Does learning the Alexander Technique help manage disability and reduce handicap in PSP: A case study
Researcher Dr Chloe Stallibrass
Institution Polyclinic at the University of Westminster
Duration 6 months
Start February 2000 End August 2000
Grant £3,500
Aims of research
To investigate the effects on disability in a PSP patient of a course of lessons in the Alexander Technique
About the research
The Alexander Technique is a method of training in posture, body movement and positioning. Exercises are geared to restoring natural posture and ease of movement with minimal muscular effort. Improvement in posture can be accompanied by health benefits such as greater mental alertness, better sleep, increased resistance to stress and enhanced performance of physical tasks - all of which are features that could be of benefit to people with PSP.
The patient received 24 lessons in the Alexander Technique, spread over 13 weeks. A range of criteria were used to assess the patient, with measurements taken before, after and during the course of lessons. Measures included self report questionnaires, reports from observers and video tape. Specific measures included:
• Quality of Life 39
• Everyday activities in daily living
• Beck Depression Inventory
• Attitude to self
• Five measures as used by the National Hospital, Queens Square, of severity of disease
• Log of number of falls weekly
• MYMOP
• Two assessments from weekly visitors
• Four reports from a friend in daily contact
• Burden of disease coin test
Findings
Between the beginning of February and the beginning of May, the patient's disease progressed considerably. Many symptoms worsened on several of the measurement scales - in particular, focusing, which gave the patient most concern throughout this period. It is notable that over the whole study period, self-report measures of well being did not decline and were the same at the end as at the beginning of the study.
Small fluctuations in well-being during the three months corresponded directly with self-report small fluctuations in speech. Other people observed that the patient's speech was clearer. The patient vastly improved on the measure of how often he had to repeat himself to be understood. Other people also observed that the patient's ability to read deteriorated but that his eyes were much brighter and that he looked more alert. Although the patient's eyesight was deteriorating, the handicap of being hard to understand and of being difficult to communicate with was much reduced by his livelier expression especially in his eyes.
After 4 weeks he said:
"It feels as if it (the PSP) is getting worse but I'm more in control."
After 13 weeks he said:
"The main benefit (of the AT) is that it allows you to keep pace."
The results of the burden of disease coin test indicated that the burden increased but only by a little.
The number of falls per week fell rapidly in the first three weeks and stayed very low for four weeks before rising slowly to almost half the original level.
What does the outcome of this research mean for people with PSP?
The implications of this case study are that the Alexander Technique may help some people with PSP with balance, gait, facial and ocular mobility and hence expression and speech. Such improvements as may occur in balance etc are not necessarily going to last but the possibility of greater control than would otherwise be the case remains.
The Alexander Technique is a learned method and to use it well in everyday life requires learning and applying mental skills (thought). For those who welcome this challenge use of the Alexander Technique can raise the spirits and is likely to give some degree of improved choice and control in the face of progressive symptoms.
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