25 exercise options to discuss, adapt, and monitor.

Family steps

1. Sit tall with back support if needed.
2. Gently draw shoulder blades back and down, then release.
3. Add slow shoulder rolls without forcing the neck or arching the back.

Professional notes

• Keep effort low and avoid resisted overhead work if scapular weakness is prominent.
• Pair with seating review if posture quickly collapses after the set.

Conservative dose

5 to 10 slow repetitions, 1 to 2 sets.

Stop or modify for

• Neck pain
• shoulder pinching
• arm heaviness that persists after stopping

Family steps

1. Move the foot up and down through a comfortable range.
2. Make slow circles in both directions.
3. Keep the movement pain-free and avoid bouncing into the end range.

Professional notes

• Use as a low-load mobility drill, not a substitute for contracture management.
• Assess calf length, foot posture, AFO fit, and standing tolerance if range is declining.

Conservative dose

10 to 20 repetitions per side.

Stop or modify for

• Pain
• cramping
• new swelling
• skin irritation from bracing

Family steps

1. Use a wall or rail for balance.
2. Place one foot behind with heel supported and knee comfortable.
3. Hold a gentle stretch without bouncing or pain.

Professional notes

• Choose standing, seated towel, or supported positioning based on strength and falls risk.
• Avoid aggressive stretching if pain, spastic guarding, or unsafe balance appears.

Conservative dose

15 to 30 seconds, 2 to 4 times per side.

Stop or modify for

• Pain
• heel lift that cannot be controlled
• loss of balance
• next-day soreness

Family steps

1. Lie or sit with the leg supported.
2. Straighten the knee only until a mild stretch is felt behind the thigh.
3. Keep the back relaxed and avoid pulling hard on the leg.

Professional notes

• Differentiate hamstring tightness from neural tension, posterior knee pain, or hip position limits.
• Use caregiver training if the stretch is part of a home plan.

Conservative dose

15 to 30 seconds, 2 to 4 times per side.

Stop or modify for

• Sharp pain
• tingling
• back pain
• guarding

Family steps

1. Use a safe supported position such as side-lying or lying near the bed edge with help.
2. Keep the pelvis steady and avoid arching the low back.
3. Hold only a mild stretch at the front of the hip.

Professional notes

• Use this only when positioning is safe and the family can reproduce it without lumbar compensation.
• Consider standing, orthotic, or seating strategies if hip flexion contracture is progressing.

Conservative dose

15 to 30 seconds, 1 to 3 times per side.

Stop or modify for

• Low-back pain
• hip pain
• unsafe bed-edge positioning
• breath-holding

Family steps

1. Lie on the back with the heel supported.
2. Slide the heel toward the body, then slowly slide it away.
3. Keep the movement smooth and below fatigue level.

Professional notes

• Use to maintain motion and assess symmetry, pain, or movement quality.
• Do not turn it into high-repetition strengthening if fatigue is prominent.

Conservative dose

5 to 12 repetitions per side.

Stop or modify for

• Hip pain
• knee pain
• cramping
• increased fatigue

Family steps

1. Sit with feet supported.
2. Turn the upper body gently to reach toward a target at shoulder height.
3. Return to the middle before reaching to the other side.

Professional notes

• Use guarding or trunk support if balance is limited.
• Avoid end-range twisting if scoliosis, pain, or respiratory compromise limits tolerance.

Conservative dose

5 to 10 reaches per side.

Stop or modify for

• Dizziness
• back pain
• loss of sitting balance
• breathlessness

Family steps

1. Sit supported and look slowly left and right.
2. Add small nods and side bends only within comfort.
3. Keep the movement slow and stop before dizziness or pain.

Professional notes

• Assess seating, head support, vision, and upper-back posture if symptoms recur.
• Avoid forceful manual stretching or rapid end-range movements.

Conservative dose

3 to 6 slow movements each direction.

Stop or modify for

• Dizziness
• headache
• radiating symptoms
• pain

Family steps

1. Choose a flat route with places to rest.
2. Walk at conversation pace for a short interval.
3. Stop before gait quality worsens and track recovery later that day and the next day.

