This article was downloaded by: [University of Calgary] On: 05 February 2015, At: 20:21 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK American Journal of Clinical Hypnosis Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/ujhy20 Hypnotherapy in the Rehabilitation of a Stroke Victim: A Case Study Aaron J. Manganiello Ed.D. Published online: 21 Sep 2011. To cite this article: Aaron J. Manganiello Ed.D. (1986) Hypnotherapy in the Rehabilitation of a Stroke Victim: A Case Study, American Journal of Clinical Hypnosis, 29:1, 64-68, DOI: 10.1080/00029157.1986.10402680 To link to this article: http://dx.doi.org/10.1080/00029157.1986.10402680 PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/ page/terms-and-conditions AMERICAN JOURNAL OF CLINICAL HYPNOSIS VOLUME 29. NUMBER 1. JULY 1986 Hypnotherapy in the Rehabilitation of a Stroke Victim: A Case Study Downloaded by [University of Calgary] at 20:21 05 February 2015 Aaron J. Manganiello Palo Alto, California Limitations of conventional rehabilitation of stroke victims have led to investigation of alternative techniques for treating neuromuscular dysfunction. This paper describes the treatment of a hemiplegic stroke victim using hypnosis. The subject regained full function of his leg and arm movements within 5 weeks, as well as improvement in facial muscle control. of motion was immediately noticeable. Posthypnotic suggestions were employed to encourage exercise and to combat depression. In the second study, Kroger reportedthat under hypnosis, spasticity was reduced in four patients who were completely paralyzed on the affected side. Supermaximal concentration, achieved through hypnosis, greatly accelerated the relearning process. In addition, the mental imagery which allowed the patients to see themselves as capable of movement served as an important motivating factor. Crasilneck and Hall (1970) reported that hypnosis was used with 25 vascular and post-traumatic neurological patients, seen over a 9-year period, who had not responded to conventional rehabilitation procedures. In 21 of these cases, hypnosis was followed by a marked reversal of psychological attitude, and subsequently, of physiological functioning. In four cases, patients did not respond to hypnotic induction. While an increase in motivation for re- The rehabilitation of a stroke victim is primarily a relearning process in which surviving cerebral and spinal pathways are mobilized to produce the desired neuromotor activity. The emotional state of the stroke victim strongly influences the effectiveness of any rehabilitation program. Stroke victims often suffer from a pervading depression and a low tolerance for frustration. Negative self-image, poor concentration, and lack of motivation can also prohibit rehabilitation efforts. Kroger (1963) cited two case studies where hypnosis was used in the treatment of hemiplegics. In one, revivification or regression to the age of 3 or 4, under hypnosis, was used to reestablish the mental image of moving the limbs. A greaterrange Accepted for publication 3/23/83 by previous Editor (Dr. Gravitz). For reprints write to Aaron J. Manganiello, Ed.D., 1005 Runnymede Street, Palo Alto, CA 94303. 64 Downloaded by [University of Calgary] at 20:21 05 February 2015 REHABILITATION OF STROKE VICTIM covery seemed to be the major change elicited by hypnotherapy, other theoretical possibilities were discussed by Crasilneck and Hall (1970). The possibility that hypnotic suggestions produced physiological changes that were not mediated through motivational change could not be discarded. Researchers have cited numerous studies where hypnotherapy produced dramatic results with patients suffering from other forms of neurological damage or disease. Chappell (1964) discussed four case studies in which the spasticity in paraplegia was reduced in patients while in a hypnotic state. Chappell questioned the neurological mechanism by which this occurred since all four cases demonstrated that impulses originating in the cortex influenced the musculature below the level of injury to the spinal cord even when there was known extensive damage to the cord. Gravitz (1981) described the treatment of a brain-damaged centrally deaf patient through the use of non-verbal hypnotic techniques. While the deafness remained, the patient was quite susceptible to hypnosis. Within 2 months the patient's physical and emotional behavior significantly improved. Brunn (1966) reported the use of hypnosis to reduce spasticity in a patient suffering from multiple sclerosis. Slater and Flores (1963) reported the use of hypnosis to remove the paralysis caused by organic brain disease. In this case study, hypnosis removed the organic paralysis in the subject's right arm and prevented the usual paralytic progression that normally follows in such cases. After the subject's death, autopsy revealed that a tumor had occupied and destroyed the entire motor and sensory cortex of the left dominant cerebral hemisphere. Slater and Flores (1963) discussed the hypotheses that either 65 rapid hypnotic transfer of dominance of the cerebral hemisphere had been accomplished, or that motor pathways in the frontal lobe were acting as a substitute motor cortex. Method Subject The subject was a 57-year-old male who