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

case for creative experimental modification of asana

      When building a therapeutic practice, there should be considerations for the actions that we wish to implement. For example, postures that stretch the front of the body are often cited as being beneficial for ailments of the digestive tract. I have seen the Wheel Pose (Upward Bow, Chakrasana), Bow Pose (Dhanurasana) and Dynamic Bow Pose quoted as beneficial for diabetes, and the internet is full of ‘this practice is beneficial for this ailment’. If we are working with vulnerable people, we need to exert caution and begin to question ‘why?’ Many postures are for adepts, which would take many years of practice to accomplish. Students and people coming for Yoga Therapy are not adepts; they are often weak, immobile and ill. So we have to find ways of applying the therapeutic principle, and adapting the asana so that the therapeutic action can be applied.

      We may be looking for optimising mobility or building strength and stamina, stretching muscles, improving alignment and posture, relaxing and relieving physical tension, relieving stress, and improving the internal functions.

      Although in this book there are many ideas for modifying practices for these particular student groups, in reality your students will be the ones to teach you how to help them. Only they can say where their pain is, what their limitations are, and what other problems they have that need to be taken into account.

      Chapter 3

      Therapeutic Practices

      In this chapter we explore a range of yoga practices suitable for people with Parkinson’s or MS or people with limited mobility for other reasons. Many of the postures described will be familiar to yoga teachers, but are offered in easy stages and in simplified and adapted versions, so that even the most physically challenged person can advance. Instructions are given to help the teacher, and points for directing the practice are included.

      All of the information for contraindications and safe practice, along with guidelines for good alignment in postures that are familiar to most yoga teachers, will apply to these specialist groups. When working with any group in a therapeutic context, it is essential to have a full picture of each individual’s health profile, as this will determine any contraindications for them personally, and will enable you, the teacher, to adapt postures for them.

Planning yoga for Parkinson’s disease and multiple sclerosis

      When working with these diseases, it is important to consider:

      •Evaluating the needs of the individual. People often have other health problems that need to be identified and taken into consideration.

      •MS and Parkinson’s can also affect the internal muscles as well as the external muscles, so there may be digestive/bowel and bladder issues as well as mobility issues.

      •Disempowerment, lack of confidence, low self-esteem, anxiety and depression are often present.

      •Low energy states and sleep issues.

      •Mobility and the ability to control physical movements may be limited.

      •Hands-on help and adjustments, with permission, can make all the difference.

      The Pancha kosha model needs to be examined for each individual.

      Useful yoga tools are:

      •warm-ups and mobilising techniques

      •balance practices

      •developing awareness – proprioception

      •visualisation – bhavana for positive thinking and renewal

      •strengthening postures adapted for the individual

      •work that helps to ease any muscle spasm, gentle stretches and relaxation

      •coordination practices

      •relaxation – Pratyahara

      •breathing and meditation

      •adapting postures with the use of props, to assist the individual.

Considerations in planning for one-to-one or group work

      Practicalities

      •Class size – can you manage the group safely and give individual attention? (A maximum of 6–8 is recommended.)

      •Room size – it should be big enough to accommodate a full class as well as equipment.

      •Room temperature – warm but not too hot; check the recommendations for the condition.

      •Disabled access to hall/bathroom, etc. Are stairs/lift manageable?

      •Chairs – stable/sturdy chairs that will not slide around easily and can be placed on a mat.

      •Props – blocks/straps/extra chairs.

      •Adaptions for wheelchairs – if the user’s feet don’t reach the floor, for example.

      What you might do with your class

      •Assess their stamina – they may tire quickly, so plan for rests.

      •If the session is an hour, for MS and Parkinson’s allow a maximum time of 20–30 minutes for postures, depending on how people are on the day.

      •Warm-ups are essential – work the small joints, fingers and toes, as these become more important in limited mobility issues.

      •Give instructions at a suitable speed – don’t rush, as there might be cognitive issues.

      •Include movements that open the chest, strengthen and stretch. Include plenty of breathing and breath awareness.

      •Don’t hold poses too long – this may tire them too quickly, and exacerbate spasticity and cramping in the muscles.

      •Hands-on adjustments can be gentle but firm, without ‘manhandling’ forcefully.

      The practices are grouped according to their action and benefits to the body for this particular student group; adaptations and modifications are described, and a separate section for chair work is included for ease of reference. Some postures are shown in several places, according to their application.

      •Preliminaries and warm-ups

      •Asana for:

      oposture and the spine

      ostability and strength

      oshoulders and the upper back

      ohips and pelvis

      obalance

      osuperstretches

      orestorative postures

      odigestion

      •Pranayama (breathing) exercises

      •Practices for mind and emotions:

      orelaxation

      omoving into positivity – bhavana, visualisation, affirmations

      omeditation

      •Chakra practices

Safety and the environment

      Before beginning to work with an individual or a small group, there are practicalities and safety aspects to consider:

      •Working one-to-one is of great benefit, as full attention can then be given to all aspects of the individual, to their health and wellbeing. However, a great deal of benefit can be gained from working with a small group, as this allows time for giving personal attention and making adjustments, and for teachers to be assured that they can observe everyone in the group.

      •Over 6–8 students, it is better for there to be a yoga teacher assistant as well as the main tutor, as help will be needed in giving personal guidance and adjustments. Up to 12 people could be taught together. Alternatively, helpers may be willing to be on hand (but bear in mind that although helpers are willing, they may not