A New Movement: Feldenkrais and Falls
Abstract & Commentary
By Russell H. Greenfield, Editor
Synopsis: Results of this small pilot trial suggest that a specialized movement program based on the principles of Feldenkrais therapy, when offered to elderly community-dwelling subjects twice weekly for 10 weeks, improves objective measures of balance and movement as well as self-confidence in both areas.
Source: Connors KA, et al. Feldenkrais method balance classes improve balance in older adults: A controlled trial. Evid Based Complement Alternat Med 2009 June 24; Epub ahead of print; doi:10.1093/ecam/nep055.
Researchers from an Australian rehabilitation center sought to determine whether a series of Feldenkrais method classes could improve balance and mobility in community-dwelling older adults using a prospective, controlled, non-randomized design. A convenience sample of 26 subjects (median age, 75 years) who were already enrolled in Feldenkrais method classes ("Getting Grounded Gracefully") were compared with 37 volunteers (median age, 76.5 years) who were recruited for participation as controls (no intervention). Subjects in the intervention group attended two 1-hour classes a week for 10 weeks, with each class emphasizing different movement tasks such as moving from sitting to standing, or shifting weight while standing. In addition, postural control exercises were a core component of each session. The instructor employed what is described as an "exploratory learning approach," where participants were verbally guided through movement sequences and progressed at their own pace. Both groups underwent tests for balance and mobility at baseline and after three months (at the end of the series of classes for the intervention group, and after a three-month period of time for the control group).
Outcome measures of interest were all related to balance, motion, and self-confidence in walking. Tests employed included the Activities-specific Balance Confidence (ABC) questionnaire (a self-rated scale used to assess confidence in balance), the Four Square Step Test (FSST, where ambulation and ability to change direction are tested), and self-selected gait speed (the latter chosen because slower gait speed has been associated with an increased risk of falls and impaired balance). Testing was performed by one of the investigators and a research assistant.
At trial's end, the intervention group showed significant improvement on all measures, while the control group improved on but one measure (FSST); however, even on the FSST, subjects in the Feldenkrais group had significantly greater improvements when compared with the control group. Of particular interest were the results of the ABC questionnaire, where the control group's scores declined slightly (nonsignificantly), while the intervention group's results improved significantly, implying enhanced confidence in the ability to move without falling. The authors conclude that a modified form of Feldenkrais movement therapy may help improve balance in older adults.
Commentary
The Feldenkrais method was developed by Dr. Moshe Feldenkrais (1904-1984), a physicist, mechanical engineer, and expert in judo. The approach borrows significantly from the martial arts in that there is a focus on engaging all parts of the body in balance and movement training. Classes are often described as gentle, as well as upbeat and optimistic in character. Participants typically have movement disorders due to a variety of maladies, ranging from traumatic injury to stroke to uncomplicated back and neck pain. The authors note that some research results suggest balance training may be more effective in lowering falls risk than strength or endurance training.
Results of the current trial are intriguing but, as with many pilot trials, there are methodological concerns, not the least of which is the potential for bias. The authors chose pragmatism and so used subjects for the intervention group who had already enrolled in the series of classes, suggesting an inherent interest in and belief in potential benefit from Feldenkrais therapy. This likely created an impact on results of at least the ABC questionnaire. In addition, the lack of blinding to group allocation is a significant weakness.
Little research has been published on the Feldenkrais method, yet a growing number of people are exploring this unique approach to improving physical function. Patients can participate in one-on-one sessions or join group classes. As noted, there is an emphasis on self-rated progression and pace of learning, and an inherent optimism girding Feldenkrais method classes that typically makes them enjoyable. Experience suggests this approach can be of benefit to patients experiencing limitations in movement, and can bolster confidence, the lack of which contributes to lessened physical activity. The current study does what a good pilot trial should it encourages further investigation and permits consideration of the treatment, but is not a critical assessment in and of itself.
Results of this small pilot trial suggest that a specialized movement program based on the principles of Feldenkrais therapy, when offered to elderly community-dwelling subjects twice weekly for 10 weeks, improves objective measures of balance and movement as well as self-confidence in both areas.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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