(56) PD & my "instinct"?

"Instinct" amended?

(I'm thinking of "instinct" as being = a natural tendency.)

Before 2013, the year of being diagnosed as a Person with Parkinson's (PwP), I was right-handed and never thought about telling my hands or arms how or when to move. But after becoming a PwP I have become left-handed so I've had to relearn a lot of basic hand movements. I've also had to instruct my legs on what I need them to do via the constant use of *internal cues (*see Post 42) to relearn how to walk, to turn 45° or 90°, including raising my hands/arms or legs/feet because Parkinson's Disease (PD) has made me unlearn how to move "instinctively". Also, there are different types of cues.

The natural tendencies I had relied on "instinctively" pre-2013 have been gradually amended by my PD! Similar, man-made amendments have been noted in the animal kingdom, dear reader.

It was observed in the USA that, after hatching - pic (right) shows a turtle hatchling's tiny size relative to an adult - baby turtles on a Miami beach crawled towards the nearby housing complexes and not into the sea. A similar scenario was recorded by a Planet Earth II film crew in Barbados. Normally, the beach hatchlings move instinctively towards moonlight in order to reach the sea. However, the bright, artificial lights of beachfront residences disorient the hatchlings and, tragically, they move towards beachfront lights rather than towards the moonlit sea. As a result, they are often crushed by vehicle tyres or stuck in drains. Consequently, many sensitised beachfront property owners now use softer lighting to prevent such misdirection and hatchling deaths.  

In the context of the tiny baby turtles' instinct being amended or misdirected, here are two personal "snoitcelfer" (see Post 54).

                          

QUESTION A: If PD has *amended [*altered to reflect changed circumstances] what I used to do instinctively, then should I accept this situation and be defined by it? 

ANSWER: Maybe not!

QUESTION B: Can I *amend my PD effects [*alter to reflect changed circumstances] and replace an instinct by consciously visualising an action, and then trying to perform that action via the following: 

(1) purposeful, internal/external cueing; and

(2) overriding my muscle memory; using 

(3) a feedforward response.

ANSWER: Yes, often!

Question A is self-explanatory in my context, but Question B requires some unpacking.

Amending my PD?

Question B above is my way of exploring the impact of PD on my motor learning challenges, a major part of being parkinsed! (Sigh...)

• 1. cueing: (SEE DETAILED Post 17: Nov 2021) As a PwP, I use the technique of cueing (used by athletes to fine-tune actions by addressing micro-movements of their limbs) to address my faltering movement. But this requires me to isolate specific actions and then to break them down into micro-movements. Only then can I assign specific words or phrases - all regarded as cues - to initiate and to execute these actions. Internal cueing, for example, would be saying "heel-toe" silently in my head to support my walking action. External cueing, for example, for me to cycle according to a rhythm or speed governed by music or a metronome. I can also engage in advanced cueing where a phrase becomes converted to numbers or a tune with which I am familiar. {NOTE Internal cues are effective when I need to initiate and sustain repetitive movement (e.g., walking or cycling) but only partially helpful if I freeze. To move legs during a freezing moment, I have to (i) distract myself by introducing a new, "wipe-clean thought", especially a silly, nonsensical one or/and (ii) shift my weight from one foot to another and then move with a cue. To move hands during freezing moments, either I look at their reflection (tiles/mirror/glass) or look away from my hands and carry out the action, with a cue.} 
• 2. muscle memory override: (SEE DETAILED Post 6: Apr 2020) I have discovered that my muscle memory appears to be guided, as well as triggered, by what my eyes are looking at during the start of a specific action. If I need to wear sandals, looking at a sandal and then my foot, seems to trigger a specific muscle memory response of how to put it on. This may be regarded as the 'previous normal' before PD, now, has caused a freezing or blocking of such a simple action.  However, I found a corrective measure for many muscle memory driven blockages in PwP, is to repeat that action but with my eyes physically closed. With regular practice, I have found my 'new normal'. I had to close my eyes in order to open my mind to new possibilities :-).     
• 3. feedforward response: while feedback is focused on analysis of the past, on mistakes and on what went wrong, I have probably been using feedforward responses to focus on analysing the present (including cueing and muscle memory issues) to find solutions to my movement disorder rather than delve into problems: essentially, how to do things better in the future. Also, a successful action generates an expectation on which I can provide myself with useful insight without being critical.  

Amended learning?

Olson, Lockhart & Lieberman (2019), in their article Motor Learning Deficits in Parkinson's Disease, state that in the context of PwP, "While individuals with PD are able to learn, certain aspects of learning, especially automatic responses to feedback, are faulty, resulting in a reliance on feedforward systems of movement learning and control." This is a useful, dense, academic piece of writing that compares and contrasts large numbers of completed research projects involving PwP and their movements. The article is thorough in its examination of gait freezing and postural instability in PwP and cites effects of a wide range of physical therapies from just walking or using treadmills to gaming consoles such as Wii Fit and XBox. 

A focal point of the article is on motor learning and its impact on the explicit learning (an active and conscious process where I would gather info via research and study of others' work) and implicit learning (a passive unconscious process of gathering info from what is learnt and observed via my experience and practice) of PwP. In my honest opinion, I have managed, regularly, to amend the total onslaught of Parkinson's Disease on me by flirting with both modes of learning. So, my own feedback responses as a PwP are not really "faulty"... 

My dilemma is that the above authors note that "PD is known to cause apathy...[leading] to a reduced tendency to evaluate and monitor outcomes and negatively impacts feedback-learning." My solution to the negative presence of muscle memory and how to override it, is based on weeks of simply observing and thinking about the problem of being unable to put on a sandal before my moment of accidental discovery.  

I believe most of my strategies to amend my PD and my reporting on these in my Blog posts since 2020 may be a healthy mix of explicit and implicit learning. What do you think, dear reader?

An important issue negating the "apathy" cited may be the fact that I am PD-drug-free! Also, Google does suggest closing one's eyes to change muscle memory but in the context of athletes and not PD. So, there!   

Conclusion

In line with the general structure of my Blog posts I write and present info in a provocative yet simple manner based on my personal observations. I share info as a PwP that is subjective and not generalisable but maybe it will be of some use to some PwP somewhere. Hopefully, some of Post 56 and my explanation of amendments has been useful for you, dear reader, rather than a misdirection. Till next time...