Posts Tagged Exercises

[Article in Press] Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Full Text

PhysioTherapy eXercises website:

PhysioTherapy eXercises is a publicly available website, created by Harvey, Messenger, Glinsky, Pattie and a collaboration of physiotherapists. It was designed as a resource for creating and distributing home exercise programs. The website has a database of images, videos and instructions for over 1000 exercises focusing on impairments (strength, balance, range of motion, and cardiovascular fitness), and activities (reaching and manipulation, sit to stand, transfers, and mobility), and is available in 13 different languages. The exercises are evidence-based and include exercises for children through to the elderly, as well as exercises targeting specific populations, such as acute and degenerative neurological conditions, and musculoskeletal conditions, including whiplash and hand injuries. The Physiotherapy Exercises App is one feature of this web-based software and is the focus of this review.

The Physiotherapy Exercises App is free and can be used on both Apple and Android tablets and phones. The app is designed for patients to use, and allows them to access their prescribed home exercise program on their devices, record their progress online, and share this information remotely with their therapist. A recent randomised, controlled trial reported that using the Physiotherapy Exercises App increased adherence to home exercise programs when compared with paper-based methods.1

The therapist designs a home exercise program by selecting relevant exercises from the database and scheduling the frequency and duration of the exercises using the PhysioTherapy eXercises website. The patient then accesses and installs the Physiotherapy Exercises App via a link embedded in an email or smart phone text message that is sent from the website. Once the app is installed, patients have direct access to their home exercise program. The app allows patients to view their program, record completion of each exercise, and provide feedback to the therapist via a ‘notes’ function. The therapist has the ability to remotely monitor the patient’s exercise adherence, review notes recorded by the patient, and adjust the program as required by logging onto the website. Therapists can also receive a notification via an email when a patient’s adherence has decreased below a set threshold, which can be adjusted by the therapist for each patient.

Ease of use

Overall, the design of the Physiotherapy Exercises App is straightforward and the basic features are easy to use. My experience suggests that patients who already use the Internet and/or mobile devices are willing to use the Physiotherapy Exercises App, and use it successfully. Patients with limited technology experience are able to use the app successfully if provided with assistance to download the app and are given a demonstration of how to use it. Once the app has been downloaded, patients have two options: view the exercises that are to be completed on that day via the home screen (Figure 1A); or touch the screen to access the illustration, aims, instructions and dosage for each exercise (Figure 1B). Similarly, recording of the completed exercises can be done by ticking the ‘done all’ box on the home screen or ticking a box on each screen for an individual exercise. Patients can record completing an exercise even if it is not scheduled for a particular day. Notes can be added on each screen that details an individual exercise.

Figure 1

Enter a caption

From the perspective of therapist use, the home exercise program is prescribed and monitored by logging directly onto the website. The website has an extensive help section to assist the therapist if required.

Strengths and limitations

The Physiotherapy Exercises App is very well designed for clinical use. One of the key strengths is that patients can only access their home exercise program once it has been prescribed to them by a therapist, which ensures that patients complete exercises appropriate for their rehabilitation. Another valuable feature is that once the Physiotherapy Exercises App has been downloaded, there is no requirement for the patient to login or remember passwords. Other strengths are that the interface is easy to understand, and patients receive detailed information about each exercise, including the aims of the exercise, illustrations, instructions on how to complete the exercise, dosage, precautions, and progressions. Furthermore, therapists have the ability to select what information the patient views on the app and/or modify the instructions and information if required. When the home exercise program is updated online, all changes occur in real time.

Limitations of the Physiotherapy Exercises App are that few patients use all the features of the app, for example the notes function. My experience using the app with people who have Parkinson’s disease is that most people primarily use the app to view and record completion of their home exercise programs. Further encouragement by the therapist is necessary to ensure regular use of the notes function, if desired. At present, patients do not receive an alert via the Physiotherapy Exercises App that their program has been updated; it simply changes on the home screen. Consequently, if the program is updated independently of a consultation, an additional form of communication may be required to inform the patient of changes made.


