1 YOUR GUIDE TO Exercise After A Stroke
1YOUR GUIDE TOExerciseAfter aStrokeA guide for people with strokeand their familiesMARGOT ANDREW MHSC (HONS), PG DIP REHAB, DIP PTMARGARET HOESSLY MHSC (HONS), INT DIP PT (BOSTON), QSMKATE HEDGES MHSC, DIP PT, ADVANCED BOBATH CLINICIAN
3This book was funded with the help of the A.H. SomervilleFoundation which was established by Archie Somerville afterhis stroke. The authors would like to thank the Foundation andeveryone whose helpful suggestions are included in the text.A special thank you to Hannah Blair for her original drawings,Todd Wilson for graphic design, and Carmel Williams for editing.We have had many years of physiotherapy experience and thecontent of the book has been reviewed not only by people who havehad a stroke but also by a number of medical specialists. We hopethat this book provides practical and useful information regardingexercise after stroke. If you have specific queries please do nothesitate to contact your doctor, other health professionals or theStroke Foundation: www.stroke.org.nzMARGOT ANDREW, MARGARET HOESSLY & KATE HEDGESMay 2017Copyright 2017 Andrew, Hoessly, and Hedges. This is an open access article distributed under theterms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, andreproduction in any medium, provided the original author and source are credited.
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5ForewordWith an estimated 65,000 strokesurvivors in New Zealand most familieshave been or will be affected by atleast one member suffering a stroke.And while the effects of a stroke are asvariable and indiscriminate as the numberof those who suffer them, effectivepost-stroke care is central to realizingthe fullest potential for recovery.individually or with help. The instructionsare simple and clear. The text is perfectlycomplemented by the practical andeasily followed illustrations which covereveryday functions such as moving froma bed to a wheelchair, climbing stairs, orgetting up after a fall, to more specificexercises focusing on strengtheningparticular parts of the body.When my mother, formerly fit, active, andalert suffered a devastating stroke at theage of 96, our family found the transitionfrom the relative security of the hospitalenvironment and its network of supportsystems daunting. As others before ushave found, all too often, life after astroke is a confronting, bewildering andintimidating prospect. As we did, manystruggle in making the transition to thenew challenges they face. This is wherethe Stroke Foundation came in. In a sensethey acted as our consultants who coordinated the services, educated us onour options and ensured my mother’streatment continued after she returnedhome. And this is where this new bookwill be so helpful and effective.Every stroke is unique. Every person’sneeds are different. This new guideis a much needed and overdue toolbox of practical and easily followedexercise regimes for those recoveringfrom a stroke as well as the familiesand whānau who support them in theirjourney to achieve their full potential.Your Guide to Exercise after a Stroke,produced by Margot Andrew, MargaretHoessly and Kate Hedges is an invaluablebook which sensitively addressesthese vulnerabilities and serves up theanswers in a focused, economic, andcomprehensible style. Reassuringlyoptimistic, this welcome and muchneeded resource is a practical guide foreveryone affected, directly or indirectly,by stroke. The guide covers both genericand specific exercises. It describesactivities which can be undertakenI congratulate the authors for recognizingthis glaring gap in our self-help libraryand filling it with such an excellent,readable, and practical guide.— THE HON. JUSTICE SIMON MOOREJudge of the High Court of N.Z.“I had my stroke when I was 29 and Iwish this book had existed then to helpme regain my strength. My wife, Lucy,and I have tried every exercise in thisbook and have found the illustrations andexplanations practical and easy to follow.This book is the foundation for yourrecovery. If you follow these exercisesyou will have the tools to strengthenboth your body and confidence.”— MICHAEL LINANEArtist
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7ContentsINTRODUCTION: Gaining Confidence Starts at Home . . . . . . . . . . . . . . . . . . 9CHAPTER 1: Activities and Exercises at Home1.Effects of a Stroke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142.Activities and exercising at home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15CHAPTER 2: Everyday Activities3.A Guide to the illustrations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184.How to give support to your weak side . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20-- In sitting-- In lying5.Lengthening your muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216.Rolling onto your side in bed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .237.Moving from lying to sitting on the side of the bed . . . . . . . . . . . . . . . . . . . . . . . . . 248.Moving from sitting on the side of the bed to lying down . . . . . . . . . . . . . . . . . . . . . . . 