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In mat treatments, we can have prone, supine and more upright activities, but there is much duplication of positions and activities. When necessary teach the patient to stabilize in each new position.

The following examples of mat activities and exercises are not an allinclusive list but are samples only. As you work with your patients you will find many other positions and actions to help them achieve their functional goals.

D Table 11.1.

Prone activities

Supine activities

Roll from supine to prone

Roll from prone to supine

Roll from prone to side-lying

Roll from supine to side-lying

Prone on elbows

From supine to side-sitting

Prone on hands

Scooting in side-sitting

Quadruped

From side-sitting to quadruped

Side-sitting

From side-sitting to long-sitting

Sit on heels

Scooting in long-sitting

Kneeling

Short-sitting (legs over edge of mats)

Half-kneeling

Scooting in short-sitting

Hands-and-feet (arched position)

Get to standing

Get to standing

11.5.1 Rolling

Certain functional activities such as rolling normally have some concentric and some eccentric components.

If the therapist wants to facilitate rolling from the supine into the prone position, the first part of the activity is a concentric action of the flexor chain (trunk flexors, neck flexors and hip flexors) (see O Fig. 11.2 a, b). When the patient rolls from the mid-position (see O Fig. 11.3 b) into the prone position, we see an eccentric activity of the extensor chain (trunk extensors, neck extensors and hip extensors). To facilitate this eccentric activity we should move our hands to the ischial tuberosity and posterior on the top of the shoulder to resist the extensor chain. We ask the patient to let us push him forward, but slowly.

Rolling is both a functional activity and an exercise for the entire body. The therapist can learn a great deal about patients by watching them roll. Some people roll using flexion movements, others use extension, and others push with an arm or a leg. Some find it more difficult to roll in one direction than in the other, or from one starting position. The ideal is for individuals to adjust to any condition placed upon them and still be able to roll easily.

The therapist uses whatever combination of scapula, pelvis, neck or extremity motions best facilitates and reinforces the desired motions.

Scapula

Resistance to either of the anterior scapular patterns facilitates forward rolling. Resisting the posterior scapular patterns facilitates rolling back. Use the appropriate grips for the chosen scapular pattern. To get increased facilitation, tell the patient to move the head in the same direction as the scapula.

The command given can be an explicit direction or a simple action command. An explicit direction for rolling using scapular anterior depression would be "pull your shoulder down toward your opposite hip, lift your head, and roll forward." A simple action command for the same motion is "pull down." A simple command for rolling back using posterior elevation is "push back" or "shrug." The simple command is always better. Telling the patient to look in the direction of the scapula motion is a good command for the head movement.

To start, place the scapula in the elongated range to stretch the scapular muscles. To stretch the trunk muscles, continue moving the scapula farther in the same diagonal until the trunk muscles are elongated. Resist the initial contraction at the scapula enough to hold back on the scapular motion until you feel or see the patient's trunk muscles contract. When the trunk muscles begin to contract, allow both the scapula and trunk to move. You can lock in the scapula at the end of its range of motion by giving more resistance and either traction or approximation. Now exercise the trunk muscles and the rolling motion with repeated contractions for the trunk muscles.

Anterior Elevation

Roll forward with trunk rotation and extension. Facilitate with neck extension and rotation in the direction of the rolling motion (O Fig. 11.1 a).

Posterior Depression

Roll back with trunk extension, lateral flexion, and rotation. Facilitate with neck lateral flexion and full rotation in the direction of the rolling motion (O Fig. 11.1 b).

Anterior Depression

Roll forward with trunk flexion. Facilitate with neck flexion in the direction of the rolling motion (O Fig. 11.1 c).

Posterior Elevation

Roll back with trunk extension. Facilitate with neck extension in the direction of the rolling motion (O Fig. 11.1 d).

Therapeutic Goals_

The goal of rolling can be:

— Strengthening of trunk muscles

— Increasing the patient's ability to roll

— Mobilizing the trunk, scapula, shoulder or hip

— Normalizing the muscle tone etc.

