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Adapting Yoga for Veterans with Brain Injury Amy Moran, MA, RYT Casey Linstad, CTRS Rose Collins, PhD, LP Minneapolis VA Health Care System April 28, 2011.

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Presentation on theme: "Adapting Yoga for Veterans with Brain Injury Amy Moran, MA, RYT Casey Linstad, CTRS Rose Collins, PhD, LP Minneapolis VA Health Care System April 28, 2011."— Presentation transcript:

1 Adapting Yoga for Veterans with Brain Injury Amy Moran, MA, RYT Casey Linstad, CTRS Rose Collins, PhD, LP Minneapolis VA Health Care System April 28, 2011

2 Objectives 1.Introduce the concept of Adaptive Yoga. 2.Experience how Adaptive Yoga feels. 3.Broaden your vision of what Yoga can look like.

3 Outline Yoga Yoga Yoga Research & Brain Injury Yoga Research & Brain Injury Adaptive Yoga Program Adaptive Yoga Program Veteran Yogis Veteran Yogis Program Evaluation Program Evaluation Looking to the Future Looking to the Future

4 Instructors Amy Moran, MA, RYT Registered Yoga Teacher Hot Yoga, Bikram-style, Hatha Casey Linstad, CTRS Recreational Therapist Kundalini Yoga Sue Benson, CYT Certified Yoga Teacher Iyengar Yoga

5

6 Yoga

7 Definition “…physical postures [asana], breathing techniques [pranayama], and meditation [dhyana] or relaxation…use…part of a general health regimen, and also for a variety of health conditions. (www.nccam.nih.gov)

8 Gates, 2002

9 Brain Injury Sequelae & Yoga Research 8 LimbsYoga ResearchBrain Injury Sequelae 1.Postures/Asana 2.Breathing/Pranayama 3.Sensation/Pratyahara 4.Concentration/Dharana 5.Meditation/Dhyana 6.Oneness/Samadhi 7.Restraints/Yamas 8.Observances/Niyamas Anxiety disorders Cancer/coping Cardiovascular disease Chronic disease risk factors Depressive disorders Fibromyalgia Multiple sclerosis Muskuloskeletal conditions Pain/lower back pain Posttraumatic stress disorder (PTSD) Quality of life (QOL) Respiratory illness Sleep disturbance Stress Stroke rehabilitation Increased GABA levels in brain (lower levels associated with variety mental health conditions) Abstract reasoning Affect regulation Anxiety Attention Awareness Concentration Depression Executive functioning Impulsivity Insight Irritability Learning Memory Pain complaints Planning QOL Problem-solving PTSD Sleep disturbance Social pragmatics

10 Defense Centers of Excellence

11 Adaptive Yoga Program

12 History MVAHCS MVAHCS Polytrauma/TBI Nathan Newhall Nathan Newhall Corepower Yoga Matthew Sanford Matthew Sanford Mind-Body Solutions

13 Adaptive Yoga All yoga is adaptive… All yoga is adaptive… Adapting yoga for a variety of physical and mental health conditions. Adapting yoga for a variety of physical and mental health conditions. Making yoga accessible on many different levels. Making yoga accessible on many different levels. Demystifying yoga Demystifying yoga Dispelling myths/stereotypes What does class look like? What does class look like?

14 Structure of ClassWelcome/introductions What is yoga? How to approach practice? Check-In (1-10) Options for practice Guidelines for practicePractice Breathing/movement Relaxation Check-Out (1-10) Check-Out #2 Describe practice (one word)Namaste

15 Adaptive Yoga Warm-Up

16

17 Veteran Yogis DEMOGRAPHICDESCRIPTION AGE RANGE21-90 GENDERGreater numbers men, lower numbers women, both represented ERAOperation Enduring/Iraqi Freedom OEF/OIF Persian Gulf War Post-Vietnam/Peace Time Vietnam War World War II PRIMARY DIAGNOSES Traumatic brain injury (TBI) Cerebrovascular Accident (CVA)/Stroke Lower Back Pain (LBP)/Pain Major Depressive Disorder (MDD) Other mental health condition Posttraumatic Stress Disorder (PTSD) Spinal Cord Injury (SCI) Obesity SECONDARY DIAGNOSESChemical Dependency Depression Pain (knee/joint) Osteoarthritis Other anxiety/mood disorders Posttraumatic stress disorder (PTSD) Sleep Apnea/Insomnia CAUSES OF BRAIN INJURYBlast Brain tumor Drug overdose Fall Motor vehicle accident (MVA) RELIGIOUS AFFILIATIONLutheran Pentecostal Roman Catholic Protestant

18

19 Adaptive Yoga Star Pose/ Tarasana

20 Specific Adaptations

21 Physical “Adaptations” 1.Breathing 2.Eyes 3.Inversions 4.Touching/adjustments 5.Modify up 6.Props 7. Visualization

22 Adaptive Yoga Spinal Twist/ Ardha Matsyendrasana

23 Cognitive “Adaptations” Repetition Repetition Recreational therapy assistance Recreational therapy assistance Simple demonstrations Simple demonstrations Several models to follow Several models to follow Group adjustments Group adjustments Non-comparison, non- competition, non-criticism Non-comparison, non- competition, non-criticism