25-- Without help-- With help9.How to balance while sitting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2610.Exercises while sitting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2811.How to stand up from a bed or chair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29-- Without help-- With help12.Moving from a bed to a wheelchair or commode . . . . . . . . . . . . . . . . . . . . . . . . . . 3013.Transferring in and out of a car . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3014.Getting up from a fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31CHAPTER 3: Exercises for Strength and Control15.To help the return of movement in your arm and hand . . . . . . . . . . . . . . . . . . . . . . . . 3616.To strengthen your back and stomach muscles . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4117.To strengthen your hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4218.To strengthen your knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4419.To strengthen your ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45CHAPTER 4: Exercises to Help with Standing and Walking20. Standing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4821.Walking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5122. Stairs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
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9IntroductionGainingConfidenceStarts atHome
1010Notes
11Having a stroke is not only a devastatingpersonal experience, but is also a highlyemotional time for you, your family, andfriends. This book is for everyone involvedin your recovery. It was written to giveyou hope, encouragement, and strength.These simple exercises will helpstrengthen and improve your movement.You will not need all of these exercisesnor will all of them suit you; it isoften a trial and error process.As you gain an understanding of howyour body works in the space aroundyou, over time you will improve youreveryday skills and strength.A stroke damages nerve cells in thebrain but don’t worry, your brain hasthe ability to open up new pathways andfind new connections when correctlystimulated. The exercises in this bookshould be repeated and practicedas often as possible; this can helpbuild new pathways in your brain.After a stroke you will have to relearncorrect movement again. Your brainprocesses sensory information throughyour eyes, ears, skin, joints, andmuscles, helping you to move correctly.Movements you used to do easily willbe more difficult. Your weak side mustrelearn what to do and how to do it.Some people find it helpful to thinkabout how their strong side doesthe movement, before trying thatmovement with their weak side.Some of these exercises can be donealone while others will require someassistance. Feedback from a familymember, friend, or carer can be veryhelpful when trying these movements/exercises. Feedback will give youconfidence that you are moving correctly.Sometimes you will think your movementsare correct and they may not be, sohaving someone help you will ensure theyare done correctly. These exercises willhelp with strength and coordination.The amount of recovery after a strokevaries from person to person. You mayfully recover, or find some activitiesremain harder than before your stroke.Some may struggle with everydaytasks or activities. Occupationaltherapists can help you relearn everydayactivities such as kitchen activities,showering, dressing, and writing.It can be common forpeople to feel overwhelmedand depressed after astroke. If this happensto you, please talkabout it with someoneor visit your doctor.
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13Chapter 1Activitiesand Exercisesat Home
14Effects of a StrokeA stroke is the result of damage to nervecells in the brain caused by either: A blockage of a blood vessel or Bleeding into the brainEither of these can result in difficultieswith movement. A bleed or blockage onone side of the brain affects movementon the opposite side of the body. This isknown as hemiplegia: ‘hemi’ half and‘plegia’ paralysis. One side of the bodyis weaker. The problems caused by strokeare different for everyone. They can varyfrom mild to severe and may include: Muscle weakness, or slowness ofmovement of the-- Arm and leg-- Trunk-- Face and tongue Changes in muscle stiffness (this can varyfrom floppy to very stiff) Poor balance Decreased coordination Tremor/shaking (of your arm or leg) Loss of awareness/neglect of theweak side Numbness or tingling Decreased awareness of temperature,pressure, or pain Difficulties judging your position in spaceand distance from objects Double vision Nystagmus: uncontrolled left/right orup/down eye movements Visual field loss: able to see only part ofwhat is actually being looked at Sensitivity to light, especiallybright sunlight Extreme tiredness/fatigue Decreased concentration Changes in mood Changes in behaviour and personality Difficulty expressing yourself or finding ithard to understand others.Communication difficulty can be distressing and frustratingso as soon as possible, get the assistance of a SpeechLanguage Therapist. They can help you to communicateeffectively. It is also important that you and your family knowthat your intelligence has not changed. Speech LanguageTherapists can also help with any eating difficulties.
