Revision 7T · Full Tutorial Edition · Updated 1 September 2026
PWR-057 · SUPERVISED full tutorial
Practise one meaningful movement with the right support, feedback and rest
Motor recovery is diagnosis- and task-specific: the movement, dose, timing and support all matter. This lesson teaches a full reach-and-place trial. A rehabilitation professional selects the trajectory and assistance; you set a stable start, aim at a real object, use one cue, rest before quality collapses and measure movement separately from real-world arm use.
What you will produceUnder rehabilitation supervision, you complete a prescribed reach-and-place block with declared support, cue, repetitions and symptom limits.
Method8 numbered Power-specific steps
Practice authorityFull method with qualified supervision where stated
Prepare the therapist-set supported seat, foam cup, 20 cm path and target, then rehearse approach–grasp–move–release without chasing speed.
Complete only the declared trial count with the stated forearm/trunk support and therapist assistance.
Record target placement, trunk lean, grip/release, help, discomfort and whether the reach helped the selected daily task.
Qualified help is required for
Assessing weakness, tone, pain, joint protection, sensation, neglect, cognition and medical precautions before selecting the reach.
Choosing posture, object, distance, repetitions, rest, manual assistance and the one cue changed between matched blocks.
Progressing load, speed, support or daily-task complexity and interpreting recovery beyond this one reach-and-place record.
Never do this from the page alone
Increase cup weight, path, speed or repetitions because one reach looked good, or remove a support to manufacture independence.
Pull the affected arm, force a painful range or continue through new weakness, severe headache, chest symptoms, dizziness or loss of control.
Treat target hits in the clinic as proof of safe cooking, driving, lifting or unsupervised arm use.
2 · Get ready
Gather what you need and check the starting conditions
What you need
A stable chair and table set to provider-selected heights.
One light, unbreakable object with an accessible grip and a marked start/finish area.
Prescribed brace, support, stimulation or assistance if part of the plan.
A trial sheet for success, movement quality, assistance, effort, pain and rest.
Before you start
The treating professional selects the limb, movement, range, load, assistance and repetition dose for the diagnosis and stage of recovery.
Check sitting/standing stability, joint position, skin, lines/tubes and prescribed equipment.
Clear the route and use a helper when loss of balance or dropping is possible.
Agree stops for new weakness, severe pain, dizziness, chest symptoms, marked fatigue or abnormal movement.
3 · The method
Follow these steps in order
Name functional goal
State the daily action this reach supports, such as moving a cup to a marked place, and your treating therapist-set success feature.
Why: A meaningful target links movement practice to use rather than isolated repetitions.
Check: You can name the reach-and-place task and one trajectory goal.
Set starting position
Place your body, limb and object exactly as your therapist specifies; keep prescribed support in place.
Why: Start position changes range, balance and difficulty.
Check: Feet/body support, object and limb match this setup card.
Preview one correct trial
Watch or feel your therapist demonstrate the reach path and rehearse it once with prescribed assistance.
Why: A clear model reduces guessing and compensatory movement.
Check: You identify starting, path and finish.
Reach on one cue
On the chosen cue, move toward the practice object at a controllable speed while your therapist provides only the planned assistance.
Why: One cue and stable assistance make errors interpretable.
Check: Your hand or device reaches the landing zone without an unsafe loss of balance.
Grasp, then place
Use the selected grip or adaptive aid, lift only as prescribed, then place the practice object fully inside the landing-zone mark.
Why: Each reach-and-place trial includes useful object control, not movement for its own sake.
Check: The practice object is secure, arrives in the landing zone; release occurs under control.
Reset without rushing
Return your working limb and object to starting with help as planned; do not add a fast return repetition.
Why: Reset quality and fatigue affect next attempt.
Check: The original configuration is restored before next cue.
Use one correction
After provider feedback, change one feature such as trunk support, reach direction or grip timing, then repeat.
Why: One correction teaches the largest error without overloading attention.
Check: The movement tally names the error and shows whether it changed.
Rest and check transfer
Stop at prescribed repetition or quality limit, rest, then test one provider-approved daily variant if appropriate.
Why: Fatigued repetitions can rehearse compensation; transfer must be tested separately.
Check: Quality remains within the agreed rule and any variant is labelled new.
4 · Worked example
See the whole method used once
Scenario
After stroke, Elena’s therapist selects moving a foam cup 20 cm across a table using her affected arm with forearm support.
