used to study the reorganization and recovery of spinal networks after injury and rehabilitation.

The effect of two types of maximal voluntary contraction and two electrode positions in field recordings of forearm extensor muscle activity during hotel room cleaning

Purpose. This study aimed to investigate the effects of using hand grip or resisted wrist extension as the reference contraction, and two electrode positions, on field recordings of forearm extensor muscle activity. Materials and methods. Right forearm extensor muscle activity was recorded using two electrode pairs (over the most prominent part (position 2) and proximal to that (position 1)) during one working day in 13 female hotel housekeepers. Each subject performed the two maximal voluntary contractions (MVCs), and the electrical activity obtained during these (maximal voluntary electrical activity (MVE)) was used for normalization. Each set of recordings was analysed twice, once using hand grip as the MVC and once using resisted wrist extension. Results. Resisted wrist extension showed a higher group mean MVE than hand grip. Position 2 had higher correlation between MVE and force during the MVCs. The workload during cleaning was lower when using resisted wrist extension as reference than when using hand grip (24%MVE vs 46%MVE; p = 0.002 at position 2) for the 90th percentile. The workload (99th percentile) was overestimated in two subjects when using hand grip as reference. Conclusions. Problems associated with poorly activated forearm extensors can be overcome by using resisted wrist extension as reference.

PEXO - A Pediatric Whole Hand Exoskeleton for Grasping Assistance in Task-Oriented Training.

Children with hand motor impairment due to cerebral palsy, traumatic brain injury, or pediatric stroke are considerably affected in their independence, development, and quality of life. Treatment conventionally includes task-oriented training in occupational therapy. While dose and intensity of hand therapy can be promoted through technology, these approaches are mostly limited to large stationary robotic devices for non-task-oriented training, or passive wearable devices for children with mild impairments. Here we present PEXO, a fully wearable actuated pediatric hand exoskeleton to cover the special needs of children (6 to 12 years of age) with strong impairments in hand function. Through three degrees of freedom, PEXO provides assistance in various grasp types needed for the execution of functional tasks. It is lightweight, water proof, and inherently interacts safely with the user. It meets mechanical requirements such as force, fast closing movement, and battery lifetime derived from literature and discussions with clinicians. Appealing appearance, user-friendly design, and intuitive control with visual feedback of forearm muscle activity should keep the user motivated during training in the clinic or at home. A pilot test with a 6-years old child with stroke showed that PEXO can provide assistance in grasping various objects weighing up to 0.5 kg. These are promising first results on the way to make hand exoskeletons accessible for children with neuromotor disorders.

Cross-limb dynamics of postural tremor due to limb loading to fatigue: neural overflow but not coupling.

Many experiments have shown independence of the index finger dynamics under bilateral postural tremor protocols. Here we investigated in young adults the dynamics of bilateral multidirectional postural tremor and forearm muscle activity under the progressively fatiguing conditions supporting an external weight to the point of induced postural failure. When no loads were applied, tremor in the vertical (VT) and mediolateral (ML) directions was similar with prominent peaks within 2- to 4-Hz and 8- to 12-Hz bandwidths. Contrastingly tremor in the anterior-posterior (AP) direction was characterized by a single peak between 0 and 2 Hz. Although no tremor coupling occurred cross limbs, strong within-limb coupling was found between ML and VT directions when no loads were applied (coherence range: 0.77-0.85), implying that these oscillations are related and likely derived from mechanical sources. Applying an external load to the index finger(s) led to significant increases in the amplitude of VT tremor and EMG activity within that limb but also caused increases in tremor directions not aligned with the gravitational vector (AP and ML). Significant increases in VT and ML tremor and EMG activity in the contralateral (unloaded) limb were also found when a single index finger was loaded; however, this bilateral increase did not align with increases in interlimb coupling (coherence <0.21). The effects of fatigue caused by prolonged loading were widespread, affecting tremor and muscle activity in both limbs through a combination of neural and mechanical mechanisms. The single- and dual-limb loading to fatigue increased neural overflow but not tremor coupling between the index fingers.NEW & NOTEWORTHY This study investigated bilateral multidirectional tremor under unloaded and loaded conditions. We found that tremor in the mediolateral and vertical directions within a limb were strongly coupled, a result not reported previously. Furthermore, when holding a weight to failure, tremor in all directions increased. Tremor also increased in the contralateral (unloaded) limb despite no interlimb coupling. This contralateral increase in tremor following loading a limb until fatigue is hypothesized to stem from motor-overflow effects.

