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PNF TECHNIQUES
• PNF IS A TYPE OF MOVEMENT THERAPY AND DERIVES ITS THEORITICAL BASIS FROM SHERRINGTONS STATEMENT
• INPUTS FROM PERIPHERAL NERVES AND RECEPTORS AFFECTS EXCITABILITY OF ALPHA MOTOR NEURONS & AMN ARE UNDER DIRECT INFLUENCE OF CEREBRAL CORTEX
• THEORTICALLY IT IS POSSIBLE TO MODIFY THE EXCITABILITY OF AMN THROUGH PERIPHERAL INPUTS IN A WAY THAT THE INFLUENCE OF CENTRAL MECHANISMS ARE REDUCED OR INCREASED
• PNF TECHNIQUE ORIGINATED BY HERMAN KABAT & CONTINUED BY MARGARET KNOTT & VOSS
• NEUROPHYSIOLOGICAL PRINCIPLES– ALL HUMAN BEINGS HAVE POTENTIALS
THAT IS NOT FULLY DEVELOPED– MOTOR DEVELOPMENT TAKES PLACE IN
CERVICAL CAUDAL DIRECTION OR PROXIMODISTAL DIRECTION
– EARLY MOTOR BEHAVIOUR IS DOMINATED BY REFLEX ACTIVITY & THE MOVEMENTS OSCILLATE BETWEEN FLEXION AND EXTENSION
• DEVELOPMENT OF MOTOR SEQUENCE OCCURS IN AN ORDERLY SEQUENCE– PROXIMAL STABILITY – SKILLED
MOVEMENTS OF DISTAL
• IMPROVEMENT IN MOTOR ABILITY IS DEPENDENT ON MOTOR LEARNING– VISUAL/AUDITORY/VERBAL & TACTILE
• FREQUENCY OF STIMULATION & REPETITIVE ACTIVITY ARE USED TO PROMOTE MOTOR LEARNNG & DEVELOPMENT OF STRENGTH AND ENDURANCE
• PRINCIPLES OF TECHNICAL APPLICATION
• APPROPRIATE POSTIONING• FREE MOVEMENTS
• MANUAL CONTACT• FACILITATE & GUIDE MOVEMENT• LUMBRICAL GRIP• EXTEROCEPTION/STRETCH/RESISTANCE/
TRACTION & APPROXIMATION
• STRETCH• FACILITATE & INCREASE THE POWER OF
WEAK MUSCLE
• PATTERNS (FOUR BASIC PATTERNS)• D1 FLEXION – FLEXION ADDUCTION• D2 FLEXION – FLEXION ABDUCTION• D1 EXTENSION – EXTENSION ABDUCTION• D2 EXTENSION – EXTENSION ADDUCTION
– COMBINATION OF UPPER LIMB• FLEXION OF SHOULDER WITH EXTERNAL
ROTATION• EXTENSION OF SHOULDER WITH INTERNAL
ROTATION• ABDUCTION WITH WRIST EXTENSION• ADDUCTION WITH WRIST FLEXION
• COMBINATION OF LOWER LIMB– FLEXION OF HIP WITH DORSIFLEXION– EXTENSION WITH PLANTAR FLEXION– ABDUCTION WITH INTERNAL ROTATION– ADDUCTION WITH EXTERNAL ROTATION
• TIMINGS
• OVERFLOW OR IRRADIATION
• MAXIMAL RESISTANCE
• AUDITORY CUES
• VISUAL CUES
STRENGTHENING TECHNIQUESI. REPEATED CONTRACTION
• NORMAL TIMINGS – GENERALISED WEAKNESS – STROKE– REPETITION OF PATTERN WITH FULL RANGE AGAINST
MAXIMUM RESISTANCE
• TIMING FOR EMPHASIS– PATCHY WEAKNESS– SPECIFIC COMPONENT IN A PATTERN IS WEAK– LMN CONDITIONS– PIVOT, HANDLE & STABILISING PART
