For my final thesis, I chose the title “The Path towards the overall coordination of body and mind”. What fascinates me is that this path towards coordination is subject to continuous change. The path towards coordination is dynamic, it is something that flows, and we should make an effort to go with this flow! This is the life force within us.
Sometimes we, in our wishes, thoughts, prejudices, ideas, and actions, block the paths towards overall coordination within us. As a physiotherapist, I also encounter children who suffer from disrupted coordination between body and mind due to illness.
Is it possible to change the coordination of body and mind in children who suffer serious brain damage from birth, which also results in damage to the body? Is it possible to change coordination when it comes to serious impairments to the feet, sensory problems, spinal and neurological damage, or a disrupted congenital primary control of the head?
I attempt to answer these questions by giving examples of children with whom I have worked and with whom I am still working.
Alexander Frederick Mattias (1869-1955) left us a wonderful tool that we can use to identify and overcome limitations in thought and movement. He also worked with sick children and seriously ill people.
What is the Alexander Technique?
The Alexander Technique is a pedagogical and empirical method used to improve the overall coordination of the human organism, which has a positive effect on the quality of all everyday life movements and activities.
As mentioned above, this is a pedagogical method, and not a medical one. However, as a physiotherapist, I use it in various medical cases, and, in my experience, I can say that by using the Alexander Technique the coordination of the children with whom I work changes much faster, better, and in a more integrated manner than when I rely solely on any physiotherapy method.
Physiotherapy often focuses only on the segment where the problem lies. Thus, if a child has a problem with his or her foot, work is devoted only to the foot. What excites me about the Alexander Technique, and this is the reason why I decided to study it, is the holistic approach to the problem. We consider the entire person, including his or her psychological, physical and spiritual components.
This is very important because, if you want to help a child, you have to get to know this child as an entire person, with all his or her potential and desires. You have to travel with this child towards a better joint coordination of the body and mind.
I will present some examples of good coordination. The first one deals with two brothers, diagnosed from birth with Pes Equinovarus. This is the most common anomaly of the foot, which is more frequent in boys. It consists of three components: EQUINUS (limited dorsal flexion), VARUS (foot rotated internally) and SUPINATION (the sole of the foot rotated upwards).

Example: Good coordination – Ilija (1-year-old) – Pes Equinovarus before the operation 

I started working with Ilija when he was only two weeks old. He cannot stand very well yet, but he wants to kick the ball. Let us recall Alexander’s plan for the well-coordinated performance of any activity. 1. The wish, the desire to perform an action. With children, we should go with their desired actions.

Look how passionately he kicks the ball at 2 years of age, and how he uses his body freely in spite of the fact that he is still waiting for an operation of his feet and walking on the lateral part of the feet.

1st Example: Ilija (4 years old) has not lost his good coordination after the operation of his feet

Ilija did not lose his good coordination even after the operation on his feet and knees. He is trying out new possibilities now that his whole foot is on the ground. He is asking himself what it feels like to stand on one leg. Good! Now I can fly like a plane, and, like Super Mario on my T-shirt, I can also stand on one leg!

1st Example: Good coordination. Gabrijel (Ilija’s brother), a boy with Pes -Equinovarus before the second operation on his feet

Gabrijel is Ilija’s older brother. He had an operation on his feet when he was eight months old. He is a lively boy in spite of the problem with his foot (a high arch and a foot that is too small for his age). These photos were taken before his second operation. Look at the coordination that Gabrijel developed thanks to his curiosity and the constant development of his capacities. His path towards good coordination enables him even to climb the door frame! I think it is extremely important for him that I, as his physiotherapist, did not try to hinder his wish to climb door frames, but I believed in him and supported him. However, I have to admit that this was not always easy, especially when he was younger, because he always tended to be on the edge of peril.
Gabrijel chose his own path to develop his coordination. Today, me, as an Alexander teacher, will continue to help him to improve his overall coordination. He is now attending the 5th grade, he plays the guitar and plays handball, and he is no longer so hyperactive. He is growing up!

Most people lose good coordination during their lives. However, does this really need to happen? Coordination depends on both body and mind. Some elderly people can have better coordination than younger ones, they can remain fully alert, lively and develop further. Alexander died when he was eighty-six, and he was the sharpest at that age.
 Children who have developmental difficulties, whether the damage occurred prenatally (from conception to birth), at birth, or postnatally, may have problems with establishing good coordination during their lifetime.

If the head in relation to the body can balance freely, all movements are better coordinated. If the head is stiff, or too limp, this affects the spine, and the entire body loses good coordination. The dynamic balance of the head in relation to the body is key for freedom and ease of movement.

