UL WB in standing with unaffected arm active

Standing at a flat surface place the palm and fingers of your affected hand on the surface. Complete an activity with your unaffected hand e.g. picking up coins, this will help your affect arm to act as a pivot as a strengthening and stretching exercise.

Scapula setting

There are a number of ways of doing this, but it can be quite difficult to feel what you are doing here, so you may want to do this with a top that allows someone to stand behind you and look at what your shoulder blades are doing. They need to give you feedback on whether both sides look the same. Try not to allow the shoulder blade to “wing” or stick out, more than the other side.
Sitting without back support push your fists into the chair either side of you and hold for up to 10 secs. You will feel your shoulder blades drawing down the back. 
Standing with your arms out in front of you, palms against the wall. Push into the wall and think about drawing your shoulder blades down your back. If they are poking out you are not doing it right, they should stay relatively flat to your back. 
 

Table slides abduction circular motion

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table). Move your hand in a circular motion on the table out to the side of your body. Please inform your therapist should you experience any discomfort or pain whilst performing this activity.

Table slides abduction - reaching

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table).

Slide your hand on the table out to the side away from your body. Aim for a target positioned out to the side of the table to aim for such as some coloured tape on the table or an everyday object such as a heavy book.

Try to keep your back in contact with the chair and avoid leaning forward or to the side.

Tip: You can progress this activity by moving the target further away but within an achievable reach. Please inform your therapist should you experience any discomfort or pain whilst performing this activity.

Tables slides abduction side to side

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table).

Slide your affected hand on the table out to the side and slide your hand back to your midline. Repeat as instructed by your Therapist. Should your arm become painful stop the exercises and speak to your Therapist.

Tip: Aim for a target within comfortable reach to begin with such as some coloured tape on the table or a book and extend the distance as your reach improves.

Table slides flexion – extension

Position yourself sitting at a table with your affected hand flat if possible on a dry cloth/ flannel or small paper bag (for ease of sliding on the table).

Keeping your back in contact with the chair, slide your hand forward on the table. Try to straighten your elbow whilst reaching forward.

Try to avoid your hand/arm coming across the table into the middle.

Tip: Position a target such as coloured tape or an everyday object in front to reach to. You can progress this activity by moving the target further away but within an achievable reach to aim for.

Wall slides

Position yourself at a wall or door frame (ensure that surfaces are smooth to avoid snagging your skin).

You want to be within extended reach.

Place your hand flat on either the wall or door frame, running your flat hand up and down. If possible aim for targets by placing coloured tape up high and waist height. Keep your hand flat against the surface throughout.

Video 1 - UL stretch – Fingers

1st Exercise: Position yourself sitting to a table. Place your flat on the table and open your fingers out and bring them back together again.

2nd Exercise: Sitting to a table keep your wrist on your affected hand in contact with the table and place an empty plastic bottle (for example empty water bottle) near your fingers. Extend your fingers out as straight as you can, try to knock the bottle over.

Repeat as instructed by your Therapist.

Video 2 - UL stretch wrist

In sitting, interlink your fingers and gently bend your wrists back and forth to allow a gentle stretch.

Place your hand flat on the table and gently bend your wrist whilst leaning forward.

TIP: If you notice some active movement in your affected wrist position your wrist over a cylindrical object (i.e. water bottle) and left your wrist up into neutral and beyond if able. You can position a pen or straw on your wrist, hold in place with your unaffected hand and try to aim to touch the pen/straw and aim or this target

Video 3- UL WB in sitting with you unaffected mark.

Standing at a flat surface place the palm and fingers of your affected hand on the surface. Complete an activity with your unaffected hand e.g. picking up coins, this will help your affect arm to act as a pivot as a strengthening and stretching exercise.

Video 1 - Epley manoeuvre left side 1

Position yourself close to one edge of your bed sat up at a 90 degree angle. Turn your head about 45 degrees to the Left. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.

Video 2 - Epley manoeuvre left side 2

Position yourself in the middle of your bed with pillows stacked at the small of your back, sat up at a 90 degree angle. Turn your head about 45 degrees to the Left. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.
 

