Thanks for your note Tom.  Below is another chapter from the Move It project
(www.parkinsonsmoveit.com) that is relevant to most folks.  It is the text
version (without photos/illustrations).

Much aloha,

Kevin


CHAPTER EIGHT



LEVEL TWO: Moderate symptomatic (Impaired balance  requires assistive
device.)



This group of exercises is good for those of you with minimal to moderate
impaired balance.  These exercises may also require more complex movements
involving multiple limbs that require greater coordination than more simple
exercises.  If you have a history of falling and/or use an assistive device
that requires just one hand such as a cane, you may find these exercises
appropriate. You may also modify the more advanced leg and balance exercises
by using some support of your arms. If your balance is impaired to the level
that does not allow for you to safely perform exercises in stance, please
proceed to the sitting and mat exercises (Level one).



.    The recommendation is to start out with 1 set of 10 repetitions for
each exercise and build up to performing 2-3 sets of 10 as you can tolerate
it.  I suggest that you also break up the exercises into different days so
that you are not performing such a large volume of exercises at one time.  One
suggestion is to perform the sitting exercise on opposite days of the mat
exercises.  A good schedule would be to perform the sitting group on Monday,
Wednesday, Friday and the mat exercise group on Tuesday and Thursdays.  The
following week, you can then reverse the days.  I also recommend that you
limit your time to spending 20-30 minutes maximum per exercise session.  It
is much better to get into the habit of exercising daily for 15-20 minutes
than not exercise daily and try to do too much to make up for missing days.
If you do not get through all of the exercises in the list, just pick up
where you started on the next day when you perform that group (sitting or
mat) exercise.



SUGGESTED EXERCISE LIST:



a.       Modified Standing Exercise routine.

1.) Static wall standing with chair

2.) Wall standing arm raise

3.)Wall standing arm diagonals

4.)Wall squats with chair



b.      Mat exercise routine

1.      Bridges

2.      Lower Trunk Rotation

3.      Supermans

4.      Airplanes



STANDING WALL EXERCISES

* *The standing exercises in this category will require the ability for
general balance with or without the need for upper extremity support.   If
your balance is impaired to the level that does not allow you to safely
perform the standing exercises, please proceed to sitting and mat exercises.


* *

Static Wall Standing

*INSERT Chapter 8 Image 1*

EXERCISE POSITION:  Stand with heels, buttocks, shoulders and head against
wall and hold posture for 30 seconds.



PURPOSE:  The emphasis is on promoting an erect posture.  The contact with
the wall gives the postural muscles feedback and a guide.  The tendency is
for the PD symptoms to want to pull you forward.  Many of you may feel like
someone is behind you pushing you forward as your muscles may not be used to
holding you up straight.  If you can retrain your muscles to maintain a more
erect posture, your skeletal system will be more mechanically stacked
actually requiring less energy to maintain an upright position.

* *

EXERCISE MODIFICATION FOR DECREASED BALANCE:*  You c*an also perform the
above exercise with a walker or tall back chair turned around and in front
of you.  Try to minimize the weight-bearing through your arms, but you have
the comfort of the support for safety.

*INSERT Chapter 8 Image 1B static wall standing with chair*

Wall standing arm raise

*INSERT Chapter 8 Image 2A and 2B and 2Cwall standing arm raise*

START POSITION:  Stand with heels, buttocks, shoulders and head against
wall.  Bring up your arms to where your elbow is same level as your shoulder
with your elbow bent to 90 degrees.  Maintain as much contact of your arms
with the wall as possible.


ACTION/FINISH POSITION: Pinch your shoulder blades together and maintain
full contact with the wall as you slowly raise your arms overhead until your
elbows are completely straight.  Hold this position for 10 seconds and
slowly return back to start position.



PURPOSE:  To stimulate and work the postural muscles as you move your arms.
This exercise also promotes stability of your scapular muscles which will
assist in maintaining functional strength and range of motion in your arms
for activities of daily living.

Wall standing alt leg lift

*INSERT Chapter 8 Image 3A and 3B*

START POSITION:  Stand with heels, buttocks, shoulders and head against
wall.



ACTION/FINISH POSITION: While maintaining contact with the wall,
purposely shift
your weight to the right leg and lift the opposite leg (left). Return to
starting position and perform to opposite side and repeat by alternatly
lifting your legs.



PURPOSE:  To stimulate and work the postural muscles as you shift weight to
off load your opposite leg.  This exercise promotes good posture while you
move dynamically and trains you in “anti-freezing techniques” by
consciously, purposely engaging in controlled movement.



EXERCISE MODIFICATION FOR DECREASED BALANCE:*  You c*an also perform the
above exercise with a walker or tall back chair turned around and to the
side of you.  Try to minimize the weight-bearing through your arms, but you
have the comfort of the support for safety.

* *

Wall Standing Diagonals

*INSERT Chapter 8 Image 4A and 4B*

Intermediate

START POSITION:  Stand with heels, buttocks, shoulders and head against wall
with hands over opposite hip.



