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1AWheelchairUsersGuideforUsingFitnessEquipmentDISCOVERACCESSIBLEFITNESS 2Copyright2014Allrightsreserved.Nopartothisguidemaybereproducedortransmittedinanyormorbyanymeanselectronicormechan-icalincludingphotocopyingrecordingorbyanyinormationstorageandretrievalsystemwithoutpermissioninwritingromthepublisher.TisguideisacollaborativeprojectotheNationalCenteronHealthPhysicalActivityandDisabilityNCHPADandBenecialDesignsInc.TeinormationprovidedinthisguidewassupportedinpartbyGrantCooperativeAgreementNum-berU59DD000906romtheCentersorDiseaseControlandPreventionCDC.TecontentsaresolelytheresponsibilityotheauthorsanddonotnecessarilyrepresenttheofcialviewsoCDC.PrintingorthispublicationwassupportedbyTeDisabilityandHealthProgramotheAlabamaDepartmentoPublicHealthCooperativeAgreementNumber5U59DD000947-02romTeCentersorDiseaseControlandPrevention.NationalCenteronHealthPhysicalActivityandDisability4000RidgewayDriveBirminghamAL35209www.nchpad.org800-900-8086emailnchpad.orgH 461921263245485131.02.04.07.06.08.09.05.03.0IntroductionSpecialConsiderationsforWheelchairUsersAdaptiveEquipmentGettingStartedFlexibilityCool-DownUpperBodyStretchesStrengthTrainingfortheUpperBodyPulleyExercisesCardiovascularExercisesTheMusclesofTheBodyTableofContents 41.0IntroductionWelcometotheexerciseprogramorpersonsusingwheelchairs.Thisbookletisnottobeusedinplaceophysicaltherapyorexercisesprescribedbyyourdoctor.Itisintendedtoincorporatephysicalactivityintoyourdailylie.Exerciseincreasesyourabilitytoperormactivitiesodailyliving.Itcanalsoincreasephysicalindependenceandsel-condence.Inadditionexercisecanalsoaidinahealthybodyimageandalloworsocialinteraction.Asaresultyoucanbecomemoreindependentinyourdailyactivitiesmoreefcientinyourlocomotionanddecreasetheriskosecondaryconditionsassociatedwithwheelchairuse.Withanyexerciseprogramproperprecautionsmustbetakenbeoreyoubegin.Anunderstandingopotentialproblemsisnecessaryoryoutoexercisesaely.Pleasecontactyourphysicianiyouhaveanyconcerns.ItisalsoadvisedthatindividualswithdisabilitiesdesiringtoengageinexercisecontactanACSMNCHPADCertiedInclusiveFitnessTrainerormoreassistance.Formoreinformationregardingatrainervisitwww.nchpad.org. 51.1.ImportanceofExerciseforWheelchairUsersIncreasesabilitytoperormactivitiesodailylivingIncreasesphysicalindependenceandsel-condenceAidsinhealthybodyimageAllowsorsocialinteractionReducesstressImprovesstabilityandbalancewhilebodyisinanuprightpositionIncreaseseciencyotheheartandincreasesbloodfowtothelowerextremitiesReduceslevelsoharmullow-densitylipoproteinLDLcholesterolandcanincreaselevelsogoodhigh-densitylipoproteinHDLcholesterolMaintainsincreasesmusclestrengthHelpsreducecomplicationsassociatedwithvasculardiseaseanddiabetesbyimprovingbloodglucosecontrolspecifcallyType2DiabetesImprovesinsulinsensitivityReducesbodyatDecreasesprobabilityoastrokeDecreasestheriskoheartdiseaseoneotheleadingcausesodeathinpersonswithspinalcordinjuryDecreasescomplicationsospinalcordinjuryandurtherhospitalizations 62.0SpecialConsiderationsforWheelchairUser2.1.TypesofWheelchairUsersAbsenceorlossoflowerextremityTypicallyduetotraumaorsurgeryprostheticsareusuallywornbutdonotresultinullreturnounction.ArthritisPaininjointsusuallyreducingrangeomotionandcausingweakness.CerebralPalsyDamagetothemotorareasothebrainpriortobrainmaturity.DiabetesAgroupometabolicdiseasesinwhichapersonhashighbloodsugareitherbecausethebodydoesnotproduceenoughinsulinorbecausecellsdonotrespondtotheinsulinthatisproducedotenresultsincardiovasculardiseasestrokeperipheralvasculardiseaseneuropathyandorlimbloss.HeartDiseaseUmbrellatermoravarietyodiseasesafectingtheheartincludingcoronaryheartdiseasecardiomyopathycardiovasculardiseaseischaemicheartdiseaseheartailurehypertensiveheartdiseaseinammatoryheartdiseaseandvalvularheartdisease.MultipleSclerosisAgroupohereditarydiseasescausingprogressivemuscularweaknesslossomuscularcontrolcontractionsanddicultyinwalkingbreathingreachinganduseohandsinvolvingstrength.ParaplegiaAnimpairmentinmotororsensoryunctionothelowerextremities.RheumatoidArthritisChronicarthritis. 7StrokeCerebralVascularAccidentCVAThrombosisbloodclotinabloodvesselwhichobstructsbloodowhemorrhageresultinginbleedingintothebraintissueassociatedwithhighbloodpressureorruptureoananeurismorembolismalargeclotbreaksofandblocksanarterywhichcausestheafectedareaothebraintoeitherstopunctioningaltogetherortobeimpaired.TetraplegiaQuadriplegiaAnimpairmentinmotororsensoryunctionotheupperandlowerextremitiesincludingthetorso.2.2.FollowFitnessEquipmentInstructionsInadditiontotheseconsiderationspleasereadandollowallinstructionslocatedontnessequipmentpriortouse.Fullyunderstandinghowtoproperlyexercisebeorebeginningwillleadtoasaeandbenecialtnessexperienceandwillmaximizeyourresults.2.3.WarningsWARNINGFailuretotakestabilityissuesintoconsiderationcouldcauseyoutotipoverwhileexercisinginyourmanualorpoweredmobilitydeviceandcouldresultinsevereinjuryordeath.Alwaysattemptexercisesorthersttimewiththeassistanceoaspotterandbeawareothepotentialoryourmobilitydevicetotipoverinanydirection.Alwayslockyourmobilitydeviceinpositionpriortoexercising.Theuseowheel-locksisrecommendedduringexercise.Poweredmobilitydevicesshouldbeturnedofpriortoexercise. 