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The Alexander Technique as a Complementary Therapy for Patients with Parkinsonís Disease
September 24, 2007††††
What is the Alexander Technique?
The Alexander Technique is a learned method that works to change movement habits in everyday activities or specialized activities. It is taught to help improve ease and freedom of movement, balance, support and coordination. AT is considered a reeducation of the mind and body, and works on the assumption that the self is comprised of physical, mental, emotional and spiritual aspects. Proponents of AT believe it helps one to discover a balance in body and mind by releasing unnecessary muscular tension through a series of learned patterns and postures, thus minimizing effort. AT is usually taught in individual or small group lessons in which the teacher uses many modes of communication including skilled hand contact, talking, visual aids, imitating, modeling, mirrors and text. The Alexander Technique is not considered a medicine or treatment but a way of thinking and moving.
††††††††††† The Alexander Technique was developed by F.M. Alexander (1869-1955). Alexander was a Shakespearean actor who toured frequently and experienced chronic hoarseness and voice loss. When no medical treatment helped him he began nine years of self-observation, looking into his own movement patterns for the source of the problem. He solved his problem, developing and using what we now know as the Alexander Technique.
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Why do People Learn Alexander Technique and What are the Supposed Benefits?
††††††††††† The Alexander Technique is often required curriculum in the performance schools of music, acting, circus, dance, and some Olympic level sports training. Its purpose in these settings is to regain balance and ease of motion, end stuttering, help voice loss and assist in speech training, to unlearn and avoid repetitive stress. Because self-image is linked to oneís posture, claims http://www.alexandertechnique.com,it has an indirect positive influence on personal confidence and social standing, depression, phobias, and anxieties.
††††††††††† The Alexander Technique is often used as a complemental therapy. Those who study and teach AT believe that it helps increase flexibility at the joints reducing excessive pull on bones, helps one to regain and maintain mobility, and helps one to increase the range of movement improving stamina and lightness of motion. One alternative therapy web site, http://www.naturalstandard.com , says that if the desired state is reached it is thought to improve breathing, organ function, digestion and absorption, and lower blood pressure. AT is used not only as a supplemental therapy for physical effects, but it is also used for improved ability to cope with chronic illness and/or pain.†
What does the scientific community think about AT?
††††††††††† While AT is not considered a treatment, many healthcare professionals recommend the AT for patients with chronic pain, stress injuries, balance and coordination difficulties, and depression or anxiety. In addition to performance schools, the Alexander Technique is offered in wellness centers and health education programs. Among the supporters of the Alexander Technique are scientists and physiologists including Dr. Rudolph Magnus, G.E Coghill, Charles Sherrington, Frank Pierce Jones, and Nilolaus Tinbergen. While these scientists published books and articles on the effectiveness of AT, they did not conduct randomized controlled studies to add to the scientific literature. Many healthcare professionals who do not publish on the AT promote it to their patients.
ďWhen someone has a profession with particular physical demands or needs to make changes in habitual movement patterns, I suggest the Alexander Technique. I have found it very helpful for patients with low body awareness or those who have trouble relaxing.Ē
- Gail King, PT, MS, Backtec Orthopedic & Sports Physical Therapy
††† The Alexander Technique is also recommended by healthcare professionals in Europe. The UK National Health Care Services affirms AT to be an alternative complementary management for back problems and to help patients with Parkinsonís Disease regain mobility (http://www.thehealthworks.co.uk/therapies/at.html). Many critics believe that the Alexander Technique is completely unresearched, but several scientists have conducted randomized, controlled trials testing the effectiveness of AT. The research conducted on the Alexander Technique is still limited compared to many therapies. For further information on scientific research see these scholarly articles:
o Stallibrass C, Frank C, Wentworth K. Retention of skills learnt in Alexander Technique lessons: 28 people with idiopathic Parkinson's disease. Journal of Bodywork and Movement Therapies 2005;9:150-7.
o Stallibrass C, Sissons P, Chalmers C. Randomized, controlled trial of the Alexander Technique for idiopathic Parkinson's disease. Clinical Rehabilitation 2002;16:695-708.
o Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson's disease - a preliminary study. Clinical Rehabilitation 1997;11: 8-12.
o Dennis RJ. Functional reach improvement in normal older women after Alexander Technique instruction. Journals of Gerontology Series A: Biological Sciences and Medical Sciences 1999;54:M8-M11.
o Austin JHM and Ausubel P. Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculoskeletal education without exercises. Chest 1992;102:486-90.
o Vickers AP, Ledwith F, Gibbens AO. The impact of the Alexander Technique on chronic mechanical low back pain (unpublished report). 2000.
o Cacciatore TW. Improvement in automatic postural coordination following Alexander Technique lessons in a person with low back pain. Physical Therapy 2005;85:565-78.
o Valentine ER, Fitzgerald DFP, Gorton TL, Hudson JA, Symonds ERC. The effect of lessons in the Alexander Technique on music performance in high and low stress situations. Psychology of Music 1995;23:129-41.
