FRENKEL’S EXERCISE

 Is a group of graduated exercises applied for the LL and designed to overcome the incoordination and proprioception loss by visual feedback. 

 Principles: 

  

      Four basic positions should be used: 

                  * supine 

                  * sitting

                  * standing

                  * walking

       Frenkel’s Exercises principles:

                  * Start unilateral then bilateral. 

                  * Start fast then slow movement. 

                  * Start by proximal then by distal joints. 

                  * Start by symmetrical then asymmetrical movement. 

                  * The patient must see the movements and verbal feedback is very important.

     General Instructions for frenkel's exercises

              * Exercises can be performed with the part supported or unsupported, unilaterally or bilaterally. 

              * They should be practiced as smooth, timed movements, performed at a slow, even tempo by counting out loud. 

              * Consistency of performance is stressed, and a specified target can be used to determine range.

              * Four basic positions are used: lying, sitting, standing and walking. 

              * The exercises progress from postures of greatest stability (lying, sitting) to postures of greatest challenge (standing, walking). 

              * As voluntary control improves, the exercises progress to stopping and starting on command, increasing the range and performing the same exercises with eyes closed. 

              * Concentration and repetition are the keys to success.

   Frenkel exercises for lower limb Exercises for the legs in lying 

              * Flex and extend one leg by the heel sliding down a straight line on the table.

              * Abduct and adduct hip smoothly with knee bent and heel on the table. 

              * Abduct and adduct leg with knee and hip extended by sliding the whole leg on the table.

              * Flex and extend hip and knee with heel off the table. 

              * Flex and extend both the legs together with the heel sliding on the table. 

              * Flex one leg while extending the other. 

              * Flex and extend one leg while taking the other leg into abduction and adduction. 

              * Heel of one limb to opposite leg (toes, ankle, shin, patella). 

              * Heel of one limb to opposite knee, sliding down crest of tibia to ankle.

 Whether the patient slides the heels or lifts it off the bed he has to touch it to the marks indicated by the patient on the plinth. The patient may also be told to place the heel of one leg on various points of the opposite leg under the guidance of the therapist.

    Exercises for the legs in Sitting

                * One leg is stretched to slide the heel to a position indicated by a mark on the floor. 

                * The alternate leg is lifted to place the heel on the marked point. 

                * From stride sitting posture patient is asked to stand and then sit. 

                * Rise and sit with knees together.

                * Sitting hip abduction and adduction. 

     Exercises for the legs in Standing 

                * In stride standing weight is transferred from one foot to other. 

                * Place foot forward and backward on a straight line. 

                * Walk along a winding strip. 

                * Walk between two parallel lines.

                * Walk sideways by placing feet on the marked point. 

                * Walk and turn around.

                * Walk and change direction to avoid obstacles.

  Frenkel exercises for upper limb 

           Similar exercises can be devised for the upper limb wherein the patient may be directed to place the hand on the various points marked on the table or wall board to improve coordination of all the movements in the upper limb.

   Some examples of Frankel exercises of upper limb in sitting position

               * Have patient sit in front of a table and place a number of objects on the table. The patient then touches each object with the right hand and then the left hand. 

               * The patient flexes the right shoulder to 90 degree with elbow and wrist extended. The patient then takes his or her right index finger and touches the tip of his or her nose. This exercise is then repeated with the left hand. The exercise is performed alternating right and left index finger. 

               * The patient taps bilateral hands on bilateral thighs while alternating palmer and dorsal surfaces as fast as possible.