Please note that the following information is based on early personal experience of the Anat Baniel Method and not based on formal research. This post appears as an entry from the original CP Daily Living blog and is written by a parent and from the vantage point of a parent–not a clinician. It is vital that parents and caregivers discuss complementary, alternative and experimental therapies with their clinical team with respect to goals, safety, evidence and investment–both financial and with respect to time. You may find our treatment checklist helpful in making decisions about whether to proceed with a particular intervention or modality.
The subject of the Anat Baniel Method (ABM) came up this weekend while visiting some close friends. We were speaking about Maya and her progress, and some of the treatments and modalities that have been working for her. This, along with the recent publication of Anat Baniel’s new book Kids Beyond Limits, inspired me to discuss the work in this week’s post.
So what is ABM? I have had this question posed to me numerous times and I have also asked this repeatedly of practitioners as well. When we first started this work we never felt we were given a good answer. We were told what ABM was not. It is not like acupressure, massage, chiropractic care, or Reiki. Ok, so what is it? From all of the exposure Maya has had, the few lessons I have experienced, and Anat Baniel’s new book, I came up with my own explanation of the work.
ABM evolved from the work of Anat Baniel’s mentor, Moshe Feldenkrais. It is grounded in the principles of neuroplasticity. In the simplest terms, neuroplasticity is the science supporting the brain’s ability to change itself, grow, and form new neural connections. ABM is a non-medical movement modality based upon Anat Baniel’s “Nine Essentials”. Through her work over 30 years and with thousands of people from five days old to ninety years of age, she has found that these “Essentials” repeatedly provide the optimum environment for the brain to notice, accept and integrate new information. This in turn, allows the brain to create more efficient movement, and allows the individual to feel more in-tune with and comfortable in her body. These are precisely the issues I have seen Maya struggle with daily.
In CP the brain, not the muscles, is the problem. So the concept of getting the brain’s attention and providing an optimum environment for it to make new connections makes lots of sense to me. Improve the quality of information getting to the brain, and in turn you will improve the quality of movement and the person’s experience of the world (Move Into Life, p25).
Here’s how you might begin think about the child with CP. Imagine that you are planning a trip and you decide to use a paper map. The first thing you do is to locate yourself on the map. Right? When you travel by car and you are at a rest stop you typically see a “You are here” pushpin. This helps you get your bearings and determine where you are going by knowing what is around you, what lies ahead and behind, etc. Well, now imagine that you did not have a “You are here” pin and you did not know where you were. Also, half of the map was missing. That would be pretty tough. Perhaps you could figure out part of the information you needed to get where you were going but you would have to improvise along the way.
Your child’s brain is like the incomplete map with the pin missing. Each child develops a mental image or map of his/her physical body by interacting with her environment and defining themselves in relationship to it. Because children with CP have fewer and more limited interactions with their environment and themselves, they are missing pieces of information to help them complete their map.
The following is my way of understanding meeting the child where they are in their understanding of their body. Let’s consider a child with CP whose legs are often scissored (crossed). For this child Anat Baniel may say that the child’s neutral position is scissoring, in contrast to the typical child whose legs would be uncrossed in a neutral position.
That missing information—about what is a neutral position for the legs— may be a problem for the child with CP. First, because the child’s brain probably does not know that the legs are crossed and what this means, the child cannot learn to uncross her legs (the child does not know where she can go because she does not know where she is). The second problem is that the brain is actively sending signals for the child to cross her legs, even though it is dysfunctional for any organized or comfortable movement. This means that the child is not in control of the movement.
When presented with scissoring of the legs the focus may be on stretching or pulling apart the leg muscles (manually and/or with equipment) to uncross the child’s legs. This is contrary to the way an ABM practitioner would approach the child. He would look at the child and ask himself, “What is the brain doing right now?” and try to meet the child in the moment (an important element of ABM). The ABM practitioner would try to bring awareness to the child that she has two legs that can move independently from one another as well as together. Starting from the child’s perspective is completely different from starting from the idea of “This is where I am taking you”. If you start from considering what the muscles are doing, the child’s brain may not have enough information to get from crossing to uncrossing.
How does an ABM practitioner make sure the child gets the information she needs? Basically, (very basically) the practitioner gently moves the child in ways that offer hints or clues about body movements that the child may not be aware of presently. The practitioner might ask the child to do more intense scissoring and then less so that the child’s brain can identify degrees of scissoring (more and less and none). Communicating with the brain about what it is doing in the present moment, along with offering clues about new ways the child may move with ease, allows the brain to create the pathways that hold the intermediary steps. Lots of these steps, gradually assembled by the child herself, lead to new and more efficient movements.
When this is done something wonderful seems to happen. The brain, and hence the child, becomes aware of new possibilities. Now there is a point of reference or a “You are here” pin to let the child know not only where they are starting on the map, but also where they may wish to go from here. I am not a neurologist and I don’t study brain plasticity, but I have my child transformed through the application of these principles. As the child becomes internally more organized, their world does also because they see, feel and relate to it differently.
Why is stretching or forcing the legs apart a more difficult movement? I think it is because the focus is on the what the muscles are doing rather than what the brain is understanding. Perhaps trying to move the legs apart when they are wanting to come together adds additional muddled signals to the brain about what to do. The brain is already signaling for the scissoring pattern to continue. When someone tries to force the child’s limbs apart it adds an additional signal on top of it. This is akin to having someone pull your arms in two directions at once. You end up going nowhere and you feel a lot of pain in the process. The child cannot feel new possibilities of movement because the brain is already putting out a stronger signal. It’s like trying to stop a train going full speed ahead and telling it to also go the other direction all at the same time.
