Video 1 - Functional UL task – Folding a Towel

Sit at a table with an unfolded pillow case or towel in front of you. Pick up the corners of the towel, one in each hand, and fold it in half.
Tip: You can increase the difficulty by folding other objects such as t-shirts.

Video 2- Handwriting tasks letters and numbers

Practice writing using your affected hand. You could sign your name, write about your day, keep or diary of your rehab or copy from books and newspapers if you cannot think of what to write. 
Tip: If you wouldn’t usually write with this hand. Don’t expect your writing to be perfect.
Tip: Using a fatter pen will make handwriting easier. You can get comfort grips which also help
Tip: Sign and date all your handwriting practice – this way you will be able to see your progress
 

Video 3 - Handwriting tasks shapes

As part of your handwriting rehab you can practice tracing around shapes. Larger simpler shapes will be easier than smaller more complex multi sided shapes.

Tip: Using a fatter pen will make handwriting easier. You can get comfort grips which also help.
 

Video 4 - Handwriting tasks lines

Try drawing lines, straight lines, vertical, horizontal, diagonal. Now try wavy lines, or zigzags.
Or try writing a line of the same letter joined up and work your way through the alphabet.

Video 5 - Reaching task - Cone placement

Similar to cup waiter:
Sit at a table and mark 4 targets, you could use tape or paper with targets drawn on. Begin with an empty cup on the table and your affected hand in your lap. Reach for the cup, pick it up and move it to one of the targets. 

Tip: Try to grab the cup from the side as though you were going to drink from it.

Video 6 - Reaching task - Jenga large

Sitting comfortably at a table, place three Jenga cones in front of you within extended reach. One to the left, right and one in front.

Pick up each and stack on the middle Jenga cone, do the same in reverse.

TIP: Keep your back in contact with the chair to avoid leaning forward, try to avoid leaning to the side, ensure that when reaching your elbows are held out straight.

Video 7 - Reaching task - Jenga small

Sitting comfortably at the table with Jenga blocks within extended reach, practice picking up Jenga blocks and stack. 

TIP: Keep you back in contact with the chair to avoid leaning forward. Avoid leaning to the side and try to only use your arm, ensuring that your elbows are held straight.

Video 1 - Side stepping

Position yourself standing with an obstacle on the floor beside you and a table nearby for support. Practice stepping sideways over the obstacle and back again. Ensure that hand support is used only if necessary.

Video 2 - Single stepping

Position yourself standing with obstacles placed on the floor in front of you. Practice stepping forwards one step at a time and then bringing your weight back to the start point.

Video 3 - Target stepping

Stand with your feet shoulder-width apart next to a countertop or rail. Mark 4 targets on the floor in front of you. Step your affected leg to the targets then return to your original position. Complete this for each target.
Tip: Vary the targets so that you are stepping left, right, in front and behind.

Video 4 - Toe tapping on cups

Take your time to tap your foot to the target, Making sure to be gentle enough to not apply too much weight. During this exercise your arms and back should be unsupported. Tip: Progression would be to move from right to left without touching your foot to the floor, or capping each cup twice.

Video 5 - Toe tapping

Sat in a chair with targets (Flat, could be steps, could be cups) Take your time to tap your foot to the target, Making sure to be gentle enough to not apply too much weight. During this exercise your arms and back should be unsupported. You can progress this exercise by aiming to move from right to left, the cross body action will increase the difficulty, or changing the rhythm e.g. two taps per target.

Video 1 - Backwards walking

Position yourself standing up. Practice walking backwards, aim to maintain your direction in a straight line.

Video 2 - Ball throwing and catching in standing

In a seated position, throw a ball up in the air in front of you and catch it. Ensure you are catching two handed or with your affected arm. Try to control the pace and direction of the throw to keep it close enough to catch. Tip: To make the exercise harder try using a smaller ball or catching one handed.

Video 3 - Slalom

Position yourself standing with obstacles placed on the floor in front of you.  Practice walking forwards zigzagging around the obstacles, without touching them.

Video 4 -Tandem walking

Position yourself close to a flat surface you can hold onto if you need it. Aim to place your feet one in front of the other heel to toe as if you were walking on a tight rope. To progress further try to do this backwards.

Video 5 - Walking ball bouncing

Start from standing position, as you begin walking bounce the ball on one side, in time with your step on the other side. To progress this activity bounce the ball from one hand to the other as you walk.

Video 6 - Walking with head turns

Start walking, as you do so move your head from left to right without breaking stride. Try to keep your rhythm and walking pattern.

Video 7 - Walking with head movements

Start walking, as you do so move your head all in all directions (Up, Down, Left and Right) without breaking stride. Try to keep your rhythm and walking pattern.

Video 1 - Orthotic donning and doffing – AFO

-Open all straps to maximum end point
-Slide foot in proper AFO, placing heel firmly down and back into the heel cup
-Fasten instep strap (on Dream Brace) to provide a firm but comfortable hold of the ankle preventing unwanted lifting of the heel from the heel cup
-Place lower leg into shell (either in front of or behind leg), and again fasten strap to provide the same level of security as noted previously
-Open shoe to maximum slackness and slide foot with AFO into shoe (shoe horns may be used)
-Secure shoe
-Loosen shoe and remove from foot
-Loosen all straps on the orthosis and remove from foot

Video 2 - Orthotic donning and doffing – Poly sling

Open out the ‘Gutter’ piece of fabric, line your elbow into the corner and fasten the straps over your forearm. Next with you affected arm resting on your stomach reach the longest strap around your neck attaching it to the white loop by your hand. Lastly repeat the above step with the remaining strap wrapping it around your torso.

Video 3 - Orthotic donning and doffing – Resting hand splint

Place the splint on a flat level surface. Lift your affected hand onto the splint. Ensure that you have fabric correctly placed between each of your finger and the heel of your hand is snug against the angle of the splint. Follow the numbers on the straps wrapping them tightly around your hand and wrist.

Video 4 - Orthotic donning and doffing  - Shoulder brace

- Grasp the shoulder strap with your sound hand and hold the orthosis by the edge of the shoulder cap. 
- Guide the paralysed arm through the orthosis up to the shoulder.
- Guide the sound hand through the shoulder strap as though putting on a sweater.
- Make sure the shoulder strap does not twist as you pull it on.
- Fasten the closure on the shoulder cuff. Make sure it fits firmly but is not too tight.
- Position the elbow opening of the lower arm cuff on the elbow. Then fasten the hook-and-loop closure.
- Tighten the straps between the forearm and upper arm cuffs, and secure them with hook-and-loop fastener.
- Tighten the shoulder strap last. This is done either from the back to the front or the front to the back, depending on how the strap was set up for you by your O&P professional.
- Verify the correct fit of the Omo Neurexa plus.
- To take off the Omo Neurexa plus, open all closures to the maximum. This also makes the orthosis ready to put on again with minimal effort.
- Open the plastic closure on the chest last and pull the orthosis down.
 

Video 1 - Crook lying breathing

Position yourself in supine with your knees bent. Gently draw your navel towards your spine. Practise slow steady breathing in this position.

Video 2 - Crook lying sit ups

Position yourself in supine with your knees bent and placed on the floor/bed. Gently tighten your navel towards your spine and slide hands up your thighs until your hands are over your knees. Repeat ensuring that you lower in a controlled manner.

Video 3 - Seated limb raises

Position yourself sitting on a chair with your feet on the floor. Practice lifting one leg up and down at a time. Keep your hips and shoulder over one another to strengthen your trunk.

Video 4 - Seated twists feet on floor

Position yourself sitting on a chair with your feet on the floor. Making sure to keep your chest up and not let your bottom lift off the chair, twist your trunk or pass a ball from side to side.

Video 5 - Sitting on uneven surfaces

Position yourself sitting on a large ball (or other uneven surface e.g two cushions) that is wedged or the second option on a chair. Practice lifting your hands up in the air without falling.

Video 6 - Trans abs activation

Position yourself in supine with your knees bent. Place two fingers on either side of your tummy in line with your navel; tighten your deep tummy muscles that you can feel underneath your fingertips. The easiest way to learn this exercise is to practise as if you needed the toilet but were holding it in.

Video 7 - Pelvic tilts

Sitting on a flat back chair with your arms resting down. Practice growing tall through your sternum and breaking contact between your lower back and the chair. Then slouch your chin down to your chest pushing your lower back into the chair. Repeat this cycle.

Video 8 - Seated twisting both legs lifted

With your back unsupported and sat on a chair try and keep both feet off the floor whilst twisting your torso. Continue to make sure to keep your chest up and not let your bottom lift off the chair, pass the ball from side to side (Or touch the ball to the wall behind you on both sides.

Video 9 - Seated twisting one leg lifted

With your back unsupported sat on a chair lift one foot up at a time and you practice twisting your torso. Continue to make sure to keep your chest up and not let your bottom lift off the chair, pass the ball from side to side (or touch the ball to the wall behind you on both sides).

Video 10 - Seated yoga ball reaching

Position yourself sitting on a large ball with your feet on the floor. Practice reaching in all directions whilst keeping your contact with the ball and maintaining your balance.

Video 1 - High marching

Position yourself in standing with targets at hip height, on a wall in front of you.  March on the spot touching your knees to the targets.  Ensure you stand up tall.

Video 2 - Hurdle side step

Position yourself standing with an obstacle on the floor beside you and stable support nearby. Practice taking a big step sideways over the obstacle and transfer your weight onto the stepping leg before stepping back.  Ensure that hand support is used only if you feel unsteady

Video 3 - Split stance ball bouncing – Bilaterally

Position yourself in standing imaging one foot is on either side of a block with your front knee slightly bent. Ensure you twist your trunk from side to side as you bounce the ball with both hands.

Video 4 - Split stance throw and catch

Position yourself in standing imaging one foot is on either side of a block with your front knee slightly bent. Throw and catch with a partner or against a wall

Video 5 - Bridge

Position yourself lying on your back with your knees bent. Tighten the muscles in your bottom and lift your bottom off the bed. Imagine you have a glass resting on your tummy that you don’t want to spill (Keep your hips level), when you reach the top make sure to lower in a slow and controlled manner.

Video 6 - Clams

Position yourself on your side with your affected hip uppermost. Bend your knees, keep your ankles together and raise your uppermost knee away from the bottom one.

Video 7 - Gym ball heel slides

Position yourself so you are lying on your back with your legs bent and heel resting on a Swiss ball/physio ball.  Push through your legs to lift your pelvis up and slide the ball away from you with your heels, maintaining a level pelvis.

Video 8 - Hip abduction

Supine:
Lie on your back. Slide the heel of your affected leg out the side to touch the edge of the mattress, then return to your original position.
Tip: Try to make the movements slow and precise. Make sure you don’t overshoot. Use a small box or a book as a target.
 

Video 9 - Hip extension

Position yourself standing facing towards a stable surface. Start with your foot in front of your body. Finish with your foot behind your body and knee straight.  Ensure to keep your back straight. Do not left your heel lift up towards your bottom, keep your toes facing forward.

Video 10 - MOS Heel strike

Position yourself standing with a table nearby for support. Practice marching on the spot. Ensure that your legs lift up an equal amount, aim to shift your weight forwards slightly and contact the ground with your heel first before rocking onto your forefoot.

Video 11 - Single leg bridge

Position yourself lying on your back with your knees bent. Lift your bottom off the bed. Shift your weight onto one leg and straighten the other leg.

Video 1 - Mini squat to back of chair

Position yourself standing with your knees straight. Bend your knees and then stand up straight again.

Video 2 - Lunge with twist and ball

Position yourself standing with one foot a large step-length in front of your other foot. Start with your knees straight. Finish with your knees bent by lowering your back knee towards the floor. Ensure that both of your feet point forwards.
Hold this position as you rotate your trunk from side to side ensuring you don’t let your knee twist. 
 

Video 3 - Lunge with twist

Position yourself standing with one foot a large step-length in front of your other foot. Start with your knees straight. Finish with your knees bent by lowering your back knee towards the floor. Ensure that both of your feet point forwards.
Hold this position as you bounce a ball from side to side ensuring you rotate your trunk. 

Video 4 - Lunge

Position yourself standing with one foot a large step-length in front of your other foot. Start with your knees straight. Finish with your knees bent by lowering your back knee towards the floor. Ensure that both of your feet point forwards.

Video 5 - Split squat

Sit on a chair/bench. Bring your affected foot directly underneath your knee, and your opposite foot just forwards. Cross your arms over your chest and try to stand up- you will feel this making your affected leg work the hardest. Return as if you were going to sit, but before you reach the chair stand up again.

Video 6 - Step down

Position yourself standing on a block / step with a foam cup placed on the floor in front of you. Practice lowering and raising your unaffected heel to touch the foam cup by bending and straightening your affected knee. Ensure that your shoulders remain over your hips, both feet point forwards and your unaffected leg does not squash the foam cup.
If you do not have a cup try to ensure your foot heading towards the floor only connects delicately before returning to standing on the step. 

Video 7 - Step up

Position yourself in standing with a block / Step in front of you, both feet on the ground and a stable support nearby. Practice stepping up on to and off the block, one foot at a time.  Ensure that hand support is used only if you feel unsteady.

Video 8 - STS with left leg bias using step

Position yourself sitting with your affected leg on the floor and your unaffected leg on a block. Practice standing up and sitting down. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 9 - STS with left leg bias

Position yourself sitting with your affected leg back and your unaffected leg forwards. Practice standing up and sitting down keeping the leg forwards. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 10 - STS with right leg bias using step

Position yourself sitting with your affected leg on the floor and your unaffected leg on a block. Practice standing up and sitting down. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 11 - STS with right leg bias 

Position yourself sitting with your affected leg back and your unaffected leg forwards. Practice standing up and sitting down keeping the leg forwards. Ensure that your shoulders and knees move forwards while moving between sitting and standing, and you weight-bear mostly through your affected leg.

Video 12 - Terminal knee extension

Position yourself standing in front of a bed with your knee slightly bent and a piece of foam placed between your knee and the bed. Practice straightening your knee to squash the foam against the bed.
Alternatively you can complete this exercise with some theraband around your knee. The further your knee is bent to begin with the more you will have to overcome the resistance of the theraband and strengthen your knee. 

Video 1 - Calf stretch

Position yourself standing with one leg in front of the other, legs shoulder-width apart and your hands resting on a wall. Lunge forwards while keeping your back knee straight. Ensure that both feet point forwards and your back heel remains on the ground.

Video 2 - Heel rockers

Position yourself sat up with your feet flat on the floor. Rock your feet from heel to toe working on increasing the height you achieve as you go.

Video 3 - Resisted ankle ROM dorsiflexion

Position yourself sat up in bed or in a chair. Place theraband with tension on it or a weight around the middle of your foot. Bring your toes up towards your knee so your ankle is bending and only your heel is touching the floor/bed. Hold, before slowly lowering your foot back to the floor.

Video 4 - Resisted ankle ROM eversion

Position yourself sat up in bed or in a chair. Place theraband with tension on it or a weight around the middle of your foot. Bring your toes and top half of your foot outwards to the side. Only your heel should be touching the floor/bed. Hold, before slowly lowering your foot back to the floor.

Video 5 - Resisted ankle ROM inversion

Position yourself sat up in bed or in a chair. Place theraband with tension on it or a weight around the middle of your foot. Bring your toes and top half of your foot inwards. Only your heel should be touching the floor/bed. Hold, before slowly lowering your foot back to the floor.

Video 6 - Resisted ankle ROM plantarflexion

Position yourself sat up in bed or in a chair. Place theraband with tension on it or a weight around the middle of your foot. Start with your toes towards you and your ankle bent up. Point your toes away from you, hold, before slowly returning to a bent ankle position.

Video 7 - Ankle ROM eversion

Position yourself lying on your back or sat up in a chair with some theraband around your forefoot. Adjust the theraband so that the direction of pull is from the inside. Start with your ankle inwards. Finish with your ankle outwards.

Video 8 - Ankle ROM inversion

Position yourself lying on your back or sat up in a chair with some theraband around your forefoot. Adjust the theraband so that the direction of pull is from the outside. Start with your ankle outwards. Finish with your ankle inwards.

Video 9 - Ankle ROM plantarflexion

Position yourself lying on your back or sat up on a chair with some theraband around your forefoot. Adjust the theraband so that the direction of pull is from your knee. Start with your ankle upwards. Finish with your ankle downwards.

GMC Number: 4735331

Year & location of first qualification: 2000, University of Wales

Specialty: Neurology

Clinical interests: Multiple Sclerosis, CNS inflammatory disorders, General Neurology and Medical Education

Secretary: Sharon Collins and Holly Yockney

Telephone number: 0117 414 6683

Dr Cossburn graduated with honours from the University of Wales College of Medicine in 2000. Following postgraduate training in South Wales and Southampton he was appointed consultant neurologist at Poole Hospital in 2012, specialising in Multiple Sclerosis and related disorders of the central nervous system, before moving to North Bristol in March 2020.

Dr Cossburn provides specialist clinics for patients with Multiple Sclerosis in the Bristol Brain Centre and general neurology clinics at both Southmead Hospital (Brunel building) and the Bristol Royal Infirmary.

GMC Number: 6164203

Specialty: Interventional Neuroradiology

Clinical interests: Diagnostic neuroradiology, neurovascular interventional procedures and angiography

Secretary: Alex Bessant

Telephone: 0117 414 9007