Here are some common types of exercise equipment available for home use.

• Ankle and wrist cuffs: Use these to attach to exercise bands. If needed, use S-biner or carabiner clip to attach bands.
• Ankle and wrist weights: Use for strengthening. Also called cuff weights.
• Assistive grasping devices: Use to assist hands with exercises. One source to consider is Active Hands.
• Exercise bands: Use for strengthening. Also called resistance bands or tubing. Latex-free options available.
• Exercise mat: Use for stretching. Consider getting one that’s at least 2 inches thick. Also called a folding floor mat.
• Grasping cuff with wrist support
• Lifting hooks: Also called weightlifting hooks
• Stretching straps
  • Gait or transfer belt: A thicker, less flexible material that can be dual purpose for walking or transfer safety
  • Yoga straps: A soft, flexible material and longer than a gait belt
• Stability ball: A soft ball filled with air. Consider a smaller one with a diameter of 7 to 12 inches. Also called a Pilates ball.
• Therapy putty: Use for hand exercises. Firmness ranges from soft to firm.

• Hold each stretch at the point of resistance for 30 to 60 seconds. If muscles are tight or motion is limited, hold for a full 60 seconds. Perform stretches daily.
• Don’t force stretch past the point of resistance.
• Move joint in a slow but steady motion to avoid increased pain or spasticity.
• To prevent caregiver injury, remember to watch body mechanics. Adjust the height of the bed or change position to avoid leaning or reaching. Keep arm close to caregiver’s body and allow the body to assist with motion.
• Stretching the shoulder blade prior to shoulder joint and in the following order is highly recommended.

Scapular protraction and retraction

Place hand underneath shoulder blade with tips of fingers curved around inside border. Place opposite hand on front over collarbone. Pull shoulder blade away from the spine and hold. Keep hand in front and reposition other hand on outside border of shoulder blade. Push shoulder blade towards center of back and hold.

Alternate position of lying on side: Cup/cradle front and back of shoulder using both hands. Gently rotate shoulder forward toward front of body and hold. Next rotate shoulder towards center of back and hold.

Scapular elevation and depression

Place hand underneath shoulder blade with tips of finger curved around top border of shoulder blade. Bottom of hand should be on lower border of shoulder blade. Place other hand in front over collarbone. Use fingertips to pull shoulder blade down and hold. Use bottom of hand to push lower border of shoulder blade up and hold.

Alternate position of lying on side: Cup/cradle front and back of shoulder using both hands. Gently push shoulder blade up toward head and hold. Then curve fingers over top of shoulder. Pull down towards feet and hold.

Shoulder external and internal rotation

Place one hand behind the elbow and other hand below wrist. Bring arm out to the side with elbow bent to 90 degrees. Stabilize at elbow and rotate arm so palm faces up, and hold. Stabilize at elbow and rotate arm so palm faces down and hold.

Alternate arm position: If limited by pain or range of motion, begin with arm at side and elbow bent 90 degrees in handshake position. Rotate hand away from body and hold. Rotate hand towards belly button and hold.

Shoulder abduction

With the arm positioned down at the side, place one hand above the elbow and the other hand on the wrist. With the arm straight and in the thumbs-up position, slowly glide the arm away from the side of the body towards the head and hold.

Shoulder horizontal abduction and horizontal adduction

Place one hand at wrist and the other hand above the elbow. Lift the arm to 90 degrees in front of the body. Bring arm out away from body, keeping shoulder raised to 90 degrees and hold. Bring arm across body, keeping elbow straight without lifting body off surface and hold.

Shoulder flexion

With one hand, support the upper arm. The other hand will support the forearm. With the arm in thumbs-up position, slowly bring arm straight up in front of body, lifting arm towards head and hold.

Elbow supination and pronation

Support elbow with one hand and grasp forearm below wrist with the other hand. Start in handshake position so thumb is pointing up. Elbow should be bent to 90 degrees. Rotate forearm so palm faces up and hold. Rotate forearm so palm faces down and hold.

