=>Moving =>Mom

Time Session Began:  1320 Duration of Session:  60 min
Exercise	Reps	Sets	Comments
ISL	15	1	First time standing; reps up from 10 yesterday; has trouble holding elbows back.
KI	15	1	Trouble on right with taking foot all the way back to the floor.
LU	15	1	First time standing; trouble holding elbows properly and returning weights to shoulders.
KNI	15	1	Better with right leg, surprisingly, since this was the side affecting by the mini-stroking.
FO1	10	1	First time standing.
SDS	15	1
FO2	15	1	Up from 10 reps yesterday.
TDS	15	1
F2S	15	1	Up from 10 reps yesterday.
SSS	15	1	A little shy on lifting leg up on return; when this happens, I have her repeat that rep.
AC	10	1	This one is hard for her. Let her slip a bit toward the end then gave her a short, easy lecture on proper technique and the reasoning behind proper technique.
MIP	15	1	Has been having trouble lifting knees because back of chair is in the way. Finally figured out that if she balances herself between two chair backs, with one arm on each chair, she should have no trouble lifting knees. We'll try that next time.
FC	15	1	Up from 10 reps yesterday; has trouble holding arms to sides, especially in the elbow area, but she did much better today with repeated reminding and a short, easy lecture on why this technique is important.
SDST	15	1
IACR	10	1
TDST	15	1	Although this is hard for her, she's game and does a good job. Tends to lean forward into chair for balance. I'm not bent on correcting this, right now. She's got good arches, so as her calves get stronger, I think she'll correct herself.
IACL	10	1
STS	5	1	This was the first time for this exercise. It throws her balance off, so we stopped at 5. Haven't decided whether to continue it. We'll see.
SSST	15	1	Somewhat the same problem as with MIP above. I'm not sure that doing this supporting herself between two chair backs would work, but we'll try it. Too bad we don't have a ballet barre. Maybe, as we do renovations, we'll have one installed.
BD	10	1	Her lack of shoulder flexibility causes her to have a problem straightening her arm above her head and keeping her upper arm still when she drops the weight, but I believe this will improve without pointing it out as her shoulder flexibility and arm strength improve.

    Overall, I have to say this is one of the best sessions we've had. Her improvement was obvious, today, and I mentioned this several times. She beamed and beamed and beamed.
    Today, for the first time, I checked with her on where she is "feeling" the effort of some of the exercises. She was very responsive about this and is, for the most part, "feeling the burn" where she should, although I'm trying to keep what she's feeling from actually being a burn, at the moment. So far, I think I'm successful in this.
    Normally, afterward, we bat a balloon back and forth as she sits, but we didn't do this today, she was pretty tired and I didn't have the heart to include this. She actually performs the balloon batting really well, sometimes better than me and I'm standing and can move around. I'm thinking, the next time we do this, we'll try a few bats standing, just to see how her balance is doing, but, until her balance improves we'll probably do most of the batting sitting.
    No walkering today, but she moved around quite a bit on her own here at home. Maybe tomorrow.

    I've been doing this since she returned from the S(killed) N(ursing) F(acility). At least once almost every day, sometimes twice, she and I go through a series of upper and lower body exercises designed to develop and increase strength and flexibility. Most of the exercises I learned by sitting in on Mom's physical therapy sessions at the SNF. Some I've added or modified to address specific problems and/or address areas for which I think she might be ready.
    The description of exercises above is permanent and will appear at the top of the page each time you visit this site. It will be modified as I add and/or modify exercises. The schedule she keeps each day will be posted much as I post her blood glucose and blood pressure readings, what she eats and comments about what I've chosen to give her at Mom's Daily Tests and Meds. This site is primarily for my reference and review, functioning in the review capacity as a chance for me to focus on what and how she's doing each day and what I might need to modify.
    You may notice that my descriptions of the exercises clumsy. They certainly aren't professional descriptions. I wrote them on my own in an attempt to describe exactly what I have her do, including every movement and posture I think is important. For instance, regarding the Demitoe exercises, since she has trouble remembering to return her foot flat to the floor after each foot lift, I included this bit of instruction. As well, if you find yourself at all interested in perusing the daily charts and can't remember which exercise is which, click on the exercise name abbreviation and it will take you directly to the appropriate description above (I hope, anyway; there may be a few bugs I need to work out, but I should catch them within the first few reports).
    A few description phrasing explanations are in order:

• Independent Alternate Reps:
  She does all reps on one side then all reps on the other. When we get to the place where she goes from side to side in the same set, I'll figure out another way to express this. At the moment, going from side to side throughout an exercise confuses her and causes her to lose her balance.
• I spent a lot of letters indicating whether weights and body parts are to be perpendicular or parallel to the floor or her body. I may have gotten a few of these wrong. If so, bear with me, they will be corrected as I discover them.
• I will make every attempt to place the exercises in the order we do them in the daily charts; they are, as of this posting, placed in the Description section in the order we did them today.

    At this point, a few words about my session design choices might be in order.

