What is the degree of improvement in upper limb physical performance and quality of living in elder people using wheelchairs and being under institutional care after a physical exercise program with elements of dance movement therapy

The subjects will be assigned randomly to one of three groups: Group 1: Basic exercises Group 2: Movement exercises with elements of dance movement therapy: Group 3: No Intervention: control, routine care

Randomization will be carried out by stratified sampling. To obtain an equal distribution of senior subjects across the study groups, the allocation will be performed as block randomization. We will use four-in-one blocks. To solve the problem of predicting the next assignment, the allocator will hide the block size from the executer and use randomly mixed block sizes.

The exercise programme: The exercises will be held in groups of five to eight in nursing homes located in South-Eastern Poland, in rooms suitable for people on wheelchairs, and will be conducted by qualified physiotherapists. The program for each group consists of 30-minute session, two times a week, 12 weeks total. Intensity of effort on the Borg scale: 11–13 points. Before and after each workout, blood pressure and heart rate is measured and noted. The intervention is considered accomplished if the patient takes part in at least 80% of entire exercise program. An attendance of participants will be checked.

Group 1: Basic exercises: The program includes exercises performed on wheelchairs and containing elements of active, stretching and balance exercises. The exercises will be performed in following scheme: Warm-up (10 minutes): simple exercises focused on upper part of the body, arms rotation, flexing arm and elbow joints, wrists turning, hands closing and opening, bending and unbending the body. Main part (15 minutes): slow active exercises, flexibility and balance exercises Cool-down (5 minutes): muscle-relaxing and calming exercises for lowering the heart rate. Stretching exercises for increasing joint motillity in upper limbs

Group 2: Movement exercises with elements of dancing: The program includes exercises performed on wheelchairs. The exercises will be performed in following scheme: Warm-up (5 minutes): The person conducting the exercises starts session with the rythmic hand clapping to the background music. The participants will follow the physiotherapist and simulate activities and phenomenas like driving the car, rustling trees, collecting fruits, etc to prepare the muscles of upper body part. Main part (20 minutes): dance-movement exercises. This phase consists of simple, easy to repeat moves performed in sitting position (on a wheelchair). The physiotherapist will demonstrate a sequence of moves without music and then the group will be repeating the sequence with carefully selected and prepared music such as cha-cha, zumba, jive, macarena, hula dance, etc. The example sequence may contain following moves: hands clapping, wrists turning, arms and body waving. Moreover, gymnastic accessories like sticks, dumb-bells, balls, elastic bands (Thera-bands) will be used. Each exercise program will contain strengthening and balance exercises. The music will be changed each week for six week and then repeated through another six weeks. The character and tempo of the music samples used during sessions will be matched for perceptive and mobility capabilities of the elder people. At the end of the main part, the patients will be asked to perform spontaneous motive improvisation to stimulate imagination, creativity and self-expression. Interactions between subjects will serve to improve communication and social skills. Cool-down (5 minutes): simple stretching and breathing exercises on a background of peaceful and relaxing music. After physical activity the therapist will initiate a short discussion on feelings and impressions after exercise session.

Group 3: No Intervention: control routine care The data of the control group will be collected simultaneously to the intervention groups. The subjects in the control group will also be advised to avoid physical activity for 12 weeks. During an interview after 12 weeks of data collection, any subject who states that he/she has started a regular physical activity of any type will be excluded from the control group. The subjects from the control group will be offered an attendance in physical exercise program after the intervention.

1. Residents of nursing homes for the elderly and people with chronic illness.
2. Wheelchair-bound seniors BBS 4 < 21 pts
3. Aged 65–85.
4. Barthel Index 21 <75 pts
5. MMSE >19 pts
6. GDS < 10 pts.

BBS- Berg Balance Scale Assessment of static and dynamic balance based on 14 types of movement in the standing and sitting position of the patient. Each task of the test is scored using a four-point scale. A maximum score of 56 points is possible. Patients with a score below 20 pts indicate high risk of fall and need of using wheelchairs.

Barthel Index is a scale for ADL (Activities of Daily Living) measurement, with lower scores indicating greater dependency in ADL. The score value ranges between 0 and 100 points. The assessment of the total score is as follows: 0–20 completely dependent; 21–61 almost completely dependent; 62–85 dependent; 91–100 – independent

The Mini–Mental State Examination (MMSE), is a brief, quantitative measure of cognitive status of adults. It can be used to screen the cognitive impairment. The score is the number of correct items. The measure yields a total score of 30. A score of 30-24 means no cognitive impairment , 23-19 pts - mild cognitive impairment, 18 or less is the severe cognitive impairment.

The Geriatric Depression Scale (GDS) is a 15-item self-report assessment used to identify depression in the elderly. Scores of 0-5 are considered normal; 6-10 indicate moderate depression; and 11-15 indicate severe depression.

1. Having severe and acute cardiovascular, musculoskeletal, or pulmonary illnesses
2. Suffering from spinal cord injury with no rehabilitation potential
3. Lack of consent of elderly person or their doctor for participation in exercises.