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1 Teresa M. Miller, PT, PhD, GCFP Associate Professor at SUNY Downstate Medical Center What is the Feldenkrais Method ® ? Approach using body awareness and movement to direct learning Process oriented Every action has 4 components Moving Sensing Feeling Thinking Moshe Feldenkrais from “Master Moves” What is the Feldenkrais Method ® ? Systems based approach What is the Feldenkrais Method ® ? Focuses on uniqueness of each individual at any moment in time Intent is to increase the individual’s options for functioning Potent self Two Approaches to the Feldenkrais Method ® Awareness Through Movement ® (ATM) Group or individual Active movement exploration Novel movements Functional Integration ® (FI) Hands-on adaptations of ATMs Uses “passively” guided movement exploration Who Was Moshe Feldenkrais? Physicist Engineer Judo expert
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Page 1: Two Approaches to the Feldenkrais Who Was Moshe Feldenkrais?c.ymcdn.com/sites/ · PDF file2 Guiding Concepts for Feldenkrais® Lessons ! Identify starting organization and body scan

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Teresa M. Miller, PT, PhD, GCFP Associate Professor at SUNY Downstate Medical Center

What is the Feldenkrais Method®?

n  Approach using body awareness and movement to direct learning

n  Process oriented n  Every action has 4 components

n  Moving n  Sensing n  Feeling n  Thinking

Moshe Feldenkrais from “Master Moves”

What is the Feldenkrais Method®?

n  Systems based approach

What is the Feldenkrais Method®?

n  Focuses on uniqueness of each individual at any moment in time

n  Intent is to increase the individual’s options for functioning

n  Potent self

Two Approaches to the Feldenkrais Method®

n  Awareness Through Movement ® (ATM) n  Group or individual n  Active movement exploration n  Novel movements

n  Functional Integration® (FI) n  Hands-on adaptations of ATMs n  Uses “passively” guided movement exploration

Who Was Moshe Feldenkrais? n  Physicist n  Engineer n  Judo expert

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Guiding Concepts for Feldenkrais® Lessons

n  Identify starting organization and body scan n  Relationship to gravity n  Areas of contact with the support surface n  Alignment of body segments n  Dynamic aspects of balance n  Overall orientation to the world

Guiding Concepts for Feldenkrais® Lessons

n  Explore pathways of easy versus less easy movement n  Move in pain-free, discomfort free ranges n  Begin with slow, small, smooth, movements

n Webner Fechner Principle

n  Use minimal effort n  Minimize the work

Guiding Concepts for Feldenkrais® Lessons

n  Play with movement options: n  Combinations of body segments n  Positions n  Speed n  Place of initiation n  Intention

Guiding Concepts for Feldenkrais® Lessons

n  Compare movement relationships n  Between adjacent body segments n  Through the skeleton n  Symmetry n  Use reference movements and references in the

environment n  Influence of movement on orientation

Guiding Concepts for Feldenkrais® Lessons

n  Select a position(s) to move from to optimize the learning n  Decrease degrees of freedom and minimize

postural control issues n  Provide support with rollers, pillows, bolsters,

and/or practitioners hands n  Teach in various positions to generalize the

learning

Guiding Concepts for Feldenkrais® Lessons

n  Learning n  Options over correction n  Discovery learning, not therapy n  No best way to move but, better n  Generalize learning of movement processes to

performance of functional activities n  Rest periods for consolidation n  Research on passive (manual/haptic)

guidance versus active movement

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Assessment of Movement Options

n  Pathway of ease n  Affordances and constraints to movement n  Neuromuscular resistance

Assessment of Movement Options

n  Distal segments on proximal vs proximal on distal

n  Cephalic on caudal vs caudal on cephalic n  Movement through whole

n  Integrated vs Differentiated n  Enblock versus Sequential n  Selective locking and unlocking

n Vjerieken, Newell

Decision Making Processes of PTs and Feldenkrais

Practitioners

Miller, T 2007

Physical Therapists’ Decision Making Incorporated:

n  Didactic knowledge n  Clinical practice experience n  Intuition n  Patient education n  Knowledge of the client’s history n  The patient’s goals

Physical Therapist Decision Making

n  Cyclical process of moment-to-moment treatment, assessment and goal setting included: n  Observation and palpation of the

musculoskeletal system n  Stabilizing body segments n  Using the client’s verbal and non-verbal cues n  Using the client’s prognosis

Physical Therapists

Observation and palpation related to: v  Musculoskeletal system v  Function v  Selecting a Position Stabilization

Moment-to-moment treatment, assessment and goal setting

Patient’s verbal and nonverbal

feedback

Start/end session/episode

of care; treatment

flexibility/rigor

Prognosis

History/ Background Information

v  Medical

v  Previous PT

v  Work, home, sleep, extracurricular

v  Patient goals

Knowledge and Experience

Intuition

Clinical Practice Experience v Impairments, functional limitations, disabilities v General practice v Precautions/ contraindications

Didactic Knowledge v Impairments, functional limitations, disabilities v Precautions/ contraindications v General practice