• In most cases each set of independent reps is followed immediately by the matching, opposite set. There is one exception, though, at this time, the Independent Arm Circles. I have separated those because Mom is currently challenged in attempting to understand how to do this one, so I separate the sides with another exercise so that she isn't overwhelmed. Similarly, the alleviation of confusion and the preservation of physical balance is why I am not, at this time, alternating reps of certain exercises within one set.
• You will notice that I am alternating upper and lower body exercises. This is to work muscle resting periods into the sessions and to keep the movement going in order to develop her aerobic capabilities. The SNF did not do this; they incorporated rests into their sessions between exercises. As well, one of her exercises at the SNF was simply sitting and standing, over and over. She hated this exercise, even though it is necessary. Alternating sitting and standing exercises gets in a sufficient amount of sitting and standing practice without her being defensively aware of it as an exercise. As our therapy program continues, I may change this arrangement; if so, it will be apparent in the daily charts.
• She is, at this time, using oxygen when she exercises, usually 1.5L.
• When we began her sessions the day after she arrived home from the SNF she was doing almost all the upper body exercises sitting down. Throughout the last two weeks I've encouraged her to stand during these exercises in order to allow her to refine her arm movements so that the exercises can do their work. She has had little difficulty cooperating, although I have yet to have her stand during the arm circles performed with weights. This exercise, in particular, really throws her off balance in her chair, so I'm sure she isn't ready to perform this one standing. When we began, though, she tended to do the sitting ones pushed into the back of the chair. On her own she's begun to move herself forward toward the edge of the chair (if she hasn't agreed to stand during performance) and hold her back straight on her own. I am very encouraged by this.
• At this point the session takes an hour, usually exactly. Since her progress is slow but steady, I expect that I will be dropping some exercises as I include others and trying to keep the session to no more than an hour at a time. As she becomes more able to have two sessions a day, I will probably set up, from session to session, a sort of exercise cross training, to keep her from getting bored and to encourage the development of a variety of muscles and physical skills.
• Her concentration and focus is very good and increases daily. I am very encouraged by this. She takes her sessions very seriously and only lags when a particular muscle group or her aerobic capacities are momentarily spent. She has yet to ask to end a session early.

    Although she has not questioned why her sessions with me are designed differently and more rigorous than her sessions at the SNF, I decided, today, to explain this to her. She rarely, for instance, got corrective feedback at the SNF and was always heartily congratulated for her performance. I give a lot of corrective feedback (not harsh, but to the point and usually during the exercise, sometimes having her repeat a few reps in order to allow her body to understand what it needs to do) along with hearty congratulations and encouragement. I explained that, at the SNF, their job was primarily to get her moving and keep her body from gelling. Thus, simply getting her out on the floor and giving her encouragement without much correction was sufficient. I told her that I'm expecting more from her because it's time for more to be expected. As well, I explained, some of the atmosphere surrounding such a facility includes the assumption that, being old and debilitated, the residents are not, in general, going to be particularly adept at any of the exercises but it is more important to keep them going than to have them go in the correct direction. They don't have the time, I said, to single people out from a group therapy session and work with eccentric strengths and weaknesses, unless the resident has a peculiar problem. Her problem, mini-stroking, isn't peculiar and there were lots of Ancient Ones there with the same problem. Here at home I can hone in on specifics, get detailed feel for her strengths and weaknesses and modify our exercise focus on a daily and even moment-to-moment basis. For instance, I told her, no one took a particular interest in the fact that at the SNF she was unable to adequately lift a weight in one hand from her hip in a quarter circle to a point directly above her head, then down. She was simply lifting it with her forearm and, in so doing, undermining the point of the exercise, which is shoulder joint flexibility and upper arm strength. Thus, I modified the exercise to address the fundamentals by taking away the weight and working, first, on getting her body to understand the concept of moving her arm from the shoulder in a circle across the front of her body, which works better for her, at this time. And, within two days of modifying the exercise, her body is getting it. Within a couple of days to a week I expect that we'll be doing the exercise as the SNF was conducting it, with the weight.
    She was very attentive while I explained all this and worked even harder after I'd finished. Our exercise sessions include a lot of explaining. As well, I do all the exercises along with her, without support and standing, except those that require me to have her spot on me, such as kicking her foot up or lifting her knee from a sitting position.
    There is one exercise that I added for two days and have already dropped because she isn't quite ready for it: The modified standing knee flex. After only a couple of reps her knees become iffy and she gets scared, so we'll wait on that one. I take the same position with all the exercises. The torso twist, for instance, is a new exercise as of today and has a very low number of reps because she began to sway after a few. If this continues over the next day or so that one may be dropped for awhile.
    My intention with this section of my web effort on behalf of my mother and myself is that I will be filling in charts by hand, which I've already devised in a spreadsheet program, as we exercise, with exactly what we do in the order we do it and include comments on her specific difficulties or triumphs that day, which I will transfer over here. Today is the first day that I've filled in such a chart, and, considering the hour, I think I'll wait to transfer the data here until tomorrow. I have a fair amount of catching up to do throughout the site this weekend but hope to get it all done before the long weekend ends and other duties take priority. Thank the gods for holidays, miscellaneous and otherwise!