Overall, the Physiotherapy Exercises App is an excellent and easy to use clinical resource. Increasing the use of devices to provide home exercise programs directly to patients is highly desirable and resource-efficient. It gives patients access to their home exercise program at all times, facilitates self-management, and, importantly, increases communication between the patient and therapist. The advantages of the Physiotherapy Exercises Appare that it is freely available, has an extensive range of exercises covering both musculoskeletal and neurological conditions, and is easy to use for both therapist and patient. Combined with the ability to remotely monitor patients’ adherence to the home exercise program, the Physiotherapy Exercises App has been a valuable addition to my clinical practice and role as a clinical educator.


  1. Lambert, T. et al. J Physiother201763161–167

View in Article   Abstract   Full Text   Full Text PDF   PubMed   Scopus (1)  Google Scholar


via Home exercise programs made effortless using the PhysioTherapy eXercises patient app – Journal of Physiotherapy


, , , , , , ,

Leave a comment

[WEB SITE] Fine Motor Skills for Adults – The Ultimate Collaborative List  

I am always looking for new fine motor skills ideas, specifically when working with adults. I tend to resort to my “old favorites” that I know work well, along with specific activities that are important to my patients.

But when I am working with a patient long term, where I need to grade the activity or trying to look for activities that are fun and new, I can get stuck.

So I asked 27 Occupational therapists –  What are your favorite fine motor control exercises when working with adults?

Below are the great ideas (and video!) we came up with – read, print and enjoy!

Get some new ideas with this HUGE list of fine motor activities when working with adults | #OT #geriatricOTNuts and bolts, lacing beads, using clothespins to pick up Pom pons to paint or just sort, buttons, zippers, snaps, putting marbles or rubber balls on golf tees, making small balls with putty or play doh, sorting jewelry, squeezing water out of sponges or towels, using different types of tongs to pick up small objects – Paula Bradley

Drawing a picture graded by changing the size of the paper. Bring in different materials stampers, finger paint, etc – Richard Brown

Folding clothes (wash cloths, socks), ADL board (button, zippers bra hooks etc), opening containers (toothpaste, lotion), clothes pins, rainbow rings for crossing midline, velcro board, keys and locks, theraputty, digiflex, beading craft – Jasmine Sohrakoff

My bin of various empty grocery containers is my go-to for FMC to open/close, and having pts reach for them in cabinets/refrigerators/shelves of various heights is one of my favorite GMC activities. – Sarah Stromsdorfer from

I take them straight to the kitchen and do bathroom stuff! I get them to open their make up containers, shampoo/conditioner bottles, wearing weights while organizing shelves in the bathroom and or kitchen…make meatballs, bread, pies for meal prep…opening different containers of milk, using the manual can opener. Sorting dry a bag of dry beans for meal prep…decorating cookies and cupcakes. – India Leah Davis

Theraband activities or squeezing a ball. – Noreena Ishtiaq


I had a patient who had a stroke that was a retired banker. I brought in all sorts of coins/dollars he really enjoyed sorting them into various piles, placing them in stacks, etc. – Samantha Kaufman

One easy fine motor activity I really like is to take a piece of paper and using one hand, make it into a ball, then spread it out flat.

Click here to see this exercise in action on the SeniorsFlourish Facebook page. 

But Rachel Hall, had a suggestion to take it one step farther to grade it by starting with the paper on table then raise it up once in the hand so no “cheating.”

My patient cleaned a tray table of shaving cream and told me she liked doing a functional task. – Sharon Leary

Graded puzzles (larger piece sizes to smaller); grooming/hygiene tasks – open/close/apply toothpaste, lotion, lipstick; sort through a purse or bag to retrieve a specified item; pulling out a Kleenex or paper towel; open/close food and kitchen storage containers; buttons and zippers; play checkers or arrange on the board; handle money; turn pages of a book or magazine; pull silverware from a dish rack, separate them, and put into silverware tray; spray and wash a window or mirror; turn faucets on/off or light switches. Anything functional! – Monica Heltemes from

I’d love to try origami – Ruby Kopenski

We use a weightwell for strengthening and grip (graded). We also have a woodwork and arts and crafts area at work which enables meaningful engagement. – Charlotte Parry

I like those fleece blankets you tie together… they can give it to someone. One of my ladies was expecting a great granddaughter – so she was able to give her something she made. She was so excited. – Tonya Gladden

HUGE list of fine motor activities when working with adults | #OT #geriatricOTMaking salt dough and using cookie cutters to make shapes. End product is endless – tags for gifts, place cards, add essential oils to dough and make hanger for closet. Stringing beads for tree decorations at Xmas and Mardi Gras.

