(Sis, me, brother-in-law, Dad, Birthday Girl)
I have a really busy time at work so blogging is taking a back seat. It has been relegated to the slow lane for a week or so. I am learning how to take things a step at a time and how to use my time efficiently.
In my posting on March 23rd, “A new train of thoughts” I wrote:
“With ataxic clients there is always the need to slow the movements down, in order to find their balance and to distribute their weight to where it is needed. Counting helps, especially when walking.”
Two people raised points in comments to this posting:
“Slowing movements down with individuals whose life is affected by ataxia increases tremor.”
Andrew Sutton asked in his comment (and in a posting on his own blog):
“How to adjudicate between two different practices/understandings? How to resolve conflicts of opinion? Should one even try to do so?”
“Where is the authority’? How is it decided? Where is the evidence for this or for that way of doing things?”
Thank you for these comments, my work has been extra specially good the past few days because of them. I have been giving much thought to what I meant and how I can best express myself.
I will try to express some of my thoughts from the past few days. Maybe these thoughts offer answers we will see if not then maybe I can open up some discussion on the matter and we can discover some together.
Whatever I do at work, whether with children or adults, whatever their diagnosis, is fine-tuned to the individuals involved, to their symptoms, to their needs, to their lives. It is difficult to say that I work like this with clients with ataxic symptoms or like that with athetoid, Parkinson’s, stroke or brain injury. I can’t say that I work “like this” with this group or that group because I work with individuals or groups of individuals with tasks to attain each individual’s aims. These tasks are not specific to a diagnosis or a symptom, they can be interchangeable, often used in one individual’s programme for very different reasons to using them in another’s.
Something almost universal, in groups or in individual sessions is the initial need to slow down, to take stock, to understand. Just like I have been doing this week.
There is a need to slow down movement, to slow down the tempo of movement and, most important this, to slow down the thought process. All this needs to take place before the speeding-up process can begin again.
My own thoughts are always several steps ahead of my actions. Perhaps you all have experienced this? I am sitting here on the bus scribbling down my thoughts as fast as I can. I quite often write words that I am thinking before I have finished writing the sentence before.
While I sit here on the bus, thinking faster than I can write, trying to catch the important bits as they whiz past as pictures in my head, I am also thinking about getting off the bus at the next stop. I do not, however get up straight away, I carry on writing, I finish the sentence, pack my notebook in my bag and then leave the bus at the right stop.
Many of the children and adults I work with react differently. Often the moment the thought of their next action comes into their head the present action is forgotten, (overpowered even) by the new one and a different movement is started.
How many conductors have experienced the following?
I pour a drink into a glass that a child is already holding. At the moment the liquid starts to flow into the glass the child begins to think about drinking and, although the child knows that the liquid will spill if the glass is moved and knows about the need to press the glass on the table, he/she will nevertheless begin to lift it from the table towards the mouth.
What is needed here? I think what is needed is to slow down the thought process and the movements to a point that they come together, where they can be synchronised. Counting and using words can help this.
Back to ataxia , perhaps
Ataxia is usually accompanied by a fast sequence of movements, by uncontrolled movement, inability to place a foot accurately where it is wanted, irregular tempo to movement. While concentrating on one limb often the control of others is lost, there is always a lot to do, lots of corrections to make at once, an almost overwhelming task.
My starting point is always learning how to slow down. Learning to separate a thought from an action, to give points or objects to aim for and learning tricks to overcome or prevent ataxic tremor. Included in this will be the use of counting and words.
What is needed is time to bring everything together. Time is something we have lots of. It is there to be used efficiently.
If children or adults learn to walk quickly, it is not because I have taught them to walk quickly. They walk how they can at a given time. As a conductor I then have to work out with them how to control all body movements. We have to work out together the best way for them to make slow movements in order to walk slowly, to reduce or overcome tremor, allowing them to learn to walk slower and slower, and eventually learning to stop, to stand still and to start walking again.
Yes, sometimes when someone with ataxic symptoms stands still for a while the body may begin to sway, which can then become incontrollable movements. The duration of standing must therefore suit the client at a specific point of development and this duration will therefore change. More tasks and “tricks” can be developed to lengthen the time of standing still without the onset of the swaying. Then tasks will be found to facilitate an increase in the tempo of walking and the size of controlled steps, till learners can walk quickly and stop without seeking a wall or furniture, and without falling on their faces.
To begin to walk quickly with controlled movement, it is first necessary to slow down.
Frenkel’s walking-sideways exercises that I picked out in my “A new train of thought”, the exercises set to a rhythmic counting, are activities that I favour for teaching any clients to “slow down”, to bring movement and thought processes into synch. To find a basis from which to build up a rhythmic and controlled, slow or fast pace of walking, and to learn to stop and to stand still. Walking sideways does not allow for forward propulsion , it does not allow for moving faster and faster, possibly leading to more and more “out-of-control” movements and tremor which can occur with all clients when walking forwards. Because of this we have more time to think, to move, to use words and counting, and to move into the slow lane. When being in the slow lane begins to bring the results that we are looking for, to solve the problems, to bring solutions that control or prevent tremor, bring about aimed movement and stability then we can think about pulling out into the fast lane again and speed up both thought and action.
Some clients with ataxic symptoms have a tremor when they walk and they discover that by walking quickly they can remain on their feet. As a conductor I see it as my task to assist them to find ways to walk slowly and also remain on their feet. This will then eventually bring about more controlled and faster walking and stopping. This is not only the case with client with ataxic symptoms, it applies to many others.
Dr Mária Hári gets a word in
I was talking about practice with a colleague this afternoon and she reminded me of what Dr Hári often said to us:
“If you have an idea and have a child in front of you, then try it out.”
There are no rules of how to find a solution, there are no set solutions. Together with a conductor all individuals find their own answers.
Andrew Sutton asked: “How to adjudicate between two different practices/understandings? How to resolve conflicts of opinion? Should one even try to do so?” “Where is the authority?”
Could it be with the client, in the practice?
He also asked: “How is it decided? “
Maybe it is decided by asking these questions: Does it work? Does it make life more liveable? Does it help to find solutions?
Does not the evidence for this or that way of doing things lie in the doing and in the developing of independent thinking and problem-solving?
“A new train of thoughts”