EXERCISES.

ACTIVE CYCLE FOR UPPER LIMBS:
Physiotherapist`s aim:
To improve fitness.
Client`s aim:
To improve your fitness.
Physiotherapist`s instructions:
Position the patient in their wheelchair with their hands in the paddles of the active cycle. Instruct the patient to cycle with their hands.
Client`s instructions:
Position yourself sitting in your wheelchair with your hands in the paddles of the active cycle. Cycle with your hands.
Progressions and variations:
Less advanced: 1. Decrease the active resistance.
More advanced: 1. Increase the active resistance. 2. Increase duration of exercise.
Precautions:
1. Check for pressure marks in areas where sensation is absent or impaired.


ANKLE DORSIFLEXOR ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of tibialis anterior.


ANKLE DORSIFLEXOR STRENGTHENING IN LONG SITTING:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in long sitting with a target held above their toes.
Instruct the patient to dorsiflex their ankles to touch the target with their toes.
Client`s instructions:
Position yourself sitting with your legs in front of you and a target held above your toes.
Practice bending your ankles to touch the target with your toes.
Progressions and variations:
Less advanced: 1. Decrease the distance to the target.
More advanced: 1. Increase the distance to the target.


ANKLE DORSIFLEXOR STRENGTHENING IN SITTING USING SANDBAG WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with a weight attached around their toes.
Instruct the patient to dorsiflex their ankle.
Client`s instructions:
Position yourself sitting with a weight attached around your toes.
Start with your toes on the floor.
Finish with your toes off the floor.
Progressions and variations:
Progress using strength training principles.


ANKLE DORSIFLEXOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their feet flat on the floor and their knees relatively extended. Instruct the patient to dorsiflex the ankles.
Client`s instructions:
Position yourself sitting with your feet together in front of you.
Start with your feet flat on the floor.
Finish with your toes lifted up.
Ensure that you keep your heels on the ground.
Progressions and variations:
Less advanced: 1. Position the feet further forwards. 2. Place a bandage around the knees to hold them together.
More advanced: 1. Position the feet further back.


ANKLE DORSIFLEXOR STRENGTHENING IN STANDING BY KICKING A BALL BACKWARDS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors.
Client`s aim:
To strengthen the muscles at the front of your ankle.
Physiotherapist`s instructions:
Position the patient in standing while holding onto a ball.
Instruct the patient to kick the ball over their head.
Ensure that their ankle dorsiflexes.
Client`s instructions:
Position yourself standing while holding onto a ball.
Practice kicking the ball over your head.
Ensure that your foot bends backwards.
Progressions and variations:
Less advanced: 1. Perform the exercise in sitting.
More advanced: 1. Kick the ball further behind.


ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SIDELYING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in sidelying.
Instruct the patient to dorsiflex and plantarflex their ankle.
Client`s instructions:
Position yourself lying on your side.
Start with your toes pointing down.
Finish with your toes pointing up.


ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SITTING BY DRAWING CIRCLES WITH THE FOOT:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in sitting.
Instruct the patient to draw circles in the air with their toes.
Ensure that only their ankle moves.
Client`s instructions:
Position yourself in sitting.
Practice drawing circles in the air with your toes.
Ensure that only your ankle moves.
Progressions and variations:
Less advanced: 1. Move the ankle up and down only. 2. Make smaller circles.
More advanced: 1. Make larger circles. 2. Vary the ankle movement (eg. write the alpabet).


ANKLE DORSIFLEXOR/PLANTARFLEXOR STRENGTHENING IN SUPINE WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle dorsiflexors/plantarflexors.
Client`s aim:
To strengthen your ankle muscles.
Physiotherapist`s instructions:
Position the patient in supine.
Instruct the patient to dorsiflex and plantarflex their ankle.
Client`s instructions:
Position yourself lying on your back.
Start with your toes pointing down.
Finish with your toes pointing up.
Progressions and variations:
Progress using strength training principles.


ANKLE EVERTOR STRENGTHENING IN SITTING WITH ASSISTANCE:
Physiotherapist`s aim:
To strengthen the ankle evertors.
Client`s aim:
To strengthen the muscles on the outside of the ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the patient to evert their ankle and bring their toes to touch a target object.
Client`s instructions:
Position the child in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the child to move their toes outwards and upwards to touch an object with the outside border of their foot.
Progressions and variations:
Less advanced: 1. Position the target object closer to the toes.
More advanced: 1. Position the target object further away from the toes.


ANKLE EVERTOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle evertors.
Client`s aim:
To strengthen the muscles at the outside of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their knees together and ankles slightly apart.
Instruct the patient to evert their ankles and bring the medial malleoli to touch together.
Ensure that the knees are kept still.
Client`s instructions:
Position yourself sitting with your knees together and ankles slightly apart.
Start with your feet flat on the floor.
Finish with outside of your soles lifted off the floor and the inside part of your ankles touching together.
Ensure that your knees are kept still.
Progressions and variations:
Less advanced: 1. Place a bandage around the knees to hold them together.
More advanced: 1. Perform the exercise in standing.


ANKLE INVERTOR STRENGTHENING IN SITTING WITH ASSISTANCE:
Physiotherapist`s aim:
To strengthen the ankle invertors.
Client`s aim:
To strengthen the muscles on the inside of the ankle.
Physiotherapist`s instructions:
Position the patient in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the patient to invert their ankle and bring their toes to touch a target object.
Client`s instructions:
Position the child in sitting with their heel on the floor and your hand stabilising their knee. Instruct and encourage the child to move their toes inwards and upwards to touch a target object with the inside border of their foot.
Progressions and variations:
Less advanced: 1. Position the target object closer to the toes.
More advanced: 1. Position the target object further away from the toes.