8IncorrectexercisepositionCorrectexerciseposition 9OVERLOADINGWHEELCHAIRWARNINGThecombinationoyourbodyweightandtheexerciseweightthatyouarelitingwhileseatedinyourmobilitydeviceefectivelyincreasesthetotalpayloadweightinyourmobilitydevice.Determinethemaximumrecommendedweightcapacityoyourmobilitydeviceandstaywithinthislimittoensurethatyouwillnotcauseoverstressingtothestructureoyourmobilitydevice.Exceedingthemaximumpayloadoyourmobilitydevicecouldresultinailureooneormorecomponentsoyourmobilitydeviceandcouldresultinsevereinjuryordeath. 102.4.PositioningandSecurementoftheWheelchairExercisinginyourwheelchairSomeftnessequipmentallowsyoutoexercisewhileseatedinyourwheelchair.Itisgenerallybesttomoveyourwheelchairasclosetotheexerciseequipmentaspossibleputtingyourrearwheelsortherameoyourwheelchairintocontactwiththesupportstructureorpaddingprovidedorexercise.Fastenyourwheel-locks.Stepriserscanbeusedtoblockthewheelsoyourwheelchairtourtherassistinpreventingmovementoyourwheelchairduringexercise.Useoweightortheassistanceoaspotterwillberequiredtomaintainstabilityduringcertainexercises.Correctexercisepositions 11PosturalpositioningstrapYoucanusealongstrapwithanadjustablebuckletostrapyourselfintoyourwheelchairseatwhileexercising.Thestrapcanbepassedunderneaththeseatframeportionofthewheelchairandoveryourthighstoholdyousecurelyintotheseatofyourwheelchairduringexercise.2.5.WaystoIncreaseStabilityoftheWheelchair2.5.1ForwardStabilityFrontwheelcasterorientationYoucanincreasethestabilityofyourwheelchairintheforwarddirectionbymovingyourwheelchairbackwardstorotateyourfrontcastersforwardbeforelockingyourwheel-locks.IncorrectfrontcasterpositionCorrectfrontcasterposition 122.5.2RearwardStabilityRearaxlepositionManymanualwheelchairshaveadjustableaxlepositioningtomovetherearwheelsforwardandbackward.Beawarethatifyourwheelchairhastherearwheelspositionedforwardmakingthewheelchairtippyyoumayneedtobeverycarefulabouttippingtotherearwhenexercisingwhileseatedinyourwheelchair.UseofaspotterMultipleexercisesmaycauserearwardtippingsuchaspushingweightsforwardorupwardorliftingweightsaboveandbehindthehead.Havingatrainerholddownthefrontofyourwheelchairnearthefrontcastersorlegsupportswillpreventyourwheelchairfromtippingovertotherearwhileexercising.UseofweightonthefootsupportAdumbbellcanbeplacedonthefootsupportofthewheelchairtoaddextraweighttothefrontofthechair.Thiswillhelptoreducethetendencytotiptotherearwhileexercisinginyourwheelchair.UseofarestraintAlargeplatethatsitsunderneathallwheelsofthewheelchairwithtworatchetstrapsatthefrontcanbeusedtoholddownthefrontofthewheelchairduringexercise.Thewheelchairusercanbackontotheplateandthetwostrapsarethenhookedontotheframeofthewheelchairnearthefrontcasterstoholddownthefrontofthewheelchairduringexercise.Incorrectrearwardstabilitymethod 13CorrectstabilitytechniquesusingspotterandorweightonfootsupportCorrectstabilitytechniquesusingspotterandorweightonfootsupportSecurementstrapCorrectrearwardstabilitymethodusingarestraint 142.5.3LateralStabilityLeaningStabilitymaybeincreasedbyleaningtowardthesideothewheelchairoppositethetippingdirection.Holding-Ipossibleyoucanholdontothewheelchairrameorwheelontheoppositesideorstability.Itmayalsobepossibletoholdontoahandrailoranotherpieceostationaryftnessequipment.UseofaspotterWhilelyingbackonabenchorraisedmatareatheassistanceoaspotterwillhelptopreventlateraltipping.UseofastrapWhilelyingbackonabenchorraisedmatareaastraparoundthelegsabovethekneesmaybeusedtokeepthelegspositionedcorrectly.IncorrectlateralstabilitymethodCorrectlateralstabilitymethod 152.6.RemovingandorMovingSeatingonFitnessEquipmentAdjustmentofseatheightMosttnessequipmenthasanadjustableseatheighttomovetheseatupanddown.Youmayneedtoaskortheassistanceoatrainertomaketheadjustmentsincetheseatscanbeheavyandtypicallyrequiretheuseotwohandstoadjust.SeatsizeIthewidthordepthotheseatonthetnessequipmentistoosmallitwillbediculttotranseronandofothetnessequipment.Keepinmindthatitmaynotberealistictoexerciseoncertainpiecesoequipment.Correctlateralstabilitymethod 16RemovalofseatSomeftnessequipmentallowstheremovalotheseataltogether.Itheramestructureotheremainingequipmentislowenoughitmaybepossibletobackordriveintotheequipmenttoexercisewhileseatedinyourwheelchair.2.7.TransfersfromWheelchairIntoandOutofFitnessEquipmentWheelchairpositioningpriortotransferFigureoutthebestangletoapproachtheftnessequipmentromyourwheelchair.Aside-to-sideparallelapproachora90-degreeapproachisusuallytheeasiestormostwheelchairusers.Lockthewheel-locksonyourwheelchairpriortotranserring. 