Elbow flexion and extension

Support elbow with one hand and grasp forearm below wrist with the other hand. Start with arm down at side and palm facing up. Bend elbow to bring hand towards shoulder and hold. Straighten elbow to bring hand towards bed and hold. With arm straight at side, rotate forearm so hand is in thumbs up position and hold. Then with arm straight at side, rotate forearm so palm is facing down toward bed and hold.

Wrist flexion and extension

Support forearm and wrist with one hand grasping around the palm. With other hand, support fingers by grasping around fingertips. With elbow bent, bend wrist down with one hand while bringing fingers straight with the other hand. Bend wrist up while other hand brings fingers into palm forming a fist.

Scapular protraction and retraction

Place hand underneath shoulder blade with tips of fingers curved around inside border. Place opposite hand on front over collarbone. Pull shoulder blade away from the spine and hold. Keep hand in front and reposition other hand on outside border of shoulder blade. Push shoulder blade towards center of back and hold.

Scapular elevation and depression

Place hand with fingertips at the bottom tip of the shoulder blade. Place other hand on the top edge of the shoulder blade. With fingertips, pull shoulder blade up towards the head and hold. Using the other hand, push shoulder blade down towards the feet and hold.

Shoulder external and internal rotation

Place one hand above the elbow and other hand below wrist. Bring arm out to the side with elbow bent to 90 degrees. Stabilize at elbow and rotate arm so palm faces forward, and hold. Stabilize at elbow and rotate arm so palm faces down and hold.

Alternate arm position: If limited by pain or range of motion, begin with arm at side and elbow bent 90 degrees in handshake position. Rotate hand away from body and hold. Rotate hand towards belly button and hold.

Shoulder abduction

Place one hand above the elbow and the other hand on the wrist. With the arm straight and in the thumbs-up position, slowly glide the arm away from the side of the body towards the head and hold.

Shoulder horizontal abduction and horizontal adduction

Place one hand at wrist and the other above the elbow. Lift the arm to 90 degrees in front of the body. Bring arm out away from body, keeping shoulder raised to 90 degrees and hold. Bring arm across body, keeping elbow straight and hold.

Shoulder flexion

With one hand, support the upper arm. The other hand will support the forearm. With the arm in thumbs-up position, slowly bring arm straight up in front of body, lifting arm towards head and hold.

Elbow supination and pronation

Support elbow with one hand and grasp forearm below wrist with the other hand. Start in handshake position so thumb is pointing up. Elbow should be bent to 90 degrees. Rotate forearm so palm faces up and hold. Rotate forearm so palm faces down and hold.

Elbow flexion and extension

Support elbow with one hand and grasp forearm below wrist with the other hand. Start with arm down at side and palm facing up. Bend elbow to bring hand towards shoulder and hold. Straighten elbow with palm facing up and hold. With arm straight, rotate forearm so hand is in thumbs up position and hold. With arm straight, rotate forearm so palm is facing down and hold.

Wrist flexion and extension

Support forearm and wrist with one hand. With other hand, support fingers by grasping around fingertips. With elbow bent, bend wrist down while bringing fingers straight. Bend wrist up while hand brings fingers into palm, forming a fist.

• Keep shoulder blade set (down and back) before starting each exercise.
• An air splint may be used to keep the elbow straight.
• Try not to shrug the shoulder during the exercise
• Hold each exercise for at least 1 second before returning slowly to the start position.
• Begin by performing 3 sets of 10 repetitions.
• Adding a weight will increase the difficulty of any exercise.
• If exercise is difficult, caregiver assistance is recommended.

Shoulder abduction

Begin with palm facing up and arm down at side. Keeping elbow straight, move arm out to side away from the body.

External and internal rotation

Begin with elbow bent and hand on stomach. Keeping elbow bent and tucked at side, rotate arm out toward edge of bed.

Horizontal abduction and adduction

Begin with arm at side and palm facing towards body. Keeping elbow straight, raise arm to 90 degrees. Keeping arm straight, squeeze shoulder blades together and bring arm out to side until back of hand touches bed. Then bring straight arm across the body to complete exercise.

