COORDINATION EXERCISES

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 Coordination
is the ability to execute smooth, accurate, and controlled motor responses
Is the ability to select the right muscle at the right time with proper
intensity to achieve proper action
Coordinated movement is characterized by appropriate
speed
distance
direction
rhythm
levels of muscle tension
the essence of coordination is the sequencing, timing, and grading of the
activation of multiple muscles groups
coordination also involves appropriate synergistic influences (muscle
recruitment), easy reversal between opposing muscle groups
(appropriate sequencing of contraction and relaxation), and proximal
fixation to allow distal motion or maintenance of a posture
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 Coordination
The ability to execute smooth accurate motor response depends on:
Deep sensations
Vision
Vestibular system and cerebellum
Motor system
Flexibility and ROM
Coordination is dependent on the synergistic activity of the somatosensory, visual
and vestibular system, cerebellum as well as a fully intact neuromuscular system
from the motor cortex to the spinal cord
The nervous system acts cooperatively with the muscular system to produce an
intended motor action
These synergistic activity produce a relatively stable movement patterns scaled
to the environment
The nervous system simplify, control, reduce or constrain the degrees of
movement, and initiate coordinated patterns of movement
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 Coordination
Schmidt and Lee defined coordination as the behavior of two or more degrees of freedom
in relation to each other to produce skilled activity
Skill and Agility
terms that are often associated with coordination
Skill
the highest level of motor control
It is a learned ability
combines stability & mobility
proximal ms are fixed/ stable while distal ms move in space
contains the phase of perfected movements, stimulation of balance reactions, forms of facilitation in
order to obtain the passing from one posture and movement to another as easily as possible
Example: use of upper limbs and hands and advanced balance and gait
Agility
refers to the ability to rapidly and smoothly initiate, stop, or modify movements while maintaining
postural control
Dexterity
refers to skillful use of the fingers during fine motor tasks

Ability
- are shaped by biological and physiological factors (Fleishman, 1964)
- Genetically predetermined characteristics that affect movement performance such as agility, coordination,
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strength, and flexibility
 Types of coordination
Intralimb coordination
refers to movements occurring within a single limb
e.g., alternately flexing or extending the elbow; use of one upper extremity to brush the
hair; or motor performance of a single lower extremity during a gait cycle
Interlimb (bimanual) coordination
refers to the integrated performance of two or more limbs working together
e.g., alternately flexing one elbow while extending the other; bilateral upper extremity
tasks as required during sliding transfers or dressing activities; or between limb
movements of the lower extremities and/or upper extremities during walking
Visual motor coordination
refers to the ability to integrate both visual and motor abilities with the environmental
context to accomplish a goal
e.g., tracing over a zigzag line, writing a letter, riding a bicycle, or driving an automobile
eyehand coordination
A subcategory of visual motor coordination with important implications for activities of daily living (ADL)
Required for using eating utensils, personal hygiene, or reaching for a visual target (e.g., a book from a shelf)
is perhaps more aptly termed eyehandhead coordination because movement of the head is typically
required for the eyes to fixate on a target or object 5
 Impairment of coordination
Characterized by awkward, extraneous, uneven, or inaccurate movements
may suggest muscle and possibly peripheral or central nervous system
dysfunction
Maybe age related
Examples of medical diagnoses (nervous system diseases and/or injuries)
that typically demonstrate coordination impairments
traumatic brain injury (head trauma)
Parkinsons disease
multiple sclerosis
Huntingtons disease
Cerebral palsy
- In these pathologies, balance and
Sydenhams chorea coordination problems are usually
cerebellar tumors present
- co-existance of both problems in
spinocerebellar ataxias many patients can be observed
Vestibular pathology - Although in some of these diseases,
sensory neuropathies balance problems are more dominant,
whereas coordination problems related
some learning disabilities to extremities are more forefront in
others 6
 Terminologies
Balance
the ability to maintain body position in equilibrium
Proper balance requires the nervous and musculoskeletal systems to interact
with the environment to control body position
After injury, if these systems are not properly integrating information, loss of
balance and coordination may result
Ataxia
Synonym for incoordination
Neuromuscular problem
can result from damage to several different motor or sensory regions of the
central nervous system, as well as peripheral nerve pathology (Bastian 1997)
a symptom developing from cerebellar influence (Martin 2009)
Can also refer to balance dysfunction as a symptom only of vestibular diseases (Brown et
al. 2006)
In general, problems in the proprioceptive system, visual system and vestibular
system, the cerebellum and/or any problem in the interconnections of these
systems, can lead to ataxia
More accurately refer to incoordination and balance dysfunction in
movements without muscle weakness
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 Clinical Differences Between Basic Types of Ataxia

