FELDENKRAIS METHOD®:Functional Activities for Children with Cerebral Palsy and Neurological Challenges
by Annie Thoe, Feldenkrais® Practitioner and Assistant Trainer in the Feldenkrais Method®
While it is difficult to assess within the brain exactly what specifically was damaged from cerebral palsy and how the damaged area of the brain interrelates with functions in the body, this will be a general guide to working with children with cerebral palsy or similar conditions.
The activities below are designed to stimulate the Sensory Nervous System which will in turn stimulate the Motor Nervous System.The Sensory Nervous System is what registers pressure, movement, direction, weight, space/time, hot/cold, smell, taste, and sounds.Using sensory stimulation is a wonderful way to work with reconnecting and helping better organize someone’s brain.I have developed the activities below and have found them extremely effective.
In general, work with what the child already does well.Identify what he or she can do and start there.If you start with something too difficult, the child can get frustrated and lose confidence and self-esteem.Always try to choose activities they can easily succeed with before introducing something difficult.Break the desired activity into smaller steps.If they fail, go back to what they know and can succeed with.
A precaution about touch:
Because children with CP are more vulnerable in being unable to move with ease or even speak easily, be careful with your touch to avoid overstimulation or confusion. Avoid random touch or movement.Touch slowly to avoid triggering spasm.Make sure you plan a little how your touch will help create a bridge of connection in their brain.Slow yourself down with some nice full breaths before you begin to sense their state of mind and what kind of attention they have in that moment.Are they tired?Sleepy?Frustrated?Content?Bored?Lonely? Happy to see you?Assess what you can about their energy level.
●Touch solid boney areas to provide stimulation to the skeletal support areas of the body.Helping a child sense their bones will give them a feeling of control.It’s difficult for muscles to stay contracted when the attention is on feeling the bones.
●Connect the bones gently by pushing through the joints to bring an area in contact with an adjoining bone.
●Give the child a break from touch, so they can feel the changes that the stimulation provide to their brain and body.
●Think about big patterns of movement.What has to connect for walking?Sitting? Standing? How do the bones connect for that to happen?
Example of differentiating an activity into steps:
Rolling
Rolling seems like an easy thing to do, but actually requires full-body cooperation and coordination.
What are the key players in the body for coordination of rolling?
Eyes
Head and neck
Hips
Ribs
Shoulders
Arms and Hands
Legs
We can work with each piece to improve rolling the eyes alone, and then add eyes with head.Or add eyes with hips.Add whatever piece naturally can roll better.This is the method of engaging parts that already have the skills.
Move slowly and clearly so they can follow your movement the way you would follow a fly walking up a wall.
●Speak slowly and allow pauses for them to contemplate what you are saying. It may be difficult for the child to follow instructions in a linear way. Especially with dyslexia or other cognitive challenges.
●Repeating yourself is helpful and helps to reinforce their understanding.It’s good to explain that you are trying to just be clear and aren’t sure how hard it is to understand you so that is why you are repeating things to them.This repetition may not be necessary as they progress, but I believe is very helpful to them as they learn to organize language and cognition again.
Activities to help stimulate the connections of movement with the brain:
Working with a ball:
Slowly roll a small ball from each finger up the arm to connect the hand to the collarbone, and also to connect the hand to the chin (for hand coordination of feeding and grooming later on…).
Slowly roll a ball from each toe up the leg to the hip and even all the way up to the chin.Again with the goal of creating neurological connections for movement of the feet and legs.
If they can hold the ball, assist them in rolling the ball on themselves, eventually to their paralyzed or disabled side (connecting the two sides in the brain).
Straddling a roller:
Having the child straddle a roller much like a horse helps to develop their pelvic balance for walking and decrease the spastic adduction tendency. You can also have the child straddle your leg and work with their feet touching the floor.
Working with a small rolling pin:
Similar to using a ball, roll the pin over areas of the body to help stimulate sensory connection. The child can do this to themselves as well.
Interlacing Fingers:
After working a bit with the paralyzed or disabled side so they are accustomed to being touched, you can begin to have the functional hand interlace fingers with the non-functional.Don’t force this.Begin slowly and watch for irritation and agitation.(If they get too irritated, they won’t learn as well and it can interrupt progress if not even be slightly traumatizing.)Stop, take a break and distract them with something pleasant. Remember to breath if you feel them tense up.If they calm down quickly, you can return to exploring the interlacing of the two hands.
Working with a clipboard:
Put their hand on the clipboard and gently, slowly move the clipboard to engage the full hand, encouraging more and more contact of the entire surface of the hand (increasing the sensory area of stimulation).As you tilt the hand using the support of the clipboard, feel how the weight of the hand connects through their skeleton—up the arm and perhaps all the way into the shoulder girdle.It’s an amazing process to feel the skeletal support in the movement and very pleasurable for the person receiving.
Very gently, bring the clipboard to touch the bottom of the foot.Sometimes, with bedridden clients this can elicit a lot of pain so you may need to do this introduction in stages.A little bit of contact at a time, but be careful it isn’t too light that they may feel ticklish.Exhaling (for yourself) as you touch will help them relax.
