Curative Eurythmy in Geriatrics
By: Angela-Sofia Bischof
Original title: "Heileurythmie bei alten Menschen" in Merkurstab 1994; 47:286-294. English by J.Collis,MIL.
JAM Vol. 12(1), Spring 1995
Introduction
This investigation took place in Basel in a retirement home belonging to the Merian Foundation in which basic nursing care was available.
The home is not run on anthroposophical lines, and this was the first time the medical and nursing staff had come across this new therapy.
In a pretrial run, 6 patients were treated once weekly for 5 months. When this had proved itself beneficial for both the patients and the staff, the curative eurythmist was taken on me payroll. The work since then has been satisfactory for all concerned.
The choice of the 6 cases discussed here was suggested by the attending physician. They depict average cases and are not specially selected examples.
The treatments took place between November 1991 and February 1992.
Attending Physician: F. Debrunner MD, internist, Merian Iselin Hospital, Basel. Curative Eurythmist: A.-S. Bischof, Dornach.
Case 1) Chronic back pain following fracture of thoracic vertebrae Patient: Female, aged 73, blind, nursing care. Appearance: A stout, friendly woman who appears to have come to terms with her blindness. Likes laughing and enjoys a little joke. Very upright posture; walks well. Indications for eurythmy therapy: Back pain caused by fracture of thoracic vertebrae when she was young. Asthma and angina pectoris.
1) Medical approach
Clinical diagnosis: Chronic bronchial asthma - coronary disease with chronic angina - osteoporosis with vertebral crush fractures - degenerative changes in vertebral column with lumbago.
Considering the patient as a whole: The patient is over-affectionate and constantly seeks tenderness even though she has a friend who is very kind and attentive towards her. Marked euphoric tendency. Short-term memory is very poor, and she is correspondingly anxious and insecure. Needs to ask the same questions many times.
Other forms of treatment prescribed: Long-term medication unchanged: Lasilactone, Unifyi, prednisone
2) Eurythmy therapy
Movement diagnosis: The patient was quite agile in her movements. Her memory for the different movements of the eurythmy therapy was surprisingly good. On the whole her movements were harmonious though somewhat limp. Given suitable encouragement her psychological involvement was good.
Treatment goals: To alleviate the pain in her back and help her be more contented and independent through achieving greater self-assurance.
Method and aims: We began with the threefold E, but as she complained of breathing difficulty we added the asthma exercise L A 0 U M in the very first session. We also worked with M I in the spine as well as with E I (an exercise especially for straightening the spine). B T U or B P T U were practised over the whole duration of the treatment. Similarly U-E (reverence), both with the aim of calming the psychological agitation caused by the hysterical tendency. Copper balls (diameter: 6 cm) were used for rhythms and forms.
Changes in treatment: As with most patients we began with 3 sessions per week before changing to once a week. There was little need to change the exercises except that the asthma exercise L A 0 U M was soon only needed occasionally.
Comparing aims with achievement: The patient no longer complains of backache. No further breathing difficulties.
Number of sessions and duration of treatment: We worked for 3 months, beginning with 3 sessions per week, then 1 per week. Total of 15 sessions.
3) Final medical report
Eurythmy therapy made the patient feel astonishingly well. Subjectively there were no symptoms. She is more herself and has been able to make special friends with a male resident in the home.
4) Staff report
No more complaints about backache. Significant improvement of breathing problems. The patient continues to insist on her inhalation (whether for physical or psychological reasons).
Case 2) Right-sided hemiplegia
Patient: Male, aged 80, nursing care. Appearance: A corpulent, ponderous man in a wheelchair. Hemiplegia following stroke. Face very fat, especially jowls and chin. Eyes small and lively. The first finger of the left, healthy hand is missing as the result of an accident. The right arm is in a foam rubber splint during the daytime. Indications for eurythmy therapy: Activation of right arm, extension of left leg. Contentedness.
1) Medical approach
Clinical diagnosis: Severe right-sided hemiplegia with occlusion of R middle cerebral artery - hypertension - recurrent bronchial asthma - Deep vein thrombosis R leg - contracture of R shoulder and in L knee joint.
Considering the patient as a whole: Emotional choleric, not very intellectual. Grateful for kindness but rude as soon as something not to his liking or when in pain.
Other forms of treatment prescribed: Melleretten (oral liquid), Co Reniten tablets, Moduretic, Adalat.