17GriplocationsfortransferversusexerciseMakesureyouknowwhichgriplocationsontheexerciseequipmentaredesignedtomoveandwhichonesarefxed.Usethefxedonesasgrippinglocationswhentranserringintoandoutotheftnessequipment.Itheftnessequipmenthasnofxedtranserpointstouseorthetranseryoucansometimesadjusttheweightotheexercisemachinetothemaximumandthenusethegriplocationthatisdesignedtomoveasatranserpointaslongasyourbodyweightislessthantheweightontheexercisemachine.Alwaystestthegripthatyouareusingtoassistintransersthefrsttimebyproceedingcautiouslyasthegrippointmaymoveunintentionallyornotholdunderbodyweight.AdjustliftpintomaximumexerciseweighttosupportbodyweightWarningFailuretoadjustexerciseweighttomaximumweightmayresultinfalling 18PressurereliefseatcushionTopreventskinbreakdownduringexerciseaSunriseJayProtectororanotherwheelchaircushionshouldbeplacedontheseatotheftnessequipmentiyouareusedtosittingonapressurereliecushioninyourwheelchair. 193.0AdaptiveEquipmentThereareseveralpiecesoadaptiveequipmentthatcanhelpyouperormyourexerciseprogramwithgreaterease.Formoreinormationonhowtoorderadaptiveequipmentvisitwww.nchpad.org.3.1.GraspingCuforActivityMittsGraspingcufscanbeusedwhengripstrengthorhandunctionislimited.Graspingcufsareveryhelpulandefectiveorhandstogripweightmachinesordumbbells.3.2.WristCufTheuseonyloncufswithametalringisagreatwaytoperormresistanceexercisesbywearingthecufontheresiduallimb.Themetalringshouldbestrongenoughtoattachweightedresistanceto.Dependingonthelengthotheresiduallimbyoumaybeabletoperormmanystrengthexercisesbyattachingthenyloncufwithametalringtoeitherresistancebandsorcableresistance.Wristcufscanalsobeusedorindividualswithlimitedhandunction.3.3.StabilizingStrapsForthosewhohavedicultywithbalanceandstabilitystabilizingstrapsandgaitbeltsaidinproperseatingandpositioninginawheelchair. 203.4.AnkleandWristWeightsAnkleweightsandwristweightsareweightedcufsthatcanbeusedorvariousstrengthtrainingactivities.Thesecanbehighlyefectiveorpersonsusingwheelchairsintermsobothupperextremityandlowerextremitymovements.TheseweightedcufscanbesecuredtothebodybyusinganadjustableVelcrostrap.3.5.MedicineBallAmedicineballisaweightedballusedduringstrengthtraining.Forindividualswithlimitedhandunctionaballwithatexturedsuracehandlesorstrapsshouldbeused.3.6.ElasticBandsorTubingElasticbandsortubingareefectivelow-costandportablepiecesoequipmentthatallowexercisecomparabletoactivitiesdonewithreeweights.Theyprovidevaryingdegreesoresistanceaccordingtotheircolorandcanbeperormedvirtuallyanywherewhetherseatedorstanding.Toincreasetheresistanceyoumayallowlessslackinthebandormoveitawayromyouranchor.Anchoringistheprocessotyingoneendotheresistivebandtoasecurexedobject. 214.0GettingStartedBeorebeginningyourexercisesitisimportantthatyourstperormawarm-uptopreparethemusclesothebody.Thewarm-upcanbeanyactivitythatgetsyoumovingsuchaslightrollingoranaerobicactivitysuchascyclingsee8.3.Ateryoucompleteyourcardiovascularexerciseandstrengthtrainingroutineyoushouldalsoperorma5-10minutecool-downincludingstretchingtomaintainrangeomotionandfexibility.Itisbenecialtoexercisemostdaysotheweek.Startslowlyiyouareabeginneroriyouhavenotexercisedinalongtime.Iyouhaveanyspecialhealthconcernsyoushouldconsultyourphysicianpriortobeginninganexerciseprogram.Ianyotheexercisesyouperormresultinpainordiscomortstopimmediatelyandletyourphysicianknow.OnceyouhavedeterminedthattheexercisesaresaeandenjoyableoryouyoucanchoosetoperormtheaerobicandweighttrainingsessionsonalternatedaysinaccordancewiththePhysicalActivityGuidelinesorAmericansPAG.4.1.RatingofPerceivedExertionRPEScaleWhenexercisingyouwanttostaybetweenlevels3and4otheRPE.Itmaytakeyouaewexercisesessionstogetaeelingorhowhardyouareworkinginordertoproperlyadjustyourexerciseroutine.AnotherwaytomeasureexerciseintensitythatislessscienticyetveryhelpulistheTalkTest.Youshouldbeabletokeepanormalconversationwhileexercising.Youmaybreathealittleheavierbutgaspingorairandeelingasthoughyoucannotbreatheindicatesthattheexerciseistoointenseandyououghttoslowdown. 