“When somebody comes with ankylosis and his X-ray and shoes you the damage in L 4/5 - what to do? First of all, this person is a person. He lives with that ankylosis daily. He has hopefully 2 legs, 2 arms and a family. This person came by foot or in a wheelchair. This means her can sit or stand. And from there you start.” (Eilat Almagor, lecture in July 27, 2006)

 

Feldenkrais® and occupational therapy: a case study: Cherrie

Copyright Jutta Brettschneider MS OTR/L and GCFP

In this single case study, the influence of ATM lessons and Feldenkrais theory on daily activities of an old-old participant with low vision was explored. Focus was laid on the functional mobility skills, safety and quality in the performance of the activities of the daily living.

Feldenkrais and occupational therapy practice and research

In Israel, I was the only occupational therapist in my Feldenkrais training group. In Germany and the US, Feldenkrais is used and billed among occupational therapists as a method for neuromuscular re-education, also in geriatrics; a search on the internet for “Occupational Therapy and Feldenkrais” in English and German presented a variety of clinics where both services are offered. The closest colleagues whose publications were available in the field of geriatrics were physiotherapists. Stephens published in 2005 the study “Learning to Improve Mobility and Quality of Life in a Well Elderly Population: The benefits of “Awareness through Movement”. Already in 1997 he had published together with Roller, Weiskittel and Pendergast a Master’s thesis about “Awareness through movement as a Strategy for Improving Coordination and Economy of Movement in Older Adults” (Stephens, 1997).

Bennett, Brown, Finney and Sarantakis presented the “Effects of a Feldenkrais Based Mobility Program on Function of a Healthy Elderly Sample” (1998). The Dystonia-Foundation offers on its website even a “Feldenkrais therapy” and incorporates Feldenkrais as “a form of physical therapy that stresses body movements and limb placement in order to break the pain cycle” (Dystonia 2007).

Other practitioners emphasize the differences and unique chances the Feldenkrais method offers. Wright stresses in his publication the different languages during a physical education lesson and a Feldenkrais movement class (Wright, 2000) and its results in a different “form of embodiment and self” (IFF, 2007). The Feldenkrais practitioner Schacker reminds that the “Feldenkrais method is foremost a practice, a practical art to utilize movement in a way that a fundamental learning process can happen. It is again and again emphasized that it is not only improved mobility (like physiotherapy measures it), but also greater self-awareness and mature behavior.” (Schacker, 2004, p. 2, translation JB). Schacker refers to Feldenkrais himself and his work about the Potent Self (Feldenkrais, 1989) and the Elusive Obvious (Feldenkrais, 1981) and encourages researchers to include the fundamental philosophy of Feldenkrais in their research process and the fact that learning happens through the living experience through contact between practitioner and client (Schacker, 2004, p. 2).

 

Cherrie: “My brain has to learn that it can trust my feet”

 

An estimated 65% of all nursing home residents suffer from impairments through low vision (RehabCare, 2007). Residents with low vision have problems with reading, increased eye fatigue, frequent headaches; they are in higher risk to get isolated, suffer from frustration and depression, to “decline in their independence in basic ADL’s, gait, cognition” , present “decreased functional activity tolerance, increased falls” and “decreased meal intake” (RehabCare, 2007, p. 8).  Loss of gait and ADL performance, hip fracture after falls or inappropriate behavior leads to a referral for Occupational Therapy (OT) and Physical Therapy (PT).

 

Feldenkrais himself did not publish any papers on low vision. However, his technique aims to improve ability and to “extend the boundaries of the possible” (1990, p. 57), mainly through awareness of one’s own movement, work on the self-image and the focus on learning. In his publication “The case of Nora - body awareness as healing therapy” (1993), Feldenkrais manages to create a situation where his student, a severely impaired young-old woman manages to re-learn parts of her lost functions. She is not “cured” but improved daily and is, in Feldenkrais’ words able to gain “knowledge that gives us freedom of choice – which is the major prerogative of Homo sapiens” (p.37).