Forward Trunk Flexion

D Fig. 11.1. Using the scapula for rolling: a forward with anterior elevation; b backward with posterior depression; c forward with anterior depression; d backward with posterior elevation

D Fig. 11.1. Using the scapula for rolling: a forward with anterior elevation; b backward with posterior depression; c forward with anterior depression; d backward with posterior elevation b a d c

Pelvis

Resistance to pelvic anterior patterns facilitates rolling forward, resisting posterior patterns facilitates rolling back. Use the appropriate grips for the chosen pattern. Ask for neck flexion to reinforce rolling forward, extension for rolling back.

The commands for pelvic motion are similar to those for the scapula. For rolling forward using anterior elevation the explicit command would be "pull your pelvis up and roll forward". The simple command for the same motion is "pull." For rolling back using posterior depression a specific command would be "sit down into my hand and roll back." The simple command for that action is "push." Facilitate with the appropriate neck motion.

To start, place the pelvis in its elongated range. To stretch the trunk further, continue moving the pelvis in the same diagonal until the trunk is completely elongated. Resist the initial contraction at the pelvis until you feel or see all of the desired trunk muscles contract. Then allow both the pelvis and trunk to move. You can lock in the pelvis at the end of its range of motion by giving more resistance and by giving traction or approximation. Then exercise the rolling motion with repeated contractions for the trunk muscles.

Anterior Elevation

Roll forward with trunk flexion, facilitate with neck flexion (O Fig. 11.2 a).

Posterior Depression

Scapula and Pelvis

A combination for rolling forward: the pelvis in anterior elevation, the scapula in anterior depression (O Fig. 11.3).

A combination for rolling backward: the pelvis Roll back with trunk extension, facilitate with neck in posterior depression, the scapula in posterior ele-

extension (O Fig. 11.2 b). Posterior Elevation

Roll back with lateral shortening of the trunk, facilitate with neck rotation to the same side.

Anterior Depression

Roll forward with trunk extension and rotation, facilitate with neck extension and rotation into that direction.

Points to Remember

Rolling is the activity, the scapula and pelvis are the handle

The rolling should occur because of facilitation from the scapula or pelvis vation (O Fig. 11.4). Upper Extremities

When the patient has a strong arm, combine it with the scapula to strengthen the trunk muscles and to facilitate rolling in the same way as with the scapula alone. Adduction (anterior) patterns facilitate rolling forward. Abduction (posterior) patterns facilitate rolling back. The elbow may flex, extend or remain in one position during the activity. Resist the strongest elbow muscles for irradiation into the trunk muscles. The patient's head should move with the arm.

Your distal grip is on the hand or distal forearm and can control the entire extremity. Your proximal grip can vary: a grip on or near the scapula is often

D Fig. 11.3a, b. Rolling forward with pelvic anterior elevation and scapular anterior depression
d Fig. 11.4a, b. Rolling backward with pelvic posterior depression and scapular posterior elevation

the most effective. Your proximal hand can also be used to guide and resist the patient's head motion.

The commands you use can be specific or simple. For rolling forward using the pattern of extension-adduction the specific command may be "squeeze my hand and pull your arm down to your opposite hip. Lift your head, and roll." A simple command would be "squeeze and pull, lift your head." For rolling back using the pattern of flexion-abduction the specific command might be "wrist back, lift your arm up and follow your hand with your eyes. Roll back." The simple command would be "lift your arm up and look at your hand."

Take the patient's arm into the elongated range and traction to stretch the arm and scapular muscles. Further elongation with traction will elongate or stretch the synergistic trunk muscles. Hold back on the initial arm motion until you feel or see the patient's trunk muscles contract, then allow the arm and trunk to move. You can lock in the patient's arm at any strong point in its range of motion, then exercise the trunk muscles and the rolling motion with repeated contractions. The exercise is for the trunk muscles and not for the shoulder muscles (change the pivot). Approximation through the arm with resistance to rotation works well to lock in the arm toward the end of its range.