224.2.ExercisePrecautionsIndividualsshouldtakenoteotheollowingspecialconsiderationsduringexerciseandphysicalactivityIndividualswithlimblossduetovasculardisorderssuchasdiabetesoratherosclerosisshouldbeawareoanyactivityrestrictionsinstructedbytheirphysician.Duetotheactthatexercisecanreducetheneedorinsulinindividualswithdiabetesshouldmonitortheirglucoserequentlyandalwayshaveaquick-actingcarbohydrateueltotreathypoglycemiaduringexercise.Appropriatecarbohydratesourcesincludebutarenotlimitedtosportsdrinksgelsandglucosetablets.Consumingaround30gramsocarbohydratesisconsideredthetypicaltreatmentorhypoglycemia.4.2.1.Wearanyspecialmedicalidenticationthatmayprovehelpulintheeventoaproblemoccurringduringexercise.4.2.2.Wearcomortableathleticshoeswithcottonsocksthatwillnotruborcausesoresduringexercises.Athoroughootinspectionshouldbedonebeoreandaterexercise.4.2.3.Beawareoanymedicationsyouaretakingthatmayhaveanefectonyourabilitytoexercise.4.2.4.Consumeadequateamountsouidspreerablywaterpriortoduringandaterexercise.AccordingtotheNationalStrengthandConditioningAssociationNSCAidealuidreplacementcallsor16ouncesoliquidbeoreexercise6to8ouncesevery15minutesduringexerciseandahal-literoreverypoundlostduringexercise. 234.2.5.Checkanytenderpointsskinbreakdownsorinfectionsintheareaofaresiduallimbespeciallyifadaptivedevicesareusedduringresistanceexercises.Inthelong-termthesecanfurtheraggravatetheresiduallimbandmaykeepyoufromparticipatinginexerciserecreationalactivitieswork-relatedactivitiesandotherdailylifeactivities.4.2.6.Avoidoveruseinjuriestotheuninvolvedlimbs.4.2.7.Youmayhaveatendencytofatigueeasilyespeciallyintheareaoftheresiduallimb.4.2.8.Lackofadequatebalancemayinterferewiththeabilitytoperformexercisessafely.4.2.9.Weaknessandorlimitedrangeofmotionofthearmsorlegsmayinterferewithapersonsabilitytomaintainaconstantrateofexercise.4.2.10.Receptiveaphasiamentalconfusionandorapraxiamayinterferewiththeabilitytounderstandandfollowdirectionsduringexercisetestingandtrainingsessions.4.2.11.Individualphysicalcapacityandendurancemaybeseverelylimitedduetosecondaryorthopedicarthriticcardiovascularandorotherinjuriesincurredatthetimeofanaccidentthatmayhavebeenthecauseofaprimarydisabilityorimpairment. 244.2.12.Iatallpossiblecheckyourbloodpressurebeoreduringandaterexercise.Youcanpurchaseabloodpressuremonitoratyourlocalpharmacy.Itisimportanttomonitoryourbloodpressureduringexerciseiyourbloodpressureistoohighitcanputabnormalstressonyourheart.4.2.13.IndividualswithspinalcordinjuriesatorabovetheleveloT6mayhaveanimpairmentothesympatheticnervoussystemwhichisresponsibleortheincreaseinheartrateduringexercise.Thereoreanalternativemethodormonitoringexerciseintensitythatdoesnotdependontheheartrateisrecommended.ExerciseintensitymaybemonitoredusingaRatingoPerceivedExertionRPEscaleseeprevioussectiononRPE.4.2.14.ThemaximalheartrateorindividualswithtetraplegiaT1andaboveistypicallylimitedto120to130beatsperminute.4.2.15.Itisimportanttocheckorpressuresoresbeoreandatereveryworkout.Specifcallycheckbonyareasothebodysuchastheelbowshoulderbladetailbonehipkneeankleheelandthesideothelegpressingagainsttheinsideoyourwheelchair.Examinetheseareasoranyrednessblistersopeningsinskinorrashes.4.2.16.Individualswithsurgicallyplacedrodsoraspinalusionshouldbeawareorestrictionstomovementandexercises.Consultwithyourphysiciantomakesurethattheexercisesinthisguidearesaeiyouhaveoneotheseconditions. 254.2.17.Thermoregulationorbodytemperatureregulationisafectedbelowtheleveloinjury.Theexternalenvironmentinwhichexerciseisperormedwillbeamajordeterminantobodytemperatureduringexercise.Anticipatetheseexerciseconditions.Keepacolddampclothanorspraybottlehandywhenthetemperatureistoohotorwhenyoueelyouaregettingoverheated.4.2.18.Individualswithsensoryimpairmentsmaynotbeabletoobtainanaccuratepulse.4.2.19.Somemedicationswillinhibitpreventheartrateromgoingaboveacertainlevelaskyourdoctortoexplainthistoyou.4.2.20.AnindividualwithaC1-C4lesionmayhavedecreasedrespiratoryunctionthatleadstoproblemssuchasincreasedriskorrespiratoryinectionscongestionrapidbreathingandorincreasedshortnessobreath.Breathingexercisesmaybebenecialinsustaininghealthylungcapacitylungexpansionandloweringriskorrespiratorycomplicationssuchaspneumonia. 265.0FlexibilityCoolDownUpperBodyStretchesJustasthewarm-upisimportanttogetyourbodystartedthecool-downisveryimportanttoreturnyourbodytoitsrestingstate.Thecool-downisagreattimetoperormfexibilitystretchingexercises.Whilestretchingndthepointwhereyoueelaslightpullandhold.Donotbounceortrytostretchtoapointatwhichpainiselt.Youshouldbreatheregularly.Holdeachstretchor10-30secondsandrepeat.UpperBodyStretches5.1.NeckRotationTakeadeepbreathinandexhalewhileturningtheheadtoonesidelookingoverthatshoulder.Hold.Repeatontheoppositeside.5.2.NeckLateralFlexionTakeadeepbreathin.Exhaleastheneckbendstoonesideandtheeargoesdowntowardstheshoulder.Hold.Repeatontheoppositeside. 