Patient Education v  Prevention

v  Home Exercises

Miller, T 2007

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Feldenkrais® Practitioner Decision Making

n  Cyclical moment-to-moment process included: n  Observation and palpation of postural

configuration n  Palpation of muscle tonus n  Selection of movements to explore the system n  Selection of positions and ways to support the

system

Feldenkrais® Practitioner Decision Making

n  Moment to Moment Decision Making (cont.) n  Plans for future learning activities n  Making judgments based on client’s reports

and requests, knowledge of the client’s background, and knowledge and experience of the practitioner

n  Selecting overall themes and goals n  Assessment of outcomes

Observes postural configuration, palpates muscle tonus, selects movement directions to explore the system

Selects positions and ways to support the system

Makes judgments for proceeding with the lesson

Analyzes change in motion through the skeleton

Analyzes change in clients perception relative to the problem or function

Analyzes change in client’s orientation to self and environment

What client reports and requests

Knowledge of clients background

Knowledge and experience of the practitioner

Weighing and Assessing Background Information

Outcome Assessment

MOMENT-TO-MOMENT DECISION MAKING

Plans for future learning activities

Selects Overall Themes and goals for the Lesson

Enhances clients

orientation in the

environment

Enhances fluidity, ease and efficiency of movement

Enhances sense of differentiation and/or integration of body segments to whole

Feldenkrais Practitioners

Comparison of PT and Feldenkrais® Decision Making Processes

n  Knowledge n  Pathophysiology, impairments, functional

limitations, disabilities, and medical and surgical interventions

n Knowledge of practice philosophy and human growth and development

n Medical terminology n Medical resource for clients

Comparison of PT and Feldenkrais® Decision Making Processes

n  Practice experience n  Impairments, functional limitations, disabilities and

medical and surgical interventions with other clients

n Collaborating with therapists/practitioners

n  Personal experience n ATM lessons

Comparison of PT and Feldenkrais® Decision Making Processes

n  Consensual themes and goals incorporated: n  Client’s goals n  Client’s verbal and nonverbal cues n  Client’s history n  Function directly or indirectly n  Type or theme of goal n  Measures of outcomes n  Documentation

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Comparison of PT and Feldenkrais® Decision Making Processes

n  Moment-to-moment decision making n  Correcting impairments, and addressing

functional limitations and disabilities n  Interventions and type of touch

n  Client education

Recommendations for Integrating Feldenkrais® Concepts into PT Practice

n  Address functioning of the whole person n  Focus on enhancing affordances and teaching

options rather than “fixing” impairments n  Empower the learner to become aware of

relationships between actions and function

n  Be mindful of individuality and variability n  No 2 individuals function the same way n  The same person can vary on different days and

different times of day

Recommendations for Integrating Feldenkrais® Concepts into PT Practice

n  Use to improve alignment and dynamic postural control n  Change balance strategies from primarily

ankle to include hip, knee and axial skeleton n  Change awareness of relationship to support

surface

Recommendations for Integrating Feldenkrais® Concepts into PT Practice

n  Use to improve range by: n  Playing with reversibility of movement

n Agonist/antagonist, contraction relaxation n Working in “safe”, easy range of attractor pattern to

turn off co-contractors

n  Asking what other associated movements can contribute

Recommendations for Integrating Feldenkrais® Concepts into PT Practice

n  Improve ease, fluidity and efficiency of movement n  Change relationships between body segments to

allow for better distribution of work load and more efficient muscle recruitment

n  Incorporate breath awareness and variation of breath with movements

n  Change site of initiation of movement n  Reduce unnecessary firing of muscles

Recommendations for Integrating Feldenkrais® Concepts into PT Practice

n  Constrain the relationships between body segments

n  Start movement passively when possible in easy range then have patient take over actively n  Beets 2012 n  Bouchard et al., 2015

n  Provide support and take over work of overworking muscle groups

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Recommendations for Integrating Feldenkrais® Concepts into PT

Practice n  Use hands-on approach to:

n  Listen or monitor n  Provide support and establish trust n  Enhance awareness of attractor pattern n  Asks questions n  Guides exploration of other options n  Constrain movement and channel in other directions

New Reference on Feldenkrais® and Neuroplasticity

Supporting Evidence

n  Improving balance in older adults n  Connors K. 2011

n  Improves Pain from fibromyalgia n  Boudreau SA et al., 2010 n  Dean JR et al., 1997 n  Stephens JL et al, 1999 n  Kendall SA et al., 2001.

