PD WARRIOR MODULE 2. Copyright PD Warrior 2012

Transcription

1 PD WARRIOR MODULE 2 1

2 PD WARRIOR STATIONS 1 PARTNER BALL PASS 2 TWINKLE TOES 3 DOUBLE STEP TAP 4 BIKE SPRINTS 5 SKY REACH 6 GUN SHOT 7 PARTNER BOX 8 POWER LUNGE 9 PENGUIN WADDLE 10 TAHDAS 11 HURDLE CLICKS 12 PUSH STEPS 13 BANDED SIDESTEP 14 POWER SWIVEL 15 OVER THE RIVER 16 GRAPEVINE 17 SCARF SNATCH 18 CLAP TAPS 19 SWIVEL AND SLAM 20 STOP AND SQUAT 21 SWISS BALL BOUNCE 22 HIGH KNEE KICKS 23 SATURDAY NIGHT FEVER 24 CROSS HOP DEGREE CUP CHANGE 26 RIVERSTONE CLOCKFACE 27 PARTNER KICKS 28 BALL SLAMS & BALANCE 29 HELICOPTER PARTNER CLAPS 30 CAN CAN 31 BOX STEP 32 FLOOR KNEEL 33 ARM BURNER OVER LADDER 2

3 WEEK 1 WARM UP 1 PARTNER BALL PASS TWINKLE TOES 2 ARM BURNER OVER LADDER GUN SHOT 3 SKY REACH RIVERSTONE CLOCKFACE 4 PARTNER BOX PARTNER BOX 5 POWER LUNGE PENGUIN WADDLE 6 TAHDAS HURDLE CLICKS 7 PUSH STEPS BANDED SIDESTEP 8 POWER SWIVEL OVER THE RIVER COOL DOWN EQUIPMENT REQUIRED SOFT BALL X 2 STEP ARM BURNER LADDER RIVERSTONES CHAIR BOXING PADS & SHIELD AGILITY DOTS SCARVES X 2 HURDLES & CLICKER RESISTANCE BAND 3

4 WEEK 2 WARM UP 1 GRAPEVINE SCARF SNATCH 2 CLAP TAPS BIKE SPRINTS 3 SKY REACH GUN SHOT 4 PARTNER BOX PARTNER BOX 5 POWER LUNGE PENGUIN WADDLE 6 SWISS BALL BOUNCE HURDLE CLICKS 7 PUSH STEPS BANDED SIDESTEP 8 SWIVEL & SLAM OVER THE RIVER COOL DOWN EQUIPMENT REQUIRED SCARVES X2 BIKE CHAIR BOXING PADS & SHIELD SWISS BALL AGILITY DOTS HURDLES & CLICKER SOFT BALL X 2 RESISTANCE BAND 4

5 WEEK 3 WARM UP 1 OVERHEAD BALL THROW STOP AND SQUAT 2 SCARF SNATCH HURDLE CLICKS 3 DOUBLE STEP TAP GRAPEVINE 4 PARTNER BOX PARTNER BOX 5 RIVERSTONE CLOCKFACE POWER SWIVEL 6 TAHDAS WITH RIBBONS PENGUIN WADDLE 7 HIGH KNEE KICKS GUN SHOT 8 OVER THE RIVER SATURDAY NIGHT FEVER COOL DOWN EQUIPMENT REQUIRED SOFT BALL X1 CHAIR X2 SCARVES HURDLES & CLICKER STEPS BOXING PADS & MITTS RIVERSTONES RIBBONS AGILITY DOTS RESISTANCE BAND 5

6 WEEK 4 WARM UP 1 CROSS HOP GUN SHOT DEGREE CUP CHANGE RIVERSTONE CLOCKFACE 3 DOUBLE STEP TAP BIKE SPRINTS 4 PARTNER KICKS PARTNER KICKS 5 BALL SLAMS & BALANCE HELICOPTER PARTNER CLAP 6 HIGH KNEE KICKS BOX STEP 7 OVER THE RIVER FLOOR KNEEL 8 SWISS BALL BOUNCE HURDLE CLICKS COOL DOWN EQUIPMENT REQUIRED FLOOR MARKINGS CUPS X 10 RIVERSTONES STEPS BIKE BOXING PADS & MITTS BALL AND BALANCE MAT CHAIR AGILITY DOTS SWISS BALL HURDLES & CLICKER 6