Model-Based Estimation of Individual Muscle Force Based on Measurements of Muscle Activity in Forearm Muscles During Isometric Tasks.

Several forward dynamics estimation approaches have been proposed to estimate individual muscle force. However, characterization of the estimation error that arises when measurements are available only from a subset of the muscles involved in the movement under analysis, as is the case of the forearm muscles, has been limited. Our objectives were: first, to quantify the accuracy of forward-dynamics muscle force estimators for forearm muscles; and second, to develop a muscle force estimator that is accurate even when measurements are available only from a subset of muscles acting on a given joint or segment. We developed a neuromusculoskeletal (NMSK) estimator that integrates forward dynamics estimation with a neural model of muscle cocontraction to estimate individual muscle force during isometric contractions, suitable to operate when measurements are not available for all muscles. We developed a computational framework to assess the effect of physiological variability in muscle cocontraction, cross-talk, and measurement error on the estimator accuracy using a sensitivity analysis. We thus compared the performance of our estimator with that of a standard estimator that neglects the contribution of unmeasured muscles. The NMSK estimator reduces the estimation error by 25% in average noise conditions. Moreover, the NMSK estimator is robust against physiological variability in muscle cocontraction and outperforms the standard estimator even when the validity of the neural model is compromised. In isometric tasks, the NMSK estimator reduces muscle force estimation error compared to a standard estimator, and may enable future applications involving estimation of forearm muscle force during coordinated movements.

Effect of milking stall dimensions on upper limb and shoulder muscle activity in milkers

Increasing societal awareness for animal welfare can promote changes in legislation. Some of these changes may also affect the person that interacts with the animal in a shared workspace, such as in milking stalls. Swiss milking stalls were designed many years ago, when cows were smaller than they are today. A recent animal-based study indicated that welfare decreased in cows exposed to restricted space allowance in milking stalls, which had resulted from increasing body size without adjustment of milking stall dimensions. However, changing the milking stall dimensions without considering the milker may be detrimental. For many years, health issues, particularly of the upper limb and shoulders, have affected milking personnel. The current study investigated the effect of large and standard milking stall dimensions on muscle activity in milkers (as a measure of workload) during milking. This assessment is fundamental to ensure that legislation improving animal welfare does not jeopardize human health. The study took place in an experimental milking parlor that allowed for size adjustment of the individual milking stall. Nine milkers performed 2 shifts of milking in a herringbone and 2 shifts in a side-by-side milking parlor. The milking stall dimensions were large on one side and standard on the other side of the parlor; the 2 sides were switched between milking shifts. We used surface electromyography to monitor bilateral muscle activity of forearm (flexor carpi ulnaris), arm (biceps brachii), and shoulder (deltoideus anterior; upper trapezius) muscles. Statistical analysis was performed separately for the herringbone and the side-by-side parlor for each muscle using mean and maximum muscle activity as the target variables in a linear mixed-effects model. The analysis showed that the different milking stall dimensions did not consistently affect activity of the measured muscles. Our results suggest that milking stall dimensions are not a primary risk factor for poor ergonomics in parlor workers.