Using one arm

— Rolling forward with trunk-extension, lateral flexion and rotation. Facilitate with neck extension and rotation in the direction of the rolling.

- Patterns: Flexion-adduction-external rotation (O Fig. 11.5 a).

— You can also use the ulnar thrust pattern.

— Rolling back with trunk extension, lateral flexion, and rotation. Facilitate with neck lateral flexion and full rotation in the direction of the rolling motion.

- Patterns: Extension-abduction-internal rotation (O Fig. 11.5 b).

— You can also use the ulnar withdrawal pattern.

— Rolling forward with trunk flexion. Facilitate with neck flexion in the direction of the rolling motion.

- Patterns: Extension-adduction-internal rotation (O Fig. 11.5 c, d).

— You can also use the radial thrust pattern.

— Rolling back with trunk extension. Facilitate with neck extension in the direction of the rolling motion.

Fig. 11.5. Using one arm for rolling: a forward with flexion-adduction; b backward with extension-abduction
Trunk Abduction

Using Bilateral Combinations

— Rolling forward with trunk flexion: chopping or reversal of lifting (O Fig. 11.6 a)

— Rolling back with trunk extension: lifting or reversal of chopping (O Fig. 11.6 c,d)

— Use the reversals of chopping or lifting either when using a reversal technique or when the patient can grip with only one hand

Points to Remember

Rolling is the activity, the arm is the handle

The techniques are applied to the trunk for the rolling motion

Lower Extremities

Use the patient's leg to facilitate rolling and to strengthen trunk muscles in the same way as with the arm. The knee may flex, extend or remain in one position. As with the elbow, resist the strongest knee muscles to facilitate the rolling. Flexion (anterior) patterns facilitate rolling forward, extension (posterior) patterns facilitate rolling back. The patient's head will facilitate rolling forward by going into flexion, and rolling back by going into extension.

Your distal grip is on the foot and can control the entire extremity. To make the activity effective give the principal resistance to the knee activity rather than the hip. Your proximal grip may be on the thigh or pelvis. When the pattern of flexion-abduction is used you may put your proximal hand on the opposite iliac crest to facilitate trunk flexion.

Trunk Abduction

The commands can be specific or simple. A specific command for rolling forward using flexion-abduction is "foot up, pull your leg up and out and roll away." A simple command is "pull your leg up." For rolling back using the pattern of extension-adduction the specific command is "push your foot down, kick your leg back, and roll back toward me." A simple command may be "kick back."

Bring the patient's leg into the elongated range of the pattern using traction to stretch the muscles of the extremity and lower trunk. Hold back on the leg motion until you see or feel the patient's trunk muscles contract then allow the leg and trunk to move. Lock in the leg at any strong point in its range of motion and exercise the trunk muscles and the rolling motion with repeated contractions.

Points to Remember

Rolling is the activity, the leg is the handle The techniques are applied to the trunk for the rolling motion

Using One Leg

— Flexion-adduction (O Fig. 11.7 a, b): Rolling forward with trunk flexion

— Extension-abduction (O Fig. 11.7 c, d): Rolling back with trunk extension and elongation

— Flexion-abduction (O Fig. 11.7 e): Rolling forward with trunk lateral flexion, flexion, and rotation

— Extension-adduction (O Fig. 11.7 f): Rolling back with trunk extension, elongation, and rotation a

O Fig. 11.7. Using one leg for rolling: a, b forward with flexion-adduction
Forward Flexion Abduction

d Fig. 11.7. Using one leg for rolling: c, d backward with extension-abduction; e forward with flexion-abduction; f backward with extension-adduction

Bilateral Combinations

— Lower extremity flexion (O Fig. 11.8 a): Rolling forward with trunk flexion

— Lower extremity extension (O Fig. 11.8 b): Rolling back with trunk extension

The head and neck move with all the rolling motions. If the patient does not have pain free or strong motion in the scapula or arm it may be necessary to use the neck alone to facilitate rolling. When using neck flexion the main force is traction, for neck extension use gentle compression.

