J. G. Garson
1912 BMJ (Clinical Research Edition)  
IN a short paper which appeared in the BRITISH MEDICAL JOUIRNAL of August 26th, 1911, 1 demonstrated clinically'the beneficial effects I had obtained'in tabes dorsalis, even when marked ataxia had occurred, from' systematic practice of the exercises designed by Frenkel of' Heiden for restoring the power of co-ordinate movement. Sinice then I have received many inquiries respecting the treatment and also on points not included in my former communication. It is'gratifying' to find so much
more » ... ind so much interest evinced in this successful method,' offered by the Frenkel system, of mitigating the unhappy condition of patients suffering from this disabling affection. Yet the correspondence also shows that there still exists a good deal of misapprehension regarding the nature and practical application of the exercises, as well as the training through which the patient must go to produce the restults desired. It is to these considerations that I propose' more particularly to address myself on the'present occasion. It may be stated at once that the Frenkel system does not consist of a series of gymnastic exercises which the patient can be set to perform each day from a list supplied to hiim with directions for doing them. It consists of a series of definitely directed movements made in different positions of the body with specific objects in view, under the immediate direction of a plhysician, who must, of course, have made himself acquainted with the dim and object of each movement used, a knowledge which can only be gained by carefuLl study and reflection. The degrees and forms of ataxia met with in different patienlts suffering from tabes being very diverse, the physician lhas, after first carefully determining the precise nature and extent of the disturbances present, to choose' the most suitable exercises and adapt their sequence as well as their duration and intensity to the individual requirements of the case. The mIiost serious disablement of the ataxic patient being usually the loss to a greater or less extent of co-ordinative power in the lower extremities, the greater number of the exercises are designed for the purpose of enabling him to regaini control over these various movements. Others of a ditferenit kiind are intended to restore lost power over the mlovements of the trunk and upper extremities. The exercises designed for restoring control over movements of the lower extremities comprise: (a) Those wlhich are practised in a recumbent position wlhile the influence of riavitationi and the necessity of maintaining the equiilibrium of the body are in abeyance; (b) those practised in the erect posture, consisting of walking exercises of various kinds; -(c? those which combine various movements and evolutions carried on dulring walking, such as turning, sitting down, etc.; and (d) those wlich are done in the sitting position. The most numerous of these exercises are those of the first class, of wlich there are ninety-four, while of the walking mnovements tlhere are twenty-eight. The physician is, therefore, well provided with an ample series from which to make a selection suitable for the patient. The exercises taken while the patient rests in bed or on a couch consist'of those practised without apparatus, whichl are far the most imrportant, and those in which apparatus-is used. The former are subdivided into six groups, eaclh of wllich has for its aim a certain definite object. Thus the first is devoted to the practice of general movements of the limbs, and consists of flexion, extension, adduction, and abduction, the heel resting on the bed during their performance in order to econonmize muscular force asmuch as possible, the range of movement in tlhcse exercises being considerable. In the second group the limb exercised is raised from off the bed while flexion and extension movements are performed, and the patient is practised in touching definite portions of the resting limb with the heel of the limb being exercised. In these exercises we have a combination of balancing the quasisuspendedlimb and the performance of movements at the joints. This series leads to another group designed to develol) a maximum degree of c:-ordination witlh a TABETIC ATAXIA. r TAn Bam= l
doi:10.1136/bmj.2.2696.471 fatcat:vmr42nmal5hmfl2ubrkmhdxwiu