Individual Care and Falls Prevention

My mother in her mid-to-late 80s had a serious fall while living in a retirement village. Fortunately, she did not suffer any fractures and, though having appeared to have suffered a minor stroke as a result, fully recovered. Her experience was by no means an isolated case. The findings of researchers in the field of falls prevention show that amongst the aged there is a high incidence of falls in hospitals and even higher rates in the wider community. And it is the aged with cognitive impairment, including dementia, who are the most vulnerable to falls.

Falls Stop Campaign in New Zealand

I was immensely impressed with the presentations at a recent Falls Prevention seminar, part of the Falls Stop campaign being conducted by New Zealand’s Health Quality and Safety Commission (HQSC) aimed at hospitals and aged care residential facilities, but having in mind extension to wider community programmes.[1]

According to keynote speaker, Dr Anne-Marie Hill of Curtin University, Australia, successful falls prevention programmes rely on effective communication between carer and patient or resident. This communication should ensure aged persons are properly informed of the nature of the risk and enabled to participate in taking care for themselves in a way that effectively lowers the risk, improves the quality of life and potentially extends the span of their lives. Anne-Marie convincingly argued that enabling a person to learn is a key driver of effective falls prevention programmes. This entails the carer taking time, and utilising the appropriate skills, to understand the individual person and her needs. In particular the carer should take time to discover that person’s preferred way of learning which guides how information should be conveyed and her personality, life history etc. Another important factor is including family in this process. These factors are even more critical in the case of those cognitively impaired who require specialised  skills on the part of carers.

Everyone at the seminar was deeply struck by the presentation of Colleen Hill and Wendy Stanbrook-Mason from the Whanganui District Health Board. Under the leadership of the outstanding Sandy Blake,  Colleen and Wendy presented research that showed how the Care with Dignity programme at Whanganui hospital has significantly reduced falls and harm from falls for the cognitively impaired aged admitted to the hospital.

Both of these presentations clearly showed that, unless programmes are designed and implemented in a manner that meets individual needs, they are doomed to fail with a considerable waste of time, money and effort.

Feldenkrais® and Falls Prevention

The experience of attending this seminar and listening to the words of these committed carers made me appreciate yet again how unique and valuable is the contribution that the Feldenkrais Method® and we practitioners make towards the wellbeing of individuals including the needs of the aged. The Feldenkrais Method® is a form of somatic education with a focus on improving overall functioning of “body and mind” – the whole person.  It uses accessible (mostly slow and small) movement to foster sensory awareness. It is this awareness that brings about real improvement in carrying out all activities in which people engage. It very much relates to the themes of the Falls Stop seminar in being fundamentally concerned with an individual person’s own learning rather than as someone to be “treated” or “instructed” on what they ought to do, or take, to be better or safer.

In both our one to one work (Functional Integration® “lessons”) and our group classes (Awareness Through Movement®) we not only give emphasis to communicating to the client or student in a way that informs their individual learning, but also to receiving information from the client or student about their individual needs through our observations and hands on touch and movement of the client. This is very much a kind of somatic learning based on care and mutual respect. It fosters self-care and realisation of the person’s potential for improvement. We work with a wide range of people of all ages and conditions responsive to sensorimotor based learning. This approach is supported by the rapidly increasing scientific understanding of neuroplasticity – the capacity of the brain and entire nervous system to re-pattern itself in the direction of better mental and body functioning. 

As a Certified Feldenkrais® Practitioner I would not be unique in having in my group classes a person who is approaching 90 and several others in their 70s and 80s. What attracts them to attend and to keep attending my classes? It is the realisation that armed with nothing but an attitude of openness to learning they are able start from wherever they are at and begin to embed learning in their daily functioning for ongoing improvement. A key component of learning in this way is improvement that addresses directly the different elements of balance that can make all the difference when it comes to preventing falls and when falls do happen minimising the damage from them.[2]

Care and Respect

What struck me most about the presentations at the Falls Stop seminar was the underlying message.  A passionate desire on the part of institutions and carers in them to show genuine respect for the dignity and unique identity of each person as an adult and their individual needs is the basis of successful programmes for the aged. Kindness and friendliness towards residents and their families is an essential starting and ending point in hospitals and care institutions for the aged. This was shown to be especially important for finding the key to unlocking the potential for improvement in the case of the cognitively impaired aged. For without that core value of care the necessary specialised skills will be wasted.

– © Alan Cameron, 2017

[1] Falls amongst the ageing population is increasingly recognized as a major but previously under appreciated phenomenon with a high incidence of serious injury. This includes fractured hips which has a significant life-shortening effect. New Zealand’s Health Quality and Safety Commission has sought to address this problem. Its focus has been on falls in hospitals and rest homes with a view to improvement in the wider community where the incidence of falls is considerably higher.

[2] For an outstanding example of a person who overcame a whole raft of traumatic brain injury effects, including balance issues, using neuroplasticity based learning see Clark Elliot’s The Ghost in My Brain, Viking, 2015.