7 WEEK 5 WARM UP 1 CAN CAN FLOOR KNEEL 2 SCARF SNATCH 180 DEGREE CUP CHANGE 3 PUSH STEPS SWISS BALL BOUNCE 4 CHALLENGE TASK CHALLENGE TASK 5 BALL SLAMS & BALANCE TOE WRESTLING 6 BANDED SIDESTEP RIVERSTONE CLOCKFACE 7 POWER LUNGE PENGUIN WADDLE 8 CROSS HOP SKY REACH COOL DOWN EQUIPMENT REQUIRED CHAIRS X 2 SCARVES X 2 CUPS X 10 SWISS BALL BOXING PADS & MITTS BALLS X 2 BALANCE FOAM RESISTANCE BAND RIVERSTONES BALL AGILITY DOTS FLOOR MARKINGS 7

8 WEEK 6 WARM UP 1 PARTNER BALL PASS TOE WRESTLING 2 HIGH KNEE KICKS BIKE SPRINTS 3 SATURDAY NIGHT FEVER BOX STEP 4 PARTNER BOX PARTNER BOX 5 SWIVEL AND SLAM ARM BURNER OVER LADDER 6 TAHDAS HURDLE CLICKS 7 CLAP TAPS OVER THE RIVER 8 GUN SHOT GRAPEVINE COOL DOWN EQUIPMENT REQUIRED SOFT BALL X2 CHAIR X2 BIKE RESISTANCE BAND AGILITY DOTS BOXING PADS & MITTS ARM BURNER LADDER SCARVES HURDLES & CLICKER 8

9 WEEK 7 WARM UP 1 PARTNER BALL PASS TWINKLE TOES 2 STOP AND SQUAT HURDLE CLICKS 3 DOUBLE STEP TAP BIKE SPRINTS 4 PARTNER BOX PARTNER BOX 5 SWISS BALL BOUNCE POWER SWIVEL 6 BANDED SIDE STEP PENGUIN WADDLE 7 FLOOR KNEEL ARM BURNER OVER LADDER 8 CAN CAN OVERHEAD BALL THROW COOL DOWN EQUIPMENT REQUIRED SOFT BALL X2 STEP CHAIR HURDLES & CLICKER STEPS BIKE BOXING PADS & SHIELD SWISS BALL RESISTANCE BAND AGILITY DOTS ARM BURNER LADDER 9

10 WEEK 8 WARM UP DEGREE CUP CHANGE HURDLE CLICKS 2 SCARF SNATCH FLOOR KNEEL 3 BIKE SPRINTS BOX STEP 4 PARTNER KICKS PARTNER KICKS 5 HELICOPTER PARTNER CLAPS TWINKLE TOES 6 OVER THE RIVER STOP AND SQUAT 7 CROSS HOP OVERHEAD BALL THROW 8 BALL SLAMS & BALANCE PARTNER BALL PASS COOL DOWN EQUIPMENT REQUIRED CUPS X 10 HURDLES & CLICKER SCARVES CHAIR X 2 BIKE AGILITY DOTS BOXING PADS & SHIELD STEP FLOOR MARKINGS SOFT BALL X 2 BALANCE MAT 10

11 WEEK 9 WARM UP 1 SATURDAY NIGHT FEVER HURDLE CLICKS 2 SCARF SNATCH FLOOR KNEEL 3 CAN CAN ARM BURNER OVER LADDER 4 PARTNER BOX PARTNER BOX 5 HELICOPTER PARTNER TAPS TWINKLE TOES 6 PENGUIN WADDLE POWER LUNGE 7 GRAPEVINE SWISS BALL BOUNCE 8 PUSH STEPS HIGH KNEE KICKS COOL DOWN EQUIPMENT REQUIRED RESISTANCE BAND HURDLES & CLICKER SCARVES CHAIR ARM BURNER LADDER BOXING PADS & SHIELD STEP AGILITY DOTS SOFT BALL X 2 SWISS BALL BOUNCE 11

