weight bearing activities stroke occupational therapy weight bearing activities stroke occupational therapy

JengaPlaying jenga involves physical and mental coordination while stacking blocks and trying to keep the tower from falling. SaeboGlove Muscle activation - pattern and timing of movement during functional activities; Weight shift - in all planes . Dance Dance RevolutionFor stroke survivors who are able to safely participate, playing games like Dance Dance Revolution can add to their exercise routine and encourage them to get moving. DrawingDrawing uses many of the same skills as painting, but it requires less equipment and is easier to clean up. 5. Functional Check points - PTs and PTAs will modify manual cues and feedback to the demands of the task and the ability of the patient. Jameela reviewed the evidence from the January/February 2015 issue of the American Journal of Occupational Therapy and the recommendations from the Occupational Therapy Practice Guidelines for Adults With Stroke (Wolf & Nilsen, 2015) and found the following information: Moderate evidence from several studies supports the use of occupation-based interventions to improve performance of activities of daily living (ADLs) in the inpatient setting. Do you have some pictures to add? MeditationMeditation can help lower stress, relieve chronic pain, and stave off depression. It wont happen all at once, but combining electrical stimulation with therapy exercise is shown to produce better results. https://sunnybrook.ca/uploads/THR_Restricted.pdf, Mayo Clinic. This, in turn, provides inhibitory proprioceptive input to the nervous system, through the use of deep pressure. Exercises and occupational therapy for upper extremity Sammons Preston Plastic Small Stack Cones Medical May 12th, 2018 - Functional Hand Therapy for Upper Extremity Hand Eye Coordination Core Exercise . If a 150-lb female patient is only allowed to place up to 50% of her body weight through her operative hip, this means only about 75lbs of pressure. Vision therapy is often overlooked in stroke rehab. Share your stroke survival story -CLICK HERE! Jameela assisted Jorge with comparing his actual and predicted task performance. Please note that submissions from others are for informational purposes only and are not professional medical advice, diagnosis, treatment or care, nor are intended to be a substitute. One of the best ways to achieve proximal stability is through weight bearing activities. Lets further explain some of the acronyms, explore interpretations, and the review the application to OT intervention, especially if you are new to working in a setting such as acute care or skilled nursing. My Account weight bearing activities stroke occupational therapythe renaissance apartments chicago. Going for a walk is a good way to get outdoors and improve cardiovascular fitness.Creative Activities. Weight Bearing Precautions Review Per usual practice, occupational therapy practitioners don't typically set up or change weight bearing precautions for their patients. . Now, lean forward while keeping yourself seated. Bed mobility, reaching tasks seated on a balance disc, lateral leans, pelvic tilts, push/pull exercises. Swallowing Exercises Dysphagia or trouble with swallowing can be a very serious impairment even life threatening. Weight bearing can help improve balance, reduce excessive tone brought on by a stroke and strengthen weak muscles. Jameela proceeded to engage Jorge in task practice, providing verbal and physical prompting as needed. When you sign up, youll also receive our popular Monday newsletter that contains 5 articles on stroke recovery. Weight bearing can help improve balance, reduce excessive tone brought on by a stroke and strengthen weak muscles. 1. 24. Jigsaw PuzzlesPutting together a jigsaw puzzle improves both concentration and motor skills. Participants in a 2009 study actually regained some of their visual field loss after doing eye exercises for an extended period of time. FitMi is a neurorehab device that you can use from the comfort of home. You should feel this stretch all the way up your torso and into your shoulder. Full Weight Bearing Walk with a Standard Walker - Non-Weight Bearing SaeboStep YogaAnother activity that can help stroke survivors improve balance is yoga. Catherine O'Brien. Rest your elbows on the table. Stroke Awareness Rehabilitation Nursing Word SearchWord searches help a stroke survivor work on their perceptual skills and attention. 26. International Partners Providing an occupation box of items related to Jorges identified goal areas, such as a deck of cards, dog brush, can opener, pen and paper, coins, and utensils and encouraging him to engage in RTP using these items during down time. These strategies were also encouraged during self-care, card playing, and meal preparation. Botox for Stroke Patients: How It Can Help with Spasticity Relief, Understanding Active vs Passive Exercises to Customize Rehabilitation to Your Ability Level, Gait Training Exercises for Stroke Patients: How to Improve Your Walk. This type of exercise will gradually and progressively overload the muscles so that they will get stronger. 