Type Cerebellar Ataxia Sensory Ataxia Frontal Ataxia Vestibular Ataxia

Upright and sometimes Upright and definitely
Head posture Leans forward Leans forward
fixed fixed
Trunk posture Stooped-leans forward Stooped-upright Upright Upright
Stance Wide-based Wide-based Wide-based Wide-based
Initiation of gait Normal Normal-wariness Start hesitation Normal
Postural reflexes +/- Intact May be absent +/-
Steps Stagger-lurching High-stepping Small-shuffling Normal
Stride length Irregular Regular Short Normal
Variable - hesitant and
Leg movement Variable, ataxic Stiff, rigid Normal
slow
Speed of movement Normal-slow Normal-slow Very slow Normal-slow
Arm swing Normal, exaggerated Normal Exaggerated Normal
Turning corners Veers away Minimal effect Freezing-shuffling Dysequilibrium
Heel-toe test Unable +/- Unable Unable
Romberg's test +/- Increased unsteadiness +/- -
Heel-shin test Usually abnormal +/- Normal Normal
Falls Uncommon Yes Very common Common

(jeffmann.net/NeuroGuidemaps/gait).
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 Problems in Ataxia
Ataxia is a neurological problem with major effect on both mobility and upper extremity
functions of the patient
when compared to other symptoms of neurological diseases (muscle weakness, spasticity),
it is sometimes more persistent and difficult to cope with
it is not possible to analyze ataxia in isolation from balance dysfunctions
In ataxia, insufficient postural control and incoordination of multi-joint movements is both
observed (DeSouza 1990)
As a result, there is impairment of motor control and neuromotor development

Postural instability
results from the inadequacy in postural control
Can lead to clinical balance dysfunctions (i.e fall & other safety problems)
Patients tend to avoid uncontrolled movements and, in particular, stop performing those movements that
demand high coordinative efforts
Thus, their movement repertoire is increasingly restricted to movements with only poor variation
As a consequence, patients lose coordination skills, reaction ability
Impaired Balance and coordination
in some cases, balance dysfunction is observed without the existence of incoordination of movements
(e.g. when there is muscle weaknesses)
Gait problems
Problems with core stability
Compensatory movement strategies
Tendency to use other muscle groups 9
PRIMARY PREVENT/REDUCE
Bradykinesia SECONDARY
SECONDARY
AkinesiaFreezing CONSEQUENCES
Strength
Dyskinesia Use structured
Endurance
Chorea exercise programs
DIRECT Range of motion
Dystonia to prevent/ reduce
Postural control Impairments
Cognitive
Behavioral
INDIRECT
DIRECT

CONSEQUENCES
Gait REDUCE
Balance CONSEQUENCES
Falls Use movement
Transfers strategies and
Upper-limb function functional task practice
Pain

A model of the direct and indirect effects of movement disorders and their consequences on key functions with suggested
goals of therapy and therapeutic approaches
Fr: Rehabilitation of movt. Disorder p.73 (Iansek & Morris, 2013)

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Rehabilitation of pxs with Coordination
Impairment
Rehabilitation always aims to improve the quality of life of the patient by increasing their
independence while performing daily life activities

Main Goals:
1. Improve the functional level of the patient through restorative techniques
2. Make use of compensatory strategies to make the patient perform as independent as possible
within his/her present functional level
When restorative techniques is not possible

Specific Goals:
To develop the ability to reproduce automatic motor behavior that is faster, more precise , and
stronger than movement
To enhance proprioceptive feedback and visual guidance

Goals of restorative physical treatment :

1. Improve balance and postural reactions against external stimuli and gravitational changes
2. Improve and increase postural stabilization following the development of joint stabilization
3. Develop upper extremity functions
4. Develop independent and functional gait

