As ALS progresses, it may be impossible for you to do all the stretching exercises. But it’s vital that you continue moving all joints through a full range-of-motion, to help prevent pain and deformity.

You may be able to perform these exercises independently for a time and later need assistance. It’s important to use assistance only for the portion of exercise that you’re unable to perform alone. Active exercises with minor assistance allow you to use as much energy as is comfortable while gaining the benefits of stretching and range-of-motion.

Precautions

Never move the limb past the point of resistance or pain, with one exception: the shoulders. See Spotlight on Shoulders for guidelines about stiff and painful shoulders.

Assistance in movement should be gentle and slow.

• The caregiver or therapist should provide adequate support to the limb during movement.
• The parts to be moved should be gently and comfortably grasped as near the joint as possible.
• The motion should be slow and rhythmical and the repetition rate maintained at an even tempo.
• It’s important for you to notify the caregiver if you experience pain dur-ing exercise.
• If you feel resistance to the move-ment because of tightness in the limb, you can overcome it by continuing slow, steady pressure to the limb. If pain occurs, stop the movement.

Arm exercises

You can do these exercises when you have one arm that’s significantly stronger than the other. You can perform them in a sitting position or lying on your back.

Shoulder

Grasp your weaker wrist with your stronger hand. Raise both arms over your head.

Cradle your weaker arm with your stronger arm, with your stronger hand under your weaker elbow. Raise both arms to chest height. Move your arms from side to side as far as possible.

Elbow

Grasp your weak wrist with your strong hand. Bring your hands to your right shoulder, then back to your knee, then to your left shoulder.

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Hand and wrist

Grasp the palm of your weaker hand with your strong hand. Move your weak hand slowly up and down as if waving.

Sit with the palm of your weaker hand facing upward. Grasp the fingertips with your stronger hand. Bend the fingers inward to touch the palm. Straighten them out fully.

With the palm of your weaker hand facing upward, grasp the tip of the thumb with your stronger hand. Move the tip of your thumb over to the base of the little finger, then straighten it again.

With the palm of the weaker hand facing down, grasp the thumb with the stronger hand and move the thumb out to the side as far as possible. Return to your original position.

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