Today you are giving yourself and your · breathing techniques to meditation to healthy values....

1

To comply with professional boards/associations standards:• I declare that I (or my family) do not have a financial relationship in any amount, occurring in the last 12 months with a commercial interest whose products or services are discussed in my presentation. Additionally, all planners involved do not have any financial relationship.•Requirements for successful completion are attendance for the full session along with a completed session evaluation.•Vyne Education and all current accreditation statuses does not imply endorsement of any commercial products displayed in conjunction with this activity.

Session 001: Yoga for Therapeutic Rehab

Betsy Shandalov, OTR/L, C‐IAYT, CYKT

Leading the Way in Continuing Education and Professional Development. www.Vyne.com

Betsy Shandalov OTR/L, yogaot.com 3

Today you are giving yourself and your clients a gift

Creative CommonsAttribution‐Share Alike 3.0 Unported

2


Let’s take our 18 hour trip to theEastern Part of the Globe

• We will see how medicine has been practiced in India

• Ayurveda and its role in physical and psychological disease

• History of Ayurveda and Yoga

• Let’s go on a journey of Integrative Medicine


Please put your pens and pencils down and close your eyes, Let’s focus on our breath and enjoy the guided seated

meditation


3

“Healing is every breath”~Thich Nhat Hanh

• Reduce anxiety and depression

• Lower/stabilize blood pressure

• Muscle relaxation

• Decreased feeling of stress

• Brain focuses on breath and relaxation

• Mindful of the mind/body connection

• Change energy levels



East Meets West: Integrating Modern Medicine with Healing Traditions

• Alternative vs. Complementary

• Integrative Health

• NIH name change 2014 from

Center for complementary and

alternative medicine to national

Center for complementary and

integrative health

•Creative Commons Attribution 2.0 Generic


Definition Of Integrative MedicineBravewell Collaborative 2009

• Patient Centered Care and focus on healing the whole person, mind, body and spirit in the context of community

• Educates and empowers people to be active participants in their own care and take responsibility for their health and wellness.

• Integrates the best of Western scientific medicine with a broader understanding of nature of illness, healing and wellness.

• Makes use of all appropriate therapeutic approaches and evidence-based global medical modalities to achieve optimal health and healing.

• Encourages partnerships between the provider and the patient; supports the individualization of care and creates a culture of wellness

4

Duke Integrative Medicine Treatment Area


According to the WHO 2005, Chronic disease is an epidemic

problem internationally

• Switch from the “Medical Model” to “Biopsychosocial Model” This is supported by the World Health Organization

• Medical Model= conventional, traditional, mainstream or Western Medicine

• Biopsychosocial Model=Integrative, complementary, functional, Eastern Medicine

• Dr. Ginger Garner, PT looks at this in her book, Medical Therapeutic Yoga, 2016



What is Ayurveda?

• India’s traditional Vedic natural system of medicine in existence fo 5,000 years old.

• Sanskrit word meaning “the wisdom of life” or “the knowledge of longevity”.

• Fundamental to well being is balance in Body, Mind and Spirit

• Diet modifications, lifestyle adjustments, herbal supplements, cleansing processes

• Links the rhythms of universal elements of earth , fire, air, water and space to individual constitutions called doshas

5


Yoga and Ayurveda:Sister Sciences

•They both use the Sanskrit language and focus on how imbalance in our bodies affects our health

•Affect of Food and Medicine on the Body

•Dr. David Fawley and Sandra Summerfield Kozak, “The interface between self-healing and self-realization is the union between yoga and Ayurveda.” Yoga for Your Body Type: An Ayurvedic Approach to Your Asana Practice

•Constitutions/Doshas: Vata, Pitta and Kapha


What is Yoga?

• (Sanskrit, Pāli: योग yóga) refers to traditional physical and mental disciplines originating in India .

• Has been practiced for thousands of years and literally means the union of body, mind and spirit.

• Yoga is an ancient philosophy and healing system of theory and practice. It is a combination of breathing exercises, physical postures, and meditation that has been practiced for more than 5,000 years.


