NB (27) above indicates the numerical order
Lights, action...freeze frame!
During the past two months four water valves in my residential area burst resulting in our being without water for up to three days at a time. This might continue as we are in an old part of Durban with crumbling infrastructure (hmm...like that of my body). I had a number of freezing incidents during these periods. For instance, once, I was unable to get out of a recliner, something that had never happened before. Also, in bed I have been struggling to turn onto my side. I assumed it was the PD but maybe my para-olympic mind-games had begun again!
My immobility may have been because missing a daily shower resulted in missing my daily stretching routines in the shower. We know the aged should be active for as long as possible, daily, otherwise, their muscles will stop responding to requests to move and become sluggish. It is likely that my muscles were unable to respond (A) because of my inactivity and (B) because of my PD. Or maybe (C) I need to have regular physiotherapy or biokinetics.
Further analysis of my freezing problem, led to my developing an amended set of previously reported Parkinson's Disease (PD) strategies called cueing that I will share later.
PD: advanced cueing & triggers
Let's start with an analogy. Small parts of the USA between the 1920s and 1940s, had two way traffic lights, that were red and green only, as illustrated in the
picture below. These were suspended above a few major city intersections to control the flow of pedestrians and traffic. An amber, third light was only introduced in the 1950s.
In the context of PD, stopping an action should be discouraged. If the equivalent of red lights are our reality, then we should encourage thinking of amber lights to introduce the possibility of further action.
Recently, I discovered that what I called 'internal/remedial messaging' (Post 17) is referred to by neurologists as "internal cueing". So, I will adapt. "Internal cueing" is used, for instance, by athletes to talk to and to understand micro-movements of their limbs by making actions transparent and visible in their minds. This is to allow them and their coaches to improve their performance.
Parkinsed people can also use this technique of cueing to address their faltering movement. But this requires us to be able to isolate specific actions involved and then to break them down into micro- movements. Only then can one assign specific words, phrases or even tunes - all regarded as cues - to initiate and to execute these actions. Isolating and identifying specific micro-actions would be like asking you, right now, to find the animal in the picture below: focus and you will find it. (Got it?)
My own system of
cueing was based on using single action words to assist the limbs to move. For example, when pulling on pants I would say "slide" and then "slip" to visually picture my hands sliding my pants up my legs and then slipping my thumbs into the waistband. Or walking up flights of stairs I would say "toe" when putting my first foot down on a stair and "toe" again when moving the other foot up to the next stair. After my recent immobility scare (courtesy of the water outages) I amended my single cue to a series of multiple cues and associated movements.
My amended cueing strategy is based on the idea that a single cue triggering a single movement is like going from a green to a red light. Saying "toe" only takes me up one stair. However, counting from "one to six" when ascending a single flight of six stairs propels me up one whole flight and then I can start at "one" again for the second flight without saying "toe" six times. So, my counting is a substitute for repeating "toe-toe" and similar to using words that trigger actions. Embedded in such triggers are meanings associated with specific series' of actions.
Advanced cueing: as easy as 1,2,3,4
Let's unpack specific conditions and my understanding of freezing. In a standard flow chart there are a set of "if-yes-then" and "if-no-then" conditions controlling a process. This is aligned to a definitive red and green robot or traffic light analogy where flow is either on or off. There is no room for the equivalent of an amber light. So, let us consider the idea of a green and amber traffic light.
Green (go) and amber (approach with caution) is more apt to my understanding of PD as it introduces the possibility of movement and flow. So for me as a PD person, initiating movement may be regarded as a set of "when-I-then-I" conditions. The green and red traffic light represents a start-stop implementation of a single action where a blockage in the pathway (dopamine depletion?) results in my freezing. But green (go) and amber (approach with caution) allows me to confront the freezing.
EXAMPLE When attempting to stand up from a seated position I used to have to repeat the action of getting up many times before being able to stand. It must have looked Chaplinesque. It used to be a single-stage failed action. But, introducing a green and amber traffic light to represent the when-I-then-I system of internal cueing, encourages a sustained multi-stage motion for me as a parkinsed person.
ACTION So, when-I wish to stand (1) then-I push my legs forward and straighten my knees, (2) then-I push myself away from the seated position and shift my weight forward, (3) simultaneously ensuring my head and neck are as far forward as possible and at right angles to my torso (so that I do not fall back into my seat) and (4) then-I stand up. Breaking the action down into four stages ensures me a 90% success rate of standing and not falling back into my seat. The critical point is that the trigger words are 1,2,3,4 and not a series of words or phrases.
And what is fascinating, is that 1,2,3,4 also works as my cue for climbing stairs: a revelation! And so far it has been effective!! I should count my blessings...
Next post
Constantly adapting to and creating new habits is central to the brain's ability to reorganise and rebuild synaptic ability, i.e. neuroplasticity! My growing ability to regenerate cues and multi-action movements are based on the brain's ability to relearn. And it needs a whole post, so I promise to pay attention to neuroplasticity in post 28.
Some Resources
