Transcript Yoga Therapy for Neurological disorders

Naveen K.V Ph.D.,
Swami Vivekananda Yoga University
Bangalore, India
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Derived from the Latin word
"rehabilitare" meaning to make fit
again.
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CAN THE BRAIN CHANGE ?
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GENETIC (Nature)
EXPERIENCE (Nurture)
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Birth
15 months
2-3 years
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Nutrition
Environmental stimulation
Learning
Social contact
…… & Yoga
( which includes all the above)
1.
Yogah cittavrtti nirodah
Yoga is the process of gaining mastery over mental
modifications
Patanjali’s Yoga Sutras 1:2
2.
Manah prasamanopayah yogah ityabidheeyate
Yoga is the skill to calm the mind
Yoga Vasista
3.
Samatvam yoga uchyate
Yoga is equilibrium
Bhagavadgita
general pain,
back and neck pain,
carpal tunnel syndrome,
headaches,
fibromyalgia,
multiple sclerosis,
epilepsy,
muscular dysfunction,
stroke,
Parkinson disease, and
attention deficit-hyperactivity disorder
Neurology. 2008 ; 70(24): 2321-8.
Yoga Therapy as an evidence based science in
the management of:
1. Multiple Sclerosis
2. ALZHEIMER’S Disease
3. Epilepsy
4. Parkinson’s Disease
5. Stroke
6. Carpal Tunnel Syndrome
7. Chronic Pain
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An auto-immune mediated progressive
demyelinating disease of the CNS
The myelin sheath is destroyed and
replaced by sclerotic tissue (sclerosis)
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CAUSE- unknown
Multiple factors- viral infection,
environmental factors, geographic location
and genetic predisposition
Common in WOMEN ages 20-40
PATHOPHYSIOLOGY
 Sensitized T cells will enter the brain and
promote antibody production that damages
the myelin sheath
 Plaques of sclerotic tissues appear on the
demyelinated axons interrupting the neuronal
transmission
PATHOPHYSIOLOGY
 The most common areas affected are
 Optic nerves and chiasm
 Cerebrum
 Cerebellum
 Spinal cord
CLINICAL MANIFESTATIONS
 1. Visual problems such as diplopia, blurred
vision and nystagmus
 2. Motor dysfunction
 3. Fatigue
 4. Psychological problems like mood swings,
depression
 5. Spasticity
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DIAGNOSTIC TESTS
1. MRI- primary diagnostic study
2. CSF Immunoglobulin G
Nine review articles and two original studies
Six months of IyengarYoga improved the symptoms
of fatigue (1)
 Three months of integrated yoga module reduced
muscular rigidity (2)
 A specialized yoga module for the elderly has
improved gait, balance and mobility in a geriatric
population (3, 4)
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Neurology. 2004 Jun 8;62(11):2058-64
Proceedings of API. 1999; 29-30
Med Sci Monit. 2007 Dec;13(12):LE19-20.
Arch Phys Med Rehabil. 2005 Sep;86(9):1830-7
Yoga Interventions
1.