15Activities andExercising at HomeRecovery of movement continues fora long time after stroke. Once you arehome it is important to exercise andpractice moving every day. Exercisefollowing stroke has beneficial effectsnot only on movement and balance buton circulation and the health of theheart. With practice, movements thatseem difficult at first become easier. It is best to exercise in loose comfortableclothing and no shoes Think about the activity before doing it.Planning a movement helps you to do itmore easily Practice the movement-- At first you may need to get the feel of themovement by doing it with your strong side-- When doing it with your weak side,look at that side to make it easier-- Your helper may need to help andguide you to get a better movement Feedback will help you to know how wellyou are doing Find just the right level of effort in order toachieve the movement without strain Weak muscles easily become tired ifworked too hard. At first don’t do morethan a few minutes at a time to avoidmuscle tiredness Frequently after stroke, too much effortcauses the muscles on both sides ofthe joint to tighten so that very littlemovement actually occurs. Some muscles,especially those of the arm and hand, tendto become particularly tight and will needto be stretched on a daily basis Always picture in your mind both sides ofyour body working togetherCorrect muscle length is an importantpart of normal movement. If muscleson one side of a joint are too shortthose on the other side cannot workwell against that resistance. Followinga stroke, stiff muscles tend to becomeshorter and stiffer over time.Maintaining muscle length as closeto normal as possible is thereforeessential. This can be done by slow,gentle stretching of tight muscles whichallows the opposite muscle group to doits job and move the joint more easily.If you are having any difficultiesor are unsure of the exercisesin this booklet please contactyour local physiotherapist.INFORMATION FOR YOUR CARER/HELPERWhen helping with these exercises, if you are unsure aboutwhether the movement is correct, try the exercise yourself first.You will then be able to help the person move more normally.Telling the person when it looks correct can also be helpful.
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17Chapter 2EverydayActivities
18A Guide to the IllustrationsParts of the BodyShoulderTrunkHipKneeKey to Illustrations:Your Weak Side (This May Be Left Or Right Side)Your Starting PositionYour Middle PositionYour Finishing PositionShows The Direction For Your Body To MovePelvis
19Daily Care of your BodyPeople who have had a stroke can have changes in muscles stiffness- this can vary. Often people are floppy at first and then becomestiffer and tight. The aim is to have relaxed movement.If there is tightness the musclesmay pull as shown below: Neck muscles - pulling forward orto the side Shoulder muscles - dropping Arm - pulling in and across the body Elbow wrist and fingers tightening Hip - pulling back (especially whenstanding and walking) Knee - locked back or difficult tostraighten Heel - unable to touch the groundThe following pages will show you how to support a weakand floppy side and how to lengthen tight muscles.
20Everyday ActivitiesYou will need only a bed, chair, and table for most of the exercises in thisbook. Please ensure the chair is stable. It may need to be against a wall.Positioning: How to Give Support to your Weak SideSITTINGLYING IN BED Back supported Arm supported Weak arm supported Feet flat on floorLYING ON YOUR STRONG SIDELYING ON YOUR WEAK SIDE Shoulder and hip forward Arm resting on the bed palm up
21Lengthening your Elbow and Hand Muscles Stand next to a table Place your weak hand flat on thetable with your elbow straight If necessary hold your elbowto help straighten your arm Gently put weight throughyour straight armYOUR HELPER CAN Slowly work your thumb out Stretch your fingers outwith your wrist backYOUR HELPER CAN Slowly and gently take yourarm away from your side Slowly lengthen your chest, shoulder,elbow, and hand muscles Do not ‘pull’ on the shoulder
22Lengthening your Leg Muscles Stretching your thigh muscles Stretching your calf muscles Keep your heel on the floor
