Trager® Movement Helps Stroke Recovery
Joe Lee Griffin, Ph.D.
In stroke recovery, a fortunate few return to normal activity with some time and professional help. Most others encounter blocks or difficulties that slow or prevent full recovery. This article identifies some common blocks to recovery and discusses how Trager movement reeducation can help one work through, avoid or go around such blocks. The Trager Approach is an educational process that uses gentle, rhythmic movement to help the functional mind learn. A post-stroke individual can usefully create self-movement or can be moved by another, like a Trager practitioner.
· Block: The belief that simple healing is enough or happens automatically.
Healing a cut in the skin can be a simple, linear process. Within a few days to weeks, scar tissue forms, the cut edges are fused and functions like keeping the inside in are restored to the skin. There is no need for relearning. Similar physical healing of brain lesions after a stroke does not restore function, because the brain cells lost were involved in complex circuits used to create learned movement patterns.
Strategy: To relearn effective movement, surviving brain cells need to be recruited to replace, in functional circuits, the neurons lost in the stroke. The nonconscious functional mind uses patterns learned in early childhood to create complex movements. Sensory feedback from the body, much like signals babies get from playful exploration, is needed to relearn the link between intent and result. Sensory input also permits release of unneeded muscular tensions.
· Block: Belief that hard work leads to success.
Stroke often affects high achievers. Individuals who have succeeded through goal oriented, focused, linear behavior often find it hard to change. While they may find merit in the saying that death is nature's way of telling you to slow down, the idea that stroke is nature's way of telling you to play more to relearn more can be dificult to accept.
Strategy: Recall that children learn life skills at least seven times as well as adults do, using exploratory play with no drills or trying hard. Children learn by moving and quit when bored. They focus intensely and then let go fully to allow the second, unconscious stage of learning, particularly before they go to school and get "righted" and "wronged." Self-generated Trager movement, called Mentastics®(1), uses simple practices like shifting, shimmys, wiggles and swings done with relaxed focus. There are no goals except to increase body awareness and reach below the conscious mind to reeducate the mostly non-conscious functional mind. Body awareness, particularly the feeling of pleasurable movement, retunes the body's control systems. Useful learning games are light, easy, simple, playful, and feel good. I recommend learning toys, like balloons and monkey sticks, because playing with toys makes it harder to get serious or try hard. Some things that interfere with physical learning are pain, fear, tension, effort, thinking, control, and attempts at perfection.Two ways to experience one's moving self are Trager self-movements (1) and Trager hands-on work (2).
· Block: When a stroke results in immobility, external input may be needed.
When actress Patricia Neal was immobilized by a stroke, medical advice to her family was that she was unlikely to get better and that they should find a care facility. Neal confounded the experts as she relearned nearly everything and resumed acting.
Strategy: I give major credit for this recovery to Neal's family, who, before she could move by herself, had someone daily touch and move her to give sensory input and remind her functional mind of her body. Like learning by babies before they can move for themselves, touch and being moved creates or recreates the body image from proprioceptive sensory signals about the body in time and space. The importance of touch in development and learning was shown in research by Rene Spitz and many others (3).
The Trager Approach is well suited to providing sensory input for relearning to those unable to move. When access to Trager practitioners is limited because of location or money, family or friends can help with simple loving touch and the lightest of exploratory movement. This practice should not be work for the toucher and should feel like a restful, comfortable break rather than an additional chore or load. Touchers need to find lightness and ease, make each move a way to listen, and stay within a window of comfort. Trager Introductory Workshops (4) can provide principles of and practice in such touch , as can coaching from individual practitioners (5).
Once a patient is beyond immobility, support groups are a useful resource, not only for human contact and encouragement from those who have been there, but also for sharing of learning games and touch. Milton Trager (6), after his strokes, had balance problems and tremor , but continued to teach. In my experience, the life enhancing quality of his touch remained. Gentle, alive touch can certainly be delivered by post-stroke individuals, even those whose recovery is incomplete, as Milton's was. Experience in just how easy easy is and in letting go of goals and the desire to fix may be needed.
· Block: Giving too much power to "Experts."
A medical expert may know about injury and disease, but may not know much about learning and relearning, what feels best to the one in each body, or how to avoid resistance reflexes, the automatic response to being pushed that blocks sensory intake and slows learning. Some experts have said that improvement (relearning) stops about two years after a stroke, which seems to me both unlikely and limiting to recovery.
Strategy: Each person needs to honor personal inner awareness. What feels good is a specifically useful functional signal, from the only expert on how one feels, the self. "When your body works well, it tends to feel good. When it feels good, it tends to work well." This feeling is a valuable tool for evaluating progress.
· Block: Depression limits mobility.
Post-stroke depression may be situational, as the sudden limitation of life actions leads to fears about the possibility of recovery. Probably, a biochemical component also exists, due to lack of movement and reduced feedback from the body affecting the production of endorphins (brain neuropeptides).