One of the ways an ABM practitioner will get the brain’s attention is through very slow gentle movements. When you approach movement very slowly, the brain notices and processes information it was not aware of before. If you are in your car speeding at 75 miles an hour and you suddenly decide to go 20 mph many things will look and feel different and be interpreted differently.
When an ABM practitioner guides the child’s movements, he allows the child to lead by exploring alternate movements that come with ease rather than force. Without pain and repetitive signaling to scissor, a brief window emerges that allows the brain to sense and perceive new information.
I will give one more example of ABM and how its approach can get to the root of a child’s interference. Maya was having several months of regular lessons and intensives (lessons two times a day for several days). It was becoming clear that she was stuck. We did not know why and we did not think more of the same lessons were the answer. Something was not connecting for her but we did not know what exactly was wrong.
We then had the good fortune of having Maya meet with Anat Baniel. In five minutes she determined that Maya did not know her belly from her back. Everyone in the room stared at Ms. Baniel like she was out of her mind. I thought to myself “What do you mean she doesn’t know her belly from her back? She can point mine out and yours!” Anat Baniel showed all of us that indeed what she was saying was true. We were astounded. Maya had no idea where her back was on her own body and in relationship to her belly. She had not had enough clear opportunities for her brain to differentiate parts of her body and accurately map them. This has nothing to do with intelligence, but rather opportunity. Since Maya is articulate it was not easy to pick up on this problem because she would talk about bellies and backs. She omitted her own. Maya was moving around the world with a “phantom torso”. How could she even begin to understand crawling if she didn’t have these key pieces? The truth was she couldn’t and it was not her fault.
We worked on helping her learn about her belly and back and having her feel each part independently in different ways so that this part of her map could begin to be filled in. Once we built this foundation we began to see progress again. Maya was picking up key pieces to help her understand where she was in space. The child (and all people) needs to know and feel where she is in space, in order to know the possibilities of where she can go.
I have seen ABM create the possibility for my child to experience within herself new potentials for her own body and how she thinks about herself and relates to other people. I have heard my daughter say during a lesson, “Wow look at this” when realizing something new about how her body works. The first time Maya rolled over, opened her left hand with ease, and got onto her knees were all during ABM lessons. We have shed tears watching the beauty with which she moves, the joy she feels while doing it, and the confidence she exudes in discovering her own hidden potential. To observe these transformations is astounding. Our feelings about this work come from a genuine feeling of gratitude that this work exists and has helped our child acquire new and lasting skills.
There have been times when we thought maybe we needed to stop (and did) because results were not forthcoming as quickly as we or our practitioners expected, or because the pace of the lessons seemed too intense for Maya. We thought the lessons, along with traveling to them, may be lowering Maya’s seizure threshold*. At those points we have stepped back and reevaluated what we needed to do or not do. (See the “Advocating for your child” section of the website for a longer discussion of how important it is for parents to take control of their child’s treatment).
ABM has worked for us over time: it is the trunk upon which we structure Maya’s other interventions and conventional therapies. We are grateful for the opportunity to have Maya experience its benefits. There are not a lot of practitioners however, and ABM lessons are typically not covered by insurance. This is why it’s very important to determine your goals, your budget and establish a timeline for trialing this modality and any other experimental or alternative approach you come across. In our experience ABM did not offer a “cure”, but in the early years it certainly offered hope for improved function and new possibilities for our child.
Update May 26, 2013: As we continue to observe Maya’s development, we are finding that she needs ongoing maintenance and consistent reminders about how to retain the new information she is learning. The brain has a tendency to revert back to old patterns of movement, so the challenge is determining how many lessons will allow Maya or any other child to move beyond a particular movement tendency. We have been fortunate to experiment with how this works for her since my mother-in-law became an ABM practitioner. She doesn’t live near us, but when we visit one another she is able to work with Maya. It’s been a process to discover how to support and “protect” the benefits of her lessons, while also considering how sustainable this is for her and for us. Can her body handle it? Can our wallet? Making these decisions can be tough especially since lessons often enable Maya to move in ways we have never seen. However, no one knows how long a child will require them. A few years? 10 years? Her entire life?
One of my suggestions to Anat Baniel’s staff has been to develop a shorter and less expensive parent training program for parents to learn how to work with their children at home. This would empower families to provide ongoing support to their child rather than waiting for the money and time to coordinate the next lesson or next series of lessons. There are many children who are able to generate momentum for building skills in between lessons, but for Maya, we have seen less of this in the area of gross motor development, her greatest challenge. At the very least I want to help her solidify the ways of moving that she is learning during lessons so that these possibilities become her new reality.
* Note: Although we have observed the combination of ABM lessons and travel seem to lower Maya’s seizure threshold, this does not mean that ABM causes seizures (or that we are saying this) or that your child will have this response. Every child is different and seizures can often be random. In our case, Maya’s seizures are infrequent and it has been a bit easier to identify some potential triggers. Nevertheless we still have several variables to tease apart but we feel our experience is worth noting and keeping in mind if your child has a seizure disorder. We always keep a log of Maya’s seizures and I think it is important to do this so that if some patterns emerge around activities, food, travel, illness etc., you can discuss them with your child’s neurologist. When I spoke with Anat Baniel via e-mail about our concerns and observations she said she has never known of a child she has worked with whose seizure disorder appeared better or worse from having lessons.