275.3.NeckForwardFlexionTakeadeepbreathin.Exhaleasyouslowlylowerthechintothechest.Hold.5.4.ShoulderRollswithDepressionTakeadeepbreathinandrolltheshouldersuptowardstheears.Exhaleandrolltheshouldersbackwhiledepressing.Hold.5.5.PosteriorDeltoidStretchTakeadeepbreathinandextendonearmoutinfrontofyou.Exhaleasyouhookthearmslightlyabovetheelbowwiththeoppositehandbringingitacrossandintowardsthechest. 285.6.TricepStretchTakeadeepbreathinandextendbotharmsabovethehead.Reachdownthecenterofthebackwithonearmandexhalepressingdownslightlywiththeoppositehandontheelbow.Repeatontheoppositeside.5.7.TrunkRotationPlacethehandontheoppositethigh.Takeadeepbreathinandexhalewhiletwistingthetorsolookingovertheshoulder.Holdandrepeatontheoppositeside.5.8.LateralTrunkFlexionWiththearmsatyoursidetakeadeepbreathinandexhaleasthetrunkbendstotheleftandtherightarmextendsoverhead.Holdandrepeatontheoppositeside. 295.9.RhomboidStretchExtendthearmsoutinrontcrossingthemoversothepalmsaretouching.Inhaleandraisethearmsuptoshoulderheight.Exhaleandpushtheshouldersorward.Hold.5.10.BicepsStretchinDoorwayExtendtheletarmouttotheside.Placetheletfstinthedoorwaywiththepalmdown.Takeadeepbreathinandexhalewhileturningtheheadtotherightlookingovertherightshoulder.Switchsidesandrepeat.5.11.SeatedChestStretchinDoorwayPlaceanarmbentat90degreesindoorway.Takeadeepbreathinexhalewhileturningtheheadtotheoppositesidelookingoverthatshoulder.Repeatwithotherarmlookingovertheoppositeshoulder. 305.12.ChestStretchhandsclaspedbehindbackClasphandsbehindyourback.Takeadeepbreathin.Exhaleandrollyourshouldersbackasyoustickoutyourchestandhold10seconds.Unclasphandsandrelax.5.13.WristFlexionandExtensionStretchExtensionExtendanarmoutinronttakeadeepbreathinpointfngersupgraspupperpalmandlowerportionofngerwithoppositehandexhalepullingpalmandfngerstowardsyou.Repeatwithotherarm.FlexionExtendanarmoutinronttakeadeepbreathinpointfngersdowngraspupperpalmandlowerportionofngerwithoppositehand.Exhalepullingpalmandfngerstowardsyou.Repeatwithotherarm. 315.14.ShoulderShrugTakeadeepbreathinlitandholdyourshouldersuptoyourearsandhold10seconds.Exhaleandallowyourshouldersandarmstodropdownbyyoursidereachingtowardthefoorandholdthatstretch10seconds.5.15.HamstringStretchLitonelegupandplaceitoutinrontoyouonachairmatorbench.Takeadeepbreathin.Exhaleasyoureachyourarmsorwardasaraspossibletowardyouroot.Holdyourootandgentlypulltheballoyouroottowardyoufexingyourankletowardyouandhold20seconds.Repeatwiththeotherleg.5.16.ShoulderRetractionTakeadeepbreathin.ExhaleandbringshouldersbackasarasyoucansqueezingyourshoulderbladesinwardseeChestStretch5.12. 326.0StrengthTrainingExercisesfortheUpperBodyWARNINGIthereisacrepitationoranypoppinginsidetheshoulderonanyexerciseyoushouldchangethemovementpatternsothatthisdoesnotoccur.Iyoudonothavegoodshoulderstabilitydonotperormanyexercisesthatcauseyourelbowtomoveabovetheheightoyourshoulder.Therearefvebasicactorsinstrengthtraining1ExerciseRepetitionOnemovementorexercisecompletedthroughafullrangeofmotion.2ExerciseSetAgroupofmultiplerepetitionsperformedinarowe.g.asetof10repetitions.3ExerciseFrequencyThenumberoftrainingtimesperweek.4ExerciseWeightTheamountyouareliftingusuallyexpressedinpounds.5StabilityThepositioningofthewheelchairuserinthewheelchairorduringtheexerciseinordertomaintainproperbalance.6.1.HowHardShouldIExerciseUselighterloadswhenbeginningaweight-trainingprograminordertomasterthetechnique.Youshouldfeelcomfortablewithbodypositioningmovingthroughacomfortablerangeofmotionliftingtheweightinaslowandcontrolledmannerloweringtheweightinaslowandcontrolledmannerandbreathingexhalewithexertiondonotholdyourbreath.Startwithaweightthatyoucanliftfor12-15repetitions.Ifyouareabletoperformmorethan20repetitionstheweightorresistancecanbeincreased.Ifyouareunabletoreach12repetitionscomfortablytheweightorresistancemaybetooheavy.Youshouldnotworkthesamemusclegroupeveryday.Alternatedaysofrestwithdaysofactivity.Makesmallincreasesintheamountofweightastheexercisebecomeseasier. 33Iyouhaveproblemswithbalanceortrunkinstabilitydonotlitreeweightsoveryourheadwithoutaspotterortrainer.Forallexercisestakeadeepbreathandexhaleduringthelitingportionotheexerciseandinhaleasyoureturntheweighttothestartingposition.Exerciseinrontoamirroranduseyourownmusclestobalanceandsitasuprightaspossible.6.2.WristStrengtheningMusclesFlexorCarpiRadialisFlexorCarpiUlnarisExtensorCarpiRadialisExtensorCarpiUlnarisGriptheendsotheFlexBarwithbothhands.Takeadeepbreathinexhaleandtwisttherighthandorwardandthelethandbackwards.InhaleasyouslowlyallowtheFlexBartoreturntothestartingposition.Repeattheexercisetwistingtheoppositedirectionwithrighthandbackwardsandlethandorwards.6.3.PowerWebMusclesFlexorCarpiRadialisFlexorCarpiUlnarisSitupwithgoodbodyalignmentandeetfat.Positionthepowerwebinrontoyou.Placeahandinthewebspreadingthengersoutandsqueezethewebinfexion.Thenplacethehandinthewebwiththengersclosetogetherandspreadthengersoutinextension.Exercisingtheopposingmusclegroupsisimportantorallexercises.Inhaleasyoureturntothestartingposition.Repeatwiththeoppositearm. 