 

Cherrie was born in Europe in 1908 and arrived with her family to the US age 4. She left school before a formal degree, worked in accounting in a hospital and has two children and several grandchildren. In 1993 she moved to a Jewish Nursing Home after her macular degeneration made it impossible for her to keep her own household. Besides her low vision, she also has a congestive heart failure, hypertension, cardiomyopathy, osteoarthritis and a depression that is treated with the medication Sertraline and weekly psychotherapy.

She is legally blind, but loves colors, the sun and the wind, music, listens to audio taped stories, enjoys a good cup of coffee or matzo ball-soup and is busy with visiting friends in the home and participating in diverse residents committees and social activities with several volunteers of all age. She moves with her power wheelchair, has a magnifying machine for reading, an acoustic watch and a huge collection of music and audio books in her room.

Cherrie reported that she developed good strategies to handle her depression and fears, including physical movement. Cherry is alert and fully oriented, her fine and gross motor skills are intact, her Range of Motion is within normal functional limits.

In the last months, her functional mobility skills, her balance and her mental and physical endurance decreased in the last months and her anxiety attacks increased. She hit herself on objects while navigating her w/c, needed more help for the completion of Activities of the daily living (ADL) and participated less and less in loved activities.

 

Cherrie came twice a week to the rehab department for “Awareness through movement” lessons (ATM); besides the lessons Cherrie would have also the opportunity to receive the usual occupational therapy, for example in form of adaptive equipment evaluation and caregiver training. All the lessons in lying needed to be modified to a sitting position; Cherrie refused to lie down. Every lesson started with a “body check” and ended with standing and body check for differences (list of the lessons with categories for choosing them see Appendix B).

After each session, I documented the performed elements of the lesson, the changes that I discovered and the feedbacks on her skills and abilities that Cherrie verbalized and the functional use that the lesson offered.

The lessons were performed in 2 phases of each 10 weeks with a break of 4 weeks in between. Cherrie had an eye surgery in that break that enabled her to see again with her “better” right eye (the lid had dropped so the eye was closed for years).

 

We agreed to focus in the inventions on functional mobility, motor planning, coordination, safety and quality of the ADL performance and on cognitive skill development to improve the self-control of her anxiety attacks. The overall goal was to return to her former level of function (goals in details see Appendix an Evaluation).

In order to reach these goals, we used the codes neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture and proprioception; therapeutic activities; self-care training and development of cognition skills to improve attention, memory, problem solving and compensatory training.

 

“I didn’t know I could move so well!” – Lessons and findings

 

Cherrie often entered the rehab department in a posture with head forward, hip extended, and the back kyphotic and with the need to share the latest problem. I listened for a bit to her words, and then encouraged her to try to start with our physical work. I invited her to stand up and transfer to the bench, checking how she can feel her body in that moment. Cherrie expressed herself verbally during the lessons, although I did not ask for detailed feedback. Not all of the lessons were a success in the sense that Cherrie enjoyed them and left the room with a significant gain in her abilities. However, she left the room after all our session with the increased awareness of her body, even when the lesson itself did not give her the usual “great fun”. During the standing parts at the beginning and at the end of the lessons, it was helpful place one of my hands on her chest bone, one on thoracic spine; in this posture Cherrie felt safe and expressed that she could trust her feet.

The following five findings were in my eyes the most significant ones:

  1. Improved self-positioning in her wheelchair: Cherrie gained with an increased self-awareness the skill to correct her positioning in the wheelchair. Already after a few ATM sessions, she was able to identify her seating positioning and therefore chance it to a more desired midline position; desired because she achieved more freedom to move.
  2. Improvement in her ADL performance and decrease of fall risk: During the initial evaluation, Cherrie’s ADL performance was at a level of minimal to moderate assistance. She expressed an increasing fear of falling (“I feel that I will fall soon!”). During the two intervention periods, she had no fall and her performance increased to mod I/supervision/minimal assistance (dressing).
  3. Improved cognitive skills: The most significant finding was her overall expressed joy about the newly discovered movement possibilities and her instant carry over to her daily life; she started for example to water her plants in her room and re-arranged her window sill with the new abilities to reach further and perform weight shift in standing.
  4. Decline during the four week break: In the four weeks break between the intervention periods, some of her skills decreased again. She had one incident where she got stuck with her wheelchair and panicked. She also declined in her standing and transfer skills. Her granddaughter passed away under tragic circumstances and Cherrie was in an acute mourning period. However, she also underwent a successful eye-lid surgery and got the sight of her right eye back.
  5. Cherrie’s retrieval of skills in the second project period: Within a few sessions, Cherrie was able to “recover” from the decline; she recalled many details of performed ATM lessons and reached an even higher level of performance in all three evaluated areas.

