Yoga Therapy for Parkinson's Disease and Multiple Sclerosis. Jean Danford
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to guide the postures and movements that you teach, so be sure to ask permission first before you get ‘hands on’.
•The room should be warm but not overheated for those with Parkinson’s, but students with MS like a cooler room, as too much heat can be a bother for them. As always with yoga, quietness and time free from interruptions is essential. These groups need all the teacher’s attention, so the fewer distractions the better. The floor should be clean and non-slip.
Equipment
•yoga mat
•a stable chair
•blocks, hard and soft
•belt
•resistance band
•blanket
•bolsters are useful for specific practices, but not essential overall.
When setting up, make sure that the chair is placed on a mat so that it can’t slip away, and that other support equipment is to hand.
Check that there are no obstacles around the floor. Cables, mats and so on are a hazard, especially for those for whom walking is a challenge.
Points for teachers
The range of ability, mobility, strength and presence of symptoms in both Parkinson’s and MS will vary greatly. Even with the same medical diagnosis, each person’s experience of the disease process is different, and each person manifests it differently, even though the symptoms look similar. Parkinson’s disease does sometimes manifest in younger people, but mostly those with Parkinson’s are over 50, and the ageing body needs to be respected. People coming into a yoga class with a Parkinson’s diagnosis may have other conditions that need to be taken into account, and many come into class having no experience of yoga before.
Some people are very able and can easily get up and down off the floor, and others cannot do this at all. A preliminary health questionnaire is useful in determining the level of fitness in the group. A range of questions about movement, flexibility and Parkinson’s symptoms, along with information on any other medical condition that exists alongside the Parkinson’s or MS, give a fuller picture to enable planning a therapeutic programme.
In those with Parkinson’s, facial muscles are often severely affected, which means that they may be unable to respond and communicate through facial expression. This can present a challenge for some teachers. As human beings, we communicate meaning and emotions through facial expressions and gestures, and we look for responses from others, which helps us to consider our response. When working with people with Parkinson’s, remember that there may not be such a response, and yet personality and intelligence are still present.
In yoga philosophy we have the idea that the atman is eternal and dwells within – the person standing before you is present and engaged; they just can’t show it. Speak to the true self element of the person.
It is essential to observe the group each time, before starting, to ascertain if everyone feels well, or whether there are other factors to consider. The timing of medication plays a big part in life for those with Parkinson’s, so beginning class before the medication activates can be problematic. People have ‘off’ days and may have other health issues, so be ready to change your plans.
Key teaching skills and qualities are:
•observation
•modification, adjustments and adaptation of yoga postures and practices
•Ahimsa, working within a non-harming rule
•compassion and respect
•patience.
When teaching a Parkinson’s-focused group we need to consider which yoga practices will be of most value. Those that develop the following are more important than ‘achieving’ a perfect posture. This would be similar in other conditions such as MS and other neurological problems where coordination and muscle strength are affected:
•awareness
•breath
•coordination
•proprioception, balance and stability
•empowerment and self-confidence
•mobility, particularly in the small joints
•strength.
Where there is restriction in the body, there is often a negative dialogue. Here the student is subject to mind chatter of a critical nature, where we have a thought process of ‘I can’t do this, my body won’t respond’, ‘this hurts’, ‘I’m too stiff’, ‘I never get this right’.
This flow needs to be converted into positive optimistic encouragement. Offer some positive phrases, such as ‘with each move I release a little more’, ‘I am feeling looser and freer’, ‘my muscles are softening and lengthening’.
We can add visualisation, such as ‘imagine the muscles releasing and lengthening’, ‘see them strong and elastic’, ‘imagine breathing golden light into the stretch’, ‘imagine pouring golden light into the joint like magical lubricating fluid’.
KEEPING AND IMPROVING THE ABILITY TO ‘TRANSFER’
Moving from a chair to the floor and from floor to sitting and standing are all essential skills for life, and it is important to maintain the strength and coordination to do this. Yoga postures practised regularly will give confidence in performing these familiar actions, and the ability to transfer will impact on how the yoga session can flow.
Moving from standing to sitting on the floor
Instruction
1.Using a stable chair, stand in front of the chair and place your hands on the seat. Hinge at the hip, and bend both knees.
2.Lower one knee to the ground, steadying yourself with the your hands on the chair.
3.Come down onto all fours, and push the chair away.
4.Lower yourself onto one hip, and then lower yourself down so that you are lying on your side.
5.Roll over onto your back.
Getting up from the floor
Instruction
1.Make sure there is a chair nearby. Crawl over to the chair if need be.
2.Or, from lying, roll onto your side.
3.With one arm, push up so that you are sitting on one hip, legs to the side.
4.Turn onto all fours.
5.Bring one foot forward, and hold the chair for support.
6.Come onto your other foot, and with both knees bent, push up to stand.
Getting up from a chair
Getting up and down out of a chair is something that we all need to work on as we get older, so that we can build and maintain strength.
Instruction
1.Sit in a chair. Practise using the pelvic floor and abdominal muscles. (This is emphasised throughout the book in almost all of the practices as it is an essential factor in stability, mobility and back care.)
2.Keep your feet parallel, and feel them on the floor.
3.Press them into the floor, breathe out and engage the core.
4.Lean forward, keeping the natural curve in the spine, and guide the knees over the toes, reach the arms forward, letting the crown of the head lead the movement.
5.Follow the movement through, lifting off the chair just a few inches, and hold.
6.Try to sit down slowly and control the action. The chair is still there.
7.Practise this often.
This exercise can be a challenge for the quadriceps, but practice will improve stability.