8 Limbs of Yoga• Yamas: A list of values or personal attitudes to cultivate

• Niyamas: A list of healthy and productive habits to develop

• Asanas: Physical Postures

• Pranayama: Breathing exercises to energize and calm the body

• Pratyahara: The practice of calming and stilling the senses

• Dharana: Focus

• Dhyana: Meditation

• Samadhi: Oneness

6


8 limbs of Yoga

• The Yoga Sutras (sort of the yoga bible) created by Yogi "Patanjali" in the second century C.E. (Common Era), incorporates yoga into life, revealing yoga's true purpose:

• To maximize the potential of the self through the recognition of one's own inner goodness and the inner goodness in all others.

• Patanjali divides the practice of yoga into eight parts, which he calls the Eightfold Path.

• This path consists of eight different aspects of living yoga, from physical exercises to breathing techniques to meditation to healthy values.


Hatha Yoga

• Hatha Yoga is the most popular form practiced in the West. Hatha yoga's aim is to prepare the body for meditation through breathing and physical exercises.

• Hatha yoga emphasizes body-mind wellness through postures or asanas which tone and strengthen our muscles and increase our flexibility.

• The different asanas, particularly the twists and inversions, stimulate internal organs, as well as the nervous system, and promote circulation in all the body's major organs and glands.

• Research has shown that the practice of yoga as a lifestyle enhances overall health and prevents and reverses disease.


Types of Hatha Yoga• Anusara Flow, poses are performed in succession, heart open

• Ashtanga Power

• Bikram “Hot Yoga” Temperature is 26 poses

• Iyengar Alignment using props

• Kundalini Yoga of Awareness, looks at chakra, mantras

• Viniyoga Adapted to fit the individual

• Vinyasa Poses performed in succession

• Yogafit Classes performed in a healthclub

7


Iyengar Yoga

• Known for its use of props, for instance, belts, blocks cushions, benches, and even sand bags, to act as aid when performing asanas.

• You slowly move into a pose, hold it for a minute or so, and then rest for a few breaths before stretching into another. It is this slow pace and emphasis on detail that makes Iyengar yoga ideal for those recovering from an injury be it internal or external.

• For all practical purposes, it is based entirely on the traditional eight limbs of yoga as enumerated by Patanjali in his Yoga Sutras, laying great stress on the development of strength, stamina, flexibility and balance, as well as concentration and meditation.

Iyengar Yoga with Props


Yoga Therapy Adaptations like ViniyogaChair yoga


8


Yoga for our Body “Never too old, never too sick, never too late to do yoga and start from scratch once again.”

Bikram Choudhury

•GNU Free Documentation License

Goal in Yoga is to move Prana

• Sanskrit for life force energy

• Through Breath

• Movement

• Neuroplasticity of our brain


Stress and it’s impact on the body

• Dr. Stephen Porges, PhD, “Polyvagal theory” looks at relationship between our physical state and range of behavior through and psychological experience, “vagal tone”.

• Health Psychologist, Kelly McGonigal, PhD and lecturer at Stanford University, expert on mind-body relationship.


9


Stress

• Stress can also affect posture and breathing.

• Anxiety before an important business presentation can result in shallow breathing and sometimes panic attacks and hyperventilation.


Yoga and the Nervous System

• Kripalu’s Richard Faulds, states, “Yoga relaxes you and by relaxing, heals.”

• “The autonomic nervous system is divided into the sympathetic system which is often identified as the flight or fight response, and the parasympathetic, which is identified with that of theRelaxation Response.

• When you do yoga---The deep breathing, the stretching, the movements that release muscle tension, and the relaxed focus on being present in your body—you initiate a process that turns on the fight-or-flight system off and the Relaxation Response on.

• The dramatic effect for the body is that the heartbeat slows, respiration decreases, blood pressure decreases and then the body can begin to heal.

• Herbert Benson is a Harvard Professor and Director of Mind/Body Medicine at Mass General Hospital talks on “Relaxation Response” We have separated the mind and the body and we need to bring it back.