 

Discussion and perspectives for future work

The following three issues moved me the most and I chose to discuss them in this paragraph:

1. The adaptability of Feldenkrais lessons to the physical or cognitive limitations of old-old students

2. The ability of Cherrie to express her learning in progress

3. The question of carry-over of gained functional progress in a geriatric setting

 

Since I could not draw on other reports or researches with students of the age group of 85+ years, I tried to experiment with Cherrie’s potential and restrictions and the Feldenkrais philosophy and material following my own judgment. Having myself done hundreds of lessons during classes and the training, I am aware that Feldenkrais built his lessons with a specific sequence to achieve improvement.

However, his main goal was not quantity of movements but functional integration and differentiation; I watched this process happening during both of the project periods – subtle, in small quantity. I watched physical changes in Cherries posture and her improved performance of her ADL; the most significant and exciting observation was the change of her self-awareness and image. In every lesson the student is asked in the end: “pay attention if … feels different from usual/easier than in the beginning/you can see more details than in the beginning…?” Cherrie expressed experienced changes elaborately.

This leads to the conclusion that the intensity of learning is not necessarily higher with a larger quantity of movements, as long as the main idea to facilitate learning and self-awareness is heart of the teaching. However, it is still questionable how much lessons can be changed or adapted without losing their genuine intention.

Besides my own close observation of Cherrie’s performance before, during and after lessons, her verbal expression was a striking experience for me. Cherrie is a person who communicates with the world predominantly verbal. During the lessons, she listened to her body, but had the urgent need to express her discoveries verbally.

Cherrie discovered a new physical perception: “I never felt my shoulder blade before”, “from head to toes. I grow…”, “feel my feet”, “my feet are still bigger and softer”. She widened her cognitive horizon “I had no idea I could ever do this”, “maybe I go finally to college”, “my brain has to learn that it can trust my feet”, “I did not know there are so many ways to do this” and she increased her quality of life “this is so much fun”, and “this feels so good in my body”. These short sentences came spontaneously. I did not ask Cherrie: “tell me how it feels!”

In a group ATM lesson, the teacher usually asks the awareness questions and the students answer them for themselves, listening to their bodies. Discussions between the teacher and the student about the work is not part of the method. Feldenkrais himself described in his case study “Nora” the “itching desire to ask what she thought I was doing” (Feldenkrais 1993, p.52), when he started to make vertical strokes on Nora’s body already for three sessions. “At long last she asked, “is this a line?” …. I kept making my little strokes and saying with each of them “This is a line from up downwards”….” (p. 52). Cherrie, a verbally oriented person, made herself order in her world expressing her new discoveries. The trap for a practitioner could be to start a conversation about her experiences from the place of own curiosity. This might endanger the just gained new awareness. I usually repeated her short sentence, and she had another chance to confirm, change or add something to her statement and then we continued the work.

The third issue in this discussion is the question about the carryover of the gained abilities into the daily routine in a geriatric setting. “Older people learn poorly, essentially because they attend with only a small part of their awareness. What they learn is not associated with their entire beings as it is in childhood” (Nora, p. 65). Cherrie’s joy over her weekly movement discoveries and her integration in her ADL performances taught me that it is possible to leave the prison of chronological time for a short while. In addition, who is old in the sense Feldenkrais described? As I understand it, old might begin already with the school age when we are busy with so many duties around us that there is often only little space left for open awareness? In my work I discovered often that the older person who is not busy with work, career, raising children, building a house… can be again gain and refreshing openness and interest in their environment.

