Yoga Therapy for Parkinson's Disease and Multiple Sclerosis. Jean Danford

and noticed a difference if they did not attend class. It clearly helped them to maintain useful movement and to stay active, and their partners noticed that they moved better and were calmer after yoga.

Research into the effects of yoga for Parkinson’s disease and multiple sclerosis

      There have been various studies looking into the impact of yoga on Parkinson’s and MS, and I present below some of the more relevant ones in this section.

      Parkinson’s-related research

      Kaitlyn Roland completed her PhD research at the University of British Columbia (2012), which measured Parkinson’s disease-related changes to daily muscle activity and the consequences for physical function and frailty. She found that yoga not only improved psychological wellbeing, but also had an effect on the mobility problems experienced by many patients.

      Boulgarides et al. (2008) researched into the effect of an adaptive yoga programme on mobility, function and outlook in individuals with Parkinson’s disease. The background for the research was:

      …that Yoga has been found to be effective in addressing problems of strength, flexibility, balance, gait, anxiety, depression, and concentration. These problems are all present to varying degrees in individuals with Parkinson’s Disease (PD). Different forms of exercise and therapy have been found to improve the symptoms related to PD, but no experimental studies have been found exploring the effects of a Yoga program on those symptoms.

      Their conclusion was that changes in measures of strength, ROM (range of movement), mobility, gait, balance and psychological health indicate a positive effect of yoga for those with Parkinson’s, supporting further study using randomised controlled research design with more subjects.

      Multiple sclerosis-related research

      The research results of yoga for MS are much more mixed, although several studies have shown that yoga practice relieves fatigue. In early 2008, The Expanding Light yoga school co-sponsored a research study of Ananda yoga that included energisation exercises, a combination of deep breathing, isometric contraction and mental focus to increase body awareness and neuromuscular coordination. The purpose of the study was to investigate the effects of this yoga routine on various aspects of day-to-day functioning and quality of life in individuals with MS. The results of the study showed encouraging positive results on many fronts, including improvements in balance, strength, levels of anxiety and depression, feeling of vitality, concentration and a sense of wellbeing.

      The Rutgers School of Health Related Professions recently conducted a pilot trial (see Fogerite et al. 2014). Those who participated were better able to walk for short distances and longer periods of time, had better balance while reaching backwards, fine motor coordination, and were better able to go from sitting to standing. Their quality of life also improved in perceived mental health, concentration, bladder control, walking and vision, with a decrease in pain and fatigue.

      Almost all of the research projects recommend further research with larger groups for a more accurate picture.

      Chapter 2

      An Exploration of the Holistic Yoga Approach and How It Can Help

      Because on the surface both Parkinson’s and MS present in such a physical way, it is hard not to see that making improvements to physical wellbeing is all that is needed to make a huge difference to someone with these diagnoses. And yet yoga, more than any other therapy, is bound up in the concept of what makes up a human being, and what makes that being whole.

      Although Western medicine separates out the systems of the body, and seeks to find the origin of the disease process to find a cure, Eastern medicine looks at a much more subtle construct of health and wellbeing, the energy or life force known as prana, which acts as a blueprint for the whole organism. Understanding how that energy flows and manifests as prana vayu to sustain the organism, or becomes stagnant or restricted, forms a different view of ill health.

      There are several models that serve as a means of looking at the qualities of each individual and therefore the kind of yoga practices that will be useful. The model of the three gunas (qualities of nature) describes states of inertia, activity or balance. Ayurveda uses the system of doshas to categorise each person and to find the treatment that will best work with their type. Yoga has the principle of Pancha kosha, an overview of the different parts of a human being from the physical to the spiritual, and even more subtle is the chakra system underlying all.

      Although I do not go into great detail about all of these systems, we can use them to understand these diseases from a yoga viewpoint, and to help guide the practices that will support the human being into a state of wellness.

      Only in the last century have psychologists, and neural scientists, come to see that the emotional, social interactiveness and thought processes of the individual have a great bearing on overall health, stress levels and happiness, and that these influence the body’s ability to heal itself.

      In the next section we will see what yoga can do, and how the different models can inform therapeutic practice.

Looking after the whole person

      When assessing the needs of individuals with a view to setting a yoga practice, for any health problem, the Pancha kosha (maya) model gives us a simple way of observing the person from five different aspects:

      •Annamaya kosha, the physical body, supporting the needs of the body, its functions and activities.

      •Pranamaya kosha, the energy body. Although we access prana (life force) from other sources (our food, water and environment), focusing on the ability to breath well is vital, as the pranic body provides a ‘blueprint’ to support the physical systems.

      •Manomaya kosha, the mental/emotional body. The lower mental function operates here, including all our emotional ups and downs. Working at this level is key to enhancing wellbeing, and bringing about mental clarity and a calm emotional disposition.

      •Vijnanamaya kosha, the wisdom body, engages the intellect and higher faculties of the mind. In this place we see from a different point of view, understand things differently, adapt and learn.

      •Anandamaya kosha, often referred to as the ‘bliss body’, needs to be nourished adequately. In lay terms, this refers to our ability to find contentment and inspiration.

      The koshas do not really operate as layers; they are imprinted into the fabric of our being and work together to form the whole. They are interdependent.

      In people with limited mobility, one would think that the physical level is the one demanding most attention, but this is not the case. Practices that support and balance the emotional and mental faculties will have just as much, if not more, benefit to the overall health and wellbeing of the person.

      Some examples of practices and activities that can nourish and balance each kosha level are shown below.

How we might support and balance the koshas

      Annamaya kosha, the physical body

      Asana, mobility, stability and awareness

      It has been shown that exercise is paramount for people with Parkinson’s. Rather than being limited by the disease, staying active and working the body keeps people active and independent for longer, giving a better quality of life and enabling people to engage in normal, everyday life for much longer than was previously thought possible. In people with MS, mobility, strength and stability are important in combating the effects of the disease. Yoga is excellent in that it is easily adaptable and can offer a variety of useful practices. Asanas have a positive effect throughout all of the systems of the body as well as on the musculoskeletal system. Asana practice improves digestion, elimination, heart and lung function, and impacts the brain, nervous and endocrine activity in a positive way.

      Firmly in the field of Annamaya, in relation to the physical body for people with Parkinson’s is the issue of posture, which often becomes stooped, or Pisa syndrome can develop, where the person leans to one side. A study by Dr Karen Doherty et al. (2013) said that:

      While