PEG'S PIANO

Barrett L. Dorko, P.T.


          Early in her illness, my mother would sit in her corner of the living room and move her fingers across a keyboard only she could sense. I wrote about this in an essay entitled "The Piano Lesson."

          I realize now that what I was describing as therapeutic for my mother is called ideo-motor movement, a category of nonconscious movement first described in 1852. In addition to providing the impetus for breathing and swallowing (excito-motor) or protective reaction (sensori-motor), the unconscious gives rise to muscular activity that expresses our thoughts and our desire for comfort (ideo-motor).

          This movement is seen in the facial expressions or gestures of card players though they might try desperately to hide them. These movements account for the "mysterious" activity of the ouija board and the dowser's rod. By definition, this unconscious activity makes it difficult for us to accept responsibility for its presence, though breathing and startling come from the same reservoir and we will readily admit that these movements are our own.

          Perhaps it is the creative and often counter-cultural nature of such movement that makes us deny that it could possibly be the result of our own desire to behave in something other than our "normal" fashion. Ideo-motor movement is the antithesis of the controlled posturing we've been admonished to maintain since our first days of schooling.

          I am suggesting here that the epidemic of chronic pain from which our culture suffers is largely due to the suppression of ideo-motor movement and its ability to resolve neural irritation. The prolonged positioning many are asked to endure at work creates the need for an instinctive shifting toward comfort, but instead of allowing this, workers are typically told to hold themselves still and erect. This admonition begins in kindergarten where the teacher never reinforces comfort, unique posturing or creative movement. It is the way they control us, and it works pretty well.

          The suppression of this instinctive movement does not completely eliminate its expression. We see its attempts to change us in the persistent isometric contraction that seems only to perpetuate the patient's pain. When asked to relax, the results are transient at best, but when allowed to isotonically contract, the restoration of normal range and pain relief typically ensue. This is how I now practice.

          Imagine living in a culture where unique and creative speech were suppressed. Wouldn't your throat commonly be tight for lack of your mouth's expression? Wouldn't you search for a safe non- judgmental audience for your words? I think that physical therapists can provide a similar environment for the body's expression, but first they must understand its presence and purpose.

          When my mother could no longer comprehend the written word, she transformed her daily ritual of reading the paper into the folding and unfolding of cloth. Sitting with several layers in her lap, she would occasionally chuckle or cluck, the patterns in the material every bit as interesting to her as the Cleveland Plain Dealer. It was the movement of her hands and arms that the Alzheimer's unleashed that kept her content, and I've not forgotten what she was trying to teach me.


Suggested Reading:

"The Piano Lesson" by Barrett L. Dorko, P.T.
Copies available from the author.

Nonconscious Movements; From Mystical Messages to Facilitated Communication by Herman H. Spitz, Lawrence Erlbaum Associates, Publishers 1997.