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 Sample pt goal for px with
coordination impairment
Early phase (Hoehn and Yahr 02): Equates to the Goal of therapy Late phase (Hoehn
Diagnostic then Maintenance clinical stages and Yahr 5) : Equates to Complex
Prevention of inactivity then Palliativeclinical stages
Prevention of fear of moving As in mid phase, and also:
Prevention of fear of falling
Maintain vital functions
Improve physical capacity
Prevention of pressure sores
Goal of therapy: Mid phase (Hoehn and Yahr 24): Equates Prevention of contractures
to Maintenance then Complex clinical stages
Consider and include support
As in early phase, and also:
from the wider network
Maintain or improve activities,
especially:
transfers
Body posture
reaching/grasping
balance
gait
Consider support from the wider network including
family and social network plus formal (paid) support
Fr: Rehabilitation of movt. Disorder p.58
(Iansek & Morris, 2013) 12
 Coordination Exercises
Are carefully planned series of exercises designed to overcome incoordination & proprioception loss by
visual and auditory feedback

Principles of Coordination Exercises

Exercises should be practiced consciously at first, and in later stages should be followed by automatic
exercise activities
Patient attention and focusing in each exercise is an essential issue
Exercises should progress from simple to complex, slow to fast
improving attention to and accuracy of movement performance will be reflected on efficacy and correctness of
functional activities
Constant repetition of a few motor activities (until the px has learned the movt) before proceeding to more
complex activities
Use of sensory cues (tactile, visual, proprioceptive) to enhance motor performance
Activities should be practiced first with the eyes open and later with the eyes closed
Vision is essential in teaching the patient with proprioception deficiency the accurate coordinated
purposeful movements
Therapists command should be informative, clear and rhythmic
After achieving proximal tonus and stabilization, the coordinated movement of the distal segments
should be taken into consideration
Compensation methods and supportive aids and equipment should be employed when necessary
Treatment should be supported by an appropriate home exercise program and sports activities
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 different approaches to therapy that
have been developed to improve
neuromuscular coordination
Frenkels exercises
Proprioceptive Neuromuscular Facilitation (Knott
and Voss)
Neurodevelopmental Treatment (Bobath)
Neurophysiological Basis of Developmental
technique (Rood, Randolph)
Sensory Integrative Therapy (Ayres)

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 Treatment Approaches (to ataxia)
Evaluation of the patient, determination of suitable treatment methods and problem solving approach,
as well as performing the exercises regularly; are of major importance for the success of treatment
program
The contents of the treatment program can vary depending on the type and characteristics of the
patients problems, but would include the following:

1. Approaches to improve proprioception while incorporating visual aids

used more commonly in patients with sensory ataxia
2. Stability training
to reduce truncal and extremity ataxia (in patients with cerebellar ataxia)
Can be in the form of resistance exercises (to address core stability) or weight bearing
exercises
3. Habituation exercises
For patients with vestibular ataxia
in order to reduce vertigo, and also to stimulate vestibulo-ocular, vestibulo-spinal reflexes &
to improve balance
Note:
Proprioceptive exercises contribute to balance while improving proprioception, and vis a vis.
Approaches in the treatment of extremity ataxia may enable proprioceptive input to increase and the balance to
develop by establishing stabilization
Therefore, it is not possible to classify the methods used in the rehabilitation of ataxia as approaches directed
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merely towards proprioception or balance, since all of these interact with each other
 Approaches for improving
proprioception
The aim is to decrease postural instability by improving body awareness
Through mechanical stimulation of joint surfaces, muscles and tendons
Approaches:
1. Proprioceptive Neuromuscular Fascilitation (PNF) rhythmic stabilization, slow reversal techniques
(Adler et al. 2000, Gardiner 1976)
2. Resistive exercises (DeSouza 1990, Arai et al. 2001)
3. Use of Johnstone pressure splints (Armutlu et al. 2001)
4. Gait exercises on different surfaces (hard, soft, inclined surfaces) with eyes open and closed
5. Plyometric exercises (Risberg et al. 2001)
6. Balance board/ball and minitrampoline exercises (Diracoglu et al. 2005)
7. Use of vibration directly to the muscle and tendon, or by exposing the whole body to vibration
(Schunfried et al. 2007, Hatzitaki et al. 2004, Semenova 1997)
8. Use of suit therapy
- The suit is made up of a vest, shorts, knee pads and special shoes attached by using bungee type bands that are
used to correctly align the body and provide resistance as movements are performed
- Its major goals are to improve proprioception (sensation from joints, fibers, and muscles), and to increase weight-
bearing for normalized sensory input regarding posture and movement (Semenova 1997)
9. Methods which develop body awareness
such as the Feldenkrais and Alexandre Techniques (Jain et al. 2004), yoga, and other body
awareness exercises Fr: Armutlu K. 2010. Ataxia: Physical Therapy and Rehabilitation Applications for Ataxic Patients. In: JH Stone, M Blouin,
editors. International Encyclopedia of Rehabilitation. Available online:
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http://cirrie.buffalo.edu/encyclopedia/en/article/112/
17
 Activities for improving balance
1. Stabilization exercises of the proximal and trunk muscles
2. Mat activities using PNF techniques
To establish static and dynamic stability in neurodevelopmental positions
Train the patient to assume different neuro-developmental positions
the patient should be trained to come to the bridge position from lying on the
back, onto the forearms from lying face down, to crawl, and to come onto the
knees, half knees and into a sitting position
Then the patient should be taught how to maintain the required position (static
stability)
by approximation and verbal directions
strengthened static stability through external perturbation (pushing and pulling in
different directions)
Afterwards, the patient should be trained in these positions for weight transference and
functional extension so as to be prepared for dynamic stabilization
Subsequently, the patient should be trained in positions in which the support surface is
narrowed or the center of gravity is changed in order to make the balance activities
difficult
e.g. establishing balance on two or three extremities in the crawling position or shifting the center of gravity
upwards by the elevation of the arms in the sitting-on-the-knees position (Addler et al. 2000) 18
 Activities for improving balance
3.Balance in the standing position
weight transference to the front, back and sides, narrowing the support
surface, balance training in tandem position, balance training on one leg
4. Balance training on the posturography device
Another option
in order to benefit from visual feedback obtained from observing the
patient's ability to sustain his/her postural oscillation in the center of
gravity (Qutubuddin et al. 2007)
5. Gait training
The best indicator of dynamic stabilization/balance
walking on two narrow lines, tandem gait, backward gait, slowed down
gait (soldier's gait), stopping and turning in response to sudden
directions, flexion, extension and left-right rotations of the head.
6. Tai Chi (Hackney&Earhart 2008) and Yoga
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 Vestibular exercises
For patients with vertigo and other vestibular problems
Since dizziness accompanies balance dysfunction
exercise program that consists of repetitive, progressively more difficult, eye, head and body
movements designed to encourage movement and facilitate sensory substitution

Repetitive head movements

Cawthorne and Cooksey exercises
Brandt-Daroff exercises
Epley maneuver

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Cawthorne and Cooksey exercises

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 Approaches to extremity ataxia
are utilized to provide fixation by establishing balance between the eccentric and concentric
contractions within the multi-joint movements of lower extremities and the upper extremities
During the performance of these exercises, it is important to establish slow, controlled and reciprocal
multi-joint movement and stabilization

1. Frenkel's coordination exercises

Specifically developed for this purpose (Edwards 1996, Danek 2004)
2. Repeated contractions (PNF)
- can be utilized on their own or by combining them with Frenkel's coordination exercises (Armutlu et al.
2001)
3. Rhythmic stabilization and combination of isotonic techniques (Adler et al. 2000)
4. Coordination Dynamics Therapy (CDT)
developed by Dr. Giselher Schalow
This therapy "improves the self-organization of the neuronal networks of the CNS for functional repair by
exercising extremely exact coordinated arm and leg movements on a special device (GIGER MD) and, in turn, the
coordinated firing of the many billions of neurons of the human CNS" (Schalow 2006, Schalow 2004, Schalow
2002)
Note:
#1 & 2 are effective in cases with mild extremity ataxia, but they can be insufficient in severe cases
#3 more effective for severe cases
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 Use of supportive aids
Used in cases wherein restorative physical
treatment applications are insufficient
enables the patient to function more easily within
his present functional level
In cases of severe ataxia, suspending weights from
the extremities and the use of weighted walkers
can be preferred (Gibson-Horn 2008)

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 Sports activities
Horse riding, swimming, playing billiards, golf and
darts are suitable (Bertoti 1988, Hammer et al.
2005)