346.4.ShoulderAbductionCautionLateralInstabilitySee2.5.3MusclesMedialDeltoidSupraspinatusNoteWristweightscanbeusedforindividualswithlimitedgripstrength.Graspadumbbell.Placethehandyouarenotlitingwithonthechairwheeloranotherstationaryobjectorstability.Situpniceandtallwiththearmextendeddownatyoursidepalmacingin.Keepingtheupperbodystationarytakeadeepbreathinandexhaleasyouextendthearmouttothesideslightlyinrontothebodyandraisetoshoulderlevel.Keepaslightbendintheelbowthehandinlinewiththearm.Donotusejerkingorswingingmotions.Inhaleasyoureversethedirectionandallowthearmtoslowlygobackdowntothestartingposition.Repeatwiththeoppositearm.Thisexercisecanalsobeperormedwiththeelbowsbent90degrees.Perormingthisexercisewiththethumbpointeddownwillengagethesupraspinatusmusclewhichispartotherotatorcufthatprovidestheshoulderwithstability.Themedialdeltoidshoulderabductioncanbeperormedwithtwodumbbellsatthesametime.Holdthedumbbellsatyoursidewithyourelbowsbent90degrees.Raiseyourelbowsslowlyuntiltheyareevenwithyourshoulders.Thenloweryourelbowsbackdowntoyoursideslowly.ExternalrotationshoulderabductionStartwithyourarmhangingdownbyyourside.Lityourarmuptoshoulderlevelkeepinginlinewiththesideoyourlegwithyourthumbpointingup. 35SupraspinatusshoulderabductionStartwithyourarmhangingdownbyyourside.Startingwithamuchlighterweightlitupyourarmtoshoulderlevelkeepinginlinewiththesideoyourlegwithyourthumbpointingdown.Thisstrengthensanimportantrotatorcufmusclethatwillhelpstabilizeyourshoulder.6.5.ShoulderAdductionMusclesPectoralisMajorGriptheendsotheFlexBarwithbothhands.HoldtheFlexBarchesthighelbowsouttothesides.TakeadeepbreathinexhaleandbendtheFlexBardownmovingtheelbowstowardthebody.Inhaleasyouraiseelbowsbackuptothestartingposition.6.6.UprightRowMusclesDeltoidsTrapeziusBicepsBrachiiStartwithyourarmsdownateithersideinrontoyoupalmsacingback.Useastraptosupportyourupperbodyineeded.Exhaleandbendyourelbowstobringyourhandsuptoyourarmpits.Keepyourhandsclosetothebodythroughthemotion.Inhaleandslowlylowertothestartingposition.NoteIndividualswithacompleteinjuryatorabovetheC6levelmaynotbeabletoperformthismovement. 366.7.OverheadShoulderPressCautionRearwardInstabilitySee2.5.2MusclesAnteriorandMedialDeltoidsUpperandMiddleTrapeziusSittingupwithgoodbodyalignmentgraspthehandgripsandineededsecurewithgloves.Bringhandstoshoulderlevelwithpalmsacingorwardandtakeadeepbreathin.Exhaleandpushthearmsabovetheheadandtowardthemiddleothebodyinanarcmotion.Donotarchthelowerbackororceullylockouttheelbow.Allowtheelbowtoslowlyfexinhaleandlowerthehandgripsbackdowntothebeginningposition.Iyoudonothavegoodshoulderstabilitythisshouldonlybedoneuntiltheelbowisevenwiththeshoulderandnohigher.6.8.LateralPullDownCautionRearwardInstabilitySee2.5.2MusclesLatissimusDorsiTeresMajorMiddleTrapeziusRhomboidsGraspthehandgripswithpalmsacingorward.Gripshouldbewiderthanshoulderwidthapart.Positiontheeetfatandleanthetorsoslightlybackwardandextendelbowsully.Takeadeepbreathinexhaleandpullthehandgripstowardtheupperchestmaintainingaslighttorsobackwardlean.Donotjerkthetorsoorassistance.Bringthehandgripsdownuntiltheyarealmosttouchingtheshoulders.Inhaleasyouallowthearmstoslowlyextendbacktothebeginningposition. 376.9.ForwardChestPressCautionRearwardInstabilitySee2.5.2MusclesPectoralisMajorPectoralisMinorAnteriorDeltoidSubscapularisSerratusAnteriorPositionyourchairtoaceawayromthetnessequipment.Graspthehandgripsandalignhandswiththecenterothechest.Takeadeepbreathinexhaleandpushhandsawayromthechesttoanalmostullyextendedelbowposition.Donotbendwristsbutkeepthemstraight.Donotarchtheback.Inhaleasyouallowthehandgripstoslowlyreturntothestartingpositionstayinglevelwiththechest.6.10.SeatedRowMusclesRhomboidsPosteriorDeltoidsLatissimusDorsiTeresMajorandMinorInraspinatusMiddleTrapeziusPositionyourchairtoacetowardthetnessequipment.Adjustchestpadsothatyourbackremainsstraightanduprightwhilebeingabletograspthehandgripswitharmsullyextendedinrontoyou.Graspthehandgripswithaclosedorverticalgrip.Thegripshouldbewiderthanshoulderwidthapart.Positionyoureetfatiyouareableto.Takeadeepbreathinexhaleandpullthehandgripsbacktowardsthechestsqueezingtheshoulderbladestogether.Pullthehandgripsbackasarasyoucanwithoutjerkingthetorso.Inhaleasyouallowthehandgripstoreturntothestartingpositionkeepingtheelbowsinwardstowardstheribs. 