23 Weight Bearing Activities ideas | pediatric physical therapy, activities, pediatric ot Weight Bearing Activities 23 Pins 10y A Collection by Aimee Prainito Similar ideas popular now Occupational Therapy Pediatrics Physical Therapy Sensory Activities Sensory Processing Activities Gross Motor Activities Sensory Integration Gross Motor Skills CLICK HERE, Share your stroke The stroke survivor must rely on their therapist for exercise instruction so it is of utmost importance to have a therapist experienced in working with stroke victims. Search for other works by this author on: Copyright 2015 by the American Occupational Therapy Association, Inc. Behavioral assessment of unilateral neglect: Study of the psychometric properties of the Catherine Bergego Scale, Archives of Physical Medicine and Rehabilitation, The post-stroke hemiplegic patient. ScattergoriesScattergories involves listing words in different categories that all start with the same letter. snoopy happy dance emoji 8959 norma pl west hollywood ca 90069 8959 norma pl west hollywood ca 90069 Guided by the occupational profile, Jorges ability to perform self-care activities was assessed using the FIM (Uniform Data System for Medical Rehabilitation, 1997) and observation of a simple meal preparation task (see Table 1 for assessment results). necrotic breakdown of a limb or joint (i.e. Click. By folding a large item, such as a comforter, your muscles can get stronger. It is important to do weight bearing for the arms and legs. Van Ouwenaller C, Laplace P,Chantraine A (1986) Painful shoulder in hemiplegia Arch Phys Med Rehabil 46:23-26. Train for functional activities Click the button and find the first one on your computer. Bend your elbows. The digital download includes 100 play activity pages and 12 tip sheets. Decreased use of the left dominant upper extremity (UE) and left unilateral spatial neglect were significant limiting factors during task performance. Its like having a virtual therapist available anytime you need it. Below, weve explained the 6 most common acronyms we may come across in treatment orders for our patients and a brief description of what each means: This means absolutely no weight-bearing through the specified joint(s). Active assistiverange of motion occurs when a weak limb is assisted through movement. ScrabbleScrabble involves a variety of skills that stroke survivors can work on. This bone loss can lead to brittle bones which also puts a person at higher risk for fractures. Evidence-Based Treatment On the basis of the evidence, Jameela chose the following interventions to maximize Jorges participation in life tasks: Occupation-based interventions to improve ADLs. tional trunk exercises to regular rehabilitation had a beneficial effect in improving trunk control, particularly the dynamic sitting postural control in sub-acute stroke [17]. Although the percentage is determined between the doctor and the patient, partial weight-bearing usually means up to 50% of the patients body weight. Jameela provided Jorge and his partner with a practice log and encouraged them to record the independent practice sessions daily. Arm and Hand Exercises 3 Stretching exercises for the shoulder, elbow, and wrist Sit with a table in front of you Sit in a supportive chair with your feet on the floor. Constraint Induced Movement Therapy (CI Therapy or CIMT) sometimes referred to as forced use therapy by some is a stroke rehab technique which involves limiting the movement of the strong side or non-affected side and forcing the weaker or affected side to attempt activities. Bowling in seated. Spasticity 13. Click here to get instant access. Fine motor skills involve hand dexterity which is important for picking up objects, feeding oneself, buttoning clothes, writing and many other activities. 7. Exercises and occupational therapy for upper extremity. Side sitting and weight bearing while we play board games or do puzzles. Task-Oriented Training Jorge predicted that each task would take approximately 10 min and that he would require supervision. Then rock from side to side, shifting your weight from one arm to the next. Stroke Exercises Stroke rehab exercises often consists of strengthening activities that involve moving a body part against resistance. ARAT = Action Research Arm Test; BDIII = Beck Depression InventoryII; CBS = Catherine Bergego Scale; FMA = Fugl-Meyer Assessment; LB = lower body; M = motor; OT = occupational therapist; S = sensory; UB = upper body; UE = upper extremity. functional activities. On the basis of Jorges primary areas of interest, assessment results, and the anticipated discharge environment (i.e., home with supervision), treatment goals were developed to target increasing independence in the performance of self-care skills, simple meal preparation, work-related activities, and the leisure activity of playing cards. AROM helps promote joint