• COMBINATION OF ISOMETRIC & ISOTONIC– MUSCLES ARE WEAK DUE TO RELATIVE LENGTHENING– EXTENSOR LAG – DUE TO RELATIVE LENGTHENING OF
QUADS DUE TO IMMOBILISATION OF KNEE IN FLEXION
• ISOTONIC CONTRACTION OF LENGTHENED MUSCLE (AGONIST)
↓• UP TO WEAK POINT OF MUSCLE
↓• ISOMETRIC CONTRACTION
↓• ISOTONIC CONTRACTON
↓• FACILITATES MUSCLE IN SHORTENED RANGE
& LENTHENS ANTAGONIST MUSCLE BY RECIPROCAL INHIBTION
II. SLOW REVERSAL• SHERRINTON PRINCIPLE OF SUCCESIVE
INDUCTION• STRONG ANTAGONIST IS USED TO
FACILITATE WEAK AGONIST PATTERNS• GROUP OF MUSCLE ARE WEAK
↓• ITS ANTAGONIST ARE MADE FOR MAXIMAL
CONTRACTION
↓• REVERSAL OF GRIP FOR WEAK AGONIST
CONTRACTION
• LENGTHENING TECHNIQUES– RELAXATION TECHNIQUES
• TIGHTNESS/HYPERTONICITY
PRINCIPLESI. WORKING ON HYPERTONIC MUSCLE
– PRINCIPLE OF MAXIMUM CONTRACTION FOLLOWED BY MAXIMUM RELAXATION
II. WORKING ON THE MUSCLE ANTAGONIST TO
HYPERTONIC MUSCLE– PRINCIPLE OF RECIPROCAL INHIBITION
• 1) CONTRACT RELAX (I ST PRINCIPLE)– PRINCIPLE IS THE CONTRACTION OF ANTAGONIST
MUSCLE IS BY ISOTONIC
• 2) HOLD RELAX (I ST PRINCIPLE)– CONTRACTION OF ANTAGONIST IS BY ISOMETRIC– PAINFUL CONDITIONS
• 3. RHYTHMIC INITIATION– RIGIDITY (PARKINSONISM)
– SPASTICITY (TRUNK)
• 4. SLOW REVERSAL – HOLD RELAX TECHNIQUE (II ND PRINCIPLE)– PRINCIPLE OF RECIPROCAL INHIBITION
– ANTAGONISTIC ISOMETRIC CONTRACTION → AGONIST ISOTONIC CONTRACTION
• MISCELLANEOUS TECHNIQUES– RHYTHMIC STABILIZATION
• RELAXATION AND STRENGTHENING
• CEREBELLAR LESIONS
BRUNNSTROM APPROACH
• MOVEMENT THERAPY DEVELOPED BY BRUNNSTROM (PHYSICAL THERAPIST)
• PRINCIPLES– ASSUMPTIONS
• IN NORMAL MOTOR DEVELOPMENT– BRAIN STEM & SPINAL CORD REFLEXES– INFLUENCED BY HIGHER CENTRES– PURPOSEFUL MOVEMENT
– STROKE – DEVELOPMENT IN REVERESE – USE OF PRIMITIVE REFLEXES– FACILITATES RECOVERY OF VOLUNTARY
MOVEMENT POSTSTROKE
– PROPRIOCEPTIVE/EXTEROCEPTIVE STIMULI ARE USED TO EVOKE DESIRED TONAL CHANGES
– RECOVERY OF VOULUNTARY MOVEMENT• MASS STEROTYPED FLEXOR/EXTENSOR
MOVEMENT PATTERNS
↓• MOVEMENTS WITH COMBINED PATTERNS
↓• DISCRETE MOVEMENT OF INDIVIDUAL JOINTS
↓• PRACTICE IN FUNCTIONAL
↓ • ENHANCES LEARNING PROCESS
• PRINCIPLES OF MOVEMENT THERAPY• TREATMENT PROGRESS FROM REFLEX TO
VOLUNTARY TO FUNCTIONAL• FLACCID → MOVEMENTS ARE FACILITATED
BY REFLEXES
↓• ASSOCIATED REACTIONS & USE OF
PROPRIOCEPTIVE & EXTEROCEPTIVE FACILITATION
↓• DEVELOPS MUSCLE TENSION IN