386.11.BicepCurlCautionLateralorForwardInstabilitySee2.5.3and2.5.1MusclesBicepsBrachiiBrachioradialisBrachialisStartwithonearmextendedatyoursidepalmacingupgraspingthedumbbell.Ineededremovethesideguardorarmsupportoyourwheelchairortranserontoabenchinordertoperormthemovementwithaullrangeomotion.Keepingtheupperarmandupperbodystationarytakeadeepbreathin.Exhaleandfextheelbowraisingtheorearmtowardstheshoulder.Donotjerkorswingthedumbbellupward.Inhaleasyoureversethedirectionslowlyextendingtheweightbacktothestartingposition.Leantowardtheoppositesideoyourwheelchairtoincreaseyourlateralstabilityaswell.Ipossibleyoucanholdontothewheelchairrameorwheelontheoppositesideorstability.Itmayalsobepossibletoholdontoahandrailoranotherpieceotnessequipmenttoassistwithyourlateralstability.Repeatwiththeoppositearm. 396.12.ArmCurlMachineMusclesBicepsBrachiiBrachialisForearmFlexorsGraspthehandgripswithpalmsacingupwardsandkeepwristsstraightthroughouttheexercise.Restupperarmsonthepadkeepingelbowsinlinewiththepivotpointothemachine.Situpstraightandtakeadeepbreathin.Exhaleandraisetheorearmtowardstheshoulder.Inhaleasthearmsslowlyreturntothestartingpositionalmostullyextended.6.13.TricepsKickbacksMusclesTricepsBrachiiPlacethehandyouarenotlitingwithonthechairwheeloranotherstationaryobjectorstabilityandtoallowyoutoslightlyleanorward.Withonehandgraspingthehandgripothereeweightorcableresistancemovetheelbowbehindthemidlineothebodykeepingthearmat90degrees.Takeadeepbreathin.Exhaleandfextheelbowandinhaleasyoureturntheorearmtothestartingposition.Repeatwiththeoppositearm. 406.14.ArmExtensionMachineMusclesTricepsBrachiiLiftuphandlesgraspthehandgripswithpalmsfacinginwardsandkeepwristsstraightthroughouttheentireexercise.Restupperarmsonthepadkeepingelbowsinlinewiththepivotpointofthemachineandwiththeshoulders.Situpstraightandtakeadeepbreathin.Exhalepushingforearmsdownwardastheupperarmsremainonthepad.Inhaleastheforearmsreturntothestartingposition.6.15.BentOverShoulderFlyCautionForwardInstabilitySee2.5.1MusclesPosteriorDeltoidTrapeziusPositionyourselffacedownonaninclinebenchandstartwithyourarmsfullyextendedoutinfrontofyou.Graspthedumbbellsinyourhandshavingthedumbbellstouchoutinfrontofyou.Extendyourarmsouttothesidecontractingyourshoulderbladesandthenloweryourarmsbackinfrontuntilthedumbbellstouchagainatthestartingposition.Keepyourelbowsstraightwithoutlockingduringtheentiremovement. 416.16.ExternalRotationRowandBentOverRowCautionLateralorForwardInstabilitySee2.5.3and2.5.1MusclesTrapeziusPosteriorDeltoidForwheelchairusersthemostefectiverowcanbeperormedonaweightbenchorbyleaningorwardonyourthighsiyouhavethecorestrength.ExternalRotationRowWiththeelbowraisedevenwiththeshoulderasshownontherightraisethehandorwarduntilthehandislevelwiththeshoulder.BentOverRowStartingwiththearmsextendedullydowntowardtheoorpullyourelbowsupandbackpinchingyourshoulderbladestogetherasshownontheright.Iyouhavethecorestrengthyoucanalsoleanorwardwithyourchestonyourlowerlegstoperormthisexercise.6.17.ReclinedPectoralFlyCautionLateralInstabilitySee2.5.3MusclesPectoralisMajorTransertoabenchorraisedmatarea.Lieonyourbackkeepingthespineneutralandyourheadremainingonthesurace.Astraparoundthelegsabovethekneesmaybeusedtokeepthelegspositionedcorrectlywhenlyingbackonthesurace.Youmayneedanassistanttohandyouthedumbbellsateryouarepositionedcorrectly.Withweightsinyourhandsandarmsextendedouttothesidesexhaleandbringbotharmstogetheroveryourchest.Keepaconsistentslightbendintheelbowthroughoutthemotionanddonotjerkorswingtheweightup.Iyoucannotmaintainyourarmsinthesameextendedslightlybentpositionthroughoutthe 42movementalowerweightshouldbeused.Inhaleasyouslowlyallowyourarmstoreturntothestartingposition.Astraparoundthelegsbeloworabovethekneesmaybeused.6.18.LyingAbdominalCrunchesCautionLateralInstabilitySee2.5.3MusclesRectusAbdominusTransverseAbdominusPositionyourselacinguponaatordeclinedbenchoraatmat.Ipossiblebendkneeswhilekeepingeetatontheoor.Astraparoundthelegsabovethekneesmaybeusedtokeepthelegspositionedcorrectlywhenlyingbackonthebench.Anadditionalstrapcanbeusedtosecuretheeettothesuraceorhaveaspotterassistbyholdingtheeetdown.Whilelyingdownwithshoulderbladesandneckinalignmentwiththebodyexhaleandcurlup.Allowshoulderbladestocomeupofthesuraceandkeepyoureyesocusedontheceilingdirectlyoverhead.Inhaleasyouslowlyreturntothestartingpositionallowingshoulderbladestoreturntothesurace.NoteForindividualswithaspinalcordinjurythisexercisecanbeperformedusingacounterweightsuchasamedicineballthrownoverheadorresistancebandpositionedaroundasecureobject. 