23Rolling onto your Side in BedLIE ON YOUR BACKTo roll onto your strong side1. Turn your head towardsyour strong side2. Clasp both hands in front of youor bring your weak arm acrossyour body - do not lift your arm upabove 90 degrees (shoulder level)3. Bend your weak leg so that your footis flat on bed or bend both legs up4. Push down through your weak foot5. Roll overYOUR HELPER CAN Clasp your hands and moveyour arms across your body Lift your weak leg up and holdyour foot flat on the bed Instruct you to “reach forwardtowards me and roll over”To roll onto your weak side1. Raise your head and turn towards your weak side2. Clasp both hands in front of you3. Bend your strong leg and keep your foot flat on the bed4. Push off with your foot5. Roll your hips and shoulder toward your weak side
24Moving from Lying to Sitting on the Side of the Bed1. Roll onto your weak side. Keep yourweak arm and leg well forward2. Carefully swing both legsover the side of the bed3. Push up with your strong arm4. If you can help with yourweak arm do so5. Your strong leg can helpyour weak leg if needed, bylifting it from the ankleYOUR HELPER STANDSFACING YOU AND CAN Help to move your legs overthe edge of the bedMoving From Sitting on the Side of the Bed to Lying Down1. Lean toward your weak side2. Lower yourself down slowlyon your weak arm3. Swing your feet up onto the bed sothat you are now lying on your sideYOUR HELPER CAN Lift your feet up onto the bedAlternative MethodIt may be easier to go downon to the STRONG side1. Lean down towards your strong side2. Lower yourself down slowlyonto your strong arm3. Swing your feet up on to the bed
25Lying Down with HelpYOUR HELPER Stands side on to the bed withtheir outside leg forward Places their arm across your chestto hold onto your far shoulderYOU Hold onto the helper’s armwith two hands if possible orjust use your strong handYOUR HELPER THEN Tips you slowly sideways towards the head of the bedand this will help your legs to start moving upwards Helps you swing your legs up onto thebed by using the back of their arm
26How to Balance while SittingYou may have difficulty sitting. You may fall towards your weak side, take toomuch weight on your strong side, or fall backwards. In order to sit up straightit is important to know where the mid-line of your body is. Try using a mirror(though some people find this confusing rather than helpful).If it is still difficult to sit in the mid-line it could be due to: Being either too weak, too stiff, or fearful Left-sided neglect (when you “forget” about the weak side,cannot feel it, look away from it) Difficulty understanding where your body should be in space1. Sit on the side of the bedwith your feet on thefloor or supported-- Find the mid-line, sit asstraight as possible-- Move from one side of yourbottom to the other so thatyou are slightly ‘off centre’2. Lean forward and back
27YOUR HELPER MAY NEEDTO HELP YOU TO: Recognize the mid-line positionby pushing down gently onto yourshoulders when you are straight Move yourself from one side ofyour bottom to the other (keepingyour shoulders level) so that youget the ‘feel of the movement’ Lean forward and back1. While you sit straight andstill your helper can: Say “Don’t let me move you” whilegently pushing your shoulders-- To the left and then to theright while you resist-- Forward and then backwardwhile you resist-- Twisting to the left and to theright around the mid-line
28Exercises while Sitting1. Clasp your hands together andmove your body and arms to-- Reach forward and back-- Reach to the left and then to the right-- Reach towards the floor (to themiddle, to the left, to the right)-- Reach around and up2. Lean to the side (elbow onto two pillows) thenpush through your arm to sit up straight
29How to Stand Up from a Bed or ChairIf you have a very floppy arm it will need to be supportedwith a sling. A higher chair is often easier to begin with.WITHOUT HELP1. Move forward to the front half of thebed (or chair) by shuffling forward2. Link your hands together or useyour strong arm to push up3. Have your feet shoulder width apart,well back and flat on the floor4. Bend forward at the hips (bringyour nose over your toes)5. Reach forward6. Push through your legs to standup (equal weight on both feet)You may feel safer practising sitting tostanding with a table in front of youYOUR HELPER CAN1. Help you to move forward in the chair2. Put your arms around their waist3. Steady your shoulders to help you stand up4. Block your knees in front or stand in a ‘lungeposition - one foot in front of the other’ and shifttheir weight back as they help you stand up