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FRENKELS EXERCISES

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 Inroduction
Developed by Dr. H.S.Frenkel for tabes dorsalis patients whose prominent symptom was
ataxia
was a Medical Superintendent of the Sanatorium Freihof in Switzerland towards the
end of the last century
Since then his methods have been used to treat the incoordination which results from
many other diseases, e.g. disseminated sclerosis
Treatment program that consist of systematic and graduated exercises applied for the lower
limb and designed to overcome the incoordination and proprioception loss by visual
feedback
Exercises are designed primarily for coordination
As an alternative method of control
they are not intended for strengthening
It is a process of motor learning
The process is similar to that required to learn any new exercise
the essentials being:
Concentration of the attention
Precision
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Repetition
 Goal of Frenkels exercise
General/ ultimate goal of the exercise:
Enable the patient to carry out activities that are
essential for independence in everyday life
Compensate for the loss of proprioceptive &
kinaesthetic sensation
inability to tell where the limbs are in space without
looking
Via :
establishment of voluntary control of movement by
the use of any part of the sensory mechanism which
remained intact, notably sight, sound and touch 30
 Technique
The patient is positioned and suitably clothed so that he can see the limbs throughout the exercise.
It is important that the area is well lit and that the patient is positioned so that he/she can watch the movement
of the limbs
A concise explanation and demonstration of the exercise is given before movement is attempted, to give the patient a
clear mental picture of it
Commands should be given in an even, slow voice
the exercises should be done to counting
The speed of movement is dictated by the physiotherapist by means of rhythmic counting, movement of her hand, or
the use of suitable music
The patient must give his full attention to the performance of the exercise to make the movement smooth and
accurate.
Exercises should be done within normal range of motion to avoid over-stretching of muscles
The range of movement is indicated by marking the spot on which the foot or hand is to be placed.
The first simple exercises should be adequately performed before progressing to more difficult patterns
The exercise must be repeated many times until it is adequately and easily performed: It is then discarded and a more
difficult one is substituted.
Avoid fatigue.
- As these exercises are very tiring at first, frequent rest periods must be allowed.
The patient retains little or no ability to recognise fatigue, but it is usually indicated by deterioration in the quality
of the movement, or by a rise in the pulse rate.
Perform each exercise not more than four times. Rest between each exercise.
The exercise routine takes about hour and should be done 2 times daily

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 Progression
can be achieved by altering the speed, range and complexity of the exercise
1. Speed
Start with fast then slow movement
quick movements require less control than slow ones
Later, alteration in the speed of conservative movements and interruptions which involve stopping and
starting to command are introduced
2. Range of movement
Start by proximal then by distal joints
Wide range and primitive movements, in which large joints are used, gradually give way to those
involving the use of small joints, limited range and a more frequent alteration of direction
3. Complexity of exercise
Simple before complex
simple movements are built up into sequences to form specific actions which require the use and
control of a number of joints and more than one limb, e.g. walking.
unilateral then bilateral
symmetrical then asymmetrical movement
4. Position
According to the degree of disability, re-education exercises start in lying with the head propped up and
with the limbs fully supported and progress is made to exercises in supine, sitting, standing, walking (4
basic positions used)
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The patient must see the movements and verbal feedback is very important
EXAMPLES OF FRENKELS
EXERCISES

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 from Susan O'Sullivan
Half-lying:
1. hip and knee flexion and extension of each limb, foot flat on the plinth
2. hip abduction and adduction on each limb with the foot flat, knee flexed; then with knee extended
3. hip and knee flexion and extension of each limb, heel lifted off the plinth
4. Heel one limb to opposite leg (toes,ankle shin,patella)
5. heel of one limb to opposite knee, sliding down crest of tibia to ankle
6. hip and knee flexion and extension of both limbs, legs together
7. reciprocal movements of both limbs-flexion of one leg during extension of the other
Sitting:
1. knee flexion and extension of each limb, progress to marking time
2. Hip abduction and adduction
3. alternate foot placing to a specified target (using floor markings or a grid)
4. Standing up and sitting down :to a specified count
Standing:
1. foot placing to a specified target (floor marking or a grid)
2. weight-shifting
Walking:
1. sideways or forward to a specified count
2. turning around to a specified count (floor markings can be helpful in maintaining a stable base of
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support-(BOS)
 Exercise for the legs in lying
Starting position:
Lying on bed or couch with a smooth surface along which the feet may be moved easily
The head should be raised on a pillow so that the patient can see every movement.

