When you build a house you want to build a strong foundation. When it's a tree grows, it doesn't grow from the leaves inward, it grows from the seed outward. For every process of growth, there is a beginning, a foundation, a germinal point.
What is the foundation for movement after stroke? If you ask most therapists they will say it is trunk (torso) control.
Focus on trunk control is the analog to building a good foundation for a house. Trunk control, so the thinking goes, will provide a good foundation for the arms and legs to do their thing.
Therapists will often continually talk about the trunk as being the most important foundational part of the movement. The way it is taught in therapy school is "proximal stability for distal mobility". And this idea-- to work from "the inside out" is not wrong per se. It's just not particularly right.
Some therapists obsess about the trunk. But what if we flipped it? What if the driver foundation of learning movement is the hand? Or the feet? But I actually don't think it is those, either.
The foundation of movement is the will of the mover.
- Mind: Expressed as intention (I want to do something)
- Brain: Starts the movement (Expressed as an electrochemical command)
- Muscles: Move the limb (muscle contraction)
- Hand: Expresses the original intention (grab a beer)
Imagine an infant. They reach because they want something. There is no one there to hold them and they may be a little unsteady, but their intention to reach makes their balance better.
The “will” of the hand drives the changes needed in the trunk. The trunk will learn, in a natural way, to get the hand where it needs to be.