EXERCISES.

ASCENDING A STEP USING A DOORWAY:
Physiotherapist`s aim:
To improve the ability to ascend a step in a wheelchair.
Client`s aim:
To improve your ability to ascend a step in your wheelchair.
Physiotherapist`s instructions:
Position the patient in their wheelchair below a step.
Instruct the patient to use the doorway to pull themselves up over the step.
Client`s instructions:
Position yourself in your wheelchair below a step.
Practice using the doorway to pull yourself up over the step.
Progressions and variations:
Less advanced: 1. Decrease the height of the step.
More advanced: 1. Increase the height of the step.
Precautions:
1. Caution required to prevent forward fall from wheelchair.


ATTAINING A WHEELSTAND:
Physiotherapist`s aim:
To improve the ability to attain a wheelstand.
Client`s aim:
To improve your ability to attain a wheelstand.
Physiotherapist`s instructions:
Position the patient in their wheelchair.
Instruct the patient to flip the wheelchair into a wheelstand.
Client`s instructions:
Position yourself in your wheelchair.
Practice flipping your wheelchair into a wheelstand.
Progressions and variations:
Less advanced: 1. Perform the task on a flat surface.
More advanced: 1. Manoeuvre the wheelchair in different directions while maintaining a wheelstand.
2. Perform the task on a slope.
3. Add a weighted bag to the front or back of the wheelchair.
Precautions:
1. Ensure that wheelchair does not flip backwards.


BALANCING ON A BALL:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a large ball that is wedged between two plinths.
Instruct the patient to lift their hands up in the air without falling.
Client`s instructions:
Position yourself sitting on a large ball that is wedged between two plinths.
Practice lifting your hands up in the air without falling.
Progressions and variations:
Less advanced: 1. Sit on a plinth.
More advanced: 1. Change the size of the ball. 2. Add a concurrent task while sitting on the ball.


BALANCING ON A BALL WHILE LIFTING ONE LEG UP AND DOWN:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a large ball with their feet on the floor.
Instruct the patient to lift then lower one leg.
Client`s instructions:
Position yourself sitting on a large ball with your feet on the floor.
Practice lifting one leg up and down.
Progressions and variations:
Less advanced: 1. Provide hand support for balance. 2. Decrease the height that the leg is lifted. More advanced: 1. Increase the height that the leg is lifted. 2. Increase the movement of the raised leg (eg. add knee extension or hip abduction).


BALANCING WHILE SITTING ON A MOVING OBJECT:
Physiotherapist`s aim:
To improve the ability to sit unsupported.
Client`s aim:
To improve your ability to sit unsupported.
Physiotherapist`s instructions:
Position the patient in sitting on a moveable object while holding onto a rope.
Instruct the patient to sit upright while getting towed across the floor.
Client`s instructions:
Position yourself sitting on a moveable object while holding onto a rope.
Practice sitting upright while getting towed across the floor.
Progressions and variations:
Less advanced: 1. Tow the patient in one direction only. 2. Tow at a slow speed.
More advanced: 1. Tow the patient in many directions. 2. Tow at a faster speed.


BEAR WALKING:
Physiotherapist`s aim:
To strengthen the shoulder and hip muscles.
Client`s aim:
To strengthen your shoulder and hip muscles.
Physiotherapist`s instructions:
Position the patient on their hands and feet with their bottom in the air.
Instruct the patient to `bear-walk` forwards along the floor.
Client`s instructions:
Position yourself on your hands and feet with your bottom in the air.
Practice `bear-walking` forwards along the floor.
Progressions and variations:
More advanced: 1. Practice `bear-walking` in different directions. 2. Increase speed of task.


BENCH PRESS:
Physiotherapist`s aim:
To strengthen the shoulder horizontal adductors and elbow extensors.
Client`s aim:
To strengthen the muscles at the front of your shoulder and chest.
Physiotherapist`s instructions:
Position the patient in supine with their shoulders abducted and elbows flexed.
Instruct the patient to lift the weights above their chest until their elbows are straight.
Client`s instructions:
Position yourself lying on your back with your shoulders out to the side and elbows bent.
Lift the weights above your chest until your elbows are straight.
Progressions and variations:
Progress using strength training principles.


BENDING AND STRAIGHTENING THE WRIST TO TARGETS:
Physiotherapist`s aim:
To improve the ability to flex and extend the wrist.
Client`s aim:
To improve your ability to bend and straighten your wrist.
Physiotherapist`s instructions:
Position the patient in sitting with a cylindrical object on a table in front of them and a sandbag on their forearm.
Draw two target lines on the table to serve as targets for wrist movement.
Instruct the patient to flex and then extend their wrist to the target lines while grasping the object.
Ensure that the forearm does not move.
Client`s instructions:
Position yourself sitting with a cylindrical object on a table in front of you and a sandbag on your forearm. :
Practice bending your wrist backwards and forwards to the target lines while grasping the object.
Ensure that your forearm does not move.
Progressions and variations:
Less advanced: 1. Decrease the distance from the wrist to the target lines. 2. Hold an object with a smaller diameter.
More advanced: 1. Increase the distance from the wrist to the target lines. 2. Hold an object with a larger diameter. 3. Hold an object that can deform. 4. Remove the sandbag holding the forearm in place.


BENDING THE KNEE IN SITTING:
Physiotherapist`s aim:
To improve the ability to flex the knee in preparation for standing.
Client`s aim:
To improve your ability to bend your knee in preparation for standing.
Physiotherapist`s instructions:
Position the patient in sitting with their toes on a line in front of their knee.
Instruct the patient to flex their knee so that their heel touches a line behind their knee.
Client`s instructions:
Position yourself sitting with your toes on a line in front of your knee.
Practice sliding your foot back so that your heel touches a line behind your knee.
Progressions and variations:
Less advanced. 1. Place the lines closer to the heel and toes. 2. Reduce the amount of friction under the foot by using a friction-reducing device (eg. a roller-skate or slidesheet).
More advanced. 1. Place the lines further away from the heel and toes.


BENDING THE KNEE IN SITTING USING A ROLLER SKATE:
Physiotherapist`s aim:
To improve the ability to flex the knee in preparation for standing.
Client`s aim:
To improve your ability to bend your knee in preparation for standing.
Physiotherapist`s instructions:
Position the patient in sitting with one foot strapped into a roller-skate and their other foot on a block.
Instruct the patient to flex and extend their knee so that the roller-skate rolls between the lines on the floor.
Client`s instructions:
Position yourself sitting with one foot strapped into a roller-skate and your other foot on a block. Practice bending and straightening your knee so that the roller-skate rolls between the lines on the floor.
Progressions and variations:
Less advanced. 1. Place the lines closer to the heel and toes.
More advanced. 1. Place the lines further away from the heel and toes.