Weaving on a simple table loom – make scarves, placemats, etc. Card making with dye cuts. Silkscreening. Puzzles with the pieces hidden in rotini pasta/beans/black eye peas all dry and uncooked. Adult coloring books. – Jane Ryan

Pony bead necklaces and bracelets, flower pens, sorting beans in a weekday pill tray, letting the patient show you how to crochet if you don’t know how, lacing boards. – Natalie Nunyabiz

We removed the line, cleaned, oiled and put a new line on a fishing rod. Box of various nuts and bolts, pennies in piggy bank, placing lots of washers on a long bolt, various locks and keys, buttoning small buttons on a shirt. Have had ladies cut coupons and make cards. – Tammy Lane

Therapy apron which has all sorts of buttons, zips, Velcro, buckles and ties. Even typing or musical instrument playing. – Bec Rourke

I’ll find out their interests. ADL (example: dressing board), IADL (example: cooking, money management like picking coin) or leisure (gardening, word finding-using pen or computer base). – Vicneas Veloo

The game “Topple” is great for fine motor. – TerriAnne Zocco Ragonese

I love to use cards games and board games: checkers, chess, Sorry, Yahtzee, Jenga, BananaGrams, Sour Apples, Chinese Checkers. Jewelry making. Cooking tasks, like that are related to holiday themes and decorating them by hand with candy decorations and frosting bags. napping fresh green beans, teaching some of the basic sign language letters. Working on the computer. Handwriting, letter writing or card writing and have them address the envelopes as well. Crochet/knit/hook rugs. Have women put on make up or do nail care and have them paint their nails. Put together models of cars or even miniture furniture. – Julie Clark Spuhler

I use culturally relevant activity prescription such as cooking. – Jouyin Teoh

Making bread and cookies. Model planes, cars and boats. Lego kits and designs. – Sandy Hanebrink

It’s always fun to bring a nostalgic type of games as long as they understand why were doing the particular task.  jacks, string games (“Cat’s Cradle”), etc. Simple sport games on the Ipad or Iphone like “swim meet” and “tennis.” – Ylisa Gabay Young

I have used woodwork projects and model airplanes – sanded and then painted projects to display in their rooms at the SNF. – Michelle Stoermer


If you are looking for a few more activity ideas for your patients, check out Domino Match Game for Patients with Low Level Dementia or Occupation Based Kit Ideas for Your Rehab Department

<< Visit Site for the Link to free PDF of this ENTIRE list in an easy, quick reference chart organized by fine motor activity type >>

Source: Fine Motor Skills for Adults – The Ultimate List | Seniors Flourish

, , ,

Leave a comment

[Review] The use of commercial video games in rehabilitation: a systematic review – Full Text


The aim of this paper was to investigate the effect of commercial video games (VGs) in physical rehabilitation of motor functions. Several databases were screened (Medline, SAGE Journals Online, and ScienceDirect) using combinations of the following free-text terms: commercial games, video games, exergames, serious gaming, rehabilitation games, PlayStation, Nintendo, Wii, Wii Fit, Xbox, and Kinect. The search was limited to peer-reviewed English journals. The beginning of the search time frame was not restricted and the end of the search time frame was 31 December 2015. Only randomized controlled trial, cohort, and observational studies evaluating the effect of VGs on physical rehabilitation were included in the review. A total of 4728 abstracts were screened, 275 were fully reviewed, and 126 papers were eventually included. The following information was extracted from the selected studies: device type, number and type of patients, intervention, and main outcomes. The integration of VGs into physical rehabilitation has been tested for various pathological conditions, including stroke, cerebral palsy, Parkinson’s disease, balance training, weight loss, and aging. There was large variability in the protocols used (e.g. number of sessions, intervention duration, outcome measures, and sample size). The results of this review show that in most cases, the introduction of VG training in physical rehabilitation offered similar results as conventional therapy. Therefore, VGs could be added as an adjunct treatment in rehabilitation for various pathologies to stimulate patient motivation. VGs could also be used at home to maintain rehabilitation benefits.