The influence of simultaneous handgrip and wrist force on forearm muscle activity

The purpose of this study was to examine forearm muscle activity during simultaneous execution of dual motor tasks; hand-gripping and wrist forces. Surface electromyography was recorded from eight muscles of the upper-limb: flexor carpi radialis, flexor carpi ulnaris, flexor digitorum superficialis, extensor carpi radialis, extensor carpi ulnaris, extensor digitorum, biceps brachii and triceps brachii. Participants were seated with their forearm supported in a neutral position with an adjustable force transducer placed on either the palmar or dorsal side of the hand (for palmar/dorsal forces). Participants performed trials of simultaneous handgrip and wrist forces of various magnitudes, ranging in intensity from 0 to 40% of their maximal voluntary contraction. Trials lasted 5 s and force and electromyography data were assessed. The wrist flexors provided greatest contributions to tasks dominated by palmar forces but exhibited very low muscle activity in dorsal dominant tasks. Wrist extensors were active at moderate-to-high levels across nearly all conditions and demonstrated greater activity than the wrist flexors during handgrip-dominant tasks. These findings suggest that the wrist extensors provide the greatest contribution to wrist stiffness in complex motor tasks, and highlight the importance of investigating forearm muscle recruitment strategies under dual task parameters.

Going Short: The Effects of Short-Travel Key Switches on Typing Performance, Typing Force, Forearm Muscle Activity, and User Experience.

This study examined the effects of 4 micro-travel keyboards on forearm muscle activity, typing force, typing performance, and self-reported discomfort and difficulty. A total of 20 participants completed typing tasks on 4 commercially available devices with different key switch characteristics (dome, scissors, and butterfly) and key travels (0.55, 1.3, and 1.6mm). The device with short-travel (0.55mm) and a dome-type key switch mechanism was associated with higher muscle activities (6%-8%, P < .01), higher typing force (12%, P < .01), slower typing speeds (8%, P < .01), and twice as much discomfort (P < .05), compared with the other 3 devices: short-travel (0.55mm) and butterfly switch design and long travel (1.3 and 1.6mm) with scissor key switches. Participants rated the devices with larger travels (1.3 and 1.6mm) with least discomfort (P = .02) and difficulty (P < .01). When stratified by sex/gender, these observed associations were larger and more significant in the female participants compared with male participants. The devices with similar travel but different key switch designs had difference in outcomes and devices with different travel were sometimes not different. The results suggest that key travel alone does not predict typing force or muscle activity.

Synergistic Myoelectrical Activities of Forearm Muscles Improving Robust Recognition of Multi-Fingered Gestures.

Currently, surface electromyography (sEMG) features of the forearm multi-tendon muscles are widely used in gesture recognition, however, there are few investigations on the inherent physiological mechanism of muscle synergies. We aimed to study whether the muscle synergies could be used for gesture recognition. Five healthy participants executed five gestures of daily life (pinch, fist, open hand, grip, and extension) and the sEMG activity was acquired from six forearm muscles. A non-negative matrix factorization (NMF) algorithm was employed to decompose the pre-treated six-channel sEMG data to obtain the muscle synergy matrixes, in which the weights of each muscle channel determined the feature set for hand gesture classification. The results showed that the synergistic features of forearm muscles could be successfully clustered in the feature space, which enabled hand gestures to be recognized with high efficiency. By augmenting the number of participants, the mean recognition rate remained at more than 96% and reflected high robustness. We showed that muscle synergies can be well applied to gesture recognition.

Effects of finger taping on forearm muscle activation in rock climbers

Flexor tendon pulley injury is associated with a change in relative activation of the flexor digitorum superficialis (FDS) and flexor digitorum profundus (FDP) muscles. The purpose of this study was to determine the effect of taping of the fingers on relative muscle activation of the FDS and FDP muscles in uninjured rock climbers. Muscle activation in 10 healthy volunteers were recorded using intramuscular electromyography (EMG) during a static hang with subjects utilizing the crimp grip without tape, with a circumferential tape and with an H-tape in random order. EMG data were normalized to a static hang with a non-crimp grip (RVC). Average EMG activity of the FDS as a percentage of RVC was 102.4 ± 59.1 without tape, 116.9 ± 35.3 with H-tape and 99.3 ± 35.3 with circumferential tape. Average EMG activity of the FDP as a percentage of RVC was 96.6 ± 40.0 without tape, 98.9 ± 30.3 with H-tape and 90.6 ± 28.7 with circumferential tape. Taping did not have a significant effect on average relative muscle activation of the FDS or FDP muscles (p = 0.069). This study showed that finger taping may not significantly affect the activity of the FDS and FDP during static holds while rock climbing.