Anti-Inflamatory neural circuit, the vagasnerve

• Controlled with conscious breathing, yoga and emotional and positive mental frameworks

• Dr. Jared M. Huston work

• Stimulating the Vagas nerve sends acetylcholine (plays a part in learning and memory) throughout the body

• Brings on relaxation, decreases inflammation from stress


10

Vagas Nerve and PNS



Breath is the Bridge to Healing

• Regulate the breath and the body and mind will follow

• Must be taught correctly

• Do everyday

• It is a “Whole Body System”

3 Diaphragms

• Diaphragm and Pelvic Floor Musculature Connection

• Neuro‐education Techniques

• Posture and Alignment and the Pelvic Floor…Hodges and Massery

• Dr. Matthew Taylor, PT, PhD and educating client on the mind, body connection


11


National Center on Physical Activity and Disability (NCPAD), yoga also aids your:

• Digestive system, as the bending, twisting and stretching poses stimulate and massage the digestive system

• Cardiovascular and cardiopulmonary systems (also known as your heart and lungs!), as the more active poses increase heart rate and lung capacity through aerobic activity

• Lymphatic system (essentially, the primary component of your immune system), which needs strong muscles and active interaction among the lungs, diaphragm, and thorax to stay strong

• Skeletal and muscular systems, which benefit from yoga’s focus on proper alignment, flexibility, and muscle-strengthening, increased bone density

Poses can be Restorative or Active

Restorative Active



Types of Yogic Breathing

• Prana= Vital energyayama= Control

• Diaphragmatic breathing (Use for Assessment)

• Ujjayi (Victorious breath)

• Alternate Nostril

• Bhramari (Humming Bee Breath)

• Spinal Breath with increased exhalation

12


Breathing can be done in different Ways

• Diaphragmatic Breathing Seated

• Diaphragmatic Breathing Supine in Savasana

Creative Commons Attribution-Share Alike 2.5 Generic

Assessing Diaphragmatic Breathing

• Start in Supine in Savasana, Corpse pose

• Use blankets, neck, lumbar and knee supports and an eye pillow (if they prefer)

• Where do they initiate their breathing?• Ask the client to inhale for a count of 2 and exhale for a count of 4

(work to 3 and 6)• Place a prompt (eye pillow or a stuffed animal) on their belly and have

them breathe



Abdominal/Core Muscles

• Open up Rib cage

• PNF Diagonals are key

Creative Commons Attribution 3.0 Unported

13

PNF patterns to encourage brain neuroplasticity (scoliosis)



Ujjayi, Darth Vader BreathEnergizing(increase HR Variability)and Calming (increase

Relaxation Response)• In Ujjai breathing, the glottis is partially closed.

• The glottis is that part in the throat area that closes when you swallow, but which is open when you breath.

• When you partially close the glottis while breathing, you can hear a sound resonate from within, as well as feel a flow of air on the palate.

• Inhale through your nose, then open your mouth and exhale slowly, making a “HA” sound

Creative Commons Attribution 2.0 Generic


Nadi Shodhana Alternate NostrilBreathing, Gives Energy, Brain Balancing• To control the flow of breath, one usually begins by using their fingers

to block off one nostril so as to allow the other to flow.

• Then, the fingers are moved so as to block the opposite nostril, and allow the previously blocked nostril to flow. This cycle will be repeated several times. Helps lower BP.

• Close Right nostril with thumb, Inhale through left

nostril, then close it with your ring finger. Open your

your right nostril and exhale slowly through it.

Inhale through Right and close it, open your left and

exhale through it. 3-5 timesCreative Commons Attribution-Share Alike 3.0

14

Kumbhaka PranayamaBreath Retention

• Holding your breath increases pressure inside the lungs and gives them time to expand. Blood travels to heart, brain and muscles are more oxygenated

• Inhale, inflating the lungs as fully as possible, hold breath 10 sec., inhale a little more, then hold it for as long as you can.

• Not reccommended for anxious people, people with heart or lung problems



Bhramari, Bee Breath, Energizing

• Brahmari means the "bee." In this practice the lips are closed, and you gently, smoothly make a sound like a buzzing bee in your throat.

• This simple practice is quite effective in making the breath smooth and allowing the mind to become quiet.

• You can feel the vibration of the sound in the areas of your throat, jaws, and mouth.

• This practice is so straightforward and it can be taught to anyone, regardless of their background. It is best done for 1-2 minutes.

Child’s pose

• Slows down breathing

• Focused and Inward breath


15


How do you think she is breathing?

Creative Commons Attribution 3.0 Unported


Cardiopulmonary System

• Fresh air enters through the mouth and nostrils and moves down the trachea, which branches into two smaller pipes (bronchi), one for each lung.

