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.
Feldenkrais in Movement Therapy for Children with Cerebral Palsy and Other Neurological Impairments by Ilana Nevill