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Yoga and Management of Parkinson's Disease: Case Study

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Yoga and Management of Parkinson's Disease: Case Study

Yoga and Management of Parkinson's Disease: Case Study

Sanjiv Chaturvedi, Bangkok, Thailand

Parkinson's disease

Parkinson's disease (PD) is a chronic, degenerative neurological disorder which induces a gradual loss of cells in the mid-brain, substantianigra, responsible for the production of dopamine. Dopamine is a neurotransmitter, a chemical messenger, which transmits signals between two regions of the brain to primarily coordinate physical activity and regulate emotional responses. PD impairs the production of dopamine, and as a result, a person inflicted with the disease experiences progressive loss of motor skills and compromised cognitive ability. Tremors in the limbs, joint pain and fatigue are symptoms of the early stage of PD (PD stages 1 & 2).

In the middle stage, a person develops slow movement due to stiffness of muscles, poor coordination resulting in loss of balance, a hunched posture, insomnia, urinary problems, depression, moodiness and general cognitive decline (PD stage 3 & 4). In the advanced stage, a person is confined to a wheel chair or bed, often accompanied by disorientation and dementia (PD stage 5).

Currently, there is no cure for this debilitating disease and causes are not definitive. Conventional medicine temporarily remedies the symptoms of PD by administering drugs and contributes towards delaying its advancement. However, the person often suffers from the medication's side effects and develops a dependency on them.

Patient

In the summer of 2016, I began teaching yoga to a patient suffering from Parkinson's disease. Mr Lojanin came to me only after he had exhausted conventional and other alternative medicine options. This brief article will chronicle the effects of yoga in improving the physical and mental health of this individual to date and its positive repercussions on his family.

Until 2011, Mr Lojanin lived an active and busy life as a business owner, husband and father and enjoyed playing soccer, ran marathons and practised judo. However, when he was 57 years old, his doctor diagnosed him with a hereditary cholesterol problem that exposed him to higher risks of heart attacks and strokes. The side effects of the prescribed medicine masked the symptoms of an early onset of Parkinson's disease, delaying an accurate diagnosis of his condition.

Diagnosis and condition

As his mobility worsened and his body began to feel stiff, he consulted ten doctors at various hospitals without any definitive diagnosis. He tried traditional Thai massage therapy and Chinese acupuncture treatment. However, his muscles had become so stiff and hard that the needle bent when it was inserted into his body. By that time, he was experiencing tremors, debilitating stiffness, insomnia and needing assistance to complete daily life activities. The compromised state that Mr Lojanin was in triggered a depression which was taxing for his entire family. After 18 months Mr Lojanin was properly diagnosed.

Prognosis and medication by conventional medicine

Once diagnosed with PD, Mr Lojanin was prescribed an array of medication to suppress the PD symptoms 24 hours a day. Although prescription levels were adjusted, the following daily allowances listed below give an idea of how heavily medicated he was, and as a result, developed physical and psychological dependency on them. It is possible that the side effects of the drugs enhanced the PD symptoms and contradicting effects of the medication further taxed his body and mental health. Most PD medication loses its effectiveness over extended use which means either dosages need to be increased or must be replaced by another medication. There are benefits in taking medication to increase dopamine levels in the brain to improve mobility, but excessive use can result in adverse effects. Mr Lojanin experienced numerous side effects of the prescribed drugs such as constipation, nausea, confusion, depression, hallucination and insomnia. Here is a brief list of the daily medication taken:

  • Sinemet Carbidopa 25mg
  • Levodopa 100mg
  • Madopar HBS Levodopa+Benserazide 125mg
  • Seroquel 25mg
  • Sifrol 250mcg
  • Rivotril Clonazepam 0.5mg
  • Neupro 4mg/24h Transdermal Patch
  • Azilect 1mg
  • Valdoxan 25mg
  • PK Merz Amantadine Sulphate 100mg

Currently, Mr Lojanin is trying to reduce his dependency on drugs. His doctor acknowledges that the yoga practices are improving his mobility and cognitive abilities but has not come up with a comprehensive reduction plan. He has stopped taking any sleeping aids and voluntarily stopped taking the anti psychotic drug. Hopefully in the near future, integrative medicine incorporating yogic therapy methods will become the norm so that patients need not feel any conflict regarding different treatments.

