Keywords: Parkinson’s Disease (December 2002)

ORIGINAL QUESTION:

Does anyone have experience teaching yoga to participants with Parkinson's Disease? Recently, a man in his 70's who has Parkinson's, attended a class I was teaching. This was his first yoga class. Due to the severity of his Parkinson's he has very limited, mobility, flexibility and balance. I feel teaching yoga to him one-on-one may be beneficial, but I know nothing about this disease. I'm just beginning my research and would be grateful to anyone with information.

BACKGROUND:

Reprinted with permission from the Parkinson's Disease Foundation's website located at http://www.pdf.org. Their toll-free number is 800-457-6676.

Parkinson's Disease: An Overview

Parkinson's disease (PD) is a disorder of the central nervous system that affects between one and one-and-a-half million Americans. Because it is not contagious and does not have to be reported by physicians, the incidence of the disease is often underestimated.

PD may appear at any age, but it is uncommon in people younger than 30, and the risk of developing it increases with age. It occurs in all parts of the world, and men are affected slightly more often than women.

Primary Symptoms

Following is a list of the primary symptoms of Parkinson's disease. It is important to note that not all patients experience the full range of symptoms; in fact, most do not.

Rigidity is an increased tone or stiffness in the muscles. Unless it is temporarily eased by anti-Parkinson's medications, rigidity is always present. However, it increases during movement. It is often responsible for a mask-like expression of the face. In some patients, rigidity leads to sensations of pain, especially in the arms and shoulders.

Tremor is the symptom the public most often identifies with PD, but in fact, up to 25% of patients experience very slight tremor or none at all. When it is present, the tremor may be worse on one side of the body. Besides affecting the limbs, it sometimes involves the head, neck, face, and jaw.

Bradykinesia means slowness of movement. This symptom is characterized by a delay in initiating movements, caused by the brain's slowness in transmitting the necessary instructions to the appropriate parts of the body. When the instructions have been received, the body responds slowly in carrying them out.

Poor balance tends to affect people with PD. This is particularly true when they move abruptly, causing a sudden change in the position of their bodies. Some patients experience repeated falls due to poor balance.

Walking problems commonly include a decreased or non-existent arm swing; short, shuffling steps (festination); difficulty in negotiating turns; and sudden freezing spells (inability to take the next step).

Secondary Symptoms

People with Parkinson's may also suffer from any of a long list of secondary symptoms. These include depression, sleep disturbances, dizziness, stooped posture, constipation, dementia, and problems with speech, breathing, swallowing, and sexual function. Again, it is important to note that different patients experience different symptoms.

What causes these symptoms?

The actual cause of PD is not known. Although a defective gene was recently found in a few families with extraordinarily high incidences of PD, most researchers believe that in the vast majority of cases, genetic factors alone are not responsible for causing the disease. Instead, it is suspected that Parkinson's usually results from the combination of a genetic predisposition and an as yet unidentified environmental trigger.

When PD occurs, degenerative changes are found in an area of the brain known as the substantia nigra, which produces dopamine, a chemical substance that enables people to move normally and smoothly. Parkinson's disease is characterized by a severe shortage of dopamine. It is this deficiency that causes the symptoms of PD.

ANSWERS:

Hello Patti:

My name is Jorge YTT Oct 2001. I have been giving privates to a guy with Parkinson’s disease. The routines that work best are restorative routines that focus on stretching and relaxation.

I usually do most of the routine on the floor. I start with breathing and warm up exercises (Energization exercises would be great) Then start doing stretches for the feet and ankles. Then I move into hip openers ( jatara parivartanasana with both legs bent and knees together, supta padangustasana,) You have to be very careful not to over stretch your student. When the stretch gets a little intense my student tends to shake, so we work on breathing and relaxing and he is able to stretch a little more and then we stop. Then I work his spine with cat cow stretches. Then we move into shoulders, if he is comfortable sitting I do circle of love, if not then I do garudasana arms while he's lying on his back.

Then I do neck stretches, moving the head front and back then side to side and then neck twists. I also do the lion’s pose to exercise his facial muscles. I usually end the session with shoulder stand, which is great for people with Parkinson's disease. If your student is 70 years old you want to modify the shoulder stand or if even that is not possible maybe even Viparita Karani at the wall. Anything to stimulate and bring blood to the glands on the head.

Remember to focus on breathing throughout the routine to keep them focus and relaxed. My student has a lot of expectations for himself so I remind him throughout the class to let go of expectations and judgements toward himself and to enjoy each asana. Remember the more relaxed he is the less he will shake.