Professional notes

• Use timed walk, gait quality, fatigue scale, falls history, and cardiopulmonary context to set intervals.
• Avoid using walking as conditioning when it repeatedly worsens falls risk or next-day function.

Conservative dose

Start with 2 to 5 minute intervals; build only if recovery stays stable.

Stop or modify for

• Tripping
• hip drop worsening
• breathlessness
• chest symptoms
• next-day decline

Family steps

1. Use warm, accessible water with safe entry and exit.
2. Walk, step, reach, or play at easy effort.
3. Keep sessions short enough that dressing and leaving the pool are still safe.

Professional notes

• Plan energy cost of transfers, stairs, changing rooms, and temperature exposure.
• Do not use pool sessions when respiratory infection, unsafe swallowing, or poor access makes risk too high.

Conservative dose

5 to 15 minutes of easy movement, adjusted to access demands.

Stop or modify for

• Shivering
• breathlessness
• unsafe transfers
• exhaustion after leaving pool

Family steps

1. Set the seat so knees do not lock or over-bend.
2. Use very light resistance and a pace that allows talking.
3. Stop before legs feel heavy or coordination changes.

Professional notes

• Check hip, knee, ankle range, seating, transfer safety, and cardiopulmonary status.
• Motor assistance may be preferable when active cycling causes fatigue.

Conservative dose

3 to 10 minutes easy cycling; increase duration before resistance.

Stop or modify for

• Knee pain
• hip pain
• breathlessness
• leg heaviness that persists
• unsafe transfers

Family steps

1. Sit with the back supported and feet flat.
2. Lift one knee a small amount, lower it, then alternate sides.
3. Use short intervals and keep breathing relaxed.

Professional notes

• Use low height and slow tempo if hip flexors are weak.
• Monitor trunk compensation, breath-holding, and post-session fatigue.

Conservative dose

10 to 30 seconds per interval, 2 to 5 intervals.

Stop or modify for

• Hip pain
• back arching
• breath-holding
• fatigue spillover

Family steps

1. Place targets within comfortable reach.
2. Reach, tap, sort, or move objects without holding breath.
3. Keep targets low enough that shoulders do not pinch or tire quickly.

Professional notes

• Scale target height, distance, trunk support, and object weight.
• Use for functional reach and endurance rather than resisted shoulder strengthening.

Conservative dose

1 to 3 minutes of light play or task practice.

Stop or modify for

• Shoulder pain
• loss of trunk control
• arm heaviness
• breathlessness

Family steps

1. Use a higher surface than a normal chair if needed.
2. Lean forward, stand with control, then sit down slowly but not excessively slowly.
3. Stop while the movement still looks safe and smooth.

Professional notes

• Use surface height to manage load and avoid repeated failed efforts.
• Watch for Gowers-style compensation, knee collapse, breath-holding, and eccentric overload during descent.

Conservative dose

2 to 6 repetitions, 1 to 3 sets with rest.

Stop or modify for

• Knee buckling
• falls risk
• pain
• loss of movement quality
• next-day decline

Family steps

1. Hold a stable support.
2. Bend knees only a small amount, then return to standing.
3. Keep the movement small, slow, and easy enough to repeat with good form.

Professional notes

• Limit depth to avoid eccentric overload and knee collapse.
• Use only when cardiac, respiratory, balance, and recovery status support upright strengthening.

Conservative dose

3 to 6 repetitions, 1 to 2 sets.

Stop or modify for

• Knee pain
• buckling
• breathlessness
• shaking that changes gait afterward

Family steps

1. Lie with knees bent and feet supported.
2. Gently lift the hips a small distance, then lower with control.
3. Keep breathing and avoid pushing into pain or cramping.

Professional notes

• Screen for orthopnea and lumbar compensation before using.
• Use partial range or assisted pelvic lifts when full bridge is too demanding.

Conservative dose

3 to 8 repetitions, 1 to 2 sets.

Stop or modify for

• Breathlessness lying flat
• back pain
• hamstring cramps
• next-day fatigue

Family steps

1. Lie on the side with the lower leg bent for support.
2. Lift the top leg only a small distance, then lower gently.
3. Keep the pelvis from rolling backward.