flexibility, strengthening, and increased muscular endurance. Putting on some of their favorite music can help motivate them to get up and move as much as they are able. She highlighted the discrepancies. Click here for more info! 69(5), 6905395010p16905395010p3. Manipulation of bathing and grooming items; specifically, organizing items in a basin, opening and closing containers, and so forth. Evidence Connection articles provide a clinical application of systematic reviews developed in conjunction with the American Occupational Therapy Association's (AOTA's) Evidence-Based Practice project. Jorges success was based on occupational therapy interventions that were evidence based, occupation based, and client centered. Free Online Continuing Education Courses for Therapists A licensed occupational or physical therapist can teach caregivers how to do passive range of motion on a stroke patient. Repeat this exercise. Stroke patients with expressive aphasia, receptive aphasia, and dysarthria will all need speech therapy. Next Step Program If you have difficulties with your seated balance, be sure to complete this in a chair with arms or with someone else nearby. Stroke patients with expressive aphasia, receptive aphasia, and dysarthria will all need speech therapy. Keep your elbowandforearm on the table. Place a water bottle arms distance in front of you. Research 19. The goal was to maximize repetitions of reaching, grasping, transporting or manipulating, and releasing various meaningful task objects as follows: Manipulation of a computer mouse; specifically, organizing icons on the screen of Jorges work laptop, entering data onto a spreadsheet, and so forth. Rest and repeat this with the other leg positioned in front. Gardening can help improve stamina, balance, and coordination. Top 10 tips for hand and arm exercise after a stroke. A study by Mudie . 0000004275 00000 n Some clinicians argue that toe-touch weight bearing precautions allow up to 20% of the body weight to be distributed through the affected joint or limb. News/Blog Hold your cane at both ends and raise it up in front of you so that your arms are parallel to the floor. Below is a list of various types of stroke rehab exercises. Every stroke survivor is different. are often unfamiliar to patients but can be some of the most important exercises that one does. induced movement therapy, contractures, ne-motor control, functional electrical stimulation, haptic training, neuroprosthesis training, physical tness, postural stabilization, virtual reality, weight bearing, and wheelchair use. Connect FourConnect Four improves attention and motor skills. (2007). Sitting balance exercises focus on strengthening the core or trunk musculature. 0000156463 00000 n Other Methods. If balance is affected, one of the first things a patient must learn in stroke rehab is the ability to maintain their balance in sitting. The definition of TTWB is poorly defined in the research literature, but as Rubin et. 10. While she still struggles with her right side, she can walk (with assistance) and is beginning to get her right arm and hand more functional. KnittingKnitting is a relaxing activity that can help stroke survivors take their minds off of their recovery. 21. Physical activity. Physical activity is important for increasing the chances of regaining function after a stroke. The word occupation is known for referring to the performance of an activity, and the pre-existing format that guides that performance. Returns Indian Journal of Physiotherapy and Occupational Therapy Editor Archna Sharma Ex-Head Dept. Sign up to receive new product updates, clinical news, research and more. Intracerebral hemorrhage, SAH, ischemic stroke,[412].pptx . Clinical Portal post-surgical condition of a limb or joint, congenital or degenerative breakdown of bone (i.e. She lights up when we bring it out and enjoys using it for about 20 to 30 minutes at a time. 23. She had Jorge identify a favorite afternoon meal. Jorge S., a 45-yr-old Hispanic man, owns a dog-walking business with two employees. Per usual practice, occupational therapy practitioners dont typically set up or change weight bearing precautions for their patients. The patient's primary impairments included right upper and lower extremity spasticity, circumduction gait, weakness and decreased range of motion of right extremities. everyday activities. Inhibits muscle activity; damping effect. This helps with language and word retrieval. /.[asvGnccs&-jtT^/*4SQUcU54Az6eLnCGyI1o}U(*Wwp6; JLQ3I*AkNxD M}4KiG:4/)Cs LMaSF)X{RY'w7G9&c|pv_vF3|$(-3i(J0#n t9!d?A.0h_kc_HhszV. Evidence Connection articles illustrate how the research evidence from the reviews can be used to inform and guide clinical decision making. Blog The muscles that attach to the scapula (or shoulder blade) are often affected after a stroke. 