Frenkel’s Exercises for Ataxic Conditions (Cervical Spondylotic Myelopathy)

Kinaesthetic Sense is the sensory information regarding the whereabouts of the body in space, the position of the joints, and the tension in the muscles. The kinaesthetic sensation forms an essential and integral part of the data upon which the neuromuscular co-ordination is based. Lesion causing loss of any of this information results in incoordination movements. Substitution of the sense of sight to compensate for the loss of kinaesthetic sense forms the basis of re-education of movements. It is to be noted that there may be undamaged or redundant pathways and the aim of Frenkel’s Exercise is to strengthen these pathways. By maintaining or resorting to relatively normal body movements, it may be possible to bring in to use some undamaged but hitherto redundant nervous pathways capable of conveying the impulses of kinaesthetic sensation.

Frenkel’s Exercises are based on the principle of training smooth coordinated movements with precision. The ultimate aim of the treatment program is to help the patient to carry out the normal activities of everyday life with minimum discomfort. He devised a method for treating incoordination in which he made use of systematic, graduated, graded and simple exercises. His treatment program is based on the principle that involuntary and incoordination movements may be controlled by making use of any other part of the sensory mechanism which remained intact i.e. sight, sound and touch to compensate for the loss of kinaesthetic sensation. This treatment program is effective only if the principles of concentration, precision and repetition are strictly followed.

1. While planning the treatment program, the physiotherapist must take into consideration the patient’s general health, mental attitude and the state of his muscles.
2. As these exercises are very tiring, frequent rest periods must be allowed. Avoid fatigue. Perform each exercise to the maximum of 5 times at a time. Give intervals of rest in between. The exercise program must be planned in such a way that it takes about half an hour at a time. The whole program may be done 2-3 times a day.The patient may not have the efficiency to feel fatigue. But fatigue is usually indicated by deterioration in the quality of movement or by a rise in pulse rate.
3. he patient is properly clothed and suitably positioned so that he can see the limbs throughout the exercise. This provides a visual impact. Once mastered, he can do the exercise without looking on.
4. The patient should be well explained regarding the exercise beforehand. If needed demonstration of the exercise may also be done. This provides the patient a clear mental picture of the exercise.
5. The patient must give his full attention and concentration to the performance of the exercise so that he can do the exercises smoothly and accurately.
6. Commands need to be given while doing the exercise. Commands must be given in a smooth and rhythmic way. The exercise must be controlled by counting i.e. the exercises must be done to counting. The speed of the exercise is controlled by the physiotherapist by means of rhythmic counting or by the movement of his hand or by the use of simple music. Counting provides an audio impact. eg. count ‘I’ on the commencement of the particular movement and the counting is progressed in a rhythmic way as the movement progresses, so that the end of the movement corresponds to the count ‘10’. To start with the counting may be made faster and then made slowly.
7. To start with simple movements are taught to the patient and it is continued till he has mastered in it. Once he has mastered in one simple movement, he may be encouraged to do other simple movements and then to complicated and complex movement patterns.
8. The aim of the exercises is to improve coordination and not for strengthening the muscles. Hence strengthening exercises need not be given. Exercises may be progressed by making them more complex and not by making them tough.
9. Exercises should be done within normal ranges of motion to avoid over stretching of muscles.
10. Exercises should be given within the limits of pain.
11. To start with the patient is encouraged to do the exercise with speed and then progressed to slow movements. This is because doing the movement slowly is very difficult when compared to doing it faster.
12. While doing Frenkel’s Exercises, the patient should be given individual attention and he should not be left unattended. If left unattended, he may practice the exercises in the wrong way.
13. Movements in full ranges are easier than those in small ranges. Hence get mastered in full ranges and then switch over to small ranges.
14. The exercises are given in any position that is suitable and convenient to the patient. The exercise may be given in sitting, standing and lying positions.
15. Progression of the exercise is made by altering the speed, range and the complexity of the exercise. Fairly quick movements require less control than slow ones. Later speed of the movements may be altered. The exercise may be further progressed by making interruptions in between by making the movements ‘stop’ and then commanding to proceed.

More of the same will be dealt with in my next article!

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