Table 4.

Details of the progression of the global postural exercises (global postural reeducation).

Global Postural Exercises (GPR) [82]
Phases	Description
1	Lying posture—without gravity load In order to achieve and maintain postural balance, specific exercises in the lying position will be used. These exercises involve a precise use of contractions, stretch reflexes, light and controlled manual traction, and sustained elongations.
A	Stretching of the anterior muscular chain	Time/mode	Progression
	Supine position; physiotherapist begins with specific focus on breathing according to the need of each patient and soft cervical traction (stretching muscles involved in breathing: scalenes, minor pectoral, intercostal, and diaphragm). Supine position with upper limbs at 45° of abduction and flexed, abducted, and laterally rotated hips, with the soles of the feet touching each other to stretch the anterior muscle chain (diaphragm, pectoralis minor, scalene, sternocleidomastoid, intercostalis, iliopsoas, arm flexors, forearm pronators, and hand flexors). The pelvis will be kept in neutral position with an initial traction of the sacrum, while the lumbar spine remains stabilized. The physiotherapist will stretch the superior shoulder muscle chain (upper trapezius, elevator scapulae) with upper limbs into adduction (to adduction from 45° to 0°), emphasizing breathing and cervical traction. The correct alignment of the patient will be accomplished throughout stretching of the thigh muscles and followed by repositioning of the segments/joint, through soft isometric contractions in more elongated positions to induce post isometric relaxation, in order to improve postural alignment awareness of that posture. The maintenance of alignment during posture will be achieved by verbal commands and manual contact of the therapist, guarantying the active engagement of patient to reach the correct posture. At the same time, gradually, the lower limbs will be extended as much as possible while maintaining the corrections.	4 min (stretching) 12 min (contractions, stretch reflexes, light and controlled manual tractions, and sustained elongations to realign posture until finishing the posture with extended limbs)	Manual traction will be applied to the sacrum and to the occiput to align the curves of the spinal column. Progressive abduction and lateral rotation of the hips, then extension, adduction, and neutral rotation. Progressive adduction of the shoulder joints. Deep rhythmic expiratory breathing throughout.
B	Stretching of the posterior muscular chain	Time/mode	Progression
	In order to stretch the posterior muscle chain (upper trapezius, levator scapulae, suboccipitalis, erector spinae, gluteus maximus, ischiotibials, triceps surae, and foot intrinsic muscles), the patient will lay in the supine position with the occipital, lumbar, and sacral spine stabilized, with the lower limbs at 90° hip flexion, and perform gradual knee extensions. In both of the postures the correct alignment of the patient will be accomplished throughout stretching of the thigh muscles and followed by a repositioning of the segments/joint, through soft isometric contractions in more elongated positions to induce post isometric relaxation, in order to improve postural alignment awareness of that posture. Contractions, stretch reflexes, light and controlled manual tractions, and sustained elongations to realign posture and finish with extended limbs. The maintenance of alignment during posture will be achieved by verbal commands and manual contact of the therapist, guarantying the active engagement of patient to reach the correct posture. At the same time, gradually, the lower limbs will be extended as much as possible while maintaining the corrections.	12 min (contractions, stretch reflexes, light and controlled manual tractions, and sustained elongations to realign posture until finishing the posture with extended limbs)	Manual traction will be applied to the sacrum and to the occiput to align the curves of the spinal column. Progressive increase of flexion, adduction, and neutral rotation of the hips, knee extension, and dorsiflexion of the ankles. Progressive adduction of the shoulder joints. Deep rhythmic expiratory breathing throughout.
2	Standing posture—integration under gravity load
C	Standing in the center
	With the participant standing with an open hip angle and slightly flexed knees, the physiotherapist will make final corrections for postural integration for the stretching while the participant extends the knees, maintaining the correct posture of the spine and upper and lower limbs.	5 min	Progressive extension, adduction, and neutral rotation of the hips. Manual traction will be applied to the occiput throughout the feet and toes in a normal alignment with the floor throughout. Progressive adduction with neutral rotation of the shoulder joints. Deep rhythmic expiratory breathing throughout.