Parkinson's Disease - A Case Study s t u d i o e v o l v i n g

Introducing Valma Scott

Val was diagnosed with Parkinson’s disease over 10 years ago. She is 76 years of age and married to child hood sweetheart, Jim for 60 years. They have 6 children including 2 sets of twins and now 17 grandchildren.

I have been working with Val since November last Year. I feel privileged and honored getting to know Val and her remarkable partner Jim. They wish to share their journey with the Alexander Technique and hope their experience will inspire other people with Parkinson’s disease to explore the Technique for themselves.

Jim found the English Alexander Technique and Parkinson’s disease study on the Internet, and with Val decided to investigate the Technique. Val’s wellbeing and quality of life was their main concern

They live in Alexandra in country Victoria and I was the nearest Alexander Technique teacher, a good 100 kilometers away in Healesville.

A Typical Day

Val is confined to a wheel chair unable to stand, dependent on Jims support. She is hoisted by crane from bed to chair. Val had both knees replaced over 30 years ago and bears horrific scars and no kneecaps. Riding a bike and walking until a few years ago, her knees finally were so painful she ground to a stop. Further surgery is impossible because of the nervous disability bought about with the Parkinson symptoms. In one sense Val’s problem with her knees is unrelated to Parkinson’s disease, but in another it is entirely relevant to the issues she faces. When people have additional problems to their Parkinson’s symptoms these are still part of the ‘whole person’s’ experience of daily life.

A usual day in Val and Jim’s life revolves around the rituals of the hoist. With Jim lifting or hoisting Val from bed to bath or to toilet or wheel chair, the tasks can take a whole day. Each day depends on her symptoms of nervousness, shakes, depression, motivation and co-operation. Television doesn’t interest her, reading she finds difficult, the radio is O.K. particularly music. She has an amazingly date retentive memory of family events, every family members birthday and names. On a ‘bad day’ her short-term memory is affected, causing panic, anxiety, dependency, clinging and insecurity. From one day to the next Val’s experience varies greatly.

Initial Presentation

When I first met Val she presented with these problems:
•Bladder - incontinency
•Bowel problems - constipated
•Collapsed head and neck
•Difficulty Speaking
•Difficulty swallowing
•Fear of falling
•Tremors
•Poor circulation in feet (cold, discolored, poor feeling)
•Cannot stand - legs fixed in one direction

Introduction

The following is a summary of of Valma's progress derived from records kept after each visit . My first Alexander lesson with Val was on November 20th 2003. Lessons have been maintained on a  weekly basis with some short breaks of two to three weeks during holidays etc. The work involves mainly table work which has extended to more free work on the floor and on a chair over a period of months. The notes below are presented as a weekly report or monthly summary depending on Val's progress.

Summary of Progress

November - December 2003
Started with table work with books under her head and bolsters under legs. After the first lesson we saw some immediate changes - less shakes, speaking more freely but could only open legs a little. Val said she felt relaxed and sleepy and slept well that night. At the end of November she looked more upright in the chair and calmer. Started giving directions to help her short shallow breathing. More movement in left leg.

December - January 2004
Positive changes include less neck restriction / speaking more freely - lucid humor, teasing and joking - calmer and less shaking. Val said she felt relaxed and sleepy. Jim was going to provide a firm board on Val's bed to try semi-supine once a day.

Third Visit
Val more upright, smiling and welcoming with a kiss. Laid flatter on the table - easier to help neck / head / jaw. Can now find room to put my hands around her neck. Jim has noticed change in bowel and bladder control. When I put my hands on Val her breathing became easier and the shakes go. Tried a pillow between her legs to help spacing between legs - to change pattern.

Fourth Visit
Jim thinks Val's skin, feet and legs feel different - feet have better color, skin more elastic texture. Val seems wider and longer on the table -moving feet and toes herself, but lack co-ordination and control - better on one side.

Fifth Visit
Val loves being touched down legs from hip to each toe. Discussed Home Maintenance with Jim. Her head position at home in the wheelchair and in the car was important - explained the effect of 'collapse' on breathing and speech. Jim will try to change pillow height and support in her bed.

Sixth Visit
Val able to put feet flat on the table at hip width apart with a pillow spacing. Val asks "when will she be walking".

Three week break. Val continued with her home self maintenance program of semi-supine, pillow changes and exercises with pillow between legs. Upon her return for the seventh visit her breathing had improved and was able to move her legs independently. Mobility improved being able to put hands on her  knees and rotate her knees together and away by herself. Val used to love riding her bicycle so we played with her pedaling her feet into my hands.

February 2004
Val's back is stronger and her neck tone improved. She sits straighter with little or no support. Bladder control better and only misses if she sleeps in.

March 2004
Val is very bright and talkative. Jim reported after a family visit at the weekend all had noticed changes in her. Muscle tone improved - now soft and less squiggy. Skin feels beautiful and has good color. Feet not blue and are more sensitive. Losing weight - less fluid retention.
Doesn't need Ventalin anymore.

April 2004
Val bright and lively. Sat her upright on the table with legs over side - first supported, then free. (Which showed her back was strong, her balance good and she was not afraid of falling forward). Introduced the yoga "bridge" - lifting the pelvis up supported on the feet - to help tone and strengthen as well as to develop hip mobility and muscle tone to the feet. Moved her bent legs side to side. Sat on wooden chair in the sunny studio with her feet on the floor and looking out at my dogs. Was able to roll a ball under her feet. Was able to bend forward and put her hands on the back of a chair - very stable and strong. When her family visited at Easter they were all thrilled with her wellness and brightness. She was full of family history and stories.

May 2004
Val tells me she stood up when she got out of bed in the night. Jim was not happy about her midnight exploits. By mid-may she was sitting unsupported on a chair moving freely from hips with feet on the floor (even though her ankles are weak and collapsing inward). With Jim's and my support Val came to standing.

June2004
Surprise ! Val came in her walking shoes and I took this to mean a strengthening in her resolve and determination to try walking. A physio visit assessment suggested exercises to strengthen her legs if Val was motivated. Val is not keen on exercises!. She is happy to play at them with me but can't maintain interest at home.

July 2004
Jim put Val on the floor with the hoist. She lay back with her head supported then experimented with rolling over onto her sides. It was easier rolling to the left than the right and Val really enjoyed the sense of freedom and mobility.

August 2004
Val was rolling over more easily in both directions and pulling herself half up to the crawling position, showing her strength, mobility and independence. She came up from lying to bend forward and untie her shoe laces (Big changes). When sitting she can now push foot into a shoe with a person or something solid for support and then tie up the laces. She has a strong motivation for independence and self sufficiency.

Outcomes

After almost one year Val can now
•Sit unsupported
•Tie her own shoes
•Crawl (pulling herself up into crawling)
•Swallow without using a straw
•Talk easily, and is socializing, interacting with her family
•Balance herself when sitting upright (can hold her own great grandchild)
•Stand up (weight bearing) with support
•(is) Continent / regular
•Motivated (to be involved) with increased self esteem and
•Has reduced or discontinued some medications (particularly analgesics
  and benzodiazepines)

Conclusion

My work with Val has made an invaluable contribution to my experience as an Alexander Teacher . Val and I will continue to work together . The experience for Val is equally if not more important as she has said herself that her day to day life experience and well being has improved.

For further information on the 'Alexander Technique and Parkinsons Disease' see the following links
•The Australian Society of Teachers of the Alexander Technique web site www.alexandertechnique.org.au
•The Society of Teachers of the Alexander Technique (STAT) web site at www.stat.org.uk.

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