Frenkel’s exercises.pptx

For physiotherapist

1. Frenkel’s exercises

2. Frenkel Exercises were originally developed in  1889 to treat patients of tabes dorsalis and  problems of sensory ataxia owing to loss of  proprioception . Dr.H.S . Frenkel made of special study of tabes dorsalis and derived a method of treating the Ataxia, which is prominent symptom of the disease, by means of systematic and graduated exercises.

3. Frenkel‘s Exercises are a series of motions of  increasing difficulty performed by ataxic  patients to facilitate the restoration of  rhythmic, smooth and coordinated  movements.

4. He aimed at establishing voluntary control of movement by the use of any part of the sensory mechanism which remained intact, notably sight, sound and touch, to compensate for the loss of kinesthetic sensation.

5. During exercises all movement required….. 1. concentration of the attention 2. precision 3. repetition The muscles sense is practically non-existent by the time a patient comes for treatment, the objective of the exercises is to teach him to replace his lost sense by the sense of sight. If the patient is in the pre-ataxic stage, he should perform the most complex movements as much as possible. Principles

6. In the later stages, the exercise should begin with very simple movements and gradually advance to more complicated ones.

7. RULES OF GIVING FRENKEL’S EXERCISE Commands should be given in an even, monotonous and the exercise should be done by counting. Patient should be able to do all exercise accurately and smoothly.

8. Exercise involving strong muscles work should not be given. Progression is by complexity, not strength. Movements in complete range are easier than those in small range but no movement should be taken beyond its normal built because the hypotonia of the muscle and laxity of ligaments render the patient vulnerable to dislocation or the onset of Charcot's joints.

9. The movements should be given rather quickly, then more slowly, this being more difficult since it requires greater control. The patient should practice movements first with his eyes open and then with close. Rest must be given between the exercise; after so many minutes work, an equal number of minutes rest should be taken.

10. 8. It is necessary, when planning the treatment scheme to take into consideration, the patient’s general health and mental attitude, the state of his muscles and any complications such as Charcot's joint

11. EXERCISES IN LYING The patient lies on a bed, plinth or couch with a smooth surface along which the feet can move easily.. His head must be sufficiently raised for him to be able to watch his feet. The exercises in this group begin with simple movements and gradually more difficult and complicated.

12. EXERCISES IN LYING

13. The 1 st set are as follows(one leg moved at a time, legs move alternatively) Flexion of one leg at hip & knee, foot kept on plinth, extension. Flexion as above, abduction , adduction ,extension. Flexion as above, but only a half way; extension. Flexion as above(half way),abduction, adduction, extension.

14. The exercises are done slowly three or four times, by using each leg in turn. The foot should be kept dorsiflexed, so as no stretch on hypotonic anterior tibial group. The Physiotherapist should count for during each movement. At a later stage both legs are moved together.

15. E XAMPLES OF MORE DIFFICULT EXERCISES IN THE LYING SERIES: Flexion of one leg at hip and knee, with the heel raised some inches from the plinth, extension. Heel of one leg placed on patella of other leg, Return. As above with voluntary halt. As above with halt to command. Heel is placed on the middle of the other tibia, lifted off and put by side of leg, extension.

16. Heel placed on knee; heel slides along tibia to ankle joint; extension. As above, but heel carried from ankle back to knee; extension. Flexion and extension of both legs, with heel off bed. As above with halts One leg flexed; left leg abducted & right leg flexed simultaneously; left leg adducted and right leg extended; left leg extended.

17. Left leg flexed, right leg abducted and flexed; Right leg adducted; both legs extended without heels touching bed till end of movement. The physiotherapist places her finger on various places on the leg; the patient places his other heel on her finger As above, but the patient reaches the finger, the physiotherapist moves it, and the patient tries to follow its course. Right heel is placed on the knee of other limb, which is in extension; with right heel in this position, the left leg is flexed and extended.

18. Right heel is placed on left knee, and slides down the tibia to the ankle; as it slides down, the left leg is flexed; as it is brought back to the knee, the left leg is extended.

