Introduction: Applying Neuroplasticity
People with Parkinson's Disease seem to increasingly lose their innate knowledge of how to move as the disease progresses when effective therapies to prevent this atrophy are not put in place. However, it is quite possible for people with PD to re-learn at least some degree of motion, and even learn to move in new and better ways than we ever did before diagnosis, extending our range of motion above the level when we were previously "healthy".
Since we know that people who've had the verbal centres of their brain damaged by a stroke can re-learn how to speak through intensive speech and language therapy, it stands to reason that it is just as possible for people with PD to (re-)learn movement despite damage to the movement initiation centres of the brain. Indeed, overcoming brain injury disability is a huge topic of science known as Neuroplasticity. The book by Norman Doidge,
is essential reading for anyone affected by PD or other brain related disabilities.
How Humans Learn to Move
Movement in humans is a learned behaviour. We learn to move mainly by watching other people go through the motions: we are not born with any innate ability to move around independently. As babies and toddlers, we spend years watching and mimicking our parents, programming our brains with the data they provide. Our brain knows all about walking before we even attempt to walk ourselves, through unconscious observation. Later, we start to get the hang of it through intensive practice, and especially by falling down and making mistakes. Encouragement and supportive instruction from adults help us to keep practising until we have, at last, developed the ability to move independently. But imagine, if as we started to trying to walk, when we fell over on the second attempt, our parents said "oh dear, walking is not for you"! Unfortunately, this is precisely the message people with PD tend to be given.
The analogy with babies is even more apt, when we understand that, while people with PD and other movement disorders not only seem to forget how to do the movements they learned in their childhood development stage or in classes as adults, but also that their Nervous System is defaulting back to Primitive Reflex responses. These reflexes are a set of innate automatic movement responses we are born with, but which are supposed to disappear (become integrated into our learned independent movements) during infancy. In his book,
Dr Joaquin Farias explores and explains the role of the re-emergence of Primitive Reflexes in neurological problems, in some detail. Indeed, he clearly demonstrates their role in conditions such as PD - the classic clenched foot/curled toes problem is a good example.
Even as adults, we optimally learn dancing, fitness exercises routines, tai chi, sports techniques, and so forth, by watching a teacher go through the motions first, over and over again. Only after watching them do we attempt to do the movements ourselves, while still watching how they move too. And we then follow them through it again. And again. Then they come and watch us and give corrective pointers to improve. Again and again.
The critical aspects in how humans learn movement noted above may be termed "mirroring" and "rehearsal", via which we can learn to move in new ways, perhaps like no other animal. Ballet and karate include moves which are neither innate nor natural for humans, but they can indeed be learned, and then developed and refined over generations, by copying other people who have already learned the movements required themselves, precisely through such mirroring and rehearsal techniques.
The Language of Movement
Perhaps we need to think in terms of movement as a "language", in an analogous way as we think of language for speech. Indeed, it is useful to consider how we learn movement in terms of how we learn to speak, including the intensive therapy techniques through which we can re-learn speech when lost. This provides clues how to re-program our brains for movement.
In my experience, taking this simple approach in understanding how humans (re-)learn movement in a similar way to speech, and considering movement as language, helps unlock progressive symptom reduction in Parkinson’s Disease and other movement conditions considerably. For example, we know when we don’t practice our Spanish as a second language, we forget words and the syntax quite quickly. The pathways in our brains get over-written rather rapidly. Just as for speech, practice makes perfect and "use it or lose it" are vital concepts in Applied Neuroplasticity for PD: consistent and persistent movement practice will be essential.
A good example of new movement languages is Shiva Nata -"a mind blowing system of formulas and patterns [of movement]". This movement system consists of "words" and "syntax" of types of moves which, for most of us, our bodies and brains have never encountered before. Yet, through enough mirroring and rehearsal, following the instructor, Beth Freeman, in the video below, it is possible for us to learn the language of Shiva Nata - even if we have Parkinson's Disease. As Beth says: "is your brain feeling a little sparky yet?"
My Personal Experience
I’ve been experimenting with mirroring and rehearsal therapies myself in order to test the hypothesis. I seek out music videos which are full of all sorts of weird and wonderful dancing and prancing, types of movement I have never done – never, even before my Parkinson’s Disease diagnosis. I watch them over and over with the music loud in my ears while lying still. I try to program my brain with the feeling of the moves, just as if I was in a dance class. Then after watching a video over and over, I attempt it, see how well I can copy the moves with the music, always when my Parkinson’s symptoms are quite noticeable.
If I have tuned in enough, I am finding I have indeed learned some movement. It is important to note that this is not necessarily recovering basic movement from the past, because these include movements I've never performed before. As a clear example, I've included a video below of my first attempt at mirroring the antics to the extraordinary video of the song "Chandelier" by Sia. I had practised it in my mind many time before this, by watching the video over and over. What we see here are the results of my first attempt to physically copy the movements, at a time at which my PD symptoms were pronounced. As we see, I am able to follow some of the odd movements in the video.
This concept is very, very important because we will find it very hard indeed to re-learn movement from our own memories – most of us with PD have literally forgotten how to move through atrophy. Just like when we forget how to speak a second language through lack of practice, we can't just re-learn it by trying to conjour the words from internal memory, external input is required - we need a refresher course! Since we did not learned to move by ourselves in isolation during our childhood, nor how to be ballroom dancers as adults without instruction and practice, so we can't re-learn movement by appealing to internal muscle memory. Humans programme their brains for movement through external cues and information.
So play ball games with someone else, and absorb the data by watching how they move their body as they throw and catch the ball. Take classes where someone is always at the front teaching by example. Sit on a bench in the park and watch the slower walkers, the joggers, the soccer players.
The most optimal way to achieve this is to work with a dedicated caregiver or therapist, with bespoke routines, where the speeds and ranges of motion can be tailored for the individual to be able to follow, based on where they are currently at, and when the exercises can be performed at optimal times based on the individual's energy levels and symptoms.
Another technique is to record ourselves moving on video during time that the PD medication is working enough to allow us temporary access to movement again, which we can then follow whilst more symptomatic, or after the meds wear off. I've included an example of this concept below.
For practical applications of mirroring and rehearsal to improve independence with PD, see my article
Transcript of "Mirroring Games for Movement Recovery" Video
Hi, this is Gary Sharpe. It is the 22nd of March 2016.
In this video I want to talk about mirroring. Now, it’s well known that doing things like dance classes, boxing classes and tai chi is extremely beneficial for reducing the symptoms of Parkinson’s.
What we think we have distilled from these experiences is the concept of mirroring. Copying people, like the “Simon Says” game we used to play as children is very important [in helping to promote movement]. And in these classes, typically there is someone at the front of the class and you mirror what they do.
So in this video, you will see me on the left hand side is when I recorded some movements while I was in a good state, and later, on the right hand side, you will see me when I came back and I filmed myself watching the original video and copying it.
Although I’m very stiff, I can copy quite easily [compared to not having the visual stimulus] what I was doing earlier. We think this is an important part of Parkinson’s which is poorly understood, but is very powerful.
By continually practicing these mirroring techniques, it helps you unlock your movement again.
Although I’m not trying to fully extend, I’m not trying to copy exactly, I’m just trying to follow the moves as best I can. Depending on the state of the symptoms depends on how well I can copy.