What is Parkinsonís Disease?
Parkinson's disease is a disorder of the central nervous system. The central nervous system includes the brain and spinal cord. Parkinson's disease is one of the conditions known as a movement disorder. The brain produces a chemical substance called dopamine that carries messages around the body telling it how and when to move. Parkinson's disease occurs when the brain cells that produce dopamine die or are damaged. If this occurs there is no longer enough dopamine to carry these messages, thus making movement more difficult. Parkinson's disease is categorized as both chronic and progressive, meaning that the disease lasts a long time and the symptoms get worse over time (http://www.stalevo.com:80/info/)
What are the symptoms of Parkinsonís Disease?
1.Tremors ó rhythmic movements or shaking, especially in the hands and particularly when they are at rest
2.Rigid limbs and trunk ó muscle tenseness, stiffness, aching, or weakness
3.Slowness of movement ó difficulty beginning a task, such as washing or dressing
4. Poor balance and coordination ó problems with walking, such as shuffling, which may cause the person to fall.
††††††††††† According to one pharmacology company, the symptoms of Parkinsonís disease vary from person to person, and patients may experience only two or more of the four symptoms listed. In addition to these physical symptoms, many experience psychological symptoms such as depression or anxiety (http://www.stalevo.com:80/info).
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What are the theories on how the Alexander Technique helps Parkinsonís patients?
††††††††††† Several informational web sites about Parkinsonís Disease recommend the Alexander Technique as a complementary therapy for Parkinsonís patients. According to these web sites, AT can help with dealing with Parkinson's disease both physically and mentally. One website promoting Stalevo, a PD drug, promotes the use of AT in addition to using their drug.
†ďBecause the Technique looks at relationship between thought and muscle activity through individual lessons, it is particularly relevant to Parkinsonís disease, as it can help with the control of balance and movementĒ Ė Novartis Pharmaceutical Corporation (http://www.stalevo.com:80/info/)
The Alexander Technique is often described by AT teachers as a spiritual education that can create a mind-body unity that helps patients deal with depression and anxiety. Not only web sites specifically promoting AT are promoting the use of AT as a therapy for PD patients; many healthcare, pharmacology, and alternative therapy web sites are presenting information on using AT as a complementary therapy for patients with Parkinsonís Disease.
Is there scientific proof that the Alexander technique helps patients with Parkinsonís Disease?
††† As you can see from the list of scholarly articles, the research focusing specifically on The Alexander Technique and Parkinsonís disease is limited. In total, three studies mention work done with AT and PD patients, each conducted by C. Stallibrass of the University of Westminster School of Integrated Medicine. One of these studies was a preliminary study (1997), which showed the likelihood of AT being effective in the management of disability for many PD patients. These preliminary studies made further research desirable.
††† In 2002 a ďRandomized controlled trial of the Alexander Technique for idiopathic Parkinsonís diseaseĒ was conducted by C. Stallibrass, P. Sissons of Peta Sissons Consultancy, and C. Chambers of the London School of Economics Department of Statisics. The study involved 93 subjects with PD. The subjects were randomly assigned to the AT group, the no additional intervention group, or the massage group. The study was not conducted in order to compare AT with massage, but the massage was used as a control for the physical touch and personal attention given in AT lessons.
††† Subjects in the AT group were given two AT lessons per week for 12 weeks. Subjects in the massage group received two massage sessions per week for 12 weeks. Subjects in the no additional care group continued with their standard treatment for PD. Results were evaluated with the Self-Assessment Parkinsonís Disease Disability Scale (SPDDS). The SPDDS measured progressive deterioration for twenty-five everyday activities, and subjects were evaluated at different times of the day. The Beck Depression Inventory, which measures subjectís feelings in the past week, was also used, as well as an Attitudes to Self Scale, which measured subjectís attitudes toward their bodies and selves. In addition, a questionnaire was given on personal changes arising from the interventions.