• Within each lung, the bronchi

branch into smaller and smaller

tubes, known as bronchioles.

Creative Commons Attribution 2.0 Generic


Disorders with Breathing

• COPD

• Asthma

• Cystic Fibrosis

• Breathing and SCI

• ALS

16


Accessory Muscles

• Inspiration

.


Inhalation and Exhalation in Yoga

• On inhalation, the diaphragm muscle contracts, and pulls downward, such that the ribs flare out slightly, and pulls the bottom of the lungs downward to bring in air.

• On exhalation, this releases and the air goes out.

• With the Yoga practice of deep diaphragmatic breathing, the space just below the breast bone, at the upper abdomen pushes in slightly to exhale more completely.

• The chest and abdominal muscles are not used in diaphragmatic breathing.

• Conscious diaphragmatic breathing is extremely relaxing to the autonomic nervous system and is essential preparation for deep meditation.


Yoga and Asthma

• 43 year old female• Asthmatic• Accessory or Chest Breather• Inhalations stronger than Exhalations• Holds breath when stressed and with exercise• Over breathes• Complains of shortness of breath and decreased energy• Mother of 3 young kids• Runner

17


Yoga Treatment

• Supine Diaphragmatic Breathing 4 inhalations and 8 exhalations, (6x) with eye pillow on belly for mindfulness

• Over the Back Tie • Cat/Cow in the Chair• Pre Camel poses• Chest Openers, locust• Shoulderstand• Homework, Mindful rhythmic breathing running errands, walking

and doing any activity.


Belly on an Inhalation in Diaphragmatic Breathing


Belly on Exhalation in Diaphragmatic Breathing

18


Over the Back Tie Training


Beginning Camel Pose

Creative Commons Attribution-Share Alike 3.0 Unported


Locust Pose

Start with just lifting

head shoulders and chest

Then lift head, shoulders chest and legs

19


Full Camel Pose



Inversion of SupportedShoulder stand

• Creates a throat lock

• Gravity can assist diaphragm

• Assist with breathing

• Raises blood supply to thyroid

gland, regulates hormonal

balance, cell’s metabolism

• Centers the body

• Gives mental balance

• Prepares body for Meditation


20



Results with Yoga Therapy

• Personal Practice at home and once a week yoga therapy for 6 weeks

• Has more energy to play sports and be with her kids

• When she becomes stressed she does diaphragmatic breathing and avoids hyperventilating

• When she has an asthmatic attack she knows how to slow and calm her breathing which she feels great to be able to control herself

• Uses her inhaler much less because she is able to do mindful rhythmic breathing with all activity


Breathing Exercises for Children

• Working on longer exhalation

• Increase length of exhaled breath

• “Take 5”

• Blowing out a candle or blowing a dandelion

21


What about yoga therapy for Pain?

• Nocioceptors are sensory neurons (nerve) cells that send electrochemical signals from the body to other neurons in the spinal cord.

• Neurons in the spinal cord send signals up to the relay stations in the brain

• The brain concludes that body tissue is in danger and action is required

• The experience of pain then goes to many parts of the brain


Nervous System and Pain

Nach Oben Picture


Pain Control

• Signals from the body can either be suppressed or amplified

• The central nervous system has it’s own mechanisms for pain control

• They are connected to the autonomic nervous system, the immune system and the emotional systems of the brain.

• These systems can inhibit danger signals from the spinal neurons and inhibit the transfer of the danger messages into and between the brain centers.

Neil Pearson article on Yoga for People with Pain.

International Journal of Yoga Therapy No.18 (2008)

22


Is pain controllable?

If people are stressed and feel out of control in their lives and bodies then they cannot limit the powerful pain inhibitory systems

One study in 2006 used functional MRI’s of the prefrontal cortex which controls (emotion, attention and pain control) to investigate how a sense of control influences the brain’s response to painful stimuli. In the self-controlled scenarios the subjects could stop the intensified stimulus whenever they wanted.

When subjects believed they had no control, they experienced increased pain.


Is pain controllable?

If people are stressed and feel out of control in their lives and bodies then they cannot limit the powerful pain inhibitory systems

One study in 2006 used functional MRI’s of the prefrontal cortex which controls (emotion, attention and pain control) to investigate how a sense of control influences the brain’s response to painful stimuli. In the self-controlled scenarios the subjects could stop the intensified stimulus whenever they wanted.