19. Hip range of motion

20. Knee range of motion

21. Combination of hip and knee

22. Anatomical land mark (Shin of tibia)

23. Exercises in sitting Those given by Frenkel consist of rising from stool or chair, and sitting down again the patient has literally forgotten how to perform these ‘stock’ movements. The rising movement, therefore is divided into its component parts, the operator counting three. At one……..the patient draws his knees under the stool.

24. At two……the bends his trunk forward. At three….he rises extending hips and knees. These movements may be done at first in the reach-grasp position, the patient sitting close to the wall-bars. Later, he rises unsupported. Later still, he attempts to do so with his eyes closed.

25. Other exercises may be given in sitting :- 1. The patient may be directed to raise his knees and place his foot on, say, the second rail from the bottom. This is done in three movements…… A) flexion of hip B) extension of knee C) lowering of foot on to bar He then replace the foot on the ground. 2. He may be made to tough marked points on the floor with his foot.

26. EXERCISES IN STANDING These are designed to give re-education in walking. They should be performed in a large space.

27. Side walking

28. Walking sideways - In this prepare to give support to the patient if necessary, it begins by walking sideways. Balance is easier in this way. Because in long step he does not have to rise on the toes of one foot, thus decreasing his base.

29. Turning towards left and right

30. He should begin by taking half-step, with physiotherapist counting three for each step, e.g. for half step to right.... a. He places the right foot on the ground a step away. b. He transfers his weight from the left to the right foot. c. He brings the left foot up besides the right.

31. He then practices quarter steps, then long steps and then finally combines all the three lengths in one exercise. a. Three quarter step to right one-two- three. b. Quarter step to left one-two-three. c. half step to right one-two-three. d. whole step to left one-two-three. - The long steps are more difficult because the toes have to be put on the ground first. The heel is raised and the patient’s base is therefore smaller.

32. 2. Walking forward - whole half and quarter steps forward, beginning with each foot alternately, counting three before….. Thus beginning with right foot… a. Place right foot forward, heel on ground. b. Transfer weight to his foot, raising heel of left foot. c. Bring left foot up besides right foot.

33. 3. Walking backward, in a similar manner. 4. Walking heel to toe 5. Walking in footsteps painted on the floor 6.Turning round 7. Walking up and down stair or steps: a. The patient first goes up one at a time, later he practices walking up the steps as a normal person would. b. He walks up and down, with support to begin with later without.

34. 8 . Finally, he is taught to walk while using his arms at the same time, carrying parcels, getting out of the way of obstacles etc. When the arms are affected, which is much more rarely the cause exercises of a similar nature are given, special attention being paid to the fine movements of hands and finger in holes in a board; inserting pegs or matches into holes; picking up small objects like marbles and arranging them in piles or patterns. He should also practice going over diagrams with a pencil,writing,drawing etc.

35. Exercises For The Arms a)Sitting (one Arm supported on a table or in slings); Shoulder flexion or extension to place Hand on a specified mark. b)Sitting; one Arm stretching, to thread it through a small loop or ring. c)Sitting; picking up objects and putting them down on specified marks

36. Exercise to promote movt and rhythm E xercises are repeated to rhythmic count. a)Sitting; one Hip flexion & adduction. b)Half lying; one Leg abduction to bring knee to side of plinth, followed by one Knee bending to put Foot on floor, the movement is then reversed & repeated. c)Sitting; lean forward and take weight on Feet(as if to stand), then sit down again. d)Standing; Arms swing forwards backwards (with partner holding two sticks). e)Standing or walking; bounce & catch, or throw & catch a ball.

37. PROGRESSION of Frenkel’s exercises alteration in speed, range & complexity Quick movements, less control S l o w movement, high control movements build up from simple to form complex e.g walking According to disability re-education starts from lying to standing.

38. BENEFITS OF FRENKEL’S EXCERCISE • Improve co-ordination. Improve balance. Improve body awareness. Improve postural awareness. Improve selective movements. Improve proprioception.

39. In the paralytic stage, only very simple movements can be given, but breathing exercise are important.

40. THANK YOU