Changing the Patients Position

There are many advantages to exercising the patient's arms in a variety of positions. These include letting the patient see the arm, adding or eliminating the effect of gravity from a motion, and working with functional motions in functional positions. There are also disadvantages for each position. Choose the positions that give the desired benefits with the fewest drawbacks.

Cross Body Adduction Rom

7.8.1 Arm Patterns in a Side Lying Position

In this position the patient is free to move and stabilize the scapula without interference from the supporting surface. You may stabilize the patient's trunk with external support or the patient may do the work of stabilizing the trunk.

Extension-abduction-internal rotation is shown in O Fig. 7.23.

7.8.2 Arm Patterns Lying Prone on Elbows

Working with the patient in this position allows you to exercise the end range of the shoulder abduction patterns against gravity. The scapula is free to move and stabilize without interference. The patient must bear weight on the other shoulder and scapula and maintain the head against gravity while exercising.

Flexion-abduction-external rotation at end range is shown in O Fig. 7.24.

D Fig. 7.24. Prone on elbows, arm pattern flexion-abduction-external rotation in the end position

7.8.3 Arm Patterns in a Sitting Position

In this position you can exercise the patient's arms through their full range or limit the work to functional motions such as eating, reaching, dressing. Bilateral arm patterns may be done to challenge the patient's balance and stability (D Fig. 7.25).

7.8.4 Arm Patterns in the Quadruped Position

Working in this position, the patient must stabilize the trunk and bear weight on one arm while moving the other. As in the prone position, the shoulder muscles work against gravity (D Fig. 7.26).

! Caution

Do not allow the spine to move into undesired positions or postures.

D Fig. 7.25. Sitting position, arm pattern flexion external rotation with visual reinforcement

D Fig. 7.24. Prone on elbows, arm pattern flexion-abduction-external rotation in the end position

D Fig. 7.25. Sitting position, arm pattern flexion external rotation with visual reinforcement i-abduction-

O Fig. 7.26. Quadruped position, arm pattern extension-abduction-internal rotation

7.8.5 Arm Patterns in a Kneeling Position

Working in this position requires the patient to stabilize both the trunk, hips and knees while doing arm exercises (O Fig. 7.27).

! Caution

Do not allow the spine to move into undesired positions or postures.

Further reading

Godges JJ, Matsen-Bell M, Thorpe D, Shah D (2003) The immediate effects of soft tissue mobilization with proprioceptive neuromuscular facilitation on glenohumeral external rotation and overhead reach. J Orthop Sports Phys Ther (12): 713-718

Kendal FP, McCreary EK (1993) Muscles, testing and function.

Williams and Wilkins, Baltimore Kots YM, Syrovegin AV (1966) Fixed set of variants of interactions of the muscles to two joints in execution of simple voluntary movements. Biophysics (11): 1212-1219 Kraft GH, Fits SS, Hammond MC (1992) Techniques to improve function of the arm and hand in chronic hemiplegic. Arch Phys Med Rehabil (3): 220-227 McMullen J, Uhl TL (2000) A kinetic chain approach for shoulder rehabilitation. J Athletic Training (3): 329-337 Shimura K, Kasai T (2002) Effects of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potentials in upper limb muscles. Hum Movement Sci (1): 101-113

O Fig. 7.27. Exercise in a kneeling position, irradiation from the arm pattern flexion-abduction-external rotation for extension of the trunk and hip

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