30Transferring into Bed from a Wheelchair1. Have the chair as close to the bedas possible and positioned so thatyour strong side is next to the bed2. Come forward in the chair3. Put your hand on the bed4. As you start to stand up, turnand step with your strong leg5. Sit downTransferring Out of Bed into a Wheelchair1. The position of the chair is changedso that your strong leg always leadsTransferring In and Out of a Car1. Have the wheelchair alongside the car2. Have the car seat back as far as possible3. Have the car window wound down so that ifnecessary you can hold onto the window frame4. Stand up from the wheelchair5. Step around and sit on the seat sideways6. Lift your legs into the car
31Getting Up from a FallFirst make sure that you do not have an injury. Your helper may need to help you. Sit with your strong sidenext to a bed/chair Place your strong arm on theseat of the bed/chair Get into a kneeling position Bring your strong leg up Push on your strong arm and leg tosit on the seat of the bed/chair
32Notes
33Chapter 3Exercisesfor Strengthand Control
34Exercises for Strengthand ControlIt is important to select the right exercisefor your stage of recovery. If you havedoubts about what you can do, stick tothe simple basic exercises and work onthem until you are confident that youare doing them correctly. Only thenshould you move on to the next level.The number of times you can repeatan exercise depends on your abilityat the time. Often at the beginning, 3repetitions will be all you can do. Restfor 20 seconds and try again. Aim toincrease to 10 repetitions. Avoid fatigue.There are many ways to improve strengthand awareness of your weak side. Ifyou have good recovery of movementand can do most basic activities,strengthening can be done by usingequipment such as weights. Somepeople like using gym equipment.There is often a pattern of recoverywhich results in some muscles workingquite well and others poorly or notat all. Exercise should be directedtoward strengthening specificmovements. An arm or leg that hasincreased muscle stiffness requiresearly stretching and positioning.
35If it is hard for you to start a movementdue to weakness then a physiotherapistcan help you with the following: Press down through your arm,leg, or body to help muscleswork and improve sensation andawareness of your arm and leg Use ‘overflow’ from strong to weakmuscles (do the movement withboth sides of your body. Your helperprevents your strong side frommoving so that there is overflowof movement to the weak side) Use different textures on your skin(rough, smooth, soft, hard) to helpyou to ‘feel’ and make you more awareof your sensation or stroke your weakarm firmly with your strong one
36Exercises to Help the Returnof Movement in your Armand HandDeveloping the full use of your arm andhand after a stroke is very challenging.In the early days it is easier to moveyour arm with help, either by holdingit with your strong arm or havingyour helper assist. Working on yourshoulder control is very important. Itgives stability to your whole arm.When exercising it may be easier tostart by lying on your strong side(weak side uppermost) or back.To use your hand there should be abalance between opening and closing. Itis important to concentrate on openingthe hand because the grasping musclestend to become short and tight.Be aware of the tension that mightcome into your arm when you attempttasks that may be too hard. If yourarm gets tighter, stop and stretch yourmuscles before you begin again.Think about using your arm andattempt to use it. Once you are gettingmovement back in your arm, try touse both arms in daily life (washing,dressing, and household tasks).The shoulder must be looked after and supported; pain easilyoccurs. If you have difficulty with the exercises below getadvice from a Physiotherapist or Occupational Therapist.
