Programme based on gravitational sensations and rhythmic exercises with music – Tubia method
Author: Maite Tubía Tejada
The programme to stop Parkinson’s tremor of the Tubía method is a physical strategy based on gravitational sensations. Specifically, sensations of unloading the weight and sensations of postural supports that rhythmic exercises with music help to find.
The tremor is stopped by adopting certain postures of rest.
The training in this tremor control programme has 3 stages:
1st Gravitational sensitization.
2nd Exercises and practices that stop tremor.
3rd Simplification of exercises.
This physical tremor control programme is considered passed when the patient is able to remain tremor-free for one hour, which is the final proof that he has assimilated and mastered everything he has learnt.
1st stage: GRAVITATIONAL SENSITIZATION
The sensation of comfort of resting postures are related to the unloading of the weight of one’s own body.
In everyday life, some people who have to stand when they are tired, take advantage of a wall and lean their back against it to unload their body weight on it, adopting a resting posture. They also often do this by resting an open hand with an outstretched arm. This unloading of weight also occurs when we rest our hands on a table with our arms outstretched, leaning towards it, and when we rest our forearms on a railing to observe a landscape.
In Parkinson’s, this capacity to unload the weight of the body on a wall, a table, may be impaired and it is common for the patient to contact the wall or put their hands on a table but not unload weight on it. It seems as if he were in anti-gravity, fleeing from gravity, from the attraction of the gravitational field on the mass of the whole body.
Gravitational sensitization consists in revitalising this sensation, in experiencing it by practising unloading of body weight and weight transmission regulation (gravitational awareness). These two practices have optimal muscle tone and that is what we are going to do, use the body’s own weight to influence muscle tone. The comfort of the postures, the feeling of firm settlement will guide the person.
The music of the rhythmic exercises will continuously provide a gravitational sensation: the musical accent, i.e. the strong beat of the bar. The music, through the musical accent and the contrasts of the melody, transmits interactions of the weight with the gravitational field that go in its direction, i.e. towards the ground, accentuating gravitational sensations. The key movement is performed in the time of the musical accent (steps, percussions, changes of postures, positions, etc.).
The following is a classification of the gravitational awareness exercises in this programme, which will be described in a separate article.
It is not advisable for a person with Parkinson’s to do gravitational sensitization exercises alone. A theoretical description is not enough; they need to be carried out correctly. He will have to practise them with someone who performs them to perfection.
GRAVITATIONAL PROPRIOCEPTIVE SENSITIZATION EXERCISES:
1 Discharge of body weight
2 Cushioning the fall of the weight.
3 Swinging of the body’s weight from one leg to the other one
4 Nullifying the forces of the weight.
5 Tension – traction
6 Walking slowly with aplomb
7 Walking slowly with aplomb coordinated with hand movements
8 Center of gravity adjustment in arm exercises
These exercises will be described in another article on this website.
2nd Stage: EXERCISES AND PRACTICES THAT STOP TREMOR:
This programme comprises 20 exercises and practices that stop the tremor.
The first practice and the first exercise that stops the tremor are described below.
1 Practice to feel the nodes of vibration nullification
When the string of a guitar is plucked, the whole string vibrates, but if the string is pressed on the frets, the pressure point of the finger acts as a node and the vibration of the string stops to the left of the finger (of the node).
We are going to create a node at the wrist to stop the vibration of the tremor. How do we do this?: by providing a fulcrum for the hand to hang relaxed in vertical abduction (a) as well as in flexion (b).
a) Providing a point of support for the hand to hang relaxed in vertical abduction.
The therapist places his index and middle fingers at the wrist joint, at the angle of vertical abduction, so that the patient puts the weight of the arm and hand on the fingers in the resting position.
Position: patient seated on a chair. Arm in semi-flexion and forearm horizontal.
Previously, the patient will perform the adduction-abduction movements as if he were tapping gently with a tool or instrument. The therapist place his index and middle fingers at the abduction angle, so that the hand hangs relaxed. The tremor stops instantly.
To act on the patient’s right hand, the therapist stands on the patient’s right. We will do the practice for both hands even if one of them does not tremble.
b) Providing a point of support for the hand to hang relaxed in flexion.
The therapist places his index and middle fingers at the wrist joint, at the flexion angle, so that the patient puts the weight of the arm and hand on the fingers in the resting position.
Position: patient seated on a chair. Arm in semi-flexion and forearm horizontal.
Previously, we mark the patient’s wrist flexion-extension movements (as when knocking gently on a table with the knuckles) by placing our index and middle fingers on the palmar face of the wrist joint, so that the patient puts the weight of the arm on it and the hand hangs relaxed in a resting position. The tremor stops instantly.
These two practices of conscious perception of proprioceptive sensations will sensitize the patient so that when he subsequently does certain exercises, he will seek the support or contact of these 2 angles.
Later we will create a node in the extension angle and in the adduction angle.
2 First exercise that stops the tremor:
The first exercise that stops the tremor is: percussions of the open-closed hand on the thigh to the rhythm of the music. Position of the patient: sitting on a chair.
Peculiarities of this percussion:
- we alternate one hit in each position (open-closed, open-closed…)
The muscle tone of these two postures is important:
- In the open hand position, the palm of the hand and the fingers fit the shape of the thigh with the fingers spread apart. The hand is full of leg. The muscle tone is that which allows us to slide the fingers and the palm backwards and forthward over the thigh.
- In the closed hand position, the hand is closed with the same muscle tone as when a die is held in the hand for shaking, and the thumb rests on the index finger. The hand acts as a cup and the thumb as a lid.
Music speed (tempo): 40 beats/minute.