Management with yoga

Mr Lojanin reluctantly accompanied his daughter to Divine Yoga Studio to attend a private therapy session with me in August 2016. The first session was indicative of his physical and psychological condition and that the latest drugs could not bring him relief. Although he was only 61 years old at the time, with a lean figure, yet he appeared much older with a hunched posture, slow shuffling gait, trembling limbs and extreme slowness in movement. He had difficulty communicating and talked only with his daughter and did not leave her side.

It was evident he was afraid to try yoga and did not trust me at first. Although private sessions are normally 45 minutes in duration, the first session took over 90 minutes. Much of the first session was spent explaining to him how yoga could help him and that practices were accessible, not impossible circus acts. After much coaxing, he entered the practice room with his daughter. Only simple body movements with my help and a few pranayama practices were possible that day.

I dedicated the first three to four private sessions to giving encouragement to Mr Lojanin by praising his efforts, realizing that mental assistance was necessary for him to regain his confidence in his physical ability and the potential to regain his health through his own efforts. By the fourth private lesson, he was able to sleep at night; a big accomplishment for a person who suffered years of insomnia, despite the use of sleeping aids.

After only ten private sessions, I put him in a beginner's group asana class. These rapid successes he experienced at the initial stage helped him to gain trust in me as a teacher and in yoga. Ever since, Mr Lojanin has become a regular practitioner of yoga and attends my classes approximately 3 to 4 times per week, with remarkable improvements in his posture, mobility, mental clarity, confidence and communication skills. His daughter has also become a regular practitioner, bringing her obvious health benefits and also a sense of relief to see her father physically and mentally stronger and emotionally stable and happy.

Challenges as a teacher

Working with a Parkinson's patient was challenging on physical, mental and emotional levels. When I first met Mr Lojanin, he was showing symptoms of PD late stage 3: rigidity of muscles and joints, tremors, slowness in movement (brady-kinesia), needing assistance in daily tasks, cognitive confusion, insomnia and depression. The initial challenges were mental and emotional. Mr Lojanin felt helpless having lost much of his mobility and having to rely on medication which did not bring complete relief from his PD symptoms. I employed positive verbal reinforcement to empower his confidence, strengthen his will and to gain his trust. The trust between the teacher and student is especially crucial in this type of rehabilitation when a teacher must ask of the student to persevere to do practices which appear difficult at first. The key is to make him want to practise.

The physical challenges were daunting. The PD rigidity was advancing, making it difficult for him to even walk into the classroom. In the beginning, the simplest asanas were tough for him. I had to physically manipulate him and move his body in order to stretch his muscles and loosen his joints. It was also difficult to ascertain how much of his physical symptoms were induced by the side effects of the drugs and how much of it by the actual disease.

Another challenge was to bridge the difference in healing methods between conventional medicine and yoga so that Mr Lojanin could understand how yoga and aspects of conventional medicine could jointly improve the quality of his life. As he experienced the improvement of his mobility, mental clarity and a hopeful outlook on his life through yoga, he began to realize that he need not be completely dependent on the drugs and began to reduce the medication by consulting his doctor.

Management of Parkinson's disease through yoga

I have incorporated the following traditional Bihar Yoga practices as well as non-traditional practices in managing and improving the PD patient's overall well being. Simple and clear instructions should accompany the practices to remind the student to practise with awareness, correct approach and a positive attitude (the 3As). Without awareness, asanas will be merely exercise and pranayama, only automatic breathing. Relaxation of the body and mind is given primary importance in order to loosen the joints and muscles so that healing could begin.

Pawanmuktasana series (PM 1 & 2)) are yogic asana practices allowing practitioners of all physical abilities to benefit from its healing properties by improving elasticity of muscles in the area of focus and thus promoting healthy circulation of blood and energy.

PM 1 is a sequence of anti-rheumatic asanas to remove stiffness from the joints through rotational movements. Co-ordination between bones, muscles, joints and ligaments improves so that they work naturally and spontaneously. Problems in the knee joints, hip joints, ankle joints, shoulder joints and wrist joints can all be remedied by these asanas, which minimize the injuries of different joints. PD patients with stiff muscles and joints would particularly benefit from these asanas.

