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.
A sampler of learning games:
· Shifting weight. A balance game like those toddlers play with gravity. Standing, with hands on secure support if needed for comfort, shift from one foot to the other. Notice the pressure on the bottom of your feet and how it changes. Ask "What would be easier?" Repeat, notice, let become easier, explore forward or back slightly, etc. If standing generates tension, one can sit, shift weight and notice seat bones. If sitting is not easy and simple, lie on your back, tilt head and knees to feel weight pour from side to side across your supported spine. Find what feels good, find and stay within your window of comfort and security. Repeat, notice. Secret shifting weight game. In line at the bank, other wait, shift weight so gently no one notices but you.
· 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:
Self movement: 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. Hands-on from others: Trager, Feldenkrais, Alexander, Craniosacral, Zero Balancing, some (when within window of comfort and in listening mode) physical therapy or massage. Many others (see 7). One needs to feel comfortable and accepting of contact. Energy: Reiki, Therapeutic Touch, Chinese, Japanese and Indian work with qi, chi, ki, and prana (see 7).
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 certified as a Trager® practitioner, tutor, and movement and workshop leader. phone: USA 912-231-8280.
1. Mentastics is a name created by Milton and Emily Trager from mental gymnastics. Info on his book on movement at www.joeleegriffin.com/links.htm
For his video on Trager movement, contact 4 below.
2. The Trager Approach. www.joeleegriffin.com/trwhat.htm
3. Spitz on touch, www.joeleegriffin.com/trwhy.htm
4. U.S. Trager® Association., 24800 Chagrin Blvd, Suite 205, Beachwood, Ohio 44122, USA, Tel. 216-896-9383,
5. Click on Find a Practitioner at www.trager-us.org
6. Milton Trager, MD, www.joeleegriffin.com/trwho.htm
7. Mirka Knaster, "Discovering the Body's Wisdom." This book provides a detailed brief coverage of dozens of "bodyways," by an author who writes clearly and simply. Any bodyway that avoids pain, fear, and struggle should improve learning and relearning.
®service marks, Trager International ©2002, J.L. Griffin
Thank you, Joe, for permitting me to publish this article here.
To find a Trager Practitioner in your area, click on Find a Practitioner at http://www.trager-us.org
To book a Trager session with Elsa Subhi Luhn in Denmark, Western Australia, click here
Elsa Subhi Luhn has been practising massage and bodywork for more than 20 years. She holds the Diploma in Remedial Massage, and has also trained in Rebalancing, Wholistic Massage, Aromatherapy, Reflexology, Conscious Touch and more.
In 1992 she took particular interest in the Trager Approach because of its gentle, non-intrusive and yet such powerful and effective nature. She is a certified Trager Practitioner, Introductory Workshop Leader and Mentastics Teacher.
Her journey of meditation as well as personal and spiritual growth has brought a fresh quality and depth of presence and compassion to her work.
We all know the feeling. Something is needed and we don’t know quite what it is. You’re feeling stressed or distracted, anxious or unhappy. Sitting in front of the computer screen, you’re meant to be working and nothing is happening. In the past, it would have been time for a smoke. Nowadays, that’s probably difficult, even if you still want to.
So, what to do? You space out for a few minutes, plough on with the work, and whatever it was that was creating a disturbance remains unresolved.
There is another option. Those few unproductive minutes could be used for meditation. What does this mean? Not concentrating on something or meditating over an issue, but taking the opportunity for a few minutes of nothingness. Meditation is taking a little time to encounter that same empty space that we go into in deep sleep. It is here that the deepest relaxation becomes available.
Going into that emptiness rests us and enables us to come back refreshed, ready to deal with the realities of the everyday world. Anxieties, stress, depression: all of these can be reduced or dissolved through meditation. They are mostly symptoms of our overly complicated lives and as such can be healed.
Below are a few suggested meditations for the workplace. All of them are quick and easy. They are derived from the meditations of the Indian mystic Osho. The best way to see if one of them is right for you is to try it for three days. If you like it, then stick with it for a while. You can even keep notes or a diary to see how it is helping.