suffered a cerebrovascular accident while working as a musician in Germany. He was hospitalized for a week while he awaited transportation to the United States. Upon returning to the United States, a review of his pre-morbid psychological and medical histories found no contributing factors. Neurological examination found the subject's mental status to be of normal intellect and sensorium. A wide-based shuffling gait with moderate truncal instability and tendency to fall to the right was evident. The Romberg sign was found to be positive to the right, and cranial nerves were intact. Visual acuity was 20/ 50 au without correction. Nystagmus was evident on lateral gaze, right to left and left to right, and upward gaze. However, no nystagmus was apparent with downward gaze. The pupils were myotic to 3 mm and were reactive to light and accommodation. Facial sensation to the right was decreased to pin-prick and temperature, and right peripheral facial weakness was noted. There was a right hearing loss with some preservation of bone conduction. There was also a deviation of the tongue to the left and impairment of gutteral sounds. Distribution of the fifth cranial nerve was decreased to the right. Computerized axial tomography obtained sequential, axial, tomographic images with and without intravenous contrast. An ectatic basilar artery was present. Enlargement of the basilar tip or right posterior Downloaded by [University of Calgary] at 20:21 05 February 2015 66 communicating artery was suggested and raised the possibility of aneurysm. The subject was diagnosed as suffering a cerebrovascular accident and was discharged from the hospital after beginning conventional physical therapy. The subject had made little improvement in the initial limitations imposed by the cerebrovascular accident when he was seen by the author. He was unable to feel the right side of his face or to control his tongue. Speech was impaired, and eating was very difficult. The right side of his cheek and his lips were swollen due to the subject biting himself. Right arm spasticity was apparent. The hand muscles remained contracted, and the hand was cupped. The subject had no digital movement in the right hand, and he could only walk with the aid of an ambulator. MANGANIELLO arm from the shoulder to the finger tips, the suggestion was given that the paralysis would be transferred to the left arm. Upon request, the subject squeezed the author's hand with his right hand to demonstrate the transfer of the paralysis. Next, the author rubbed both arms of the subject from the shoulders to the finger tips and suggested that both arms would function normally. Again, upon request, the subject squeezed both the author's hands with his hands. The subject also squeezed the hands of an observer. Neither the author nor the observer could feel a difference in strength between the subject's right and left hands. Next, the author requested that the subject count from one to one-hundred. Guided imagery was again used to deepen the trance state, and the suggestion was given that with each number the subject's speech would become clearer as he gained Procedure more control of his facial muscles. As he In the first session, the subject was re- continued to count, the subject's speech gressed, under hypnosis, to the age of 10. became noticeably clearer. Finally, the At that age, the subject had been a track suggestion was given that the subject would and field competitor and was in excellent be able to hear in his right ear. While the physical condition. Hypnotic suggestion author held his hand over the subject's was given that the subject would be able left ear, he softly rubbed his fingers toto do everything he could do at age 10, gether near the right ear. There was imand that he would remain in trance, re- provement in the subject's hearing. In the second session, a week later, the gressed to age 10, as he demonstrated his subject reported that he was walking unability. After walking 15 paces forward while supported except for steep inclines. He holding the author's arm, the subject was also reported that it was much easier for able to tum and stand unsupported. Guided him to eat and talk. The swelling had deimagery was used as a deepening tech- creased around his mouth and cheek. The nique, and the suggestions was given that subject continued to have limited use of the subject would open his eyes, remain his right hand. Although he now had some in a hypnotic state, and walk to his chair finger movements, he could not grasp a just as he was able to do in his IO-year- pencil correctly, and he trembled when he old body. The subject walked to his chair attempted to write. A sample of the suband seated himself. Guided imagery was ject's writing was obtained as baseline data. used once again to deepen the trance state. He attempted to write the numbers "one" As the author rubbed the subject's right to "ten," but most numbers could not be Downloaded by [University of Calgary] at 20:21 05 February 2015 REHABILITATION OF STROKE VICTIM 67 recognized by the author. Using a stan- on piano while the subject played for 30 dard trance induction, the subject was then minutes before stopping. hypnotized and told to open his eyes and again write the same numbers. There was