Walkthrough
The therapist positions Elena, the cup and a target circle; logs the amount of forearm support.
Elena watches one demonstration and rehearses the reach path with assistance.
She reaches on the cue, secures the foam cup, then places it inside the circle.
After a trunk-lean error, the therapist adds one support cue and Elena repeats.
They stop after five prescribed trials, record successes and test no heavier object.
Result
Elena completes four of five placements with declared support and less trunk lean. This demonstrates progress on the prescribed task, not recovery across all arm use.
5 · Right and wrong
Compare correct or safer execution with the common wrong version
Right and wrong comparison
Moment
Right / safer
Wrong / riskier
Why it matters
Task choice
Use each reach trajectory selected for this diagnosis and goal.
Copy a generic exercise or force a weak limb through range.
Dose and movement safety depend on the person and recovery stage.
Assistance
Keep motor planned assistance visible in movement tally.
Hide help to claim independence.
Unrecorded assistance makes change uninterpretable.
Speed
Move slowly enough to keep balance and object control.
Use momentum to finish the reach.
Momentum can mask control and increase risk.
Compensation
Accept or correct trunk movement according to your therapist’s goal.
Assume every successful placement uses intended movement.
A result can improve by compensation rather than recovery.
Dose
Stop when trajectory quality or symptom rule is reached.
Continue until exhaustion.
Fatigue can worsen movement and safety.
6 · Common mistakes
Spot the error and apply the correction
Common mistakes and corrections
Mistake
Fix
Copy a generic exercise or force a weak limb through range.
Use each reach trajectory selected for this diagnosis and goal.
Hide help to claim independence.
Keep motor planned assistance visible in movement tally.
Use momentum to finish the reach.
Move slowly enough to keep balance and object control.
Assume every successful placement uses intended movement.
Accept or correct trunk movement according to your therapist’s goal.
Continue until exhaustion.
Stop when trajectory quality or symptom rule is reached.
7 · Practice
Turn the steps into a usable skill
First session
Elena’s therapist fixes the supported sitting position, foam cup, 20 cm path, target circle, assistance level, five-trial limit and symptom stops.
Elena watches one approach–grasp–move–release demonstration and completes one therapist-assisted rehearsal without chasing speed.
A first three-trial block records cup placement, trunk lean, forearm support, grip release and discomfort on every attempt.
The therapist changes only the trunk-support cue, then Elena completes two matched trials with the same cup and distance.
After rest, a daily-use check is attempted only if trajectory quality and symptoms remain inside the therapist’s rule.
Repeat plan
Rehabilitation professional sets session frequency and progression. Change only one of distance, object, support, speed or context after stable quality. Record real-world arm use separately from clinic performance.
Progress when
More prescribed placements succeed with equal or less assistance.
Trajectory quality remains within your therapist’s rule across the full block.
The skill appears in a provider-approved daily object transfer without worse symptoms.
Do not progress when
New weakness, loss of coordination, pain, swelling, dizziness or unusual fatigue appears.
Compensation or assistance rises across this repetition block.
You or helper cannot reproduce the safe setup.
8 · Check the result
Measure what changed
Successful 20 cm foam-cup placements with trunk compensation, assistance, grip release, symptoms and separate real-world arm use
How: Record successful placements out of prescribed trials, movement-quality error, assistance level, time, effort, symptoms; note whether each reach-and-place trial appears in real-world arm use.
Good result: Your treating therapist confirms meaningful improvement on repeated matched trials and at least one relevant daily object transfer without increased harm or burden.
This does not prove: Better supported foam-cup placement does not prove full neurological recovery, independent arm use, safe handling of heavier objects or transfer to an untested daily activity.
Self-check
Can you demonstrate “Set starting position”? Feet/body support, object and limb match this setup card.
Can you demonstrate “Grasp, then place”? The practice object is secure, arrives in the landing zone; release occurs under control.
Can you demonstrate “Rest and check transfer”? Quality remains within the agreed rule and any variant is labelled new.
9 · Stop, adapt or get help
Keep the safety boundary practical
Stop and get help
Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
Stop this repetition block for increasing pain, unsafe balance, uncontrolled spasm, joint strain or sharp decline in trajectory quality.
Contact rehabilitation team after a fall, new swelling, skin injury or sustained loss of function.
Accessibility and adaptations
Use your prescribed seating, brace, grip aid and communication method.