PREPARATION OF VOLUNTARY MOVEMENT• PROPRIOCEPTIVE – RESISTANCE• EXTEROCEPTIVE – TACTILE STIMULATION
• AS VOLUNTARY MOVEMENT IS GAINED – PATIENT IS ASKED FOR ISOMETIC CONTRACTION
↓
• ECCENTRIC CONTRACTION
↓
• CONCENTRIC CONTRACTION
• AS VOULUNTARY CONTROL IS GAINED FACILITATION IS REDUCED/STOPPED
• PRIMITIVE REFLEXES ARE DROPPED FIRST• EXTEROCEPTIVE ARE DROPPED AS LAST• NO PRIMITIVE REFLEXES ARE USED BEYOND
STAGE – 3
• EVALUATION• NO FACILITATION IS USED DURING
EVALUATION• EACH MOVEMENTS ARE PERFORMED IN
NORMAL LIMB & THEN IN AFFECTED LIMB• INSTRUCTIONS SHOULD BE GIVEN IN
FUNCTIONAL TERMS
– FLEXOR SYNERGY• TOUCH BEHIND EAR
– EXTENSOR SYNERGY• REACH OUT TO TOUCH YOUR OPPOSITE KNEE
– PATIENT ABILITY IS RECORDED ACCORDING TO PERCENTAGE OF ROM THAT HE HAS COMPLETED
– PATIENT IS REPORTED TO BE IN THE STAGE AT WHICH HE IS ABLE TO ACCOMPLISH ALL MOTIONS SPECIFIED FOR THAT STAGE
– IF MOVEMENT IS IN TRANSITION BETWEEN STAGES RECORDED AS “2 GOING ON 3”
• BRUNNSTROM RECOVERY STAGES OF UPPER EXTREMITY (6 STAGES)– STAGE – 1
• FLACCIDITY – NO VOLUNTARY MOVEMENT
– STAGE – II• SYNERGIES DEVELOPING FLEXION
DEVELOPS BEFORE EXTENSION (SPASTICITY DEVELOPING)
– STAGE – III• BEGINNING VOLUNTARY MOVEMENT IN
SYNERGY, INCREASED SPASTICITY WHICH IS MORE MARKED
• STAGE – IV• SOME MOVEMENTS DEVIATING FROM SYNERGY
– 1. HAND BEHIND BODY– 2. ARM TO FORWARD HORIZONTAL POSITION– 3. PRONATION – SUPINATION WITH ELBOW FLEXED TO
90 DEGREES, SPASTICITY DECREASING
• STAGE – V• INDEPENDENCE FROM BASIC SYNERGIES
– 1. ARM TO SIDE HORIZONTAL POSITION– 2. ARM FORWARD AND OVERHEAD– 3. PRONATION – SUPINATION WITH ELBOW FULLY
EXTENDED, SPASTICITY WANING
• STAGE – VI• ISOLATED JOINT MOVEMENTS FREELY
PERFORMED WITH NEAR NORMAL COORDINATION, SPASTICITY MINIMAL
HEMIPLEGIA – CLASSIFICATION AND PROGRESS RECORD
DATE STAGE
1
2
3 – SYNERGIES INITIATED VOLUNTARILY, SPASTICITY MARKED
PERCENTAGE ACTIVE JOINT RANE
FLEXOR SYNERGY
SCAPULAR ELEVATION
SCAPULAR RETRACTION
SHOULDER ABDUCTION
SHOULDER EXTERNAL ROTATION
ELBOW FLEXION
FOREARM SUPINATION
EXTENOR SYNERGY
4 – MOVEMENTS DEVIATING FROM SYNERGIES
PERCENTAGE ACTIVE JOINT RANE
A. HAND BEHIND BACK
• TONIC REFLEXES• STNR & ATNR• TONIC LABYRINTHINE REFLEX• TONIC LUMBAR REFLEX
• ASSOCIATED RECATIONS– FLEXOR SYNERGY
• RESISTANCE TO SHOULDER ELEVATION/ELBOW FLEXION
– EXTENSOR SYNERGY• RESISTANCE TO HORIZONTAL ADDUCTION
• RAIMISTES PHENOMENON
• FLEXOR SYNERGY– STRONG COMPONENT – ELBOW FLEXION