Feldenkrais wrote not only a book about maturity but emphasized the importance of maturity for his concept. One of his key sentences is the statement that the only constant in our life is change. “When one or another important condition is changed, the maturing process must be set going again. Maturity is not a state reached with age or experience - it is a process that goes on until death in all evolving and creative people... The rigor with which we inculcate the rigidness of Human Nature is the main reason for our misery.” (Feldenkrais, 1989, p. 102/103). Cherrie was a master in searching constant further inner and outer development. She carried over in her daily life, was she had learned and discovered in during the lessons. With a better trunk rotation she started to reach objects from her windowsill and place them in a new place. She enjoyed to stand up “just for fun” and because “it feels so good”. She was able to elevate her legs herself without any help and strain in the back. And she looked for physical activity when her inner fears started to scare her again.

However, after a break of 4 weeks, Cherrie presented a decline in her performance again. What had happened? The nature of ATM lessons is that the student listens to the directions of the teacher, carries them out and listens to the reactions in her/his body. Cherrie had not forgotten the lessons, was amazingly able to recall detailed movements and elements of lessons verbally and physically; however, she was not able to keep her newly gained self-image without her weekly lessons and the attention of a teacher in a personal encounter. This might have been different if we had worked for months or years together instead of weeks. Nevertheless, as therapists in a long term care facility, we observe this phenomenon quite often that residents are able to keep a higher level of functioning as long as they are in a supportive context with a personal vis-à-vis. The philosopher Martin Buber elaborated the concept of “I and Thou” and I discovered this highly valuable in my daily work with clients. I would like to state at the end of this project that the Feldenkrais work in a geriatric setting is a highly valuable method for increasing performance; to be aware and use the aspect of personal encounter in this work might increase the performance and outcome of this work.

 

Conclusion:

Although participation in ATM lessons as a preventive service is not covered by health insurances, I surely would recommend for a number of people in a rehab setting weekly Feldenkrais ATM or FI lessons to maintain a good neuro-physiological condition and therewith functional skills. To promote the need and benefits of Feldenkrais is my ongoing work project. I am currently working on documenting the benefits of Feldenkrais in hand therapy with persons with stress injury (carpel tunnel and De Quatrain tendonitis).

I take the following sentence of Eilat Almagor as my guideline: Feldenkrais work is an “invitation to our students to do concrete movements that they thought they are unable to perform them, while respecting the same time they believe that they could not do it. The result should be to enable people to believe again in themselves.” (Eilat Almagor, lecture in December 20, 2006).

 

 

List of References

 

AOTA (2002). Occupational Therapy Practice Framework: Domain

And Process. American Journal of Occupational Therapy, 56 (2),

609-635.

Bennett, J. L., Brown, B. J., Finney S.A., & Sarantakis C.P. (1998). Effects of

A Feldenkrais Based Mobility Program of Function of a Healthy Elderly Sample. Lecture presented at CSM in Boston; abstract available in Geriatrics 1998.

Dystonia (2007). What is Feldenkrais? Retrieved January, 20, 2007 from

http://www.dystonia-foundation.org/treatment/comp.asp#feld

Feldenkrais, M. (1993). The Case of Nora. Berkeley, California: Somatic

Resources, 1993.

Feldenkrais, M. (1990). Awareness through Movement. New Work: Harper

Feldenkrais, M. (1989). The Potent Self. New Work: Harper Collins.

Feldenkrais, M. (1981). The Elusive Obvious. Cupertino, California: Meta

Publications, 1981.

IFF (2007). Research list. Retrieved January 24, 2007 from:

http://feldenkrais-method.org/flexinode/table/5?sort=desc&order=Year

Kielhofner, G. (2003). Model of Human Occupation. (3rd edition). Baltimore

MD: Lippincott Williams& Wilkins.

King, L. (1978). Towards a Science of Adaptive Responses. In A Professional

Legacy. The Eleanor Clark Slagle Lectures in Occupational Therapy, 1955-2004 (2nd edition). Bethesda MD: AOTA.