Video 3- Epley manoeuvre right side 1

Position yourself close to one edge of your bed sat up at a 90 degree angle. Turn your head about 45 degrees to the Right. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side but make sure your neck continues to be extended. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.

Video 4 - Epley manoeuvre right side 2

Position yourself in the middle of your bed with pillows stacked at the small of your back, sat up at a 90 degree angle. Turn your head about 45 degrees to the Right. Once your head is turned, lie down on your back so your head is slightly extended, but still turned to one side. 

Once you get into this position, it is common to experience your vertigo symptoms. Don't worry; your spinning symptoms will pass within 30 to 60 seconds. Stay in position until the spinning stops. Next slowly rotate your head to the opposite side but make sure your neck continues to be extended. Your head should be turned about 45 degrees in the opposite direction. Remain on your side for 30 seconds or until spinning subsides, slowly return to the seated position on the edge of your bed. Remain seated for a few minutes to ensure that you are not dizzy before standing up.

Video 5 - Gaze stabilisation with progression

Hold your finger out in front of you or place a business card/paper with X on it onto the wall in front of you at eye height. Rotate your head side to side, keeping your finger in focus.  Continue to do this as you take steps forwards, backwards, side to side or with the X placed on a busy background.

Video 6 - Gaze stabilisation

Hold your finger out in front of you or place a business card/paper with X on it onto the wall in front of you at eye height. Rotate your head side to side, keeping your finger in focus.  Continue to do this for 1 minute without stopping.

Video 7 - Substitution

Place 2 targets at eye level on a wall, approx. 1m apart.
Stand approximately 1 m away from the wall. Move your eyes to the target on your left whilst keeping your head in neutral. Then move your head to face the same target on your left. Then move your eyes to the target on your right. Once the eyes are fixed on the target, move your head to face the target on your right. Continue to repeat this exercise for up to one minute. 

Video 8 - Walking with head movements

Start walking, as you do so move your head all in all directions (Up, Down, Left and Right) without breaking stride. Try to keep your rhythm and walking pattern.

Video 9 - Walking with head turns

Start walking, as you do so move your head from left to right without breaking stride. Try to keep your rhythm and walking pattern.

Video 10 - BBQ roll

Video 1 - Functional UL task – Folding a Towel

Sit at a table with an unfolded pillow case or towel in front of you. Pick up the corners of the towel, one in each hand, and fold it in half.
Tip: You can increase the difficulty by folding other objects such as t-shirts.

Video 2- Handwriting tasks letters and numbers

Practice writing using your affected hand. You could sign your name, write about your day, keep or diary of your rehab or copy from books and newspapers if you cannot think of what to write. 
Tip: If you wouldn’t usually write with this hand. Don’t expect your writing to be perfect.
Tip: Using a fatter pen will make handwriting easier. You can get comfort grips which also help
Tip: Sign and date all your handwriting practice – this way you will be able to see your progress
 

Video 3 - Handwriting tasks shapes

As part of your handwriting rehab you can practice tracing around shapes. Larger simpler shapes will be easier than smaller more complex multi sided shapes.

Tip: Using a fatter pen will make handwriting easier. You can get comfort grips which also help.
 

Video 4 - Handwriting tasks lines

Try drawing lines, straight lines, vertical, horizontal, diagonal. Now try wavy lines, or zigzags.
Or try writing a line of the same letter joined up and work your way through the alphabet.

Video 5 - Reaching task - Cone placement

Similar to cup waiter:
Sit at a table and mark 4 targets, you could use tape or paper with targets drawn on. Begin with an empty cup on the table and your affected hand in your lap. Reach for the cup, pick it up and move it to one of the targets. 

Tip: Try to grab the cup from the side as though you were going to drink from it.

Video 6 - Reaching task - Jenga large

Sitting comfortably at a table, place three Jenga cones in front of you within extended reach. One to the left, right and one in front.

Pick up each and stack on the middle Jenga cone, do the same in reverse.

TIP: Keep your back in contact with the chair to avoid leaning forward, try to avoid leaning to the side, ensure that when reaching your elbows are held out straight.

Video 7 - Reaching task - Jenga small

Sitting comfortably at the table with Jenga blocks within extended reach, practice picking up Jenga blocks and stack. 