& FIRST TO BE FACILITATED– WEAK – SHOULDER ABDUCTION &
EXTERNAL ROTATION
• EXTENSOR SYNERGY– STRONG – PECTORALIS MAJOR– SHOULDER ADDUCTION & INTERNAL
ROTATION IS THE FIRST TO BE FACILITATED
– SECOND STRONG – PRONATION– WEAK – ELBOW EXTENSION
– TYPICAL POSTURE OF HEMIPLEGIA – STRONG COMPONENTOF FLEXION & EXTENSOR SYNERGIES
• FLEXOR SYNERGY OF LL – STRONG – HIP FLEXION – WEAK – HIP ABDUCTION & EXT ROTATION
• EXTENSOR SYNERGY OF LL– STRONG – HIP ADDUCTION, KNEE
EXTENSION, PLANTAR FLEXION & INVERSION
– WEAK – HIP EXTENSION, INTERNAL ROTATION & PLANTAR FLEXION
• TREATMENT– STAGES 1 TO 3
– FLEXOR SYNERGY IS FIRST TO DEVELOP– ELBOW FLEXION IS THE FIRST MOTION TO BE
ELICTED– RESISTANCE TO LATERAL FLEXION OF NECK
TOWARD AFFECTED SIDE → SCAPULAR ELEVATION
– PERCUSSION/STROKING OVER TRAPEZIUS– ISOMETRIC – DON’T LET ME PUSH YOUR
SHOULDER DOWN– ECCENTRIC LET THE SHOULDER MOVE DOWN
SLOWLY– CONCENTRIC – NOW PULL YOUR SHOULDER UP
TOWARD YOUR EAR– ACTIVE SHOULDER EVOKES OTHER FLEXOR
COMPONENTS & INHIBIT PEC MAJOR
– SHOULDER ELEVATION EVOKES SHOULDER ABDUCTION
– EXTERNAL ROTATION & FOREARM SUPINATION
• EXTENSOR SYNERGY– ASSOCIATED REACTION TO HORIZONTAL
ADDUCTION COMMAND – DON’T ALLOW ME TO PULL YOUR ARM APART
– DUE TO WEAK EXTENSORS & STRONG FLEXORS FOLLOWING METHODS ARE ADOPTED
– ROWING– RESISTANCE TO NORMAL FOREARM &
ASSISTANCE TO AFFECTED FOREARM
• AFTER INITIATION BILATERAL RESISTANCE TO ELBOW EXTENSION
• HOLD AFTER POSTIONING• BILATERAL WEIGHT BEARING WITH ELBOW
EXTENSION STROKING ON TRICEPS• WEIGHT SHIFTING
– AS SYNERGIES COMES UNDER VOLUNTARY CONTROL – FUNCTIONAL ACTIVITIES
• EXTENSOR SYNERGIES– PUSH ARM IN TO SLEEVES– SMOOTH OUT SHEET ON BED
• FLEXOR SYNERGIES– PUTTING ON GLASSES
• BOTH SYNERGIES– IRONING, POLISHING
• STAGES 4 TO 6• PROMOTE VOLUNTARY MOVEMENTS THAT
COMBINES COMPONENTS OF BOTH SYNERGIES LEADING TO DEVAITE FROM SYNERGY PATTERNS
• DISSOCIATION OF TRICEPS & PECTORALIS MAJOR
• DROP OUT ASSOCIATED REACTIONS• PROPRIOCETIVE & EXTEROCPTIVE CAN BE STILL
USED FOR TRAINING
– FIRST OUT OF SYNERGY– 1. HAND BEHIND BODY – SHOULDER
ABDUCTION, ELBOW EXTENSION & FOREARM PRONATION
• STROKING THE DORSUM OF HAND TO SACRUM
• ASSISTED BY THERAPIST• BECOMES VOLUNATRY WITH PRACTICE• PRACTICE WITH FUNCTIONAL TASK
– TUCKING SHIRTS– PUTTING BELT
– 2. SHOULDER FLEXION – HORIZONTAL POSITION WITH ELBOW EXTENSION
