The Frenkel exercises are a series of exercises developed by Professor Heinrich Sebastian Frenkel (1860–1931) to treat patients with ataxia, particularly those with sensory ataxia due to tabes dorsalis (neurosyphilis affecting the dorsal columns of the spinal cord). These exercises are designed to improve coordination, proprioception, and balance. Over time, they've been adapted and used for a broader range of neurological conditions that affect coordination.

The primary principle behind Frenkel exercises is the conscious control of movement. The patient is asked to perform the exercises by paying meticulous attention to the movement, ensuring precision and accuracy. By doing so, it's hoped that the nervous system can be retrained.

Steps in Frenkel's Exercise

1.Understanding the Exercise: Before the exercises are performed, the therapist must explain and demonstrate the movement to the patient.

2.Observation: The patient should first observe the exact movement and understand it completely.

3.Mindful Execution: The patient then executes the movement slowly while consciously thinking about and controlling it.

4.Regular Feedback: The therapist gives feedback during the exercise about the correctness of the movement, and the patient tries to correct it accordingly.

5.Repetition: The exercise is repeated multiple times, ensuring that each repetition is done with precision.

Examples of Frenkel Exercises

1.Sitting Exercises

  • Moving the foot from heel to toe and vice versa.
  • Sliding the heel along a straight line drawn on the floor.

2.Lying Down Exercises

  • Bending one knee followed by straightening it.
  • Raising one leg followed by lowering it.
  • Flexing and extending the ankle.
  • Moving the leg in the form of a large circle.

3.Standing Exercises

  • Standing and sitting in a chair without using the hands.
  • Transferring the weight from one foot to the other.
  • Standing on one foot.

4.Walking Exercises

  • Walking in a straight line.
  • Changing direction while walking.
  • Walking over obstacles.
  • Walking while turning the head from side to side.

5.Hand and Arm Exercises

  • Reaching out and touching an object with the tip of the finger.
  • Picking up objects of various sizes and weights.
  • Turning the hand palm up and palm down.

Consideration 

  • It's essential that the exercises be graded in difficulty so that the patient can start with simpler movements and then progress to more challenging tasks as their coordination improves,
  • The environment should be safe to prevent injury in case of a fall or misstep.
  • The frequency and duration of exercises should be adjusted based on the patient's tolerance and fatigue levels.

Frenkel exercises are an excellent tool in the rehabilitation of patients with ataxia and coordination deficits. However, they need to be integrated into a comprehensive rehabilitation program tailored to the individual needs of the patient.