Claire Cunningham's previous work has included operatic singing, aerial skills and a meditation on being single, and has often explored deeply personal thoughts about disability and social attitudes. In Give Me a Reason to Live, she approaches the terrible murder of 70,000 people by the T4 Nazi euthanasia programme by incorporating a live art element into her choreography, pushing her body to the extremes of physical exhaustion.

With a haunting score by Zoe Irvine and a superb use of Tramway's long space (she is caught in a single beam of light, like a fugitive from a concentration camp), Cunningham evokes the strange creatures found in Hieronymus Bosch's paintings. Her crutches become additional limbs, or manacles, or supports: her presence is simultaneously charismatic and confrontational, especially when she pauses to address the audience directly, in silence.

The effect is disorientating and moving: unlike her earlier works, Cunningham does not attempt to present moments of spectacle or beauty, but homes in on the struggle and the desperation of her body as it achieves acts of remarkable endurance. By the final scene, when she begins to sing, in a faltering yet clear voice, the theme of survival despite the anguish is articulated eloquently. The battle against death resolves into a fragile victory.

As both a broad statement of resistance to limitations, both physical and social, Give Me a Reason to Live is shocking and immediate. While it lacks the dynamic panache of Cunningham's Mobile, or the humour of Ménage à Trois, it is another testament to her restless imagination and belief in performance as a medium for serious ideas.