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


update


An update of my work with Val and Parkinson's Disease.

Val passed away in 2007. Her husband, Jim kept up a quality of life for Val but sadly
the symptoms of the disease and the side effects of the medications combined to limit
her ability to manage travelling or change of routine of any sort.

Jim, ever creative continued to manage their increasingly difficult life until Val passed
away. The following is a record of my Alexander work with Val.









introducing Val Scott


Val was diagnosed with Parkinson’s disease in 1996. She was 76 years of age when
I first met her.and married to child hood sweetheart, Jim for 60 years. They had 6
children including 2 sets of twins and now 17 grandchildren.
I started working with Val in November 2003. I felt privileged and honoured
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 lived in Alexandra in country Victoria and I
was the nearest Alexander Technique teacher, a good 100 kilometres away in
Healesville.




a typical day

Val was confined to a wheel chair unable to stand, dependent on Jims support. She was
hoisted by crane from bed to chair. Val had both knees replaced over 30 years ago
and bore 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 was
impossible because of the nervous disability bought about with the Parkinson
symptoms. In one sense Val’s problem with her knees was unrelated to Parkinson’s
disease, but in another it is entirely relevant to the issues she faced. 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 revolved around the rituals of the hoist. With Jim
lifting or hoisting Val from bed to bath or to toilet or wheel chair, the tasks could take a
whole day. Each day depended on her symptoms of nervousness, shakes, depression,
motivation and co-operation. Television didn’t interest her, reading she found difficult,
the radio is O.K. particularly music. She had an amazingly date retentive memory of
family events, every family members birthday and names. On a ‘bad day’ her short-term
memory was affected, causing panic, anxiety, dependency, clinging and insecurity.
From one day to the next Val’s experience varied greatly.

initial presentation


When I first met Val she presented with these problems:

•Bladder - incontinence
•Bowel problems - constipation
•Collapsed head and neck
•Difficulty Speaking
•Difficulty swallowing
•Fear of falling
•Tremors
•Poor circulation in feet (cold, discoloured, poor feeling)
•Could not 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 had been
maintained on a weekly basis with some short breaks of two to three weeks
during holidays etc. The work involved 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 humour,
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 was more upright, smiling and welcoming with a kiss. Laid flatter on the table - easier
to help neck / head / jaw. Could 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 went. Tried a pillow between her legs to help
spacing between legs - to change pattern.

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

Fifth Visit
Val loved 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 was stronger and her neck tone improved. She sat 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 was not keen on exercises!.
She was 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
could 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 could now:-

•Sit unsupported
•Tie her own shoes
•Crawl (pulling herself up into crawling)
•Swallow without using a straw
•Talk easily, and was socialising, 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

Working with Val made an invaluable contribution to my experience as an Alexander
Teacher. The experience for Val was equally if not more important as she had said
herself that her day to day life experience and well being improved dramatically, though
for a short time, whilst waiting for a miracle cure. My learning is whatever the incapacity
you are working with, the Alexander Technique can help with the every day quality
of life.

For further information on the 'Alexander Technique and Parkinson's Disease' see the
following link.

•The Australian Society of Teachers of the Alexander Technique
web site www.austat.org.au