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Promote physical mobility
Sukshma Vyayama,
Breathing exercises
Asanas with support
Schedule activity and rest periods
Yoga Interventions
2. Prevent injuries
 Improve the gait and Balance
 Wide stance walking
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The Practices
Baddha Konasana strech (assisted)
Pavanamukthasana kriya (assisted)
3. Enhance bladder and bowel control
 Set a voiding schedule
 Adequate fluids, dietary fibers and bowel
training program
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Yoga practices:
Satvic Diet
Yoga kriyas (gaining voluntary control over
involuntary functions)
4. Manage speech and swallowing difficulties
 Speech therapy &
 Carefully feeding
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Yoga practices:
Chanting (nadanusandhana)
5. Improve Sensory and Cognitive function
 For diplopia
 Offer emotional support by involving the
family in the care
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Yoga practices
Trataka
Pranayama
Bhakthi yoga
Philosophy of yoga
6. Strengthen coping mechanism
 Alleviate the stress
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Yoga Practices:
Chanting
 Meditation
 Relaxation techniques
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A progressive neurologic disorder that
affects the brain resulting in cognitive
impairments
CAUSES:
 Unknown
 Potential factors- Amyloid plaques in the
brain, Oxidative stress, neurochemical
deficiencies
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CLINCAL MANIFESTATIONS
1. Forgetfulness
2. Recent memory loss
3. Difficulty learning
4. Deterioration in personal hygiene
5. Inability to concentrate
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LATE CLINICAL MANIFESTATIONS
6. Difficulty in abstract thinking
7. Difficulty communicating
8. Severe deterioration in memory, language
and motor function
9. Repetitive action- perseveration
10. Personality changes
DIAGNOSTIC TEST
 Neurologic examination
 PET scan
 EEG, CT and MRI
 Other tests to rule out Vit B deficiencies and
hypothyroidism
 Autopsy is the most definitive
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Physical activity and enhanced fitness to
improve cognitive function in older people
without known cognitive impairment
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Cochrane Database Syst Rev. 2008 Apr
16;(2):CD005381
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Sahaja yoga improves neurocognitive
functions in patients with major depression 1
Pranayama improves verbal and spatial
memory scores 2
Combination of aerobic exercises and yoga
improved cognitive and psychological
functioning in the elderly 3
1. Psychol Rep. 1997 Oct;81(2):555-61
2. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83
3. J Gerontol. 1991 Nov;46(6):P352-61
Yoga Interventions aims at improving:
1. Physical well being
2. Cognitive functioning
3. Communication skills
1. Physical well being: improve mobility
 Passive sukshma vyayama
 Simple asanas in sitting (with props)
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Group practice
2. Cognitive functioning
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Nadanusandhana
Pranayama
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Supported by physical activities
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3. Establish an effective communication system
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Use simple sentences, words and gestures
Use of Mudras,
Chanting syllables
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A slowly progressing neurologic movement
disorder
The degenerative idiopathic form is the
most common form
CAUSATIVE FACTORS: unknown
 Potential factors: genetics, atherosclerosis,
oxidative stress, viral infection, head
trauma and environmental factors
Pathophysiology
 Decreased levels of dopamine due to
destruction of pigmented neuronal cells in
the substantia nigra in the basal ganglia
 Clinical symptoms do not appear until 60% of
the neurons have disappeared
CLINICAL MANIFESTATIONS
 1. Tremor- resting, pill-rolling
 2. Rigidity- cog-wheel, lead-pipe
 3. Bradykinesia- abnormally slow movement
 4. Dementia, depression, sleep disturbances and
hallucinations
 5. excessive sweating, paroxysmal flushing,
orthostatic hypotension
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Forced exercise improves manual dexterity
and other motor functions (1)
Exercise can influence the reduced balance
and leg muscle strength and freezing of gait
and hence prevent falls in PD patients (2)
Taichi improved balance and mobility (3)
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Neurorehabil Neural Repair. 2009 (ahead of print)
BMC Neurol. 2009 Jan 22;9:4
Gait Posture. 2008 Oct;28(3):456-60
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Yoga Intervention
1. Improve mobility
2. Improve Motor skills and enhance Self- care
activities
3. Improving communication skills
4. Adopting coping strategies
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Yoga Intervention
1. Improve mobility
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 Assisted balancing postures
 Lower limb and hip strengthening practices
▪ Uattana padasana, vakrasana (modified), lumbar
stretch, cycling in supine
 Attention and concentration
▪ Pranayama and chanting
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Improve Motor skills and enhance Self- care
activities
 Sukshma vyayama – shakthi vikasaka practices
 Mudras
 Pranayama
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Improving communication skills And Coping
strategies
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Breathing and awareness