436.19.SeatedAbdominalMachineMusclesRectusAbdominusTransverseAbdominusFoldarmsrestinghandsonshouldersandrestingarmsontopothepad.Keepchinrestingonpadorarmsthroughouttheentireexercise.Situpstraightslightlyarchingbacktoextendabdominalmuscles.Takeadeepbreathin.Exhaleasyoumovethepaddownallowingelbowstotouchkneesipossible.Keepchinrestinginsameposition.Inhaleasyouslowlyreturntothestartingposition.Makesuretoengageyourabdominalmuscleswhilepushingthepaddownandnotutilizingarmorbackstrength.6.20.InternalRotationCautionLateralInstabilitySee2.5.3MusclesAnteriorDeltoidPositionthesideoyourchairtowardtheftnessequipmentandgraspthehandgripwiththehandclosesttotheequipment.Placetheotherhandonyourlaporwheelorstability.Bendthearmata90degreeangle.Keepelbowfrmlyagainstyourside.Takeadeepbreathin.Exhaleasyoubringyourhandacrossyourbody.Inhaleasyouslowlyreturntothestartingposition. 446.21.ExternalRotationCautionLateralInstabilitySee2.5.3MusclesRotatorCufPositionthesideoyourchairtowardthetnessequipmentandgraspthehandgripwiththehandarthestromtheequipment.Placetheotherhandonyourlaporwheelorstability.Bendthearmata90degreeangleelbowrmlyagainstyoursideandorearmacrossyourbody.Takeadeepbreathin.Exhaleasyoubringyourhandouttotheoppositesideoyourbody.Inhaleasyouslowlyreturntothestartingposition. 457.0PulleyExercisesTheollowingpulleyexercisesarealldesignedtostrengthenthemusclesintherotatorcufgroupomuscles.Perormingtheseexercisesonaregularbasiswillstrengthenallothemusclesthatunctionallyholdyourshouldertogethertoperormmostotheactivitiesthatyouneedtobeabletoperormusingawheelchair.Thisincludespropellingyourwheelchairandperormingtransers.Whileperorminganypulleyexerciseinordertoexerciseandstrengthenyourbalanceandtorsoavoidgraspingtightlyontotheramewheelorarmsupportothewheelchair.Thiswillgenerallyrequireleaningawayromthepulleymachineduringtheinitialportionothepull.Asthehandholdingthepulleycrossesthecenterlineothebodyyouwilllikelyhavetoleanintheotherdirectiontostaybalanced.Keepingahandonasolidpartothewheelchairwillallowyoutomaintainyourbalanceiyoustarttoloseyourbalance.Formoreinormationonstabilityissuesseesection2.5.Selectaweightthatseemseasyatrst.Youshouldbeabletoperormtheexerciseorupto15to20repetitionsinonesetoexercisesbeoreyouincreasetheweight.Itissuggestedthatyouperormthreesetsorepetitionsoeachpulleyexercisethatyouaredoingonanyparticularday.Iyoucannotperormatleast12repetitionsduringeachsetoexercisesyoushoulddecreasetheamountoweightthatyouareusingtoexercise.Inmostotheseshoulderstabilityexercisesthenumberorepetitionsismoreimportantthantheamountoweight.OverheadTricepsExtensionDeclinePress 46One-ArmTricepsExtensionPull-DownDiagonal1Pull-DownDiagonal2Pull-BackStraightArmPull-BackRotationPull-PushInclinePress 47TricepsExtensionwithRopePull-BackStraightArmShoulderInternalRotationSee6.20ShoulderExternalRotationSee6.21Pull-AcrossDiagonal1Pull-AcrossDiagonal2 488.0CardiovascularExcerciseHowHardShouldIExerciseTargetHeartRateAge-predictedmaximumheartratecanbeusedtofndatargetheartraterangeoraerobictraining.Theequation220minusageisusedtofndamaximumheartrate.ItisrecommendedbytheAmericanCollegeoSportsMedicineACSMthatindividualswithspinalcordinjuriesexerciseat50-80otheirage-predictedmaximumheartrate.HoweverindividualswithaspinalcordinjurymayneedtouseanalternativemethodtodetermineexerciseintensitysincetheuseosmallermusclesinexercisewillgenerallyresultinlowerheartratesSee4.1oralternativemethods.8.1.RowingMachineBothlockingthewheelchairandtheuseowheelchocksmayhelptosecureastationaryposition.Holdontoasingleordoublehandleandreachorwardasaraspossiblewithoutlosingyourbalanceintheorwarddirection.Pullbackleadingwithyourshoulderstotherearwhilepullingyourarmsbackasaraspossible. 498.2.AlternatingFlexionExtensionoftheArmintheForwardDirectionHoldontothehandgripsverticallyandalternatepushingthelefthandforwardwhilepullingtherighthandbackwardandvise-versa.Keepanuprightbalancedposturewithyourbackslightlyarched.8.3.ErgometerAlignwheelchairdirectlyinfrontoftheergometer.Adjustpedalstotheproperalignmentwithshoulders.AdjusttheresistancesothatahigherRPMmaybemaintainedwithoutusingupmusclestrength.8.4.VLTRopeTrainerTransferfromwheelchairontotheseatorremovetheseatandalignwheelchairdirectlyinfrontoftheropetrainer.Positionyourselfclosertotheedgeoftheseattoengagethecore.Forindividualswithhigherlevelspinalcordinjuriespositionyourselftothebackoftheseatandifnecessaryplaceastabilizingstraparoundyourwaistandorthighs.Forgeneralcardiovasculartrainingworkatalowtomediumresistancesetting. 508.5.SkiErgUsingacabledrivenergometeravarietyofexercisescanbeperformedinarepetitivewaytoobtaingoodcardiovascularexerciseusingmovementsthatarenotoverusedduringwheelchairpropulsion.BeginFinishPull-DownAcrossAnteriorOverheadTricepsExtension 519.0TheMusclesofTheBodyAnteriorDeltoidMedialDeltoidPectoralisMajorBicepsObliquesAbdominalsIliopsoasQuadricepsHipAbductorsHamstringsHipAbductorsGluteusLatissmusDorsiTricepsRhomboidsPosteriorDeltoidTrapeziusFRONTREAR 52Hwww.nchpad.orgwww.benefcialdesigns.com