[Ronhutton]

Re: the recent thread on hypnotism, I thought this was interesting. First paragraph only in case I get into trouble for publishing the whole article!!
Ron

See Morris ME, Iansek R, Kirkwood B. A Randomized Controlled Trial of Movement Strategies Compared with Exercise for People with Parkinson’s Disease. Mov Disord 2009;24(1):64-71.

Mind over Matter: Can Thinking about Movement Help People with PD Move more Fluidly?

Background

The motor and nonmotor symptoms of Parkinson disease (PD) affect people in many aspects of their lives. One main motor symptom, bradykinesia, involves difficulty starting a movement and changing directions. For example, people with PD often have difficulty taking the first step when trying to walk down a hallway. When they get to the end of the hallway, they often find it extremely difficult to turn around. People who do not have PD simply rotate on one foot and turn around in one fluid motion. People with PD, however, take several tiny steps, turning in place, to end up facing the other direction. This difficulty with movement usually results in frustration for people with PD as well as those around them. Doctors and researchers are trying to determine the best form of rehabilitation for people with PD. The goal of this rehabilitation would be to regain better motor control, resulting in more fluid movement.



Many different types of rehabilitation have been tested in people with PD. Two of these are exercise therapy and movement rehabilitation strategies (MRS). Exercise therapy focuses on increasing muscle strength, range of motion, posture, and overall fitness. MRS is based on a program in Australia designed for people with PD. Rather than being a therapy based on actual exercise, MRS teaches people to mentally focus on movement. It also teaches people to focus on external cues to help with movement to improve walking, turning, and getting up from a chair. The key difference between MRS and exercise therapy is that no muscle training is actually used in MRS.

[Fiona]

I think it is a commonly used technique in many movement disciplines or practices to mentally visualize one's movement performance as a way of practicing and optimising actual movement. Apparently rehearsing the mental process involved can be even more effective in preparing the body to improve.

[reverett123]

Somewhere I read that imaging studies showed that the same areas of the brain lit up in the imagining as in the actual doing of the task.

Originally Posted by Fiona

I think it is a commonly used technique in many movement disciplines or practices to mentally visualize one's movement performance as a way of practicing and optimising actual movement. Apparently rehearsing the mental process involved can be even more effective in preparing the body to improve.

[gardengrl]

I do not have PD myself, but Mom does, or atleast she has due to meds? Anyhoo...I do have Nerve Damage & Drop foot on my left leg. I wear a brace. Dr's told me I would NOT be able to ever pick up that foot, which of course I could not for several years.
I did this Visual Focusing, it worked for me! I Can tell my leg to move & it will, I can even walk without a limp most times....BUT, it I get tired or my mind is not paying close attention, it all goes away! I lose control. So I know there is a link.

I try this mental imaging with my mom, but she can't seem to hold onto a thought long enough. She also has AD & Schizo which makes it harder. I would like to get some CD's though & perhaps "replace" or "Implant" positive info to her.

[ZucchiniFlower]

The symptoms mentioned in the article are exactly what I deal with all the time, and it would be very difficult to get through the day if I did not use rehearsal and external cues.

My cues are visual, moving towards something on the ground, usually lines in a sidewalk. I have an internal metronome going when I move, to establish rhythm. I often sing, or count.

I think 'side to side' instead of walking forward and that helps me overcome start hesitation and walking.

I'll stand on the train as we're arriving in the station and I move side to side with my feet to help me get off the train. Many times the door has closed on me. I'm sure people don't understand what's going on when my slow Frankenstein walk is happening. I'm just happy my legs are moving at all!

I'll look for that complete article. I'm curious about what techniques they use in the program. I learned some cues in PT and they helped me a lot. I was standing up and sitting down multiple times and then I got stuck and could not get up. The therapist handed me a cane sideways and as I reached for it, I got up easily.

So reaching for something helps me walk. I usually imagine reaching and it helps just as well.

Turning a corner is easier when I'm pushing something with my hand. I think the reaching and pushing is establishing an external cue that allows feedback to my brain which in turn helps me move.

Here's the complete article:

http://www3.interscience.wiley.com/c...973/HTMLSTARTW

[ZucchiniFlower]

From the article:

"Strategy training was based on the principles of the Victorian Comprehensive Parkinson Disease Program (Australia), as documented in detail by Morris, Iansek, and Kirkwood.[6][8][21][22] Strategy training aimed to teach people how to use attention and to use the frontal cortical regions to compensate for movement disorders.[6][8]

This included teaching people with PD to plan in advance for forthcoming movements, mentally rehearse complex actions before they were performed, consciously focus on movements while they were being performed, breaking long or complex movement sequences down into component parts, avoiding dual task performance and using external visual and auditory cues to guide movements.[6][8]

External cues and attention strategies aimed to improve the size, speed, and sequencing of movements. Conventional musculoskeletal exercises aimed to improve strength, range of movement, posture, general fitness, and function, based on Schenkman's[13] protocols. This included lower limb and trunk strengthening exercises, spinal and lower limb flexibility exercises and receiving feedback on optimal postural alignment for a range of positions."

ANOTHER STUDY:

Article from 2000:
The role of sensory cues in the rehabilitation of parkinsonian patients: A comparison of two physical therapy protocols
Abstract

We devised a single-blind study to assess the role of providing external sensory cues in the rehabilitation of patients with idiopathic Parkinson's disease (PD). Twenty stable, nondemented patients with PD entered a 6-week rehabilitation program and were randomly assigned to two balanced protocols which were differentiated by the use of external sensory cues (non-cued vs cued). Patients were evaluated by a neurologist, who was blind to group membership, with the Unified Parkinson's Disease Rating Scale (UPDRS) at baseline, end of treatment, and after 6 weeks. Patient groups were comparable for age, disease duration, and severity. A significant reduction of UPDRS scores (activities of daily living and motor sections) was present after the rehabilitation phase in both groups. However, at follow up, while this clinical improvement had largely faded in the non-cuedgroup, mean UPDRS scores of the cued group were still significantly lower than baseline values. The incorporation of external sensory cues in the rehabilitation protocol can extend the short-term benefit of physical therapy in moderately disabled patients with PD, possibly as a result of the learning of new motor strategies. Cued physical therapy for PD should be targeted to compensate for the defective physiological mechanisms.

http://www3.interscience.wiley.com/j...08409/abstract
Full article:
http://www3.interscience.wiley.com/c...08409/PDFSTART

They used a metronome and visual cues, and some sensory cues that I don't understand. The therapy improved bradykinesia and balance.

They think cueing makes motor tasks less automatic and enables one to modify motor strategies to involve a "closed loop" performance. External cues help one to switch from one movement component to the next "compensating for a defective internal trigger from the pallidum to the supplementary motor area."

Cueing led to new "attentional strategies" which allowed for better movement.

[pegleg]

This hesitation in stopping and starting is a new thing for me. I sometimes "freeze" in a tight spot when I am "off" ( in doorways, in a crowd, and even when the textures of the floor change - like going from wood to carpet). That's gotta be a visual thing.

Some trainers have said to "swing your arms" when you freeze and you can get started again - it works! But first I have to tell my arms to swing - it doesn't just happen.

so when they use hypnosis I suppose they tell you "You will not have to stop and take baby steps -" - good luck with that!

[vlhperry]

There is an excellant book called , "Your Brain on Music" that deals with this topic and explains how it works. The white matter in the brain is like the REM on a computer. Your memories and knowledge which you have done repeatedly is hard wired into the brain up until you are between 8 and 11 years old. After that the brain starts building and pruning the grey matter at a much slower pace. The gray matter in the brain, the RAM, is what gives your brain its neuroplasticity, or the ability to build new pathways to bypass damage in the white brain matter. Unfortunately it takes about 10,000 repetitions to be able to build those pathways. Doctors place your hopes in biofeedback techniques to monitor your success. The patient ends up racing the rate the lewy bodies are building up in the brain while you are trying to use the "Music Man's" think system to control your symptoms.

Will the think system win? That remains to be seen. But it is an avenue of Hope. Isn't that why we come here? Looking to each other for hope?

Vicky