Lighten up: Specific postural instructions affect axial rigidity and step initiation in patients with Parkinson's disease

Neurorehabilitation and Neural Repair 2015 Feb 9. pii: 1545968315570323. [Epub ahead of print]

Cohen RG, Gurfinkel VS, Kwak E, Warden AC, Horak FB.



A study called 'Lighten Up' has suggested significant benefits in balance and mobility for people with Parkinson's when they practised instructions based on Alexander Technique principles. The instructions included phrases such as 'notice that you are pulling yourself down and give yourself permission to stop doing it; let your head balance easily....let your shoulders and chest be open and light'. In contrast, no such benefits were observed with instructions that were based on popular concepts of posture correction (such as 'use your core muscles to pull yourself up to your fullest height...pull your stomach in, your head and chest up and your shoulders back'). A third set of instructions focused around relaxation were used as a control. These results for the Alexander-based instructions, showing increased upright postural alignment with decreased muscular rigidity, were particularly impressive considering there was no hands-on instruction.



Background. Parkinson's disease (PD) is associated with stooped postural alignment, increased postural sway, and reduced mobility. The Alexander Technique (AT) is a mindfulness-based approach to improving posture and mobility by reducing muscular interference while maintaining upward intentions. Evidence suggests that Alexander Technique can reduce disability associated with PD, but a mechanism for this effect has not yet been established.

Objective. We investigated whether Alexander-Technique-based instructions reduce axial rigidity and increase upright postural alignment, and whether these instructions have different effects on postural alignment, axial rigidity, postural sway, and mobility than effort-based instructions regarding posture.

Method. Twenty subjects with PD practiced 2 sets of instructions and then attempted to implement both approaches (as well as a relaxed control condition) during quiet standing and step initiation. The ”Lighten Up” instructions relied on Alexander Technique principles of reducing excess tension while encouraging length. The ”Pull Up” instructions relied on popular concepts of effortful posture correction. We measured kinematics, resistance to axial rotation, and ground reaction forces.

Results. Both sets of experimental instructions led to increases in upright postural alignment relative to the control condition. Only the Lighten Up instructions led to reduced postural sway, reduced axial postural tone, greater modifiability of tone, and a smoother center of pressure trajectory during step initiation, possibly indicating greater movement efficiency.

Conclusion. Mindful movement approaches such as Alexander Technique may benefit balance and mobility in subjects with PD by acutely facilitating increased upright postural alignment while decreasing rigidity.