Be Patient and Create Safety: A Case Study
Monday, March 25, 2019
by: Rose Eisenberg

Section: Practitioner Spotlight




In May of 2017, the daughter of a 70-year-old woman contacted me. Her neurologist had suggested Feldenkrais® sessions for the following reasons:
a) She had a strong chronic right lateral contracture of the neck that kept her right ear close to the right shoulder and her face facing the floor, both when walking and when sitting. In addition, there was moderate spasticity of her leg and right arm but with the possibility of moving them a bit, when invited to do so.
b) She had been diagnosed with senile dementia between grade 3 to 4 with mild to moderate cognitive impairment. She had problems finding words and names, she does not understand well, or remember what she reads, or reads with great difficulty. She lost personal objects, and had difficulty concentrating.
c) She suffered from Parkinson's Stage 3, causing extreme difficulty walking in a straight line, with greatly compromised balance. In addition, her ability to accomplish daily tasks like grooming and feeding was very affected.
 
Up till now, she has had sixty-nine Feldenkrais sessions, more or less once a week: a combination of both Functional Integration® lesson and some Awareness Through Movement® lesson explorations. In the first session I observed her difficulty walking, and in flexing the right knee, while dragging the same foot, always keeping the right arm in flexion. When sitting down, she did not want to perform simple suggested movements and preferred to lie down for Functional Integration lessons. She lay on her back with help, could not lie on her side or make the transition from side to face up. Occasionally, she managed to be on her back, on a soft roller, recognizing the support of her feet, elbows, hands, head and spine with extremely soft and small movements, but she did not like it very much.
 
Due to the comment that she had just had a grandson, I invited her several times to sing lullabies and notice words. She remembered some words and tonalities. The family told me that when she was young, she played the piano. The first three sessions, because she was tense and nervous, I added very soft classical music to the environment, and invited her to guess what instruments she listened to. This allowed her to be calmer, to have more confidence and to be able to work together with FI® sessions or some ATM® lessons.

I discussed with the neurologist that the spasticity on the right side and legs was very strong despite her ability to feel the softness of the left side. He added certain medications that acted slowly and progressively, month by month decreasing a little the spasticity. However, the difficulty to walk and climb stairs increased so in September 2018, it was suggested to use a wheelchair to transport her from the street to the stairs. To this day, she goes up and down with help and support. I cannot comment in detail what changes I made in each session, I can only list some strategies practitioners can try:
  1. Make the person as comfortable as possible using cushions and / or rollers.
  2. Start the FI with the patterns you observe each day. For example at the beginning, she did not accept very slight movements of the head or spine because she heard noises from the joints of the cervical vertebrae and she was afraid she could only comfortably sense her vertebrae further away from the neck. When sitting at the end of these FI lessons, her head was more or less centered and we could face each other.
  3.  Engage in light talks at the beginning of each session: about the temperature of the day (it is very cold) or of your own grandchildren or what you liked to watch on TV. Make a friendly and trusting environment.
  4. From the beginning, I showed his caretaker (who is quite clever), some small movements from ATM or FI lessons, very simple but that I considered necessary to realize during the days between sessions. For example: to learn to cross the middle line, I had her bring hands slowly to the face, her hand or forearm on  her forehead or chin, to just roll her head to the side easier.
  5. Invite the caregiver when you start the sessions, to lie down on the carpet, rest, enjoy and remember the movements that you taught, and sometimes add some extra, simple movements.
 

After ten to fifteen Functional Integration sessions face up, inviting her to pay attention to arm and leg movements on the left side, as well as the trunk and pelvis, making her notice the supports when rolling just to the right side (the spastic), the fear of rolling decreased. From the sixth session, when sitting down in a chair, I put several cushions in the lumbar region and that allowed her to hold her head more erect. That strategy pleased the family.  Since then, when they had guests or went out to the restaurant they took the cushions and she could look more in front with very slight inclination of head towards the right side. Near session fifty,  she agreed to work sideways, managing to better identify her spine, but with several cushions on her shoulder, trunk and pelvis because the work table felt very hard. The fear of rolling had decreased, persisting slightly when I would help her to sit down. To date, we have been able to work both on the right, left and face up. I continue to stimulate her memory of songs or photos that  her caregiver brings.
 
Rose Eisenberg (2002) is in private practice in Naucalpan, Mexico. She is a retired physician at the Universidad Nacional Autonoma de Mexico (UNAM). She holds a PhD in Educational Sciences. Rose teaches Feldenkrais classes at the UNAM Iztacala and at the Mexican Israeli sports center.


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