For Parkinson's Disease Professionals

Alexander technique (AT) is an educational approach that teaches attention and inhibition to change functional patterns, reduce rigidity, and improve balance and efficiency during exercise and both basic & instrumental activities of daily living (ADLs & IADLs). Lessons involve verbal instructions and hands-on guidance to teach self-management strategies that improve and, as much as possible, restore functional movement patterns, enabling the person with PD to participate in ADLs with greater confidence and minimal interference from PD symptoms.

Studies indicate that AT can help people living with Parkinson's in daily activities:

  • A randomized controlled trial found that 24 AT lessons reduced PD disability and depression (Stallibrass et al 2002), and benefits were retained at 6 months indicating positive potential for long-term retention. (Stallibrass et al 2005). Participants reported "subjective improvements in balance, posture and walking, as well as increased coping ability and reduced stress."
  • A study of an AT-based intervention reported improved postural alignment, reduced postural sway, improved torso mobility, and smoother movement during step initiation, likely indicating better movement efficiency (Cohen RG, 2015

AT shows promise as a long-term self-management approach to reduce PD motor symptoms and maintain an active life. Hybrid delivery of AT (individual and group sessions) shows promise as a cost-effective intervention for PD.

THE POISE PROJECT is an international initiative to expand access to the benefits of AT by creating and delivering programs adapted for specific populations and industries and supporting research in the field. Our coordinated team approach unites AT professionals, individuals who have benefited from AT, and industry experts to create targeted programs that will work within existing care delivery systems.

For this initiative, we have identified AT teachers with experience teaching clients with Parkinson's and their partners; people with PD who are AT teachers; people with PD and their partners who have benefited from AT lessons; medical professionals in the field who have studied AT; and we have reached out to experts in the field to test our models for effective service delivery.

Our Objectives

·       To design and deliver continuing education courses (CECs) for medical professionals, such as physical, occupational and speech therapists, nurses and social workers, to incorporate Alexander Technique (AT) strategies in their work with Parkinson's disease (PD) patients

·       To design and deliver AT classes for people with Parkinson's and their partners in community-based settings

·       To have specialized teams of AT teachers available to deliver intensive programs of group and private lessons for people with Parkinson's and their partners where need and interest is identified

·       To identify alternative funding sources to make programs affordable across socioeconomic groups

·       To design protocols for research in the field of AT for Parkinson's and to facilitate large-scale, multi-site trials


THE POISE PROJECT presented six poster abstracts at the 4TH WORLD PARKINSON CONGRESS in Portland OR in September 2016
View all Abstracts & Posters presented by The Poise Project at the WPC 2016 


 

Alexander technique & Wellness Program Classes

 

The JCC in NYC in partnership with NYU Langone Hospital has an ongoing Alexander technique class for people with Parkinson's. This program is being replicated in Boston and Washington DC. An abstract about this program was presented at the 2013 3rd World Parkinson Congress in Montreal.

In the Clinic, in education and in the Community: A capacity building strategy for comprehensive supportive services and wellness programs through community partnership   Authors:  Alessandro Di Rocco; Amy C. Lemen; Virgen Luce; Roger Rossi

PDF of Abstract

All published abstracts from 3rd World Parkinson Congress, Montreal 2013

Clinical Trials in Alexander technique and Parkinson's Disease

 

Randomized controlled trial of the Alexander technique for idiopathic Parkinson's disease  Authors:  Chloe Stallibrass; P Sissons; C Chalmers

A randomized controlled trial with three groups, one receiving lessons in Alexander technique, another receiving massage and one with no additional treatment. Measures were taken pre- and post-intervention, and at follow-up, six months later with ninety-three subjects with clinically confirmed idiopathic Parkinson’s disease. The Alexander technique group improved compared with the no additional treatment group, pre-intervention to post-intervention, both on the SPDDS at best, and on the SPDDS at worst. The comparative improvement was maintained at six-month follow-up. The Alexander technique group were comparatively less depressed post-intervention, and at six-month follow-up had improved on the Attitudes to Self Scale. There is evidence that lessons in Alexander technique are likely to lead to sustained benefit for people with Parkinson’s disease

Abstract Online 

PDF of study


Retention of skills learnt in Alexander technique lessons: 28 people with idiopathic Parkinson’s disease Authors:  Chloe Stallibrass; Christine Frank; Karen Wentworth

This paper describes the responses to a questionnaire completed by a sample of 28 people with idiopathic Parkinson's disease six months after receiving a course of lessons as participants in a controlled trial. It is the first time that retention of skills has been investigated in relation to learning the Alexander technique. The responses show that every participant retained some degree of skill; at the same time the responses indicate a wide variation in level of commitment and application.
 