4) Sit to Stand. Then bring it back down just as slowly. This technique was developed by Edward Taub and his research team at the University of Alabama at Birmingham (UAB) and u. sually consists of using a sling or mitt for 90% of waking hours on the non-affected arm, while intensively trying to use the more-affected arm. al discuss in the research article titled,Toe-Touch Weight Bearing: Myth or Reality, they describe TTWB asnone, with having the ability to touch the foot or toes to the floor without supporting weight from the affected limb. endstream endobj 55 0 obj<> endobj 56 0 obj<> endobj 57 0 obj<> endobj 58 0 obj<> endobj 59 0 obj<>stream Therefore, awareness training became an integral part of her intervention plan. If a stroke victim tends to put all of their weight on the strong leg, then the weak leg will begin to experience decreases in bone density. After 10 seconds or so, place your other arm out beside you so that youre supported by both arms. This can be measured by using a scale and crutches and practicing weight distribution with the patient (we had a really great discussion on this topic after reading the article, Effectiveness of Audio Feedback for Partial Weight-Bearing in and Outside the Hospital: A Randomized Controlled Trial in the OT Flourish Membership). Electrical Stimulation Moderate evidence supports combining a task-oriented training intervention such as RTP with a cognitive strategy such as action observation (AO) to improve UE function. Trunk work! Improper form or overexertion can worsen preexisting shoulder conditions. However, the majority of their weight should be going through their arms and shoulders via crutches or a walker. Knowing the evidence supports the use of VST, she realized that Jorge required improved awareness to use such strategies. The weak limb is helping but cannot perform all of the work on its own. In the past six months, she has been blessed with a supportive medical team, therapy team, and family team that has worked together to gain remarkable results. Placing a hand on your affected shoulder or using a mirror to watch your form may help you to keep your shoulder from hiking up. Upper Body Strength Training Handout The National Flute. Blog Hanover, PA. Pediatric Outpatient Therapy Center. 30. Following stroke, one may have decreased sensation, numbness, or tingling. Always seek the advice of a physician or other qualified health provider concerning questions you have regarding your health or a loved one's health concerns. %PDF-1.4 % but with less time than traditional CIMT. Check out our bestselling tool by clicking the button below: Copyright 2023 All rights Reserved. Audio books are another great option for those with visual deficits. Clinical Presentations Wii SportsVirtual reality games like Wii Sports have been found to motivate and help stroke survivors stay more committed to their exercise routines. 28. Retrieved February, 10, 2010, from, http://www.mayoclinic.com/health/arthritis/AR00015. Would you like to receive information on exercises, nutrition, apps, equipment, technology and more for stroke survivors? For example, if a patient recently had a total shoulder replacement, the doctor may ask the patient to non-weight bear on the surgical shoulder up to several weeks. injury to a limb or joint (i.e. Sunnybrook Holland Orthopaedic and Arthritic Centre. Upper Body Exercises Back Shoulders Arms nmh org. startxref AO combined with task practice to promote self-directed independent practice.1. How-to: Sit in a chair, lean forward, and use your legs to stand up. We never sell your email address, and we never spam. Using different colors and textures also helps stimulate the brain. Examples would be a patient taking his strong arm and moving the weak or paralyzed arm, a caregiver or therapist moving an affected limb, or a machine moving an extremity. Thanks for creating such powerful tools to help those of us caring for stroke patients. This can be especially difficult if sensation is impaired in the hands. Retraining the brain (a process formally known asneuroplasticity) may also help reduce pain, especially when the pain is caused by mobility impairments like shoulder subluxation and frozen shoulder. doi: https://doi.org/10.5014/ajot.2015.695002. Its the doctors intent to keep all or a certain amount of weight off of a limb entirely or just a single joint to prevent further damage or injury commonly. Cause Primary cause is a stroke, although a traumatic injury or brain tumor may also cause hemiplegia . amp Injuries of the Hand and Upper Extremities. Cortical Plasticity Then lean into it. 14. endstream endobj 46 0 obj<> endobj 47 0 obj<> endobj 48 0 obj<> endobj 49 0 obj<>/ProcSet[/PDF/Text]/ExtGState<>>> endobj 50 0 obj<> endobj 51 0 obj<> endobj 52 0 obj<> endobj 53 0 obj<> endobj 54 0 obj<>stream Before we dig into thestroke rehab exercises, well explain what these shoulder conditions are. Passive range of motion is important to maintain flexible joints and prevent joint contracture. Stroke patients may also be unable to discriminate where they are being touched (i.e. osteogenesis imperfecta, severe osteoporosis, etc.) 0000073725 00000 n Biofeedback What it's good for: strengthening your core and