“Learning to stand lying down” is a catch-phrase that Anat Baniel used on several occasions during the workshop I attended in London a few weekends ago. Anat Baniel is a gifted practitioner who studied high performing adults and children with special needs over many years and gradually formulated her approach and 9 essentials to upgrade the way the brain can organise information. The essentials involve giving the brain the quality information it needs to keep learning.
Anat’s applies her approach and ‘9 essentials to adults and children, as they all have one thing in common: they all have a brain, and their brains require ‘upgrading’ to improve the quality of their movement. She spoke about how a common approach, using movement can enable the brain to ‘upgrade’ and improve a violinist’s playing a ballerina’s alignment and coordination or a child’s ability to communicate in social situations, to roll, to reach or to walk. Anat has developed the Anat Baniel Method (ABM) that she now teaches, working on the assumption that if we provide the brain with varied, high-quality information it is then more able to spontaneously discover new and more successful solutions to overcome or solve a variety of difficulties.
A few of the families I work with take their children for ABM lessons, and one family asked me to go along to the workshop to find out more about it. I read Anat’s book Kids Beyond Limits [http://www.anatbanielmethod.com/members/shop/kids-beyond-limits/], which sparked my interest– she seems to have consistently good outcomes when working with children with additional needs and she has the long game in mind – yes a child may be able to walk now if we teach them or allow them to move like this, but we know that the way they are moving will likely mean that they will not be able to walk this way as an adult. ABM is not goal focussed, the aim is to build quality foundations with which the child can move in a greater variety of ways which will enable them to do a great variety of things and keep learning more.
The theory or approach didn’t sound dissimilar to what I am striving to do and I felt it perhaps started to explain why certain techniques (tools in my Physio treatment tool box) work better than others. Sometimes I will use a certain technique with a child and it will work well, and when I repeat the same movement with a different child or even with the same child it won’t have the same effect – and sometimes I’m not sure why this is. Reading about Anat’s “Nine Essentials for Positive Brain Change” and then discussing them over the course of the workshop has helped me to start to understand why a technique might be more, or less effective, in given situations.
Anat’s nine essentials are as follows:
- Movement with attention: We know that the best way to communicate with the brain is through our senses (look back at some of my earlier posts if you don’t know this). During the workshop we talked about our sense of movement and balance (vestibular), our sense of body awareness (proprioception), and our sense of touch (tactile). All these can help either to calm and organise the brain, or to arouse and alert it (Sensory Integration). When Anat talks about ‘movement with attention’, I think she refers to helping a child to register, to take note of components of sequences of movement.
An example of how I’ve applied this to my own practice: when working with a child with cerebral palsy that has dystonic spasms, rather than trying to reduce the spasm by bringing the child into an opposite pattern, I have been experimenting with going with the spasm and making the child more aware of it, and so helping the brain to really register this movement again – when it has likely become an habitual pattern of movement.
From only a weekend workshop I can’t start to use this approach so I am trying to link this theory to what I know. So, I look at which movements to use and to play with when working with a child to help them start to build more quality and I go to my knowledge of typical child development. I look at babies when they’re moving on the floor, rolling, coming up against gravity, and look at all the complexity of the movements they do before they have assigned any intention to the movements. These are the movements and sequences I have experimented with. I have had success – revising child development and seeing that the patterns of movement needed for standing and stepping, for example, can be practiced on the floor (where it is easier for the child to focus and be more relaxed to be able to move with attention), then when the child stands the quality of their postural adjustments is better. The is presumably because they have been able to experience the sequence with greater attention to how the whole body is involved and how distinct parts move in rhythm with other parts.
- Slow: This essential is a reminder that the brain can only learn something new if the information it must process is provided slowly enough. If someone tries to teach you something new but expects you to take it in fast or react fast, you will tend to revert to what you always did before, to get to where they want quickly. If on the other hand someone teaches you something slowly, and you move with attention, you can take time to think about the different components and then may be able to learn new skills. This is something I often need to remind myself of when learning new things and teaching them!
- Variation: The brain responds to things that are new and different; this is something I was aware of from my sensory integration training – from the workshop I got some more ideas about how to introduce variation to get the brains attention. It can be very simple: if you’re going to lie down on your tummy, lying down first through the right side, and then the next time you do it, through the left side lying means to think more about how you are moving. Or if you have your hands behind your head, switching the interlace so that one hand is on top then the other– offers subtle change to bring your attention back to the movement, so that the brain is registering the changes and can learn something new.
- Subtlety: This essential is about the importance of parents and therapists using subtle, light handling, and recognising (and encouraging children to recognise) subtle differences in movement. The body has so many joints, and so many different ways it can move; sometimes a movement will look the same, but if you’re able to recognise the subtleties, you’ll see that the child has made a change and you’ll know you’re on the right track. This has emphasised to me the importance of my ability to hone in on subtle differences, and has helped me to highlight them to both parents and children so that they can become more aware of them too. It has also made me think about facilitation and handling I do with children and when light touch is not enough or when I use equipment – I wonder how much long-term change I am making within these activities? I am starting to think what am I aiming for and is there another way to do it that doesn’t require such force to get the child into a position of for the child to achieve that task.
- Enthusiasm: Often, and for me especially, enthusiasm looks like someone saying, “Yay, well done, good job!” – but Anat calls this ‘cheerleading’ and says that it’s not helpful. Anat talks about a ‘quiet’ enthusiasm to help the child recognise and be proud of their own movement, and not need external input to validate it. We have the ability within our own brain to check whether a movement has been successful, and Anat says we detract from this if we give too much external validation. She has found that when parents sit quietly during sessions, smiling and noticing subtle changes with internal enthusiasm, rather than cheering from the side lines, this allows the child to feel the improvements themselves, to ‘own’ them and to feel their own enthusiasm for them, rather than looking for external validation from their parents or therapist. Thinking back over my past sessions, it seems to me that this could often be the key to why children perform better in certain circumstances than in others; this is something for me to consider further.