Over the days we will increase the speed to 50 beats/minute and 60 beats/minute.
After having sensitized the patient with musical pieces at 40 beats per minute (3 or 4 sessions are enough) we will play these musical pieces again and during their course we will count 4 beats: 1, 2, 3, 4 (open-closed-open-closed) at the rhythm set by the music. We will count 4 beats because on beat 4 the hands will fall to rest and remain at rest in order to stay still for a while. The tremor stops first when the hands fall in a closed posture. When the thumb shows signs that it is going to tremble again, we resume the exercise, counting 1, 2, 3, 4 again after a few bars. And so on until the end of the piece of music. Later on, when the piece of music is over, we will do the exercise with the voice only, but now, as we are sensitizing the patient to the rhythm, we will do it all with music, so that the patient internalise the rhythm and to stimulate the feeling of a relaxed hand during rest.
In these first sessions we will also make the hands fall open, and here the hand will not be full of leg, as in the percussion time, but will remain in a tent. It happens that the tremor stops completely. We proceed as before: as soon as the thumb shows signs of trembling, we resume the exercise and continue with the percussions and resting stops counting 4 beats. With practice, the time of cessation of the tremor becomes longer and we resume the exercise from the cessation of the tremor and without the thumb showing signs that it is going to tremble. In other words, we do not wait for the tremor to appear, but continue. If we wait any longer the tremor would appear, but the tactic we follow is not to wait for it to appear and so all moments of rest are with cessation of tremor.
Variations to sensitize the arm and hand to the good weight aplomb in different positions:
Making the percussions at different distances along the thigh: knee – mid-thigh – proximal thigh to groin.
Also going through these 3 positions to the rhythm of the music, all the time with the open hand and all the time with the closed hand.
Then, without music and counting 4 beats, the hands fall at rest in non-premeditated places. To fall at rest in both open and closed hands.
In the videos in this article we will see how a person with Parkinson’s tremor performs these exercises and manages to stop the tremor at rest. In video 1 we can appreciate the degree of tremor that he presents continuously. In video 2, we can see the performance of the percussion exercise open hands – closed hands and fall to rest with a whole piece of music at 50 beats/minute.
This patient is at a stage where he is already familiar with gravitational sensitization exercises as well as open-closed hand percussions at 40 beats/minute …50 beats/minute. He performs the exercise correctly. Throughout the piece of music, the patient shows more fluency and expressiveness in the mobility of the hands, as well as being able to stop the tremor at rest in a relaxed manner.
Video 3 corresponds to the stage of exercises simplification and cessation of tremor for one hour.
3rd STAGE: SIMPLIFICATION OF EXERCISES THAT STOP THE TREMOR
If the patient is able to stop the tremor by himself in this whole little program, then what is appropriate is to start the following sessions with a simplified review of exercises and practices, so that he can concentrate on gravitational sensations and the aplomb of his posture changes. He will do it without music and in silence.
Simplifying the exercises and practices means that the patient will do them as few times as possible and in some cases will refer to going directly to the final resting posture. Let’s look at some examples:
a) The exercise described above, in which the hands are percussed open and closed, is intended to lead to a resting posture with cessation of tremor. The patient, after a sufficient number of sessions of this exercise with music, is sensitized to well settlement of the forearm and hand on the thighs, which has left its imprint on the memory of his proprioceptive sensations. Simplifying this exercise means that the patient will percuss only 4 beats if with just those 4 beats the tremor stops at rest on beat 4 (with open hands and with closed hands). The same can be said when this exercise is performed on a table. He will then take a long resting pause in that posture.
When the exercise is performed on a table, we will place a pile of paper for each hand or a large open notebook to cushion the percussion of the hands.
b) Another simplification is to go directly to the resting posture of open hands on thigh (or on a table if the exercise is performed on a table).
It is a matter of adopting the final resting postures of each exercise, of which he already has practice, and moving from one to the other, remaining in each of the postures as long as the tremor is stopped.
When the patient has both hands trembling it is common that, if the patient is practising exercises with one hand and manages to stop the tremor in the corresponding resting posture, the other hand, which is kept aside, also stops the tremor, as if there were an empathy.
The duration we can give to these simplified exercise practices, in which the patient is aware that he can stop the tremor by himself, will progressively increase. There will be days when we will dedicate 10 minutes, 15 minutes, 20 minutes, until a day comes when we will dedicate the entire session (1 hour). As the resting times will become longer and longer, we will spend them in conversation, looking out of a window and testing for the cessation of tremor. This involves directly adopting the final resting postures of the exercises, of which the patient already has enough practice and proprioceptive memory.
Extract of the complete work registered in the Intellectual Property (in Spanish):
“Control del temblor en el Parkinson: tratamiento del temblor del Parkinson basado en sensaciones gravitatorias y en ejercicios rítmicos con música – método Tubía “. 52 páginas. Madrid – Spain 2017.
(“Tremor control in Parkinson’s disease: treatment of Parkinson’s tremor based on gravitational sensations and rhythmic exercises with music – Tubía method». 52 pages. Madrid – Spain 2017)
Five people with Parkinson’s tremor followed training in this program and all five responded in the same way to the exercise proposals described in this article.
Although there are effective and long-lasting treatments for Parkinson’s tremor, Musical Body Rhythmics Classroom deals with studying and researching everything that can naturally improve the person with Parkinson’s by himself (without biochemical or surgical intervention). This is its contribution to find out more about Parkinson’s tremor.
Moreover, the exercises in this programme have a beneficial effect on mobility, muscle tone and fluidity of movement in the hands of people with Parkinson’s disease who do not have tremor.