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In a message dated 98-09-07 02:28:08 EDT, you write: >Subj: "I can't pick up my feet" Dear Tom, I have some questions on your posting to Ed Keith's mention of not being able to move his feet at times. >I would suggest that there are two components which contribute to problems >of gait in PD. One is a visual component and has to do with the improper >perception or processing of low velocity apparent motion (optical flow) Could you say a bit more about that? Are you saying that if a person is not moving their legs that they can't see it.* I'm not trying to be sarcastic but genuinely trying to understand your statement. Low velocity = hypokinesia? I do not have PD, and as I move my hand the slowest I can, I believe I am perceiving the motion and am also able to process internally the sensations of movement - this is substantially limited however, if I close my eyes. Is what you talking about specific to PD? * (More on this at a later time, but does anyone have any information on the imagination of movement assisting in movement with people with PD? This is not anywhere as far fetched as some may first think. It is also used in Tai Chi as a prelude to movement. J.R. Bruman jump in here...the imagination of movement creates the request of the system to allow for movement - [the call goes out for dopamine production sufficient to make it happen] and the person's job is to essentially remove any postural/musculat/thinking problems which may be inhibiting fine movement) >and a second autonomic nervous system (ANS) component which tends to >pathologically augment the normally occurring tone in muscles to the point >of rigidity. The vision mediated component is always present when there >are gait abnormalities and when PD worsens over the years the autonomic >nervous system (ANS) component becomes clinically apparent. To test >oneself for the presence of the ANS component one need only get down on all >fours in the crawling position. The inability to take a step with one's >arm suggests the presence of the ANS component. This is because when the >arm, like the leg, assumes a weight bearing posture it has postural tone. >This postural tone is augmented by the ANS system to the point of rigidity >of the muscles and inhibits the lifting of the extremity to take a step. Tom, I find this real interesting. In a previous posting I began to explore the impact of stress on moment to moment fluctuations of PD and also on the rate of development (progression) of PD. As a psychologist/psychotherapist/biofeedback person, as soon as I hear about "the Autonomic Nervous System component" I immediately think of the psysiological correlates of ANS arousal - increased breathing, constriction of peripheral vasculature, increased heart rate, etc. - is that general arousal level what you are talking about? If so, let me draw your attention to a process which has been coined as "hot responders." It has been used to describe those people who have a sudden and dramatic increase of their ANS system and who also have at those times sudden and substantial increases in their blood pressure. From personal experience I can tell you that it is real and that amazingly people (me, at least initially) are often not aware of what is going on in their bodies (although they can learn to identify the process.) More on this later. But if that is what you are talking about, then from a stress point of view, one further strategy to explore is the impact of an acquired ability to relax on the spot - virtually instantly - when one freezes up. (Again, I do not have PD so I offer this very humbly but it makes sense to me and seems to be supported by what you are saying.) Putting it differently, consider this scenario....when you freeze instead of the mantra: "oh BLANK, BLANK, not AGAIN + fear + anger + despair statements," consider: "Hmmmmm..." combined with a significant abdominal exhale, general muscle relaxation and shifting your gaze to "soft focus" (i.e., for the moment not over focusing). I'll elaborate on this at a later time. (For those wishing to try this, remember that it is a skill and that it will take practise but if it has merit you should be able to learn this in a relatively short amount of time) >Ed Keith later says: "When I get going, I do alright untill I stop again." >If by some means we can initiate walking this rigidity diminishes because >as the leg walks it alternately bears weight and then doesn't bear weight >as it cycles through the stance and swing phase of gait. The net result is >a decrease in postural tone and ANS rigidity. For the same reason >momentarily leaning against a wall can overcome a freeze. In psychotherapy there is a technique used sometime called "taking over the problem." It sound crazy but it has merit. (e.g., to a person who is on edge during a session, and relaxation, encouragement, etc, etc, isn't helpful and the person can't get beyond the edginess, I might say something like (as corny as it may sound) "look you look so uneasy and edgy all the time and you must be frustrated about that, why don't you let me be edgy for you for a while." There is something about maintaining the level of defensiveness but relieving the person of having to do it him/herself which then frees the person to feel / be aware of things which they otherwise couldn't get to if all their energy continues to go into the symptom. I'm not asking you to buy it, only offering a further interpretation as to why leaning on the crutches or the wall, or on another person may help to initiate movement again - it frees them up to not overfocus and to begin to explore other options. >Another better way to overcome this ANS induced rigidity is to use under arm crutches. >By bearing a significant amount of the body's weight under the arms, weight >(and thus background, postural tone) is reduced in the legs which in turn >reduces rigidity allowing one to lift the legs. As a speculation, the leaning against something firm may help to reinstate a more normal (healthier) pattern of breathing and thereby also help to lower ANS arousal. Tom and anyone else, I would be interesting in hearing your thoughts on this. Tim Hodgens ******* Tim Hodgens, Ph.D. Psychologist Westborough, MA