2) Eurythmy therapy
Movement diagnosis:
1 Very lethargic and does not participate very intensively in the work. Is pleased when progress is made.
2 The left, healthy hand is clumsy and not used much. The left leg with the contracture cannot be treated because the patient is hypersensitive and refuses to cooperate.
Treatment strategy:
Organically the entirely motionless right hand is to be vitalized and gradually included in movements. Psychologically the patient is to become more contented and cooperative. At a later date we hope to have a go at making the healthy leg capable of taking me patient's weight once more. Method and aims: Treatment of the left leg (extension the aim) had to be postponed as the patient was not sufficiently motivated. It was easier to win his cooperation in work on the paralysed left hand. He was overjoyed when he found that he could move his fingers again. The work is protracted but rewarding when success is achieved. We work with contraction and expansion (fingers and arms). The fingers make L and small vowels. L with shoulders and elbows. Later large vowels, especially alternating A and E (7 times E, followed by A once), with the therapist moving the paralysed side. Efforts were made to make the stiffened shoulder joint more mobile. Changes in treatment: After approx. 3 months it was possible to include the copper ball (6 cm) in the exercises. The patient was able to hold it and after letting it go catch it with his healthy hand. Or he rolled it on the table and caught it again. Apart from this, therapy was more or less along the same lines, without much change. Elderly people like what they are accustomed to and have learnt. Comparing aims with achievement: Confidence in the therapy grew as success increased, and the patient was more contented.
The paralysed arm is becoming increasingly mobile. Having been totally flaccid with only minor reflexive movements, the fingers and lower arm can now be moved intentionally. It is hoped to increase this as therapy continues.
Mobility of the shoulder joint is slowly increasing. At present passive lifting of the lower arm is painless to an angle of over 90 degrees.
Number of sessions and duration of treatment: We have been working for 4 months. During the first month 3 sessions per week, then once a week. Treatment continues.
3) Final medical report
R shoulder mobility had clearly improved after eurythmy therapy. The contracture in the left knee joint did not respond. Patient was also able to make slight voluntary movements with the paretic upper extremity, but there was as yet no functional improvement.
4) Staff report
It was obvious to the nursing staff that the paretic arm was more mobile and without pain.
Case 3) Cervical syndrome - Apathy
Patient: Female, aged 80, nursing case. Appearance: Stout lady of medium height. Wears spectacles. Upright posture. She is still independent. Indications for eurythmy therapy: Pain due to tension in dorsal and nuchal region, lack of drive, single epileptic attack 5 months prior to starting treatment.
1) Medical approach
Clinical diagnosis: Subcortical dementia with episodes of seriously impaired vigilance - ischemic colitis with periods of diarrhea - cervical syndrome - generalized locomotor pain.
Considering the patient as a whole: The physical body of the patient appears to be too heavy and dense, so that the otherwise cheerful, friendly soul can no longer cope with it properly. Spontaneous utterances are rare. The lack of drive is such that the patient is even unwilling to cut up her own food. In direct contrast, however, she is quite capable of laughing and having fun.
Other forms of treatment prescribed: Tegretol, discontinued after 2 months of eurythmy therapy, Hismanal, stopped after 2 months, Panadol, stopped after 21/2 months.
2) Eurythmy therapy
Movement diagnosis: Taking her age into account, the patient is perfectly mobile and has no problems in copying the exercises either with her arms and fingers or with her legs.
Treatment strategy:
The aim is to reduce tension in the dorsal and nuchal region and to get the patient to take a greater interest in life.
Method and aims:
1 For back and neck, M with the back arched was alternated with I in the spine. Similarly an E-I exercise was done specifically for the spine. 2 For the psychological condition of the patient threefold E was combined with I. We also did a lot of work with small and large vowels. Also L, R, N, I orLI, R-I, N-L
Changes in treatment: Doing I the patient reacted happily and humorously, her eyes lighting up, so the proportion of I-exercises was increased as treatment progressed. Occasionally we used copper balls for forms or rhythms.
Comparing aims with achievement: The patient ceased to complain about back pain. During the sessions she was jolly and laughed a lot. She even made large movements independently. Apart from these periods she sat with a stony expression and was not even prepared to eat by herself but had to be fed. The eurythmy sessions appear to give her moments of brightness when her will to live is temporarily revived. The epileptic attack has not been repeated.
Number of sessions and duration of treatment: We worked for 3 months, at first 3 times, then once a week, 15 sessions in all.