Physical rehabilitation (PR) is a long and difficult process that may be hindered by many difficulties. Clinicians might encounter patients with counterproductive conditions during the PR program, such as poor motivation, limited time to perform rehabilitation exercises, financial issues, and difficulties reaching the PR location. Over the last few years, the user experience in video games (VGs) has changed from passive (i.e. a relatively passive player is seated with the controller in one hand) to active (i.e. the VG software tracks real physical displacement of the player’s body parts to control the game) participation. Such active game control requires a higher level of physical activity (Taylor et al., 2011). The integration of commercial VGs into conventional PR started about a decade ago, and several articles have reported integrating VGs with PR schemes. However, little is known about the real clinical efficacy of such integration. The evidence thus far is limited to a positive effect of VGs on PR motivation and engagement (Lohse et al., 2013). It is also important to define the limits of such interventions. The overall aim of this paper was to provide an overview of the scientific evidence from previously published studies related to the use of VGs in PR schemes and, more specifically, to determine in which clinical fields (e.g. neurology, orthopedic) and for what kind of patients (e.g. stroke, multiple sclerosis) VG research is being performed. The clinical efficacy of VGs on PR for various pathologies will also be discussed.

Continue —> The use of commercial video games in rehabilitation: a syst… : International Journal of Rehabilitation Research

Fig. 1. Flow diagram of study selection. CP, cerebral palsy; PD, Parkinson’s disease

, , , ,

Leave a comment

[WEB SITE] Sitroll Offers Older Adults Low Impact and Ease of Use for Strength Building and Range of Motion Exercises – Rehab Managment

Published on June 9, 2016

A Sitroll user demonstrates exercise by grasping both side handles and holding firmly. Both feet are placed on lower resistance bands, and the user then rolls forward and backward at a comfortable speed by pulling and pushing with the arms and legs.

A Sitroll user demonstrates exercise by grasping both side handles and holding firmly. Both feet are placed on lower resistance bands, and the user then rolls forward and backward at a comfortable speed by pulling and pushing with the arms and legs.

The new Sitroll multi-function strength trainer, available from New York-based Sitroll and Amazon, offers a variety of resistance training options that older adults can easily perform from a seated position. Sitroll’s exercises are directed at individuals unable to perform intense, strenuous forms of exercise but who need activity they can perform regularly by themselves or with assistance.

Designed for ease of use, Sitroll is built on wheels and rolls forward and backward smoothly on a track. The patented device is equipped with a series of upper and lower natural rubber tubing, hand gripping slides, and soft balls designed to provide non-strenuous resistance exercise movements.

Sitroll can be used by one or two participants simultaneously. The device’s resistance bands facilitate more than 30 different exercises, including flexion and extension routines, which make it useful for physical therapy and occupational therapy activities. Sitroll is engineered to have a compact design so it can be easily folded and stored when not in use.

A Sitroll user demonstrates optional exercises using resistance bands located on top of the device.

A Sitroll user demonstrates optional exercises using resistance bands located on top of the device.

Applications for the Sitroll include therapeutic activity after accident trauma, stroke, or surgery. It can also be used after any period of hospitalization when a period of remissive time in recovery is required to regain prior health. Populations for whom the Sitroll may be particularly effective include older adults and geriatric users, and individuals affected by high blood pressure, Parkinson’s disease, or diabetes. Those who are affected by arthritis, heart, and lung problems can also benefit from using the Sitroll.

Meyer Rotberg, DPT, Preferred Therapy of New Jersey LLC, describes Sitroll as the perfect home gym that requires minimal setup or supervision.

“Patients being discharged from the clinical setting can continue to progress at home with the use of the Sitroll,” Rotberg says.