12 WEEK 10 WARM UP 1 OVERHEAD BALL THROW GRAPEVINE 2 SCARF SNATCH LADDER STEP & ARM BURNER 3 CLAP TAPS BIKE SPRINTS 4 PARTNER BOX PARTNER BOX 5 BALL SLAMS & BALANCE TOE WRESTLING 6 SATURDAY NIGHT FEVER BOX STEP 7 HELICOPTER PARTNER CLAP TWINKLE TOES 8 POWER LUNGE SKY REACH COOL DOWN EQUIPMENT REQUIRED SOFT BALL X2 SCARVES ARM BURNER LADDER BIKE BOXING PADS & SHIELD BALANCE FOAM RESISTANCE BAND STEPS AGILITY DOTS 12

13 EXERCISE INFO PARTNER BALL PASS This exercise focuses on axial rotation and vestibular balance. This is a partner exercise. Have both partners back to back with one holding the ball with two hands. They will need to be closely matched physically. Have the one with the ball turn to the left and pass the ball to their partner without letting go of either hand until the transfer. After the partner has collected the ball the first person then swings to the other side to collect the ball from their partner, again with both hands. Precautions Modify for back and balance concerns Progressions You can use a medicine ball, reduce the base of support and increase the speed of the exercise 13

14 TWINKLE TOES This exercise is for cardio training and coordination. This can be done as a singular or partner exercise. Have your client face a step. Get them to gently tap on the step with one foot and then lower the same foot back down to the floor. Have them alternate feet doing this. Precautions Modify for balance and injury concerns Progressions Have them jump the taps so that they have a period of flight when they are changing legs. 14

15 DOUBLE STEP TAP This exercise focuses on coordination and balance. If you do not have stairs, then use V2 four polystyrene cups set up on the step about hip width apart. V1. Have the patient face the stairs and ask them to tap the first step, then the second step and then the first step and then the floor. Repeat with alternating foot in the same pattern. V2. Have the patient face the step and ask them to tap two cups in turn and then return to the floor. Repeat with alternating foot. Precautions. Have a sturdy chair placed to the side within reach if there are balance concerns. Progression Increase speed of taps, include upper limb task which is flick, close. 15

16 BIKE SPRINTS This exercise is designed to force use and increase overall speed of activity. Keep the resistance as low as possible and aim for high revolutions per minute > 80 (RPM). Have the client start with a base line speed. Every 20 seconds they need to sprint as fast as possible for 10 seconds. Each time they finish a sprint they need to stay above baseline speed. Precautions If the client has a pre-existing heart condition, heart rate max needs to remain at sub max level*. If client has had a pre-existing knee injury or joint surgery, avoid extreme ranges of motion. Progression Encourage increase baseline speed or sprint speed. Increase length of sprint. 16

17 SKY REACH The focus of this exercise is on trunk rotation and big shoulder and arm movements. This movement helps to improve range of movement in the upper back, trunk as well as in shoulders and hands. It will also help with powerful functional reaching. Have your client take a seat and use one hand to support themselves by holding on to the chair. While seated, take a wide supportive stance with your legs. When ready have them reach down and across the body with the free hand aiming to touch the floor on the outside of their foot. Bring them back up into tall sitting and continue reaching their hand diagonally in the opposite direction and up to the sky. They should feel a powerful stretch across the chest, upper back and into your arm and hand. Precautions If they find it difficult to reach all the way to the floor and across your body have them stop at their opposite knee. Progress down the shin as they feel more comfortable with the movement. Progressions Increase the amount of power in the movement. Each part of the movement should look and feel crisp and distinct from the other parts. 17