— Neck flexion: Rolling forward from supine to side-lying (O Fig. 9.8 a, b)

— Neck extension: Rolling backward from side-lying to supine (O Fig. 9.8 c)

Points to Remember

— Rolling is the activity, the neck is the

handle

— For more sideways motion, allow more

neck rotation

— The techniques are applied to the trunk

for the rolling motion

11.5.2 Prone on Elbows (Forearm Support)

Lying prone on the elbows is an ideal position for working on stability of the head, neck, and shoulders. Resisted neck motions can be done effectively and without pain in this position. Resisted arm motions will strengthen not only the moving arm

O Fig. 11.8. Using both legs for rolling: a forward with flexion; b backward with extension

O Fig. 11.8. Using both legs for rolling: a forward with flexion; b backward with extension

but also the shoulder and scapular muscles of the weight-bearing arm. The position is also a good one for exercising facial muscles and swallowing.

Assuming the Position

The patient can get to prone on elbows from many positions. We suggest three methods to facilitate the patient who is not able to assume this position independently.

— From side-sitting

— Rolling over from a supine position

Resist the patient's concentric contractions if they move against gravity into the position (e. g., moving from prone to prone on elbows, O Fig. 11.9 c, d). Resist eccentric control if the motion is gravity assisted (e. g., moving from side-sitting to prone on elbows).

Stabilizing

When the patient is secure in the position, begin stabilization with approximation through the scapula and resistance in diagonal and rotary directions. It is important that patients maintain their scapulae in a functional position. Do not allow their trunk to

Prone Elbows Head Flexion Cough

sag. With the head and neck aligned with the trunk, give gentle resistance at the head for stabilization (O Fig. 11.9 e). Rhythmic Stabilization works well here. Use Stabilizing Reversal with those patients who cannot do isometric contractions.

Motion

With the patient prone on elbows you can exercise the head, neck, upper trunk, and arms. A few exercises are described here but let your imagination help you discover others.

— Head and neck motion: resist flexion, extension, and rotation. Try Slow Reversals and Combination of Isotonics.

— Upper trunk rotation: combine this motion with head and neck rotation. Use Slow Reversals and resist at the scapula or scapula and head (O Fig. 11.10 a, b).

Weight shift: shift weight completely to one arm. Combine the techniques Combination of Isotonics and Slow Reversals. Arm motion: after the weight shift, resist any pattern of the free arm. Use Combination of Isotonics followed by an active reversal to the antagonistic pattern. Use Stabilizing Reversals on the weight-bearing side (O Fig. 11.10 c, d).

Points to Remember

This is an active position. The patient should not "hang" on the shoulder blades If the position causes back pain you can put a support under the patient's abdomen

O Fig. 11.10. Prone on the elbows: stability and motion. a Reciprocal scapular patterns; b resistance to head and scapula; c resistance to head and raised arm; d resistance to raised arm and contralateral scapula

11.5.3 Side-Sitting

This is an intermediate position between lying down and sitting. There is weight-bearing through the arm, leg, and trunk on one side. The other arm can be used for support or for functional activities. For function the patient should learn mobility in this position (scooting).

Side-sitting is a good position for exercising the scapular and pelvic patterns. Movement in reciprocal scapular and pelvic combinations promotes trunk mobility. Stabilizing contractions of the reciprocal patterns promote trunk stability.

We list below some of the usual activities. Do not restrict yourself only to those given; let your imagination guide you. — Assuming the position

- From side-lying

- From sitting

- From the quadruped position

- Scapula and pelvic motions (D Fig. 11.12 ad)

- Upper extremity weight bearing (D Fig. 11.12 e)

— Moving to sitting

— Moving to prone on elbows

— Moving to the quadruped position

Quadruped PositionRight Shoulder FlexionSitting Assisted Flexion Hangs

O Fig. 11.12. Side-sitting. a-c Pelvis and scapula motion; d emphasis on weight-bearing activity on the right shoulder; e resistance to the left arm flexion-adduction and resistance for elongation of the left side of the trunk; f hip extension-abduction b a d c f e

11.5.4 Quadruped

In the quadruped position patients can exercise their trunk, hips, knees, and shoulders. The ability to move on the floor is a functional reason for activity in this position. The patient can move to a piece of furniture or to another room.