Change object size, contrast or target position while preserving the same functional goal; log the change.
Allow hand-over-hand or robotic assistance when prescribed; supported performance remains valid when labelled.
10 · Evidence and limits
Why these instructions are here
primary research
The EXCITE trial supports task-specific upper-limb practice for selected stroke survivors, not a universal dose or unsupervised forcing.
Steven L Wolf; Carolee J Winstein; J Philip Miller; Edward Taub; Gitendra Uswatte; David Morris; Carol Giuliani; Kathye E Light; Deborah Nichols-Larsen; EXCITE Investigators · 2006 · Primary research
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Step-by-step learner mode
Each activity includes its success check, a nearby accessible alternative and an “I’m stuck” correction path. Alternatives preserve the target where possible; when they change the task, Titan labels them as related rather than equivalent.
01
Name functional goal
State the daily action this reach supports, such as moving a cup to a marked place, and your treating therapist-set success feature.
Why this step exists
A meaningful target links movement practice to use rather than isolated repetitions.
Success check
You can name the reach-and-place task and one trajectory goal.
I’m stuck on this step
Reset: Re-read this authored instruction — “State the daily action this reach supports, such as moving a cup to a marked place, and your treating therapist-set success feature.” — and its success check, then attempt only this step.
Possible snag: Copy a generic exercise or force a weak limb through range.
Correction: Use each reach trajectory selected for this diagnosis and goal.
Possible snag: Assume every successful placement uses intended movement.
Correction: Accept or correct trunk movement according to your therapist’s goal.
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
02
Set starting position
Place your body, limb and object exactly as your therapist specifies; keep prescribed support in place.
Why this step exists
Start position changes range, balance and difficulty.
Success check
Feet/body support, object and limb match this setup card.
I’m stuck on this step
Reset: Re-read this authored instruction — “Place your body, limb and object exactly as your therapist specifies; keep prescribed support in place.” — and its success check, then attempt only this step.
Possible snag: The result from “Place your body, limb and object exactly as your therapist specifies; keep prescribed support in place.” does not yet meet this declared check: Feet/body support, object and limb match this setup card.
Correction: Return to the start of “Set starting position”, reduce complexity or pace, and repeat only the part needed to satisfy: “Feet/body support, object and limb match this setup card.”
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
03
Preview one correct trial
Watch or feel your therapist demonstrate the reach path and rehearse it once with prescribed assistance.
Why this step exists
A clear model reduces guessing and compensatory movement.
Success check
You identify starting, path and finish.
I’m stuck on this step
Reset: Re-read this authored instruction — “Watch or feel your therapist demonstrate the reach path and rehearse it once with prescribed assistance.” — and its success check, then attempt only this step.
Possible snag: The result from “Watch or feel your therapist demonstrate the reach path and rehearse it once with prescribed assistance.” does not yet meet this declared check: You identify starting, path and finish.
Correction: Return to the start of “Preview one correct trial”, reduce complexity or pace, and repeat only the part needed to satisfy: “You identify starting, path and finish.”
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
04
Reach on one cue
On the chosen cue, move toward the practice object at a controllable speed while your therapist provides only the planned assistance.
Why this step exists
One cue and stable assistance make errors interpretable.
Success check
Your hand or device reaches the landing zone without an unsafe loss of balance.
I’m stuck on this step
Reset: Re-read this authored instruction — “On the chosen cue, move toward the practice object at a controllable speed while your therapist provides only the planned assistance.” — and its success check, then attempt only this step.
Possible snag: Hide help to claim independence.
Correction: Keep motor planned assistance visible in movement tally.
Possible snag: Use momentum to finish the reach.
Correction: Move slowly enough to keep balance and object control.
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
05
Grasp, then place
Use the selected grip or adaptive aid, lift only as prescribed, then place the practice object fully inside the landing-zone mark.
Why this step exists
Each reach-and-place trial includes useful object control, not movement for its own sake.
Success check
The practice object is secure, arrives in the landing zone; release occurs under control.
I’m stuck on this step
Reset: Re-read this authored instruction — “Use the selected grip or adaptive aid, lift only as prescribed, then place the practice object fully inside the landing-zone mark.” — and its success check, then attempt only this step.
Possible snag: The result from “Use the selected grip or adaptive aid, lift only as prescribed, then place the practice object fully inside the landing-zone mark.” does not yet meet this declared check: The practice object is secure, arrives in the landing zone; release occurs under control.