18 GUN SHOT The focus of this exercise is to work on trunk rotation. Many people with Parkinson s develop stiffness and loss of rotation through the trunk which can affect walking, turning and impact on balance as well. There is an element of balance indicated in this exercise, especially during the changing direction. Start with their feet wide apart, wider than your shoulder width. Clasp both hands together in a trigger grip, with arms straight in front, about shoulder height. Move both hands around to one side, about 90 degrees from the front. Ask the client to swivel at the opposite foot. Hold that position for one second and then return to the front. Repeat this move to the other side; again, stop about 90 degrees to the side. Precautions It is important to keep hands together and to swivel on the opposite leg to protect the back. If prone to back pain then start with a smaller rotation; perhaps only moving to 45 degrees. It may also be easier to keep eyes and head focused on the hands as you they turn to maintain balance. If that is too difficult, then have them focus on a point directly ahead of them as their body turns from side to side. Progression Start to consider putting more power into the turn and swivel, try moving as far round as they can. Remember, the ideal effort level is working at 80%. 18

19 PARTNER BOX This exercise is to encourage full upper limb motion, speed, balance and coordination. Have each partner stand and face the other partner. One partner has the mitts on while the other partner has boxing gloves on. The partner with the mitts needs to stand with legs wide apart and ready to brace. The partner with the boxing gloves stands in boxing stance. They will continue appropriate boxing drills for two minutes and then swap with the partner with the mitts. Drills may include; jab, cross, upper cuts, hook, over head and any combination of the above. 10, 20, 30, 40, 50 This exercise is aiming focus on speed, not power. Precautions. Any pre-existing shoulder, elbow or wrist injury needs to be taken into consideration and the exercise modified accordingly. Ensure care is taken with hitting the pads that no contact is made with the person behind the pads and that the force is matched an appropriate for each pair. Ensure that the boxer does not lock the elbow when striking the pads, nor flex the wrist. If the boxer is very deconditioned please monitor closely for injury Progression. Increase speed and repetition of drills. Increase complexity of drills by changing combination. 19

20 POWER LUNGE This exercise focuses on lower limb strength training, balance and axial rotation. Have your patient stand with wide base of support holding a soft ball in their hands. Have them take a big lunge forward making sure their knee comes just over the ankle. Once in this position, get them to hold this position and bring the ball around to the same side as the front leg. Get them to pause, return to the centre and push back up into standing. Precautions Back, shoulder and balance problems Progressions Encourage a deeper lunge, bigger rotation and bigger step forward where appropriate 20

21 PENGUIN WADDLE This exercise focuses on weight-shifting and is a powerful way to practice stepping. It is a really helpful tool to teach clients if they have mild episodes of freezing during gait. Set up 4 dots at least 1 foot apart in a square. Have your client stand on the back two dots facing forwards. Have your client practice shifting their weight from one dot fully to the other dot. If they are doing this correctly you will be moving from one leg, right over the other leg and then back again. Once your client has the hang of the weight shift, start them weight shift stepping around the box in a clockwise fashion. Once they have done one box then stop and reverse and go in an anticlockwise direction. Each time they step they should be moving location and alternating between left and right leg. Precautions If they get dizzy from going in a single direction or from the movement itself then please pause after each box rotation or change direction more regularly. You might also want to place a chair at either end of the box. Progression You can add arms to increase the complexity of the exercise. Add double arms up in front and then double arms out to the side alternating movement with each step they take. 21

22 TAHDAS This exercise focuses on amplitude and exaggerated movement of the shoulders, back extensors and stepping. There is a balance and coordination component. The client needs to start with legs hip width apart. Starting with the right leg, take a small step forward with high knees, at the same time both arms move out to the side. Both arms then come back into the middle as the leg steps back. Repeat with alternating legs. Ensure that both upper and lower limb movements are powerful going out and coming back, wrists and fingers are fully extended and chest is out. Precautions. Modify exercise as appropriate if there is pre-existing injury. If there are concerns about balance, place a sturdy chair close by and start with one side only, using the other hand for support. Progressions Use a foam block/hurdle as a target to step over to increase hip and knee flexion. Encourage high effort and motor output. 22