Supporting Evidence

n  Decreases Pain n  Bearman and Sharfman 1999 n  Phipps et al., 1997 n  Lundblad et al., 1999 n  Rardin MA, 2007 n  O’Connor et al., 2002

Supporting Evidence

n  Increased hamstring length n  Stephens J et al., 2006 n  Chowdhury S. 2011

n  Improved measures of mobility and postural control n  Hall SE et al., 1999 n  Stephens J et al., 2001 n  Batson G et al., 2005

Supporting Evidence

n  Body awareness, body image, quality of life n  Steisel SG, 1993 n  Deig D, 1994 n  Elgelid HS, 1999 n  Laumer U, 1999

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Questions and Answers References

n  Miller TM. Decision making processes of physical therapists and Feldenkrais practitioners. PhD dissertation. Temple University, Philadelphia, PA, May 2007.

n  Beets1, IA, Mace, M �, Meesen RL, Cuypers, K, Levin O, Swinnen, SP. Active versus Passive Training of a Complex Bimanual Task: Is Prescriptive Proprioceptive Information Sufficient for Inducing Motor Learning? PLoS ONE | www.plosone.org. 2012; 7 (5): e37687.

n  Bouchard AE, Corriveau H, Hélène Milot JM. Comparison of haptic guidance and error amplification robotic trainings for the learning of a timing-based motor task by healthy seniors. Front. Syst. Neurosci., 2015; 9: 1-9.

n  Connors KA, Galea MP, Said CM. Feldenkrais Method® balance classes improve balance in older adults: a controlled trial. Evid Based Complement Alternat Med. 2011; 873672, 1-9.

n  Boudreau SA, Farina D, Falla D. The role of motor learning and neuroplasticity in designing rehabilitation approaches for musculoskeletal pain disorders. Man Ther. 2010 Oct;15(5):410-4.

n  Dean JR, Yuen SA, Barrows SA. Effects of a Feldenkrais ATM sequence on fibromyalgia patients. Poster session presented at: Annual conference of the Feldenkrais Guild of North America; August 1997; Tamiment, Pa.

n  Stephens JL, Herrera S, Lawless R, Masaitis C, Woodling P. Evaluating the results of using Awareness Through Movement with people with fibromyalgia: comments on research design and measurement. Paper presented at: Annual conference of the Feldenkrais Guild of North America; 1999; Evanston, Ill.

n  Kendall SA, Ekselius L, Gerdle B, Soren B, Bengtsson A. Feldenkrais intervention in fibromyalgia patients: a pilot study. J Musculoskel Pain. 2001; 9(4):25-35.

n  Bearman D, Shafarman S. Feldenkrais Method® in the treatment of chronic pain: a study of efficacy and cost effectiveness. Amer J Pain Manage. 1999;9(1):22-27.

n  Phipps A, Lopez R, Powell R, Lundy-Ekman L, Maebori, D. A functional outcome study on the use of movement re-education in chronic pain management [unpublished master’s thesis]. Forest Grove, Ore; Pacific University, School of Physical Therapy; 1997.

n  Lundblad I, Elert J, Gerdle B. Randomized controlled trial of physiotherapy and Feldenkrais interventions in female workers with neck-shoulder complaints. J Occup Rehab. 1999;9(3):179-94.

n  Rardin MA. The effects of an injury prevention intervention on playing-related pain, tension, and attitudes in the high school string orchestra classroom. Dissertation, DMA, USC, LA. 2007.

n  O’Connor M, Webb R. Learning to rest when in pain. Euro J Palliat Care. 2002; 9(2): 68-71.

n  Stephens J, Davidson JA, DeRosa JT, Kriz ME, Saltzman NA. Lengthening the hamstring muscles without stretching using “awareness through movement”. Phys Ther. 2006; 86(12): 1641-1650.

n  Chowdhury S. Static stretching versus awareness through movement in improving hamstring flexibility. Masters dissertation submitted to the Rajiv Gandhi University of Health Sciences, Bangalore, India. May 2011.

n  Hall SE, Criddle A, Ring A, Bladen C, Tapper J, Yin R. Study of the effects of various forms of exercise on balance in older women [unpublished manuscript]. Healthway Starter Grant, File #7672, Dept of Rehabilitation, Sir Charles Gairdner Hospital, Nedlands, Western Australia; 1999.

n  Stephens J, DuShuttle D, Hatcher C, Shmunes J, Slaninka C. Use of Awareness Through Movement improves balance and balance confidence in people with multiple sclerosis: a randomized controlled study. Neurology Report. 2001;25(2):39-49.

n  Batson G, Deutsch JE. Effects of Feldenkrais awareness through movement on balance in adults with chronic neurological deficits following stroke: a preliminary study. Complementary Health Practice Review. 2005; 10(3): 203-210.

n  Steisel SG. The client’s experience of the psychological elements in functional integration. Dissertation Abstracts International, Massachusetts School of Professional Psychology. University Microfilms;1993; Ann Arbor, Mich.

n  Deig D. Self Image in Relationship to Feldenkrais Awareness Through Movement Classes [unpublished master’s thesis]. Indianapolis, Ind; University of Indianapolis, Krannert Graduate School of Physical Therapy; 1994.

n  Elgelid HS. Feldenkrais and Body Image [unpublished master’s thesis]. Conway, Ark; University of Central Arkansas; 1999.

n  Laumer U, Bauer M, Fichter M, Milz H. Therapeutic effects of Feldenkrais Method® "Awareness Through Movement" in patients with eating disorders. Psychother Psychosom Med Psychol. 1997;47(5):170-180.