Introduction to Frenkel Exercises: 

Frenkel Exercises is a sequence of different exercises performed in a system and gradual manner to improve coordination in patients having cerebellar ataxia. Our body naturally performs coordinated movements that are smooth, organized, and accurate. In certain diseases like cerebral palsy, tabes dorsalis and disseminated sclerosis movements become inaccurate and convulsive. These jerky movements lead to incoordination which is a prominent feature of ataxia. Frenkel’s exercises are performed repetitively and accurately in a different posture, lying, sitting, standing, and walking to regain smooth and purposeful movements which are lost due to neurological problems.

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Historical background of Frenkel Exercises:

Dr. Heinrich Frenkel, a physician and a medical superintendent in a hospital for chronic disease in Switzerland developed these exercises to treat a patient with ataxia. He studied a chronic disease called Tabes dorsalis and aimed to treat incoordination and by using an intact sensory mechanism like sight, touch and sound established voluntary control of movements. In tabes dorsalis, there is degeneration of neurons present in the dorsal column of the spinal cord which results in loss of coordination with other symptoms. The essentials of His exercises were accuracy, the full attention of the patient, and practice. After successful improvements of coordination in an ataxic patient since Frenkel's exercises have been used for many other diseases where coordination is lost.

Aim of Frenkel Exercises:

The main and basic purpose of Frenkel's exercises is to change jerky, inaccurate and disturbing movements into smooth, accurate, and purposeful movements. Voluntary control of movement is lost due to loss of proprioception(awareness of the position of a body in space) and kinesthetic sensation( awareness for movements of joints). These exercises use other intact sensory mechanisms such as vestibular apparatus and vision to compensate for this loss. The aim is achieved with more and more practice and giving full attention to movement patterns.

Frenkel Exercises
Frenkel Exercises

Principles of Frenkel Exercises:

These exercises are based on three basic principles which include:

  • Concentration. The full attention of the patient is required while performing exercises so that movements become smooth and purposeful.
  • Precision. Accurate and qualitative movements are achieved by performing exercises in a precise manner.
  • Repetitions.  more and more practice and repetitive movements are required until exercises become perfect.

Methods for applying Frenkel Exercises:

The following points should be considered while applying Frenkel Exercises.

  1. Patient position:

The patient should be positioned in a way so that he or she can easily move body parts in space during exercise. Position the patient in lying, sitting, standing, or walking in such a manner he feels comfortable and relaxed. 

  1. Suitable clothing:

The patient should be suitably clothed so that he/she can see her or his limbs while performing the exercise. Remove the constrictive clothing such as corsets and belts. There should not be so tight dressing so that full range of motion becomes difficult to perform.

  1. Explain exercises to the patient:

Before starting any exercise give a brief demonstration about exercise to the patient. So that he clearly understands and easy exercises. You can explain exercises by first performing on your body in front of a patient or through a video.

  1. Maintain rhythm:

The rhythm or speed of the movement is maintained by counting one, two, three, or playing suitable music.

  1. Rest period:

After performing a set of exercises for two to three minutes, patients should have to take a rest by playing games on mobile, reading a story, or chatting to someone.

  1. Repetitions :

Each exercise should be repeated many times. More and more practice is required and when these exercises become easy then move to the next exercise.

Frenkel Exercises

Frenkel Exercises for balance:

Frenkel’s exercises are used to treat balance problems so these exercises are used in all diseases where balance and coordination is a major problem. Some of these diseases are given below:

  • Multiple sclerosis
  • Parkinson’s disease 
  • Cerebral palsy
  • Cerebellar ataxia
  • Stroke
  • Brain degeneration 
  • Other neurological disorders.

Progression of Frenkel Exercises:

  • Frenkel Exercises is progressing by increasing difficulty. When someone masters an exercise then changes the speed of movement to change the simple movement into complex movement.
  • Movements of large joint substitutes by small precise movements of hands and wrist.
  • To add complexity change the position from lying to sitting and then sitting to standing or walking.
  • Initiate exercise with eyes open when it becomes easy to perform it with closed eyes.
Frenkel Exercises

Examples of Frenkel Exercises:

We can perform Frenkel's exercises in more than one position depending on the patient's level of comfort. These exercises involve upper and lower limb flexion, extension, abduction, and adduction. The posture which attained during these exercises are given below:

  • Lying
  • Sitting
  • Standing
  • Walking

These exercises are performed on all the joints of arms and legs including shoulder, elbow, hip, knee, etc.

General discussion about Frenkel Exercises:

In this article, I have tried my best to share my whole knowledge about Frenkel Exercises.

Here I have discussed the introduction, history, purpose, principles, procedures, indications, and progression of Frenkel's exercises. In my next article, I will discuss examples of Frenkel's exercises on the upper limb and lower limb in detail.  For more information and knowledge about physiotherapy, content go and visit my youtube channel “Afsheen’s PhysioDose.