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1 DEEP BREATHING... BREATHING EXERCISE: EXERCISE SUGGESTIONS: Use a comfortable chair. Relax your back. Your feet should touch the floor or be supported comfortably. Inhale through nose, exhale with pursed lips. Make exhaling slower and longer than inhaling. PRACTICE INHALING AND EXHALING A FEW TIMES TO GET USED TO THE SLOWER EXHALATION. A. INHALE: Spread fingers out. Place both hands on stomach. Concentrate on expanding belly as you inhale through nose. B. EXHALE: Slowly exhale through pursed lips. The exhale should be longer and slower than the inhale. times, times per day. RELAXATION and STRESS... GOALS OF RELAXATION ARE TO: Release tension and stress in various parts of the body Reduce irritability, nervousness, and anxiety Improve concentration skills WARNING SIGNS: Learn to recognize the warning signs of stress: PHYSICAL SYMPTOMS:. tightness in neck and shoulders. high blood pressure. fatigue. irritated bowels. grinding of teeth EMOTIONAL SYMPTOMS:. anger. depression. irritability. apathy. overeating. disturbed sleep pattern Page 1 of 7

2 SHOULDER - 1 Flexion: ROM (Supine) SHOULDER - 6 Extension: ROM (Sitting) Position (A) Helper: arm close to side of trunk. Motion (B) - Lift arm over head in line with trunk, palm turned inward. not push into shoulder joint. not force movement if painful. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. Position (A) Patient: Keep trunk steady. Relax shoulder. Helper: Stabilize behind shoulder. arm above elbow with other hand. Motion (B) - Bring elbow back gently. not force motion if painful. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. SHOULDER - 10 Abduction: ROM (Sitting) ELBOW - 1 FLEXION: ROM (Supine / Sitting) Position (A) Helper: Bend your knees to reach for arm. Motion - Keep thumb pointed in direction of movement. - Lift arm out to side. (B) - Raise above head to complete an arc. (C) with other arm. not force movement if painful. not push into shoulder joint. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. Position (A) Patient: Place arm against side of trunk. Helper: elbow to stabilize. Motion (B) - Lift hand toward shoulder, palm up. - Keep wrist straight. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. Page 2 of 7

3 ELBOW - 5 Extension: ROM (Sitting) Position Helper: Place one hand under elbow to stabilize. Motion - Straighten elbow fully. - Helper assists by using gentle downward pull. not force elbow joint. with other arm. Variation: Contract method: Resist (see card G.G.- 14) Patient is passive. ELBOW - 13 Pronation: Resisted (Sitting) Position Patient: Bend elbow to 90. arm firmly at side, thumb up. Helper: Place hand on upper arm to stabilize. Motion - Cue patient to turn forearm so palm faces down. - Helper resists throughout motion with hand on palm side of forearm. - Elbow remains in place. Relax. with other arm. ELBOW - 14 Supination: ROM (Sitting) Position (A) Helper: Bend elbow to 90. arm at side with thumb up. Motion (B) - Turn forearm so palm faces up. not push into elbow joint. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. FINGER - 15 Extension: ROM Position (A) Helper: Stabilize hand near wrist. Support fingers at tips. Motion (B) - Straighten fingers fully. - Helper assists by guiding all fingers straight. not force movement. with other hand. Variation: Perform with wrist bent back to. Perform with wrist flexed toward palm. Patient is passive. Page 3 of 7

4 ELBOW - 1 Flexion (Passive) ELBOW - 2 Flexion (Assistive) Use other hand to bend elbow, with thumb toward same shoulder. NOT force this motion. With towel under forearm resting on smooth table, slide hand toward chest to bend elbow. ELBOW - 6 Extension (Passive) ELBOW - 7 Extension (Assistive) With towel under forearm resting on smooth table, slide hand away from chest to straighten elbow. Place thick telephone book on table and rest upper arm on it. Grasp forearm with other hand and use a steady downward and outward pull to straighten elbow. Activity: Swing object, such as briefcase, to straighten elbow.* Activity: Use this motion to rub lotion on opposite arm. Page 4 of 7