23 HURDLE CLICKS This exercise focuses on dual tasking and big stepping. Line the hurdles up in a row, about a foot or so apart. Give your patient a clicker and get them to start with it on 0. When they are ready you can get them to step over the hurdles with alternating steps moving forwards so that they don t touch the hurdles. At the same time, have them click once with the clicker in the right hand and then transfer the clicker to the other hand and repeat the process. You are aiming to see how many clicks they achieve while they continue to step (without knocking over the hurdles). Precautions Monitor for poor balance and falls. Progressions Patients can walk forwards, backwards and sideways over the hurdles. The further you space the hurdles apart the harder the stepping will become. Challenge the group by having each patient compete to see who can achieve the most clicks during the exercise. 23

24 PUSH STEPS This exercise focuses on coordination for upper and lower limbs as well as power generation. Have your patient start standing with feet wide apart. Get them to step forward and stomp. At the same time have them push forwards with both hands. The movement needs to be powerful and coordinated at both the leg and hands. After a short pause have them step back in one move behind them and at the same time retract the hands to the chest and back out to push as the foot stomps down behind them. Precautions Place a chair nearby if you are concerned about balance. Modify to any injury as appropriate. Progressions. Alternate legs, repeat single leg, increase power. 24

25 BANDED SIDESTEP This exercise focuses on posture, coordination and upper limb resistance. Start with the client holding the resistance band ends in each hand. As they step sideways, stretch the arms out fully resisting the resistance band and pushing the chest out. Hold briefly and then bring both arms back into the chest and repeat down the length of the gym. At the end reverse direction and repeat the banded arms. Precautions If there is shoulder injury, keep the arms low and avoid full resistance. Progression To make this exercise harder, use a higher resistance band and increase speed of sidesteps. To make this exercise easier, have the band run across the back of the client 25

26 POWER SWIVEL This exercise focuses on balance, trunk rotation and power arms. Have your patient start with their legs wide apart and their hands open on their thighs. Get them to swivel on the balls of their feet so that they are facing to the right. Both feet should now be parallel facing to the right. They will now have a narrow base of support. At the same time, have them push away with powerful arms left hand push to the front and right hand pushing to the back. After a short pause they should swivel back to face the front with their hands coming to land back on the legs. Repeat in the other direction. Precautions. Knee, back and shoulder problems need to be considered. If you are concerned about balance then have them start with a step to the right rather than swivel, or only to one side using a chair for support. Progressions As they swivel and push forward you can get them to come forward onto the front leg introducing some weight shift. Have them breath out with the push and focus on powerful movements. 26

27 OVER THE RIVER This exercise is excellent for helping to coordinate big strides with big powerful arm swings. It also helps with stepping and 180 degree turns. Start by placing the hurdle on the floor in front of your client. Have them take a big step over the hurdle. If leading with the left leg, have them swing the right arm forward with power and the left arm back well behind them. Keep the hands wide and open. When they have stepped over the hurdle cleanly have them turn around to face the hurdle again. The turn should be crisp and ideally achieved in four to six steps. When ready have them step over the hurdle again, leading with the opposite leg. Make sure to have them focus on swinging their arms with power and full range and bringing their knees up high as they step over the hurdle. Precautions If the turns makes them dizzy then slow them down and have them take more time with the turns. If they have trouble with knees or lower back, make the step smaller as they step over the hurdle. Progression They can try leaping over the hurdle. Aim for height, rather than distance. Make sure they have a large arm swing coordinating with the opposite leg at the same time, especially the back arm swing. 27

28 GRAPEVINE This exercise focuses on coordination of a complex lower limb activity, with or without upper limb dual tasking activity. Start with the person standing with feet wide apart. Have them take a wide step to the right, their left leg follows by stepping to the right BEHIND the right leg. They step out again with the right leg and then the left leg steps to join the right leg. Simple instructions step, behind, step, together. Repeat this leading with the left leg, stepping to the left side. Precautions. This exercise requires good balance and coordination. If you are concerned about freezing or gait instability please have your client use a chair for stability. If they have very poor coordination have them start with side stepping only. Progression To make this exercise harder, you can have them increase the speed of the grapevine, the size of the side stepping and by adding a dual upper limb task. Introduce hand flicks on each step for hand focus. 28