Sitroll can also be a valuable asset to long-term care facilities, hospitals, adult day care, or assisted living facilities, according to Rotberg.

“Patients in nursing homes are often faced with many medical issue stemming from a lack of exercise,” Rotberg says. He points out that patients are often limited with the amount of therapy they may receive and frequently are provided maintenance programs with insufficient activity.

“Sitroll can be used in exciting ways to keep patients active by providing a full range of exercises,” Rotberg says.

[Source: Sitroll]

Source: Sitroll Offers Older Adults Low Impact and Ease of Use for Strength Building and Range of Motion Exercises – Rehab Managment

, , , ,

Leave a comment

[ARTICLE] What Do Stroke Patients Look for in Game-Based Rehabilitation: A Survey Study. – Full Text


Stroke is one of the most common causes of physical disability, and early, intensive, and repetitive rehabilitation exercises are crucial to the recovery of stroke survivors. Unfortunately, research shows that only one third of stroke patients actually perform recommended exercises at home, because of the repetitive and mundane nature of conventional rehabilitation exercises. Thus, to motivate stroke survivors to engage in monotonous rehabilitation is a significant issue in the therapy process.

Game-based rehabilitation systems have the potential to encourage patients continuing rehabilitation exercises at home. However, these systems are still rarely adopted at patients’ places. Discovering and eliminating the obstacles in promoting game-based rehabilitation at home is therefore essential.

For this purpose, we conducted a study to collect and analyze the opinions and expectations of stroke patients and clinical therapists. The study is composed of 2 parts: Rehab-preference survey – interviews to both patients and therapists to understand the current practices, challenges, and expectations on game-based rehabilitation systems; and Rehab-compatibility survey – a gaming experiment with therapists to elaborate what commercial games are compatible with rehabilitation. The study is conducted with 30 outpatients with stroke and 19 occupational therapists from 2 rehabilitation centers in Taiwan.

Our surveys show that game-based rehabilitation systems can turn the rehabilitation exercises more appealing and provide personalized motivation for various stroke patients. Patients prefer to perform rehabilitation exercises with more diverse and fun games, and need cost-effective rehabilitation systems, which are often built on commodity hardware. Our study also sheds light on incorporating the existing design-for-fun games into rehabilitation system. We envision the results are helpful in developing a platform which enables rehab-compatible (i.e., existing, appropriately selected) games to be operated on commodity hardware and brings cost-effective rehabilitation systems to more and more patients’ home for long-term recovery.

Continue —>  What Do Stroke Patients Look for in Game-Based Rehabilitatio… : Medicine

Download PDF




, , , , ,

Leave a comment

[ARTICLE] Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): study protocol for a randomized controlled trial – Full Text HTML


Background: Several systematic reviews have shown that additional exercise therapy has a positive effect on functional outcome after stroke. However, there is an urgent need for resource-efficient methods to augment rehabilitation services without increasing health care costs. Asking informal caregivers to do exercises with their loved ones, combined with e-health services may be a cost-effective method to promote early supported discharge with increased functional outcome.

The primary aim of the CARE4STROKE study is to evaluate the effects and cost-effectiveness of a caregiver-mediated exercises program combined with e-health services after stroke in terms of self-reported mobility and length of stay.

Methods: An observer-blinded randomized controlled trial, in which 66 stroke-patients admitted to a hospital stroke unit, rehabilitation center or nursing home are randomly assigned to either 8 weeks of the CARE4STROKE program in addition to usual care (i.e., experimental group) or 8 weeks of usual care alone (i.e., control group). The CARE4STROKE program is compiled in consultation with a trained physical therapist. A tablet computer is used to present video-based exercises for gait and gait-related activities in which a caregiver acts as an exercise coach.

Primary outcomes are the mobility domain of the Stroke Impact Scale and length of stay. Secondary outcomes are the other domains of the Stroke Impact Scale, motor impairment, strength, walking ability, balance, mobility, (Extended) Activities of Daily Living, psychosocial functioning, self-efficacy, fatigue, health-related quality of life of the patient as well as the experienced strain, psychosocial functioning and quality of life of the caregiver. An economic evaluation will be conducted from the societal and health care perspective.