5 SCAPULA - 1 Elevation (Passive) SCAPULA - 3 Depression (Passive) Place opposite hand under armpit. Push upward. Place opposite hand on top of shoulder. Apply steady pressure downward. SCAPULA - 5 Protraction (Passive) SCAPULA - 6 Protraction/Retraction (Assistive) Clasp hands together. Keeping elbows straight, slide arms forward, assisting with opposite hand, without moving trunk. Use table surface for support. Sit close to table edge and rest arm on surface with elbow straight. Slide entire arm forward as far as you can, then back. Use only shoulder blade movements. Place towel under arm for easier sliding. Page 5 of 7

6 FOREARM - 1 Pronation (Passive) FOREARM - 2 Pronation (Assistive) Keep elbow bent at right angle and held firmly to side. Use other hand to turn forearm until palm faces downward. With forearm resting on table, elbow bent and palm facing center, turn palm down. Keep elbow at side and wrist straight. FOREARM - 6 Supination (Passive) FOREARM - 7 Supination (Assistive) Keep elbow bent at right angle and held firmly at side. Use other hand to turn forearm until palm faces upward. Start with forearm on table, thumb up and elbow held at side. Turn palm upward as far as possible. Page 6 of 7

7 SHOULDER - 21 Abduction (Passive) SHOULDER - 29 Horizontal Abduction/Adduction (Isometric) With arm out to side, resting on table, lower head toward arm, keeping trunk away from table. Clasp forearms with hands. Pull apart then push together without actually moving arms. seconds in each position. Relax. STROKE - 16A Supine Reach Use stronger arm to move involved arm straight up. Try to keep arm up after letting go with stronger arm. Page 7 of 7

8 CHART COPY Routine For: DEEP BREATHING... EXERCISE SUGGESTIONS: Use a comfortable chair. BREATHING EXERCISE: RELAXATION and STRESS... GOALS OF RELAXATION ARE TO: Relax your back. Your feet should touch the floor or be supported comfortably. Inhale through nose, exhale with pursed lips. Make exhaling slower and longer than inhaling. PRACTICE INHALING AND EXHALING A FEW TIMES TO GET USED TO THE SLOWER EXHALATION. A. INHALE: Spread fingers out. Place both hands on stomach. Concentrate on expanding belly as you inhale through nose. B. EXHALE: Slowly exhale through pursed lips. The exhale should be longer and slower than the inhale. times, times per day. Release tension and stress in various parts of the body Reduce irritability, nervousness, and anxiety Improve concentration skills WARNING SIGNS: Learn to recognize the warning signs of stress: PHYSICAL SYMPTOMS:. tightness in neck and shoulders. high blood pressure. fatigue. irritated bowels. grinding of teeth EMOTIONAL SYMPTOMS:. anger. depression. irritability. apathy. overeating. disturbed sleep pattern SHOULDER - 1 Flexion: ROM (Supine) Position (A) Helper: arm close to side of trunk. Motion (B) - Lift arm over head in line with trunk, palm turned inward. not push into shoulder joint. not force movement if painful. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. SHOULDER - 6 Extension: ROM (Sitting) Position (A) Patient: Keep trunk steady. Relax shoulder. Helper: Stabilize behind shoulder. arm above elbow with other hand. Motion (B) - Bring elbow back gently. not force motion if painful. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. SHOULDER - 10 Abduction: ROM (Sitting) Position (A) Helper: Bend your knees to reach for arm. Motion - Keep thumb pointed in direction of movement. - Lift arm out to side. (B) - Raise above head to complete an arc. (C) with other arm. not force movement if painful. not push into shoulder joint. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. ELBOW - 1 FLEXION: ROM (Supine / Sitting) Position (A) Patient: Place arm against side of trunk. Helper: elbow to stabilize. Motion (B) - Lift hand toward shoulder, palm up. - Keep wrist straight. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. ELBOW - 5 Extension: ROM (Sitting) Position Helper: Place one hand under elbow to stabilize. Motion - Straighten elbow fully. - Helper assists by using gentle downward pull. not force elbow joint. with other arm. Variation: Contract method: Resist (see card G.G.- 14) Patient is passive. ELBOW - 13 Pronation: Resisted (Sitting) Position Patient: Bend elbow to 90. arm firmly at side, thumb up. Helper: Place hand on upper arm to stabilize. Motion - Cue patient to turn forearm so palm faces down. - Helper resists throughout motion with hand on palm side of forearm. - Elbow remains in place. Relax. with other arm. ELBOW - 14 Supination: ROM (Sitting) Position (A) Helper: Bend elbow to 90. arm at side with thumb up. Motion (B) - Turn forearm so palm faces up. not push into elbow joint. with other arm. Variation: Contract method: Resist (see card G.G.-14) Patient is passive. FINGER - 15 Extension: ROM Position (A) Helper: Stabilize hand near wrist. Support fingers at tips. Motion (B) - Straighten fingers fully. - Helper assists by guiding all fingers straight. not force movement. with other hand. Variation: Perform with wrist bent back to. Perform with wrist flexed toward palm. Patient is passive. Page 1 of 3