• FACILITATION OVER ANTR DELTOID & TRICEPS & ASSISTED PASSIVELY TO POSITION → ACTIVE MOVEMENT
• FUNCTIONAL TASK – PAINTING
– 3. PRONATION & SUPINATION WITH ELBOW FLEXED WITH 90 DEGREES
• RESISTANCE TO PRONATION IN ELBOW EXTENSION → ELBOW FLEXION → FT – TURNING OBJECTS
• STAGE 4 TO 5– ACTIVE MOTIONS OF PATIENT TO MOVE
IN PATTERNS AWAY FROM SYNERGY– EXCESS EFFORT SHOULD BE AVOIDED
• I - ARM RAISED TO SIDE HORIZONTAL - SH ABD WITH ELBOW EXTENSION
– PRACTICE WITH FUNCTIONAL TASK
• II – ARM OVERHEAD– PASSIVE SCAPULAR MOBILIZATION– ACTIVE SCAPULAR PROTRACTION– FUNCTIONAL TASK – PAINTING
• III – SUPINATION & PRONATION IN ELBOW EXTENSION
– SWISS BALL ROTATION IN ELBOW EXTENSION
STROKE REHABILITATION
POSTIONING STRATEGIES
• TO MAXIMIZE PATIENT AWARENESS ON HP SIDE
• OUT OF UNDESIRABLE POSTURES
• AVOID PROLONGED STATIC POSTIONING
• EARLY UPRIGHT POSTIONING– PELVIC TRUNK ALIGNMENT– SCAPULAR ALIGNMENT– GLENOHUMERAL ALIGNMENT
– UE MALALIGNMENT– LE MALALIGNMENT
• LYING IN SUPINE POSTIONING– SCAPULA PROTRACTION– UE – EXT ROTATION & ABDUCTION– LE – PELVIS PROTRACTION, NEUTRAL
ROTATION
• LYING ON THE UNAFFECTED SIDE– PILLOW UNDER TRUNK TO MAINTAIN
ELONGATION OF HP SIDE– SH PROTRACTION, THUMB ABDUCTION &
HIP PROTRACTION
• LYING ON THE AFFECTED SIDE• SITTING ON WHEELCHAIR/BED
– SYMMETICAL WT BEARING ON BUTTOCKS
• RANGE OF MOTION/PREVENTION OF LIMB TRAUMA– ROM EXERCISES– SPLINTING – PROLONGED STRETCHING– SCAPULAR MOBILIZATION– SELF ROM TECHNIQUES– SH ROM TO 90 DEGRESS– TABLE TOP POLISHING
– SITTING, CLASPED HANDS – REACHING FLOOR
– HUMERAL CUFF SLING – SH SUBLUXATION– PLANTAR FLEXOR SPASTICITY – AFO, TILT
TABLE WITH TOE WEDGES, MODIFIED PLANTIGRADE POSITION
• SENSORY TRAINING STREATEGIES– STRETCH, STROKING, PRESSURE, WT
BEARING WITH APPROXIMATION
• STRATEGIES FOR TONE REDUCTION– SPASTICITY
• ELONGATION OF SPASTIC MUSCLES
– RHYTHMIC INITIATION– WT BEARING POSTURE – SH EXTENSION,
ABDUCTION & EXT ROTATION & EXTENSION OF ELBOW, WRIST & FINGERS
– PNF TECHNIQUES– INHIBITION TECHNIQUES
• STRATEGIES TO INPROVE POSTURAL CONTROL & FUNCTIONAL MOBILITY– FUNCTIONAL TRAINING ACTIVITIES
• ACTIVITIES IN LYING– ARM
• ELONGATION OF TRUNK• MOBILISATION OF SCAPULA• ELEVATION OF ARM
– FLEXION WITH WRIST EXTENSION– ABDUCTION WITH WRIST EXTENSION
• SELF ASSISTED ARM MOVEMENTS
• LEG• HIP EXTENSION WITH KNEE FLEXION OVER SIDE
WITH ANKLE DORSIFLEXION• KNEE FLEXION & EXTENSION WITH FOOT