When subjects believed they had no control, they experienced increased pain.


What activities give us control over our bodies and limit pain?

• Studies show that intervention techniques that could stimulate pain-inhibitory systems and stimulate production and release neurotransmitters and opioids that dampen the experience of pain.

• Meditation and Chanting

• Rhythmic Breathing

• Yoga Postures

23


Yoga Treatment and Pain

• In working with our pain clients we need to really listen and observe

• Begin in savasana or if they cannot focus lying down in quiet have them focus on your voice

• Using pranayama (breath work), where you promote longer and smoother-paced exhalations, use bee breath, or alternate nostril breathing, vibration with chanting

• Body Scan exercise, the client may change positions frequently

• Encourage intention as you practice slow and easy asanas (poses)


The Brain Neuroplasticityand Chronic Pain

• According to Dr. Timothy McCall, Author of Yoga As Medicine

“the modern understanding of the brain is that rather than being a static structure (which is what I was taught in medical school), this organ is constantly remodeling itself, a phenomenon scientists call neuroplasticity.”

• “ Repeated thoughts and actions can rewire your brain, and the more you do something, the stronger those new neural networks become.”

• Walk Backwards and Superbrain Yoga (Master Choa Kok Sui)

• “Almost 2,000 years ago, Patanjali was onto this when he suggested that the key to success in yoga is dedicated, uninterrupted practice over a long period of time. “


Eye and Balance Exercises and Neuroplasticity

• Eyes follow in directions with head still

• After this set, rub the palms together until some warmth is generated

• Gently cup the hands over the eyes ("palming") and relax.

• Do another set of eye exercises. At the last set of exercises, end with palming and gently massage the eyelids with the fingertips, then massaging other areas of the face, neck and shoulders

• Close Eyes and begin to challenge client with balance

• Check out www.brainhighways.com

24


Eye Exercises for Kids

• Begin with Palming or Eye Pillow on Eyes as helps with over stimulation

• Great for clients with Brain Injury for focus and concentration

• Follow a pen with a funny animal/object on top with eyes

• Owl Pose, (Eyes rotate side to side)

• Lion Pose (Eyes bug out and tongue sticks out)


Begin to build strength throughProper Alignment

• Strengthening muscles to support Joints

• Discover imbalances in sides of body and

working to correct them

• With proper placement learn to open

up tight areas and use breath to assistCreative Commons Attribution-Share Alike 2.5 Generic


Tadasana, Mountain Pose

• The basic characteristics of optimal breathing are that it should be diaphragmatic, nasal, deep, smooth, even, and without pause.

• We need to look at age, gender and posture

25


Kyphosis vs. Lordosis

• Kyphosis

• Lordosis

Creative Commons CC0 1.0 Universal Public Domain Dedication

Assessment of Posture


What needs to be lengthened vs. Strengthened/Right Angle at Wall



26

Kyphosis vs. Lordosis in Tx

Kyphosis• Over the back Tie• Consider towel roll to support

down spine• Sidelying breathing work• PNF Patterns• Cat/Cow seated• Beginning Camel• Right Angle at the wall

Lordosis

• Tadasana with block between legs

• Pelvic Tilts with block between thighs

• Bridge

• Tennis ball under foot in standing

• Front and back breathing



Establishing Tadasana• Stand with feet slightly apart• Inhale as you lift your toes• Exhale below your waist as you

spread your toes• Send the energy to the outside of

your feet • You will feel your knee caps lift• Inhale as you draw your

bellybutton into your spine• Lengthen through your spine, lift

your chin slightly as you hug yourshoulder blades to your back

• Release your shoulders from your ears• Inhale above your waist,• Exhale below your waist


Good Seated Posture

27


Shoulder Functional Assessment

• Clavicular, Scapular and humeral ROM

• Raise arm overhead, touch shoulder and bring arm behind back

• Impingement/pain?

• Winging of shoulder blades

• Scapular positioning

• Daily Activities


The Shoulder Joint

• The shoulder joint is made up of three bones, the humerus, the scapula, and the clavicle. The joint itself is very shallow, with the humerus fitting into the scapula (at the glenoid), resembling the fit of a golf ball sitting on a tee.