TIP: Keep you back in contact with the chair to avoid leaning forward. Avoid leaning to the side and try to only use your arm, ensuring that your elbows are held straight.

Video 1 - Side stepping

Position yourself standing with an obstacle on the floor beside you and a table nearby for support. Practice stepping sideways over the obstacle and back again. Ensure that hand support is used only if necessary.

Video 2 - Single stepping

Position yourself standing with obstacles placed on the floor in front of you. Practice stepping forwards one step at a time and then bringing your weight back to the start point.

Video 3 - Target stepping

Stand with your feet shoulder-width apart next to a countertop or rail. Mark 4 targets on the floor in front of you. Step your affected leg to the targets then return to your original position. Complete this for each target.
Tip: Vary the targets so that you are stepping left, right, in front and behind.

Video 4 - Toe tapping on cups

Take your time to tap your foot to the target, Making sure to be gentle enough to not apply too much weight. During this exercise your arms and back should be unsupported. Tip: Progression would be to move from right to left without touching your foot to the floor, or capping each cup twice.

Video 5 - Toe tapping

Sat in a chair with targets (Flat, could be steps, could be cups) Take your time to tap your foot to the target, Making sure to be gentle enough to not apply too much weight. During this exercise your arms and back should be unsupported. You can progress this exercise by aiming to move from right to left, the cross body action will increase the difficulty, or changing the rhythm e.g. two taps per target.

Video 1 - Backwards walking

Position yourself standing up. Practice walking backwards, aim to maintain your direction in a straight line.

Video 2 - Ball throwing and catching in standing

In a seated position, throw a ball up in the air in front of you and catch it. Ensure you are catching two handed or with your affected arm. Try to control the pace and direction of the throw to keep it close enough to catch. Tip: To make the exercise harder try using a smaller ball or catching one handed.

Video 3 - Slalom

Position yourself standing with obstacles placed on the floor in front of you.  Practice walking forwards zigzagging around the obstacles, without touching them.

Video 4 -Tandem walking

Position yourself close to a flat surface you can hold onto if you need it. Aim to place your feet one in front of the other heel to toe as if you were walking on a tight rope. To progress further try to do this backwards.

Video 5 - Walking ball bouncing

Start from standing position, as you begin walking bounce the ball on one side, in time with your step on the other side. To progress this activity bounce the ball from one hand to the other as you walk.

Video 6 - Walking with head turns

Start walking, as you do so move your head from left to right without breaking stride. Try to keep your rhythm and walking pattern.

Video 7 - Walking with head movements

Start walking, as you do so move your head all in all directions (Up, Down, Left and Right) without breaking stride. Try to keep your rhythm and walking pattern.

Video 1 - Orthotic donning and doffing – AFO

-Open all straps to maximum end point
-Slide foot in proper AFO, placing heel firmly down and back into the heel cup
-Fasten instep strap (on Dream Brace) to provide a firm but comfortable hold of the ankle preventing unwanted lifting of the heel from the heel cup
-Place lower leg into shell (either in front of or behind leg), and again fasten strap to provide the same level of security as noted previously
-Open shoe to maximum slackness and slide foot with AFO into shoe (shoe horns may be used)
-Secure shoe
-Loosen shoe and remove from foot
-Loosen all straps on the orthosis and remove from foot

Video 2 - Orthotic donning and doffing – Poly sling

Open out the ‘Gutter’ piece of fabric, line your elbow into the corner and fasten the straps over your forearm. Next with you affected arm resting on your stomach reach the longest strap around your neck attaching it to the white loop by your hand. Lastly repeat the above step with the remaining strap wrapping it around your torso.

Video 3 - Orthotic donning and doffing – Resting hand splint

Place the splint on a flat level surface. Lift your affected hand onto the splint. Ensure that you have fabric correctly placed between each of your finger and the heel of your hand is snug against the angle of the splint. Follow the numbers on the straps wrapping them tightly around your hand and wrist.