Scapular protraction and retraction

Lie on back with arm straight in front at 90 degrees. Bring shoulder forward towards the ceiling, lifting shoulder off the surface.

Shoulder flexion

Lie on side with top arm resting on hip and palm facing down. Keeping elbow straight and the arm in thumbs up position, bring the arm forward and up towards head.

External rotation

Lie on side with elbow bent to 90 degrees. Keeping elbow bent and tucked at side, draw arm up towards the ceiling.

Shoulder abduction

Lie on side with arm straight. Raise up the arm towards shoulder height while keeping elbow straight.

Serratus punch

Lie on back with arm straight in front, towards the ceiling. Keep elbow straight. Bring the shoulder forward towards the ceiling, lifting shoulder off the surface.

Chest press

Lie on back with elbows bent and slightly out to the side. Slowly raise arm up towards the ceiling while straightening the elbow.

Shoulder flexion

Start with elbow straight and arm down by hip. Slowly raise the arm to shoulder height.

• Exercise one or both arms at a time.
• Always slowly return to the start position.
• Weights or resistance bands may be used.
• Try not to shrug the shoulders.
• Set the shoulder down and back before any exercise.
• A table and pillowcase can be used to decrease friction. If a table is not available, someone can support the elbow and hand and still perform the exercises.
• An air splint can be used to help keep the elbow straight.
• A chest strap or body bracer can help support the trunk, if needed.
• Lift the wheelchair arm rest up to keep the arm closer to the body, if desired.

External rotation

Keeping the elbow bent and tucked into the side, push the pillowcase away, moving the arm and/or hand away.

Protraction

Reach the whole arm forward, using shoulder only, without bending the elbow.

Reverse fly

Keep the elbow straight. Move the whole arm open and back.

Lateral raise

Support the elbow and hand. Lift the whole arm out and up, keeping the elbow bent.

Elbow flexion

Support the elbow and hand. Keep palm facing up. Bend the elbow, bringing the hand to the shoulder while providing support to maintain elbow heigh.

Front raise

Support the elbow and hand. Keep palm facing you. Lift the arm up to shoulder height while providing support to the maintain the elbow straight.

Front raise

Start with arm by the side with thumbs facing up. Raise the arm to the front at shoulder height.

Bicep curls

Bend the elbow and bring the arm to shoulder.

Lateral raise

Raise the arm to shoulder height.

Reverse fly

Keep elbows straight. Raise the arms up and out towards the ceiling.

Triceps kickback with assistance

Extend elbow until the arm is straight. Provide assistance at the wrist and elbow.

• Try not to shrug your shoulders.
• Set your shoulder down and back before you start any exercise
• You can perform these exercises without any resistance, a resistance band, or a weight.
• Slowly return to the start position.
• Feel free to do some of the exercises one arm at a time.
• Use a body bracer or chest strap to support the trunk, if needed.
• Hold each exercise for at least 1 second before returning slowly to the start position.
• Begin by performing 3 sets of 10 repetitions.
• A resistance band or weight will increase the difficulty of any exercise
• Pillows or lying next to the wall may assist the upper body from rolling side to side.

Abduction

Keep the elbow straight as the arm raises out to side to shoulder height.

External rotation

With the elbow bent and tucked at side, rotate arm towards the ceiling.

Reverse fly in prone

Lift the arm up towards the ceiling out to side.

Push up on elbows

Press elbows into bed, lifting chest and shoulders.

Push up in prone

Press arms into bed, lifting chest and shoulders up. Straighten elbows as much as possible.

Rows in prone

Pull elbow up towards ceiling. Keeping elbow bent, squeeze shoulder blade back.

Extension in prone

Raise arm back and at side while keeping elbow straight. Squeeze shoulder blade back.i

Front raise

With thumb up, raise arm while keeping elbow straight.

External rotation

Keep elbow close to side, move wrist away from body with thumb up.

