By Ilana Nevil
From time to time
Feldenkrais teachers get asked by physiotherapists how they
could benefit from our method in their work and not just for
themselves. Since I wanted to give more informed answers to
such questions, I decided to take up the invitation of two
German physiotherapists who apply Feldenkrais in their everyday
treatment of children in need of help I visited the Sozialpadriatrisches
Zentrum in Hamburg, a centre devoted to the early treatment
of newborns and young infants with cerebral palsy and other
neurological impairments. Meike Weitermeier , an inspired and
inspiring specialist with 35 years experience, gave me the
opportunity to observe her in action and ask relevant questions
during a 2 hour session with a little spastic girl. Ursula
Reuter, equally well-known in the field with over thirty years
of gratifying experience, kindly made time for an interview.
First a few words about the paediatric centre, a model of
its kind in Europe. It is run by child neurologist Dr Inge
Flehmig whose philosophy and approach closely resemble those
of Moshe Feldenkrais. She and her staff see their task as
involving the facilitation of all those learning processes
that normal children experience more or less unaided in their
contact with the world into which they are born. Infants
referred to the centre are gently and playfully helped to
discover ways of overcoming impediments to well-coordinated
movement and psycho-neurological maturation, actualizing
thereby their innate potential. Over the course of time Dr
Flehmig and her team have developed an eclectic, flexible
approach, by taking the best from different techniques and
adding new elements discovered through practical experience
in ongoing work. They are convinced that the successes they
achieve are due to this integration of a broad spectrum of
methods which is highly sensitive to each individual child's
needs.
In the 70s Dr Flehmig had introduced the Bobath Method to
her staff, and her team subsequently refined a technique
they call "Sensory Integration" or "SI".
At the beginning of the 80s Dr Flehmig met Moshe Feldenkrais
in Israel and invited him to teach her staff. Owing to ill
health Moshe was unable to follow the invitation and delegated
Mia Segal instead. A 5 day workshop took place in 1984, the
year of Moshe Feldenkrais's death, with everybody employed
by the centre attending. It proved such a success that further
workshops followed. Some of the centre's therapists have
already completed a full Feldenkrais training or are at present
complementing their professional skills in that way. However,
professionals with such a broad range of skills are often
not able to spell out how they apply principles derived from
different methods in their work.
TWO HOURS OF NOTHING BUT SMILES AND LAUGHTER
So I was very grateful for the opportunity to observe Meike,
one of the most senior and experienced therapists at the
Centre, and her little patient, 2 1/2 year old Jana, in a
spacious, wonderfully equipped workroom. To begin with Jana
had to renew acquaintance with Meike and her assistant. She
quickly decided she and her doll didn't mind me being there
as well. During this warm-up phase I was introduced to Jana's
mum and aunt and learned a bit about the child's history.
Premature birth led to fairly severe cerebral palsy. The
therapy she had received in her home town some hundred miles
from Hamburg unfortunately lacked sensitivity, and when she
finally came to see Meike about a year ago she screamed at
the very idea that she might be touched. Since then she has
been coming once every month, and I witnessed two hours of
nothing but smiles and laughter plus the occasional protest
when Jana wanted to continue with a particular game. In accordance
with the centre's philosophy, her mother had been trained
to become a skilled co-therapist; and the sympathetic physio
who now looks after Jana during the intervening weeks is
regularly given precise instructions as to how to proceed.
From many more or less indirect clues I got the idea that
a lot had already been achieved to help Jana escape from
the prison of spasticity involving, for instance, extremely
tense extensors preventing all movement, and tightly clenched
fists. Meika kept exclaiming excitedly: "Look at your
hands, Jana! That's wonderful ... look how you can grasp
things!" Play and work were indistinguishable.
What became quite clear to me is the following: A therapist
as experienced and inspired as the one I was privileged to
observe always adapts to the child she happens to be with.
She no longer applies clearly defined methods in accord with
her initial or any additional training but simply enters
a deep-level, profoundly satisfying communication with her
little patient, letting the child take as much initiative
as possible. This intensely sensitive interaction leads to
new exciting discoveries, games, fun, and ultimately wonderful
progress. We who were looking on were not excluded from this
fascinating process though. While Meike gently and rhythmically
pushed Jana's legs, flexing and extending her hip-joints,
stimulating the proprioceptive nerves in her joints, tendons,
and muscles, inhibiting old patterns and preparing neural
pathways for the acquisition of more differentiated and coordinated
movements, we occasionally joined her in producing rhythmic
sounds to add another sensory dimension to Jana's experience.
Then there would be a pause, and the child's spontaneous
response would result in a change of rhythm, vowel, and frequency.
A high pitched "Hi-Hi-Hi...', for instance, would be
replaced by a low pitched 'Ho-Ho-Ho...' to accompany another
round of what is called 'tapping' in the Bobath Method.
AN AMAZING SOFTENING OF ALL JOINTS AND MUCH EXPRESSION OF
SHEER DELIGHT
Even more enjoyable games followed. Jana was undressed and
spent nearly half an hour slithering about on her tummy on
a mat made nice and slippery with vegetable oil. She kept
dipping her hands into a huge pot of Nivea and painted her
own and her mum's and aunt's faces with the white cream.
The tactile experience of effortless sliding as well as Meike's
skilful handling of the oily little limbs brought about an
amazing softening of all joints and much expression of sheer
delight. Again Jana experienced a wealth of sensations via
her skin, her bones, joints and muscles, her eyes and ears.
Some were coordinated and structured according to the aims
of SI, others arose spontaneously within the context of the
child's own increasingly spontaneous activity.