Investigating the optimal handle diameters and thumb orthoses for individuals with chronic de Quervain's tenosynovitis – a pilot study

Aims: The aims of this study were to compare the differences in forearm muscle activities between two types of thumb orthoses and the optimal handle diameter when the orthosis is worn during a power grasp for individuals with chronic de Quervain’s Tenosynovitis.Methods: A 2 × 3 (Group × orthosis) and a 2 × 2 × 3 (Group × orthosis × diameter) repeated factorial design were used. Grip strength and muscle load were measured. A 2 × 3 mixed repeated measures ANOVA was conducted, and the Least Significant Difference (LSD) test was used for post hoc analysis. Cohen’s d was used to calculate the effect size between groups and handle diameters.Results: Grip strength was significantly lower (in long/short/no-orthosis conditions) and muscle load was higher in 12 participants with chronic de Quervain’s Tenosynovitis than in 16 healthy participants (p < 0.001). No differences in muscle activities were found when the two different orthoses were worn. The muscle activities were higher during grasping of the 33 mm handle diameter.Conclusion: Individuals with chronic de Quervain’s Tenosynovitis require greater muscle loads than healthy controls to produce the same power grasp, and when one of the two orthoses is worn, the optimal handle diameters for performing a power grasp are relatively larger (45 and 55 mm).Implications for RehabilitationBoth the long and short thumb orthoses can be worn by individuals with de Quervain’s Tenosynovitis during daily activities because wearing both orthoses requires the same exertion of muscle load.When performing a power grasp, individuals with de Quervain’s Tenosynovitis tend to exert greater muscle loads than healthy controls to produce the same power grasp.We suggest that patients with de Quervain’s Tenosynovitis use utensils with larger handle diameters, such as 45 mm and 55 mm.

Forearm muscle activation, ulnar nerve at the elbow and forearm fatigue in overhand sports

ABSTRACT This study examined the morphologic changes of the ulnar nerve in different elbow positions by ultrasonography and the effects of fatigue on forearm muscle control during overhand movements. We enrolled 12 tennis players who performed flat serves and 15 baseball pitchers who performed fastball pitching. The motion capture was conducted with 14 reflective markers attached on anatomic landmarks of the participant for tennis serve and baseball pitching data collection. The distance from the nerve to the medial condyle between the tennis players and baseball pitchers showed significant differences (p = 0.006) as the elbow flexed to 90°. The differences are due to the baseball player’s repetitive pitching motion while such motion does not apply to tennis player. Activity of the extensor carpi radialis (ECR) during the cocking phase in the tennis serves showed significant differences (p = 0.022) between the nonfatigued and fatigued states; the maximal value was observed in the fatigued state. The significant increase in the ECR activity in the fatigued state might be responsible for grasp-and-release activities and maintaining the wrist joint stability when performing overhand movements. Forearm fatigue influenced their overhand motion ability in accurate ball control, although it did not decrease the ball speed.

Neural coding of intended and executed grasp force in macaque areas AIP, F5, and M1

Considerable progress has been made over the last decades in characterizing the neural coding of hand shape, but grasp force has been largely ignored. We trained two macaque monkeys (Macaca mulatta) on a delayed grasping task where grip type and grip force were instructed. Neural population activity was recorded from areas relevant for grasp planning and execution: the anterior intraparietal area (AIP), F5 of the ventral premotor cortex, and the hand area of the primary motor cortex (M1). Grasp force was strongly encoded by neural populations of all three areas, thereby demonstrating for the first time the coding of grasp force in single- and multi-units of AIP. Neural coding of intended grasp force was most strongly represented in area F5. In addition to tuning analysis, a dimensionality reduction method revealed low-dimensional responses to grip type and grip force. Additionally, this method revealed a high correlation between latent variables of the neural population representing grasp force and the corresponding latent variables of electromyographic forearm muscle activity. Our results therefore suggest an important role of the cortical areas AIP, F5, and M1 in coding grasp force during movement execution as well as of F5 for coding intended grasp force.

