FRENKEL  EXERCISE

Professor Heinrich Sebastian proposed a series of exercises specifically for the treatment of ataxia called as Frenkel exercises which are slow and makes a system of repetitious exercises . The hands or arms movement are being observed critically by the patient and amended if necessary. These exercises require no equipments and can simply be carried out by the patient with focus and determination. The patients with ataxia may feel difficulty while performing Frenkel exercises but this set of movements helps the patients to restore their coordination. The purpose of these exercises is to restore the rhythmic movements for coordination in the patients. The human brain is made such a way that it recognizes all the discrepancies and provide motor problems in the spinal cord where needed. The patients with ataxia may use one or multiple mirrors to learn the accurate way of head movements.

Frenkel stated in his text book that while treating the patients by performing exercises, the sense of visualizing plays a great role, describing that it is necessary for the patients to watch their movements. He also suggested that by putting a timer while performing exercises for three minutes also helps in making the treatment less hectic for the patient. After three minutes, patients should take a gap for 15 minutes and do some other activities such as talking to someone or reading a book, as this gap provokes the development of new neural connections. These sets of exercises are suggested to be carried out every day for at least six months. A patient may perform the exercises but it is recommended that a physiotherapist must be present with the patient for the proper guidance so that the patient can watch his/her own movements and motivates the patient by talking and encouraging him/her. Apathy or the lack of motivation and clinical stress during treatment has been observed in cerebellar ataxic patients.

Frenkel exercises were formerly proposed in 1885 for the treatment of such patients facing difficulties of sensory ataxia leading to loss of proprioception. These exercises may be carried out in sitting, standing or walking position.

The fundamentals of Frenkel exercises

The fundamentals of Frenkel exercises are as follows:

Concentration or attention
It is a set of exercises to promote patients to enhance their ability to tell the position of their arms and legs without looking.

General instructions for Frenkel exercises

1.Exercises are not developed for the strengthening, but only for coordination
2.  Instructions given by the physiotherapist should be in slow voice, in a gradual manner and to the counting.
3.The area should be lit enough that the patient can watch the movements in their legs.
4. There should be some gap between each exercise and every exercise should be performed only four times.
5. Over stretching should be avoided.
6. The simple exercises should be performed first, followed by gradual transition into more difficult exercises
7. The exercises should be in smooth timing manner carried out at a slow pace by counting out a bit louder.
8. The uniformity of exercises should be maintained and a specific range can be focused.
9. Lying, sitting, standing and walking are the four basic positions to carry out exercises.
10. The part may be supported or unsupported, unilaterally or bilaterally.
11. The exercises are performed with eyes closed once the patient has voluntary control improvement.

Exercises for lower limb

Exercises for the legs in lying position

1. Stretch the leg by the heel and place it on the table.
2. Abduct and adduct the hip smoothly with the knee bent placing the heel on the table.
3. Now abduct and adduct the leg with knee and hip protracted by placing the leg on table.
4. Stretch and extend the hip and knee with heel
5. Stretch and extend both legs together with the heel on table.
6. Stretch one leg and extend the other one.
7. Now stretch and extend one leg while abduct and adduct the other one.
8. Heel one limb to the other leg (toe, ankle, shine)
9. Heel one limb to other knee by sliding down the crest of tibia to ankle.

Exercises for the legs in sitting position

1. Lift one leg to place the heel on the marked area, while the other one is stretched to slide the heel on the mark on floor.
2. Patient is asked to stand and sit again from a sitting posture.
3. Abduct and adduct the hip in sitting position.

Exercises for the legs in standing position

1. The weight of patient is transferred from one foot to another.
2. Foot is moved forward and backward on a straight line.
3. The patient is asked to walk along a winding strip.
4. Walk between two lines.
5. Walk sideways by placing the feet on a mark.
6. Walk forward and come to the mark back again.
7. Walk and switch the directions.

Exercises for upper limb

The exercises performed for lower limb may be practiced for the upper limb in a way that the patient places his/her hands on the mark on the table or the board to improve coordination and movements in upper limb.