We know that exercise is a vital component of overall health, both physical and mental. This is just also true for individuals suffering from quadriplegia. For quadriplegic patients' active movement is limited, therefore, it is necessary to find alternative ways to incorporate movement into their daily life. Movement can be incorporated with the help of an experienced physiotherapist, who can recommend exercises according to the patient's needs. Regular exercises can benefit quadriplegic patients in a variety of ways. Exercising helps maintain the range of motion and promotes circulation, bone density, and muscle mass. And also minimizes the additional complications of quadriplegia and thus increases the ability to participate in daily activities. This blog has been written to give you some idea about exercises that can be done for quadriplegic patients.
Quadriplegic patients with less severe and incomplete injury to their cervical spine can move their upper limbs. Whereas, those patients with more severe spine damage have to deal with total loss of upper limb function. The recovery of the quadriplegic patient relies on the nature of the injury. Mostly, patients with incomplete quadriplegia have a higher chance of recovering lost functions to some degree.
Passive range of motion exercises plays a significant role in quadriplegia recovery.  Passive range of motion exercises makes a big difference in the healing and recovery journey. The physiotherapy technique consists of assisted activities that stimulate nerve healing and increase muscle strength. Quadriplegic patients can practice passive range of motion exercises. This type of exercise requires no active muscle contraction, instead, a physiotherapist or a trained caregiver can facilitate the movements for the patients to make sure that the joints move through their full range of motion.
Doing regular exercises can improve digestive function and also reduces the risk of urinary tract infections or constipation. Exercising strengthens the breathing muscles, improves blood circulation, and also helps prevent secondary complications such as swelling, pressure sores, infections like pneumonia, etc.

Exercises can be recommended for patients with both incomplete and complete paralysis.  Discussed below are some examples of passive range of motion exercises used for quadriplegia recovery:

Neck rotation stretch
Neck exercises like neck rotation, tilting the head left to right, up and down strengthen and re-activate the neck muscles, shoulders, and upper back, and also helps release tension in the muscles, easing pain in most quadriplegic patients.

Piriformis stretch
  • Increased hip flexibility can improve hip movements, and eases lower back pain, which is a common problem among patients with paralyzing injuries to their upper and lower limbs. Quadriplegic patients do this exercise, with the help of a physiotherapist.
  • The therapist gently pushes one leg in while the patient grasps his knee for around 8 to 10 seconds.  
Doorway chest stretch
  • Stretching the chest muscles can relieve pain in the upper neck or upper back. This exercise lengthens the pectoral muscles and strengthens other muscle groups that help in facilitating upper limb movement.
  • The physiotherapist bends the elbow and positions the forearm against a doorway opening.
  • Lunge forward to open up the chest and stretch the muscles 
Spine twists
  • Spine or trunk rotation exercises improve lower back flexibility which can increase spine mobility and rotation.
  • To rotate the trunk, the therapist needs to raise and bend the legs and push them gently toward the chest.
  • After completing the movement, the patient should tilt his knees from one side to the other without moving his shoulder muscles.
Shoulder Flexion
  • The patient's arm is relaxed by the side so that the palm is facing inward.
  • The therapist raises the arm forward slowly, keeping the elbow straight, bringing it up so that the hand reaches up and the arm is as close to the ear as possible.
Shoulder Abduction
  • The patient's arm is straight with the palm facing forward.
  • The therapist slowly brings the arm and hand outward to the side, away from the patient's body.
  • The patient's arm should be level with the shoulders or higher.
  • Then, bring the arm back to the starting position.
Elbow Flexion and Extension
  • The therapist bends the elbow so that the hand can touch the shoulder.
  • Then extends it so that the arm is fully straight.
Forearm Rotation
  • The therapist bends the elbows at 90° at the patient's sides with the back of the hands facing up.
  • With one hand, hold just above the elbow, and with the other, flips the hand over so that the palm faces up.
  • Forearm rotation can also be completed with the arms straight and positioned at the patient's sides.
Wrist Flexion and Extension
  • The therapist bends the patient's wrist so that the palm moves toward the inner arm and makes a 90° angle.
  • Then, extends the wrist in the opposite direction.
Finger Flexion and Extension
  • The therapist curls the patient's fingers inward towards the palm, creating a fist.
  • Then extends them back so that they are straight.
  • Keep the wrists neutral (straight) while doing this.
Finger O's
  • The therapist touches the tip of the patient's each finger to the tip of the thumb.
Finger Abduction (Splits)
  • The therapist separates the patient's two adjacent fingers by moving them away from each other.
  • Then brings them back together.
Finger splits
  • The therapist splits the fingers through the passive exercise that helps loosen up stiff joints and activate the hand and finger muscles. The physiotherapist does this movement by separating two adjacent fingers and putting them back in their resting position. 
Hip Rotation
  • The therapist bends the patient's knee so that the thigh is perpendicular to the bed and there's a 90° angle at the knee.
  • Then he rotates the patient's hip in the socket by holding the thigh just above the knee and moves the foot inward towards the opposite leg. Further, reverse the direction of rotation and move the foot outward, keeping the thigh perpendicular to the mat the whole time 
Hip Abduction
  • The patient's legs should be straight. The therapist pulls one leg to the side away from the midline of the body and creates a separation between the feet until there's slight muscle resistance. Then, brings the feet back together.
Ankle Rotations
  • The therapist puts one hand just above the patient's ankle to stabilize the leg and the other hand on the foot.
  • Then moves the foot in a circular motion to stretch the ankle and calf.
Toe Flexion and Extension
  • The therapist bends the toes of the patient towards the sole and brings them back out to neutral.
  • Then extends them upward toward the shin to stretch the bottom of the foot.
Breathing Exercises
  • The muscles of the abdomen and diaphragm are vital to performing breathing exercises depending on the level of injury, these muscles may be affected. Breathing function and overall respiratory health are also important for quadriplegic patients. Breathing exercises help maximize respiratory function.
  • The patient takes a deep breath through the nose, trying to expand the chest and lungs. The patient holds this breath for 2-3 seconds and releases slowly through pursed lips.
Air stacking
  • The patient sits upright or reclines slightly with the support behind his back. Then takes a deep breath in and holds, then breathes in more air and holds again. The patient then continues this exercise 4-5 times without exhaling and holds for 2-3 seconds, then exhales slowly to finish one cycle of the exercise.
Number Counting
  • The patient takes a deep breath in, then releases the breath slowly while counting out loud. Then tries to gradually increase the number to reach to improve his breath control.
The above-mentioned exercises are designed in such a way that they are to be performed for the patient by the therapist or caretaker. As the patient continues practicing these exercises, he might find that he can actively do some of the movements. Then this is a sign of recovery and progress.
The article as first published at CB Physiotherapy