Next Jana spent a lovely time in a tiny tub filled with
warm water. (The corner for water-play is Meike's special
pride.) While the child was playing with her assistant squeezing
small sponges, Meike explained that spastic children can't
feel themselves at all because of their excessive muscle
tone; hence the need for lots of sensory input and, in this
particular case, for the very small bowl which closely touched
Jana's body all round, giving her a sense of space. Meike
also tried to pinpoint what she has gained from studying
the Feldenkrais Method in depth: Most importantly, having
experienced herself more fully and gained more self-awareness
in the process, she is now able to observe much more effectively
what her little patients are already doing, and how that
could be a basis for further developments, demanding the
least possible intervention.
As a result, consultations with doctors often put her in
the position of genuine authority since she is now able to
point out to them what they simply haven't yet noticed, thus
convincing them that the child is already well on her or
his way towards conquering a skill the doctor is impatient
to see developed, if need be by a little forceful action. "Doctors
usually see only what is not happening, but ought to happen
if the child had all the abilities of a normal baby!" Having
learned to be more patient with herself through Feldenkrais
work, Melke also feels she is now capable of a degree of
patience she could hardly have imagined previously. All her
recent experience has taught her that such patience results
in an atmosphere of relaxed ease, in which much more can
be achieved by all involved in the complex process of assisting
a little human being to actively find a way towards growing
independence. This relaxed atmosphere prevailed throughout
the session despite the fact that it was interrupted by a
number of phone calls.
Meike also feels that she has become both much more sensitive
and also more creative or inventive, because she can now
see alternatives where she might before have seen one or
at best two possibilities. She knows that it is safe to rely
on her spontaneity and intuition, and her job has become
even more rewarding as a result.
THE CHILD WAS ABSOLUTELY STILL AND ATTENTIVE
And Meike certainly did enjoy the next treat for Jana. Sitting
on a sheepskin covered platform suspended from the ceiling
with the child between her legs facing a huge mirror on the
wall she gently rocked to-and-fro, sideways first and later
forward and back, singing softly in rhythm with the motion
about all the things Jana is interested in, her mum and dad,
auntie and brother, the dog, the flowers in the garden, the
trees and birds. The child was absolutely still and attentive,
listening, sensing, and watching her reflection move closer
to the mirror and further away, left and right...
After this fairly meditative phase there followed some wild
horseplay on a huge sausage-shaped air-cushion made from
clear plastic with many colourful balls rolling about inside,
so kids who need to be eased out of excessive extension have
something nice to look at when they lie on this inflatable
on their tummy. Jana shrieked with pleasure as she got turned
with one sudden jerk and shot onto her back and then onto
her stomach again. She also enjoyed the beginnings of a head-over-heels.
Her mum was eager to help her chin tuck into the chest but
did not interfere when that didn't quite work out this time.
She too has understood ore of the central Feldenkrais principles:
it is pleasant, safe, and ultimately more promising not to
use force in the patient and playful step-by-step approximation
to a possible goal. Her little daughter cried only once,
and that was when she had to stop playing and leave.
REALLY SENSING MY RIBS WAS THE MOST EXTRAORDINARY THING
FOR ME
The interview with Ursula Reuter basically she confirmed
very much what Meike had told me in the morning. Ursula too
cannot always tell which method she is applying at the moment.
Many of her tools are Bobath derived and much of her thinking
and talking employs concepts belonging to that method or
to SI. But now everything seems subtly influenced by her
Feldenkrais experience too. She feels she has become more
sensitive, patient, confident, and more competent in her
work.
"Thanks to Feldenkrais I have understood how much cleaner
some of my work could be when it comes to preparing the way
for the development of more coordinated movements... how
the trajectory always has to go through the whole bodily
structure... how important the ribs are. That I realized
through my own thorax. The torso is important in Bobath as
well, but since the Feldenkrais training I differentiate
much more between the individual ribs. Where I used to differentiate
the odd rib, say the fifth or seventh, I now distinguish
each individual rib. Really sensing my ribs was the most
extraordinary thing for me. I could never feel my breastbone
and that drove me crazy, because in Bobath it is one of the
key-points of control for flexion, extension, side-bending,
but I never felt anything there. Before the training I used
to look like that.." - she collapses into a hunched
posture - "Since the training I take one number bigger
when I buy shoes. In fact, I had to throw all my old shoes
away. And of course, since I have myself acquired the feeling
of what it means to be more erect, I now have a keen eye
for the potential erectedness in others.
I have also learned not to inhibit (a Bobath principle)
as much as I used to. That tends to overload the brain. With
spastics I now tend to be much more lenient, allowing them
to feel for themselves what it means if one side is soft
while the other is still tense and spastic. Formerly my Bobath
training would have impelled me to inhibit the old pattern
much more. I wouldn't have dared to let spasticity be, so
the child could grasp the difference. My aim would have been
to release the spasticity as quickly as possible. I don't
know, I might have misunderstood Bobath... Anyway, thanks
to Feldenkrais I now understand much better that such differences
need to be made much clearer. A spastic child also can and
must feel: "On this side I do this, and on the other
that. But I could also do the opposite, that on this side
and this on that side..."
A 'DIALOGUE FOR ALL THREE'
The other dimension of her work, Sensory Integration, has
become more skilled and subtle too. Ursula defines SI as
a complex dialogue - a tonic dialogue between the therapist
and the child who needs to trust and accept whatever the
professional does if its muscle tone is to improve; an unspoken
dialogue between the therapist and the mother, who, through
trust, will grow into her role as a reliable co-therapist;
and finally a 'dialogue for all three', a delicate dance
between them, creating optimal conditions for the child's
learning.
I came away from Hamburg convinced that the Feldenkrais
Method can increase physiotherapists' capacity for sensitive
and successful work.
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