Class plan for mobility and stability – 30 minutes

Seated on a chair

• Shoulder shrugs and circles
• ½ roll down (start with a forward head nod and then curl forward to the base of the ribs; hold a chair for support as needed)
• Spine rotation with hugging arms (start with a hug and then turn spine side to side)
• Drawing circles with elbows
• Windmill arms (start the windmill motion with elbows then progress to fully extended arms)
• Foot slides
• Psoas isometric (press thigh and hand into each other)
• Open & close knees with arms hugging an imaginary tree
• Bowing with hand slides (1/2 roll down)
• Hugging thoracic rotation

Standing

• Squats with arms slides
• Split stance rock forward and back from foot to foot (multifidi rock)
• Hugging Thoracic rotation

Seated on a chair

• Psoas isometric (press thigh and hand into each other)
• Windmill arms
• Shoulder shrugs

Class plan for balance and sensory/neuromuscular integration – 30 minutes

Seated

• Stimulate the feet (roll foot over soup can; dorsi & plantar flexion; slide foot for sensation on the floor)
• Toe press, lift and wobble heel
• Toe curls
• Stimulate the hands (hand flicks; wrist motions; hand pull & flash)
• Cross body arm series
• Conductor arms
• Hairbrush combing legs and arms
• Cross body arm & leg motion – open & close
• Foot stimulation with hairbrush or soup can

Standing Quadruped with hands on seat of chair

Spinal motions

• Stand in a slight squat position while flexing and extending (cat/cow)
• Stand with feet wider than hip distance apart while side bending left and right

Hand tapping

• Hands on chair, tall on one arm as other hand taps seat

Heel bumps

• With hands on chair seat, alternate lifting and lowering heels
• Squat with hands on legs alternating heel bumps

Alternate Limb lifts

• Lift opposite foot and hand simultaneously and switch (like a minute march)
• Hands on seat of chair – wipe feet on floor as if trying to clean off bottoms of shoe (one foot at a time) 

Standing

• Step back and slightly to one side and gesture as if presenting something
• Hold a split stance lunge position and pump the back heel up and down (hold the back of a chair)
• Make a wide parallel stance and move as if swinging a golf club
• March while tapping hands to opposite thighs (as one knee lifts, tap that thigh with opposite hand)
• Hold stride stance while turning head side to side
• Arm sweeps/throws from up top to down low

Teaching tips

Tip #1: Cluster exercises around one goal for coordination and mastery

If the goal is to enhance mobility…

Teach three mobility exercises in three different body zones: Start by choosing three distinct exercises for three different body zones. For example, pelvic tilting, ankle plantar and dorsiflexion, and lateral arm arcs. Teach each exercise separately and repeat the sequence if you like.

Teach three mobility exercises in one body zone: Focus on one body zone like the ankles and do three mobility exercises. For example, ankle plantar and dorsiflexion, circles and side to side foot sweeps. Change the body zone to the shoulders and teach three mobility exercises for that zone. If we use shoulders as the example, try figure-8 conductor arms, bent elbow shoulder abduction like wing flapping and soldier arms.

Tip #2: Make cues visual and tactile rather than cerebral – don’t rely on words too much

Demonstrate often.

Use hand gestures.

Offer hands-on feedback or ask people to touch their own body parts.

Tip #3: Choose exercises that are accessible – ascertain individual needs

This can be a tricky balancing act. We want to stimulate and challenge while respecting limitations and movements that make people feel uncoordinated. Your choice may not always work, but if you watch and listen carefully to client responses, you’ll know when it is time to switch gears for more or less challenge.

Never underestimate the subtle nuances of this.

Tip #4: Focus on doable tasks to encourage a sense of accomplishment and minimize frustration

The emphasis here is on “tasks.” Choose exercises where you can focus on the task at hand rather than how to execute certain movements. For example, if teaching squats, have people practise sitting down and standing up from a chair without using their arms (if appropriate). The task is to sit down and stand up from the chair.

Tip #5: Infuse fun, play and socializing through interactive exercises

How do you do this? One way is by using props like two small squishy balls and ask people to be in a circle. Pass a ball around, person to person. Periodically, someone has to stand and sit back down while holding the ball. In essence, people play a game rather than focus on their movements.

Positions that work and ones that don’t

In a group class it is important to determine which positions participants are able to do beforehand (where possible) to help with planning. A group class experience requires cohesive flow to avoid having to teach one-on-one sessions within a group. How? Choose positions based on the majority of participants’ abilities to help manage multiple needs at once. Avoid changing positions too often in a group. Stick with one for several exercises and maximize it.

For one-on-one sessions, body positions can be adapted moment to moment based on an individual’s needs, but it is important to start upright (seated or standing) to build rapport.

• Seated – easy to get into, minimizes fatigue, can watch teacher clearly
• Standing – may need to hold something for balance, weight bearing, opens hips & uses feet
• Standing quadruped – hands on table, or chair seat (if tolerable)
• Supine – dependent on comfort (not suitable for all)
• Side lying – dependent on comfort (not suitable for all)
• Prone – awkward for some, impedes ability to watch teacher
• Quadruped – uncomfortable for wrists, impedes ability to watch teacher (standing alternative)

Using props

Unstable surfaces

The list could include pillows, balance cushions, foam rollers, a wobble board, spiky pods, swivel discs, soft balls. Consider how to use unstable props safely to assist with your objectives for your clients. Unstable surfaces provide somatosensory stimulation but should not be so unstable as to be unsafe. Do no, for example, ask people with PD to stand on a wobble board without anything to hold on to. Instead, ask them to sit on a chair with one foot on top of the wobble board so as to stimulate the proprioceptors in their feet. Simplicity is key. If the unstable surface is difficult for a person to navigate, don’t use it!

Closed chain props (hands or feet are fixed)

Props like a chair, the wall, the floor, a foam roller, walking poles, a resistance ring, balance cushions or soft balls can all be used to create a closed chain environment for clients. Use these props to provide a stability challenge and tune into your client(s) agility, control and interest. For example, a roller under feet while seated on a chair may be helpful for one person but awkward for another.

Open chain props (hands or feet are free to move and not fixed)

Props like free weights or resistance bands (e.g. Theraband^TM) are excellent resistance tools, but are inherently less stable and more difficult to use than props that provide a closed chain environment.

Troubleshooting for success

When faced with challenges in teaching people with PD, be sure to implement one or more strategies from this checklist to help the client process information better and to increase movement accessibility for them. Start with one, then incorporate more as needed. Progress gradually.

1. Emphasize large, visual movements and avoid micro movements
2. Use mirroring and mimicking – show, don’t tell and get people to follow you
3. Break movements down – use progressive sequences to make movements accessible
4. Include opposite limb and cross-body movements for hemispheric brain coordination
5. Include touch from you, from themselves, or a combination to help people make sense of a movement or movement sequence
6. Use unstable surfaces to possibly subdue tremors (this is based on in-studio evidence)
7. Choose closed chain exercises whenever possible for co-contraction of muscles around multiple joints
8. Reduce verbal cues, speed and complexity if signs of confusion or freezing emerge
9. If people seem despondent ask them if they know what they need – allow ample response time 

Refine your skills and knowledge

Want to learn more about how to develop meaningful Pilates & Movement exercise interventions for people with PD?

Sign up for Working With Parkinson’s Disease, taught by Registered Physiotherapist and Body Harmonics Pilates Certified Teacher Trainer, Bonnie Jeng.

Read Parts 1 and 2 of our PD series: Living better with Parkinson’s disease through Pilates & Movement here and here.