To end you can do a regular savasana or you can do a savasana with the upper body resting on blankets and a weight on his forehead this will relax his nervous system more. Be very watchful of the weight because it can slip from his head. I usually hold the weight all the time he is in Savasana. To find out more about this kind of Savasana read an Iyengar book (any Iyengar book will do).

I give you my blessings may you and your students both help each other.

Namaste

Jorge Sevillano

From Linda Martin, YTT, Summer 2001:

Blessings to you, Jodi!

First, a little personal background (mine): my mother had PD--and I was responsible for her care, that is, seeing that she had the proper care for many years. She had a long, difficult struggle. Shortly before I left for YTT, I had the thought, why not yoga for PD patients? I knew that anything that would help them with balance and flexibility would be invaluable. I searched the internet and Amazon...the only book I found on the topic was "Parkinson's Disease and the Art of Moving" by John Argue. It's a very good book; I highly recommend it. He talks of yoga and other movement exercises, such as Ta'i Chi, has good illustrations.

When I returned from YTT, I called the Mohammed Ali Parkinson’s Research Center here in Phoenix (I live in Tempe, a Phoenix suburb) about teaching yoga to PD patients. At that time the Center was just getting started here and in the Spring of this year I started offering yoga--the first classes of any type to be offered there! Fortunately, I already had been teaching a class of "adaptive" yoga at a retirement apartment, using a lot of the variations given in our YTT manual for special needs students.

We've agreed to cap the class at 6 persons--it's just too difficult to watch more people than that. I begin with chairs seated in a circle. We do a lot of breath work...very important for PD patients...I do 3 part breathing, ratio breath, hissing breath, sometimes even lion! Focusing on relaxation, which is very important to them. A lot of seated upper body warm ups. Then we move to standing...doing some "feel good" stretches, and some qi gong standing moves (I've been studying and doing Qi Gong and Ta'i Chi a lot on my own--these moves are very good for their balance and very gentle--I'm planning to get into Qi Gong and Ta'i Chi a lot more as I have the time). Then we do "gentle" standing poses--tadasana, backward bend, chandrasana, the "teapot" version of triangle, a "gentle" warrior. Those with severe problems can remain seated, or stand and use chair as support or move back and forth between seated and standing...with two chairs...one for seating, one for balance when standing. I conclude standing poses with balance work...so important...and again the chair are there for balance and support...I do tree and several other standing balance poses...leg circling, ankle rotation, heel-toe (point/flex) etc. A good reference for balance work is the book Strong Women, Strong Bones by Miriam Nelson...some of the things I do are from that book. Then we return to the chairs for concluding relaxation.

The participants are so supportive of each other...and it so good for them to have classes with each other. It really helps them a lot with relaxation and flexibility. One woman said her chiropractor noticed an improvement in her ability to move her head after a few weeks of yoga! So often PD patients have so little neck mobility they turn their entire bodies to look behind them, then due to lack of balance, they fall.

PD is an on-off disease--some days are better than others. Be aware of that. We require a caregiver present for the class if the participant is unable to move on their own. Be aware that PD patients can fall, quick and hard! The participants at the M. Ali Center have signed their liability waivers and given complete medical histories to the Center staff. And they come there for other services so the staff knows them. The current participants are all at a very high level of ability; it is very difficult when different ability levels are in class, even in that controlled, ideal environment. This fall, we tried to offer classes in the suburban areas at other sites, and that attracted people not familiar with the Center and they just sort of "dropped in"--didn't bring their waivers, histories, or caregivers! All levels appeared--I quickly realized that was a disaster in the making and stopped those classes!!

Check to see if you have a local chapter of the American Parkinson's Disease Association for information and support. If that isn't available, try calling local neurologists offices for info.

Again the risk of falls--small women can fall quickly and hard, but so can large men!!! So, again, be very, very aware of the risks! That's why poses seated in a chair and with the caregiver present is the way to go with severe cases. Personally, I also find environment very important. the lack of expression on the PD patients' face begs for pleasant surroundings, I think! I use music, at the Center we are in a beautiful carpeted room with wonderful chairs and a 7th floor view! Not always possible, I know, but I found the glum windowless, carpet less suburban sites totally unacceptable! With the windows we use only natural lighting, but more advanced patients may want more light. Obviously, the poses, even seated ones, are pretty short. I use affirmations where I think it is appropriate but didn't get too spiritual last spring...one evaluation requested more spirituality...so you never know!!

