If you’re unable to move against gravity, a caregiver or physical therapist can help you fully stretch your muscles and move the joints to prevent contractures associated with immobility. For maximum benefit, it’s important that you continue to participate as fully as possible.

The following illustrations indicate normal range-of-motion of each joint. If strong resistance or pain occurs, stop the movement.

Note: The following instructions are written to the caregiver.

Arm exercises

Shoulder

Help the person with ALS lie comfortably on his or her back. Place the person’s arm at his or her side.

Supporting the elbow and wrist, pick the arm up and over the head to a position behind the ear. Return the arm to the person’s side.

Supporting the elbow and wrist, move the arm along the bed to a position above the person’s head and next to his or her ear. Return the arm to the person’s side.

Move the arm along the bed to shoulder level. Bend the elbow to 90 degrees (hand pointing toward ceiling). Support the elbow and wrist and keep elbow stabilized.

Rotate the arm until the hand and wrist touch the bed near the hip and rotate the arm back until the wrist touches the bed near the head.

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Elbow

Stabilize the elbow and bend and straighten it in three positions: palm down, thumb down and palm up.

With the elbow bent at the person’s side, rotate the palm toward and away from the person’s face.

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Wrist

Holding the wrist and hand, bend the wrist up and down as if waving. Holding the arm and hand, with the wrist straight, bend the hand to one side and then the other.

Fingers

Take each finger and pull gently to touch the base of the finger and then the heel of the hand. Touch the tip of each finger to the tip of the thumb.

Straighten each finger. Spread the fingers apart and back together.

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Leg exercises

Hip

Help the person with ALS to lie on his or her back with legs straight and relaxed. Stand beside the leg to be exercised, and place one hand above the knee to keep it straight and the other hand under the heel.

Bend the knee of one leg and cross the foot over the thigh of the other leg. Push the knee toward the opposite shoulder. Repeat with the other leg.

Keeping the leg straight, slowly raise the leg until the person you’re assisting feels a stretch. Be sure to keep the other leg flat during the stretch.

Support the leg at the knee and heel, and bring the knee toward the chest. Return the leg to the bed, and repeat with the other leg.

Bring the leg out to the side. Return the leg to the center. Repeat with the other leg.

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Ankle and toes

Place one hand on the person’s shin and cup the heel in your other hand. Gently bend the ankle upward by pushing against the bottom of the foot with your forearm. Don’t allow the foot to turn in or out.

Grasp the foot and turn the bottom of the foot toward the inside and then the outside.

Bend and straighten each toe. Spread the toes apart and then return them to the original position.

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