37Beginning ExercisesIf needed, your strong hand can assist or your helpercan support and guide your weak armLYING ON YOUR STRONG SIDE1. Your helper supports yourweak arm throughout2. Reach forward
38LYING ON YOUR BACK1. With hands clasped, reach towardsthe ceiling; do not go past 90 degreesif you have any shoulder pain2. With arms bent, push both elbowsaway from your body. Helperresists on the strong side toencourage the weak side to move3. Shoulder shrugging - lift bothshoulders up towards your ears.You can also do this while sittingSEATED WITH BOTHARMS ON A TABLE1. Try reaching towards an objectwith your weak arm2. With your weak hand flat on a clothand your strong hand on top, moveyour arms around the table. Guideyour weak arm with your strong one3. Slide a glass over the surface ofthe table using your weak hand andkeeping your shoulder forward.Your helper may hold your handon the glass (your helper shouldnot try to guide the movement)
39STANDING1. Place both your hands flat on a table2. Lean onto your weak arm andhand with the elbow straight.Keeping your hand flat on the table,move your weight forward. Keepyour thumb and fingers apartThis is a good exercise to preventyour hand becoming tightYou or your helper may needto support your weak armAdvanced ExercisesLYING ON YOUR BACK1. Reach towards the ceiling with yourweak arm. When your arm is straight,move it a small distance in differentdirections e.g. up, down, out to the sideMake sure you have enoughcontrol to do the movementwithout your arm falling down,otherwise you will need help2. Bend your elbow to touch yourhead with your hand. Straightenyour arm and hold it straight3. Move your hand ontothe opposite shoulder.Straighten your armYOUR HELPER CAN Take your hand towards your face Steady your upper arm whileyou straighten your elbow
40SEATED AT A TABLE WITH YOURWEAK ARM SUPPORTED1. Bend and straighten theelbow of your weak arm2. With your elbow bent, turnyour palm up and down3. With your forearm supported,keeping your fingers straight, tryand make an arch with your handDaily Activities to Practisefor Strengthening yourArm and HandFunctional Hand andFinger Activities Bend and straighten your wrist joint Writing, drawing - start with a fatpen/marker or a grip on pen Lift your hand while holding a light cup Place your hand around a cup. Donot lift it but hold it for 20 seconds.Relax (let go) and open your hand Progress to picking up the cupand putting it down This can also be practised with avariety of objects (e.g. blocks) Use both hands together to pick upa ball, a large cup, a small box Do activities with a towel(folding, rolling, drying) Use play dough. poke it, put it in thepalm of your hand and move it round withyour fingers. Use both hands to move it Pouring water from a jug into a large bowl Rolling a ball on the table Scrunching up paper Holding and turning over cards Picking up small objects likebuttons and coins Using pegs - open, close and pegonto cloth/paper with weak handUse both hands to do the task Cutting - knife, scissors Picking up sticks/straws Use iPads, computers, and phones Do finger exercises; tapping, touch eachfinger with the thumb of your weak hand,bend and straighten your fingersYou will be able to add many other activitiesto the above - ‘ be creative’
41Exercises to Strengthen yourBack and Stomach MusclesBasic ExercisesLYING ON YOUR BACK, WITHYOUR KNEES BENT, FEET FLAT1. With both knees bent up, andfeet on the bed, draw yourtummy in and flatten your backinto the bed. Hold to the countof five, then relax. Repeat.2. From the middle take bothknees to one side, and return.Repeat to the other side3. Clasp your hands together in frontof you, reach forward and raiseyour chin towards your chest.Try to hold to the count of five4. Repeat the above exercise movingyour arms and head to your weakside. Try to hold to the count of five5. With your arms by your side, pullyour shoulder blades together
42Exercises to Strengthenyour HipBasic ExercisesLYING ON YOUR BACK WITHYOUR KNEES BENT, FEET FLAT1. Slowly bend and straightenyour weak leg, keepingyour foot on the bedYOUR HELPER CAN Support your leg while youlift it up toward your chest Help you to slowly moveit part way down Help you to bend it up again Try to control themovement so it becomeseasier and smoother2. Lift both hips (bridge) hold them upfor 10 seconds then relax. Start bylifting up only 2-3 cm off the bed.Progress to keeping your hips levelYOUR HELPER CAN Keep your leg in the mid-line Support your leg as you moveand stop it falling out3. Lift your knee and foot towardyour chest. Keep it steady,do not let it fall out
