452752 - Alexander Technique Classes are a Feasible, Cost-Effective, and Promising Intervention for Balance in Older Women

Mon, Oct 1
3:30 PM – 4:30 PM

Poster Location: 230

Track: Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)|Geriatric Rehabilitation|Complementary Integrative Rehabilitation Medicine

Research Objectives : To determine whether Alexander technique (AT) group classes provide psychological or physical benefit for care partners of people living with Parkinson’s disease.

Design : Single group pre-test/post-test pilot study with three- and six-month follow-up. Participants completed ten weeks of weekly 90-minute AT classes.

Setting : Cabarrus County Senior Center, Concord, NC; Groce United Methodist Church, Asheville, NC.

Participants : Seventeen women (aged 67+/-6 years) participated. Most were white, non-Hispanic college graduates, retired from white-collar jobs and caring for spouses/partners.

Interventions : Alexander Technique is an educational approach that seeks to manage stress and improve posture and movement through inhibition of unproductive psychomotor habits. Though AT is traditionally delivered one-to-one, these classes were designed to: a) counter care partner isolation; b) allow peer to peer learning in a community-based setting; and c) remove economic barriers to participation.

Main Outcome Measure(s) : Posture in sagittal plane (assessed by photographs with markers on tragus, C7, and sternal notch), balance (assessed by mini-BEST), caring burden (Zarit Burden Interview), self-efficacy, and subjective evaluation.

Results : Two participants dropped out, both citing changes in their schedules, with one additionally citing social discomfort. Among the 15 who completed the classes, balance was significantly better (1.9 points, p=.002) and posture was marginally more upright (4 degrees, p=.06) after the class than before. Perceived burden was non-significantly reduced (4.6 points, p=.14) and self-efficacy was non-significantly increased (1.2 points, p=.38). Participants reported that they enjoyed the classes and learned practical tools to help care for themselves physically and emotionally.

Conclusions : Group AT classes are an innovative, cost-effective, and feasible intervention for older women, with potential to improve balance. Additional classes are underway and follow-up testing is scheduled.

Author(s) Disclosures : Two of the authors (MG and RGC) are trained teachers of Alexander technique.


Rajal G. Cohen

Associate Professor
University of Idaho
Moscow, Idaho

Rajal Cohen, M.AmSAT, Ph.D., is an Associate Professor at the University of Idaho. Dr. Cohen’s Mind in Movement Laboratory uses tools and concepts from cognitive psychology, neuroscience, and kinesiology to inform and inspire questions about postural organization, cognition, and voluntary movement, in healthy young adults and in the context of Parkinson’s disease, aging, and musculoskeletal pain. Dr. Cohen completed Alexander technique training in 1997 at the Virginia School for Alexander Technique and received a Ph.D. in Psychology with a minor in Kinesiology from Penn State University in 2008. She completed a four-year postdoctoral fellowship on cognitive and motor aspects of Parkinson’s disease at Oregon Health & Science University. Dr Cohen serves as Scientific Consultant for The Poise Project®.

5 Key Publications (2013-2018): (*students mentored by Dr. Cohen)
1. Cohen, R.G., Gurfinkel, V.S., *Kwak, E., *Warden, A.C., Horak, F.B. (2015). Lighten up: Specific postural instructions affect axial rigidity and step initiation in patients with Parkinson’s disease. Neurorehabilitation & Neural Repair, 29, 878-888. PMID: 25665828
2. Cohen, R.G., Klein, K.A., *Nomura, M., *Fleming, M., Mancini, M., Giladi, N., Nutt, J.G., Horak, F.B. (2014). Inhibition, executive function, and freezing of gait. Journal of Parkinson's Disease, 4, 111-122. PMID: 24496099
3. *Becker J.J., Copeland S.L., *Botterbusch E.L., Cohen, R.G. (2018). Preliminary evidence for feasibility, efficacy, and mechanisms of Alexander technique group classes for chronic neck pain. Complementary Therapies in Medicine 39 (2018) 80–86. PMID: 30012397
4. Fling, B.W., Cohen, R.G., Mancini, M., Nutt, J.G., Fair, D.A., Horak, F.B. (2013). Asymmetric pedunculopontine network connectivity in parkinsonian patients with freezing of gait. Brain, 136, 2405-2418. PMID: 23824487
5. Peterson, D.S., King, L.A., Cohen, R.G., Horak, F.B. (2016). Cognitive contributions to freezing of gait in Parkinson disease – Implications for physical rehabilitation. Physical Therapy Journal, 96, 659-670. PMID: 26381808

