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Closed Chain Exercises for Late Stage Alzheimer’s Disease



Closed chain exercises are exercises that are performed with the hand or foot fixed on a stable surface.  They usually involve weight bearing, compression forces to the body.  Push-ups and pull-ups are considered closed chain exercises since the hands are in a fixed position. In standing, a person might hold onto the sink or counter top and squat or lunge, which are examples of closed chain lower extremity exercises.  Even walking with two hands on a walker or a shopping cart is considered a closed chain activity.

At the point in the Alzheimer’s disease process when a person is no longer able to participate in conventional exercises (dumb bells, resistance bands, eye-hand coordination activities), consider what areas of the brain are still highly functional- the sensory and motor cortices- and elicit what comes naturally.

Pushing and pulling activities are a great way to elicit primative movement patterns buried deep in the motor cortex, which are essentially closed chain patterns of movement. Throwing a ball is a higher level, open chain activity.  But pushing a ball (especially a weighted ball or a ball that you can manually resist) is a great way to achieve some upper body exercise in a closed chain.

Parachutes, pulleys, rocking, and pulling to stand are some ideas for closed chain exercises in the later stages of Alzheimer’s. Think about how babies move and play.  They are the masters of closed chain movement.

This is my favorite closed chain exercise.  I think I enjoy it so much because of the human connection we make as a team.  We are like two links in the closed chain:

I like to sit directly in front of him (or her), cross my forearms, and take his hands in mine (the handshake grasp).  I then guide him into a movement pattern with our arms moving back and forth, almost like we’re sawing wood.  We get our trunks involved and rock forward and back, scissoring our arms while we alternately extend our arms out and pull them back in against our bodies.  Then I add resistance.

I say “push, push, push” as he meets the resistance in my hands and has to push against me to get his arms out straight.  And then “pull, pull, pull” to pull my arms and trunk back toward him.  He really appreciates the minimal use of language, the tactile input, my being inside his visual attention field (14 inches directly in front of his face), the comfort of gross motor, repetitive movement, and participation in an activity in which he is highly successful.  There are no rules to this game, but it somehow just feels right.

He knows exactly what he’s supposed to do- or more precisely- his motor cortex knows just what to do.

Got any other examples?


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  1. Hi! I’m an activity leader in a care home. Your blog is amazing and inspiring- I’m going to try your ideas with our residents. Can’t wait!

  2. I would love to see a video of your favorite closed chain exercise, as I just can’t get a “visual” on it!

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