Progress Report June 4th: Strength Exercises: B.G.

has been doing the program on the air-resistance machines that was set out for him by one of the YMCA trainers in March. Subjective: B.G. has told me that he is enjoying the workouts that he has been prescribed and has been meeting me once a week since March 11th with no issues. He has raised only one concern to me in his strength training in that his right shoulder sometimes gives him gives him some pain when he tries uses the military press machine. He does not, however, experience this pain in any other exercise nor in any daily activities. He seems interested in trying some exercise to help strengthen the muscles surrounding the capsule; this could help alleviate pain caused by using the military press machine. Objective: Since March 11th B.G. has made some great progress in the weights that he is lifting. Until April 15nd, his weights were not adjusted so as to allow him to get used to the program and become comfortable with attending the gym regularly. Leg press: B.G. has progressed from 150kg (2x15) on March 11th to 180kg (3x10) on May 29th *Note: On April 22nd, we could not find B.Gs program in the folder so we attempted to estimate the weights that B.G. felt comfortable lifting and he managed to do 200kg on the leg press (3x10). This is a very impressive, although B.G. has felt more comfortable to slowly continuing to work up in weights according to the workout plan this is certainly a strong exercise for B.G. Leg extension: This exercise has shown to be a difficult one for Bob and has not been increased in weight as some days he struggles to complete all of the reps (3x10); May 29th he did complete all reps though so I believe he has still made progress. Chest press: On April 29th, B.G. increased the weight for chest press from 40kg (3x10) to 43kg (3x10) and has been working at achieving all of the reps. He has progressed from a set of 10, 7, 7 on April 29th to a set of 10, 10, 8 on May 29th. Upper Back (rows): This exercise is not difficult for B.G. and he has been able to increase from 30kg (3x10) to 33kg (3x10) with no problem (March 11th to May 29th). This a good exercise to continue increasing in weights over the next few weeks.

Lat pull downs: This exercise, as well, has been no problem for B.G. and on May 29th increased his weight from 40kg (3x10) to 43kg (3x10); this exercise had not yet been increased since the start of the program due to other exercises being increased in weight in the other weeks. Military press: As mentioned in Subjective, B.G. has some pain with this exercise so we have continued to maintain the same weight that was initially set: 20kg (3x10) and has not been encouraged to complete all of the reps if the uncomfortable feeling turns to pain. Assessment: I believe that B.G. has shown a lot of progress in these exercises and I am pleased that he puts in a great effort to do as much as he can with each exercise. I think it would benefit B.G. to continue slowly increasing the weight of certain exercise as he continues to get stronger. I would also like to build in some shoulder strengthening exercises into his program to build stability in the capsule and help to reduce any pain he experiences from the military press exercise. Plan: I will continue to increase 2.5-3kg per week in one exercise that B.G can do all the prescribed reps (3x10) with control and good form. I would like to eventually incorporate a few shoulder strengthening exercises; I will start with one exercise using a resistance band around a pole and have Bob use the resistance as he externally rotates the arm from a 90o bent arm position this will strengthen the Infraspinatus and Teres Minor rotator cuff muscles. Balance Exercises: Subjective: B.G. has informed me that through doing these exercises each week, he has felt much more comfortable with doing them and has noticed an improvement in his own performance. He tells me he feels much more stable resisting pushes from the sides than from the front or back. In the exercises involving lifting one leg at a time he says he finds it hard to lift the right leg (balance on the left). B.G. finds the bridge exercise (lying on the back, knees bent and raising the hips up and down) sometimes too difficult to remember the sequence for; it helps to instruct him at each step thought it may be difficult to advance this exercise. Objective: Heel to toe walk the line: (3meters x4) This exercise has significantly improved over the weeks we have been meeting. When he first began, he had a lot of difficult placing the foot correctly in front of the

other and required assistance every time to prevent falling off to the side. As of May, B.G. has progressed to much more accurate foot placement; he can place the heel with control against the toe of the other foot before planting the rest of the foot on the line. On May 20th, B.G. attempted to perform this exercise without assistance and was successful with only a slight decrease in stability. Stepping (standing one leg at a time) (2x15): B.G. has gained a lot more control of his legs in this exercise since the first day and has begun to perform it in a more rhythmic pattern of equally timed lifts for each side. He is comfortable to raise each foot about 1ft off the ground and does not often lose his balance or control as he would sometime do earlier in this program. B.G. has worked up to comfortably holding each foot up for about 15 seconds each. Side to side/Front to back pushes: B.G. has significantly improved in his ability to maintain balanced as I push his shoulders and hips side to side and front to back. As his confidence has improved in the exercise, I believe his strength to resist my push has improved as well. The side to side pushes are very stable, however pushing front to back, particularly pulling back at the shoulders, is much weaker. Body weight calf raises (2x15): Since the start, B.G. has improved in the control that he has over his body as he goes up on his toes. He now keeps his weight more over his ankles as he goes up with less ankle movement out to the sides. It is clear to see that his performance increases with each set of the same day as well. Ball passes (x20): This exercise started out as a good way to get B.G. to shift his weight in different ways to the sides, however, I do not think that Bob finds this very challenging and I have decided to put it aside to make more time for other exercises that challenge him more. I hope to look into finding a way to making this a more challenging exercise for B.G. in the future; e.g. using a smaller ball to pass. Wall push ups on exercise ball (x30): This is not a difficult exercise for B.G., thought I think it does help to further strengthen muscles in his arms, chest and core as the ball does create some instability as he performs the reps. Bob has very good form when doing this exercise. Single leg raises sitting on the ball (2x15): In congruence with the other balancing exercises, B.G. has improved in his control and rhythm of his legs as he raises one and then the other. At first I needed to hold the exercise ball in place to help him balance, but he can now keep balanced without the support most of the time. I have observed that B.G. shows more difficulty with lifting the right leg (balancing on the left leg) with control then he does with the other leg.

Bridges (3x10): This exercise is a good core exercise for B.G. and he performs it with good form. I have intentions of advancing the exercise to incorporate single leg lifts with each hip raise, which he has attempted, but finds too difficult to maintain for all of the sets due to the difficulty of remember the pattern. I think that it can be beneficial to keep attempting this new exercise to not only test his balance, but be a cognitive exercise as well. Supermans (2x10) On all fours, raise one arm and the opposite leg, then switch to the other side: This exercise, being at the end of the workout, has been on and off performed each week depending on how B.G. is feeling at this point strength-wise. It is a good additional core exercise and final balancing exercise that B.G. has maintained a consistent level of performance in due to it being used a supplementary exercise. My one concern with this exercise is that B.G. does not always fully extend his arm and leg out fully in each rep and I am wondering if this could possibly hinder the benefits of doing it. Assessment: I think these exercises have been great for B.G. so far to improving his balance and allowing him to feel more comfortable with situations that may throw him off balance. I would like to continue exploring new exercises for B.G. that can practically apply to activities that he does at home and in his daily life that require balance to help reduce his risk of falling or getting injured. I think it is important to bring new exercises into the program periodically to prevent B.G. from getting bored and ensure that he is continually being challenged. Plan: I plan to begin incorporating at least one new balance exercise every second workout day to allow him time to learn and progress with the activity and begin to phase out activities that are no longer challenging. I am interested in using steps in some exercises to work on balance for walking up stairs which he could benefit in the public.