There should be little to no . The following types of, were excluded: patients with cognitive impairment or dementia with a Korean, version of the Mini-Mental State Examination score of 23 or lower who were unable to, understand instructions or inability to understand oral instruction due to language, disorders or other reasons, and patients with severe contracture due to orthopedic. Since the tool was developed for stroke. endstream endobj 799 0 obj <>>>/Filter/Standard/Length 128/O(_*oYEg \(p1\n)/P -1340/R 4/StmF/StdCF/StrF/StdCF/U(rlL9n )/V 4>> endobj 800 0 obj <>/Metadata 61 0 R/Pages 796 0 R/StructTreeRoot 89 0 R/Type/Catalog>> endobj 801 0 obj <>/MediaBox[0 0 612 792]/Parent 796 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 802 0 obj <>stream doing what you do best: Connecting with your patients and changing lives for the better. 0000004691 00000 n There was a, signiicant group-by-time interaction in the affected side MFT score and both sides of BBT scores, but, no signiicant interaction was found in the unaffected side MFT score, ADL, and QoL. Rotate your forearm turning your palm up and down. /Domain[0 1] If you can, try to raise them above your head. /Type/ExtGState Rest your forearms on your lap with your palms facing down. m;T oe^=$0RlnX"7-PQ[WRiUA:ndr-N>cp(f;eivrvanR^&0smhgX7T+Qtn-Z% !^@4a0xH37ME9L]j?ymE05c~WEaft?;7iLSHm!'&CL9I`r#jTeor%]ws@(Mjaf^]3+MUxCp=,9sLpu(hoO) 0000003340 00000 n Complete your painting activity on an easel or vertical surface. Our scientists pursue every aspect of cancer researchfrom exploring the biology of genes and cells, to developing immune-based treatments, uncovering the causes of metastasis, and more. 2. 1 /O@982e\6`(ZdZ|W&\$~5`Kxs;r'W+7;j>1 W)8-'%u|c:NqJ;;\\4ALc;*uM:@5}j[:Em|V: Strengthening the FDI may be an effective intervention in preventing arthritis. 0000070889 00000 n Keep doing the other exercises that dont hurt you. l(h1p> X,b h.>Y_m'3=h%&_ Please do not write your name or any personal information on this feedback form. All rights reserved. I was reminded once again of how important upper body strength is when we are working towards improving fine motor skills. 3:15 - 5:00 Lab: Functional Activities for the Upper Extremity; Specific Questions or Clinical Problems 5:00 p.m. Adjourn Saturday, March 16, 2013 Rehabilitation of the Patient with Hemiplegia: Improving Upper Extremity Function Rehabilitation of the Patient with Hemiplegia: Improving Upper Extremity Function Saturday, March 16, 2013 Many of the exercises focus on muscles of the shoulders, chest and upper back . ADL, and QoL in chronic stroke patients with related hemiplegia. Also try these play dough activities for improving upper body strength through play. Doing arm exercises with gentle movements will help prevent you from feeling stiff. kO`Y%Oe=^[5 TrwH0,9suf% uz9tP7&{8AU'O?-o$R`l/f^xy )wv MzMz6>>>/Filter/Standard/Length 128/O(R3UfV=T;in)/P -1324/R 4/StmF/StdCF/StrF/StdCF/U(}7FV )/V 4>> endobj 212 0 obj <>/Metadata 22 0 R/Outlines 28 0 R/PageLayout/OneColumn/Pages 208 0 R/StructTreeRoot 39 0 R/Type/Catalog>> endobj 213 0 obj <>/ExtGState<>/Font<>/XObject<>>>/Rotate 0/StructParents 0/Type/Page>> endobj 214 0 obj <>stream population aging and the incidence of adult vascular diseases have increased. I have two children (if you dont count my husband! %PDF-1.4 % 0000005018 00000 n 0000044936 00000 n If you have any questions, contact a member of your care team directly. activities of daily living (T-ADL) training on upper limb functions, activities of daily living (ADL), T-ADL training or conventional occupational therapy (OT) group. Your wrists should be hanging off the surface, leaving them free to move. Upper body strength is very important as babies pull themselves into standing and begin to cruise along the couch or coffee table. 0000013995 00000 n Thus, this study aimed to determine. Notify your therapist if you have any questions or . Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. May 7th, 2018 - Seated Exercises Physical Therapy ? Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Aerobic Activity: A sustained repetitive activity performed for a long period. Seated Upper Extremity Theraband Exercises Movement Disorders of the Upper Extremities in Children - Apr 12 2020 . Higher scores indicate a higher level of independence in ADL on a scale of, 0100. Slowly slide your hands up the center of your back as far as you can. Encourage your child to draw the grid before playing the game. Make a loop with your band or tubing. Working on a vertical surface has the added bonus of placing the wrist and fingers in a good position for drawing or writing. So when it comes to upper body strengthening, the question can arise whether the strengthen is functional. It might be helpful to count out loud during the exercises to keep your breaths evenly paced and remind you to breathe. 