Journal of Bodywork and Movement Therapies, April 2005, Volume 9, Issue 2, Pages 150–157

 

Lighten Up - Specific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease  Authors:  Rajal G Cohen; Victor S Gurfinkel; Elizabeth Kwak; Amelia C Warden; Fay B Horak

Parkinson’s disease (PD) is associated with stooped postural alignment, increased postural sway, and reduced mobility. Alexander technique (AT) is a mindfulness-based approach to improving posture and mobility by reducing muscular interference while maintaining upward intentions. Evidence suggests that AT can reduce disability associated with PD, but a mechanism for this effect has not yet been established. In a single-session study, postural instructions consistent with AT decreased postural sway and axial rigidity, and facilitated smooth initiation of stepping and upright postural alignment in people with Parkinson's disease. Standard “straighten up” postural instructions tended to produce the opposite effect. Mindful movement approaches such as AT may benefit balance and mobility in subjects with PD by acutely facilitating increased upright postural alignment while decreasing rigidity.

Neurorehabilitation & Neural Repair (2015) Vol. 29(9) 878-888 

 PDF of full text

 


Case Studies

 

Long term effects of Alexander technique (AT) in managing motor symptoms of young onset Parkinson’s disease  Author: Candace Cox, presented at the 3rd World Parkinson Congress (2013)

Abstract and full text and charts/photos

All published abstracts from 3rd World Parkinson Congress, Montreal 2013


Related Scientific Research in Alexander technique

Increased dynamic regulation of postural tone through Alexander technique training
Authors: T.W. Cacciatore, V.S. Gurfinkel, F.B. Horak, P.J. Cordo, K.E. Ames

Gurfinkel and colleagues (2006) recently found that healthy adults dynamically modulate postural muscle tone in the body axis during anti-gravity postural maintenance and that this modulation is inversely correlated with axial stiffness. Our objective in the present study was to investigate whether dynamic modulation of axial postural tone can change through training. We examined whether teachers of the Alexander Technique (AT), who undergo ‘‘longterm’’ (3-year) training, have greater modulation of axial postural tone than matched control subjects. In addition, we performed a longitudinal study on the effect of ‘‘short-term’’ (10-week) AT training on the axial postural tone of individuals with low back pain (LBP), since short term AT training has previously been shown to reduce LBP. Axial postural tone was quantified by measuring the resistance of the neck, trunk and hips to small (±10_), slow (1_/s) torsional rotation during stance. Modulation of tone was determined by the torsional resistance to rotation (peak-to-peak, phase-advance, and variability of torque) and axial muscle activity (EMG). Peak-to-peak torque was lower (_50%), while phaseadvance and cycle-to-cycle variability were enhanced for AT teachers compared to matched control subjects at all levels of the axis. In addition, LBP subjects decreased trunk and hip stiffness following short-term AT training compared to a control intervention. While changes in static levels of postural tone may have contributed to the reduced stiffness observed with the AT, our results suggest that dynamic modulation of postural tone can be enhanced throughlong-term training in the AT, which may constitute an important direction for therapeutic intervention.

Human Movement Science 30 (2011) 74–89

PDF of full study


Reductions in co-contraction following neuromuscular re-education in people with knee osteoarthritis Authors: Stephen J. Preece, Richard K. Jones, Christopher A. Brown, Timothy W. Cacciatore, and Anthony K. P. Jones

Both increased knee muscle co-contraction and alterations in central pain processing have been suggested to play a role in knee osteoarthritis pain. However, current interventions do not target either of these mechanisms. The Alexander Technique provides neuromuscular re-education and may also influence anticipation of pain. This study therefore sought to investigate the potential clinical effectiveness of the AT intervention in the management of knee osteoarthritis and also to identify a possible mechanism of action. 

This is the first study to investigate the potential effectiveness of an intervention aimed at increasing awareness of muscle behaviour in the clinical management of knee osteoarthritis. These data suggest a complex relationship between muscle contraction, joint loading and pain and support the idea that excessive muscle co-contraction may be a maladaptive response in this patient group. Furthermore, these data provide evidence that, if the activation of certain muscles can be reduced during gait, this may lead to positive long-term clinical outcomes. This finding challenges clinical management models of knee osteoarthritis which focus primarily on muscle strengthening.