Qurioga, V. A. M. (1995). Occupational Therapy. The First 30 Years.

Bethesda MD: AOTA.

RehabCare (2007). Interventions to Enhance Visual Functioning &

Compensatory Strategies for Visual Loss. In-service presented for RehabCare workers on February 8, 2007 per conference call.

Rehabworks (2003). Program of the Month – Activities of Daily Living

(ADL/Grooming Program). Internal Guidelines for Rehabworks-staff.

(No publisher/location).

Schacker, W. (2004). Zur eigenen Sprache kommen. Scientists meet

Feldenkrais teachers. Feldenkrais Research Journal, 1, 1-7.`Paris/New York: IFF Academy

Stephens JL, Pendergast C, Roller BA, & Weiskittel R. S. (2005). Learning to

Improve Mobility and Quality of Life in a Well Elderly Population: The Benefits of Awareness Through Movement. International Feldenkrais Federation (IFF), IFF Online Research Journal, http://www.iffresearchjournal.org/ , Volume 2, November 2005.

Stephens, I., Pendergast, C., Roller, B.A., & Weiskittel R.S. (1997).

Awareness through Movement as a Strategy for Improving Coordination and Economy of Movement in Older Adults. Unpublished Master’s Thesis at Widener University, Institute for Physical Therapy Education.

Wright, J (2000). Bodies, meanings and movement: a comparison of the

Language of a physical education lesson and a Feldenkrais movement class. Sport, education and society, 5 (1), 35-49: Abington, England.

 

 

 

 

 

 

 

 

 

Appendix A Evaluation and goals

 

Significant clinical findings about abilities and impairments at day of evaluation:

Functional mobility:

-      Power wheelchair navigation: Cherrie reports repeatedly about a decrease in her vision and her fear to lose the ability to navigate her power w/c with moderate independence; currently supervision, elevator minimal to moderate assistance.

-      Transfers from wheelchair to chair, bed to wheelchair: minimal assistance with extended time.

-      Sitting and positioning in wheelchair: minimal to moderate assistance

Activity of daily living:

-      self-feeding: supervision to CGA with set up

-      grooming: minimal to moderate assistance

-      bathing: moderate assistance

-      toileting: supervision to moderate assistance, depending on daily condition

-      upper body dressing: minimal assistance

-      lower body dressing; moderate assistance

Cognition: Cherrie is fully alert and intact; however, she presents increased anxiety and fear, reports of sleepless nights because of circling thoughts and needs extended time for task performance and focus on tasks.

         

Physical status at day of evaluation:

Balance:

- supported static standing: fair; unsupported static and dynamic standing: fair- (loss of quality of movement and balance through stiffening; participant reports of fear); supported static sitting: good; unsupported static and dynamic sitting: fair

Endurance: needs rest breaks every 2 minutes

Fine Motor Movement: intact

Gross Motor Movement: slightly diminished sec to loss of vision

Perception: intact, able to integrate new experiences in body schema

Posture: round back, especially in lumbar area

Range of Motion (ROM):

- Lower extremities within functional limits in flexion, extension, abduction, adduction, plantar and dorsi flex feet, to everse and inverse

- Upper extremities, pc is able to perform flexion, extension, abduction, adduction, internal rotation, external rotation, and dorsi and plantar flexion of hand, as well as supination and pronation, inversion and eversion. Pc is able to rotate to left and right and perform lateral flexion.

Cherrie reported that many of the movement that I checked she has not done since a long time and it feels very strange.

Strength: 3/5 grossly

Sensation: tactile, kinesthetic and proprioception intact, vision poor, hearing fair-.

