Constraints | Exercise principles/Actions | Exercise examples | Exercise progressions |
---|---|---|---|
Narrow base of support | Widen base of support with walking and turning at varying turn angles and speeds Avoiding crossover with sideways walking | Walking with turning at various degrees Figure 8 s around cones | Decreasing external cues (visual and verbal) for foot placement, increased speed |
Rigidity | Decrease axial rigidity through axial mobility: improving trunk/pelvis flexibility Promote top-down approach for turning: eyes/head/trunk/pelvis coordination | Axial mobility exercises: trunk rotation, pelvic tilts Segmental turning | Progressing from mat table to floor, improve form and speed |
Bradykinesia | Weight shifting with large APAs Use of metronome to increase speed of movement | Clock turns Rocking turns Lateral stepping over hurdles | Decreasing UE support, decreasing visual input with dribbling glasses, increasing speed, dual task |
Impaired sensory integration | Kinesthetic awareness on body movement and foot placement Decrease visual dependence | Turning at various angles, navigation around obstacles and narrow spaces | Decreasing UE support, decreasing external cues (visual and verbal), adding hand and arm weights, decreasing visual input with dribbling glasses |
Reduced attention | Dual tasks during mobility and turning exercises | Random callout on turns Adding cognitive dual-task activities Inhibition Go-No Go | Increased complexity of exercise, increased speed |
Inflexible set-switching | Difficulty with functional mobility including sequencing | Rolling and bed mobility Sit to stand + turn | Decreasing visual cues, increased speed |