Exploration of an Alexander Technique Approach to Quadriplegia

I decided to train as an Alexander Teacher when I realised that the Technique, with its simple but sophisticated means of accessing and working constructively with the mind/body interaction, had the potential to affect chronic conditions where mainstream medical science couldn't.

Initially I intended that the Alexander Technique would be a useful adjunct to my physiotherapy skills. However, the demand for an Alexander Teacher with physio skills as a backdrop meant that a private practice in Alexander Technique virtually created itself as I was completing my three-year Alexander training course.

My first Alexander Technique client was a woman with a complete C-7 spinal cord lesion, who was interested in exploring how the Alexander Technique might improve her neck and shoulder pain and her whole body sense generally. My specialty area as a physiotherapist was neurology, but I when I began work with Frances (not her real name), it was from an Alexander perspective, my physiotherapy experience providing the necessary handling skills.

When I first saw Frances in 1990, she was hoping to combat the extreme disconnection with her lower body caused by the injury, and to minimise its ill effects. Later on, in 1998, she was offered splinting by another practitioner as a solution to a post-fracture tibial torsion/subtalar inversion problem, but was concerned about pressure areas developing. She wondered whether the Technique could offer a functional integrative rather than a remedial mechanistic approach .

There was a complete absence of literature, and I had zero experience in applying the Alexander Technique to this kind of problem, so we started with no established processes and no idea of the possible outcomes.

What we had was the question of whether it was even possible to restore some sense of whole body, thereby improving posture and breathing and decreasing neck and shoulder pain as secondary effects. Our tools were the principles of the Alexander Technique. After the initial series of lessons in 1990, when Frances returned in 1998 we had the goal of arresting and, if possible, reversing the developing twist in her lower leg and foot.

I always addressed Frances' body as a whole. When she first arrived, she presented a bit like a marble bust sitting on a pedestal. Awareness and function were understandably restricted to above the armpits, the area of her body she could feel and move. Lack of postural support through the trunk meant that she slumped down onto her abdomen, which restricted breathing and created an accentuated cervical lordosis with resultant intervertebral compression and pain.

We began by working in the wheelchair and lying supine on the plinth, with me using my hands on the areas of Frances' body which were been deprived of movement and sensation by her quadriplegia, as well as those areas left intact. We found that the sessions stimulated a sense of body support, which had the effect of improving her posture and breathing and reducing her neck and shoulder discomfort.

In the second set of lessons after her leg fractures we included weight-bearing, to see if we could inhibit the developing ankle inversion and improve transfers.

In an attempt to further stimulate functional improvement in postural support, I incorporated sitting balancework in the wheelchair and on a physioball, work in prone on a very large ball, and in four-point and supported two-point kneel.

At present the treatment sessions are once each week for approximately an hour. Given the fact that this is the only opportunity for strenuous active exercise that Frances has, it is not surprising that she has experienced an increase in her overall fitness level as a result of them. Transfers are much easier, and the abnormal postural changes in the left ankle have resolved. Unexpected benefits have been:

Ø Ability to use conscious direction to void her bowels, reducing the need for manual evacuation and the incidence of bladder infections, which are a major menace in quadriplegia;

Ø Ability to inhibit clonus by using conscious direction;

Ø Sense of body presence has extended from armpit level down to the mid-lumbar region.

The Alexander Technique applied in this instance is an effective means of providing physical feedback which has the continuing effects of maintaining overall stamina, improved respiration, decreased pain in the neck and shoulders, improved functional postural support as a base for upper limb movement in sitting as well as for transfers, and improved bowel function with attendant reduction in urinary tract infections. For Frances, having greater solidity in baseline function means that she can pursue an active lifestyle with fewer complications and a higher degree of ease.

Author & Copyright: Ann Shoebridge
Permissions: First published in APA News, October 2003