ACTION/FINISH POSITION: Maintaining contact with the wall during the
exercise. Pinch your shoulder blades together while  lifting your arms
simultaneously in a diagonal position until your arms are overhead with
elbows extended.



PURPOSE:  To stimulate and work the postural muscles as you move your arms.
This exercise also promotes stability of your scapular muscles which will
assist in maintaining functional strength and range of motion in your arms
for activities of daily living.



Wall standing squats

*INSERT Chapter 8 Image 5A and 5B*

START POSITION:  Stand with heels approximately 18 inches away from the wall
with your buttocks, shoulders and head against wall.



ACTION/FINISH POSITION: Maintain your buttock, shoulders, and head in
contact with the wall while you slide down the wall.  The bottom of the
squat position will be dictated by your strength, but you should not squat
deeper than 90 degrees at the hip which is when your hip and knees are at
the same level.  The deeper the squat, the greater strength is required.  One
modification is to place your feet further away from the wall which
decreases weight-bearing there to make the exercise easier.



PURPOSE:  To stimulate and work the postural muscles, in particular hip
extensors (gluteals)  and knee extensors (quadriceps).

MAT EXERCISES

*  *The mat exercises do not require very much balance and are appropriate
for everyone as long as you can achieve the required positions.  The
positions that may be the most difficult to achieve are the exercises
requiring for you to lie  on your stomach. The focus of mat exercises are
the same as the wall exercises, which is to encourage purposeful movement
and to strengthen the postural muscles to better combat the forward
posturing and other related PD symptoms.

Supine (Lying on Back)

Bridges

*INSERT Chapter 8 Image 6A and 6B*

START POSITION:  Lie down on your back with your elbows in contact with the
bed or mat and arms resting on stomach or with arms crossed on chest.  These
alternate arm positions lessen the contact of the upper extremities making
the exercise more challenging. Bend both of your knees to where your feet
are flat on the mat or bed.



ACTION/FINISH POSITION: Hold your stomach tight as you squeeze your buttocks
muscles and lift your buttocks as high off the mat or bed as possible.  Hold
the bridge position for 5 seconds and return to starting position.



PURPOSE:  This exercise focuses on the postural muscles for hip and back
extension.  Your hip and back extensors will aid you in maintaining the
strength and motion for a more upright posture.

* *

Lower trunk rotation (Wind shield washers):**

*INSERT Chapter 8 Image 7A and 7B*

Beginning

START POSITION:  Lie down on your back with your arms extended by your side.
Bend both of your knees to where your feet are flat on the mat or bed.



ACTION/FINISH POSITION: Maintain your shoulders in contact with the bed
during the entire exercise.  While keeping your knees and feet together,
roll your knees as far to the right as possible (You will feel a stretch on
the opposite side). Hold for 3 seconds and then roll your knees as far as
possible to the left side. Return to starting position and then repeat for
the desired amount of repetitions.



PURPOSE:  This exercise focuses on trunk rotation.  Flexibility in your
trunk or pelvic rotation is essential for maintaining an efficient gait or
walking pattern as well as general mobility such as getting in and out of a
car or out of bed.

* *

Superman

*INSERT Chapter 8 Image 8A and 8B*

START POSITION:  Lie flat on your stomach with your arms hanging down over
the edge of your mat or bed.

ACTION/FINISH POSITION: Lift your arms straight up in front of you as high
as you can as if you are flying like superman. Hold this position for 5
seconds and repeat to complete the desired  amount of repetitions.  Keep
your head and neck neutral with your eyes gaze straight down.  Do not look
or gaze forward which will hyper-extend your neck.



PURPOSE:  To stimulate the postural muscles in your upper back (posterior
shoulder and scapular muscles.  Strength in these muscles will greatly aid
your posture and assist you in preventing the rounded shoulders and tendency
for “forward posturing”.  This also aids in maintaining the flexibility
needed in your shoulders for activities of daily living such as upper
extremity dressing, bathing and grooming.

* *

Airplane

*INSERT Chapter 8 Image 9A & 9B*

START POSITION:  Lie flat on your stomach with your arms hanging down over
the edge of your mat or bed.

ACTION/FINISH POSITION: Lift your arms out to side with your wrist, elbow
and shoulders in the same plane as high as you can as if you are flying like
an airplane. Hold this position for 5 seconds and repeat to complete the
desired amount of repetitions.  Keep your head and neck neutral with your
eyes gaze straight down.  Do not look or gaze forward which will
hyper-extend your neck.



PURPOSE:  To stimulate the postural muscles in your upper back (posterior
shoulder and scapular muscles.  Strength in these muscles will greatly aid
your posture and assist you in preventing the rounded shoulders and tendency
for “forward posturing”.  This also aids in maintaining the flexibility
needed in your shoulders for activities of daily living such as upper
extremity dressing, bathing and grooming.


On Sun, Jul 19, 2009 at 1:56 AM, Tom Clift <[log in to unmask]> wrote:

> Kevin,
>
> This post is most timely for me.  I would appreciate any other information
> you would be willing to share.
>
>
>

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