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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Returning to the student with hemiplegia, the YT would initially confirm or establish a diaphragmatic breath, utilizing the student's voluntary ability to regulate the normally autonomic function of respiration. Once mastered, this breath would be incorporated into and synchronized with all movement. The reader is referred to Light on Pranayama in which advanced breathing techniques that have unilateral emphasis for hemispheric integration, energizing effects for the despondent student, or deeper relaxation effects for the agitated or angry student are described." These techniques would be instructed as home activities to be practiced daily, as well as on demand when the student becomes aware of imbalance in any of the koshas during activities of daily living (ADLS).

Asana is the other tool of the YT that shares much in common with physical therapy therapeutic exercise. Asana has been defined as a postural pattern created by deviating the head and trunk from the center of gravity and having the pattern maintained purposefully for a length of time. These patterns are prescribed and ideally performed using a minimum amount of voluntary effort and a minimum expenditure of energy for its maintenance and adjustment. True asana is classically described as having the qualities of stability (sthira), ease (sukha),1,11 and effortlessness or minimized effort (prayant shaithilya). The YT has thousands of asana to choose from in order to create an environment of mindfulness and kosha awareness.

An asana postural pattern is initiated slowly and with attention to internal sensation and breath. It is maintained for varying lengths of time and is released in a smooth and effortless manner. An asana is not an artificially held or braced 'posture' or a 'pose.' An EMG study revealed that when an asana is performed isometrically, there is a 30% increase in heart rate over the initial resting rate compared to only a 6% increase over resting rate when practiced effortlessly and with full awareness as described in yoga.5

From the yoga therapeutic perspective asana is an attitude that is psycho-physiological in nature where state of mind or mindfulness is of the utmost importance, hence linking the physical position with the higher koshas. Every asana is purported to have an effect on each of the 5 koshas. The YT utilizes this understanding to facilitate balance based on the assessed imbalances. Since yoga is unique as an experiential philosophy meaning, "do not believe what is postulated, rather experience it." We suggest you try the following: sit in a deep forward head sitting posture for 10 breaths and sense the joy and enthusiasm of the asana. Now contrast that with upright, heart open, and arms spread wide overhead, face soft... feel the attitudinal difference? Every asana contains some of those subtle experiences as well as the physiological responses that are discussed below.

The final stage of an asana is achieved through natural sequence of mini-stages challenging the student to progress from midline stability distally, restoring stability and motor sequencing. The YT considers that each mini-stage may create a potential temporary disequilibrium by deviating the position of the center of gravity relative to midline or the base of support. Progressing slowly to insure each mini-stage is mastered through integration of the koshas; the YT advances the asana along a continuum. This continuum is generally from the core, proximal to distal toward the full postural pattern with symmetry along the midline, which have been described as key components of functional movement.12