Mihael is a child with serious damage to his psychomotor system. Even today, as a 10-year-old, he cannot sit by himself, or speak, and he is not motivated to play. It is difficult to assess the level of his consciousness, but we can say that he reacts with laughter to the familiar voices of his loved ones.
His neck and the whole body are hypotonic, which means that his muscle tone is low. 
 In the first photograph, we can see that he cannot hold his head up by himself. Please focus attention on the expression on his face. 
 In the second photograph, I help him establish primary control. His facial expression changes. Not only does the body become integrated, but Mihael also integrates as a person. He finds himself, and experiences himself differently; he becomes attentive.
 In the third photograph, he takes over his own primary control. Can you see the slight expression of satisfaction on his face? Unfortunately, he can maintain primary control in the sitting position only for a short time, but he succeeds in attaining it anyway. Mihael is 10 today, and thanks to continuous work, in spite of the fact that this has taken a long time, we have succeeded in obtaining some fluidity in his spine, and in establishing primary control, at least for a short time.

Luka is also a hypotonic child, with frequent daily epileptic attacks. In the photo where Luka is lying on his back at six months of age, by adjusting the supine position, we build his muscle tone in order to achieve better primary control.
 At one year of age, he can autonomously turn on his side when motivated by a toy.
 At two years of age, he can sit autonomously, and, considering the problems that affect Luka, I dare to say that his primary control is good in comparison with a child that has no developmental difficulties, and that he has perfect primary control in the sitting position.

Primary control is the relation between the spine and the head. When the conditions are right, the spine is flexible and extended, and the head balances lightly on the first vertebra (atlas). When primary control is disrupted, the spine stiffens and contracts, the head pushes back and downwards. This is a comprehensive process which depends on our mental, emotional and spiritual condition, and vice versa.

F.M.A. working with a child who has recovered from polio, an acute infectious disease caused by poliovirus. It manifests itself in meningitis and muscle paralyses and paresis. 
He founded a small school for children, which was run by teachers trained in the Montessori and Alexander Technique methods.

There are different approaches that improve primary control. The Halliwick Swimming School also applies one of these approaches.
 In a supine position in the sea (floating), in order to improve the better relation of the head and the neck, I placed an accessory under Mihael’s neck. While the head balances in suitable conditions, I can deal with other parts of the body, and improve their coordination.
 In order to provoke Mihael’s primary control (since he cannot autonomously achieve primary control), I immerse myself with him under water and I use the propulsion of the sea (or water in a swimming pool) to lead his head forwards and upwards. I also give him information about primary control with my own body, and I “guard” his head so that it does not bend backwards. Remember the photograph of him in a sitting position – his head, due to the hypotonic neck muscles, as well as his whole body, fall backwards. With this kind of immersion, we also indirectly work on breathing control.
 On the beach, we integrate everything we have done in the sea once more in a sitting position. You can see on his face that he is tired, and that he has received enough information.

-       OUR THOUGHTS AND OUR CONCEPTS DETERMINE THE QUALITY OF OUR PERFORMANCE

1st Example: Penelopa – cerebral palsy – she cannot walk by herself

Penelopa is an intelligent girl, but she suffers from serious cerebral impairment. She has increased muscle tone in her legs, arms, and torso, and movement is difficult for her. She cannot walk by herself. She dreams of becoming a ballerina. Her father bought her a ballet dress, which she wore when she came to exercise. Several of us gathered around. I had a camera, and she started to dance “HER BALLET”. All of us who had gathered were amazed and shocked when we saw how easily she was moving her arms, rotating her torso, and growing upwards while she was entranced in her dancing!

„Her thought and her concept determined the quality of her performance in spite of the “real impairments” of her body.“

1st Example: Lovro – spina bifida – he has reduced feeling in his legs, and no feeling in his feet. In spite of this, he has been walking (below-knee orthosis).

The frontal lobe of the brain performs very important functions:

1.     PLANNING – Any damage in this part of the brain causes problems in planning all activities.

2.     ORGANISATION – Part of the frontal lobe has the task of controlling emotions that come, for example, with aggression, when we are hungry. It tells us to get food. It interprets emotions and, according to them, it moves parts of the body.

THE SPINAL CORD – enables nerve impulses from different parts of the body to travel to the brain and vice versa. It is also responsible for reflexes, which means that the brain does not participate in reflex actions. Since it is independent of the brain, it is considered a separate entity.

 Lovro was born with a condition called spina bifida. This means that the lumbar part of the spine is damaged, so that a cist forms in this area, containing both nerves and the spinal cord, which leads to paralysis and a loss of feeling below the affected area. The severity of the damage depends on how severely the nerves are affected. Sometimes, bladder and bowel dysfunctions can also occur.
 Since Lovro suffers from such damage, he can barely feel his legs, and he cannot feel his feet at all, but we can see in the photo that he is walking independently. His frontal lobe plans and organises the action. However, the spinal cord cannot fully transmit impulses towards the lower extremities, but only partially, because of a problem that occurred in the prenatal stage affecting the lumbar section of the spine. Lovro can feel the inner part of his extremities better, and, in spite of the fact that there is no connection between the brain and the feet, he can still walk.
 Lovro believes that the ground carries him and this is obviously enough for this realistic and intelligent boy to venture into walking autonomously. He cannot walk for a long time, but he can move around the house and cover short distances.