You can also use the clipboard vertically as a divider between the soles of both feet and use it to help develop a sense of proprioception of where each foot is in relation to the other.
Working with an Egg:
An "Egg" is a partially inflated egg-shaped ball. There are a variety of sizes and these partially inflated balls can be used many different ways to provide a child (or adult) with a sense of their skin, a sense of their side, a sense of connection to a large area of themselves. This is a fabulous tools for sensing boundaries and engaging areas to coordinate together and feel oneself along a large area. For brain-injured people, this is very helpful and relieving since the egg provides feedback and assists them to do movements that would be impossible.
As a practitioner, the egg acts like an encompassing hand that can connect large areas with the softest, gentlest touch. For hypersensitive and easily-startled people, which CP folks often can be, this tool is very soothing and helpful. I have not used it with autistic people, but I would bet this tool would work marvelously with autistic people.
Be careful with the egg that the person is not held down from moving but place the egg in a position that allows them freedom to move (either from the side or underneath their body). You can gently push or move the egg to provide movement into the person's body. Go slowly and watch for breathing.
Working with the Hands and Connecting to the Face and Head
The Hands, Face and Head have enormous connection with the brain. With CP, these connections may be broken or tangled in a way that makes coordination difficult. It's important when "untangling" movement to be clear, slow and provide breaks for the person to digest the sensations you are providing them.
If a child is clenching their hands in an undifferentiated way, there are a number of ways I have worked with them.
One is to go further into flexion and come out again while touching something in flexion and something else in extension. This way, the movement of flexion and extension has meaning and function. I use toys or balls or even food to increase curiosity and desire for the child. This reward system is also meaningful to them as it will provide them with more autonomy to get what they want.
If they have the abililty to touch themselves with their own hand, I work with that-- especially if it's possible to touch their face or head and create a connection of feeling between the hand and the head.
Sometimes, if they can tolerate it, I place an object in their hand, like a small piece of foam, or a soft leg of a stuffed animal-- something pleasurable to touch. Then we begin exploring movement with the object. Opening and closing, lifting it, rolling it. Tracking this with the head and eyes.
I had one boy do this with a one-inch piece of foam. After a few weeks of lessons, he was able to hold the foam in his hands (for the first time in 9 years!). Over time, he got proficient in the ability to pick up the foam, roll to his side and stack pieces of foam in a pile. This was so exciting for him (and his family and me.)
I've put rings or other objects on kids fingers for stimulation. I will blow on each finger or find ways to differentiate each finger. Cross their fingers in prayer positions. Play tapping and rythmic games with the hands and fingers. Even holding one finger for a long time while moving the arm or rest of the body will increase awareness and connection to the finger and help organize the hand and arm.
Some people will restrict the movement of the "good" arm so the affected arm can learn. This can work and any way of cleverly inhibiting the more functional side is a good idea for learning as long as it is not too frustrating for the child. I've sometimes "swaddled" a child in a way that restricted the "good" arm in a blanket and made the child use the other arm. It's important to work on this as early as possible before they get too habituated to not use the restricted side. If you can find activities for the "uncoordinated" side to do and master, that is the best way to increase the function of that side.
Music and Rhythm:
Music is one of the oldest and broadest links within the brain.Find out what their favorite music is and play it or sing it.Use the beat of the songs to stimulate movement:clapping or tapping fingers or toes.If they can’t tap, you can gently tap with your hands on their palms (imitating clapping) or on their thigh (simulating patting their own leg).Sometimes, these experiences trigger links in the brain that tie into old movement patterns.I’ve seen leaps of recovery using music.Even if you don’t have the best singing voice, it can be lovely to have someone sing to you in loving manner.
Rhythmical Poetry:
Especially if they like poetry, this can be a nice tool to combine with touch or movement.Be sure to repeat lines often.It actually is a wonderful way to stimulate short term memory, especially if it’s a good poem!The Poet David Whyte often repeats lines over and over when he reads poetry and it’s a wonderful effect and really helps the words stay in your memory.
Games:
Games are fun because they are social and appear like it is play versus work or therapy.Make sure it stays fun, explorative.Stop if they get frustrated and come back when it’s fun.Have other activities to do if one doesn’t work.
Board Games:there are plenty of kids games that are colorful that can be used to point to colors, move the pieces on various colored squares and help with language and special connections.
Playing Tag the Base
For Children who have difficulty with rolling, this provides incentive by making rolling a game and learning how to coordinate different parts by moving the object to tag in various places. Rolling and then reaching with the hand for a "base" to touch makes the movement functional.
Playing Tag the Ball (prelude to catching and throwing)
To help develop eye-hand coordination. Move the ball slowly toward the child and see when they can begin to zero in on the ball to touch it. Go slow enough and make it easy enough for them to touch. Gradually move the ball in areas that require a little more reaching.