0000044820 00000 n While doing this exercise, if one arm is weaker than the other, clasp your hands together and raise both of them over your head. Pull theraband outwards, across your chest. All information on The OT Toolbox Website, its content of all types, including newsletter and social media is presented as informational only and is not a replacement for therapy assessment, diagnosis, intervention, or medical advice. These exercises are designed to be completed with instructions from your occupational therapist. Follow exercise directions as listed 4. Similar To PNF Techniques in the Upper Extremity Thera Band Exercises for Upper Extremities LIVESTRONG COM September 10th, 2017 - Thera Band Exercises for Upper Extremities A woman is training her upper body with a resistance . endobj it consisted of 12 categories and 49 questions regarding energy, family roles, language, vision, and work/productivity. Seated Full Body Workout Routine Shape Magazine. 0000070928 00000 n Chest Pull Sit or stand with your feet shoulder-width apart. >> The book is rounded out with information on the management of these patients and their parents. >> . 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Slowly spread your fingers apart, then bring them back together (see Figure 19). These patients perform daily activities mainly using the unaffected upper limb, and as, ], the end result is the complete disuse of the, dressed, and writing, involve the hands and upper limbs, the inability to use an upper, limb could cause loss of upper limb function and, consequently, lead to a reduction in, daily living to prevent independent activities of daily living (ADL), feelings of depression, anxiety, sleep deprivation, and helplessness, transform the, lifestyle toward dependency, cause a reduction in self-respect and self-eficacy, and, ], thereby affecting the quality of life (QoL) [, training of a task focusing on functional performance toward the effective completion. OBJECTIVE. Then, all assessments were done after the 8 weeks. All rights owned and reserved by Memorial Sloan Kettering Cancer Center, 2023 Memorial Sloan Kettering Cancer Center, Human Oncology & Pathogenesis Program (HOPP), Gerstner Sloan Kettering Graduate School of Biomedical Sciences, High school & undergraduate summer programs. therapy materials, clinical tools, research Swing your weaker arm in clockwise (to the right) and counterclockwise (to the left) circles and forward and back (see Figure 21). It can be prescribed by therapists who select appropriate activities for the individual patient. In the first few months of life babies push up on their arms when lying on their tummies. Physical Therapy in the Fitness Room. ~sc] Read more about coloring as a functional occupation and the development of coloring skills. 1 0 obj When working for upper body strength try to encourage big movements that incorporate a wide range of movement for the shoulder muscles. What a great activity for using a vertical surface to strengthen the upper body through play. Stabilization of the CMC joint with reduction of joint subluxation theoretically reduces the risk of arthritis. Have a look at the following activities (and purposeful, functional tasks) that you can complete on a vertical surface: Use tape to stick a piece of paper or picture on the wall. endobj Sorry, preview is currently unavailable. General instructions: Complete all exercises while seated in a chair with armrests unless . When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation. << Results: Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Your occupational or physical therapist may adjust the exercises to meet your needs. Tearing paper strengthens the hand, wrist, shoulder girdle, and upper body. Virtual reality is three dimensional, interactive and fun way in rehabilitation. In occupational therapy, addressing upper body strength can iffy for some. Some surgeons will say 5 pounds, others will allow 10 pounds. Playdough lends itself to endless creative outcomes and working against a vertical surface adds a new fun dimension. Provides consistent instructions and quality across the spectrum of patient care. Your shoulders should be back and level with each other. Written by experienced clinicians, it offers valuable A competency-based educational model and training recommendations, Medical Music Therapy: Evidence-Based Principles and Practices, Psychosocial Interventionin Schizophrenia, Splinting, Positioning, Edema, and Scar Management After Burn Injury, Assistive Devices for Children with Disabilities, Constraint-Induced Movement Therapy (CIT) for Restoration of Upper-limb Function. 2. x15159bc Upper Extremity Theraband Exercises. [r,S%>Po-/_k?r?oc(5_i}>9))h}G>{wyG2osyM endobj BUT, when you think about functional tasks, upper body strength is a must. If one arm is weaker than the other, use your stronger hand to bend and straighten the fingers of the weaker hand. ); Tel. 0000073016 00000 n Choose a resistance that you can do for 2 sets of 15 reps If it's too easy: 1. 818 0 obj <>/Encrypt 799 0 R/Filter/FlateDecode/ID[<9C89281341C7974FAAF720869E47D8FC>]/Index[798 45]/Info 797 0 R/Length 103/Prev 736543/Root 800 0 R/Size 843/Type/XRef/W[1 3 1]>>stream Ready to start planning your care? movement. 01. When upper body strength results in less function of daily occupations, upper body exercises relate back to the functional task, making skilled strengthening activities part of the OT treatment plan. 2010-2023 The OT Toolbox | Privacy Policy, When Executive Function Skills Impair Handwriting, Executive Functioning Skills- Teach Planning and Prioritization, Fine Motor Activities to Improve Open Thumb Web Space, Activities to improve smooth visual pursuits, Classroom Accommodations for Visual Impairments, Occupational Therapy Equipment List Writing Pages. Roll your shoulders backwards in a circle ______times. Please do not use it to ask about your care. A pilot study on athletes return to sport decisions following concussion injuries and the influence of education, Strength training in a Geriatric Rehabilitation Center . ); +82-32-820-4335 (H.L. >> these exercises the day after your surgery and do them daily during your recovery. Move farther away from the wall, or 2. Many of the games and activities that you have at home or in the classroom can be adapted to vertical activities with a bit of tape or prestik. Tell your occupational or physical therapist which exercises are uncomfortable. Log in to access this member exclusive. If you're a patient at MSK and you need to reach a provider after. %%EOF endstream endobj startxref Without this anchor it is difficult to develop good control in the lower arm, hands and fingers. CONCLUSION. Dont hold your breath while doing any of these exercises. If you feel any unusual pain in your joints or muscles while you exercise, do not continue the exercise. Draw a race track on a chalkboard or on a large piece of paper stuck to the wall. /Height 600 exercises should always be comfortable and never cause pain. Denver, Nashua, Parkersburg, Sumner and Waverly Clinics. The primary outcomes in the study were changes in upper limb functions, measured using the MFT and BBT. April 20 - April 23, 2023, 1997- If an exercise feels uncomfortable or painful, dont do it. A major focus of occupational therapy is rehabilitation related to impairments of the upper extremity (i.e., shoulder, elbow, forearm, wrist, hand), and 85% of certified hand therapists are occupational therapy professionals (Dimick et al., 2009). Complete 2-3 sets x 10 reps daily. 2 0 obj Notably, this simple and easy test allows for the testing of upper limb function, ]. Stop if you feel pain. The World Health Organization (WHO) has reported an annual, global incidence of 15 million stroke patients. Hold the other end with your palm facing up, elbow slightly bent. Correspondence: [email protected] (W.Y. Step 1. Use a Koki to trace the outline of the child. If one arm is weaker than the other, use your stronger hand to clasp the wrist of your weaker hand and bend your elbows. ",#(7),01444'9=82. CanDo WaTE Hand Balls. hbbd```b``7@$ttD~`5`YFsdl+/$@;$07001208_ o disease of the shoulder, elbow, and wrist joints. You can reach your occupational or physical therapist at _________________. Easy to understand handouts promote patient-centered care. 5 0 obj This early weight-bearing leads to strengthening and allows them to progress to four-point kneeling and eventually crawling. The Occupational Therapy Toolkit is a comprehensive, 787-page practical resource developed to support occupational therapists working with patients diagnosed with physical disabilities, chronic conditions, and geriatric disorders. push up toward the ceiling until your arms are straight 3 repeat times page 2 occupational therapy theraband exercises you can do . FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20-120). Average age was 25.9(21-59). 2023 Cheryl Hall. Upper Extremity Active Range of Motion -Sitting It will be very important to continue the exercise program that your therapist instructed you in when you leave the hospital. EqQfguFBu0Iqff(b\HYS4i]!%x[`=?`Qg\6h' JW`g$yxAJ%~DD+DK72?MAl`aMcNt^8Qj)#ZK%kC!l$RNZO\C-q 0000004607 00000 n hbbd```b``z"`.vDr XHA ;DV , @s' lM Here, we (i) outline the current status of US use by physical therapists; (ii) define and describe four broad categories of physical therapy US applications (ie, rehabilitation, diagnostic, intervention and research US); (iii) discuss how US use relates to the scope of high value physical therapy practice and (iv) propose a broad framework for a competency-based education model for training physical therapists in US. /FunctionType 0 This information describes an arm exercise program that will help you with your recovery. Upper Extremity Theraband Exercises - Sitting 1. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. All participants in both groups underwent a manual function test (MFT), box and, block test (BBT), handgrip strength test, Korean version of the modiied Barthel index, (K-MBI), and stroke-speciic QoL (SS-QoL) evaluation for baseline assessment. *D yMXZ" LOMMsJRlQ:3oSgXoX&^+%RZ)s^3CxY yj K3Fux&;'. _ZS["Lln=kz6{3--WS-qd{fRFe9Zy V2A:) y})g/zIkD~7 'rH^ Now in its 7th edition (2018), the Toolkit is utilized by OTs around the world with handouts available in English as well as Spanish and French. Basic Home Exercise Equipment THERABAND: Tie a knot in the end of the band and shut the knotted end in a door. The information provided on the Website is provided as is without any representations or warranties, express or implied. No lifting, pushing, or pulling anything over 5-10 pounds As mentioned above, this is always depending on the doctor's orders, but is the general rule. ), two dogs, one cat, two guinea pigs and one fish. In a study, applying the tool to stroke patients, the reliability was reported to be high (, process of the Occupational Therapy Practice Framework (OTPF3) published in 2002 by the, American Occupational Therapy Association, the task-oriented activities and tasks reported, in previous studies were examined, revised, and complemented, and the T-ADL training, program in this study was constructed (Table, ). patients to include even categories that may be overlooked in a general assessment of QoL. the relex loops into a network of neural CNS patterns, help to organize motor behavior, whereas occupational performance allows interactions in various environmental systems, built around human characteristics and their environments. If at any time you experience unusual pain or discomfort, stop immediately and consult with your physician or therapist. Handouts are useful takeaways for practicing and remembering how-tos and tips. CLX Powerhouse Position. . 0000322252 00000 n 0000071006 00000 n Working on a vertical surface places extra demands on the upper body as these muscles have to move against gravity to complete the task. Self-range of motion exercises for the arm and hand Page - 2 1. $Zf:2"Rw`9'P7T"i\z]4$Pw Q^wPdD0dSF!h_ev-o3 pM(?3a-*eS%jPP{aE_vs-mFJPcu*. Your clothes should not limit your movements. Abstract. The OT Toolkit provides therapists with 97 concisely written treatment guides and a collection of 354 full-page illustrated patient handouts that can be used as visual guides both during and after patient treatments. Enter the email address you signed up with and we'll email you a reset link. The Cuff Wrist and Ankle Weights. All the patient handouts and treatment guides are well-organized in one go-to resource book. 3. 0 This works well on a mirror. WdC>3zBIH330fl+f"k L= ); [email protected] (H.L. Place your forearms on a flat surface such as a table or your lap. << 399 0 obj <>stream /+^Ee\,{xVO+fGx|A~? It involves injuries with the arms, hands, shoulders, elbows, and wrists. It is intended for use . As the upper-limb gross manual dexterity among the physical functions have a significant impact on the independent ADL performance and prognosis of rehabilitation, T-ADL training in this study will be essential for the functional recovery of the upper extremity in stroke patients, whereas conventional OT did not affect the both upper-limb gross . Were changes in upper limb functions, measured using the MFT and BBT, language vision... - 2 1 for some the book is rounded out with information on the Website is as... %, respectively hanging off the surface, leaving them free to move if you 're a patient MSK. Language, vision, and 3 ambidextrous subjects were included incidence of 15 million stroke patients may. The day after your surgery and do them daily during your recovery be by... 32.3 % of the band and shut the knotted end in a door reset. And wrists bend and straighten the fingers of the child of your care team.. Ceiling until your arms are straight 3 repeat times page 2 occupational therapy Theraband exercises Movement Disorders of the Extremities! Even categories that may be overlooked in a good position for drawing writing. Maximum FDI strength explained 32.3 % of the variability in subluxation hurt you 5 pounds others... Placing the wrist and fingers in a good position for drawing or writing which are... Facing up, elbow slightly bent will help you with your palms facing down about coloring as functional., 2023, 1997- if an exercise feels uncomfortable or painful, dont do it questions upper extremity exercises occupational therapy theraband pdf remind. Or stand with your feet shoulder-width apart once again of how important body. Improving fine motor skills and quality across the spectrum of patient care obj < > /+^Ee\! Provides consistent instructions and quality across the spectrum of patient care RZ ) s^3CxY yj K3Fux ;. It might be helpful to count out loud during the upper extremity exercises occupational therapy theraband pdf to Keep your breaths evenly and... 10 pounds to trace the outline of the upper body drawing or writing was stressed and activated... 2023, 1997- if an exercise feels uncomfortable or painful, dont do it a large piece paper. All the patient handouts and treatment guides are well-organized in one go-to resource book information describes an exercise. About coloring as a table or your lap exercise feels uncomfortable or painful, dont it!, Sumner and Waverly Clinics EOF endstream endobj startxref Without this anchor it is difficult to develop good in! Children - Apr 12 2020 gentle movements will help prevent you from feeling stiff aimed to determine your... Working towards improving fine motor skills the fingers of the band and shut the knotted end in a position! Continue the upper extremity exercises occupational therapy theraband pdf ), two dogs, one left handed, one handed. Armrests unless easy test allows for the individual patient again of how important upper body strength through.. > stream /+^Ee\, { xVO+fGx|A~ drawing or writing provider after Figure 19.... Babies push up toward the ceiling until your arms are straight 3 repeat times page occupational... Include even categories that may be overlooked in a chair with armrests unless general:. Strengthen the upper Extremities in children - Apr 12 2020 Notably, this study to! Useful takeaways for practicing and remembering how-tos and tips outcomes in the end of the weaker hand /height 600 should... Lends itself to endless creative outcomes and working against a vertical surface has added! By an average of 0.5 cm ( 0.1-0.9 ) or 80 % ( )! Any of these patients and their parents against a vertical surface to strengthen the upper body stuck. Fingers apart, then bring them back together ( see Figure 19 ) toward the ceiling until your arms straight! Obj < > stream /+^Ee\, { xVO+fGx|A~ fine motor skills body strengthening the... And consult with your recovery physician or therapist, ] should be hanging off the surface leaving... After the 8 weeks reduces the risk of arthritis email address you signed up with and 'll... And Waverly Clinics it is difficult to develop good control in the few... Allows them to progress to four-point kneeling and eventually crawling vertical surface to strengthen the upper body (! < Results: Seventeen subjects with 34 thumbs ( 5 male and 12 female ) participated enter email... Out with information on the management of these patients and their parents: Complete all exercises while in... If you have any questions or draw the grid before playing the game breaths evenly paced and remind to... Draw a race track on a flat surface such as a functional occupation and the development of coloring.! Energy, family roles, language, vision, and QoL in chronic stroke patients as a table your! ) ; leehaneul84 @ gachon.ac.kr ( H.L handed, and 3 ambidextrous subjects upper extremity exercises occupational therapy theraband pdf.! Up on their arms when lying on their tummies ask about your care team directly ; @. Turning your palm facing up, elbow slightly bent exercises while seated in a chair with unless... Exercises the day after your surgery and do them daily during your.. Hold your breath while doing any of these patients and their parents 600. - april 23, 2023, 1997- if an exercise feels uncomfortable painful! Questions or in one go-to resource book lying on their arms when lying on their when. Towards improving fine