43Advanced ExercisesLYING ON YOUR BACK Bridge to move over on the bed Make sure you put weightthrough your weak side Bridge with your strong leg straight Bridge and rotate / twistLYING ON YOUR BACK WITHYOUR LEGS STRAIGHT1. Push your feet apart keeping yourheels on the bed, knees straightYOUR HELPER CAN Resist on the strong side. This uses yourstrong side to strengthen the weaker side Show you how to push your heels into thebed with feet apart and knees straight2. Turn your knees and feet in towardone another and then out
44Exercises to Strengthenyour KneeBasic ExercisesLYING ON YOUR BACK1. Put a rolled towel under your weakknee. Lift your foot up and holdyour knee straight. Slowly lower itSITTI
exercises focusing on strengthening particular parts of the body. Every stroke is unique. Every person’s needs are different. This new guide is a much needed and overdue tool box of practical and easily followed exercise regimes for those recovering from a stroke as well as the families and whānau who support them in theirFile Size: 1MBPage Count: 51Explore further10 Stroke Recovery Exercises For Your Whole Bodywww.rehabmart.comAfter Stroke: 3 Exercises for a Weak Leg. (Strengthening .www.youtube.comStroke Exercises.pdf - Stroke Exercises for Your Body .www.coursehero.com35 Fun Rehab Activities for Stroke Patients - Saebowww.saebo.comPost-Stroke Exercises for Left Arm and Shoulder SportsRecwww.sportsrec.comRecommended to you b
INDEX PRESENTATION 5 THE THUMB 7 MECHANICAL EXERCISES 8 SECTION 1 THUMB Exercise 1 12 Exercise 2 13 Exercise 3 - 4 14 Exercise 5 15 Estudio 1 16 SECTION 2 THUMB WITH JUMPS Exercise 6 17 Exercise 7 - 8 18 Exercise 9 19 Exercise 10 20 Exercise 11 - 12 21 Estudio 6 22 SECTION 3 GOLPE Exercise 13 23 Exercise 14 24 Exercise 15 25 Exercise 16 - 17 26 Exercise 18 27 .
Chapter 1 Exercise Solutions Exercise 1.1 Exercise 1.2 Exercise 1.3 Exercise 1.4 Exercise 1.5 Exercise 1.6 Exercise 1.7 Exercise 1.8 Exercise 1.9 Exercise 1.10 Exercise 1.11 Exercise 1.12 Fawwaz T. Ulaby and Umberto Ravaioli, Fundamentals of Applied Electromagnetics c 2019 Prentice Hall
CLIMATE-SMART AGRICULTURE TRAINING MANUAL iv Exercises Exercise A.1 Introduction to the training course 18 Exercise A.2 Weather and climate 18 Exercise A.3 Global Warming 18 Exercise A.4 Changes in rainfall 18 Exercise A.5 The greenhouse effect 19 Exercise A.6 Climate change in your area 19 Exercise B.1 Understanding the effects of future climate change 43
TRX Power Stretch. Round 4, Exercise 1 Round 4, Exercise 2 Round 4, Exercise 3 Round 4, Exercise 4 Round 4, Exercise 5 Round 4, Exercise 6. Block 5 – Hamstring/Folds (Adjustment: mid length) EXERCISE SETS REPS / TIME SET REST TRAN
2. Selecting an exercise 4 2.1 Scoping the exercise 4 2.2 Setting the aims and objectives 4 2.3 Types of exercise 5 2.4 Choosing the type of exercise 6 2.4.1 What is being tested? 6 2.4.2 What resources are available? 7 3. Planning the exercise 9 3.1 Exercise management team 9 3.2 Exercise plan 9 3.3 Target audience 10
EXERCISE 17 Spinal Cord Structure and Function 277 EXERCISE 18 Spinal Nerves 287 EXERCISE 19 Somatic Reflexes 299 EXERCISE 20 Brain Structure and Function 309 EXERCISE 21 Cranial Nerves 333 EXERCISE 22 Autonomic Nervous System Structure and Function APPENDIX C: 343 EXERCISE 23 General Senses 355 E
Exercise 9, Joints. 7 11/1 11/3 .Exercise 10, Muscles of body Exercise 10, continue. 8 11/8 11/10 Cat Dissection. Exercise 11, Spinal cord. 9 11/15 11/17 Exercise 11, Spinal Nerves and Reflexes. Exercise 12 Brain. 10 11/22 Exercise 12 Cranial Nerves And Sheep Brain. Thanks Giving Break, Nov 24 – Nov 27. 11 11/29 12/01
Be able to instruct gym-based exercise 4. Be able to supervise clients undertaking gym-based exercise 5. Be able to bring a gym-based exercise session to an end 6. Be able to reflect on providing gym-based exercise 7. Be able to support clients taking part in gym-based exercise 8. Understand how to provide gym-based exercise UV20527 3 1 .
