 |
 |
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. > > > ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn