How many enjoyed the movie, "A Late Quartet" about a world famous string quartet? Remember when the cellist-founder attends a movement class for his encroaching Parkinson's? The therapist tells the group that Parkinsons tends to "shrink everything," steps, movement and so on. She then flings open her arms and advises everyone to stretch and breathe and open their chests. A dynamic moment. So qi inspired! As it happened, I watched this gem while researching this column on the importance of movement for movement disorders – having just attended a review course held in Austin on the topic run by the Parkinson's Disease and Movement Disorder Center of the University of Kansas Medical Center. Although the course's emphasis was on medication, one of the presenters, Cynthia Comella MD, Rush University Chicago Professor of Neurological Sciences, told us she advises all her patients to integrate some form of exercise daily, Tai Chi, Qigung, Dance, or whatever works for them. Surprisingly, Dr Comella admitted it was "hard to get funding" for studies involving movement.
Dancing Shoes?
That same week, BBC TV happened to air a story about the research on vibratory shoes for Parkinson's patients underway at the University of Delaware's Biomechanics and Movement Sciences Program.1 As far as I know, the story has yet to be picked up by any of the networks in the U.S. The research is fascinating. Ingrid Pretzer-Aboff PhD RN, the program's research director, and members of the team, discovered that Parkinson's patients who arrived at the center by train, demonstrated more gait stability and less "freezing" than patients who arrived by car or bus. This prompted the team to research a vibratory shoe that mimicked train rhythms. Dr. Aboff also emphasized the need for a "non-medical device."
The TV clip shows a before-and-after case study and the difference is stunning. The shoes prompted a steady gait and a more balanced posture, inspiring confidence and joy in the patient. As the shoes are still in the experimental stage, it might take time for them to hit the general market. Until then, I will encourage all my graduates who work with Parkinson's clients to spend more time activating their patients' feet or experimenting with applying a train-like rocking movement. The clip resonated instantly with a wide range of my ABT and LAc colleagues, and with global colleagues who practice The Trager Approach, and those who are Certified Rolfers, and especially those who travel frequently by train.
Shiatsu therapist Tarja Gromes (Finland, Germany and the U.S.), emphasizes "smoothing, rotating, expanding and holding" techniques for the feet, with a focus on meridian imbalances pinpointed during assessment. Especially for movement disorders, based on her early experiences of experimenting with creative footwork for cerebral palsy.
Tai Chi?
A colleague who teaches Tai Chi observed the way one of his students, Gina J*, possibly in the early stages of Parkinson's, prefers to repeat the first movement ("Parting the Wild Horse's Mane") over and over instead of following a sequence of movements with the group. Repeating one simple movement – and to one side – helps minimize her shaking. The effectiveness of dance, and especially Argentine tango for Parkinson's, has been thoroughly documented. Just Google the topic, especially the YouTube clips! Dance groups for Parkinson's have sprouted in most states.2 During 2015, researchers at McGill University Health Center and the Montreal Neurological Institute recruited 49 men and women with idiopathic Parkinson's from McGill's Movement Disorders Clinic, for a tango study with dance teachers. Lead researcher Dr. Silvia Rios Romenets told Science Daily3 that the study showed how tango improved balance and functional mobility and cognitive functions, as well as reducing fatigue.
According to the report, the 12-week course was the first to assess the impact of tango on non-motor symptoms. Interestingly enough, those tango steps involving walking forward and backward rhythmically were discovered to minimize gait freezing and backward falls. A back-and-forth rhythm, of course, mimics the movement of a train! So it remains to be seen which method works best. Tango and the tight proximity of a dancing partner? Or the vibratory shoes?
Tango's inspiring music and social aspect has been noted across the board as being equally beneficial for Parkinson's patients, especially for those patients who find solo exercises boring and isolating. Indeed, as the late neurologist Oliver Sacks emphasized most eloquently, the right music for Parkinsons has a "well defined rhythm" and is the "most potent unlocker." His chapter on Parkinsons in his book Musicophilia4 describes the importance of external stimuli, of dance, of movement in pairs, even paired walking, to combat "freezing."
I experimented with this while teaching a class of Shiatsu therapists who were also Physical Therapists in Dresden, Germany. We invited Parkinson's patient Karl S*, a retired university professor, to join us. At the start of the class, I put on a tango CD and invited Karl to join me on the floor. Simple steps, two forward, one back. Slow and even. Repeat. Repeat again. Within minutes, I noted that Karl's hands stopped shaking, and his gait steadied for the the entire 3-hour class. The group was amazed. I encouraged all of them to incorporate tango music and steps in their clinics and to evaluate the difference between a session with music and without music. More than anything to bring fire and joy to a stiff clinical setting. To remove passivity from a session. Ah, perhaps that's the key.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Traditional Chinese medicine and the Vedic traditions both offer rich frameworks for understanding human health, emphasizing the balance of physical, mental, and spiritual aspects. The concept of "souls" or spiritual components in TCM, namely Hun, Po, Shen, Yi, and Zhi, bears significant similarities to the yogic concept of koshas. Their similarities and differences provide insights into how these systems contribute to holistic health practices.