Discussion: The main aspects of the CARE4STROKE program are

  1. increasing intensity of training by doing exercises with a caregiver in addition to usual care and
  2. e-health support.

We hypothesize this program leads to better functional outcome and early supported discharge, resulting in reduced costs.

Source: Caregiver-mediated exercises with e-health support for early supported discharge after stroke (CARE4STROKE): study protocol for a randomized controlled trial – Springer

, , , , , , , ,

Leave a comment

[ARTICLE] Potential of motor recovery in upper limb after a 3-month robot assisted therapy in subacute stroke patients


Following stroke, the use of robotic in rehabilitation program leads to increase the number of movement performed on each session. The present study aimed to investigate predictive factors of upper limb motor recovery after a 3-month robot-assisted therapy added to conventional occupational therapy.


In this retrospective study, 22 post-stroke patients (9 women, 53 ± 18 y, delay post-stroke at baseline, M2, 63 ± 25 days) performed robot-assisted shoulder/elbow training in subacute phase (InMotion 2.0, 50 ± 17 sessions over 3 months). All participants underwent evaluations before (M2) and after the training (M5) using the clinical score of Fugl-Meyer (FM) and the hand mean velocity (V) measured by the robot in reaching tasks on horizontal plane toward 3 directions (forward, inside and outside). A predictive model of the patient benefit was tested using Receiver of 0.04 m/s in hand velocity.


At M5, the FM score increased by 28% (p = 1.2E−3, t-test) and V by 122% (p = 1.2E−7). Concerning the ROC analysis, based on the first criteria, +9 pts of FM score at M5, the probability (AUC) is 0.86 with a 17 pts FM cut-off at M2 (p = 4.32E−5) and 0.64 with a 0.02 m/s velocity cut-off at M2 (p = 2.62E−2). Based on the second criteria, +0.04 m/s of hand velocity at M5, the probability is 0.93 with a 20 pts FM cut-off (p = 7.34E−16), while the velocity cut-off is no significant.


The potential functional benefit (+9 pts of the Fugl-Meyer score [1]), associated with a rehabilitation program including robot-assistive training between the 2nd and the 5th months after stroke might be predicted from baseline evaluation.Keywords

Source: Potential of motor recovery in upper limb after a 3-month robot assisted therapy in subacute stroke patients

, , , , , , , ,

Leave a comment

[ARTICLE] Use of exergames for upper extremity rehabilitation in stroke patients


Virtual reality (VR) can promote functional rehabilitation of arm movements through environments allowing the practice of a variety of tasks while providing feedback [1]. We evaluated an affordable VR system for arm rehabilitation, developed by Jintronix Inc and based on the Microsoft Kinect, that provides three unilateral and two bilateral activities, each with ten difficulty levels.


Our objectives were to (1) determine which activities and levels of difficulty are appropriate for rehabilitation of arm movements in stroke patients with different degrees of motor impairment; and (2) determine the ease of use and subjective experience of patients using the VR arm rehabilitation system.


Clinicians each supervised two to four stroke patients who participated in three 20-minute sessions with the Jintronix system. We determined the highest level of difficulty attained by patients in each activity with a performance score of at least 50%. Arm impairment was assessed using the upper extremity section of the Chedoke-McMaster Scale (CM) [2]. Patients and clinicians completed a questionnaire on the usability of the Jintronix system, based on the technology acceptance model (FD Davis [3]).


Fifteen clinicians supervised a total of 40 stroke patients. Over 80% of the clinicians and patients provided positive feedback in terms of ease of use and VR experience. For each activity of the Jintronix system, results indicated a positive correlation between the CM score and the maximal difficulty level reached by stroke patients.


Our data demonstrate the feasibility of using an affordable VR arm rehabilitation system in a clinical setting and provide clinical guidelines for the selection of impairment-specific difficulty levels.

Source: Use of exergames for upper extremity rehabilitation in stroke patients

, , , , , , , , ,

Leave a comment

%d bloggers like this: