While lying in bed in a supine position (staring up at the ceiling) without the SOMI brace

Hold each position till a count of ten

Lower Body:

1. Move feet up and down from the ankles.
2. Raise the right leg then the left… without bending the knees
3. Lift the right leg a little bit and move it sideways to the right…repeat with left.
4. Bend one knee and try to touch the knee to the chest. Pull with your hands to draw the knee as much towards you as possible.
5. Raise hips: Bring the ankles as close to the buttocks as possible, raise the hips, all the while keeping the hands straight on bed.
6. Bring ankles close to the buttocks; twist from the waist to touch knees to left side of bed then the right.
7. Straighten left leg, take the bent right knee across the left leg and try to touch the bed. The physiotherapist pushes down the shoulders during this exercise.

Upper Body:

1. Lie supine and move the arm along the bed all the way up till the upper arm touches the ear.
2. The Physiotherapist holds the patient’s elbow with one hand, and the rotates the shoulder
3. Bring the elbow as high up as possible or atleast in a straight line with the shoulder and move it from the left to the right.

As you get stronger workout against resistance ie with the physiotherapist opposing each of your actions.

Put on the brace while the patient is lying down. Then do some deep breathing or use the spirometer.

Getting up:

1. The patient lies with her legs straight. The Physiotherapist stands on the right side of the bed. The patient stretches her arms out and interlocks both her hands. The Physiotherapist holds onto the interlocked hands with one hand (his other hand is free to maintain his own balance or to provide additional support if required) and pulls. The patient resists and as a result is pulled up into a sitting position with her spine absolutely straight. (Now-a-days Bula repeats this 5 times as part of the exercise schedule.)
2. Use the same technique to swivel the patient around and have her sitting with the legs dangling from the side of the bed.
3. Use the same technique to get the patient to stand up or sit down …repeat 5 times
4. Deep breathing

Walking:

1. The feet should land on heel first and legs should be held a little apart. Try not to hold onto the thighs…swing them as if you are marching ie left arm swings out with the right leg and vice versa.
2. The right shoulder was sloping down in Bula’s case and she needed to consciously correct it.
3. Climbing up and down the stairs. The pain in the right hip has gone but the left leg is weaker than the right. So in Bula’s case she will first put her right (stronger leg out). The Physiotherapist (he is a big powerfully built man) stands a couple of steps below and moves down backwards while Bula is climbing down. He remains by her side with his arms on either side (without actually touching her) as she climbs up. (Earlier two physiotherapists held her, then loosened their hold just enough for moral support, then she was asked to hold the banister with one hand and now she is walking /climbing without holding onto anybody or anything.)

The neck exercises have yet to begin in earnest. After tightening the SOMI by two notches ….and after the truth about the Halo brace was revealed…she says the pain is better. PATIENTS YOUR DOCTORS AND THERAPISTS ARE ONLY HUMAN. BE KIND TO THEM AND HELP THEM HELP YOU. Bula still has trembling fits after 30 to 40 minutes of exercise but we are all hoping that it will get better.

ANKYLOSING SPONDYLOSIS PATIENTS BULA IS YET TO RESTART HER ENBREL AND METHOTREXATE. She is managing on Saaz, Indomethacin, Tegretal and Neo Gaba in far reduced doses than what was being given earlier. The only difference is the serious Physiotherapy that is taking place now.