Police Officer performance and perception using light, medium and heavy weight tactical batons

ObjectiveCompare the effectiveness of light, medium and heavy weight Police expandable batons from a performance and a user perception perspective. RationalePolice Officers are required to control combative individuals using less lethal tactics in proportion to the threat they face. Officers need to deliver sufficient force quickly and accurately. As such, it is important to select batons that are optimal for both performance and user experience. MethodsEleven active-duty New York Police Department Officers completed static and dynamic strike testing followed by a questionnaire. Six baton types were tested using different weights and lengths. ResultsPeak force, dynamic task speed and accuracy were similar between baton types. Peak impulse, forearm muscle activity, and discomfort were higher with the heaviest baton. ConclusionsLighter batons can deliver sufficient force to control assailants while imposing lower ergonomic costs and being preferable to the user with no impact on speed or accuracy.

Upper Extremity Biomechanics and Gender: The Effects of Modern Computing Technologies

Mobile computing devices are often designed with a one-size-fits-all approach, and consumers purchase devices based off of technical specifications rather than whether the devices fit them. Female gender is associated with higher risks of upper extremity repetitive injury, which may be caused by the generally smaller anthropometry of women (Cote, 2011; Won, Johnson, Punnett, &amp; Dennerlein, 2009). This paper explores two mobile technologies’ effects on forearm muscle activity, performance, and self-reported experience within each gender for two recent laboratory experiments. A typing study with four short travel keyboards showed that female participants are more affected by different key switch designs than male participants. A touchscreen thumb swiping study revealed that male and female participants were similarly affected by tablet size, swipe location, and swipe direction. These results demonstrate the need to include both genders in usability testing for mobile technology and to consider individual differences when designing technologies.

The Effect of 5 Mechanical Gaming Keyboard Key Switch Profiles on Typing and Gaming Muscle Activity, Performance and Preferences

Introduction:Single force-displacement characteristics of mechanical key switches have been shown to affect performance, fatigue and discomfort during keyboard use. This study compared the effects of mechanical key switches with differing force-displacement characteristics on forearm muscle activity, typing performance, Fitts Study task performance, subjective fatigue and user preference. Methods: Using a within subjects intervention study of crossover design, 64 subjects completed modified Fitts and typing tasks on five different mechanical key switches to mimic dual word processing and gaming keyboard use. Bilateral muscle activity was recorded using surface electromyography (EMG); typing and Fitts task performance measures were tracked. Results: The key switch with a linear force displacement curve had higher net strokes and lower net typing speed than two key switches with tactile feedback (p&lt;0.05). The key switch with the longest tactile travel, operating travel and highest bottom force required slightly higher peak muscle activity compared to 2 other key switches with lower values (p&lt;0.05). Key switches with shorter tactile and operating travel and lower bottom forces were preferred over other key switches.Conclusions: Among mechanical key switches, a linear force displacement curve had the worst outcomes; key switches with shorter tactile (1.2mm) and operating travel (2.0mm) and a lower bottom force (35-40g) had best outcomes overall.

Surface electromyography of the forearm musculature during an overhead throwing rehabilitation progression program

ObjectiveThe flexor carpi ulnaris (FCU) and flexor digitorum superficialis (FDS) provide dynamic stabilization to the medial elbow. It remains unclear how these muscles function during progressive throwing exercises. Our objective was to compare FCU and FDS surface electromyography (sEMG) during a throwing progression. DesignCrossover. SettingLaboratory. ParticipantsSixteen healthy males. Main outcome measuresParticipants completed a plyometric throw (PLYO), long-toss 50% (LT50), long-toss 75% (LT75), and pitch (PITCH). sEMG was synchronized with three-dimensional kinematics to assess the acceleration phase of each exercise. Peak sEMG amplitude (%MVIC) and percentage change between progressive exercises was measured. Continuous sEMG data were assessed to determine when peak activation occurred during acceleration. ResultsFCU activity was greater during PITCH than LT50, and during LT75 than LT50. Percentage change was greater from LT50-to-LT75 than PLYO-to-LT50 for both muscles. PLYO and PITCH increased most during late acceleration, whereas LT50 and LT75 increased most during mid-acceleration. ConclusionsFCU activity did not increase in a stepwise manner, and FDS remained unchanged. Each muscle demonstrated a disproportionate increase in activation during the second exercise progression (LT50-to-LT75) compared to the first (PLYO-to-LT50), suggesting that additional exercises may be required to achieve a stepwise progression relative to forearm muscle activation.