Several Causes of Shoulder Pain

• Tight Subscapularis that prevents effective scapular ROM

28


Someone with Shoulder Pain and Neck Coming off of the mat


Subscapularis Passive Stretch

• Middle trapezius weak

• Rhomboids weak

• Lower trap Upward Rotates

• Beginning stages of Warrior I

Cobra, locust, shoulder opening and Restorative poses


29


Sub Scapularis Stretch Picture

• Do not perform if you have scapular winging


Cat/Cow Variation 1

• Inhale above your waist. Exhale below your waist. Client is in tabletop position with hips just forward of knees and hands just forward of shoulders. Open up jar to align muscles over joint.


Cat/Cow Variation 2

• As client begins to bend both elbows, ensure that the arms are staying in line with the shoulders and elbows are not bending out to the side. Elbows should be bending back toward the knees. ..

30


Cobra Variation 1

• Have the client start in preparation for Cobra, neck an extension of the spine, elbows bent and palms down on floor at mid-chest level.

• The forearms should be close to the ribs. Ask the client to begin to release both elbows toward the heels to hug the shoulder blades down the back. Melt your heart.


Cobra Variation 2• State “Melt your heart, taking a deep breath in above your waist” as

they lift into Cobra. Inhale into breastbone and exhale, release between shoulder blades.

• The palms are on the floor The client should keep the chin parallel to the floor so as to not overarch the cervical spine.

• Emphasize releasing elbows toward the heels and hug the shoulder blades to the middle back.


Anatomy of Hip Joint• The structure of the hip joint consists of the acetabulum (socket) and

the femoral head (ball). The acetabulum is the socket in the pelvis formed by three innominate bones: the ilium, the ischium and the pubis. The socket faces laterally and also slightly inferiorly and anteriorly.

31


The Pelvic Girdle

• Different from the shoulder girdlebecause it provides stability instead of mobility

• Primary purpose is to carry andtransfer weight from the spine tothe legs

• Stability from back side comes fromexternal rotators, from the inside isare the hip adductors and the outsideare the hip abductors

• Together these muscles bridge the connectionfrom the spine, through the pelvis and onto the femur

Pelvic Floor Muscle Role

• Muscles Support pelvic floor organs

• Urinary and fecal continence

• Aid in sexual performance

• Stabilize connecting joints

• Venous and lymphatic pump for pelvis



Hip Flexors from front

• GNU Free Documentation License

32

Yoga poses can relax musculature or strengthen them



Piriformis Opening with Balls

• Lying on your back, take a rubber ball, (either a tennis ball or a toy ball the size of a hardball), and place under the hip where the piriformis muscle is located.

• Lie on it and gently roll the ball very slowly over the affected area. Perform this exercise for about 3-5 min once a day. If the area is more sensitive the next day, reduce time to 2-3

minutes.


Psoas Muscle

33

Strap Held by therapist can help with posture and open psoas in

Warrior I


Sensory Kid, Not Grounded

• Needs to begin in Child’s pose (turtle)

• Crossing midline, eagle pose

• Superbrain yoga

• Cat/Cow, cobra and down dog

• Give Self a hug

• Body Scan with Flashlight and their energy, shine light on themselves and into the world.


Switch from active/downdog to restorative, turtle


34

End in Restorative Fruit Roll Up



Active vs. Restorative Poses

• Judith Lasater states, “Restorative poses are poses of being rather than doing.”

• Active poses are doing poses they sometime require props but not always. Almost all restorative poses require props for support.

• Both poses focus on the breath but with Restorative poses you are slowing down the nervous system with longer exhalations your body begins to move closer to a meditative state.

• The client stays in the restorative poses for much longer than an active pose.

• Active poses are about centering through movement and breath where as Restorative poses are still and you learn to identify where you hold tension and release it using breath


People with Disabilities Need Props

• Tightness due to Spasms, Spasticity

• Contracture

• Pain and Discomfort

• Weakness or Hypotonicity

35


Nontraditional Props

• Folding chairs

• Wedges from thrift store

• Small bed roll pillows

• Carpet remnants


Active Adaptive Poses in Bed

• Restorative Mountain Brook with Eye Pillow, Diaphragmatic Breathing

• Twist

• Hamstring Opener

• Bridge if strong enough

• Tree Pose on back

• Warrior Pose on back


• Lying on your back, inhale as you lengthen through your right leg and bend your left leg and draw it up and over your right

• Have your arms in a T-position on the floor with palms up as you exhale into your right ribcage, looking over your left shoulder.

