from an electrical implant in the brain help reduce Parkinson’s symptoms, such as tremor and stiffness. Deep brain stimulation is not a cure, but it can give some people better control of their symptoms. It may help to reduce some movement symptoms of Parkinson’s, such as slowness of movement, stiffness and tremor. It may also mean that someone has to take less medication, which can reduce the risk of side effects, such as involuntary movements (dyskinesia).
In providing Yoga Therapy, the pacing of the drug regime needs to be considered, as this will affect the optimal time when the student will be active. Parkinson’s has daily on/off phases: the terms ‘on/off’ or ‘motor fluctuations’ refer to the period when people can no longer rely on the smooth and even symptom control that their drugs once gave them. Each individual will need to consider this, along with the timing of yoga practice.
Exercise is essential for both quality of life and for maintaining mobility for as long as possible. Swimming, walking, stretching and other physical activities are encouraged. In some areas Conductive Education is offered, a system of integrated education and therapy that can help any child or adult with a neurological movement problem (cerebral palsy is the most common condition treated). It is also useful for genetic disorders and for adults with Parkinson’s, MS, stroke or acquired brain injury.
Parkinson’s UK say that an exercise regime will improve the following:
•walking, sitting down, standing up and turning in bed
•keeping joints flexible and relieving the effects of rigidity
•improving or maintaining muscle strength
•balance training and preventing or managing falls
•pain relief through manual therapy
•maintaining or improving effective breathing.
We can see that yoga can help to meet many of these.
The progress of Parkinson’s disease is measured by the Hoehn and Yahr scale, a system commonly used for describing, in broad terms, how Parkinson’s symptoms progress and the relative level of disability. It was originally published in 1967 in the journal Neurology by Margaret Hoehn and Melvin Yahr, and included stages 1–5. Since then, stage 0 has been added, and stages 1.5 and 2.5 have been proposed and are widely used. The stages are as follows:
•Stage 0: No signs of disease.
•Stage 1: Symptoms on one side only (unilateral).
•Stage 1.5: Symptoms are unilateral and also involve the neck and spine.
•Stage 2: Symptoms are on both sides (bilateral), but there is no impairment of balance.
•Stage 2.5: Mild bilateral symptoms with recovery when the ‘pull’ test is given (the doctor stands behind the person and asks them to maintain their balance when pulled backwards).
•Stage 3: Balance impairment; mild to moderate disease; physically independent.
•Stage 4: Severe disability, but still able to walk or stand unassisted.
•Stage 5: Needing a wheelchair or bedridden unless assisted.
In a clinical setting, however, a more practical evaluation is used based on everyday activities. This asks questions about speech, swallowing, difficulty using utensils, handwriting, difficulty dressing, falling, ‘freezing’, walking, turning in bed, etc.
What is multiple sclerosis?
Multiple sclerosis (MS) is a condition of the central nervous system, involving the immune system. More than 100,000 people in the UK have MS. Symptoms usually start in the twenties and thirties, and it affects almost three times as many women as men. It is a lifelong condition, and the cause is not known. As yet there is no cure, but research is progressing fast.
In MS, the immune system begins to attack a substance called myelin, which protects the nerve fibres in the central nervous system. This damages the myelin and strips it off the nerve fibres, either partially or completely, leaving scars known as lesions or plaques.
This damage disrupts messages travelling along the nerve fibres – they can slow down, become distorted, or not get through at all. As well as myelin loss, there can also sometimes be damage to the actual nerve fibres. It is this nerve damage that causes the increase in disability that can occur over time.
As the central nervous system links everything the body does, many different types of symptoms can appear in MS.
There are several different types of MS. Relapsing-remitting MS is the most common and first stage of the illness. It may be, but is not always, followed some years later by secondary progressive MS, where disability gradually increases. Other types are primary progressive MS, which usually affects people from their mid-forties onwards, and does not have the relapse-remission pattern, and benign MS, where there has been an initial illness with recovery and few symptoms following, although this does not mean that it will not develop.
Treatments for MS include disease-modifying drugs that have an immunomodulating effect. These are often interferon-based and are injected. They work with the immune system in various ways, and often have flu-like side effects that may last 48 hours or so. Various drugs are prescribed to help with symptoms such as tremor, sleep difficulties and tiredness.
Physiotherapy, massage and modifications to diet are also recommended, as well as Yoga Therapy.
MS symptoms include numbness, tingling, loss of muscle strength, paralysis, difficulty balancing and walking, and difficulties with both coordination and dexterity. Spasm and stiffness may be present, and there may also be bladder/bowel problems, speech difficulties and overall mental and physical tension.
There are often accompanying emotional disturbances, depression, anxiety, mood swings frustration and fears. Tiredness is a debilitating problem with this disease.
Comparing Parkinson’s disease and multiple sclerosis
We can see that both Parkinson’s and MS are neurological diseases but have very different causes. Although they affect different age groups, there are similarities in the needs of both groups that can be met through yoga practice. This book may therefore be useful for working with both of these groups as:
•both have mobility and movement issues
•both have spasm, stiffness and balance problems
•in both cases there is disruption to daily life and possible depressive conditions, tiredness, loss of confidence and quality of life.
Cautionary note
As I am not a medical doctor, nor a research scientist, my experience is from directly working with people, and so the practices and methods suggested in this book are to be used alongside orthodox medical treatment, and they should not be used instead of orthodox treatment.
It is always best to refer a student to their specialist nurse or doctor if is there is any doubt as to whether a particular yoga practice would be contraindicated.
How yoga makes a difference
A small survey of our practising groups has shown that for MS, in a range of practices covering joint mobilising, strengthening, stretching, balancing, relaxation, breathing and visualisation, the most helpful, and the one that the students themselves perceived as producing a noticeable beneficial effect, was relaxation, followed by strengthening and breathing practices. All of the students reported feeling energised and well after the sessions. We asked if partners were able to note any differences. Those that reported back commonly said that their partner was calmer, steadier, moving better and sleeping well after yoga practice.
A similar survey of our Parkinson’s students over the same practices – joint mobilising, strengthening, stretching, balancing, breathing relaxation and visualisation – found that stretching and joint mobilising were the practices that they enjoyed and found the most useful. Students reported feeling more mobile and energised after class. Although it was hard for them to identify any specific improvements in their condition, they all reported