Results an immediate and remarkable improveWithin five sessions of hypnotherapy, ment in control, and the previously unthe subject's hemiplegia was greatly rerecognizable numbers were easily duced, restoring him to a nearly normal discernible. functional level. A cerebrovascular acciWhile continuing the hypnotic trance, dent had severely impaired the subject's the subject walked across the office. He right side. Right arm spasticity was apappeared to have full function of his foot parent: the hand muscles remained conand leg. During the session, the author tracted and the hand was cupped. The worked in the same manner with the subsubject had no digital movement in the ject's speech as in the previous session. right hand. He suffered foot-drop and could The speech was clearer, and the facial only walk with the aid of an ambulator. muscles were far more controlled. The The right side of the subject's cheek and subject walked unaided out of the clinic lips was numb and swollen. Speech was after this session. unclear, and eating was difficult. There The subject returned one week later for was a severe hearing loss in the right ear. the third session. He no longer required Within three weekly sessions, the suban ambulator in any situation, his gait was ject regained full use of his leg and foot. steady and coordinated, and he spoke more By the third session the subject had gained clearly. The author continued to work with enough hand control to write his name the subject as he had in the first two sesand the numbers from "one" to "ten." sions. The subject signed his name for the By the fourth session he had enough dexfirst time under hypnosis. terity and facial muscle control to play his By the fourth session, the subject had saxophone. By the fifth session, the subfull function of his leg, facial muscles, ject gained enough facial muscle control arm and hand. During this session, the to play his saxophone for up to 30 minsubject who had been a professional saxutes while in trance. His speech was reophone player, was able to play his instored to a near normal level of clarity. strument for the first time in a waking None of the hearing impairment in the state. He had proper embouchure and good right ear was restored. dexterity; however, he could only play for approximately 5 minutes. After the subDiscussion ject was hypnotized, he played for 17 The limitations of a case study are obminutes before tiring. Five days later the subject returned for vious; however, this present study sugthe fifth and final session. During this gests possibilities for the application of session, the subject played his saxophone hypnosis in the rehabilitation of stroke alone in a hypnotic state for 10 minutes. victims. Positive results were achieved in The subject was instructed to keep his eyes a brief period of time with the subject. closed. He was later instructed to open The subject began treatment within 2 his eyes, remaining in trance, and con- months following his stroke. He did not tinue to play. The author accompanied him show the pervading depression and frus- Downloaded by [University of Calgary] at 20:21 05 February 2015 68 tration that often develops in stroke cases. Equally important, the subject did not apparently reach the point where he was receiving secondary gain from his impairment, and he was highly motivated to regain his normal level of function. The rapport between the subject and the operator was extremely strong. The operator was also a musician and acquainted with the work of the subject so that he had a practical understanding of the degree of control that would be needed for the subject to resume his career. This not only allowed the operator to make specific suggestions regarding adjustments in movements, but it also appeared to build confidence in the subject for the operator's abilities, thereby enhancing the rapport. In this case the subject was highly susceptible to the hypnosis as evidenced by the achievement of somnambulistic states where he was able to open his eyes while remaining in trance. One can only speculate whether such results could have been achieved with a less susceptible subject. Nevertheless, this present case study invites further investigation into the appli- MANGANIELLO cation of hypnosis in the rehabilitation of stroke and other brain-damaged persons. REFERENCES Brunn, J. T. (1966). Hypnosis and neurological disease: A case study. American Journal of Clinical Hypnosis. 8, 312. Chappell, D. T. (1964). Hypnosis and spasticity in paraplegia. American Journal of Clinical Hypnosis. 7, 33-36. Crasilneck, H. B. & Hall, J. A. (1970). The use of hypnosis in the rehabilitation of complicated vascular and post-traumatic neurological patients. International Journal of Clinical and Experimental Hypnosis. 18, 145-159. Gravitz, M. A. (1981). Non-verbal hypnotic techniques in a centrally deaf brain-damaged patient. International Journal of Clinical and Experimental Hypnosis. 29, 110116. Kroger, W. S. (1963). Clinical and experimental hypnosis: In medicine. dentistry, and psychology (2nd ed.). Philadelphia: Lippincott. Slater, R. C. & Flores, L. S. (1963). Hypnosis in organic symptom removal: A temporary removal of an organic paralysis by hypnosis. American Journal ofClinical Hypnosis. 5,248-255.