Characterization of Parkinsonian Hand Tremor and Validation of a High-Order Tremor Estimator.

Recent progress in wearable technology has made wearable tremor suppression devices (WTSDs) for Parkinson's patients a potentially viable alternative solution for tremor management. So far, in contrast to wrist and elbow tremor, finger tremors have not been studied in depth despite the huge impact that they have on a patient's daily life. In addition, more evidence has been found showing that the performance of current tremor estimators may be limited by their model order due to the multiple harmonics present in tremor. The aim of this paper is to characterize finger and wrist tremor in both the time and frequency domains, and to propose a high-order tremor estimation algorithm. Tremor magnitudes are reported in the forms of linear acceleration, angular velocity, and angular displacement. The activation of forearm flexor and extensor muscles is also investigated. The frequency analysis shows that Parkinsonian tremors produce oscillations of the hand with pronounced harmonics. At last, a high-order weighted-frequency Fourier linear combiner (WFLC)-based Kalman filter is proposed. The percentage estimation accuracy achieved from the proposed estimator is 96.3 ± 1.7%, showing average improvements of 28.5% and 48.9% over its lower-order counterpart and the WFLC. The proposed estimator shows promise for use in a WTSD.

Effect of hand postures and object properties on forearm muscle activities using surface electromyography

Introduction. The objective of this study was to measure the effect of hand postures and object properties on nine forearm muscle activities and their contribution using surface electromyography. Methods. Ten male university students participated in the experiment. The objects used were cylindrical and rectangular, with lengths and weights of 2, 4, 6 and 8 cm and 400, 800, 1400 and 1800 g. The experimenter told the participant to pick up the object using a particular hand posture, lift the object to approximately shoulder height and maintain this posture for 3 s. Results. The hand posture, object size and object weight greatly influenced the muscle activities, but the object shape did not. Pinching with two or three fingers yielded the greatest muscle activities with the 8-cm, 1800-g object. The extensor pollicis longus and flexor pollicis longus muscles exhibited the highest submaximal voluntary contraction. Conclusion. This study provides basic information about the specific activities of the forearm muscles and the effects of the hand postures and object properties on those activities.

Building interactive computer play games with youth with cerebral palsy: Improving practice efficacy through biofeedback and user-centered design

Interactive computer play (ICP), or serious games, can provide motivational and flexible rehabilitation environments. This is useful for the 1 in 400 children born with Cerebral Palsy (CP) each year, whose daily activities are impacted by impaired motor control. Improvement through traditional rehabilitation is often hindered by low adherence and limited repetitions. This study aims to build an ICP game which offers a motivational and effective environment to supplement reaching and grasping rehabilitation in youth with CP. Through a user-centered design process, we first met with five youth with CP and four occupational therapists to establish reach and grasp movement priorities. Then, seven youth, age 16–23 years with hemiplegic CP, participated in 1–3 game design sessions. During each design session, participants extended and relaxed their hand to control an ICP game using a forearm muscle activity sensor (Myo Armband). Participants played games with different types of feedback and control mechanisms (detailed in Fig. 1 ). Game versions were iterated between design sessions. The top priority identified by youth and therapists was increasing amplitude and endurance of wrist extension while fingers open. Thus, this action was used as the primary game control. At each design session, participants played an average of 15 levels, each lasting 129 ± 56 seconds and requiring 43 ± 19 wrist extension repetitions. In total, during a typical session, participants practiced 645 ± 285 repetitions through the ICP game. User input showed participants were most responsive when feedback directly followed wrist extension (e.g. increased power bar or bonus points). The user-centered design process engages participants to build practice tools that they find motivating. The ICP game can offer youth with CP the high quantity of repetitions required to improve reach and grasp activities. Next, the game will be used in a home-based pilot study to demonstrate its efficacy for improving reach and grasp activities.