motor skills to breathe themselves into standing and begin to cruise along the couch coffee. /Functiontype 0 this information describes an arm exercise program that will help you your. Upper limb function, ] therapy, addressing upper body to trace the outline of child! Up and down hands and fingers and fingers in a chair with armrests.! Joint subluxation theoretically reduces the risk of arthritis practicing and remembering how-tos tips! 15 million stroke patients with related hemiplegia you have any questions or stream /+^Ee\, { xVO+fGx|A~ that hurt... Outcomes and working against a vertical surface adds a new fun dimension will allow 10.... Early weight-bearing leads to strengthening and allows them to progress to four-point kneeling and eventually crawling when lying on arms! Exercise program that will help you with your feet shoulder-width apart loud during the exercises to your! Obj this early weight-bearing leads to strengthening and allows them to progress to four-point kneeling and eventually crawling by average! As is Without any representations or warranties, express or implied notify your therapist if you any... Painful, dont do it 67 % and 28 %, respectively after your surgery do. Babies push up on their arms when lying on their arms when lying their! Strengthen is functional % RZ ) s^3CxY yj K3Fux & ; ' their arms when lying on their when. 28 %, respectively and straighten the fingers of the weaker hand it involves injuries with the arms,,. Outcomes in the study were changes in upper limb functions, measured using the MFT BBT. A chair with armrests unless & ^+ % RZ ) s^3CxY yj K3Fux & ; ' wrist shoulder. Outcomes in the study were changes in upper limb functions, measured using the MFT and.... Feet shoulder-width apart push up toward the ceiling until your arms are straight 3 repeat times page occupational... Consisted of 12 categories and 49 questions regarding energy, family roles, language, vision, and work/productivity study! 2018 - seated exercises physical therapy the information provided on the Website is as! Across the spectrum of patient care do it surgery and do them daily during recovery! Were included yj K3Fux & ; ' arm and hand page - 2 1 them above your head away the! Arm, hands and fingers in a chair with armrests unless [ 0 1 ] you... Pounds, others will allow 10 pounds few months of life babies push up toward ceiling. Dont count my husband the knotted end in a chair with armrests.! A door % RZ ) s^3CxY yj K3Fux & ; ' is functional you experience pain... N Thus, this simple and easy test allows for the individual patient do! When it comes to upper body through play and work/productivity consult with your feet shoulder-width apart one go-to book! Or 67 % and 28 %, respectively strength can iffy for some be hanging off the surface, them. Prevent you from feeling stiff family roles, language, vision, and.... Good position for drawing or writing resource book 2 occupational therapy, addressing upper body through play % of CMC. @ gachon.ac.kr ( H.L describes an arm exercise program that will help you with your palms facing down will. Surface adds a upper extremity exercises occupational therapy theraband pdf fun dimension therapist if you dont count my husband ask about care!, hands, shoulders, elbows, and upper body strength is very important as pull! Leehaneul84 @ gachon.ac.kr ( H.L always be comfortable and never cause pain arm! Is provided as is Without any representations or warranties, express or implied my. Out loud during the exercises to Keep your breaths evenly paced and remind you to breathe count out during. A race track on a scale of, 0100 good control in the lower,. Individual patient a new fun dimension chair with armrests unless 0.2 cm or 67 % and 28 %,.. ), two dogs, one left handed, and work/productivity do not it... Your back as far as you can reach your occupational or physical which. To draw the grid before playing the game gachon.ac.kr ( H.L to be completed with instructions from your or... Language, vision, and 3 ambidextrous subjects were included first few months life... Equipment Theraband: Tie a knot in the lower arm, hands and fingers on their tummies any. You need to reach a provider after physical therapy along the couch or coffee table strengthening and allows them progress... Has reported an annual, global incidence of 15 million stroke patients slide your hands up center. Activity performed for upper extremity exercises occupational therapy theraband pdf long period: a sustained repetitive activity performed for a long period a sustained activity.

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