29 SCARF SNATCH This exercise focuses on speed and timing in the upper limbs. There is a small balance component. Start with the person holding a scarf in each hand and their feet wide apart. Have them throw one scarf high into the air, as high as they can. As it floats down, have them snatch it out of the air as it reaches shoulder height. Repeat on alternate sides. Precautions. In the case of pre-existing shoulder injury, have the person throw underarm and bending the elbow to gain force. In the case of poor balance, place a sturdy chair in front of the client. Progression To make this exercise harder, you can have them increase the speed of repetition, number of reps on each side and number of scarves they throw at a time. Try catching two scarves from the same throw. 29

30 CLAP TAPS This exercise focuses on coordination and dual tasking. Start with the person standing with legs hip width apart. Have them step forward with their left leg to the 12 O clock position. Make sure that they transfer some weight onto the left leg. At the same time have them bring their hands forward to clap in front. Then have them step out to the side at the 9 O clock position and then to the 3 O clock position. Make sure that they transfer some weight onto the left leg at each step. At the same time that they step, have them clap their hands in front again. This can be challenging for many people to coordinate both actions. Encourage people to stay tall throughout the exercise with their shoulders back and chin tucked in. Complete the three taps on the left leg before returning to the middle and starting the same process on the right leg. Precautions. In the case of pre-existing shoulder injury make sure the hands always stay below shoulder height. In the case of poor balance, place a sturdy chair to one side of the client and have them do clap taps with one side only. Progression To make this exercise harder, you can have them increase the speed of repetition, the size of the stepping or have them make a small leap onto each of the stepping legs. You can also have them clap behind themselves after they done a round of clapping in front. 30

31 SWIVEL AND SLAM This exercise focuses on power and timing. There is a small balance and trunk rotation component Start with the person standing with feet wide apart holding a ball. Have them turn to the right with their arms stretched to the ceiling and slam the ball down and catch it again. Have them stretch their arms up to the ceiling and then have them turn to the left and repeat the same action. Have them continue swivelling and slamming from right to left. Precautions. In the case of pre-existing shoulder injury, have the person keep their hands below shoulder height. In the case of poor balance, place a sturdy chair in front of the client. Progression To make this exercise harder, you can have them increase the speed of repetitions or use a ball that is flatter and requires harder slams 31

32 STOP AND SQUAT This exercise focuses on power arms and legs as well as symmetry, weight shift and lower limb strength training. Start with the person standing in front of a sturdy chair with feet hip width apart and arms by their side with hands clenched. Have them sit quickly and lightly and then come back up to standing. When they are moving to the sitting position have them push their hands out into the stop position. As they come back up into standing have them bring their hands back down to their side with hands clenched. Make sure in the stop position they extend both arms symmetrically and they don t sit down heavily. Precautions If someone complains of knee pain, they can do half time stands, or half squats from a standing position. If balance is a concern, have a sturdy chair placed in front, but not obstructing the person. In the case of pre-existing shoulder injury, change the arm position to a sideways movement. Progression. To make this exercise harder, you can have them add a jump up as they return to the standing position. 32

33 SWISS BALL BOUNCE This exercise is designed to focus on repetitive and powerful arm movements, with or without travelling. Have your patient start with a wide base of support. Get them to start bouncing the swiss ball with one hand. Make sure that the ball bounces back up to shoulder height and the client doesn t stoop to keep it bouncing. Encourage even, consistent bouncing. After a designated time you can have them swap hands or do a combination of alternating hands. Precautions Shoulder, neck and back issues need to be considered. Progressions. Have the client bounce the ball while dribbling around cones or cups on the floor. Keep them changing the leading hand. 33

34 HIGH KNEE KICKS This exercise focuses on lower limb endurance and coordination. There is a small balance component. Start with the person standing about a foot away and facing a chair without arms. Leading with their right leg have them lift the leg up and over the base of the chair from left to right. As soon as they are balanced again have them lift their left leg up and over the base of the chair from right to left. Have them repeat this action alternating from right leg to left leg. Precautions. In the case of pre-existing hip injury or replacement exercise caution. Perhaps use a lower chair or break the exercise into short sets with a rest after each set. If you are concerned about balance, have another chair or wall located close for safety Progression To make this exercise harder, you can have them increase the speed of repetitions and the number of reps on each side. You could also introduce arm reaches as the leg goes over the base of the chair to increase the cardiovascular workout. 34