DORSIFLEXION• HIP ABDUCTION & ADDUCTION IN HOOK LYING
• ISOLATED KNEE EXTENSION• BRIDGING WITH ROTATION OF PELVIS• BRIDGING ON AFFECTED LEG & STRAIGHTENING
OF SOUND LEG• ROLLING TOWARDS AFFECTED & UNAFFECTED
SIDE
• ACTIVITIES IN SITTING• WT TRANSFERENCE FROM SIDE TO SIDE WITH
FEET UNSUPPORTED• MOVING IN SITTING WITHOUT HANDS• WT TRANSFERENCE THROUGH ARMS BEHIND • WT TRANSFERENCE THROUGH ARMS SIDEWAYS• RAISING THE HIP IN SITTING WITH LEGS
CROSSED
• STANDING FROM HIGH BED TO GROUND WITH FOOT IN DORSIFLEXION
• PRACTICE ISOLATED KNEE EXTENSION WITH FOOT IN DF
• STANDING FROM CHAIR• MOVING IN SITTING WITH FOOT ON FLOOR• TRUNK CONTROL – CLASP HANDS & REACHING
FORWARDS/SIDES & TO FEET
• ACTIVITIES IN STANDING• WEIGHT BEARING ON AFFECTED LEG• PLACING THE SOUND LEG ON STEP• STEPPING OUT TO SIDE WITH SOUND LEG• MAKING A FIGURE OF 8 WITH SOUND LEG• WT BEARING ON AFFECTED LEG & PLACE SOUND
LEG AT RIGHT ANGLE TO AFFECTED LEG IN FORWARD/BACKWARD
• CONTROL OF HIP ABDUCTORS & EXTENSORS
• STEPPING UP WITH AFFECTED LEG ON STEP
• PUTTING SOUND LEG FURTHER BACK
• WITH AFFECTED LEG ON STEP, STEP UP & OVER WITH SOUND LEG
• RELEASING KNEE IN HEMIPLEGIC LEG IN STANDING
• RELEASING KNEE WITH HEMIPLEGIC LEG BEHIND & PELVIS FORWARD
– STAIRS• ASCENDING STAIRS – ASSISTING AFFECTED LEG
UP
• ASCENDING STAIRS – SUPPORTING THE AFFECTED KNEE TO STEP UP BY SOUND LEG
• DESCENDING STAIRS – HAND SUPPORT ON AFFECTED KNEE
• ACTIVITIES IN TILT BOARD• GAIT TRAINING
• ACTIVITIES FOR ARM– IN LYING
• SMALL CIRCLES ON AIR WITH ELBOW EXTENSION
• TOUCHING HEAD & UP AGAIN• FLEXION & EXTENSION OF ELBOW WITH
HAND IN DORSIFLEXION• HOLDING A POLE IN HAND RAISING &
LOWERING IT
– IN SITTING• HOLDING A TOWEL IN AFFECTED HAND
• IN STANDING• MODIFIED PLANTIGRADE POSITION• WEIGHT BERAING IN AFFECTED HAND &
TRUNK ROTATION• HANDS FLAT ON WALL
PT MANAGEMENT OF PARKINSONS DISEASE
RELAXATION EXERCISES
• GENTLE ROCKING & ROTATIONAL EXERCISES• SLOW REPETETIVE VESTIBULAR STIMULATION• EXERCISE IN FULLY SUPPORTED POSITION• SUPINE – SLOW SIDE TO SIDE HEAD ROTATIONS• HOOK LYING – LOWER TRUNK ROTATIONS• SIDELYING – UPPER & LOWER TRUNK
ROTATIONS• RHYTHMIC INITIATION• DBE – B/L PNF D2 F (INSPIRATION) & D2 E
(EXPIRATION)
• RELAXATION AUDIOTAPES
• GENTLE POSTIONS OF YOGA
• STRESS MX TECHNIQUES
• LIFE STYLE MODIFICATIONS & TIME MX TECHNIQUES
• FLEXIBILITY EXERCISES• AROM & PROM EXS
