Case studies part 4: trial and error

Here are the lists of exercises I've tried for each case study, with comments about which ones worked and which ones didn't.

Case study A) 75 y.o. female with multiple myeloma:

Exercises that worked

• theraband rows
• theraband reverse flys
• single leg calf raises holding onto wall
• single leg hip abduction holding onto chair
• wall pushups
• sitting on edge of chair with hands on seat, pushing hips up off the seat (this was supposed to be bench dips, but just lifting up like this was challenging enough)
• seated theraband shoulder press (couldn't get arms all the way up, but was still good to put some strain in the shoulders)
• seated knee crunches
• SL bridge, alternating feet every 5 seconds
• plank from knees rather than toes
• single leg chair squat holding onto arm rests 
• side plank, again pushing up from knees

Exercises that didn't work

• doing any of the arm exercises seated on the ball, which is what I had originally planned; she didn't feel stable enough, and we can't risk a fall
• ball squats: again, too unstable and hurt her knees (though squats holding onto a counter are fine)
• ball cobra: lying on the ball was too uncomfortable on her chest
• single leg front and side raises: her balance wasn't good enough, so switched to just doing the side raises with her holding onto the chair
• theraband side raises: she's had problems with her shoulders and neck as well, and this just brought on too much pain

So overall, some basic exercises, mostly body weight, and making sure she's in a very stable position with low falls risk. Trying to build up the basic strength at this point to be able to do exercises that will take her through a fuller range of motion


Case study B) 34 y.o. female with lat dorsi flap reconstruction after double mastectomy

Exercises that work best (and what we progressed from)

• wall pushups seem to be the single best thing for total upper body activation and motion
• wall crawls (standing inches from the wall and running hands up and down in wide circles) is a great stretch that helped her quickly add about 20* to her shoulder ROM
• theraband rows: she's been able to do these well all along, but are still good to work on building up muscular endurance and neural activation in rhomboids
• ball reverse flys: fighting gravity is better for her than using a theraband, because the slightly extra effort (there's no added weight) helps her focus more without being too hard
• lying prone on the plinth with arms straight overhead, actively going into more flexion; originally, we did this sitting with pillows on top of a table propping her arm up so she started at 90*, then had her raise up; then we progressed to standing with her arm up as high as she could hold it to start with and then trying to raise further; both worked well and were necessary early on, but she progressed almost weekly to the next step; now I've got her doing in on the plinth face down to really force the arm to stay in a lot of flexion, and she's working on engaging her deltoids and other scapular stabilizers to work on the end of range motion. She said this works much better as the ones we did standing allowed her to slack off and not keep her arm up.

Haven't found anything that didn't work, but as I mention above, made several quick progressions early on to continue to challenge her and to target her week spots