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Yoga therapeutics in neurologic physical therapy: Application to a patient with Parkinson's disease

Neurology Report, Jun 2001 by Taylor, Matthew

ABSTRACT

Yoga therapeutics may have the potential to complement neurologic physical therapy. In this paper, the principles of the yogic health model and yoga therapeutics are described. Fundamental themes of yoga therapeutics that are germane to clinical interventions, a list of resources, and some practical elements for immediate clinical implementation are offered for consideration. A case study involving a patient with Parkinson's disease illustrates the clinical thought process used in applying yoga therapeutics to examination, intervention, evaluation, and outcomes.

INTRODUCTION

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As the physical therapy profession considers its response to the many complementary medicine practices, it is important to have a balance of openness to possibilities with analytic scrutiny. The incorporation of the conceptual framework as well as the elements of yoga therapeutics into neurologic physical therapy may serve as complements to our current practice. Yoga therapeutics offers a highly refined, specifically delineated practice for affecting human behavior primarily through the integration of the central nervous system with the entire human experience. While yoga therapeutic principles and interventions have been presented and adopted at major rehabilitation clinics and hospitals across the country, little is written to describe these practices and their outcomes. In this paper we will describe yoga and yoga therapeutics as well as illustrate the application of yoga therapeutics in the management of a patient with Parkinson's Disease (PD).

THE YOGA HEALTH MODEL

The term yoga is derived from the Sanskrit verb 'yuj,' meaning to yoke or unite, often referring to uniting the body, mind, and spirit. Feuerstein's review of the term 'yoga' states that technically it refers to that enormous body of precepts, attitudes, techniques, and spiritual values that have been developed in India for over 5000 years.1 The western focus on yoga to date has been on the physical and measurable health benefits that result from a prolonged practice of this tradition. The postures (asanas), chanting, and meditation represent only a small portion of what is described as a psychospiritual technology. A full, traditional yoga practice as listed in Table 1 consists of 8 paths or spokes on a wheel to attaining one's maximum potential. These paths include moral restraints, personal behavioral observances, postures, regulation of the breath, drawing the senses inward, concentration, and meditation. The focus of this article will be on asana and pranayama because of their more direct application by a physical therapist to clinical intervention. It is important to note that all 6 remaining paths are taught as part of a yoga therapy curriculum. The goal of a yoga practice is to attain a clear, fully actualized and integrated human being.2

Over time, a regular, disciplined practice of yoga results in increased strength, balance, stamina, flexibility, and relaxation.3-6 These are all manifested as optimal psychomotor functions. Simple body movements done with mindfulness or attention (asanas) achieve the outcomes without pain or extremes of range of motion. Yoga as a life science philosophy also makes no statement about any specific religious practice or spiritual belief, and can be used to support all major faith traditions.

In this paper, yoga therapeutics will be defined as the application of yoga for health benefits. Yoga therapeutics is practiced by yoga professionals. This group is currently in the process of creating a national registry with the responsibility of credentialing practitioners. Requirements for credentialing are presented later in the paper. Presently a yoga therapist is a yoga teacher who instructs individuals with health concerns. It is important to note that the role of the teacher in yoga therapeutics is to create an environment where the student (as the patient is called) develops awareness to facilitate his or her own innate healing, rather than being the active therapeutic agent.7

Yoga therapy is a philosophical model of health based on the whole human experience. As such, it is a tool in bridging the historical parts paradigm to the frequently marketed wholistic model of human movement. The yoga model of health includes all dimensions of the patient's human experience and traces back c. 3000-4000 years to the Taittiriya-- Upanishad, which suggests the Vedanta doctrine of the sheaths or koshas.1 Koshas, or bodies, as they are sometimes described, are listed in Table 2. Koshas denote allegorical layers or envelopes of reality within the realm of the human experience. This model was developed in an Eastern culture that used concrete images (bodies, sheaths, etc.) to describe what was understood to actually be an interwoven, indivisible whole, or in western terminology, quantum reality. Historically the koshas were condensed 2000 years ago into 3 similar categories known as shariras (bodies) described as the physical, subtle, and causal bodies. Beneath the Sanskrit name of the koshas in Table 1 are listed the modern equivalent of today's terminology of "Body, Mind and Spirit" for wholistic care. Reviewing the description column, it is apparent that koshas are progressively subtler to perceive moving from the lower or physical to the higher or spiritual level.

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Yoga therapeutics in neurologic physical therapy: Application to a patient with Parkinson's disease

Neurology Report, Jun 2001 by Taylor, Matthew

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