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.
· 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
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
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
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.
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.
Pilot Study in Alexander Technique and Care Partners of People Living with Parkinson’s
Alexander Technique Group Classes Are a Feasible, Cost-Effective, and Promising Intervention for Balance in Older Women
Presented at the American Congress of Rehabilitation Medicine Annual Conference, Dallas TX, September 28-October 3, 2018
Single group pilot study to investigate whether Alexander technique group classes would provide psychological or physical benefit for older women who are care partners for people living with Parkinson’s disease.
Seventeen women (aged 67+/-6 years) participated. Participants completed 10 weeks of AT classes (90 minute meetings, once per week) with testing before and after. AT group classes were held in non-clinical settings, in Concord NC at the Cabarrus County Senior Center between September and November 2017, and in Asheville NC at the Groce United Methodist Church between September and November 2017. Among the 15 who completed the classes, balance was significantly better (1.9 points, p=.002) and posture was marginally more upright (4 degrees, p=.06) after the class than before. Perceived burden was non-significantly reduced (4.6 points, p=.14) and self-efficacy was non-significantly increased (1.2 points, p=.38). Participants reported that they enjoyed the classes and learned practical tools to help care for themselves physically and emotionally.
Group AT courses appear to be an innovative, cost-effective and feasible intervention for older women. Participants reported that they enjoyed the classes, learned some practical tools to help care for themselves physically and emotionally, and their objectively assessed balance improved.