 

Goals

Cherrie and me, the OT agreed on the following occupational therapy long term goals:

  1. Functional Mobility:
    1. Cherrie will be able to transfer from w/c to stand or sit on chair with supervision.
    2. Cherrie will be able to navigate her power w/c in the building with moderate independence and no incident of hitting objects.
    3. Cherrie will be able to position and re-position herself in her w/c with moderate independence.
  2. Activities of Daily living (ADL):
    1. Cherrie will use compensatory strategies to participate with ADLs (safely placing, color and tactile markers, finger sweep for plates and cups, clear location of articles and good balance in reaching objects)
    2. Cherrie will self-dress with minimal assistance and tolerate support when needed.
    3. Cherrie will perform toileting with moderate independence and will be able to pull up her pants.
    4. Cherrie will increase her balance in sitting, standing and midline crossing and her trunk control to good.
  3. Cognitive-Perceptional skill development:
    1. Cherrie will be able to recall sequence of tasks with moderate independence at all times.
    2. Cherrie will apply gained movement skills into the daily routine and present significant improved self-regulation of her behavior (less emotional outbreaks/anxiety attacks) also between the meetings.
    3. Cherrie will return to her former level of social interaction and participation.

 

 

 

 

 

 

 

Appendix B: list of ATM lessons with categories for choosing them:

 

1. Lesson # 27: Elbows and knees touching in combination with “lessons for elderly citizens, 3: “children may flex more”

2. Lesson # 124: work with the active [dominant] hand

3. Lesson # 54: Differentiation of eyes, head, and back in twisting movements

4. Lesson # 10; Covering the eyes

5. Lesson # 13: Buttocks

6. Lesson #19: Preparation for a clock (extended to clocks on different locations on the body)

7. Lesson # 85: bending the right ear to the right shoulder and the left ear to the left shoulder

8. Lesson # 86: Forward and backward – bending the head – a gestalt

9. Lesson # 251: Ankle Movements

10. Lesson # 274: Introduction to walking 1

11. Lesson # 300: In standing, turning the heels outside

12. Lesson # 120: The feet in combination with lesson “sensible feet” from “lessons for elderly citizens, 6: sensible feet”

 

I chose the lessons according to the following categories:

- did they facilitate trunk flexion/rotation?

- did they challenge the participant to differentiate between upper and lower back/arm/leg while she was sitting?

- could the lesson be translated into sitting keeping the core movement?

- Lessons in standing position

- Movements that could be repeated easily also in the daily life.

 

 

 

 

Appendix C: lessons with movement examples, Cherrie’s comments and observed performance

 

Title of lesson

Functional movement example

Cherrie’s comment

Observed performance

#27:Ellbows and knees touching

Reaching for objects crossing midline, e.g. reaching for the bed remote control to elevate head or legs in bed

“This is so much fun!”

“I did not know I could move so well”

Beginning: C’ kept her neck extended and reported pain in back while trying to get the elbow to the knee; after imagining the movement and doing it smaller, she started to breath deeper, and was able to coordinate exhale and flexion. It also helped her to stand up in between.

# 124: work with the active (dominant) hand

 

Fine and gross motor activities: getting clock out of w/c bag

“Looks like I have five fingers – that is a lot!

A shoulder blade! I never felt a shoulder blade before…”

C. could not soften wrist in beginning. Needed more verbal cues and time. Shoulder blade tapping in sitting hardly possible

# 54: Differentiation of eyes, head, and back in twisting movements

 

Compensatory movement for peripheral view, for example in dining room to find food on tray or communicate with neighbor

“This is hard. I have bad eyes. Left and right (much laughter)…this is confusing”

C. did not close eyes. Could not differentiate between head and shoulders. Fixing object and then turning shoulders helped. Range of neck rotation at the end of lesson significantly higher.

# 10; Covering the eyes

 

Improvement of visual perception/seeing details; reading daily schedules or newspaper, watching TV, recognize staff members entering the room

“I wonder if there comes a time where I am not so happy with our lessons...”

C. could not cover the eyes and expressed being scared by the directions to move the eyes. I stopped the lesson and continued with weight shift in standing; idea: to offer C some secure ground. C. relaxed and performed a fair weight shift (see # 274)

# 13: Buttocks

 

Head – neck – pelvis alignment in sitting, weight bearing through spine, necessary for sitting performance

“Riding on a horse, so whereto do we ride? You know, I have to become 98 years old to ride finally learn riding (laughing) – I had no idea I could ever do this!”