PM 2 is a sequence of anti-gastric asanas focusing on strengthening the abdominal muscles and organs and builds stamina. They improve the digestive system, which is important for the proper functioning of other systems of the body. PD patients suffer fatigue and thus building stamina is crucial for them. I combine practices from PM 3 including crow walking to strengthen the lower body.

Selected sequence of standing, stretching and spinal bending postures, which are physically accessible, gives elasticity to the muscles and the organs.

Backward bending and spinal movements: Marjariasana, tiger pose, and cobra and bow poses were practised initially. Once the student's body was little flexible, camel pose and standing backward bending were introduced. Before star ting to teach surya namaskara, three poses consisting of parvatasana, ashtanga namaskara and cobra are practised to give him more strength and confidence. This sequence and combination is particularly effective.

Balancing pose: It was almost impossible for him to do any balancing pose at first. The wall or my physical assistance was given as support to manage the balance pose. After 2 or 3 months, he began trying the pose on his own and was able to do so with ease. Verbal encouragement was also effective in motivating him to achieve the poses. In time, he was doing almost all groups of asanas correctly and with awareness.

Nadi shodhana, alternate nostril breathing: It gives deep relaxation which is much needed by PD patients to relax their stiffened bodies. I use breathing separately like 10 breaths from only left nostril, 10 breaths from right nostril and then alternate nostril breathing.

Swana pranayama, dog panting breath: This energizing breathing practice builds the immune system and vitalizes the fatigued body. I feel swana pranayama is more effective than kapalbhati and other heating pranayama. This helps to throw out suppressed emotion and fear and gives more confidence and alertness. On occasion, I also teach bhastrika and kapalbhati.

Simhagarjanasana, roaring lion pose: Stimulates and stretches the muscles in the throat which is important for PD patients facing difficulty in speaking. Throws out fear and builds confidence. Co-ordinated breathing with physical movement: Inhalation from the nose and forceful exhalation from the mouth.

Neti: I taught him neti but he is not doing it every day. Currently, he practises it 2 to 3 times per month.

Yoga nidra: A short yoga nidra practice is effective in relaxing his stiff body and giving him physical and mental relaxation. Most PD patients suffer from insomnia so the inclusion of yoga nidra is important. Mr Lojanin often will start snoring after just 5 minutes of the practice. Once he starts feeling relaxed and fearless he can sleep well and feel fresh.

Ideally, these practices should be done daily. However, even though Mr Lojanin cannot come to class every day due to time and transportation restraints, he is making visible progress. Now he is doing yoga classes 4 to 5 days per week and I ask him to do some breathing practices, at least nadi shodhana, at home.

Effects of yoga on Mr Lojanin

It has not even been twelve months since Mr Lojanin began practising yoga but his transformation is apparent. He looks much younger than when I first met him. He now has an upright posture, a smile on his face and a bounce to his steps. He carries and places his own yoga mat and even does it for his daughter. He completes an hour group class with focus and determination and has become an inspiration to other yoga members, young and old alike. He has become very sociable and often engages in humorous conversation with fellow classmates. All of these achievements were unimaginable last year.

When asked what he has learned through yoga, he replied, 'Yoga defies what conventional medicine teaches us. I know now that yoga helps me to relax my body and mind. When I am relaxed, I can heal myself and the medicine works more efficiently. I am confident again and will not be scared anymore. I am trying to reduce my medication now. It is difficult at first but I try to distract my mind from the fear of not taking medicine and try to relax. Mr Lojanin's resolve to practise yoga has reaped great results. On days when his medication dosage is reduced, his mobility has a temporary setback but he never gives up. His horizons are expanding again and he is living his life to the full , enjoying social and business events and looking forward to an upcoming family holiday abroad.

Note

Now Mr Lojanin looks and behaves normal and is active in his daily life with more energy and confidence, but sometimes when medicine taking time comes he starts feeling some change in his body. His body starts shaking and he feels mentally disturbed. After 10–15 minutes, he starts becoming normal.