legs, improving your weight shifting and balance. Our Guarantee Occupational Therapy Toolkit Treatment Guides - Section 1 ADLs and IADLs Activities of Daily Living Bathing and Showering Clothing Care Community Mobility Dressing Driving Feeding, Eating, and Swallowing . Standing balance exercises will help improve a patients ability to stand in place as well as walk or perform activities without loss of balance. Get a free copy of our ebook Full Body Exercises for Stroke Patients. Click. Your home rehab team can work with you and your family to improve safety and mobility. It's a great way to encourage strength and motor return. If the scapula cannot move properly, one cannot lift their arm overhead. UAB Pediatric Neuromotor Clinic Intensive Occupational Therapy . When you practice thesestroke recovery exercises, aim for at least 10 repetitions each. It helps keep the elbow straight, provides extra support and may help make your exercises easier. Mayo Clinic. Passive range of motion is important to maintain flexible joints and prevent joint contracture. After suffering a stroke, many survivors find themselves with some loss of physical function. Crossword puzzles help with word-finding skills. Examples of gradation include increasing the number of items manipulated; changing the location of items in the environment to encourage reaching over greater distances and in different planes of motion; changing the size, shape, and weight of objects; and varying the speed requirements. 81 0 obj<>stream (2018). Journal of neuroengineering and rehabilitation. Effectiveness of Combined Balance and Step Training versus Task-Oriented Exercises with Sensory Input on . 0000006129 00000 n 15. 2. Forms of sensation that can be impaired are detection of heat/cold, pain, light and deep touch. bone cancer). Get recovery tips, special offers, and new product announcements. Stroke victims often have poor balance. Occupational therapists focus on weight bearing through the upper extremities. In summary, defining weight bearing precautions and recommended percentages of body weight can be very subjective depending on the doctor. Jameela met Jorge in the ADL kitchen. In addition to individual sessions, Jameela provided Jorge with specific opportunities for self-directed independent practice. Program components included, Watching AO videos on his computer, followed by actual task practice of manipulating cooking utensils and grooming items, and. Sitting balance exercises focus on strengthening the core or trunk musculature. Live Course, Foot Drop Weakness. Reliance on any information provided by the Saebo website is solely at your own risk. And there you have it! It is important to keep up with current research to find out which stroke rehab exercises are effective. You can place a rolled towel underneath your hand to increase comfort. BMJ Open Sport Exerc Med. 25. 1. Christina Komaniecki is a school based Occupational Therapist. 0000007806 00000 n Purposeful activitiestasks that are part of daily routines and hold meaning, relevance, and perceived utility such as personal care, home management, school, and workare a core premise of occupational therapy. For more information on stroke rehab exercises for speech, you can visit. SaeboMAS This technique was developed by Edward Taub and his research team at the University of Alabama at Birmingham (UAB) and usually consists of using a sling or mitt for 90% of waking hours on the non-affected arm, while intensively trying to use the more-affected arm. This may include thickened liquids, pureed food, or even nutrition through a feeding tube if a patients swallowing is severely impaired. Standing upright position one foot in front of the other so the heel of the front foot is touching the toes of the back foot - as if standing on a tightrope. Jameela continued to address awareness building using task prediction methods and videotape feedback. 0000003705 00000 n If it feels good, stay there and feel the stretch for 10 seconds or so. Mat activities are given to: Facilitate balance Promote stability Mobilize and strengthen the trunk and limb. A method for evaluation of physical performance, Scandinavian Journal of Rehabilitation Medicine, Canadian Occupational Performance Measure, A performance test for assessment of upper limb function in physical rehabilitation treatment and research, International Journal of Rehabilitation Research/Internationale Zeitschrift fur Rehabilitationsforschung/Revue Internationale de Recherches de Readaptation, Uniform Data System for Medical Rehabilitation, Guide for the Uniform Data Set for Medical Rehabilitation (including the FIM instrument), Version 5.1, Occupational therapy practice guidelines for adults with stroke, This site uses cookies. She introduced the concept of VST to Jorge. BattleshipPlaying Battleship is good practice for stroke survivors with speech or word retrieval problems. General Guidelines So, I am looking forward to continued improvement.. You will need: A tabletop and water bottle. Stroke rehab exercises