by Annie Thoe, Feldenkrais® Practitioner and Assistant Trainer
This article will be a general guide to working with people with a stroke. Many of the activities work effectively with trauma as well.
While the brain is different from a spider web, as humans, we can learn something from the spider. Our internet is built in the image of the spider. We store information in a “web.” It would behoove us in medicine to use this model of the spider for healing, repair and bridging the gaps in the brain and nervous system. How do we bridge the nervous system?
Engage as many senses as possible. Nature is powerful and a good place to begin. Be creative and start with aspects of nature that the patient connects with. Sunlight is universal. Water. Clay. Rocks. Teddy Bears– or cats or dogs, even better. Fresh air, breezes, sounds of trees blowing in the wind. All this is stimulating. Be careful to provide small amounts of stimulation at first followed by quiet rest. The brain needs a lot of rest in between short periods of careful stimulation to connect areas that have lost feeling or coordination. The following protocols will address that.
The activities below are designed to stimulate the Sensory Nervous System which will in turn stimulate the Motor Nervous System. The Sensory Nervous System is what registers pressure, movement, direction, weight, space/time, hot/cold, smell, taste, and sounds. Using sensory stimulation is a wonderful way to work with reconnecting and helping better organize someone’s brain. I have developed the activities below and have found them extremely effective.
In general, work with what the person already does well. If her right side is paralyzed, work with the left side first to improve her coordination and sensitivity and gradually introduce the less sensitive or responsive areas into the activity. For the activities below, start with the functional side and spend a shorter time on the less functional side (so you don’t irritate them or frustrate them.) Always try to choose activities they can easily succeed with before introducing something difficult and if they fail, go back to what they know and can succeed with.
A precaution about touch:
Because they are more vulnerable in being unable to move or speak, be careful with your touch to avoid overstimulation. Slow yourself down with some nice full breaths before you enter the room to sense their state of mind and what kind of attention they have in that moment. Are they tired? Sleepy? In Pain? Content? Bored? Lonely? Happy to see you? Assess what you can about their energy level.
One way I have found to connect that is very effective to slow down and connect to the person is Ho’oponopono, a Hawaiian healing technique. There are four parts, and each part is designed to connect you to the aspect in yourself that is reflected by the patient. You take responsibility for this illness that is somehow reflected within yourself.
Part one: Say “I love you” to yourself and this part that is represented by the patient/client.
Part two: Say “I am sorry” to yourself, connecting to the hurt or dis-owned part of yourself that is suffering.
Part three: Say “I forgive you” to yourself, for whatever you may have done that treats yourself with disrespect, harm or neglect.
Part four: Say “thank you” to yourself, for receiving this healing, forgiveness and love. This thanks is one of the most important parts of healing, by acknowledging all three of the other steps and accepting help.
After practicing Ho’oponopono, I have found a much more patient and gentle attitude with clients who may be terrified, angry or in a difficult place of suffering and pain. I can connect with my own feelings and work from a neutral, yet loving place. I highly recommend this practice. (For more information, check out Joe Vitale’s book, Zero Limits.)
Once you have found a good connection with the patient/client, then begin with movement and speaking.
●Move slowly and clearly so they can follow your movement the way you would follow a fly walking up a wall.
●Speak slowly and allow pauses for them to contemplate what you are saying.
●Repeating yourself is helpful and helps to reinforce their understanding. It’s good to explain that you are trying to just be clear and aren’t sure how hard it is to understand you so that is why you are repeating things to them. This repetition may not be necessary as they progress, but I believe is very helpful to them as they learn to organize language and cognition again.
Activities to help stimulate the connections of movement with the brain:
Working with a ball:
(The picture above is with a non-stroke client, but demonstrates a way to use the ball in walking. There are many ways to use a ball. More pictures will be added to this article in the future.)
Slowly roll a small ball from each finger up the arm to connect the hand to the collarbone, and also to connect the hand to the chin (for hand coordination of feeding and grooming later on…).
Slowly roll a ball from each toe up the leg to the hip and even all the way up to the chin. Again with the goal of creating neurological connections for movement of the feet and legs.
If they can hold the ball, assist them in rolling the ball on themselves, eventually to their paralyzed side (connecting the two sides in the brain).
After working a bit with the paralyzed side so they are accustomed to being touched, you can begin to have the functional hand interlace fingers with the non-functional. Don’t force this. Begin slowly and watch for irritation and agitation. (If they get too irritated, they won’t learn as well and it can interrupt progress if not even be slightly traumatizing.) Stop, take a break and distract them with something pleasant. Remember to breath if you feel them tense up. If they calm down quickly, you can return to exploring the interlacing of the two hands.
Working with a clipboard:
Put their hand on the clipboard and gently, slowly move the clipboard to engage the full hand, encouraging more and more contact of the entire surface of the hand (increasing the sensory area of stimulation). As you tilt the hand using the support of the clipboard, feel how the weight of the hand connects through their skeleton—up the arm and perhaps all the way into the shoulder girdle. It’s an amazing process to feel the skeletal support in the movement and very pleasurable for the person receiving.
Very gently, bring the clipboard to touch the bottom of the foot. Sometimes, with bedridden clients this can elicit a lot of pain so you may need to do this introduction in stages. A little bit of contact at a time, but be careful it isn’t too light that they may feel ticklish. Exhaling (for yourself) as you touch will help them relax.
Music and Rhythm:
Music is one of the oldest and broadest links within the brain. Find out what their favorite music is and play it or sing it. Use the beat of the songs to stimulate movement: clapping or tapping fingers or toes. If they can’t tap, you can gently tap with your hands on their palms (imitating clapping) or on their thigh (simulating patting their own leg). Sometimes, these experiences trigger links in the brain that tie into old movement patterns. I’ve seen leaps of recovery using music. Even if you don’t have the best singing voice, it can be lovely to have someone sing to you in loving manner.
Especially if they like poetry, this can be a nice tool to combine with touch or movement. Be sure to repeat lines often. It actually is a wonderful way to stimulate short term memory, especially if it’s a good poem! The Poet David Whyte often repeats lines over and over when he reads poetry and it’s a wonderful effect and really helps the words stay in your memory.
Games are fun because they are social and appear like it is play versus work or therapy. Make sure it stays fun, explorative. Stop if they get frustrated and come back when it’s fun. Have other activities to do if one doesn’t work.
Cards: Solitaire is excellent for working with numbers, sequential number recall, hand-eye coordination. Just putting the cards in order or by suit can be satisfying.
Board Games: there are plenty of kids games that are colorful that can be used to point to colors, move the pieces on various colored squares and help with language and special connections.
Catching and Throwing things: Use nerf like balls or light small beachballs or balloons, small basketball nets for targets or cans, any kind of simple easy games of catch or target practice is very fun. It’s satisfying to bat things around and helps relieve some pent up frustration or aggression from being immobile.
Engaging the Mouth: Use a straw and practice blowing the wrapper off, or blowing paper wads. Use a lollipop for sucking and have her move her lips and tongue in various ways to develop control. Practice smacking lips, licking lips in all different directions. Making vowel sounds. Making one consonent sound over and over while singing… “Ba, Ba, Ba…….La, La, La.”. It’s endless the list of things we can do to refine the movement of the lips, tongue and mouth.
There are more activities, but these are great foundation activities to address movement, language, and cognition.
©Annie Thoe, Feldenkrais Practitioner, www.sensingvitality.com 2012