Parkinson’s Disease & AT

Parkinson’s disease (PD) is a progressive neurological disease that includes a range of symptoms related to control of posture (Doherty et al., 2011). The biological basis for PD is death of dopamine secreting neurons caused by degeneration of the substantia nigra and nigrostriatal system. The brain contains two major systems of dopaminergic (DA) neurons: the nigrostriatal system (damaged in PD), and the mesolimbic/mesocortical system, which consists of dopaminergic neurons in the ventral tegmental area that innervate the nucleus accumbens and the prefrontal cortex. Parkinson’s disease (PD) damages only the nigrostriatal system because elevated intracellular calcium ions and dopamine combine to kill cells in the nigrostriatal system; the mesolimbic/mesocortical lacks elevated levels of calcium ions (Carlson & Bricket, 2022).

Most cases of Parkinson’s disease (PD) do not have genetic causes but there are PD correlated gene mutations known to cause higher levels of defective proteins to accumulate and damage dopaminergic neurons. Primary symptoms of PD are muscular rigidity, slowness, tremor, and postural instability. PD can be caused by environmental toxins (i.e. insecticides), faulty metabolism, or unrecognized infectious disorders. Functional-imaging studies have shown that akinesia (difficult initiating movement) was associated with decreased activation of the supplementary motor area and that tremors are associated with abnormalities of a neural system involving the pons, midbrain, cerebellum, and thalamus (Carlson & Bricket, 2022).

The standard treatment for PD is L-DOPA, the precursor of dopamine. Increased levels of L-DOPA causes a patient’s remaining dopaminergic neurons to produce more dopamine but eventually the number of nigrostriatal dopaminergic neurons declines and symptoms become worse. Deprenyl, an MAO inhibitor, slows the progression of PD, especially if therapy begins soon after onset. MAO inhibitors appear to work on symptoms but do not slow the degeneration of neurons (Carlson & Bricket, 2022). Medication often alleviates some Parkinsonian motor symptoms, but it does not cure them and may make aspects of postural control worse (Contin et al., 1996). Surgical options including fetal tissue transplant, but not all patients benefit and some transplant recipients later develop severe dyskinesias. Other surgical options include brain lesioning the globus pallidus (GPi) and/or the subthalamic nucleus (STN), or implanting electrodes for deep brain stimulation (DBS) of the STN (Carlson & Bricket, 2022). 

Woodman & Moore (2011) suggest the effectiveness the Alexander Technique (AT) in PD related disability. Movement based embodied cognitive practices (MECPs) similar to AT (Posadzki, 2009), such as Yoga, Qigong and Tai Chi have shown promise in alleviating symptoms associated with PD disability (Cohen et al. 2015). The AT is a method of neuromuscular re-education known to affect postural tone and movement coordination (Cacciatore et al., 2011). According to the National Health Service (UK), “lessons in the AT may help one carry out everyday tasks more easily and improve feelings about Parkinson’s disability.” A pilot study (Stallibrass, 1997) indicated that, in conjunction with drug therapy, AT could benefit people with Parkinson’s disease. 

A subsequent larger scale study (Stallibrass et al., 2002) included ninety-three people with idiopathic PD assigned into three groups (AT, massage, and no additional care) assessed using the Self-assessment Parkinson’s Disease Disability scale (SPDDS), Attitudes to Self-scale and Beck depression inventory (BDI). The AT group improved compared with the no additional intervention group, pre-intervention to post-intervention on SPDDS tests and was comparatively less depressed post-intervention, supporting evidence that lessons in the AT are likely to lead to sustained benefit for people with Parkinson’s disease (Stallibrass et al., 2002). Reductions in depression seem to stem from greater agency based on questionnaire responses (Stallibrass, 2005). 

 More recently, Cohen et. al (2015) showed that distinct effects on posture and mobility were apparent by measuring axial tone, postural sway, postural uprightness, and step initiation after Parkinson’s patients were given brief postural instructions based on AT directions. These inquiries all have interesting implications for the philosophical mind-body problem and have inspired continuing research.

More on the topic.

References

Carlson, N., Birkett, M. (2022), Foundations of Behavioral Neuroscience (10th ed.), Pearson.

Cacciatore T., Gurfinkel, V. S., Horak, F. B., Cordo, P. J., & Ames, K. E. (2011). Increased dynamic regulation of postural tone through Alexander Technique training. Human Movement Science, 30(1), 74–89. https://doi.org/10.1016/j.humov.2010.10.002

Contin M, Riva R, Baruzzi A, Albani F, Macri’ S, Martinelli P. Postural stability in Parkinson’s disease: the effects of disease severity and acute levodopa dosing. Parkinsonism Relat Disord. 1996;2:29-33.

Cohen RG, Gurfinkel VS, Kwak, E, Warden AC, Horak FB. Lighten up: specific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease. Neurorehabilitation and Neural Repair. 2015;29:878–888. doi:10.1177/1545968315570323

Doherty K., van de Warrenburg, B. P., Peralta, M. C., Silveira-Moriyama, L., Azulay, J.-P., Gershanik, O. S., & Bloem, B. R. (2011). Postural deformities in Parkinson’s disease. Lancet Neurology, 10(6), 538–549. https://doi.org/10.1016/S1474-4422(11)70067-9

Posadzki P. (2009). Qi Gong exercises through the lens of the Alexander Technique: A conceptual congruence. European Journal of Integrative Medicine, 1(2), 87–92. https://doi.org/10.1016/j.eujim.2009.04.001

Stallibrass C. An evaluation of the Alexander Technique for the management of disability in Parkinson’s disease- a preliminary study. Clinical Rehabilitation. 1997;11(1):8-12. doi:10.1177/026921559701100103

Stallibrass, C., Sissons, P., & Chalmers, C. (2002). Randomized controlled trial of the alexander technique for idiopathic parkinson’s disease. Clinical Rehabilitation, 16(7), 695-708. https://doi.org/10.1191/0269215502cr544oa

Stallibrass, 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(2), 150–157. https://doi.org/10.1016/j.jbmt.2004.06.004

Woodman, J. P. Moore, N. R. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review 2011 – International Journal of Clinical Practice VL  – 66 IS  – 1 SN  – 1368-5031 UR https://doi.org/10.1111/j.1742-1241.2011.02817.x

National Health Service of the UK – AT page https://www.nhs.uk/conditions/alexander-technique/

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