Video 4 - Orthotic donning and doffing  - Shoulder brace

- Grasp the shoulder strap with your sound hand and hold the orthosis by the edge of the shoulder cap. 
- Guide the paralysed arm through the orthosis up to the shoulder.
- Guide the sound hand through the shoulder strap as though putting on a sweater.
- Make sure the shoulder strap does not twist as you pull it on.
- Fasten the closure on the shoulder cuff. Make sure it fits firmly but is not too tight.
- Position the elbow opening of the lower arm cuff on the elbow. Then fasten the hook-and-loop closure.
- Tighten the straps between the forearm and upper arm cuffs, and secure them with hook-and-loop fastener.
- Tighten the shoulder strap last. This is done either from the back to the front or the front to the back, depending on how the strap was set up for you by your O&P professional.
- Verify the correct fit of the Omo Neurexa plus.
- To take off the Omo Neurexa plus, open all closures to the maximum. This also makes the orthosis ready to put on again with minimal effort.
- Open the plastic closure on the chest last and pull the orthosis down.
 

Video 1 - Crook lying breathing

Position yourself in supine with your knees bent. Gently draw your navel towards your spine. Practise slow steady breathing in this position.

Video 2 - Crook lying sit ups

Position yourself in supine with your knees bent and placed on the floor/bed. Gently tighten your navel towards your spine and slide hands up your thighs until your hands are over your knees. Repeat ensuring that you lower in a controlled manner.

Video 3 - Seated limb raises

Position yourself sitting on a chair with your feet on the floor. Practice lifting one leg up and down at a time. Keep your hips and shoulder over one another to strengthen your trunk.

Video 4 - Seated twists feet on floor

Position yourself sitting on a chair with your feet on the floor. Making sure to keep your chest up and not let your bottom lift off the chair, twist your trunk or pass a ball from side to side.

Video 5 - Sitting on uneven surfaces

Position yourself sitting on a large ball (or other uneven surface e.g two cushions) that is wedged or the second option on a chair. Practice lifting your hands up in the air without falling.

Video 6 - Trans abs activation

Position yourself in supine with your knees bent. Place two fingers on either side of your tummy in line with your navel; tighten your deep tummy muscles that you can feel underneath your fingertips. The easiest way to learn this exercise is to practise as if you needed the toilet but were holding it in.

Video 7 - Pelvic tilts

Sitting on a flat back chair with your arms resting down. Practice growing tall through your sternum and breaking contact between your lower back and the chair. Then slouch your chin down to your chest pushing your lower back into the chair. Repeat this cycle.

Video 8 - Seated twisting both legs lifted

With your back unsupported and sat on a chair try and keep both feet off the floor whilst twisting your torso. Continue to make sure to keep your chest up and not let your bottom lift off the chair, pass the ball from side to side (Or touch the ball to the wall behind you on both sides.

Video 9 - Seated twisting one leg lifted

With your back unsupported sat on a chair lift one foot up at a time and you practice twisting your torso. Continue to make sure to keep your chest up and not let your bottom lift off the chair, pass the ball from side to side (or touch the ball to the wall behind you on both sides).

Video 10 - Seated yoga ball reaching

Position yourself sitting on a large ball with your feet on the floor. Practice reaching in all directions whilst keeping your contact with the ball and maintaining your balance.

Video 1 - High marching

Position yourself in standing with targets at hip height, on a wall in front of you.  March on the spot touching your knees to the targets.  Ensure you stand up tall.

Video 2 - Hurdle side step

Position yourself standing with an obstacle on the floor beside you and stable support nearby. Practice taking a big step sideways over the obstacle and transfer your weight onto the stepping leg before stepping back.  Ensure that hand support is used only if you feel unsteady

Video 3 - Split stance ball bouncing – Bilaterally

Position yourself in standing imaging one foot is on either side of a block with your front knee slightly bent. Ensure you twist your trunk from side to side as you bounce the ball with both hands.

Video 4 - Split stance throw and catch

Position yourself in standing imaging one foot is on either side of a block with your front knee slightly bent. Throw and catch with a partner or against a wall

Video 5 - Bridge

Position yourself lying on your back with your knees bent. Tighten the muscles in your bottom and lift your bottom off the bed. Imagine you have a glass resting on your tummy that you don’t want to spill (Keep your hips level), when you reach the top make sure to lower in a slow and controlled manner.