• STRENGTHENING – WEAK & ELONGATED EXTENSOR MS
• RANGING – SHORTENED TIGHT FLEXOR MS
• D2 F PNF – B/L PATTERNS IN SITTING – TO IMPROVE EXTENSION
• D1 E PNF – COUNTERACT LL FLEXION & ADDUCTION
• HOLD RELAX & CONTRACT RELAX• TRADITIONAL STRETCHING – KNEE
FLEXORS/ELBOW FLEXORS & PF• JOINT MOBILISATION TECHNIQUES• STRETCH – 15 TO 30 SECONDS• AVOID BALLISTIC/AGGRESSIVE/VIGROUS &
EXCESSIVE STRETCHING• PASSIVE POSTIONING• AVOID PHANTOM PILLOW POSTIONING• MECHANICAL STRETCHING
– WEIGHTS/TILT TABLE
• MOBILITY EXERCISES• MVTS SHOULD OCCUR WITH TRUNK ROTATIONS• AIM – TO IMPROVE SEGMENTAL MOBILITY OF
HEAD, TRUNK, HIP & SHOULDERS• PRONE – EXTENSION ACTIVITIES• STANDING – WALL PUSH UPS• BED MOBILITY ACTIVITIES• SIDE LYING ON ELBOW – TRUNK ROTATIONS
WITH LATERAL FLEXION• PELVIC MOBILITY EXS (PELVIC TILTS)• SWISS BALL• UE WT BEARING IN SITTING → WT SHIFTING →
REACHING ACTIVITIES• PNF D2F & D2 E OF UE
• ROCKING FORWARD & BACKWARD IN STANDING• ROCKING CHAIR• RAISED SEAT – SIT TO STAND ACTIVITIES• MODIFIED PLANTIGRADE POSTION• SUPPORTED TO UNSUPPORTED STANDING –
RECIPROCAL ARM SWINGS• WT SHIFTING IN STANDING• STEPPING – SIDE, FORWARD, LATERAL STEP
UPS• FALL – BACK TO STANDING• FACIAL MOBILISATION FOR FACIAL MS
– MASSAGE/STRETCH/VERBAL COMMANDS/MANUAL CONTACTS
– MVTS OF TONGUE, SWALLOWING, SMILING, FROWNING, OPENING & CLOSING MOUTH
• BALANCE ACTIVITIES• WT SHIFTING IN SITTING & STANDING
→REACHING TASKS• MOVEMENT TRANSTIONS
– SIT TO STAND– HALF KNEELING TO STANDING
• SITTING TASK ON GYMNASTIC BALLS• EXTERNALLY INDUCED PERTUBRATIONS• KITCHEN SINK EXERCISES
– HEEL RISE, TOE OFF, PARTIAL WALL SQUATS, CHAIR RISE
– SINGLE LIMB STANCE - SIDE KICKS, BACK KICKS– MARCHING IN PLACE
• GAIT TRAINING• MARCHING IN PLACE • WT TRANSFERENCE IN STANDING• SIDE STEPPING, CROSS WALKING• BRAIDING• STOP, START & TURN 180 DEGREES• TWO WAND STICKS• SHUFFLING GAIT
– SMALL BLOCKS– COLOURED TRANSVERSE LINES
• FREEZING– USE OF TRAINED ASISSTED DOGS
• AUDITORY TAPES
• FUNCTIONAL ADAPTATIONS• ELECTRONIC BEDS – SUPINE TO SIT• KNOTTED ROPES• FIRM MATRESS• CAPTAINS CHAIR• CHAIRS WITH SPRING LOADED SEATS• SHUFFLING GAIT – HARD COMPOSTION
SOLES• FESTINANT GAIT – WEDGES HEEL/TOE
– PROPULSIVE – TOE WEDGE– RETROPROPULSIVE – HEEL RAISE
• CANE/WALKER• SPECIALLY ADAPTED UTENSILS
• RESPIRATORY EXERCISES• BREATHING EXS• AIR SHIF MANOEVUER
• AEROBIC CONDITIONING• WALKING/SWIMMING
• GROUP HOME EXERCISES