Reverse fly

Keeping arms straight, move arms back to form a T-shaped position.

Triceps kickbacks

Keep elbow tucked in and straighten arm back.

Row

Lift elbow towards the ceiling.

Circuit resistance training can be used for strengthening or cardiovascular endurance.

• If focusing on strength, the exercises can be performed individually without air boxing or arm spinning.
• If focusing on cardiovascular endurance, follow these guidelines:
  • Round 1: Continuous air boxing/arm spinning for 2-4 minutes. Proceed to 3 sets of 15, bicep curls, and seated row.
  • Round 2: Continuous air boxing/arm spinning for 2-4 minutes. Proceed to 3 sets of 15, lat pull down, and triceps extensions.
  • Round 3: Continuous air boxing/arm spinning for 2-4 minutes. Proceed to 3 sets of 15, chest flys, and shoulder press.

Bicep curl

With arm straight down and palm up, bend the elbow to bring hand to shoulder.

Seated row

Begin with arms straight in front and bands at chest or shoulder height. Pull elbows back, squeezing shoulder blades together.

Lat pulldown

Begin with arms straight in front and bands at highest point. Pull elbows back, squeezing shoulder blades together.

Triceps extension

With arm bent and elbow at side, extend arm forward and down until arm is straight.

Chest fly

Begin with arm straight out to side at chest height. Keeping arm straight, bring arm forward in front.

Shoulder press

With elbow bent and hand aimed upward, press arm up and forward until elbow is as straight as possible.t

• Don’t force stretch past point of resistance.
• Move joint slow but steady to avoid increased pain or spasticity.
• If muscles are tight or motion is limited, hold for full 60 seconds.
• Do not push into pain.

MCP PIP to DIP flexion

Hold finger above and below large knuckle. Bend finger down and hold. Keep finger bent and slide hand down to middle knuckle. With hand above middle knuckle, bend finger down and hold. Keep large and middle knuckle bent, slide hand down to fingertip, bend down, and hold.

MCP extension

Stabilize wrist and palm while keeping fingers free. Hold finger between large and middle knuckle using other hand. Lift finger up and hold. Repeat on each finger.

PIP & DIP extension

Grasp the finger above and the hand below the middle knuckle using both hands. Gently straighten the middle knuckle and hold. Move hand from middle knuckle to fingertip. Straighten fingertip and hold. Repeat on each finger.

Thumb CMC, MP, IP flexion

Stabilize hand at base of thumb. Push thumb towards the palm and hold. Use other hand to bend large knuckle and hold. Slide the hand to tip of thumb, bend fingertip down and hold.

Thumb palmar abduction

Hold base of thumb below large knuckle. Pull thumb down away from palm and hold.

• Complete 3 sets of 10 repetitions.
• Hold each exercise for 2 to 3 seconds.

Flexion and extension gross grasp

Keep wrist straight. Make a fist and hold. Straighten fingers out and hold.

Finger abduction and adduction

Keep fingers and wrist flat on the table. Spread fingers apart and hold. Pull fingers back together and hold.

AROM MP extension to intrinsic plus positioning

Curl ends of fingers while keeping wrist and first set of knuckles straight. Hold. Push fingers out and into a sock-puppet position with fingers flat. Hold.

Putty gross grasp

Squeeze hand into a fist. Dig fingertips into putty and hold.

Putty lateral pinch

Pinch along putty with the pad of thumb against the side of the index finger. Complete 5 sets of pinches.

Putty two-point pinch

Pinch along putty with pad of thumb against pad of index finger. Complete 5 sets of pinches.

Putty three-point pinch

Pinch along putty by bringing the thumb, index, and middle fingers together. Complete 5 sets of pinches.

Lumbrical pull-apart

Pull putty apart with all five fingers of both hands in sock-puppet position.