• Knees together, preferred to protect back and spine

Twist, with arms in T-position, helps with digestion, Immune System

36


Hamstring opener with strap

Bridge and Tree pose lying down



Virabhadrasana I on side

37


Props most importantly help with elongation of the body

• This elongation assists with the natural relaxation of the body which enables the parasympathetic nervous system to engage and calm the body

• The props minimized spasticity and maximize movement with little effort of the client

• The rib cage is most importantly assisted by props so that these clients can breathe better and gain elongation in their trunk and torso

• Breathing is key; Breathing into the joint (Relaxing)


Downdog on the Ball


Virabhadrasana I in the chair with block to support knee

38


Modified Down Dog


Twist from Chair


2 Person Twist Assist

• Helps pain

• Digestion

• Bowel Programs

39


Straps on wall support downward dog


Restorative Poses and Your Treatment Plan

• Most any yoga class ends in Savasana or Corpse Pose

• In therapeutic yoga we sometimes start and end in Savasana

• My Cancer classes all begin with legs up in a chair in Savasana

• Restorative poses before active poses can help the client set an intention and gain greater control of their body by letting go using their breath for relaxation

• Some clients get better results in their therapy session when they begin with Restorative poses.


Restorative PosesSee Restorative Asana and Treatment Form

• I will let my body flow like water over the gentle cushions. Sappho

40


Restorative Mountain Brook Pose


Wedge and rolled mats for support for legs up the wall


Chair with bolster for Legs Up the Wall

41


The Wall Comes to You!


Set Up for SuptabalasanaSupine Child’s Pose


Settling Client Into the Pose

42


Client finally made it to the poselengthening spine, release low back and neck


Restorative Child’s Pose, Balasana with 3 Bolsters

Supportive Bound Angle


43


Case Study9 Year old girl with Decreased Confidence and

Focus

• Start with centering breathing, “Melt your heart meditation”

• Needs poses that give her confidence and courage

• Needs poses for balance


Warrior I“I am brave”


Warrior II“I am bold”

44


Warrior III“All my power, I can hold”


Case Study32 Year old woman with MS

• Complains of difficulty with balance

• Loves to go on long walks but gets tired easily

• Depression, decreased confidence


Alternate Nostril Breathing Forward Fold

45


Cat/Cow and Supported Half Moon

Supportive Forward Fold



End in Restorative Child’s Pose

46


Types of Props

• Wall

• Chair

• Head Stander

• Bolsters

• Wedges

• Blankets

• Straps

• Blocks


Case Study with 60 year old woman recovering from breast cancer

• She has decreased balance and strength because of meds

• Limited ROM in her left shoulder due to mastectomy and arthritis in knees

• She wants to get stronger and feel “more sure on her feet”

• Start with restorative (supportive bound angle)

Shoulder Openers


47


Wall as a prop for Modified Warrior I


Chair as a Prop for Modified Tree pose and Trikonasana


End in Restorative Child’s Pose

48


Results

• Start in Savasana on floor with legs in chair for every class

• Focus on belly breathing

• Body Scan for Healing

• Hamstring and Hip Openers on the floor

• Move to standing poses using wall or chair for balance and shoulder, hip openers.

• Self directed Healing Guided Meditation at end of session

Documentation• Intake Form: includes Energy Levels, Sleep,

Bowel/Bladder, Diet, Lifestyle, Dosha self-assessment

• Evaluation: 90 min.

• Integrative Medicine home program will include Active and Restorative Asana, diet for that dosha, Mediation or Mindfulness component

• See patient as little as possible with treatment 45 min.

• 15 min. Phone follow-up


Therapeutic Yoga:Evaluation (SOAP) 45 min.

Subjective Intake: PMH, HPI, Pain, Personal Goals for therapy

Objective Intake: Diet, Posture, Movement Patterns, Cognition, Balance, Sensory, Sleep patterns

Postural Assessment Intake: Supine, Seated or Standing, Functional poses, Canadian Occupational Performance Measure (COPM)

Plan: Breath work, Active and Restorative Asanas throughout day


49


Case Study for Group What Poses Are Best and Why?