Video 6 - Clams

Position yourself on your side with your affected hip uppermost. Bend your knees, keep your ankles together and raise your uppermost knee away from the bottom one.

Video 7 - Gym ball heel slides

Position yourself so you are lying on your back with your legs bent and heel resting on a Swiss ball/physio ball.  Push through your legs to lift your pelvis up and slide the ball away from you with your heels, maintaining a level pelvis.

Video 8 - Hip abduction

Supine:
Lie on your back. Slide the heel of your affected leg out the side to touch the edge of the mattress, then return to your original position.
Tip: Try to make the movements slow and precise. Make sure you don’t overshoot. Use a small box or a book as a target.
 

Video 9 - Hip extension

Position yourself standing facing towards a stable surface. Start with your foot in front of your body. Finish with your foot behind your body and knee straight.  Ensure to keep your back straight. Do not left your heel lift up towards your bottom, keep your toes facing forward.

Video 10 - MOS Heel strike

Position yourself standing with a table nearby for support. Practice marching on the spot. Ensure that your legs lift up an equal amount, aim to shift your weight forwards slightly and contact the ground with your heel first before rocking onto your forefoot.

Video 11 - Single leg bridge

Position yourself lying on your back with your knees bent. Lift your bottom off the bed. Shift your weight onto one leg and straighten the other leg.

Video 1 - Mini squat to back of chair

Position yourself standing with your knees straight. Bend your knees and then stand up straight again.

Video 2 - Lunge with twist and ball

Position yourself standing with one foot a large step-length in front of your other foot. Start with your knees straight. Finish with your knees bent by lowering your back knee towards the floor. Ensure that both of your feet point forwards.
Hold this position as you rotate your trunk from side to side ensuring you don’t let your knee twist. 
 

Video 3 - Lunge with twist

Position yourself standing with one foot a large step-length in front of your other foot. Start with your knees straight. Finish with your knees bent by lowering your back knee towards the floor. Ensure that both of your feet point forwards.
Hold this position as you bounce a ball from side to side ensuring you rotate your trunk. 

Video 4 - Lunge

Position yourself standing with one foot a large step-length in front of your other foot. Start with your knees straight. Finish with your knees bent by lowering your back knee towards the floor. Ensure that both of your feet point forwards.

Video 5 - Split squat

Sit on a chair/bench. Bring your affected foot directly underneath your knee, and your opposite foot just forwards. Cross your arms over your chest and try to stand up- you will feel this making your affected leg work the hardest. Return as if you were going to sit, but before you reach the chair stand up again.

Video 6 - Step down

Position yourself standing on a block / step with a foam cup placed on the floor in front of you. Practice lowering and raising your unaffected heel to touch the foam cup by bending and straightening your affected knee. Ensure that your shoulders remain over your hips, both feet point forwards and your unaffected leg does not squash the foam cup.
If you do not have a cup try to ensure your foot heading towards the floor only connects delicately before returning to standing on the step. 

Video 7 - Step up

Position yourself in standing with a block / Step in front of you, both feet on the ground and a stable support nearby. Practice stepping up on to and off the block, one foot at a time.  Ensure that hand support is used only if you feel unsteady.

Video 8 - STS with left leg bias using step

Position yourself sitting with your affected leg on the floor and your unaffected leg on a block. Practice standing up and sitting down. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 9 - STS with left leg bias

Position yourself sitting with your affected leg back and your unaffected leg forwards. Practice standing up and sitting down keeping the leg forwards. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 10 - STS with right leg bias using step

Position yourself sitting with your affected leg on the floor and your unaffected leg on a block. Practice standing up and sitting down. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 11 - STS with right leg bias 

Position yourself sitting with your affected leg back and your unaffected leg forwards. Practice standing up and sitting down keeping the leg forwards. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 12 - Terminal knee extension

Position yourself standing in front of a bed with your knee slightly bent and a piece of foam placed between your knee and the bed. Practice straightening your knee to squash the foam against the bed.
Alternatively you can complete this exercise with some theraband around your knee. The further your knee is bent to begin with the more you will have to overcome the resistance of the theraband and strengthen your knee.