3) Final medical report
The patient often sits for hours doing nothing in a twilight state from which she is easily aroused, however, with good contact established. She complains of generalized pain all over her body, which she says makes it difficult for her to stand and move about. She can be persuaded to walk, which she can do quite well by herself, and which makes the pain disappear. She greatly enjoyed the eurythmy therapy and during sessions was very lively and cooperative.
4) Staff report
Compared with physiotherapy, which had previously been prescribed, the effect of eurythmy on the patient was quite different. It gave her energy, lightness and enjoyment. It gave her an external stimulus which she needed psychologically.
Case 4) Agitated depression
Patient: Female, aged 90, nursing case.
Appearance: A petite, energetic woman with fine facial features. Recently confined to wheelchair owing to lack of sensation of unknown origin and incipient paresis of the legs.
Indications for eurythmy therapy: Strong hysterical tendency; paraparesis greater on L.
1) Medical approach
Clinical diagnosis: Mitral insufficiency, moderately severe senile dementia - with episodes of agitation - chronic arterial insufficiency in legs - status post acute arterial occlusion in leg.
Considering the patient as a whole: Life has been good to this woman with the result that she cannot tolerate suffering and is now overreacting hysterically to the aches and pains of old age. She moans and weeps all day long.
Other forms of treatment prescribed: Aspirin, Lasix, Melleretten, valerian, Dupholax (all long-term).
2) Eurythmy therapy
Movement diagnosis:
1 Voluntary movement of arms relatively good, except for limitiation of upward mobility in shoulder joint.
2 In the wheelchair essentially only passive movement of legs. Can move feet up and down if lying down and willing to cooperate. Draws up legs if touch is felt to be unpleasant.
It is difficult to determine the part played by anxiety and over-sensitivity in what she says.
Treatment strategy: First of all, the patient needs to be reassured and made to feel more contented. Secondly, providing the paresis is not due to a tumor in the dorsum, we should attempt to revitalize her feet and legs.
Method and aims: To strengthen the patient in herself we worked a great deal with E: 'threefold' E with the arms, sevenfold E followed by A with the legs.
As an exercise for the hysteria, B P T U was done actively with the arms, passively with the legs. The evolution sequence was also done passively with the feet. The aim being a greater degree of incarnation both psychologically and in the legs, the same sounds were appropriate for both.
Changes in treatment: There were 3 sessions per week until the patient's psychological state improved; by and large the same exercises were maintained.
Comparing aims with achievement: After approx. 4 weeks the patient's psychological state had become bearable for herself and those around her. However, there was no improvement in her legs.
Number of sessions and duration of treatment: 15 sessions over 2 1/2 months. Treatment continues.
3) Final medical report
The depressive states of agitation made it very difficult to nurse the patient. Antidepressants having elicited no response, she was given 20 Melleril 3 times. Her state of mind improved noticeably after me eurythmy treatment; she was much calmer and coped better with the paraparesis.
4) Staff report
The agitated and dissatisfied state of the patient improved greatly after a relatively short time, although she remained very sensitive. Mobility of the legs did not improve.
Case 5) Senile pruritus
Patient: Female, aged 86, nursing case. Appearance: A woman of medium height with lively, alert but shy eyes. She is even-tempered but somewhat retiring. Her skin is pale, almost translucent, with some red patches. Wears white gloves held in place by elastic bandages to prevent scratching. She tolerates this quite well. Indications for eurythmy therapy: Senile pruritus, tendency to circulatory collapse.
1) Medical approach Clinical diagnosis: Senile dementia - arterial occlusion in legs - deep venous thrombosis in L leg - recurrent diarrhea with suspected ischemic colitis -senile pruritus - orthostatic hypertension. Considering the patient as a whole: She has a great deal of patience, and her alertness and memory are very good for her age. Her joints are mobile. Other forms of treatment prescribed: Long-term medication unchanged: aspirin, Atarax, Kendural. 2) Eurythmy therapy
Movement diagnosis: Obediently carried out all the movements. Her rather dry and sober character does not offer much of an opening psychologically. Between making the different sounds she laid her hands on her thighs and drummed lightly with her fingers. This suggested a tick also with the pruritus.
Treatment strategy:
Improve skin health, excluding possible allergies, and activate the patient. She should be more alert and better incarnated to counteract low blood pressure and her involuntary movements.
Method and aims:
We began with T S R M A in order to strengthen the personality and exclude a possible allergy. Then E in various forms with arms and legs was added. B and L were practiced for the slightly dry skin.