Professional notes

• Use very small ranges and no added weight unless specifically justified.
• Stop if compensatory trunk movement dominates the task.

Conservative dose

3 to 8 repetitions per side.

Stop or modify for

• Hip pain
• back pain
• cramping
• loss of control

Family steps

1. Sit with back supported and feet on the floor.
2. Slowly straighten one knee partway or fully if comfortable.
3. Lower the foot back down without dropping it.

Professional notes

• Avoid ankle weights as a default; use range, tempo, and low repetitions first.
• Monitor for fatigue that affects transfers or walking afterward.

Conservative dose

5 to 10 repetitions per side.

Stop or modify for

• Knee pain
• thigh cramping
• fatigue affecting transfers

Family steps

1. Stand close to the wall with hands at chest height.
2. Bend elbows slightly, then push back to the start.
3. Keep the range small and stop before shoulder fatigue.

Professional notes

• Use counter height or seated wall press variations if standing is risky.
• Avoid if scapular winging, shoulder pain, or respiratory effort increases.

Conservative dose

3 to 8 repetitions.

Stop or modify for

• Shoulder pain
• wrist pain
• breath-holding
• arm heaviness

Family steps

1. Sit supported with elbows near the sides.
2. Pull the band or towel gently toward the body.
3. Release slowly without letting shoulders hike.

Professional notes

• Start with no band or minimal resistance if weakness is significant.
• Avoid high repetitions that create delayed arm heaviness or neck compensation.

Conservative dose

3 to 8 repetitions, 1 to 2 sets.

Stop or modify for

• Neck pain
• shoulder pain
• arm heaviness
• loss of posture

Family steps

1. Stand with hands on a stable support.
2. Tap one foot onto a low step, then return it to the floor.
3. Alternate sides only if balance and control remain steady.

Professional notes

• Choose taps before step-ups when weakness or falls risk is present.
• Progress height only if gait and recovery stay stable.

Conservative dose

3 to 8 taps per side.

Stop or modify for

• Toe catching
• knee collapse
• hip drop worsening
• fear of falling

Family steps

1. Stand with hands on a stable support.
2. Shift weight gently side to side without lifting the feet.
3. Keep the movement small and stop while posture is still steady.

Professional notes

• Use guarding, orthotics, and surface choice based on falls history.
• Do not progress to single-leg balance unless safety and strength clearly allow it.

Conservative dose

5 to 10 shifts each direction.

Stop or modify for

• Fear of falling
• knee buckling
• toe catching
• fatigue that changes gait

Family steps

1. Use only the prescribed device and setup.
2. Check straps, foot position, comfort, skin, and breathing before starting.
3. Begin with short tolerance sessions and stop before fatigue or discomfort builds.

Professional notes

• Requires individualized assessment of contracture, bone health, orthostatic tolerance, skin, pain, and respiratory status.
• Document tolerance, alignment, blood pressure symptoms, and post-session recovery.

Conservative dose

Team-prescribed; often short initial trials with gradual tolerance building.

Stop or modify for

• Dizziness
• pain
• skin redness
• breathlessness
• orthostatic symptoms

Family steps

1. Sit or recline with the trunk supported and shoulders relaxed.
2. Place one hand on the lower ribs or belly and breathe quietly without forcing a deep breath.
3. Use 3 to 5 calm breaths before activity, after activity, or when recovering.

Professional notes

• Use this as a screen for symptom change, not as respiratory treatment by itself.
• Coordinate with pulmonary review if orthopnea, weak cough, morning headaches, or daytime sleepiness are present.

Conservative dose

1 to 3 minutes, several times daily as tolerated.

Stop or modify for

• Dizziness
• new breathlessness
• chest symptoms
• panic with breathing focus

Family steps

1. Recline over pillows or sit with a towel roll behind the upper back.
2. Let the shoulders relax open without forcing the arms backward.
3. Breathe comfortably and come out of the position slowly.

Professional notes

• Screen for orthopnea before prescribing reclined positions.
• Adapt around scoliosis, pain, ventilation interface, or shoulder restrictions.

Conservative dose

1 to 3 minutes if comfortable.

Stop or modify for

• Orthopnea
• dizziness
• shoulder pain
• breathlessness