††† The results showed that on the SPDDS scale members of the AT group improved in everyday activities post-intervention compared with the no-additional-intervention group. A six-month follow-up showed that the scores of both groups were lower, but the AT groupís scores were still higher than at the start of the study. Results show no statistical difference post-intervention or at follow-up for the massage group compared to the no-additional-intervention group. The Beck Depression Inventory showed that the AT group felt significantly better than the no-additional-intervention group, although members of the massage group showed positive change as well. The AT group felt significantly better, on the Attitudes of Self Scale, than subjects in the no-additional-intervention group. The massage group showed some change on the Attitudes of Self Scale, but their results had declined by the six-month follow up.
††† The questionnaire showed that eight subjects from the massage group reported improvement in specific physical actions, while 59 subjects from the AT group reported the same improvements. Only 17 subjects from the massage group made mention of general physical improvement, while 89 subjects from the AT group made the same mentions. According to the authorís of the study, ďWe conclude that the positive results for the Alexander Technique group across several measures, including the most accurate type of measure of disability (self-rated) for Parkinsonís disease (the SPDDS) show that it is likely to benefit most moderately mobile, non-demented people with Parkinsonís disease who are interested in a technique for self-help,"
††† In 2005 Stallibrass published another article on AT and idiopathic Parkinsonís Disease. This paper describes the responses to a questionnaire completed by a sample of 28 people six months after receiving AT lessons in the controlled trial. The responses from the questionnaire indicate that every subject retained some degree of skill, although there was a wide variation in amount of commitment and application.
SoÖDoes the Alexander Technique help patients with Parkinsonís Disease?
††† While it may seem easy to view Alexander Technique as a fix-all for many problems, it is still important to remain critical. The scientific research supporting the positive effects of AT on patients with PD is still extremely limited and must be expanded in order to have a better understanding of its benefits. It is important to understand that the Alexander Technique should never be used as a sole treatment for Parkinsonís Disease. The studies that have been done show that AT can be beneficial in PD patients interested in a technique for self-help, meaning that the patient must be motivated, eager to learn and open-minded in order for AT to be effective. Patients with learning disabilities or mental illness may not benefit from AT. So far no negative or dangerous effects have been found from learning AT. The Alexander Technique is proposed as a complementary therapy, so if you or someone you know is not satisfied with the results of your current PD treatment plan, you might want to consider looking into complementary therapies and definitely include the Alexander Technique on your list.
Stallibrass C. (1997). An evaluation of the Alexander Technique for the management of †† disability in Parkinson's disease - a preliminary study. Clinical Rehabilitation, 11, 8-† 12.
Stallibrass C., Frank C., Wentworth K. (2005). Retention of skills learnt in Alexander ††††† Technique lessons: 28 people with idiopathic Parkinson's disease. Journal of Bodywork ††† and Movement Therapies, 9, 150-157.
Stallibrass C., Sissons P., Chalmers C. (2002). Randomized, controlled trial of the ††††††††††† Alexander Technique for idiopathic Parkinson's disease. Clinical Rehabilitation,16, ††† 695-708.
Woodman, J. (2007) The Alexander Technique; Scientific Research. Retrieved September 22, 2007, from http://www.julia-woodman.co.uk/info/scientific-research.php
†(2007) Complementary and Alternative Therapies. Retrieved September 21, 2007, from ††† http://www.intelihealth.com
(2007) Living With Parkinsonís Disease. Retrieved September 22, 2007, from †††††† http://www.stalevo.com:80/info/
(2007) Natural Standard; The Authority on Integrated Medicine. Retrieved September ††††† 22, 2007, from http://www.naturalstandard.com
(2007) The Alexander Technique. Retrieved September 21, 2007, from ††††† http://www.crystalinks.com/at.html
(2007) The American Society for The Alexander Technique. Retrieved September 20, 2007, ††††††††† from http://www.alexandertech.com/
(2007) The Complete Guide To The Alexander Technique. Retrieved September 22, 2007, ††††††††††† from http://www.alexandertechnique.com
(2007) The Health Works; Complementary Therapy Centre. Retrieved September 19, †††††† 2007, from http://www.thehealthworks.co.uk/therapies/at.html
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