Kinaesthetic learning – the key to learning how to function in the world at any age

In my last blog I talked about what is required for getting down to the ground and rising up from the floor to standing with minimum effort – actions that seem to become difficult as we age. I introduced the idea of spiralling as an essential element of good human action and how this is part of getting down to and up from the floor or ground. Here I am connecting what is involved in the spiralling movement to our somatic (whole person) learning applicable from infancy to old age.

Human Somatic Learning
Everything a human does as a matter of habit is learnt and not purely instinctively as a matter of survival. We have a tremendous capacity for learning. Infants are “hard wired” with the desire to learn. However, this human learning takes time and is highly social and cultural.

It’s social because for a child to learn to walk, for example, requires interaction with other humans, normally the parents. Though the child does much of its learning on its own through exploring what interests him or her, yet the conditions for effective and healthy learning is dependent on other humans.

Learning to Function in the World – Kinaesthetic Learning
The Feldenkrais Method® uses the early childhood way of learning – kinaesthetic learning. Feldenkrais practitioners say we do not directly teach people how to do this or that. Rather, through our verbal instructions in classes and by hands-on movement of individuals in our one to one lessons (functional integration®), we set up the conditions for each person to learn for themselves what is good and effective somatic (whole person) functioning.

A developing child from the outset is learning for itself not by obeying someone else’s instructions or by rote learning. Kinaesthetic learning means learning by attending to one’s sensory experiencing in movement, directly engaging the sensorimotor cortex of the brain and nervous system which connects to muscles that do the moving work for us.

But human learning is also cultural. For an individual child this means how the child learns – the manner and style of learning that embeds itself as acquired habits – is a reflection of her context, the total environment including the social environment of its immediate family. If a child’s parents themselves never learnt to embody well the elements of spiralling movement neither may the child – influenced as it is by the example of its parents’ own habits of moving.

Losing childhood kinaesthetic learning
But even when we did learn to move and function well in our youth, as we age, under social and cultural influences, we lose those abilities to function in that easy flexible way. The most serious loss however is our ability to learn kinaesthetically as a child does – even while our conceptual and analytical skills have developed. We have lost the somatic awareness that enables us to retain or regain these abilities.

To a great extent in our society loss of this effective functioning is due to our own neglect, a failure to avail ourselves of the somatic awareness that we had as a child.

Spiralling movements that are found in young people then are lost for many as they age. But this is not an inevitable process. My Feldenkrais® teachers in their 70s and 80s demonstrate this truth. Through embodying this way of learning I walk more easily and powerfully at 64 than I did in my 30s and probably than I ever did!

Recovering the ability to learn kinaesthetically
So what is the key to adult learning that enables us to recapture the ability for easy effective spiralling movement?

Firstly it is not by relying on our developed analytical and theoretical thinking disconnected from kinaesthetic experience.

Instead, like a child, we must once again recover the kinaesthetic way of learning. But unlike a child, for us adults it has to be with conscious awareness that we are doing this. Studying anatomy or the discipline of kinetics and then directly attempting to imitate what they seem to show is needed is not effective somatic learning (though such somatic learning is enhanced by such knowledge).

This is because our systems cannot embody directly such analytical conceptual learning. The amazing complexity of our bodies and human functioning in movement far exceeds our capacities to analytically comprehend that complexity in a functionally self-applied way.

Spiralling is complex
Spiralling like all completed human actions involves three essential elements of timing, orientation, and coordination. But when it comes to normal functioning in our own environment, unlike animals, we are not “wired” to carry out actions embodying these three elements in an effective or efficient way.

So how can we learn to embody the principles of timing, orientation, and coordination for spiralling movements – an amazingly complex achievement for a human being – following the childlike way of kinaesthetic learning?

In my previous blog I explained how good action involves spiralling movement and how this this is required for easy getting down and up. This is very complex movement, firstly, because spiralling requires constant shifting of weight over the two feet and also over the bottom of the pelvis when in the sitting position on the ground or floor. This in turn involves constant changing of one’s anatomical orientation. If you just consider your head movements in spiralling up and down. Your head is constantly changing its orientation as you move your body through different planes of action. So moving the whole body and its parts required for spiralling movement up and down must be coordinated – there is a connected sequence of bodily movements. But effective coordination depends upon a precise timing throughout the action in order to effortlessly go down to and reverse back up from the floor without a break or jerkiness in movement. This is only learnt by paying attention to what one is experiencing through the internal kinaesthetic sense – through proprioception.

Spiralling is embodied through kinaesthetic learning
One must embody this way of learning to identify your current less-than-effective patterns of movement and to re-form them into new more functional habits. Embodying is the key concept here.

The young child does not analytically comprehend, or may not even have heard of, the three principles or of spiralling or any of the concepts I have discussed. Yet she has learnt to practise kinaesthetic learning at a very early age and embodies these somatic principles without that kind of conscious analytical knowledge.

In the end the same kind of kinaesthetic embodying must be practised by us as adults if we wish to recover, or even discover for the first time, really effective functioning in movement. But for us, unlike the young child, acknowledging the theoretical and scientific basis of such learning may be required to lead us back to that way of learning.

The process of learning to spiral in getting down and up has many more benefits than just getting up and down. It can be life changing for all of your movement based activities and more besides!!

– © Alan Cameron, 2017