Be sure that the scapular muscles are strong enough to support the weight of the upper trunk. There must be no knee pain. Because the spine is in a non-weight-bearing position, when spinal pain or stabilization is the problem, working in this position will make many activities possible.

Use the techniques Stabilizing Reversals and Rhythmic Stabilization to gain stability in the trunk and extremity joints. Resist rocking motions in all directions using Combination of Isotonics, Dynamic Reversals (Slow Reversals) and a combination of these techniques to exercise the extremities with weight bearing. Resisted crawling enhances the patient's ability to combine motion with stability.

When the patient is assuming and working in the quadruped position the therapist gives resistance at scapula or pelvis, at the head and a combination of these areas.

— Assuming the position

— Crawling: in addition to giving resistance to the scapula, pelvis and neck the therapist also gives resistance

- to arm motions

Prone Hip Extension With Knee Flexed

d Fig. 11.13. Moving to quadruped. a-c From prone on elbows, resistance at the pelvis; d From prone on elbows, mid-position, resistance to the pelvis; e resistance to neck flexion b a d c e

Fig. 11.13. Moving to quadruped. f, g Moving from side-sitting resistance at pelvis
Quadruped Kneeling The BedTrunk AbductionTrunk AbductionQuadruped Kneeling The Bed
Fig. 11.18a,b. Crawling, resisting leg motions

11.5.5 Kneeling

In a kneeling position patients exercise their trunk, hips and knees, while the arms are free or used for support. For function patients go from the kneeling position to standing, or move on the floor to a piece of furniture such as a bed or sofa. If the patient is unable to work in kneeling, for example because of knee pain, most of the kneeling activities can be done in the kneeling down (sitting on the feet) position.

To increase trunk strength and stability resist at the scapula and pelvis using Stabilizing Reversals or Rhythmic Stabilization. To increase the strength, coordination, and range of motion of the hips and knees exercise the patient moving between kneeling and a side-sitting position. Combination of Isotonics will exercise the concentric and eccentric muscular functions. — Assuming the position

- From a side-sitting position (O Fig. 11.19 a, b) or a kneeling-down (sitting on your feet) (O Fig. 11.19 c-f)

- From a quadruped position (O Fig. 11.20)

Fig Lesson
O Fig. 11.19. Assuming the kneeling position. a, b Moving from side-sitting to kneeling; c, d moving from heel sitting to kneeling, resistance at pelvis; e, f resisted lifting to the left; g kneeling for floor wheelchair transfer
Assuming The Position
Fig. 11.19. Assuming the kneeling position. e, f resisted lifting to the left; g kneeling for floor-wheelchair transfer
Moving Picture Kneeling Head
Fig. 11.20a,b. Moving from quadruped to kneeling

Balancing

- Resistance at the scapula and head (D Fig. 11.21 a, b)

- Resistance at the pelvis

- Resistance at pelvis and scapula (D Fig. 11.21 c)

- Resistance at the trunk and head (D Fig. 11.21 d)

- Resistance to the arms sitting on your heels (O Fig. 11.21 e, f)

Walking on the knees

Cinesioterapiana
d Fig. 11.21. Stabilization in kneeling. a Resistance at the scapula; b resistance at the head and scapula; c resistance at the pelvis and scapula; d resistance to the sternum and head
Sternum Flexion

D Fig. 11.21. Stabilization in sitting on the heels. e bilateral asymmetrical reciprocal arm patterns; f bilateral symmetrical arm patterns

