classes because they feel embarrassed when they can’t manage the posture, or they ‘freeze’ or shake, and yet with a little tact and sensitivity we can offer a different way and give that person a sense of achievement and belonging with the added benefit of increasing their quality of life. And it is a similar scenario for those with multiple sclerosis (MS).
Chapter 1
My Experience
Quite early in my life I began to see the impact that Parkinson’s disease could have on someone’s life. First, with an uncle, whose movements were slow and curious to me as a child, but who always looked solemn, and later on, another very dear relative, who, on retiring from a busy and stressful job, was diagnosed with the disease. This changed his sociability, his powers of communication and his enthusiasm for life. I was already into yoga at that time and we discussed how it might help him, and so, encouraged by his wife, he began a daily regime of postures and breathing (Asana and Pranayama). This helped him to stay reasonably mobile and active despite the disease.
So when I was asked to take on a group that had been running for some years for people with Parkinson’s disease, I accepted to see what more I could do. This has become an interesting and enjoyable session with lovely caring people, so supportive of one another, and the highlight of my week. They have taught me about the disease, how its symptoms are managed, and how differently it affects people; they have shown me what can and can’t be done, and what can be achieved by focus and mental application.
Many years ago I was offered work as a yoga teacher within a psychiatric unit at my local general hospital. Having had little hands-on experience in this area as a specialism, I fell back on my basic yoga training, which fortunately was broad and based on a ‘yoga for health’ model. I stayed in this post for ten years or more, and learned much. This led me to work with a special needs group at my local college, a group of very mixed students – two were in wheelchairs, others with mental illnesses, and some with limited physical mobility after experiencing road accidents. This gave me experience beyond my official training.
My work with people with multiple sclerosis (MS) has been largely on a one-to-one basis, as each individual can be at a very different stage of the disease, from wheelchair-bound to able-bodied. I was always on the lookout for new ways that I could offer yoga to assist these students, carefully watching them to see how they responded and which approaches worked. I was thirsty for knowledge, and I still am.
I hope that this book will encourage yoga teachers to work with groups like this. Far from being limited and mundane in yoga practice, they are rewarding and inspiring, a fertile learning ground for all involved.
To some, all yoga is therapeutic. It is possible to bring about positive change using a general yoga teaching approach, adapting postures and offering a class that includes breathing and relaxation. A good, inclusive yoga teaching qualification will give a teacher adequate skills to offer this.
My message here is that Yoga Therapy training is extremely useful but would have given only some of the understanding that I have gained through practical, therapeutic experience. But do not dismiss the good that can be done with the basics, common sense, applying Ahimsa (doing no harm) and having a curious and inventive mind.
I added to my yoga teaching skills by studying further, with training in a psychophysical therapy, Postural Integration, which is akin to Rolfing and Emotional Therapy. This reinforced my belief and understanding that body and mind are one, and that working on the physical can bring about transformation in the mental and emotional fields, a belief, for me, supported by the yoga Pancha kosha model. I have developed many of my subtle energy techniques by blending these approaches together. What I knew to be effective in the body-mind model is now being proven and explored as neuroception and interoception, in the field of neuroscience. The outcomes of my work have come not from research (and I am not a medic); they have come from my hands-on experience with people, over many years.
Yoga Therapy helps us to understand the depth of the individual condition. While seeking therapy for one thing – Parkinson’s, for example – what is often revealed is another underlying issue. This may be a belief, a state of being, and we may find that this underpins everything else. A karmic pattern may be revealed. We seldom get to this in a group situation, but in one-to-one work there is the opportunity to go below the surface, if the student is ready.
It is easy to get distracted by the need within ourselves as teachers to see measurable improvements. We want to see better balance, improved stability. We want to offer the dream of this condition not getting any worse. But let us not forget the goal of yoga – peace of mind, inner stillness, or even enlightenment.
I sometimes modify these goals with a modern psychotherapeutic approach, ‘to be the best I can be, with all my faults, quirks and health conditions’ today. It is known that if we can improve breathing, relax and stay mobile, the organism is less likely to fall into a cycle of illness and added health complications.
Both Parkinson’s and MS are not going to go away for those with the diagnosis. It may incur fear, anger and despair, and these may continue as the disease process takes away the person’s normality. Many come to a place of acceptance – not that other emotions stop (we never stop feeling), but adjustments are made, and building from a new place, a new way of being begins. What does not change is the inner being, and maintaining this connection is what yoga does best.
What is Parkinson’s disease?
One person in every 500 has Parkinson’s. That’s about 127,000 people in the UK.
Most people who get Parkinson’s are aged 50 or over but younger people can get it too. (Parkinson’s UK)
Parkinson’s is a progressive neurological condition, where the cells that produce the chemical dopamine cease to function and die. Dopamine enables nerve messages to be transmitted from the brain to the muscle. Interruption in its flow means that the message doesn’t get through properly, causing dysfunction in muscle control and mobility, which sometimes results in the classic Parkinson’s symptoms – tremors, a shuffling walk and lack of facial expression. Other symptoms are rigidity, muscle spasm and ‘freezing’. People also find that they may suffer from tiredness, pain, depression and constipation. As well as the physical problems caused by motor activity, the area of the brain responsible for motor activity is also responsible for mood, so people with Parkinson’s are susceptible to anxiety and may also be depressed. The disease process and the speed of its progression are different for everyone, but these should all be taken into account when planning a yoga programme.
Treatment of Parkinson’s disease
There is currently no cure for Parkinson’s, and the cause is not known. It is managed by a drug regime, occasionally surgery and other supportive therapies. Drug treatments aim to increase the level of dopamine that reaches the brain, and to stimulate the parts of the brain where dopamine works. There are many different drugs prescribed for Parkinson’s, and it is helpful for a yoga therapist to understand how these work, and how they may affect behaviour, muscle control and energy levels.
Levodopa is the main drug treatment for Parkinson’s, and in the UK these are Madopar and Sinemet® (it may be prescribed under different names in different countries); the body changes this drug into dopamine. It is important to consider the side effects when looking to plan Yoga Therapy, as the following may be reported:
•confusion
•hallucinations and delusions
•mood swings
•psychological changes
•sleepiness, fainting or dizziness.
If students report these, advise them to refer to their specialist nurse.
There are many other drugs that supplement the activity of dopamine, either damping down the motor responses that cause tremors, by boosting the uptake of dopamine, or slowly releasing dopamine into the system. Deep brain stimulation is being used more frequently for those for whom dyskinesis (severe trembling) is a growing problem during their ‘off’ times. According to Parkinson’s