by Ernie Adams, GCFP
For a person with Parkinson’s Disease (PD), the natural rhythm and flow of perception, feeling, and movement is disrupted. There is a disconnection between the intention to move and the ability to start or complete an action. Routine automatic behaviors, such as those involved in walking, speaking, breathing, swallowing, and facial expression, become difficult or unavailable.
In his book, Musicophilia, Oliver Sacks describes how the “Kinetic Melody,” or the “smooth, graceful flow of movement,” becomes a “Kinetic Stutter.” The “kinetic stutter” in Parkinson’s is related to the depletion of the neurotransmitter dopamine. Dopamine is a chemical messenger that allows information to travel across synapses to a part of the brain that helps control movement and coordination. When communication becomes disrupted, tremor, slowness of movement, or rigidity can result. Balance and coordination become progressively worse.
PD originates in the brain. Even so, neuroscientists have proven that other intact areas of the brain, including the visual and auditory systems, as well as sensory and motor pathways in the peripheral nervous system, can compensate for lost function in the parts of the brain affected by PD, and improve control of movement. This means the nervous system has the capacity, to some extent, to “rewire” and reconfigure itself to overcome some limitations imposed by PD. This is called neuroplasticity.
In 2010 the New England Journal of Medicine published videos of a 58-year-old man, with a ten year history of Parkinson’s Disease, who would “freeze” in place whenever he wanted to walk, yet could ride a bike very well. As soon as he dismounted from the bike, however, he once again became frozen and unable to walk.
The Mark Morris Dance Company in Brooklyn, NY, began offering dance classes for persons with PD in 2001. They report that during classes many students shed some symptoms of PD, at least temporarily, and were able to flow gracefully in a kind of choreographic harmony with other dancers. Outside the classroom, some discovered they could cue themselves into moving with feelings, qualities, and rhythms they had practiced in Dance for PD classes, and were able to walk, speak, and express themselves better.
There are many stories about how individuals with Parkinson’s are able to shed symptoms while climbing stairs, riding a bike, playing piano, skiing, singing and acting. Neuroscientists and clinicians have begun to identify how these remarkable things are possible and to develop strategies using music, dance, exercise and movement, as well as including the Feldenkrais Method, to help persons with Parkinson’s live a more active life.
Some people theorize that the rhythm and phrasing of music, dance steps, choreography, and perhaps the cadence created by the crank on a bike, or visual rhythms from stairs, or lines on the sidewalk can give people with PD enough visual, kinesthetic and auditory cues to keep pace with the activity. Clearly defined rhythm, tempo, larger amplitudes, and dynamic range can help carry action forward in time and space. This is particularly useful for walking. Vivid kinesthetic experiences, visual imagery, metaphor, and dramatic involvement can also help express emotions, meaning, and feeling for actions, which is good for communication. Whatever is happening, the nervous system is finding a way to creatively circumvent some PD symptoms, at least temporarily.
The Feldenkrais Method
The Feldenkrais Method influences brain and behavior through a learning process involving movement exploration, trial and error, and problem-solving. With the Feldenkrais Method students develop their ability to attend to internal (proprioceptive ) as well as external and environmental feedback. Children learn to lift their heads, crawl, roll over, sit, stand, walk and talk using this same process. Rather than “correcting” or “showing’’ the student how to do something, the practitioner presents possible choices that may help the client solve the problem for herself or himself. These ‘choices’ are carefully designed movement sequences that can be adapted to the student’s specific needs. The student decides what feels right and what works. It is a self-organizing learning process, rather than a prescription to follow a generic exercise regime. The Feldenkrais Method offers persons with Parkinson’s Disease a way to discover and implement action patterns that can enhance functional ability. It will be different for each student. The goal of the practitioner is to create the optimal conditions for learning. Below are some particularly important areas a practitioner may address during a Feldenkrais® session:
FOCUSING: Directing attention towards the physical requirements of the action, rather than trying to persuade the body to move. If you get “frozen” focus on: “shifting your weight,” “freeing the opposite foot,” “taking a step.”
GROUNDING: Waking up your feet to get more information about weight bearing, feeling the surface you are standing on, and experiencing the feet and ankles as balance sensors.
BALANCING: Practicing and improving balance in a safe environment, learning how to prevent falls, how to protect yourself and fall more softly if you do fall, and how to get up and down from the ground.
WALKING: Exploring cadence, amplitude, tempo, swing between hips and arms, develop rhythmic structures to carry yourself forward, for example, imagining walking to tango, turning to a waltz, finding a marching beat, strutting, swaggering.
ACTION THINKING: Using vivid visual and physical imagery to cue yourself into initiating and completing a desired movement. Using drama and playfulness to amplify emotions and motivate you to move bigger.
SWALLOWING: Experiencing how the voice box lowers when you yawn, and rises when you swallow; noticing how the tongue anchors deep in your throat, and how it profoundly affects breathing, swallowing and speaking.
VOCALIZING: Using your voice to create good vibrations to wake up the lips, skull, jaw, face, and self-expression.
INCREASING CORE AWARENESS: Developing strength and flexibility in the core, spine, and legs to support yourself. Learning how your pelvis and hips are the center of support, balance, and power.
During an individual or group Feldenkrais® session, the practitioner will suggest specific actions and movement sequences verbally or through hands-on direction, in sitting, standing, or lying positions, or while doing activities, such as walking. Some of this is to assess your specific needs; some of it will be to explore action patterns that may require a novel or unusual solution. This “problem solving”, is not necessarily stressful or difficult; it is done to shed light on ways of moving that you may not have considered.
Many people with PD are frustrated with the typical generic prescriptions of “exercise therapy’,’ “fall prevention,” or “gait training,” and want to find additional ways to help themselves. There has been an upwelling of political advocacy and fundraising in the last few years to increase research and awareness of PD by nonprofit organizations, such as the Michael J. Fox Foundation. Complementary medicine and mind-body approaches, such as the Feldenkrais Method, are becoming more widely recognized as significantly beneficial to people with both orthopedic and neurological conditions. Students and clients of mine with PD have enthusiastically embraced the Feldenkrais Method because it empowers them to take control and make things happen. If you are interested in finding out more about the use of the Feldenkrais Method to address PD, please contact me.
Ernie Adams is a Guild Certified Feldenkrais PractitionerCM and Certified Pilates Trainer, with an extensive background as a professional dancer. He works with both orthopedic and neurological conditions in many different settings, including physical therapy clinics, Kaiser hospitals, yoga and pilates studios. His private office is in Albany, California.