BMC Musculoskeletal Disorders (2016) 17:372

PDF of full study


Neuromechanical interference of posture on movement: evidence from Alexander technique teachers rising from a chair Authors: Timothy W. Cacciatore, Omar S. Mian, Amy Peters, and Brian L. Day

While Alexander technique (AT) teachers have been reported to stand up by shifting weight gradually as they incline the trunk forward, healthy untrained (HU) adults appear unable to rise in this way. This study examines the hypothesis that HU have difficulty rising smoothly, and that this difficulty relates to reported differences in postural stiffness between groups. AT's smooth rises can be explained by heightened dynamic tone control that reduces leg extensor resistance and improves force transmission across the trunk. Our results suggest postural control shapes movement coordination through a dynamic “postural frame” that affects the resistive behavior of the body. 

Poor postural regulation has the capacity to affect movement profoundly. Here we have presented evidence from rising from a chair, but other movements have similar mechanical conflicts. For example, stair climbing requires flexing leg joints to move the CoM over the foot while generating large extensor moments to rise up. Eccentric contractions are necessary for many everyday movements, such as gait, squatting, lunging, sitting down in a chair, etc. This potential interference may be exacerbated in the elderly. For example, when rising from a chair, the elderly have a CoM position that is even more posterior at SO (Mourey et al. 2000), which can cause “sitback” failures and lead to functional disability (Riley et al. 1997). While their difficulty has been attributed to fear of falling (Mourey et al. 2000) or low strength (Bernardi et al. 2004; Schenkman et al. 1996), it may stem from a poor ability to drive eccentric contractions due to excessive stiffness. If this is the case, perhaps training programs should not address strength or teach greater momentum (Schlicht et al. 2001; Schot et al. 2003), but instead address postural control to reduce its interference with movement, leading to more efficient coordination.

Journal of Neurophysiology (2014) 112. 719-729

PDF of full study


Improvement in automatic postural coordination following Alexander technique lessons in a person with low back pain  Authors: Timothy W Cacciatore,  Fay B Horak, and Sharon M Henry

The relationship between abnormal postural coordination and back pain is unclear. The Alexander technique (AT) aims to improve postural coordination by using conscious processes to alter automatic postural coordination and ongoing muscular activity, and it has been reported to reduce low back pain. This case report describes the use of the AT with a client with low back pain and the observed changes in automatic postural responses and back pain. The client was a 49-year-old woman with a 25-year history of left-sided, idiopathic, lumbrosacral back pain. Automatic postural coordination was measured using a force plate during horizontal platform translations and one-legged standing. 

The client was tested monthly for 4 months before AT lessons and for 3 months after lessons. Before lessons, she consistently had laterally asymmetric automatic postural responses to translations. After AT lessons, the magnitude and asymmetry of her responses and balance improved and her low back pain decreased.

Further research is warranted to study whether AT lessons improve low back pain–associated abnormalities in automatic postural coordination and whether improving automatic postural coordination helps to reduce low back pain. [Cacciatore TW, Horak FB, Henry SM.] Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain.
 

Physical Therapy Journal (2005 June) 85(6): 565–578

PDF of full study


Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain  Authors: Paul Little, George Lewith, Fran Webley, Maggie Evans, Angela Beattie, Karen Middleton, Jane Barnett, Kathleen Ballard, Frances Oxford, Peter Smith, Lucy Yardley. Sandra Hollinghurst, Debbie Sharp

Factorial randomised trial to determine the effectiveness of lessons in Alexander technique, massage therapy, and advice from a doctor to take exercise (exercise prescription) along with nurse delivered behavioural counselling for patients with chronic or recurrent back pain. Exercise and lessons in Alexander technique, but not massage, remained effective at one year. Exercise after six lessons achieved 72% of the effect of 24 lessons alone. Number of days with back pain in the past four weeks was lower after lessons (compared with control median 21 days: 24 lessons −18, six lessons −10, massage −7) and quality of life improved significantly. No significant harms were reported.

One to one lessons in Alexander technique from registered teachers have long term benefits for patients with chronic back pain. Six lessons followed by exercise prescription were nearly as effective as 24 lessons.

British Medical Journal (2008) 337:a884

PDF of full study

 View Video about study


Feasibility of group delivery of Alexander technique on balance in the community-dwelling elderly: preliminary findings  Authors: Glenna Batson; Sarah Barker

A research study conducted by Glenna Batson and Sarah Barker in 2007 at the University of South Carolina on the effects of a two-week trial of the Alexander Technique on balance in community dwelling elderly ages 60-89. You will see selections from their balance testing both before the two-week group lesson series and then right afterwards. Both pre-test and post-test comparisons are also posted for the various balance tasks.

(Please note: there is no sound in this video)