I hope I have not scared you! I think we have a lot to offer PD patients. But I have become very aware of the importance of the support of the Center and my own limitations. Also, PD is very depressing disease; maybe more so for me because of my mother. But having said that, I must say that the students are so appreciative that they often make my day! So I do feel I am doing something worthwhile.

Oh yes, I've discovered that the Argue book is well known by those working with PD patients. The author lives in the Bay area and conducts speech and movement classes in his studio and for the Kaiser Hospitals. He is a former actor; he was in Tucson last year but I didn't know about it until afterwards...if he returns I will go see him!

I have a handout of a seated pose that is not in the books...sort of a seated ardha/warrior if you can imagine...students love it. I'll email it to you if you want to email me directly at linda.martin@asu.edu

And, any other questions you may have, I'll be happy to talk "direct"...you have touched an important chord in me, needless to say! You teach a lot!! I'm teaching about 12 classes/week and have decided that is my capacity!

Again, many blessings to you. Linda

ANOTHER ORIGINAL QUESTION:

From Jorge Sevillano, Dana Point, CA:

Hello everyone:

I just recently found out that one of my friends has been diagnosed with Parkinson's disease. I would like to find out how Hatha Yoga can help people in this situation. If you know of any literature I could use to inform myself and help my friend with Hatha Yoga please let me know I would greatly appreciate it. Thank you

In Love and Gratitude

Jorge Sevillano

ANSWERS:

From Linda Martin, grad. 2001:

Hi, my mother had Parkinson's disease, so it is a special interest of mine.  I teach a class for PD patients at the Mohammed Ali Parkinson's Disease Research Center at the Barrow Neurological Institute in Phoenix, and we are adding classes in suburban locations.  I recommend the book, "Parkinson's Disease and the Art of Movement" by John Argue (available from Amazon.com). Although the book deals with many other types of movement in addition to yoga (tai chi, etc), yoga teachers will recognize many moves they are familiar with!  Yoga benefits pd patients in that it improves balance, co-ordination, strength, flexibility, etc.  And, needless to say, these attributes need improving in patients with other disorders, so other books are helpful too.  For example, improving balance, co-ordination and strength is also important for people with osteoporosis, and the book "Strong Women, Strong Bones" by Miriam E. Nelson has useful exercises for balance and strength and "balance tests" (my pd students found these very challenging!).  Also, the book, "Yoga Builds Bones" by Jan Maddern includes many poses for improving balance (and also strength, of course).  All of these books are well written with excellent descriptions/pictures of the poses/movements). I also recently read a newspaper article about proprioception (the ability of the brain and body to know where every body part should be when a person is in motion--important in balance, obviously!)  All these sources I've mention describe the tree pose and Tadasana in some form (without using those labels!!) The Nelson book is widely available; the Maddern book probably will have to be ordered. Lack of balance, co-ordination, flexibility, and strength are the principa physical problems that I see in Parkinson's, and yoga helps so much with all of these.  I think that it is unlimited the help we can provide to these people.  We just need to remember to be very gentle and meet them at their levels.  I teach seated yoga, standing poses behind chairs for support, and standing at the wall poses for balance.  The "special needs" section of the Ananda teachers manual provides a lot of help.  The people in class are in various stages of Parkinson's, which is challenging, but the students are so supportive of each other it is amazing.  The students are so appreciative--it is the most rewarding thing I do!!!

And I think that yoga provides a lot of mental relief.  PD patients often are depressed and their self-confidence erodes.  Working through poses with them increases self-confidence and mind set!

My students have asked for write-ups of my classes so they can practice at home and for an audiotape of the Savasana portion.  I've distributed the write-ups and suggested they bring tape recorders, which they do.  But let me know if you would like copies of these write-ups. I have not found other books, although they may be out there.  A search for "yoga and Parkinson's disease" yielded only the Argue book.  Suza Francina's book "The New Yoga Book for People Over 50" is somewhat helpful with poses for "special needs".  This book is also widely available.  Please let me know if you find additional books, resources.

Blessings to you.  Again, we can do a lot in this area....we just need to listen, listen...  Linda

From Valerie Wint:

Hi there, Jorge,

This is your classmate, Valerie in Toronto. If you do a search on the internet giving "Yoga and Parkinson's" as your search parameters, you will bring up a number of interesting sites. Good luck.

From:  Marcia Framsted, AYTT 1989

Jorge,  

There is an alternative/complementary medicine web site that your friend MAY be interested in exploring. < http://www.pdtreatment.com >   This site is not about yoga for Parkinson's disease, but it may offer some ideas for healing that are not generally found in the traditional medical approach to Parkinson's.  Bless you.