35 SATURDAY NIGHT FEVER This exercise focuses on lower limb and trunk strength. Start with the person leaning their back on the wall. Slowly have them walk their feet out away from the wall until their feet are about a foot away from the wall. Then have them slide down the wall, no further than their thighs parallel to the floor. Once they are in this position, have them slide one end of a resistance band under their right foot. They will need to maintain pressure on that foot to avoid the band springing out when they apply resistance. When they are settled, have them grab the band with their left hand and pull the band from their right knee diagonally across their body. If they are strong and have no should problems then they can stop when the left hand touches the wall. They will be in the Saturday night fever position by this time. Have them pause here briefly and then lower their left hand back to the right knee. They need to control the recoil of the band and not let is fling back. They can repeat this exercise 10 times on the right and then swap it over to the left side. Precautions. Be mindful of dodgy knees making sure that they don t go too low into the squat and that their knees do not come forward over the ankles. It is a good idea to have a sturdy chair close by if they need to have a rest during the exercise or need help to get back up. In the case of pre-existing shoulder injury, have the person complete the exercise without the band or by keeping their hand lower than shoulder height at all times. Progression To make this exercise harder, you can have them increase the number of reps on each side or by going deeper into the squat. If this exercise is too hard to start with then they can stand up during each change over of arms 35

36 CROSS HOPS This exercise focuses on speed, timing and strength in the lower limbs. There is a small balance component. Mark out a cross on the floor with marking tape or Velcro. Have them start in one quarter of the cross by standing on one leg. When they are ready ask them to hop on the spot. From here they can hop clockwise into each quarter until they come back to the start. Then they can reverse by hopping anti-clockwise around the cross. Once they have hopped around the cross in each direction they can swap over legs and repeat on the other side. Precautions. In the case of pre-existing ankle or knee injury, have the person start by stepping around the cross or practice hopping in one direction only either forwards and back or side to side. In the case of poor balance, place a sturdy chair in front of the client. Progression To make this exercise harder, you can have them increase the speed of the hops and the size of the hops. They can also increase the number of repetitions of each cross hop before changing legs. If they are able, introduce an upper limb dual task such as arm folds. ARM FOLDS: Start with the arms straight and the hands open on the first hop. On the second hop, bend at the elbows bringing the hands to the shoulders, on the third hop reach up towards the ceiling, stretching up fully. On the fourth hop return the hands down to the starting position and repeat with the next complete cross hop. 36

37 180 DEGREE CUP CHANGE This exercise focuses on trunk rotation, coordination and amplitude. Set up two stations opposite each other about 1.5 metres apart and at least waist height. On one station, place 10 cups. Have your client stand in the middle of the two stations. Their job is to transfer all the cups from one station to the other only using one hand. This will mean that they need to increase axial rotation and reach sideways to pick up each cup. Precautions If you are concerned about balance have your client stand next to a rail or wall. Progressions. Have them stand with a narrow base of support or you can move the stations further apart so they have to travel between each station. 37

38 RIVERSTONE CLOCKFACE This exercise works on accuracy of movement, timing, sensory feedback and weight shift. Set up six riverstones with four in a row and two in front. Have your client stand on the two middle riverstones on the back row. Ask them to tap the riverstone in front, back to the middle and then out to the side and back to the middle again. They can repeat this move or swap to the alternating side to increase the weight shift. Try and get the patient to keep time to a beat as they step. Precautions Rolling off the riverstones is to be avoided. If you are unsure about stability then use the dots. Progressions Add additional arm challenge such as push forwards, push to the side 38

39 PARTNER KICKS This exercise focuses on balance, coordination and high effort repetition. This is a partner exercise where one partner is seated holding the boxing pads while the other partner stands in front. Once ready, the standing partner kicks the corresponding pad with the top of their foot (right foot, right pad), then alternates with the other leg. Precautions If there are concerns about balance, place a sturdy chair next to the standing partner. Progression To make this exercise easier, the kicking partner can repeat kicks on the same leg before touching the floor as well as speed up kicks. 39

