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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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.