 

1st Example: Marija, problem with sensory integration and Penelopa (the ballerina)

Marija is a girl with sensory problems. She cannot feel her body very well, which also hinders her communication and socialisation. Penelopa is our ballerina.
 The dynamic balance of the head in relation to the body is key for ease and freedom of movement.
 However, it is not easy to work in this area with children. When they are small, they are not happy someone working on them directly, or touching this part of the head and neck. This is why I usually use different moments when they are occupied with something else (for example, reading or playing) in order to be allowed to touch this area and affect the dynamic balance of the head.

Relax your neck for the head to be able to direct itself forwards and upwards, in order for the back to extend and broaden.

2nd Example: Niko diagnosed with torticollis

Niko’s diagnosis is torticollis, a twisted neck. When he first came to see me, he was about two and a half years old. Only two years later, when he was four, he had gained so much trust in me that I could touch this area, albeit through play. Before he came to me, he had had a therapist who used other methods, and this experience had been quite traumatic for him.
 Niko’s head hangs downwards and falls to the left, because his sternocleidomastoid muscle is shorter on that side. In the photos you can see how, through play, and in front of a mirror, we succeed in indirectly gaining directions for primary control, so that the head would direct itself up and forwards, and the back could be expanded and broadened.

3rd Example: Working on primary control while jumping from a balance board

In the ecstasy of play, I manage to directly affect the primary control of the head and neck, while Niko jumps from the balance board and laughs.

 

 

Inhibition: The possibility of supressing the reaction to any stimulus. The capacity of saying “no”, even when all our mental, physical or emotional habits force us to react.

 

4th Example: Žarko, a boy with cerebral damage, cannot walk by himself

Žarko, a boy with cerebral damage, cannot walk by himself, and in the photo, he is wearing an orthopaedic device – orthoses – on his legs. The muscles on the right side of his body are shorter, so when he is not wearing orthoses he walks on tiptoes.
 His old habit is to start movement from the chest by strongly propelling the chest forwards. Now, when he is wearing orthoses, and does not have to propel his chest, his old habit still persists. I am trying to inhibit the chest, so that it does not react when he is walking, to help Žarko acquire a new idea of walking. This is partially successful, the chest still reacts, but not as forcefully as before.

 

 

 

5th Example: Petra, a girl with hemiparesis (damage to one side of the body) and Penelopa (the ballerina)

Penelopa has now grown bigger, and she finds it more difficult to maintain good coordination in the sitting position. In order to prevent undesirable habits and provide an optimum physiological basis for learning new activities, we decided that she should socialise and play with Petra in the prone position. This position will increase the muscle tone of her back and improve the primary control of the head and the neck, which will later result in better coordination in the sitting position.
 This also extends the possibility of thought and movement, not only for Penelopa, but also for her friend, Petra.

 

-       Improves the focus and effectiveness of performance

-       Optimises the coordination of movement

-       Establishes harmony between body and mind

 

1st Example: Rafaela and Jakov suffer from cerebral damage

Rafaela and Jakov can walk with an orthopaedic device (a walker). By improving their focus and effectiveness of performance, we started walking with the help of a walker. Jakov’s movement coordination is better, so he can move faster and more easily, but he has been using a walker for a longer period. These are Rafaela’s first steps with a walker, and, since she has a good model – Jakov walking in front of her – her coordination also improves, and she can autonomously move towards Jakov.
 The feeling of independence fills them both with satisfaction, and establishes harmony between body and mind.

·       The desire or will (to perform an activity)

·       Observation (How do I do it? What is my coordination while doing it?)

·       Analysis (What is wrong?)

·       Inhibition = decision to change something

·       Creating a new plan + new directions

·       Projecting the new directions

·       Possibility of choice:
 a) Perform the selected action
 b) Not do anything
 c) Do something else

 

Not being fixated on a goal means taking wholly into account the possibility of choice related to the goal. This is a precondition for good coordination.

1st Example: Penelopa receives a medal, and I receive a bouquet of flowers

Had Penelopa been focused only on the goal of receiving a medal at the end of the year, or I on receiving a thank-you bouquet, we would probably not have enjoyed our exercises. Perhaps Penelopa would never have danced her ballet with the coordination she achieved. In this way, every class was open for new possibilities. These open possibilities led us towards the medal award ceremony at the end of the year, which we all really enjoyed!

At the end of this paper, we can conclude that it is possible to change the coordination of body and mind in children with an impairment if we awaken the vitality, fluidity, and openness to new possibilities that lie within them. If we determine where they are, and if we have a direction towards which we want to go with them, it is possible to change their coordination, regardless of the impairment which affects them.
 As a physiotherapist, occupational therapist and hippotherapist, I can say that there are various methods that affect coordination. Today, as an Alexander teacher, I am grateful to F.M. Alexander who discovered this technique and to all the teachers who followed his teaching, especially Aranka Fortwängler, Hedda Mikausch, Ellen Mross and our supervisor, Giora Pinkas, as well as to all the teachers and students who, by working with me and educating me, have changed my coordination, so that I come out of this school today with improved harmony between body and mind. I believe that I will be able to develop this harmony even further, and transfer it to the children and all the people with whom I work. By using the Alexander Technique in a more subtle and comprehensive way, working on ourselves, we change the persons with whom we work. This gives our work a special dimension, and, in a specific way, establishes harmony, not just of the body, but also of the mind.