Fig. 11.22. Walking on the knees: a, b forward
Forehand Vuru

Fig. 11.22. Walking on the knees: c backward; d, e sideways

Fig. 11.22. Walking on the knees: c backward; d, e sideways

11.5.6 Half-Kneeling

This is the last position in the kneeling to standing sequence. To complete the work in this position the patients should assume it with either leg forward. Moving from kneeling to half-kneeling requires the patient to shift weight from two to one leg and move the non-weighted leg while maintaining balance. This activity challenges the patient's balance, coordination, range of motion and strength. Use both stabilizing and moving techniques to strengthen trunk and lower extremity muscles. Shifting the weight forward over the front foot promotes an increase in ankle dorsiflexion range.

Assuming the position

- From a kneeling position (O Fig. 11.23)

- From standing Balancing (O Fig. 11.24 a-c)

Weight shift over back leg with trunk elongation (O Fig. 11.24 c) Weight shift to front leg Standing up (O Fig. 11.25)

Lumbar Trunk Shift

O Fig. 11.24a-c. Balancing and weight shift in half-kneeling. a Resistance at the pelvis; b resistance at pelvis and forward leg; c resistance at arm and head for trunk elongation

11.5.7 From Hands-and-Feet Position (Arched Position on All Fours) to Standing Position and back to Hands-and-Feet Position

The people who use this activity for function are most often those whose knees are maintained in extension. For example, patients wearing bilateral long leg braces (KAFOs) or those with bilateral above-knee prostheses can go from standing to the floor or from the floor to standing. Use of this position requires full hamstring muscle length.

Amputee Bed Based Exercises

O Fig. 11.26. Moving to the floor and back up again. a, b Resistance at the pelvis; c guidance at the pelvis, patient with amputation of left leg b a c

11.5.8 Exercise in a Sitting Position Long-Sitting

This position is functional for bed activities such as eating and dressing. Use all the stabilizing techniques to increase the patient's balance in this position. Because the patient can sit on the floor mats, this is a safe position for independent balance work. Long-sitting is also a good position for exercises to increase arm and trunk strength. All the strengthening exercises are appropriate here. Patients can practice all the lifts used for transfers.

— Assuming the position

- From side-sitting

- From supine

— Balancing with and without upper extremity support (O Fig. 11.27 a)

— Pushing up exercises

- Resistance at the pelvis and shoulders (O Fig. 11.27 b-d)

— Scooting forward (O Fig. 11.27 i) and backward a

b
Push Ups Long Sitting Position
Fig. 11.27. Exercises in long-sitting. a Stabilization; b-c pushing up, resistance at pelvis; d pushing up, resistance at scapulae
Abduction Sitting

Short-Sitting

To use their arms for other activities, patients need as much trunk control as possible. To reach for distant objects they need to combine trunk stability with trunk, hip, and arm motion. Those patients with spinal problems can learn to stabilize their back while moving at the hip when reaching with their arms.

Patients need to exercise while sitting on the side of the bed and in a chair as well as on the mats. Static exercises in short-sitting will increase the pa tient's trunk and hip stability. Dynamic exercises will increase trunk and hip motion. Resisting the patient's strong arms will provide irradiation to facilitate weaker trunk and hip muscles. Combining static and dynamic techniques facilitate the patient's ability to combine balance and motion. — Assuming the position from side-lying

- Resist the patient's concentric contractions while they move into sitting.

- Resist the eccentric control as they lie down.

Fig. 11.28a,b. Moving from side-lying to short-sitting

Fig. 11.28a,b. Moving from side-lying to short-sitting

Balancing

Use Stabilizing Reversals or Rhythmic Stabilization to increase trunk stability. Resist at the shoulders, pelvis, and head (D Fig. 11.29).

- With and without upper extremity support

- With and without lower extremity support

Fig. 11.29. Stabilization in short-sitting ; c Stabilization on a Pezzi ball
Fig. 11.29. c Stabilization on a Pezzi ball

Trunk exercises

Use Dynamic Reversals (Slow Reversals) and Combination of Isotonics to increase the patient's trunk strength and coordination. Resist at the scapula (O Fig. 11.30 a, b) or use chopping (O Fig. 11.30 d) and lifting combinations to get added irradiation.