1 Touching the eyes, light as a feather
Very simple this one, so simple you can do it many times during the day. You can do it on the train or on the bus or maybe just sitting on your chair. It feels good when you are getting sleepy. It brings a certain alertness.
Close your eyes and place your palms lightly on the eyelids, without pressing, soft as a feather. You will find that the thoughts tend to slow down or stop. The eyes become still and lose their tension. You will see that when the eyes are relaxed the mind tends to relax also. When you continue with this practice regularly you will find it brings a sense of joy into your life.
2 Watching the breath – the Silent Witness
This too can be done just for a moment, wherever you are. However, it is most beneficial as a regular practice. You can do it for a few minutes or continue as long as you want.
Close your eyes, sit in a relaxed position and start watching your breath. This means that as you breathe in, you let your attention fall inside with the breath. As you exhale, your attention moves outward.
Feel the breath coming in; let it move in. Move with the breath fully consciously. Do not go ahead and do not follow behind, just go with it. Then you may find that point, which is between two breaths. For a fragment of a moment, the inbreath stops before it starts moving out again. The same happens after you have exhaled, for a split second the breathing stops, before it again moves in.
The gap between inbreath and outbreath is of a very short duration, but with close attention you can feel the gap. Once you can feel the gap, you have a glimpse of the witness. If you enjoy this and continue with the practice you will find the gap expanding and you may experience profound silence.
Somebody can be sitting by your side and he will not know what you are doing. You can do it any time. Not only at work, but also just before going to sleep. If you are not feeling sleepy just try watching the breath for a few minutes. You will wake up so relaxed; you will still be in a space of meditation. And you will not know when you fell asleep.
Try it first for a few minutes at work, not when you are feeling sleepy or you may fall asleep. If you like it, try it more often.
3 Meeting the Problem, Greeting the Tension
This is a great meditation when you are feeling in too much of a hurry, too speedy, or when some inner tension or anxiety will not allow you to relax.
When you feel hurried, just watch. Are you trying to escape from something? Are you trying to avoid some situation? Are you trying not to notice something that is bothering you? Are you trying to suppress something, or worrying about something? Is there a wound inside that you don’t want to feel? Watch deep down. This habit of hurrying is usually an attempt to avoid some deep sense of worry, some underlying tension. Bring it up, let it surface and meet it.
People are constantly hurrying because they are avoiding so many issues, so many old wounds. We avoid the memory of this person who treated me badly, that man or woman who betrayed me. Or we worry about an investment that may or may not come good. Right now, nothing can be done about it, yet we go on worrying. Greet the worry, meet it face to face, get to know it and it begins to disappear. Avoid it and you will have to start running. In the end you will be running even in your sleep, in your dreams.
You will be surprised. If instead you can encounter any problem directly, face to face, it disappears. It dissolves. In the inner world, to exactly know what a problem is and to meet it is the treatment. A problem only continues so long as you go on suppressing it. Of course, this does not apply to the practical problems of everyday life. They still have to be dealt with. It is the inner problems that dissolve. When they are gone half the stress is gone and what remains is so much easier to deal with.
To be continued
These three meditations are just a starting place. If one of them appeals to you, have a go and see what happens. In a future article, we will be offering some other meditations. In ancient India Shiva declared that there are one hundred and twelve possible ways to meditate. There are plenty to choose from.
You are visitor:
How about making something we do every day into a meditation and reaping health benefits from it at the same time?
When you eat, let your senses open. Be simply present ... take a moment to enjoy the look of the food, the smell ... as you pick up the fork, feel the touch of fork on skin, maybe feel the sunshine or the air on your hands, your face ... slowly raise the food to your mouth, being aware of the anticipation ... and then experience the flavour, the temperature and texture of the food, bite by bite.
Take your time to taste all the different nuances the food has to offer.
Allow your eyes to be soft, your breath to be free.
What a gift, a moment of simply being here, not distracted by TV or radio, a book or computer.
Simply tasting, smelling, feeling.
Eating as a meditation allows you to relax while you eat, to feel more calm and peaceful, more centered.
In this state the nervous system supports the digestion and the absorbtion of nutrients to its optimum.