- Flexible goals: Rather than trying to ‘fix’ problems, Anat talks about helping the brain to get back on track so that it can start learning again. If a brain has ‘stalled’, for example if a child is repeating the same movements again and again, those movements may have become a habit. Rigid goals, such as for the child to be able to roll within three months, do not leave room for the child, parents or therapist to be enthusiastic about more subtle (and possibly more important) changes – for example, the way a child is moving with more attention. According to Anat, if you have got the brain back on track and it is more aware of different movements, we know where the goals are going to go because we know from child development that children work towards certain milestones.
If I am working for quality, is this a goal? Then my aim could be for a child to be able to reach further or stand for longer. Or could better quality of movements be my aim, and then the child being able to use this for improved performance in reaching, standing could be an inevitable bonus, but not the goal or aim I work towards. If I set a timed goal that a child will achieve an improvement in a specific task within 3 months my focus may come off the quality and be too much on the performance. This is something that I need to have a think about in relation to how I practise and the goals that I set. Short term a child may take longer to be able to perform a task but if we feel that when they do get there the quality of how they can move will be better, and if this means they will be able to perform that task better, and maybe for longer or in a greater variety of positions or environments then this is what we want to work for, no?
- The learning switch: I think we all recognise when a child is really ‘in the zone’ and paying attention. This comes back to something I really learned and started to practise following my Bobath course – there is a difference between distracting a child and having them actively participate. If a child is being distracted, they are probably not paying attention to what you are doing with them, which means the learning switch is not on – so the movements or sequences you are supporting them to experience are being done to them – then there is less potential for positive brain change.
However, if a child is actively participating in a reach, or a roll, or just in being aware of the position their body is in, the learning switch is on. I’ve found that when I say things like, “Can you feel your spine?” or, “Can you feel your shoulder blade moving?”, I can often see the child taking notice of whatever I’m drawing their attention to. This is something I’m trying to look out for more often, and something I am helping parents and carers to look out for.
- Imagination and dreams: We did some movement lessons during the workshop where we were lying on the floor performing simple movements lying on our backs, our sides and our fronts. The sequences were parts from that we see young babies practice when they are playing with movement. First, we did a lot of work on one side of the body and then we all felt a bit uneven – one leg felt longer, one arm was more relaxed. We then imagined the same movements (which we knew well by this point – lots of repetition and fine tuning the quality) on the opposite side, and after imagining the sequence of movements two or three times, we then performed it once or twice – and felt the same results as we had on the first side after only minutes rather than the twenty minutes+ we did on the other side. This brought home the power of the imagination to communicate with the brain to help learning, and how much the quality of a movement sequence is dependent on the planning stage in the brain, rather than the muscles actually doing.
I’ve started to use this more with the children that I work with, after working through a sequence, or components of a sequence in a position where child is relaxed, they are then able to imagine other sequences (involving those components) as being easy and effortless, thinking about the movement starting in the trunk or spine and then the shoulder girdle offering stability for the arm to move… When children have been able to do this before they perform a movement, I have noticed less spasms and improved flow of the movements – it is easier and the quality is better.
- Awareness: I have become more aware of what I am doing and why I am doing it, how things are helping, why some things don’t work. I have become more attuned to when a child is better ‘awaring’ – as Anat puts it, when they are thinking about a new movement I may be doing with a part of the body. Being more aware, more present, can also help parents, families and carers to know what to look for to see that we are building on the quality of movements. Then we know the brain is making positive changes.
I now have many more questions to ask myself and discuss with colleagues, to think about how we approach treating children with cerebral palsy or other similar neurological conditions. How we can build better quality foundations of movement for them to use as what they want to do demands better variety.
Learning to stand lying down – refers to bringing children back down, sometimes to the basics, moving on the floor to improve the quality of how they move and help them think about their movements and be more selective with how they complete a sequence. To move in new ways a child needs to slow down and build the quality, to learn to stand through activities lying down.
I found the workshop thought provoking. I want to learn more feel I should be able to get to a similar place as a Physiotherapist and don’t need to throw out everything we know and do now as therapists– as Anat suggests we do, and re-train as an AMB practitioner.
That is not to say that what we, as therapists are doing now is always getting it right. If we knew how to consistently ‘get it right’ we would all do the same thing – yet there are many approaches to treating children with the same conditions. It is something to look into whether ABM practitioners get better results on long-term with children with complex neurological based movement disorders, than we do currently using our therapy approaches. Our approached predominately work on reducing the impact of the compensation strategies that children are using, because the lack the selectivity and quality of movement.
ABM practitioners look like they are using some of the same treatment tools that I have and use, but why they are doing it is different. I think they are working more slowly, working with children more intensively, to improve the quality of movement, communicating directly with the brain to give the brain more movement experiences and help it to better organise them rather than on ‘treating what we see’. So, instead of working on muscles to lengthen them, or on muscle tone to increase or decrease it, they work on getting a stalled brain back on track and moving again – in any direction. If a child is doing something else, moving in a different way, they are learning and if children move in many different ways then we will not need to treat or work to manage the implications of the repetitive strategies they use when they can’t. Food for thought indeed!
ABM Workshop was 17th and 18th June – blog post with my reflections written 20th July.