1. Hip abduction and adduction

The leg is fully supported throughout on the smooth surface of a plinth or on a re-
education board
2. One Hip and Knee flexion and extension
The heel is supported throughout and slides on the plinth to a position indicated by
the PT
3. One Leg raising top/ace Heel on specified mark
The mark may be made on the plinth, on the patients other foot or shin, or the heel
may be placed in the palm of the physiotherapists hand
4. Hip and Knee flexion and extension, abduction and adduction
The legs may work alternately or in opposition to each other
Stopping and starting during the course of the movement may be introduced to
increase the control required to perform any of these exercises
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 Exercise for the legs in lying
5. Bend one leg at the hip and knee with the heel raised from the bed.
Straighten your leg to return to the starting position. Repeat with the
other leg.

6. Bend and straighten one leg at the hip and knee sliding your heel
along the bed stopping at any point of command. Repeat with the other
leg.

7. Bend the hip and knee of one leg and place the heel on the opposite
knee. Then slide your heel down the shin to the ankle and back up to
the knee. Return to starting position and repeat with the other leg.

8. Bend both hips and knees sliding heels on the bed keeping your
ankles together. Straighten both legs to return to starting position.

9. Bend one leg at the hip and knee while straightening the other in a
bicycling motion. 36
 Exercise for the legs in sitting
Starting position:
Sit on a chair with feet flat on the floor.

1. one Leg stretching, to slide Heel to a position indicated by a mark on the floor.
2. Marked time, Raise just the heel
- Then progress to alternate lifting
3. Lift leg and place foot on a marked point on the floor or a traced foot print
4. Make two cross marks on the floor with chalk. Alternately glide the foot over the marked
cross:
forward, backward, left and right
4. alternate Leg stretching and lifting to place Heel or Toe on specified mark
- One leg is stretched to slide the heel to a position indicated by a mark on the floor
- The alternate leg is lifted to place the heel on the marked point
5. Sitting to standing and vise versa
Learn to rise from the chair and sit again to a counted cadence
From stride sitting progress with knees together
At one, bend knees and draw feet under the chair; at two, bend trunk forward; at 37 three,
rise by straightening the hips and knees and then the trunk. Reverse the process to sit
 Exercise for the legs in standing
Starting position: Stand erect with feet 4 to 6 inches apart.
Stride standing;
1. transference of weight from Foot to Foot
2. Place foot forward and backward on straight line
3. March
Walking
1. walking placing Feet on marks
a. Walk forward placing each foot on a footprint traced on 3. turn round
the floor. Foot prints should be parallel and 2 inches
from a center line. The length of the stride can be varied by
the physiotherapist according to the patients capacity
Practice with quarter steps, half steps, three-quarter
steps, and full steps
b. Walk forward between two parallel lines 14 inches apart
placing the right foot just inside the right line and the left
foot just inside the left line. Emphasize correct placement.
Rest after 10 steps.
Walking
2. walking sideways placing Feet on marks on the floor
Some support may be necessary, but the patient must be
able to see his feet.
Perform this exercise in a counted cadence: At one, shift the
weight to the left foot; at two, place the right foot 12 inches
to the right; at three, shift the weight to the right foot; at
four, bring the left foot over to the right foot.
Repeat exercise with half steps to the left. The size of the
step taken to right or left my be varied.
Patients find this difficult and are helped by marks on the
floor.
Turn to the right. At one, raise the right toe and rotate the
right foot outward, pivoting on the heel; at two, raise the left
heel and pivot the left leg inward on the toes; at three,
completing the full turn, and then repeat to the left.
4. walking and changing direction to avoid obstacles
5. Walk up and down the stairs one step at a time
Place the right foot on one step and bring the left up beside
it. Later practice walking up the stairs placing one foot on
each step. At first use the railing, then as balance improves
dispense with the railing.
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 Note:
Group work is of great value as control improves, as it teaches the
patient to concentrate on his own efforts without being distracted
by those of other people.

In walking, patient gains confidence and becomes accustomed to

moving about with others, to altering direction and stopping if he
wishes, to avoid bumping into them.

The ability to climb stairs and to step on and off a curb helps him
to independence.

Diversional activities such as planting, building with toy bricks, or

drawing on a blackboard, lead to more useful movements such as
using a knife and fork, doing up buttons and doing the hair

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 Exercises for the arms
Various coordination boards may be used to improve eye-hand
coordination
Can also use a blackboard and chalk
Change a minus sign to a plus sign; copy simple diagrams (straight lines,
circles, zig-zag lines, etc.)

