Alexander Technique and Parkinsons Disease

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The progression of Parkinson’s Disease is measured in a few ways…  one of them is through a series of tests called the Unified Parkinson’s Disease Rating Scale.  On this scale the patient is put through a variety of activities and asked a series of questions in order to test the degree of disability in areas including tremor, rigidity, arising from a chair, etc.

Generally, in a progressive disorder like PD, the score on the UPDRS scale can be expected to slowly rise, even with adjustments to medications.   One recent study suggested the average score increase to be about 1.2 points per year.1

As the chart below shows, our subject, Ms. W., has seen a steadily decreasing curve in her UPDRS score over the past 7 years since she began Alexander Technique lessons.  What is most remarkable is that although there are intense fluctuation with life events, she is consistently able to regain her ability to manage her symptoms and bring them under control again.

The 2013 World Parkinson’s Congress published the abstract concerning this work.  The link to the abstract can be found at http://iospress.metapress.com/content/y146585107g14028/.   There are hundreds of other abstracts at this link documenting the incredible amount of PD research pulled together for this Congress.  You can also find it on http://bigsky-at.ca/links.html, or read the long version below.

AT Sample Compared to Typical Progression Assessment-1


 

Long Term Effects of Alexander Technique (AT) in Managing Motor Symptoms of Young Onset Parkinson’s Disease

Background

Alexander Technique is an educational and holistic treatment developed to change functional patterns.  It is not a passive therapy, but actively involves students in driving their own learning and success.   The aim of AT is to allow students to function with greater ease and confidence, whether as part of an exercise regime or simply in the daily act of living.

For PD patients, an understanding of AT principles empowers them to undo their own mis-functioning; hands-on guidance from a teacher further increases awareness of balance and kinaesthesia.  AT has been shown to enhance respiratory function1, improve functional reach2, and reduce lower back pain3 in non-PD patients; a 2004 study on AT showed sustained benefit for PD patients4, particularly in the area of depression.

Methods 

The subject in this case study was diagnosed with PD in 2003.  At the point of diagnosis, she already suffered from chronic stooped & painful posture, and knee pain.  Standard rehabilitation therapies including physiotherapy, tai chi, personal training, chiropractic and acupuncture resulted in no improvement.  Cumulative damage in the left knee due to severe tremor prompted knee replacement surgery in Nov. 2008.

As PD affects the ability of bodily systems to perform as intended, our focus was restoring normalcy to external functions. Lessons involved verbal instruction and discussion, as well as hands-on guidance, to facilitate a mental and physical change in order to access stability, and to improve static and dynamic balance.  The subject began AT lessons sporadically from Nov. 2007 through June, 2008.   From Sept. 2009 through June 2011, the subject received weekly or twice-weekly 45-minute  lessons.  From Sept. 2011 through Sept. 2013 she received intensive groupings of 4 – 6 lessons every 8 – 12 weeks.

The progress of the subject’s PD symptoms were measured by tracking standard PD assessments, carried out independent of the AT work through qualified physiotherapists at the Edmonton Movement Disorder Clinic.

Results

A greater range and control of motion resulted, leading to improved robustness, which allowed re-learning of activities such as: sitting, standing, walking, and reaching. The orthopaedic surgeon who performed knee replacement surgery observed that the subject was the only patient (including non-PD patients) to recover full movement without a limp in less than a year. 7.5 years after diagnosis and 2 years after knee surgery, the subject was rated 56/56 on the Berg Balance Scale.  Since AT treatment, TUG (Timed-up-and-go) speed continues to decrease after 10 years since diagnosis. Steady downward curve was observed on the UPDRS (Unified Parkinson Disease rating scale), and only 2 minor adjustments in medication were made since 2007. Subject reports: improved posture far beyond pre-PD state; ability to recover immediately from semi-freeze; ability to walk normally even in midst of severe tremor; improved singing voice; ongoing ability to travel widely and live with reasonable normalcy; and hope.

Conclusion

Continued access to a skilled AT teacher over several years allowed the subject to first develop and then maintain a high standard of physical functioning; her posture and balance through sitting, standing and reaching are measurably better than they were 10 years ago.

These findings are by no means a cure; the disease continues to progress.  However,regular AT lessons have extended the subject’s ability to not just live independently, but travel widely, over a number of years.   They also decrease or even stop symptoms.  Without regular lessons, symptoms come back, but tools to manage them remain.  Similar work done with other PD patients over shorter time frames indicates the successes gained by this subject are reproducible.

The use of AT in conjunction with medication therapy and as a foundation for exercise and/or physical therapy should be considered as an option for any PD patient willing to commit to the work involved.


1.Williams, James; Mari, Zoltan; Pontone, Gregory; Bassett, Susan.  (April 25, 2012)  Natural History of UPDRS Motor Scores in an Observational Parkinson’s Disease Cohort (S22.004). 

2.  Austin, John H.M., Ausubel, Pearl (1992).  Enhanced Respiratory Muscular Function in Normal Adults after Lessons in Proprioceptive Musculoskeletal Education without Exercises. Chest 102: 486-90.

3.  Denis, Ronald J. (1999)   Functional Reach Improvement in Normal Older Women After Alexander Technique Instruction.  Journal of Gerontology 54A: M8-M11.

4.  Little, Paul, Webley, Fran, Evans, Maggie, et al.  (2008).  Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain.  BMJ 337: a884.

5. Stallibrass, C, Sissons, P, Chalmers, C, 2004. Randomized controlled trial of the Alexander Technique for idiopathic Parkinson’s disease.  Clinical Rehabilitation vol. 16 no. 7695-708.*All photos used in this poster were taken between May – September, 2013.


Alison’s story, in other’s words…
I first became aware of the Alexander Technique and its adaptation for people with
Parkinson some years ago. I ran off a copy of the article I had read and left it floating around the house for some years. Dave was not interested at that time as he had been through several things which had cost lots of money but with no benefits. (Chinese medicine- stinky stuff we had to brew and then he had to drink, a chiropractor who said he could cure it; etc). He knew exercise was essential to his well-being but became hampered by an arthritic hip which eventually took away his ability to walk without support. 
 
We attended a lecture which Alison Wood was chairing and I was amazed at what I saw. She had been standing to the side and was visibly shaking and somewhat hunched over, but when she was required to go to the podium she was transformed. She stood upright and walked 
towards the podium, arms swinging and head up. (I was gobsmacked.)
 
When the lecture finished I went over to her and asked her what happened that she could take hold of the P.D. like that and she said “Alexander Technique”.
 
I insisted Dave go over and and see how she could get control of her tremor and P.D. symptoms. Alison was only too happy to show him what she could do. 
 
That’s when he first started coming for sessions. It was the first time he felt there may be a way to get back some control.
-Mrs. H, wife of a student with Parkinson’s Disease