Many books provide introductory information about FM. They fall into three general categories: those dealing with the rationale and methodology behind the development of the method by Moshe Feldenkrais, the originator; those that are secondary interpretations and presentations of the method by Feldenkrais practitioners; and those that focus on specific applications to a variety of problems. The first group includes the classic Body and Mature Behavior,² which was Feldenkrais’ first approximation of articulating his work, and the more recently published The Potent Self.³ Each of these books details the anatomical, physiological, life-span developmental, and psychosocial thinking that informed the development of method. The underlying theme is that humans learn throughout their lifetime, that faulty learning can produce pathology of the mind and body, and that much of this pathology can be addressed by exploratory body movement lessons executed with careful attention to the details of the task-individual-environment constellation. Another book in this group is The Elusive Obvious,⁴ which is the most accessible and conversational of Feldenkrais’ writings. Awareness Through Movement⁵ is the most practical; it details 12 movement lessons and the rationale behind their development and usefulness.

The second group contains books such as those by Rywerant ⁶ and Shafarman.⁷ These books expand the rationale behind the method and include brief case examples and movement lessons. The case examples usually involve applications to the process of rehabilitation.

The third group of books deals with application to a specific problem, such as Body Awareness as Healing Therapy: The Case of Nora,⁸ in which Feldenkrais talks about his work with a woman who had a stroke; Heggie’s book on running⁹; Hutchinson’s work on transforming body image for people with obesity¹⁰; and Jackson-Wyatt’s¹¹ book on adapting to ergonomic problems in the workplace. This array of topics demonstrates that FM has a wide application to issues of living in addition to specific applications to movement problems in rehabilitation.

Briefly, FM was created by Moshe Feldenkrais, who was trained as a mechanical and nuclear engineer and became a neurobehavioral scientist. He developed a method of attending to his own posture and movement to resolve the functional limitations associated with a medial meniscus tear he received while playing soccer as a young man in Paris in the 1920s. He later taught this method in two forms, ATM and functional integration (FI), to students who have carried it worldwide to be movement occurs that is absent in relation to normal movement organization expressing the intended movement used in many ways. One of these applications is in rehabilitation from injury and chronic disease.¹²

Assumptions Underlying the Feldenkrais Method

In his book Awareness Through Movement⁵ Feldenkrais stated, “Each of us acts according to the image of himself that he has built up over the years” (p. 10). This self-image has been constructed from movement, sensation, feeling, and thought. He continued, “In order to change our mode of action, we must change the image of ourselves we carry within us.” The rest of the book presents, by example through 12 movement lessons, a method of changing self-image and subsequently the ability to act in the world.

Feldenkrais believed that an individual’s self-image was a complex composite. For Massion,^13,¹⁴ self-image, which he calls body schema, is at the heart of the motor control process. Massion’s body schema is a construct of the sensory/perceptual processes that represent the body’s position and orientation in space, the organization of body segments, and the movement of those segments in terms of velocity, direction, and force. Feldenkrais believed that this self-image comprises sensation (and movement) and our emotional sense of ourselves, our thoughts about who we are and what we can do, and our sense of self-efficacy.

Little research has been done in this area to test the assumption that FM can change self-image. Using ATM as an intervention Dieg ¹⁵ reported increased accuracy of representation in blindfold-constructed clay models of self; Hutchinson¹⁰ and Elgelid¹⁶ reported improvements in description of body image using semantic differentiation scales; Dunn and Rogers ¹⁷ reported changes in the sense of body size and weight; Ginsburg¹⁸ argued for broad changes in self-image in his presentation of case studies; and Stephens et al¹⁹ reported large, positive changes in self-efficacy in a group of people with MS. Feldenkrais created a method that uses movement to alter self-image with the understanding that the altered self-image allows generation of new movement. From a clinical perspective, this means that people gain a sense that they are able to do things that they were not able to do before.²⁰

Writing in 1949, Feldenkrais ² envisioned learning as a process by which the experience of life is recorded in the cortex by alteration of the connections between cells. This was accomplished by attending to the events in progress, discriminating among the actions and the resultant outcomes, and so producing new modes of action. Attending to the sensory, emotional, and thought processes and making real discriminations related to the actions in progress is therefore a method of modifying the self-image and laying the basis for generating new patterns of action. This process is closest to that described for motor skill acquisition by Newell.²¹ It now appears that Feldenkrais’ idea of learning is close to the process of active plasticity that goes on in the central nervous system as described by many current researchers using both animal and human models and in humans.²²^–²⁸ Currently preliminary evidence suggests changes occur in the brain activity associated with movement after work with FM that facilitated recovery of upper extremity functions after a stroke.²⁹

Feldenkrais believed that in an ATM lesson, as people attended to and made discriminations among the effects of small movements, the central nervous system processes related to body schema or self-image would be refined and expanded. During this process of exploration using small movements, attention is paid to the organization, timing, and movement of body segments in relation to base of support and to the effort related to intention for the action and what Feldenkrais called “parasitic activity,” which can be described as some aspect of the body organization that opposes the primary intention.^5,¹² In an ATM lesson, a movement is repeated in many variations. One of the goals of the ATM lesson is to identify and integrate into function variations of movement that require the least amount of effort while still effectively achieving the intentions of the performer. This often may involve relearning strategies and patterns of use of the larger muscle groups, which provide more of the power of movement.⁵

General Outline of a Session

The practitioner training process is informal and experientially based. No written, standard, accepted guidelines exist for how a lesson with an individual client should be conducted. As such, each practitioner’s approach is somewhat different. For more insight into how approaches may differ, the reader is referred to Stephens and Miller,¹² who describe several client cases.