Changes in treatment:
Once it was thought to be more likely that the itching was a kind of tick, I was added to the E, with the other exercises continuing. Comparing aims with achievement
1 No further circulatory incident since commencement of the treatment. 2 After approx. 2 months the gloves were no longer needed during the day. They were retained at night because there was a danger of the patient scratching open a leg injury while asleep.
Number of sessions and duration of treatment: Three times a week for the first 5 weeks, then once a week. Treatment is ongoing.
3) Final medical report
After the eurythmy therapy the orthostatic hypertension was no longer detectable. The distressing senile pruritus with often multiple excoriation on face or body improved greatly.
4) Staff report
Before the eurythmy therapy the patient had visible scratches on her face, so that she had to wear gloves and bandages. The therapy brought about a marked improvement. She has no more scratches on her face and only rarely wears the gloves. She has to wear them at night to prevent her from opening a wound on her leg.
Case 6) Crural edema, lack of vitality
Patient: Female, aged 81, nursing case. Appearance: Large, dark-haired woman with hardly any greying. Deep-set eyes with dark rims; pale. Generally in bed, spending only an hour at a time in her wheelchair. Indications for eurythmy therapy: pedal edema, high blood pressure (up to 200 systolic), fatigue, lack of drive, poor renal function, nocturia. Cerebral atrophy.
1) Medical approach
Clinical diagnosis:
Progressive cerebral atrophy of unknown etiology, with severe depressive, dysphoric mood changes and impaired vigilance - chronic depression - hypertension - crural edema of uncertain etiology, poss. chronic venous incompetence following thrombosis.
Considering the patient as a whole: Very tired and lacking drive. Fully conscious when awake and remembers what she is told once. Worked as a waitress in a good hotel (always on her feet).
Other forms of treatment prescribed: Long-term medication unchanged: Eitroxin, Adalat, Moduretic.
2) Eurythmy therapy
Movement diagnosis:
The patient was initially too weak and unmotivated for active movement; her joints were also somewhat stiff. For a considerable time the therapist had to move the patient's arms. This continues for her legs under the bedclothes. The patient finds this agreeably stimulating.
Treatment strategy: Fluid must be drained from the legs and renal function regulated so that daytime elimination is adequate (B P F, A B). Secondly blood pressure must be reduced (S and Staff of Mercury). This and the other movements must also be taken downwards. Thirdly cerebral atrophy must be counteracted (R L S I). Fourthly, the patient's interest in me life around her must be stimulated, and she must become more active (E).
Method and aims: Intense work was done with the feet in order to stimulate vitality in the head. Once the patient's interest and gratitude had been aroused she became increasingly willing to exert herself and make me arm movements actively; this in turn led to increased mental activity. Doing I with her fingers amused her, which contributed to her health.
Thirdly, we worked towards the threefold E in the E-exercises; this has proved very successful in helping old people become more awake, active and harmonious. E made with the lower arms – ‘I resist' - six times, die 7th E as 'humility-E' with arms crossed over the chest - concluding with the 'large, all-embracing E' - then relax and pause.
Changes in treatment:
Once the crural edema had gone down and eliminations became more regular the emphasis shifted to the brain exercises and the E. Otherwise the exercises remained more or less the same, with occasional recourse to the vowels or similar exercises to nourish the soul and relax the patient.
Comparing aims with achievement:
1 After 3 weeks (6 sessions) the crural edema had gone down completely; the feeling of tightness had improved, and blood pressure was satisfactory.
2 The patient's own initiative had increased so that she made the arm movements actively, which was very strenuous for her in her state of exhaustion.
She was also in the mood for a bit of fun sometimes. After about 8 weeks it became clear that she was approaching death. The exercises were therefore redirected to easing her body and helping her mind. Medical treatment was also stopped. After two weeks she was serene and able to fall asleep in peace.
Number of sessions and duration of treatment: 13 sessions in 10 weeks
3) Final medical report
The patient's condition deteriorated during the period of eurythmy therapy and she died within 3 weeks. She grew calmer and died peacefully, which surprised the nurses and the physician in view of previous experiences.
4) Staff report
The crural edema did not recur. Blood pressure remained stable.
Angela-Sofia Bischof
Curative Eurythmist
Burgstrasse 6
CH-4143 Dornach
Switzerland
Citation: Bischof, A.-S. (1995). Curative Eurythmy in Geriatrics (J. Collis, Trans.). Journal of Anthroposophic Medicine, 12(1), 70–79.