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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To address the lack of pelvic mobility (1st/2nd kosha) she then was instructed in a seated, cross-legged cat/camel with flexion of the trunk at the hips (see Figure 3). The right side was well tolerated, though on the left she could barely cross left over right and was directed to limit movement within a comfortable range. This was followed by a seated twist (see Figure 4), in which she placed one hand behind her and the opposite hand on the knee toward which she was turning. On the inhalation she lengthened the spine in camel, and upon exhalation maintained that height while turning a body segment in that direction. Internal attention was maintained by having her focus with each breath on different body segments during rotation to include shoulder, navel, heart, and chin. The twist was repeated to the opposite side with the intention of reintegrating awareness of scapular and thoracic mobility. She was then instructed in what was known as lion pose (4th/5th kosha) (see Figure 5), in which she abducted and externally rotated both upper extremities to 90/90 at the elbows and shoulders while opening her hands and spreading fingers to bear her claws. This is accompanied by opening the eyes and mouth as wide as possible while sticking out the tongue and roaring on the exhalation. She reported significant proprioceptive feedback from the entire oral-facial complex after 10 breaths reported sensing the need for the ferocity of the pose in meeting her daily challenges with PD. The final exercise was a hook lying, supine supported fish pose as in Figure 6. Rolling a small blanket into a cylinder 3 inches in diameter, she was instructed to breathe fully as she lay on the cylinder with support from sacrum to occiput to work passively against the forward head posture, as well expand the excursion of movement associated with the breath. She reported this posture as uncomfortable, and limited the exercise to only 1 of the requested 3 minutes. She was instructed to attempt a gradual increase in endurance, but only within her level of comfort. She was given written instructions and told to perform the exercises daily. Follow-up was set for 3 weeks with the opportunity to call with questions.

Outcomes: Patient's Report: Upon follow-up she noted increased awareness of how small her breath was most of the time (2nd kosha). Found the breath to be comforting and relaxing (3rd-5th kosha). She related significant improvement in vocal projection and facial awareness (4th kosha). While verbalizing some frustration about limited exercise time, she related immediate benefit postexercise and an intuitive sense that this type of movement was more natural and functional than the parts-type therapeutic exercises of the past. She noted the emotional effect the lion pose had on adapting that spirit when faced with the daily challenge of PD (5th kosha). Her gait felt more efficient (1st kosha) she had, however not been shopping to test her endurance. She incorporated the breath work at night when sleep was difficult and found it both comforting and restorative (3rd & 5th kosha).