Correction: Return to the start of “Grasp, then place”, reduce complexity or pace, and repeat only the part needed to satisfy: “The practice object is secure, arrives in the landing zone; release occurs under control.”
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
06
Reset without rushing
Return your working limb and object to starting with help as planned; do not add a fast return repetition.
Why this step exists
Reset quality and fatigue affect next attempt.
Success check
The original configuration is restored before next cue.
I’m stuck on this step
Reset: Re-read this authored instruction — “Return your working limb and object to starting with help as planned; do not add a fast return repetition.” — and its success check, then attempt only this step.
Possible snag: The result from “Return your working limb and object to starting with help as planned; do not add a fast return repetition.” does not yet meet this declared check: The original configuration is restored before next cue.
Correction: Return to the start of “Reset without rushing”, reduce complexity or pace, and repeat only the part needed to satisfy: “The original configuration is restored before next cue.”
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
07
Use one correction
After provider feedback, change one feature such as trunk support, reach direction or grip timing, then repeat.
Why this step exists
One correction teaches the largest error without overloading attention.
Success check
The movement tally names the error and shows whether it changed.
I’m stuck on this step
Reset: Re-read this authored instruction — “After provider feedback, change one feature such as trunk support, reach direction or grip timing, then repeat.” — and its success check, then attempt only this step.
Possible snag: The result from “After provider feedback, change one feature such as trunk support, reach direction or grip timing, then repeat.” does not yet meet this declared check: The movement tally names the error and shows whether it changed.
Correction: Return to the start of “Use one correction”, reduce complexity or pace, and repeat only the part needed to satisfy: “The movement tally names the error and shows whether it changed.”
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
08
Rest and check transfer
Stop at prescribed repetition or quality limit, rest, then test one provider-approved daily variant if appropriate.
Why this step exists
Fatigued repetitions can rehearse compensation; transfer must be tested separately.
Success check
Quality remains within the agreed rule and any variant is labelled new.
I’m stuck on this step
Reset: Re-read this authored instruction — “Stop at prescribed repetition or quality limit, rest, then test one provider-approved daily variant if appropriate.” — and its success check, then attempt only this step.
Possible snag: Continue until exhaustion.
Correction: Stop when trajectory quality or symptom rule is reached.
Stop / get help: Stop and seek urgent help for sudden new weakness, facial droop, speech change, severe headache, collapse, chest pain or severe breathlessness.
Correct versus incorrect execution
These accessible process diagrams are built from the tutorial’s own right/wrong teaching. They are not anatomical illustrations and do not add technique beyond the canonical tutorial.
Task choice — Dose and movement safety depend on the person and recovery stage.
Correct / safer
Use each reach trajectory selected for this diagnosis and goal.
Wrong / riskier
Copy a generic exercise or force a weak limb through range.
Assistance — Unrecorded assistance makes change uninterpretable.
Correct / safer
Keep motor planned assistance visible in movement tally.
Wrong / riskier
Hide help to claim independence.
Speed — Momentum can mask control and increase risk.
Correct / safer
Move slowly enough to keep balance and object control.
Wrong / riskier
Use momentum to finish the reach.
Compensation — A result can improve by compensation rather than recovery.
Correct / safer
Accept or correct trunk movement according to your therapist’s goal.
Wrong / riskier
Assume every successful placement uses intended movement.
Dose — Fatigue can worsen movement and safety.
Correct / safer
Stop when trajectory quality or symptom rule is reached.
Wrong / riskier
Continue until exhaustion.
Method-structure checklist
10 of 10 structural checks present
✓ Ordered, Power-specific instructions — present
✓ Every activity has a success check — present
✓ Materials or supplied records are declared — present
✓ Measurement or assessment rule is present — present
✓ Tutorial-specific troubleshooting is present — present
✓ Stopping or escalation boundary is present — present
✓ Every activity has an adjacent alternative — present
✓ Correct-versus-incorrect comparison is present — present
✓ Evidence context is bound to the Power record — present
✓ Planning metadata is present — present
The method-readiness band and presence checklist assess tutorial presentation and are separate from evidence quality for the underlying Power. They are automated editorial aids, not human approval.
Manual editorial sign-off: Pending. This tutorial must not display a human-approved state until an identified editor signs the exact content hash.