Outline: Contextualized Arm and Hand Rehabilitation

Approximately 80% of stroke survivors experience upper limb impairments, yet fewer than 15% regain full bilateral coordination. Recovery is often slow and incomplete, attributed to the complexity of upper limb control and the limited therapy time allocated in conventional rehabilitation. Evidence supports a range of interventions, including constraint-induced movement therapy, mirror therapy, motor imagery, progressive resistance training, repetitive task-specific training, and electrical stimulation, that can facilitate functional recovery. However, their feasibility in low- and middle-income countries (LMICs) is constrained by limited infrastructure, a lack of skilled personnel, and costly technologies. Contextualized approaches are therefore essential. Integrating culturally relevant, task-oriented training using locally available resources, caregiver-supported home practice, and community-based rehabilitation models can help bridge these gaps. Bilateral arm functional training, particularly when applied through structured yet low-cost strategies such as the “table wrap” approach and household-based adaptations (e.g., cooking, clothing, or household chores), promotes neuroplasticity, overcomes learned nonuse, and supports participation in daily life. Caregiver training and balanced involvement are vital to sustain motivation and autonomy. This chapter highlights the importance of evidence-based yet context-sensitive interventions to improve upper limb recovery, independence, and quality of life in stroke survivors in resource-limited settings.