- Trunk flexion (O Fig. 11.30 c) and extension

- Reaching forward and to the side with return: this requires hip flexion, extension, lateral motion, and rotation with the trunk remaining stable

Moving

These activities teach mobility in sitting and exercise pelvic and hip muscles.

- From side to side

at scapula

Trunk exercise in short-sitting. a, b Resistance

at scapula

Trunk exercise in short-sitting. a, b Resistance a c b

Pelvis Trunk Rhythm

d Fig. 11.30. Trunk exercise in short-sitting. c flexion with traction through arms; d chopping; e moving forward with resistance at pelvis

11.5.9 Bridging

In the hook-lying position the patient exercises with weight-bearing through the feet but without danger of falling. Lifting the pelvis from the supporting surface makes it easier for a person to move and dress in bed.

Working in the hook-lying position requires some selective control of the lower trunk flexors and the leg muscles. Patients must keep their knees flexed while extending their hips and pushing with their feet. When patients push against the mats with their arms, their upper trunk, neck, and upper extremity muscles are exercised. Resist concentric, eccentric, and stabilizing contractions to increase strength and stability in the trunk and lower extremity.

— Assuming the hook lying position

If the patient is unable to assume this position independently:

- Move from a side-lying position with hips and knees flexed. Facilitate at the knees, pelvis or a combination of these

- From supine, guide and resist the bilateral pattern of hip flexion with knee flexion

- With approximation from the distal femurs into the pelvis combined with stabilizing resistance

- With approximation from the distal femurs into the feet combined with stabilizing resistance

- Stabilizing resistance without approximation

Use resistance with approximation at the legs to facilitate lower extremity and trunk stability. Give the resistance in all directions. Resistance in diagonals will recruit more trunk muscle activity. As the patient gains strength, decrease the amount of approximation. Resist the legs together and separately. Resist both legs in the same direction and in opposite directions when working them separately.

— Lower trunk rotation in the hook-lying position

The motion begins with the legs moving down diagonally (distally) toward the floor. When the hips have completed their rotation, the pel

vis rotates, followed by the spine. The abdominal muscles prevent any increase in lumbar lordosis. The return to upright requires a reverse timing of the motion. The lumbar spine must de-rotate first, then the pelvis, and then the legs. Correct timing of this activity is important. Limit the distance that the legs descend to the ability of the patient to control the motion. O Fig. 11.31 b shows resistance to returning to the upright leg position with lower trunk rotation to the right. You can use Combination of Isotonics and Slow Reversals to teach and strengthen this activity.

- Stabilize the pelvis with resistance in all directions (O Fig. 11.32 a, b, resisting from below; O Fig. 11.32 c, d resisting from above)

Fig.11.32a-d. Bridging on two legs in supine position

Fig.11.32a-d. Bridging on two legs in supine position

- Lead with one side of the pelvis

- Resist static and dynamic rotation of the pelvis

- Scoot the pelvis from side to side

Use Combination of Isotonics to strengthen the patient's antigravity control.

! Caution

Monitor and control the position of the patient's lumbar spine while the pelvis is elevated.

— Other bridging activities

- Stepping in place

- Walking the feet: apart, together, to the side, away from the body (into extension) and back

- Bridge on one leg (D Fig. 11.33). The abdominal muscles maintain the pelvis level and the hip muscles on the supporting side work to prevent lateral sway. The more the lifted leg moves into extension or ab duction, the harder the supporting muscles must work

Bridge while bearing weight on the arms (D Fig. 11.34-11.36)

Fig. 11.33. Bridging on one leg
Fig.11.34a,b. Bridging on the hands
Fig. 11.35a,b. Bridging on the elbows
Fig. 11.36a,b. Bridging on the arms and one leg

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Responses

  • nina
    Which condition we give tha mat activities?
    3 years ago

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