Alexander Technique exposure and physiological measures of movement planning and execution Audre Wirtanen1,2 and Harlan Fichtenholtz3 1 Balance Arts Center, (New York City, New York, United States); 2 Bennington College, Department of Science, Math, and Computing (Bennington, VT, United States); 3 Keane State College, Department of Psychology (Keane, New Hampshire, United States) Author contributions: Both authors developed the current study’s task, procedures, and data analysis strategies; A. Wirtanen analyzed data and wrote the current publication. *To whom correspondence should be addressed: [email protected] # of pages # of figures # of tables # of multimedia 28 6 0 0 Word count: Abstract (267), Body (4,286) Acknowledgements: The authors would like to thank Rebecca Brooks for aiding with recruitment of AT participants, Rebecca Warzer contributing to the pilot work this study was based upon. Conflict of interest: The authors have no conflicts of interest that relate to the present work. Funding sources: Thank you to the Geary Fund at Bennington College and the Bennington College Department of Science, Math, and Computing for supporting this project. 1 Alexander Technique exposure and physiological measures of movement planning and execution Audre Wirtanen1,2 and Harlan Fichtenholtz3 1 Balance Arts Center, (New York City, New York, United States); 2 Bennington College, Department of Science, Math, and Computing (Bennington, VT, United States); 3 Keane State College, Department of Psychology (Keane, New Hampshire, United States) 1. Abstract Alexander Technique (AT) is a somatic practice aimed at increasing awareness of one's movement habits in order to undo inefficient neuromuscular patterns that people learn in response to environmental shifts or stressors over time, so that they can move more dynamically and with ease. Practicing AT has therapeutic effects for both clinical and healthy populations but there is no basic research regarding the underlying physiological shifts that AT practice may correlate with. The goal of the current study was to determine the changes in electrophysiological measures of motor preparation and output in people with significant AT exposure. We examined electrophysiological correlates of motor planning including Event Related Potentials (ERPs), activity of the deltoid muscle using EMG, and trajectory of a reaching movement with a twin axis goniometer during a version of a Go/NoGo task. AmSat certified practitioners and students with at least one consecutive year of AT experience (n=10) were compared to participants (n=8) with no AT experience. Individual averages were combined into grand averages within each group, and groups were compared with 2 independent t-tests. Response accuracy of inhibition was calculated with a Chi-square analysis. AT practice for at least one year significantly correlated with changes in movement planning ERPs in the cerebrum, a different pattern of muscular activation, and changes in the pathway of movement compared to control. In addition, the AT group was more accurate at successfully inhibiting a motor response during STOP trials. This data provides the first electrophysiological evidence of Alexander Technique practice influencing brain activity, and identifies correlations between AT and differences in movement preparation and execution during a unilateral motor response. 2. Author Summary This study examined the way people with significant exposure to the Alexander Technique plan and make movements. Alexander Technique is a somatic practice that aims to re- educate poor movement patterns over time. Movement preparation in the brain, muscle activity, and the pathway of the movement were recorded during a task that prompted the participant to press a space bar or stay at rest and wait for the next trial. 3. Keywords Alexander Technique, motor planning, motor execution 4. Introduction Somatics is a field that studies the body from a first-person perspective. Internal awareness supports the way someone senses and interacts with their environment, and is just as 3 important as external awareness. There are many forms of Somatic practices, but all include a focus on proprioception and sensation of the body in various contexts. Most use mental imagery and movement explorations in addition to internal and external observation. The differences between varying methods is how the body is consciously thought about. The Alexander Technique is a form of somatic practice that teaches correct anatomical awareness and use of the body to undo learned tension or laxity so that people can feel freer mentally and physically in their daily lives. Alexander Technique The Alexander Technique (AT) is a somatic practice aimed at identifying and undoing inefficient neuromuscular patterns that develop over time to improve the functioning of the body as a whole. These inefficient neuromuscular patterns are referred to as habits because movement is most often coordinated in that manner or use. To re-train poor habitual motor functions into a more supportive neuromuscular coordination, AT teaches an increased form of awareness in action and inhibition, and emphasizes the relationship between how a person thinks about moving, and how that thinking informs subsequent movement patterns. This process utilizes conscious thought and hands on guidance to alter imbalances in muscular tone, unconscious automatic postural mechanisms, and operation of the whole body when preparing for and executing motor acts [1,2] F.M. Alexander initially described the technique in the 1920s [for example see 1], and while the basic principles have remained central to the practice, multiple lineages of the work exist. AT is well known among performing artists who recognize that the way they use their body affects the quality of their work, but is relatively unknown to other working populations. Most recently, the practice has been used to relieve chronic pain, increase independence, and regain ease and 4 movement ability in various clinical populations. More research needs to be done to understand how and why AT provides these beneficial and therapeutic effects to more diverse populations of people. It is important to review the findings of previous studies implementing AT to put the current study into perspective. Exposure to the Alexander Technique has been shown to enhance respiratory function by increasing respiratory capacity [3] improve Functional Reach (FR) as an indicator of balance [4] and affect coordination during sit-to-stand movements in normal populations [for examples see 5,6]. Biomedical interventions using AT have focused on exploring its potential to mitigate signs and symptoms of joint pain, neurodegenerative disease, and include measures of well being in addition to measures of pain and disability. Following AT lessons, subjects with chronic low back pain (LBP) reported less pain and increased dynamic modulation of postural tone [7,8,9]. Other studies correlated AT practice with decreased neck pain, increased self-efficacy [10], and reduced musculature co-contraction and knee pain during early stance and gait in subjects with knee osteoarthritis [11]. Studies specifically utilizing AT as a co-intervention for Parkinson's Disease found improvements in axial rigidity, postural sway and tone, measures of disability, back depression, and attitudes to self [12,13]. In addition, people with Ehlers-Danlos Syndrome (EDS), a genetic connective tissue disease with limited treatment available, are more frequently seeking out AT lessons to decrease the probability of joint dislocations, and improve their quality of life [14,15]. These studies and materials suggest that AT influences the way movements are planned and executed, and may contribute to efficiency in automatic and volitional motor output in both normal and clinical populations. Thus, recent publications have begun to elucidate AT's potential biomedical value in relation to movement and pain [1-15]. However, there are no current studies exploring 5 more fundamental physiological changes associated with AT exposure. A more detailed picture of how the technique may be influencing motor planning and execution is necessary to support its value as intervention in physically compromised populations. This study investigates physiological changes in the motor cortex during motor planning, and features of movement execution during a version of a Go/NoGo task compared to age matched control. Electrophysiological Correlates of Motor Control Event Related Potentials (ERPs) preceding movement were recorded to monitor the accumulation of neural activity before subjects made a reaching movement to press a button. ERPs are summed voltage recordings of cortical activity using non-invasive Electroencephalography (EEG) electrodes positioned on the scalp. These time-based waveforms are the result of several overlapping components that represent mental activation processes, and cannot be deconstructed into separate cellular mechanisms, but indicate changes in brain activity. The Readiness Potential (RP) is an averaged movement ERP consisting of a phasic negative shift in voltage preceding voluntary unilateral limb movement [16]. RPs are greater in the contralateral motor cortex, and have been confirmed across species by direct subdural recordings from the primary motor cortices and supplementary motor areas in monkeys, humans, and invertebrates [17,18,19,20]. Because greater activation occurs on the contralateral side of the brain corresponding to the limb