Feldenkrais Method® with Anna
Monday, March 11, 2019
by: Susan Free, GCFP

Section: Healthy Aging

In 2011, a woman contacted me whose 97-year-old mother lived in the dementia unit of a large medical and residential complex in Toronto.  Anna, the mother, had moderately advanced dementia along with Parkinsonian rigidity. Her movement and speech were limited, and she needed caregivers around the clock. The nursing staff had recently informed Anna's daughter that it was often too difficult for even two people to help her transfer from sitting to standing, and that they would have to start using a lifting apparatus.
Anna was a feisty and determined person. She had volunteered for over fifty-five years at the institution which was now her home. Though she had many challenges, Anna could still use a walker to travel down the halls with her caregiver and participate in activities. Anna's daughter shared her mother's "never give up" attitude. She knew that the use of the standing lift would lead to an overall diminishment of her mom's activity. Familiar with the Feldenkrais Method® of somatic education, she hoped that I could help her mom move more comfortably and recover the ability to stand up.
When I first met Anna, she was sitting in a chair with her arms and legs extended stiffly in front of her. She could not sit upright without back support, and it took great effort for her to look anywhere but straight ahead. When we helped her come up to stand, she pushed and struggled; though once she was standing, she was able to tear down the hall with her walker. I could see that Anna's natural fear of falling, combined with a reduced ability to keep track of her whole body or feel for support with her feet, contributed to her current difficulties.
I visited Anna twice a week. With friendly and patient respect, I hoped to develop her trust in me and help her re-awaken the felt sense of her whole body; to help her find connections in her dynamic "body map." Specifically, to transfer from the stability of sitting to less stable standing, she needed to learn to spontaneously feel for, recognize, and make use of support whether she was standing, sitting, or lying down. For example, the experience of folding and unfolding of her ankles, knees, and hips needed to be clear in her sensation and easy to do, so that in preparing to stand she could freely bend forward from her hips, feel weight in her feet, then unfold to stand. Awareness of herself also included awareness of her surroundings.
Anna and I gradually developed a routine where I would do a hands-on Functional Integration® lessonwork with her following her afternoon nap. Then she would sit up and we did more active things that were interactive and fun, and at the same time, employed learning from the hands-on work.
For instance, I would sometimes sit behind her and be her "rocking chair," rocking this way and that. We would sing a familiar song, like Take Me Out to the Ballgame. Though she had trouble articulating her thoughts in speech, she loved singing and knew the lyrics of many songs. As we sang, I shifted her weight right and left, forward and back, in time to the music, to engage her rhythmically in a pre-walking sort of movement. I could move her hips or her arms, or turn her a little each way, attending also to her feet on the floor. Anna clearly enjoyed herself as we continued to clarify the practical sensory, rhythmic, and spatial demands of sitting, standing, and walking, and other functional movements.
When she had learned to sit upright without back support at the side of her bed, we played floor hockey and other games with half-length pool noodles and a bright foam ball. Anna became very alert as she followed the ball with her eyes and swung the pool noodle at it. Hitting the ball was only part of what we were doing, however. Her feet were planted on the floor, and I made sure the ball came to her from different directions so that she would have to turn and shift both her gaze and her weight, simultaneously adjusting and balancing herself with her feet on the floor. She was able to expand her awareness into the space around her. Her daughter later told me that as a teenager, her mom had been a keen grass hockey player, which I was not surprised to hear!
Early in our work together, Anna re-learned how to stand up from sitting easily with the help of two people, then easily with the help of one person. Sometimes, she stood on her own. She also learned to bring herself up to sitting from lying down, with minimal assistance. From sitting at the side of her bed or on a chair, she learned how to bend forward at her hips and sense the weight come into her feet to prepare to stand. As her overall movement, agility, and spatial awareness improved, she became more alert and engaged with her environment, turning her head to say hello to people she passed in the hall, and reaching for objects she was interested in. Her daughter observed that her mom had more confidence and self-esteem. She developed more self-agency.
I worked with Anna until just before she died, on the eve of her 101st birthday. Apart from those times when she was recovering from a health issue or hospitalization, she generally maintained her ability to come to stand, and she could walk with the help of her walker and her beloved caregiver until a week before she died. She demonstrated to everyone that a very elderly person with dementia, given some guidance, encouragement, and help of caring people around her, may learn and recover abilities that were presumed to be lost forever.
One of movement sequences Anna and I repeated over the years, with variations and modifications, is described below. It is a sequence I taught Anna's caregiver to do with her every day. I hoped it would become second nature to Anna to feel movement in her hip joints, to shift her weight different ways over her pelvis, to feel connected to her feet on the floor, and to integrate the movement of her trunk, arms, and head in relation to support. These movement ingredients are part of many activities of daily life.
To do some or all of the sequence with someone with dementia, the instructions need to be clear and simple, with more showing and hands-on help than verbal explaining. Humour and enthusiasm are important! Each variation in the sequence invites a slightly different movement in a person's hips, back, and head, and changes how weight comes onto the person's feet. Do the movements slowly and gently, with attention to ease, and with short rests in between.
The Sequence:
Sitting with feet squarely on the floor, put the palms of your hands on your legs: Right palm on R leg, Left palm on L leg.
1. Slowly slide your R hand down the outside of your leg and come back. Your fingertips may go just a little past your knee, and that's fine. Don't turn it into a stretch. Do this movement a few times, slowly down and back up.
2. Next, slide your R hand down the front of your R leg and back again, a few times-again, small movements are fine.
3. Now slide your hand down the inside of your leg, a few times.
4. Repeat all of the above on the Left.
5. Slide both hands down and over the knees and back up, a few times.
4. Move your R hand over to your L knee and slide it a little way down your L leg. Then take the L hand to the R knee. (These last movements are good both for creating a cross-lateral connection in movement, but also is good for connection both sides of the brain.)
-- Susan Free, GCFP (2004) has taught movement for almost thirty years to a diverse range of students, from highly skilled athletes and performers in post-secondary programs, to very elderly people with significant mobility issues and dementia. She currently teaches Awareness Through Movement® classes and Functional Integration® lessons in downtown Toronto. Susan has a BA in Communication (Dance minor), and an MFA in Dance History and Criticism. She is a Certified Laban Movement Analyst and a Guild Certified Feldenkrais PractitionerCM. For more information, contact Susan at <susan@susanfree.ca> or call 647-261-0248.

L to R, Susan Free and Anna
Post a Comment