Catching and Throwing things:Use nerf like balls or light small beachballs or balloons, small basketball nets for targets or cans, any kind of simple easy games of catch or target practice is very fun.It’s satisfying to bat things around and helps relieve some pent up frustration or aggression from being immobile.
Pulling the Fingers/toes: Like Tug of war, you can have the child pull their finger away from you. Hold on firmly but let them pull out of your grip. Do this with each finger and/or toe. This helps differentiate the toes and fingers and also develops balance, coordination and strength.
Engaging the Mouth:Use a straw and practice blowing the wrapper off, or blowing paper wads.Use a lollipop for sucking and have her move her lips and tongue in various ways to develop control.Practice smacking lips, licking lips in all different directions.Making vowel sounds.Making one consonent sound over and over while singing… “Ba,Ba,Ba…….La, La, La.”.It’s endless the list of things we can do to refine the movement of the lips, tongue and mouth.
Cards:Solitaire is excellent for working with numbers, sequential number recall, hand-eye coordination.Just putting the cards in order or by suit can be satisfying.
There are more activities, but these are great foundation activities to address movement, language, and cognition.
Excerpt from Cerebral Palsy Source.com
The Feldenkrais Method for Cerebral Palsy
Since cerebral palsy usually affects motor and muscle function, many therapies and treatments are based on focusing on movement optimization. One method of rehabilitation for cerebral palsy is called The Feldenkrais Method. The method is named for its inventor Moshe Feldenkrais. Through a unique combination of physical therapy, psychology, and martial arts, Feldenkrais aims at developing movement and physical growth in its practitioners.
The Feldenkrais method relies on the nervous system’s ability to change and learn. Through “teaching” the nervous system, the Feldenkrais method can redirect a body’s nervous growth. The Feldenkrais method can help people with cerebral palsy do such basic things as move and lie more comfortably. The method can also aid people with cerebral palsy in pain cessation or avoidance.
The Feldenkrais method for cerebral palsy is based on redirecting misdirected patterns of physical and psychological behavior. By varying therapy sessions, the Feldenkrais method can change and modify certain habitual inclinations such as sensory and motor functions. In people with cerebral palsy this therapy can particularly be of help in overcoming movement problems. By retraining the body and mind to move in certain and varying patterns, the Feldenkrais method can help a person with cerebral palsy make progress.
The combination therapy consists of developing movement, biomechanics, psychological treatments, and even martial arts. The Feldenkrais method for cerebral palsy can organize these elements of the person into learning how to better control one’s movements and to train the nervous system in acting in different ways. The method can help by using very simple techniques that aid in spastic muscle function and its development. Many patients in cerebral palsy have spasticity, or stiffness, in their muscles. The Feldenkrais technique can be used to help spasticity and aid in walking, sitting, or pain relief from the tension in the muscle.
As the senses interact with motor functions, a development takes place that falls into an effective pattern for future improvements. Using the Feldenkrais method for cerebral palsy, an affected person can work toward controlling and manipulating their own bodies. This control is essential in maintaining balance during walking or standing.
The Feldenkrais therapist is trained in these developments. The therapy is often very slight, non-invasive, gentle, and even pleasurable. This kind of therapy can be effective because it is so gentle and guiding.
The Feldenkrais Method for Children with Cerebral Palsy
The first scholarly research paper on the use of the Feldenkrais Method® with children was written by Chava Selhav Silberbush in 1987. This was her thesis for her Masters in Education from Boston University in 1987.
Chava identified several ways in which the Feldenkrais Method develops neurological functioning for individuals who were not able to develop these functions in a natural way due to the disease. First, a Feldenkrais® practitioner interacts with the whole being of the child, observing and responding to the developmental, emotional and social needs of the child. Second, the practitioner immediately works to “instill confidence in the child,” so that the child looks forward to each session. Third, the practitioner looks beyond the achievement of passive motor patterns towards “giving the child the possibility of learning to integrate existing patterns and to create new patterns by using other alternatives to serve the need of the moment.” Thus, the method helps the child to enable themselves.
One of two case studies presented in detail was about a boy who had received conventional therapies since he was diagnosed with CP at 3 months of age. Yet, at six years of age the boy was unable to sit unaided, to crawl, or to lie on his back with his knees bent. He lacked motivation to draw or to move by himself.
The boy received ten Functional Integration® lessons with Chava over the period of a year. At the end of the year, the head of the boy’s school reported that he “no longer needs special care. He can sit freely, alter his position and return to sitting without assistance… He has learned to relax separate parts of his body at will.” The report continues, “He is now capable of doing arithmetic… His ability to paint and the enjoyment he derives from it have greatly increased… He has manifested for the first time the desire to move.”
According to the boy’s mother, the former methods created an atmosphere of tension; he was forced to remain in fixed positions causing him pain. Then, after participating with the Feldenkrais Method, the mother could work with the child in a way that was enjoyable for both. She reported, “He has changed, not only physically, but also in his whole being. He has found faith again… he himself has discovered his potential and this gives him self-confidence… Our relationship has become wonderful.”
Subscribe to this Site