• Hold each stretch at the point of resistance for 30 to 60 seconds. If muscles are tight or motion is limited, hold for a full 60 seconds.
• Perform stretches daily. Consider performing stretches more than once a day to address increased tightness or spasticity.
• Do not force stretch past the point of resistance.
• Move joint in a slow but steady motion to avoid increased pain or spasticity.
• Performing these stretches in the order listed to transition from
  position to position with greater ease.
• If unable to complete stretches independently, do not hesitate to ask for assistance from a caregiver for any aspect of the program.
• If loops are unavailable, try using a gait or transfer belt, a yoga strap, or a sheet or large towel.

Calf stretch

Place the loop around the ball of the foot with the leg straight. Pull back on the foot, but do not lift the leg up.

Hip abduction

Place the loop on the middle of the foot and move the leg out to the side.

Hamstring stretch

Place the loop on the middle of the foot. Pull the leg straight up and off the bed. Be ready to place opposite hand on knee to prevent buckling. Continue to lift leg as knee is stabilized.

Knee to chest

Support the knee with one hand and lower foot with the other. Use hands or loops to pull knee to chest.

Piriformis stretch

Lower the foot and place next to opposite knee. Pull knee across the body, stopping if the hips start to turn.

Groin stretch

Keep the foot next to the opposite knee. Lower the knee towards the bed. May add gentle pressure with the hand to increase the stretch.

• Hold each stretch at the point of resistance for 60 seconds.
• Perform stretches daily.
• Don’t force stretch past the point of resistance.
• Move joint in a slow but steady motion to avoid increased pain or spasticity.
• To prevent caregiver injury, remember to watch body mechanics. Adjust the height of the bed or change position to avoid leaning or reaching. Keep leg close to caregiver’s body and allow body to assist with motion.

Calf stretch

Cup the heel in caregiver hand and align forearm along the foot. Use body weight to lean forward into the ball of the foot to stretch the back of the ankle.

Hip abduction

Supporting at the knee and ankle, hold the knee straight and slide the leg out to the side. Opposite leg should not move.

Hamstring stretch

Supporting at the knee and ankle, slowly lift the leg to rest on caregiver’s shoulder. Lift the leg further by raising up from kneeling and/or moving caregiver body forward. Try to rest the weight of the leg on the caregiver’s trunk. As an alternative, hold leg at knee and ankle as stretch is performed.

Knee to chest

Support the leg at the knee and ankle. Keeping leg in line with hip, bend knee while bringing leg towards chest.

Internal rotation

Supporting at the knee and ankle, bend the leg so the knee is positioned directly over the hip. While stabilizing in this position, turn the leg so the foot is rotated away from the body.

External rotation

Supporting at the knee and ankle, bend the leg so the knee is positioned directly over the hip. Turn the leg so the foot is rotated towards the body.

Piriformis stretch

Bend the knee and place the foot next to the opposite knee. Place one hand on the hip to keep the hips from turning while pressing the knee toward the other side of the body.

Groin stretch

Bend the knee and place the foot next to the opposite knee. Slowly lower the knee to the side and down towards bed. Apply gentle pressure downwards.

Hip flexor stretch

While positioned on the side, lift the top leg and bend the knee, supporting in one arm. Block the hip with the other arm while pulling back on the leg.

• Begin by performing 3 sets of 10 repetitions. Hold each exercise for 2 seconds.
• Do not perform if painful.
• Slowly return to start position after each repetition.
• Focus on specific movement.
• A pillowcase or towel can be used under the foot or leg to decrease friction.

Quad sets

Place a pillow or towel under the knee. Straighten the knee to lift foot off ground, like kicking a ball.

Heel sides

Start with the leg straight. Slide the heel towards your buttocks. Keep the knee from falling side to side.

Hip abduction

Start with the knee straight and toes pointed towards the ceiling. Slide your leg towards the side.

Internal and external rotation

Keep the knees straight. Turn toes in then out to rotate at the hip.

Pelvic tilt

Use the lower stomach muscles to flatten back to touch the bed.

Ankle dorsiflexion

Move ankle up. Stabilize the lower leg to prevent the leg from moving.