Ramyaa Ravichandra

Graduate Student
University of Idaho
Moscow, Idaho

Ramyaa Ravichandra is a first year graduate student in the M.S in Experimental Psychology (Human Factors) program at the University of Idaho. Since mid-2017, she has been working in Dr. Cohen’s Mind in Movement Lab, collecting and analyzing data to explore the relationships among posture, cognitive factors, and interventions such as the Alexander Technique. She completed her BBA in Industrial/Organizational Psychology and Computer Information Systems (Data Analytics) from CUNY Baruch College. Her research interests are related to Parkinson’s disease, ageing, and applying human factors principles to assistive technology and healthcare.

Wilson Trusty

Research Assistant
University of Idaho
Moscow, Idaho

Wilson Trusty is a senior in psychology and undergraduate research assistant at the University of Idaho. He works with Dr. Rajal Cohen collecting data for studies on the relationships between postural and cognitive factors, while also conducting independent research on stress and coping under the supervision of Dr. Clarissa Richardson. He plans to pursue a PhD in clinical psychology after he completes his undergraduate degree in 2018.

Teresa Moote

Research Assistant
University of Idaho
Moscow, Idaho

Teresa Moote is a third-year undergraduate at the University of Idaho. She has been assisting in Dr. Rajal Cohen's lab since early 2018, working to understand the relationship between posture and cognition. Specific projects include studies on individuals with neck pain using EMG. Teresa is interested in the neurological function of the brain and its relationship with cognitive processes. After her graduation in 2019, she plans to pursue a PhD in Cognitive Neuroscience.

Monika Gross

Executive Director
The Poise Project
Asheville, North Carolina

Monika Gross, M.AmSAT, mATI, RSME, BFA, is the Executive Director of The Poise Project®, a nonprofit with the mission of maintaining natural poise and personal growth throughout all stages and challenges of life through the principles of Alexander technique (AT). The Poise Project® is committed to removing barriers and making Alexander technique training available across socio-economic groups and to those with chronic conditions. We are the 2017 recipient of a $25,000 Parkinson's Foundation Moving Day® NC Triangle Community Grant to deliver AT-based classes to care partners of people living with Parkinson's disease at eight sites across North Carolina, and the 2018 recipient of a $10,000 Parkinson's Foundation Moving Day® DC Community Grant to expand our care partner course to the Metro DC area. In addition, we are the recipient of the 2018 American Society for the Alexander Technique (AmSAT) Research Grant to aid in data collection and management for our IRB approved research study through the University of Idaho on outcomes for our care partner courses. Monika is a certified Alexander instructor since 1985, a teaching member of the American Society for the Alexander Technique (AmSAT) and Alexander Technique International (ATI), and a Registered Somatic Movement Educator with the International Somatic Movement Education and Therapy Association (ISMETA). She holds a BFA in Drama from the University of North Carolina School of the Arts and is the co-owner of Form Fitness and Function with a private AT practice in Asheville and Charlotte NC. She also offers AT distance training through video conference via Skype or Zoom. Monika leads continuing education programs for medical and allied health professionals to gain understanding of the role of AT and the AT specialist in enhancing patient self-care, as well as AT-based training programs for medical and allied health professionals themselves to recover from and/or reduce their risk of occupational musculoskeletal pain and discomfort.