ANKLE INVERTOR/EVERTOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle invertors and evertors.
Client`s aim:
To strengthen the muscles on the inside and outside of your ankle.
Physiotherapist`s instructions:
Position the patient in sitting.
Instruct the patient to invert and evert their ankle.
Client`s instructions:
Position yourself sitting with your feet on the floor.
Start with the soles of your feet facing in.
Finish with the soles of your feet facing out.
Ensure that your knees are kept still.
Progressions and variations:
Progress using strength training principles.


ANKLE PLANTARFLEXOR STRENGTHENING IN SITTING USING SANDBAG WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in sitting with a weight attached to the top of their knee.
Instruct the patient to lift their heel off the floor by plantarflexing their ankle.
Client`s instructions:
Position yourself sitting with a weight attached to the top of your knee.
Start with your feet flat on the floor.
Finish with your heel off the floor.
Ensure that you keep your toes on the floor.
Progressions and variations:
Progress using strength training principles.


ANKLE PLANTORFLEXOR STRENGTHENING IN SITTING USING THERABAND:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions
Position the patient in sitting with their foot on a wedge and some theraband attached under the wedge and over the top of their knee.
Instruct the patient to lift their heel off the wedge by plantarflexing the ankle.
Client`s instructions:
Position yourself sitting with your foot on a wedge and some theraband attached under the wedge and over the top of your knee.
Start with your foot flat on the wedge.
Finish with your heel off the wedge.
Ensure that you keep your toes on the wedge.
Progressions and variations:
Less advanced: 1. Downgrade the colour of the theraband.
More advanced: 1. Upgrade the colour of the theraband.


ANKLE PLANTORFLEXOR STRENGTHENING IN SITTING WITHOUT WEIGHTS:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in sitting with their knees together.
Instruct the patient to lift their heels off the floor by plantarflexing the ankles.
Client`s instructions:
Position yourself sitting with your knees together.
Start with your feet flat on the floor.
Finish with your heels lifted off the floor.
Ensure that you keep your toes on the floor.
Progressions and variations:
Less advanced: 1. Place a bandage around the knees to hold them together.
More advanced: 1. Place a weight over the knees.


ANKLE PLANTORFLEXOR STRENGTENING IN STANDING USING A WEDGE:
Physiotherapist`s aim:
To strengthen the ankle plantarflexors.
Client`s aim:
To strengthen your calf muscles.
Physiotherapist`s instructions:
Position the patient in standing against a wall with their foot on a wedge and their other foot resting on a stool in front of them.
Instruct the patient to lift their heel off the wedge by plantarflexing their ankle.
Ensure that most of the weight is borne through the leg on the wedge, the knee is kept straight and the back remains against the wall.
Client`s instructions:
Position yourself standing against a wall with your foot on a wedge and your other foot resting on a stool in front of you.
Start with your foot flat on the wedge.
Finish with your heel lifted off the wedge and standing on your toes.
Ensure that most of your weight is borne through the leg on the wedge, your knee is kept straight and your back remains against the wall.
Progressions and variations:
Less advanced: 1. Move the stool closer. 2. Provide hand support for balance.
More advanced: 1. Move the stool further away.


ANKLE PLANTARFLEXOR STRETCH BY WALKING UP A STEEP SLOPE:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankles.
Physiotherapist`s instructions:
Position the patient in standing on a steep slope such as a slippery slide.
Instruct the patient to walk slowly up the slope.
Ensure that the back heel remains down and the back leg is kept as straight as possible.
Client`s instructions:
Position yourself standing on a steep slope such as a slippery slide.
Practice walking slowly up the slope.
Ensure that your back heel remains down and your back leg is kept as straight as possible.
Progressions and variations:
Less advanced: 1. Decrease the incline of the slope. 2. Provide hand support for balance.
More advanced: 1. Increase the incline of the slope.
Precautions:
1. Impaired or absent sensation of stretch.


ANKLE PLANTORFLEXOR STRETCH IN STANDING:
Physiotherapist`s aim:
To stretch or maintain length of the ankle plantarflexors.
Client`s aim:
To stretch or maintain range in your ankle.
Physiotherapist`s instructions:
Position the patient in standing with one leg in front of the other and their hands resting on a wall.
Instruct the patient to lean forwards while keeping the back leg straight.
Ensure that both feet point forwards and the back heel remains on the ground.
Client`s instructions:
Position yourself standing with one leg in front of the other and your hands resting on a wall. Lean forwards while keeping your back leg straight.
Ensure that both feet point forwards and your back heel remains on the ground.
Progressions and variations:
Less advanced: 1. Decrease forwards lean.
More advanced: 1. Increase forwards lean.
Precautions:
1. Impaired or absent sensation of stretch.


ANTERIOR DELTOID ELECTRICAL STIMULATION:
Physiotherapist`s aim:
To strengthen the shoulder flexors.
Client`s aim:
To strengthen the muscles at the front of your shoulder.
Physiotherapist`s instructions:
Place the electrodes over the muscle belly of the anterior deltoid.
Client`s instructions:
Place the two electrodes over the muscle belly as shown.
Precautions:
Perform skin tests.