9 CHART COPY Routine For: ELBOW - 1 Flexion (Passive) ELBOW - 2 Flexion (Assistive) ELBOW - 6 Extension (Passive) Use other hand to bend elbow, with thumb toward same shoulder. NOT force this motion. With towel under forearm resting on smooth table, slide hand toward chest to bend elbow. Place thick telephone book on table and rest upper arm on it. Grasp forearm with other hand and use a steady downward and outward pull to straighten elbow. Activity: Swing object, such as briefcase, to straighten elbow.* ELBOW - 7 Extension (Assistive) SCAPULA - 1 Elevation (Passive) SCAPULA - 3 Depression (Passive) With towel under forearm resting on smooth table, slide hand away from chest to straighten elbow. Place opposite hand under armpit. Push upward. Place opposite hand on top of shoulder. Apply steady pressure downward. Activity: Use this motion to rub lotion on opposite arm. SCAPULA - 5 Protraction (Passive) SCAPULA - 6 Protraction/Retraction (Assistive) FOREARM - 1 Pronation (Passive) Keep elbow bent at right angle and held firmly to side. Use other hand to turn forearm until palm faces downward. Clasp hands together. Keeping elbows straight, slide arms forward, assisting with opposite hand, without moving trunk. Use table surface for support. Sit close to table edge and rest arm on surface with elbow straight. Slide entire arm forward as far as you can, then back. Use only shoulder blade movements. Place towel under arm for easier sliding. FOREARM - 2 Pronation (Assistive) FOREARM - 6 Supination (Passive) FOREARM - 7 Supination (Assistive) With forearm resting on table, elbow bent and palm facing center, turn palm down. Keep elbow at side and wrist straight. Keep elbow bent at right angle and held firmly at side. Use other hand to turn forearm until palm faces upward. Start with forearm on table, thumb up and elbow held at side. Turn palm upward as far as possible. Page 2 of 3

10 CHART COPY Routine For: SHOULDER - 21 Abduction (Passive) SHOULDER - 29 Horizontal Abduction/Adduction (Isometric) STROKE - 16A Supine Reach With arm out to side, resting on table, lower head toward arm, keeping trunk away from table. Clasp forearms with hands. Pull apart then push together without actually moving arms. seconds in each position. Relax. Use stronger arm to move involved arm straight up. Try to keep arm up after letting go with stronger arm. COMMENTS: Patient Name/Number: Clinician Name/Signature: Date: Page 3 of 3

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