Cyclic meditation (modified)
Relaxation techniques
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A group of syndromes characterized by recurring
seizures
CAUSES
1. idiopathic
6. brain tumors
2. Birth trauma
7. head Injury
3. perinatal infection
8. metabolic disorders
4. infectious disease 9. CVA
5. ingestion of toxins
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Recurring seizures may be classified as
GENERALIZED or PARTIAL SEIZURES
Generalized Seizures- cause a generalized
electrical abnormality within the brain
Partial seizures- these seizures arise from a
localized part of the brain and cause specific
symptoms
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1. General Tonic-Clonic seizure- (Grand mal)
characterized by loss of consciousness and
alternating movements of the extremities
2. Absence Seizure (Petit mal)- common in
children, begins with a brief change in the
LOC, indicated by blinking, rolling of eyes and
blank stares
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3. Myoclonic seizure- characterized by brief,
involuntary muscular jerks of body
extremities
4. Akinetic seizure- general loss of postural
tone and a temporary loss of consciousnessa drop attack
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1. Simple partial seizure- typically limited to
one cerebral hemisphere
2. Complex partial seizure- begins with an
aura, then with impaired consciousness, with
purposeless behaviors like lip-smacking,
chewing movements
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DIAGNOSTIC TESTS
1. EEG
2. CT
3. MRI
4. LP
5. Angiography
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Yoga a commonly used CAM in the management of epilepsy (1)
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yoga meditation protocol (YMP) was useful as an adjunctive
treatment in patients with drug-resistant chronic epilepsy (2)
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Studies on sahaja yoga and epilepsy - reduced level of stress
and seizure frequency (3)
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10 weeks yoga program modulated the autonomic balance and
reduced seizure frequency (4)
1. Curr Neurol Neurosci Rep. 2006 Jul;6(4):347-53
2. J Altern Complement Med. 2006 May;12(4):367-71
3. Appl Psychophysiol Biofeedback. 2000 Mar;25(1):1-12
4. Epilepsy Behav. 2008 Feb;12(2):245-52
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Yoga Intervention
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Ability to manage triggering stimuli
Stress management and
Coping strategies
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Managing a triggering stimuli
 Meditation and pranayam – helps de-focussing
 Strategies such as attend and ignore would
facilitate
 Pratyahara the best tool in yoga
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Stress management and coping strategies
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Regular integrated yoga practice
Asanas, Pranayama, Meditation, Kriyas and
Relaxation techniques
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A Rapidly developing loss of brain function(s)
due to a disturbance in the blood supply to
the brain.
CAUSATIVE FACTORS:
This can be due to ischemia (lack of blood
supply) caused by thrombosis or embolism or
due to a hemorrhage
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Modifiable risk factors
 Advanced age,
 Hypertension (high blood pressure),
 Previous stroke or transient ischemic attack (TIA),
 Diabetes,
 High cholesterol,
 Cigarette smoking and
 Atrial fibrillation
Symptoms
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Early recognition: Sudden-onset of face weakness, arm drift, and
abnormal speech
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Based on the area of the brain affected:
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Hemiplegia and muscle weakness of the face
Numbness
Reduction in sensory or vibratory sensation
Trouble walking
Altered movement coordination
Vertigo and or disequilibrium
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Associated symptoms:
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Loss of consciousness,
headache, and vomiting
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Pathophysiology
 loss of blood supply to part of the brain, initiating
the ischemic cascade
 Infarction of the affected brain tissue
 Brain tissue ceases to function
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Diagnostic tools
 neurological examination,
 CT scans (most often without contrast
enhancements) or
 MRI scans,
 Doppler ultrasound, and
 arteriography
A slice of brain from the autopsy
of a person who suffered an acute
middle cerebral artery (MCA)
stroke
CT scan showing an
intracerebral hemorrhage
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Kundalini yoga practice of 12 weeks showed an
improvement in aphasia as well as in fine motor
coordination in stroke patients (1)
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A Yoga-based exercise program was beneficial in
people with chronic poststroke hemiparesis (2)
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Top Stroke Rehabil. 2007 Jul-Aug;14(4):1-8
Phys Ther. 2004 Jan;84(1):33-48
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Offers variety of techniques to work at
different levels viz.
 Physical
 Mental
 Social
 Emotional
 Spiritual
Hence a comprehensive package
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involves the interaction between
 yoga therapy physician,
 therapist (PT),
 patients/clients,
 other health professionals,
 families,
 care givers, and
 communities
Hence Yoga Therapy offers a Holistic Healing
Experience