Feedback of firm surface helps performance of movement (C. changed from w/c cushion to firm bench). C. was able to differentiate well between left/right sides.

#19: Preparation for a clock

Positioning/repositioning in chair during activities, e.g. brushing teeth

“A clock, like Big Ben? I am sitting on Big Ben and move from 6 to 12, from 3 to 9. I feel my sitting bones, they are definitely there. A clock, a clock...; it is incredible: this feels so good in my body. I never did that before…”

C. needed some auxiliary movements (touching sitting bones with hands) then quick understanding of directions; C. even suggested to move from 1-2-3…; second session: C. had remembered clock directions and performed them; significant change of sitting posture!

# 85: bending the right ear to the right shoulder and the left ear to the left shoulder

 

Standing and transfers w/c – chair or toilet

“This is a real adventure. I did not know there are so many ways to do this. Maybe I go now finally to college”.

C. had a weak day. The lesson was taught in her room, C. in her w/c. C. was able to stay focused on the variations of the movement. At the end of the lesson, she was able to get up and stand for 2 minutes.

# 86: Forward and backward – bending the head – a gestalt

Bending the upper body, important e.g. for toilet hygiene; standing endurance e.g. to pull pants up

“I never thought about this before. This feels different. From head to toes. I grow…”

This lesson was performed mainly in standing to increase the awareness for the feet and whole body involvement. C. was able to stand longer than usual and had a lot of fun with it.

# 251: Ankle Movements

 

Weight bearing in standing, clear perception of foot position (important for safe w/c navigation to prevent foot injury)

“My feet are growing… I feel my feet… I am standing on my feet…”

Lesson performed in sitting and standing; C. was able to shift weight to inside and outside of sole in sitting; in standing she was scared; I held my hands on her chest and thoracic spine and C. improved movement significantly during lesson.

# 274: Introduction to walking 1

This lesson was performed many times; I added the picture of letting roots grow in the floor

Balance during weight shift in standing and walking, e.g. toilet transfers

“Hands by the side, hands by the side… This is very scary…. This is an adventure…. I did it. I did not know that I can still do that. I know my brain has to learn that it can trust my feet….”

C. was sometimes very scared to get to standing, sometimes it took a long time until she was ready. In the standing position, her posture changed; C. was able to let her shoulders go down and regulate her tonus. This lesson is one of the most beneficial ones for self-esteem and change of self-image.

# 300: In standing, turning the heels outside

 

Tonus-regulation in pelvis region and whole body, gross and fine motor activities, e.g. opening and closing of cookie box

“I feel this movement in my whole leg. The shoes are all of a sudden to large” [C. wears large shoes because she feels otherwise squeezed].

C. needed extended time to weight shift and differentiate between heel and toes. I offered tactile cues. When location of heel was clear, C. was able to turn heel outside. With second leg, c. was immediately able to turn heel outside.

# 120: The feet

(in combination with lesson “sensible feet” from “lessons for elderly citizens, # 6: sensible feet”); partly taught as FI, partly as ATM

 

Balance while standing, awareness for condition of feet;

“I had no idea that I still could reach my feet!”

1 day later: “my foot pain disappeared”; 4 days later: “my feet are still bigger and softer.”

 

C, truly loved this lesson; she was highly motivated to reach her feet while sitting in her w/c; feet were placed on the physio bench. She was able in the end to pull her big toe without the usual back pain that she reports during bending over activities. She stood up with ease and good balance after this lesson and was able to maintain good balance in unsupported standing for 3 minutes.

C. started elevating her edema feet after performing this lesson with moderate independence

Copyright Jutta Brettschneider MS OTR/L and GCFP

Contact: Jutta@themovementclinic.org

 

About the author: Jutta worked in nursing homes in Germany, Israel and the USA as an occupational therapist and offered groups with physical and cognitive activities. She graduated from the Feldenkrais-training taught by Eilat Almagor and Anat Krevin in 2007. She works currently in outpatient rehab in Maryland and loves to teach her open Feldenkrais ATM class. October 2015 Update: Jutta opened her private practice The Movement Clinic www.themovementclinic.org