Sitting (one Arm supported on a table or in slings)

1. Shoulder flexion or extension to place hand on a specified mark
2. one Arm stretching, to thread it through a small hoop or ring
3. picking up objects and putting them down on specified marks.

Standing or walking
1. Arm swing forwards and backwards (with partner, holding two
sticks).
2. bounce and catch, or throw and catch a ball 40
Sample exercise for MS
fr: Physical Therapy Online

41
1.Sit on the chair without touching the chair
back. Keep your hands on the knees and try to
hold your balance. If it is possible rise on leg
from the ground, then another. If not - then
slowly slide you heel in front, and then slowly
come back.

2. Sit on the chair. Bend your arms in the

elbow joints for 90 degrees. Hold one of the
palm looking up wards, other hands -
downwards. In same time change placement
of the palms. (One who was looking up- now
looks down, and who was looking down -
looking up). Perform this very fast and if made
a mistake, don't worry and continue
performing this exercise.

3. Bend and put your both arms on the chest.

Then simultaneously rise one hand forward,
other backwards. Come back to starting
position and repeat to the other sides.
Perform this exercise as fast as you can.
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4.Stand of four limbs:
a. Rise left and forward and hold it for
5s, then come back to starting
position. Rise right hand and repeat.
b. Extend left foot backwards and hold
it for 5s. Repeat with other foot.
c. 1. Rise on leg and arm
simultaneously and hold it until you
count to 5s. Come to starting position
and do it with other limbs.

5. Kneel on the floor

Place right knee in front that way that
left heel would be in one line with
right knee.
Try to hold your balance while in this
position, if it is too hard - place right
knee wider. Try to keep your back
straight.
Repeat this with other side 43
6. Standing with closed legs
a. hold balance for 30s
b. stand with different arm positions (on the
chest, spread and to the sides) - every time
hold for 30s.
After that, if possible perform the above
exercises with closed eyes

7. Stand and place one foot in front of another

a. stand for 30s and try to hold balance
b. progress by standing on an unstable
surface or simply pillow
Later do the exercises with closed eyes

8. Walk forward and backwards by placing your

foot in front of other foot (in one line)
You can change placement of the arms
while walking (look at the picture)
The distance should be ~5m. or ~16ft
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9. Stand in one spot. Legs spread in shoulder wide.
Slowly lean forward and transfer your body weight
on the fingers. Then slowly lean backwards and
transfer your body weight on the heels. (don't lift
your fingers or heels from the floors during this
exercise).
Slowly lean to the left by transferring body weight
to the left leg, then to the right side and right leg.
Then combine all movement in one motion.
Slowly make a circle by moving like pendulum.
In time increase amplitude of the motions. (when
doing this exercise for the first time for the safety
ask someone for help)

10. Stand on right (left) foot

slowly transfer body weight on the heel and lifting
your fingers. Come back to starting position.
Slowly transfer weight on the fingers, lift your
heel. Come back to starting position. Repeat with
other side.
You can make this exercise on the unstable
surface, pillow or with closed eyes.
45
11. Stand on the soft or unstable surface
(pillow)
Keep legs shoulder wide. Slowly lean
forward and hold this position 2s. Come
back to normal position. Slowly lean
backwards and hold 2s. Come back to
normal position

12. Walk to the sides by crossing your legs.

Don't forget to change how you cross your
legs.
Later you can make this exercise with
closed eyes

13. Walk (march by rising you knees) in the

line and throw ball from one hand to
another.
You can do this in one place in front of the
wall by marching in the place and
bouncing ball from the wall. 46
14. Walk in the line, place some object on the
ground, walk in the line. Spin around, walk,
take the object, walk. You get better result if
walk by placing foot in front of other foot.

15. Walk forward 4-8 steps, then stop, spin

around 180 degrees, walk backwards 4-8 steps.
Repeat.
You will get better results if walk foot-by-
foot.
Later you can do this exercise with closed
eyes

16. Walk forward 4-8 steps, spin around 360

degrees in one spot, walk forward 4-8 steps
again.
Watch out for dizziness. don't spin around to
fast 47
17.Place some obstacles on the
floor ( it can be every day
objects ). Walk by going
around or overstep these
obstacles

18. Walk by making "8

19. Walk forward and

backwards by bouncing and
catching ball

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END

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