often consists of strengthening activities that involve moving a body part against resistance. From a seated position, place the cane away from you at arms length and place your affected hand on the handle. We invested in the FitMi + MusicGlove + Tablet bundle for her at the beginning of August. Bilateral activities Other stroke rehab exercises include the use of technology and robotics ,mirror box therapy, graded imagery, and more. People with certain conditions may benefit from shoulder weight-bearing and balance exercises in quadruped (the crawling position on all fours) or in the plank position. Exercises to improve speech may aim at improving articulation due to weak mouth and tongue musculature or improving a patients inability to recall or understand words. If it feels good, stay there and feel the stretch for 10 seconds or so. FAQs, 1-Minute Referral I do walk now with a cane or walker, but my right hand curls up and my right arm is also weak. Typically, tremors occur in upper extremities such as the hands but tremors can exist in other body parts as well (Mayo Clinic, Aug 2017). Weight bearing activities through the arms - animal walks, wheelbarrow walking, crawling, planks, and wall push ups all help to increase muscle strength and improve coactivation of the shoulder and postural muscles. For more information on stroke rehab exercises for speech, you can visitwww.speech-therapy-on-video.com. PaintingPainting uses fine motor skills and helps stroke survivors practice their grip. How to orthopaedic surgeons and rehabilitation professionals interpret and assess toe touch weight bearing and partial weight bearing status in the rehabilitation setting? There are many types of strengthening exercise equipment including bands, dumbbells, tubing, putty, and exercise machines. New Stroke Rehab e-book. strengthening Chedoke-McMaster Stroke Assessment Scale (Gowland et al., 1993) Canadian Occupational Performance Measure (Law et al., 2014) Modified Ashworth Scale (Bohannon & Smith 1987) Stroke Impact Scale (Duncan et al., 1999) Occupational Therapy Intervention: ADL, IADL, productivity and leisure training . For survivors who are limited to one functional hand, a knitting aid makes one-handed knitting possible. 15. Clasp your hands together. The occupation-based intervention of making a chopped salad was chosen because Jorge identified it as meaningful. 2. Jameela began the session by describing the two occupations that would be practiced and asked Jorge to predict (awareness training) how long each would take and how much assistance he would need. For example, if a patient recently had a total shoulder replacement, the doctor may ask the patient to non-weight bear on the surgical shoulder up to several weeks. That order comes from their primary physicians who also order therapy evaluations and services to begin with. All Rights Reserved. At Reddy Care Physical and Occupational Therapy, we can get you set up with the right therapist for you. These types of exercise work directly on the bones in your legs, hips and lower spine to slow mineral loss. Passive range of motion refers to an external force moving a body part rather than it moving on its own volition. Electrical Stimulation If the scapula is unstable, then arm movement may be jerky or uncontrolled. Gravity Compensation 0000001545 00000 n Retrieved February, 10, 2010, from http://www.mayoclinic.com/health/arthritis/AR00015. 0000160579 00000 n Save my name, email, and website in this browser for the next time I comment. Copyright Saebo, Inc 2023. DancingDancing is an enjoyable activity for many stroke survivors. Many of the above standing recreational activities can also be applied while seated. They have no children, but they have a large social network. 7 Tips For Success As A New Grad Occupational Therapy Practitioner, 14 Occupation Based Kit Ideas for Your OT Department. 45 0 obj <> endobj UPMC. When my 84-year-old Mom had a stoke on May 2, the right side of her body was rendered useless. Use these for pull-downs, shoulder rotations, and arm and leg-extensions. For the arm, this could vary. Stroke survivors may suffer visual problems such as visual field loss, visual spatial disorders, impaired eye movement or double vision. Standing balance exercises will help improve a patients ability to stand in place as well as walk or perform activities without loss of balance. In the area of motor impairment, strong evidence supports using repetitive task training (RTP) to improve UE function, balance, and mobility and activity and participation for clients with motor impairments. We hope these shoulder exercises for stroke patients help improve your mobility and reduce your pain. WarWar is a simple card game in which you flip over a card, and the person with the highest card wins. 34. 6. These shoulder exercises may also help if you are experiencing paralysis of the arm, affecting your shoulder range of motion. Players pick up and drop small disks, and they pay attention to both their and their opponents pieces.