A session may begin with practitioners observing the postural configuration of the clients in one or more positions. When asked to stand, sit, or lie down, clients perform that activity according to the image and habit they have for doing it, incorporating any process of compensation that they may have developed. The practitioners then observe this habitual organization as it presents and further explore it by gently pushing or supporting through the skeleton of the clients to see how they respond to this perturbation. Practitioners approach this with an understanding of what a normal, unimpaired response to such a push or support may look and feel like. Practitioners look for postural alignment and a flow of mechanical energy through the skeleton that engages other segments of the body in a way appropriate in response to the direction and force of the push or support. Practitioners then use this process to identify some aspect of the postural or movement organization that appears unusual as a focus for work.

The practitioner’s intent is to create an environment and an opportunity for learning related to the client’s problem and attend to environmental factors such as lighting, temperature, and noise. Physical comfort is important. The client is asked to dress comfortably in clothes that do not restrict movement. Props are used to support clients in their preferred posture so that they may attend to the movements presented by the practitioner in addition to their responses to movements. Practitioners approach working with the client through FI, ATM, or some combination of the two.

In FI, practitioners work with clients first by continuing the ATM process or supporting the habitual postural configurations of the client to facilitate a good understanding of how this posture is achieved and controlled, allowing clients to relax and perform their spontaneous movement or posture. Then practitioners lead clients through small movements into patterns of organization slightly different from what is spontaneous and natural and help the client to realize that these patterns are different and are a choice for voluntary action.

In ATM the FI process is performed at the level of voluntary movement. Clients are asked initially to observe the feeling of their resting posture. Then they are asked to repeat a small movement (e.g., rolling the head to the side while in a supine position) and to begin observing how the rest of their body participates in this movement. Through this process the spatiotemporal pattern of control (coordination) can be observed. Attention is brought to areas of the body where unnecessary movement occurs or where move-ment is absent in relation to normal movement organization. Small exploratory movements are then done or artificial constraints applied (e.g., locking the head and shoulder together by placing the hand on the forehead) to give the client a clearer sense of how the body is or could be organized in movement. This small movement then is placed into other movement and postural configurations to see how other parts of the body can be integra-ted with this movement to make it smoother and easier. To illustrate using the example of the client rolling the head while in a supine position, the client would try turning the head while moving the arms or legs or while sitting or standing rather than supine. New options for move-ment are thus created from an exploratory pro-cess, and the client can begin to develop and expand the use of those new options in functional activities.

Searching the Databases

Many approaches exist for a search on FM. For example, a search of the term Feldenkrais through the OVID Gateway, including the databases MEDLINE from 1966 to present, CINAHL, all evidence-based medicine (EBM) reviews, Health Star, Sport Discus, and PsychInfo, yields 148 hits. Removing duplicates reduces the number to 115. Selecting only those papers that have English abstracts and are either reviews of the use or process of the FM or experimental or case studies reduces the number to 39. These papers fall into three categories: (1) experimental or case studies involving patients with neurological diagnoses, five papers (four MS and one traumatic brain injury); (2) experimental or case studies involving orthopedic or other diagnoses, 20 papers; and (3) review papers describing the process or general use of FM, 14 papers. This search turned up most of the relevant literature on FM. Because the author has been in contact with practitioners and researchers throughout the world for many years, he also refers to some papers that are not listed in any of the databases mentioned above.

Critical and Primary Source Reviews

One Cochrane critical review of complementary therapies was found for people with MS.³⁰ This review included one paper that used FM. Although the sample size was small, the results suggested that FM was a promising treatment for people with MS in terms of psychological well-being. The study reviewed used 20 patients with MS in a crossover design, in which patients received eight weekly sessions of FI and eight weekly sessions of sham “non-therapeutic passive bodywork.”³¹ The results suggested improvements related to perceived stress and lowered anxiety related to the Feldenkrais intervention but no changes in measures of hand function or other measures of function. Another, more thorough review of FM in general was done by Ives and Shelley,³² who concluded that despite serious methodological flaws in much of the research, a consistent direction of outcomes suggests that the work may be effective and that more research is needed.

Evaluate the Literature

1. What impairments that present in MS may cause postural control and balance problems?

Postural control is understood to be a multifaceted, systemic process that involves the expression of the motor system, the functions of the sensory system, and their integrated action through the processes of intention, planning, anticipation, and adaptation within specific movements.³³ Rodgers et al³⁴ identified deficits in ROM, strength, spasticity, and sensory disturbances in people with MS who also had gait deficits. They followed up with a 6-month aerobic exercise program and failed to find any resulting changes in gait. Strength, spasticity, balance, and gait deficits in people with MS were addressed in studies by Lord, Wade, and Halligan³⁵ and Petajan and White³⁶ with use of broad intervention programs directed toward impairments. These programs were successful in improvement of balance and gait, but no specific parameters of impairment were identified as being of primary importance. Cattaneo et al ³⁷ studied groups of people with MS who were either fallers or nonfallers based on their history. They were unable to develop a logistic regression model that effectively predicted who would be a faller based on measures of impairment such as strength or spasticity. In a similar effort, Kasser, McCubbin, and Hooker³⁸ studied the intrasubject variability in a range of physical measures, including strength and upright postural control; psychological measures including stress, mood, and self-efficacy; and functional assessment of performance of ADL. They observed covariation among physical measures (with high variability) and psychological measures (with lower variability) but no consistent correlations between these impairment measures and functional performance. They concluded that their findings suggested that the system places a high value on organization to preserve and optimize functional performance in the face of dynamically changing impairments. All these results suggest that an approach that addresses the integration and dynamics of many factors affecting performance is more likely to have an impact on function.