Strategy: One needs to find a way to move, either physically or mentally, both if possible. This could be creative small movements, maybe using movement on one side and imaginaries on the other. Also, one can find ways to be pleasurably moved from outside, as in a Trager table session. One stroke recovery client learned a qi gong move called swimming dragon or triple circle, which involves balance and curving movements to each side, then did daily sessions of up to 20 minutes moving in a warm shower, an excellent personal strategy for this individual. Felt comfort, security, and ease plus the sensations of movement are most helpful to the relearning process.
· Block: Postponement. "When I get better I'll work on learning."
Of course, the learning is the way to improvement. A real problem is that useful sensations needed for relearning come from movement but movement is limited, compared to the prestroke experience, and does not feel easy and fun.
Strategy: Group energy can help, both support groups and exercise groups. One individual I know gets great benefit from working out with a group in a warm pool, with aids like float belts. There are creative ways to use small movements, easy movements, and mental movements to generate sensations. One can alternate sides, using the feeling of one side to educate the other.
· Block: Impatience.
The only place one can go on from is where one is. There is no leverage for action in the future or the past. Taoist philosophy presents the idea of being in the gate. We are always in the gate of the now, not yet in the future and with the past behind us. Impatience can lead to trying too hard, which is a block, as is the idea of an "A" for effort. If one practices hard while struggling, one improves struggling, not the intended skill.
Strategy: Exploratory play needs to become a more practiced art, along with noticing the now.
Almost any kind of movement can create sensations useful for relearning:
"It's not what you do, but how you do it." Self-care movement practices include shift, drop, ripple, wiggle, swing, stretch, oscillate, toss, dangle, shimmy, nod, rock, roll, weigh, listen, visualize, imagine, and pretend. Most useful is a light focus on present time feeling. Note that this is not strength work. Also, TV, reading and other distractions limit awareness. In my classes, I sometimes give the five important instructions, which are notice, notice, notice, be aware, and notice.
Post stroke individuals need to monitor the self while practicing movement. Open questions, questions without answers or only felt answers, help to focus on feelings. Examples of open questions are: "Oh, that feeling. What would be lighter than that?" "What would be easier?" "What does it weigh?" "Does this feel good?" "How does my body like to move?" Trager practitioners ask similar questions in hands-on work, usually silently with their listening hands.
Both for contacting the self and for contacting others, Milton Trager recommends a state he calls Hook-up. This is a relaxed, connected, physically meditative state, in the now, easy. Milton says it's like where you go when you see a new baby or a moving sunset.
of learning games:
· Imaginaries. Suppose one side is more able to move. With that side find and feel something, like an arm drop with weight and reverberation or any other easy move. Repeat and let in and feel, then imagine the same feeling in the less knowing side. Stay within your window of comfort and ease, imagine simple balanced movement on both sides. Imaginaries help slow or reverse the loss of sensory feedback caused by inactivity.
· Feel Weight. With elbows at side, palms up, weigh your hands or air above your hands. Notice use of movement to get feeling. Do your hands weigh the same palm down? If out further from your body? Dangling? Swinging like a pendulum? Can you weigh your foot?
· Pretend to be supported and moved. Stand or sit, imagine yourself as a kelp plant, rooted in the ocean bottom, supported by the water, moved gently by the currents, supported and moved.
· Body awareness toys. Balloons. US made, helium grade, inflated to half rated size or less for strength. Explore support, bounce, rebound, elasticity, on floor, walls, tables, etc. Dumbbell shape for effortless support of body parts, two balloons tucked firmly into a kneehigh stocking, tied with butcher twine bow knot. Adjust stocking tension after gradual deflation. Monkey Sticks. A newspaper section is rolled to make a light stick about a foot long, covered with paper folded in to prevent paper cuts and taped at the ends and middle. A light weight to listen to during movement. Passing side to side uses one side to educate the other, above the head opens breathing, Tapping tight muscles, as in shoulders or neck, improves awareness. More with both toys, explore.
Approaches that can yield body signals useful in restoring or maintaining body image:
Trager Mentastics, Feldenkrais® Awareness Through Movement, swim or
walk with ease, qi gong, t'ai chi,. yoga, and others (7). Gentle movement
for awareness, not struggle.
Feedback: "I think I have every block but one. Am I hopeless?" Answer: "No. Just human." We would like to be magically restored to the time when we didn't need to learn or feel frustrations, when the functional mind worked without attention. Recovery can happen. It will probably happen more slowly than most demand. Improvement is more likely than perfection, but persistence with lightness and ease can result in significant connections and integration of signals. How many times was Patricia Neal touched and moved before she was able to generate her own body feedback?
This article was written to inform post-stroke people and care-givers. Individuals, support groups, health care staff, and practitioners of The Trager Approach have permission to distribute to interested others. Publication requires author's permission. Posted on the web, March 2002. Note that Trager is an educational process, not therapy. For medical problems consult your physician.
Joe Lee Griffin
has a Ph.D. from Princeton University, taught premedical and cellular
physiology as an Assistant Professor at Brown University, and was an NIH
Special Fellow in Anatomy at Harvard Medical School. He did muscle and
nerve research as Chief of Experimental Neuropathology, AFIP, Walter Reed
Army Medical Center and worked in the Walter Reed Hospital Wellness Center.
He is a retired Trager® practitioner, tutor, and movement and
®service marks, Trager International ©2002, J.L. Griffin