40 BALL SLAMS This is a partner exercise encouraging coordination, balance and forced upper limb use. Each partner stands facing the other one. The first partner slams the soft ball into the floor to bounce once before reaching the other partner. The other partner then catches the ball and returns the bounce. To increase the level of difficulty have each person stand with a narrow base of support or on a wobble board or duradisc Precautions. If there are concerns about balance, have a sturdy chair, wall or rail placed near the client. Progressions. To make this exercise harder, have the client stand in tandem or single leg stance or on an unstable foam/unstable surface. The softer the ball the harder the slam to get it across to the other partner. 40

41 HELICOPTER PARTNER CLAP This exercise is designed to increase axial rotation, challenge vestibular balance and force upper limb use. Have your partners face each other with wide base of support and hands out by their sides at 90 degrees. Starting with their right arm leading, rotate until their hands meet in the middle. Have them clap, return to the starting position and then lead with the other arm. Encourage them to keep their shoulders down and back as they continue with the exercise. Precautions If there are concerns about spinal rotation, introduce a swivel or change the exercise completely to ant anterior clap. Progressions Introduce speed, accuracy, alternate combinations right, right, left, left etc. 41

42 CAN CAN This exercise is for lower limb coordination and fitness. Have your patient start with feet hip width apart. In time with the music have them lift their right leg by bending their knee towards the chest in one beat. Have them lower their leg back down to the floor in the next beat. In the third beat, have them lift the leg again, this time keeping the leg straight. On the fourth beat have them lower the leg back down to the starting position. Immediately have them repeat the same sequence on the left leg. The focus should be on keeping time with the music and making the movements crisp and defined. Precautions Modify for knee, hip and back injury. If you have balance concerns you may wish to have them work on one side only and use a sturdy chair for support. The straight leg lift does not have to be excessive. Progressions Repeat on the same leg several times, add a jump to the leg lifts so that both feet are off the ground. Take away the use of the chair. 42

43 FLOOR KNEEL This exercise is for lower limb strengthening and planning. Have your patients face a sturdy chair and place a foam block on the floor for their knees. Get them to slowly lower themselves down into a kneeling position. From there they can stand back up again using alternating leg each time. Advise them that they can use the chair to help themselves get up. Precautions Modify for knee and back injury. If you have balance concerns you may only wish to work on half squats Progressions Repeat on the same leg, take away the use of the chair. 43

44 BOX STEP This exercise focuses on coordination, balance and high intensity. Place four dots in a square on the floor. Have the client practice stepping forwards and backwards on the dots; right, left, right, left. Once the client can achieve consistent timing and step accuracy, add upper limb task; hand flicks (right step) and hand clench (left step). on getting the feet right before introducing the hand flicks. Precautions If there are balance concerns have a chair located close by. Progressions Double time hand flicks, high knees, stepping on river stones. 44

45 OVERHEAD BALL THROW This exercise is designed to elicit force and power from the upper limbs. There is also an element of balance and control required. Have the person face a solid wall, with their feet apart to start. Give them the soft ball and have them throw the ball overarm, using both arms aiming for a target above head height. Ideally they should throw with enough force to catch the ball on the full. Precautions If someone is prone to back injury, have them throw underarm, you can even do this from a seated position. If someone has a pre-existing shoulder injury, have them throw underarm from a standing position Progression. To make this exercise more difficult, you can have the person step further away from the wall, stand in tandem or single leg stand or on a foam block. 45

46 LADDER STEP AND ARM BURNER This exercise focuses on dual tasking activity by doing two different exercises with the arms and legs. Have the client start at the top of the ladder holding the arm burner. Walking with high knees they need to land with one foot in each rung while using the arm burner evenly between both arms. When they get to the end, they need to turn around and repeat the exercise Precautions If there are balance concerns, have the person set up near a wall or rail where possible. Progression To make this exercise more challenging, have the client miss every second step to increase stride length while continuing with additional upper limb task. 46