What Props do you need?

• 60 Year old male with Parkinson’s Disease

• Complains of Slight rigidity with exercise

• Difficulty standing for long periods due to low back pain

• Poor posture and weak abdominals




• 47 year old ambulatory male client

• Mild Brain injury years ago

• Has some balance problems with walking and walks with a cane

• Has slight weakness on right arm, hip and hand




• 70 Year old woman in fair health

• Has Plantar Fasciitis on R foot

• Ankle weakness on L foot

• Chronic smoker with shortness of breath

• Just lost her husband to cancer 1 week ago

50




• 30 Year old woman with Osteogenesis Imperfecta (fragile) bones

• In a power upright wheelchair

• Left hip and groin pain whenever she is in her wheelchair

• Slightly overweight




• 8 Year Old with ADD

• Has a hard time sleeping

• Feels disconnected with friends and family

• Cannot focus in school

• Loves Nature

• Does not feel connected to their body and is not grounded

Yoga Therapy and CPT codes• Neuromuscular re-education, balance, coordination: 97112• Therapeutic Exercise: 97110

• Manual Therapy: 97140

• Therapeutic activity: 97530

• Cognitive training:97532

• Sensory Integration: 97533• Selfcare management training: 97535


51

Yoga Therapy Certification

• Yoga Alliance: (RYT, 200, 500, 800)

• Yoga Kids training: (RYT, 200)

• International Association of Yoga Therapists (IAYT) 200 hour plus 1000 hours from a yoga therapy school certified by IAYT, (C-IAYT).

• Consider Certification from Center for Mind Body Medicine

• Certification in Mindfulness, (MBSR)



• The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper

diet, and in the cause and prevention of disease. • Thomas A. EdisonUS inventor (1847 - 1931)


• When you come to a fork in the road, . . . take it.

• Yogi Berra

52


Taking the Fork in the Road• Integrative Medicine is an overall philosophy of care; it is

primary care par excellence, emphasizing provider-patient relationships, the innate human capacity for healing, individualization of care, and use of a holistic (bio-psycho-social-spiritual) approach.

• IM focuses on prevention, healthy lifestyle choices, and fresh approaches to chronic disease management. It also promotes provider self-care, an all-too-often ignored aspect of our work.

• Patients want this approach.

• It is the perfect bridge for allied health care workers and their clients.

National Health Interview Survey Results:Most Commonly Used Mind Body Practices

• Yoga- 2012, 9.5% of US adults , US Kids 3.1% 2007, 6.1% adult, 429,000 more kids use in 20122002, 5.1% adults

• Meditation- 2012, 8.0% adults, 1.6% kids, 202,000 morekids used in 2012 vs. 2007

• Massage Therapy- 2012, adults 6.9%, 2007, 8.3% .7% kids in 2012, 194,000 fewer children 2012 vs. 2007

• Chiropractic or Osteopathic Manipulation, 8.4% adults, same for both 2012 and 2007, 3.3% kids 2012, up 112,000



The Current Bridge between Client and Healthcare

GNU Free Documentation License

53


The Bridge Needs to be Reliable and Natural

• Changing Healthcare and being apart of that change


ObjectivesDescribe how yogic breathing can influence pulmonary, cardiovascular, and immune systems while alleviating pain

Cite ways that yoga can provide therapeutic benefits to improve muscular and joint stability

Explain the difference between active and restorative poses and list the therapeutic benefits of each

Identify how positioning and pranayama can improve your clients’ overall wellness

Objectives, cont.

• Demonstrate how to use basic yoga poses, sequences, and deep relaxation using props for modification depending on client’s diagnosis

• Create customized client treatment plans that incorporate yoga.


54


It is time to end our journey and return back home

• May we continue to keep and open mind and learn about Integrative Medicine

• May we use and do yoga wherever and whenever we can

• May we light our candles every day and “Take 5” deep breaths whenever we can.



Let’s Light our Candles For Health

55


Keep Doing Your Yoga!!!

Today you are giving yourself and your · breathing techniques to meditation to healthy values....

Documents

Transcript of Today you are giving yourself and your · breathing techniques to meditation to healthy values....