Ankle plantarflexion

Move ankle down. Stabilize the lower leg to prevent the leg from moving.

Ankle inversion

Move ankle to the inside. Stabilize the lower leg to prevent the leg from moving.

Ankle eversion

Move ankle to the outside. Stabilize the lower leg to prevent the leg from moving.

Straight leg raise

Begin on back with one knee bent so that the foot is flat on surface. The opposite leg should be straight with the foot pointed toward the ceiling. Tighten thigh muscle to keep the knee straight, then lift the leg up and off surface. Do not go past the height of the opposite knee. To progress, place a cuff weight around the ankle.

Bridging

Begin with both feet flat on the surface. Tighten buttocks muscles and lift hips up toward the ceiling until the lower back starts to rise. Keep back straight and knees steady. To progress, place a resistance band around the knees. At the top of the bridge, open the knees out. Bring knees together before lowering hips to surface.

Clamshells

Begin on side with knees bent towards chest. Feet and knees should be in line with each other. Rotate hip so the top knee points toward the ceiling. Do not rotate trunk.

Quadriceps

Sit with thigh fully supported. Kick the leg out until the knee is straight.

Hamstring curl

Sit with thigh fully supported. Start with leg straight out, bring heel back towards the chair or bed. To progress, anchor a resistance band to a secure location and attach to ankle.

Ankle dorsiflexion

Support the foot on a flat surface. Rest the heel. Attach the resistance band to the middle of the foot. Pull the foot up towards knee. May also attach resistance band to a secure location.

Ankle plantarflexion

Support the foot on a flat surface. Rest the heel. Attach the resistance band to the middle of the foot. Push the foot down.

Ankle inversion

Support the foot on a flat surface. Rest the heel. Attach the resistance band to the middle of the foot. Turn the ankle towards the middle. May also attach resistance band to a secure location.

Ankle eversion

Support the foot on a flat surface. Rest the heel. Attach the resistance band to the middle of the foot. Turn ankle towards the outside. May also attach resistance band to a secure location.

• Perform 3 sets of 10 repetitions. Hold each exercise for 2-3 seconds.
• Perform exercises with or without resistance. Consider using a resistance band, weighted ball, or dumbbells.
• Slowly return to the start position after completing each repetition.
• Avoid straining neck and shoulder muscles.
• Maintain good posture. If using a chair, exercises may be performed with full back support.

Seated balance

Start with arms in a resting position. Maintain neutral sitting position. Lift arms up to challenge balance.

Back extension

Lean forward by bending at the hip. Keep trunk straight. Return to neutral sitting position.

Trunk flexion

Curl or crunch the trunk off the back rest slowly and without using neck.

Active rotation

Sitting with good posture, turn the chest to the side to look over shoulder. To increase difficulty of the exercise, add a dumbbell weight.

Active side bend

Sitting with good posture, lean down to the side. Safely reach towards the floor while keeping buttocks planted in seat. To decrease difficulty of the exercise, do not use a dumbbell weight.

Pelvic tilt and march

Bend knees so feet are flat on surface. Use lower stomach muscles to flatten back onto the surface. Keep back flat and slowly raise one bent leg partially up toward the chest. Alternate legs.

Trunk rotation

Bend knees so feet are flat on surface. Rotate knees as far to one direction as possible. Keep back on surface. Slowly return to start position. Alternate directions. To increase difficulty, perform with feet on a ball.

Open/close book

Begin on side with arms straight in front and palms touching. Rotate top arm up and out, turning chest and shoulders towards ceiling. Continue rotation as far over as possible while keeping arms straight. To decrease difficulty, exercise may also be performed with arms folded on chest.

Back extension

Begin laying on stomach. Set shoulder blades down and back. Lift chest and shoulders off the mat. To decrease difficulty, exercise may also be performed with elbows and hands down on mat.

Modified prone to plank

Press up and back on elbows, tightening the core and lifting trunk until chest is off the mat. Feel body weight transition onto knees. Keep back as straight as possible.