24 Language Matters Yoga is an opportunity to… Yoga is an opportunity to… Practice with what is available to you today Practice with what is available to you today Choose option that makes sense for your body today Choose option that makes sense for your body today Option/alternative vs. challenge/modification Option/alternative vs. challenge/modification Relaxation vs. meditation Relaxation vs. meditation Stress response & relaxation response Stress response & relaxation response You are the expert of your own body You are the expert of your own body Your body gives you information Your body gives you information Practice listening to your body Practice listening to your body Use wisdom -what is too much/not enough Use wisdom -what is too much/not enough

25 Adapted Asana Demonstration Awkward/chair pose Holding posture Utkatasana Eagle Pose Compression posture Garurasana Tree Pose Balancing posture Tadasana Cobra Pose Spine Strengthening Bhujangasana

26 Adaptive Yoga Awkward Pose/ Utkatasana

27 Adaptive Yoga Eagle Pose/ Garurasana

28 PROGRAM EVALUATION

29

30

31 Descriptive Words Frequency Descriptor 1.RELAXED or RELAXING 2.CALM or CALMING

32 In their own words… “I know more about yoga today – I want to learn more. Felt better after the first time.” “The stiffness in my arm is almost gone from all the stretching. I feel relaxed after each class. I have a beginner course at home and try to do yoga every day.” “Made my back feel better. Also improved mood. Visualizing is powerful.” “Helps me with ortho problems as well as bipolar & PTSD episodes.” “Very relaxing and interesting.” “It is great, really helps with the stress.”

33 INTERVIEWS

34 What did you think of yoga before you started practicing? “I didn’t understand it. It seemed hokey, bogus, tricks, people blowing smoke.” -Olaf “I’ve been watching it on Channel 2. Some people have issues but I was anxious to try it.” -Jim “Eastern, control, in shape, has it together.” -Jo “DUMB. Would have never considered it.” -Rick “I thought it was painful, impossible, that I had to be strong. I didn’t think I could do it.” -Suzanne

35 What did you think of yoga now? “Very relaxing, helps me prepare for the week, to be more accepting. Can’t do what I did 30 years ago.” -Olaf “It has given me a more relaxed feeling. I didn’t think I would be using muscles that I haven’t used. I generally get stiff from not moving.“ -Jim “My perception of yoga was always positive, but I have an even more positive attitude now.” All positive, calming, lovely, gold, and blue-green, and feels good.” -Jo “I like the stretching. Loosens up your body. Pain has gone away in my shoulder. Relaxing and warmth of your body.” -Rick “I like it now because it’s relaxing, breathing is healing. I can lose weight through mindful breathing. Here, I am comfortable, I’m not overweight.” -Suzanne

36 What was the hardest thing for you when you started practicing? “The breathing. I could go even slower. Sometimes I have to tune the teacher out.” -Olaf “First time was getting to class, long hallway.” -Jim Always felt I was behind on the positions, getting more familiar and catching up.” -Jo “Moving my arm and not being able to stand (in a wheelchair). This continued from my rehab process. I can do this for the rest of my life.” -Rick “Relaxing different parts of my body. I’m still not sure if I am relaxing them or not! I’m amazed that you know my tongue is on the roof of my mouth! How do you know that?” -Suzanne

37 Why do you continue to practice? “I can’t even explain. It gives me so much. It gets me out of my house. I have time on my drive down. I like people, but I hate crowds. I can’t do this myself. Here I can be with people. I’m comfortable here. There’s nothing better for me. I get cabin fever (in the winter), depressed, compulsive eating.” -Olaf “It feels good, a positive experience – always. Helps to control myself, calming. Lessens stress in my life.” -Jo “Stretching feels really good. I get really stiff, but am so relaxed after meditation. My mood is much better.” -Suzanne

38 Adaptive Yoga “I relax more each time. Better breathing even with COPD. I use breathing techniques to relax and hopefully my muscles will start working better.” -Jim Star Pose/ Tarasana Why continue to practice?

39 Adaptive Yoga “Fitness, being with my friends here. Stretching and loosening my body.” -Rick Warm- Up Why continue to practice?

40 On days that you practice, do you notice anything different? “I feel good when I leave. Relaxed. I look forward to coming. I get energized about it. I feel better in general. It’s not a chore.” -Olaf “Yes, I think it has a calming effect. I used to show more anger, I show less now. I’m more relaxed.“ -Jim “Feel that mind/body more in control – I’m more centered. I feel good about myself.” -Jo “My body is looser, relaxed, warm. Able to move further each time (arm).” -Rick “I feel better. I feel happier, more relaxed. Whatever was bothering me before is gone.” -Suzanne

41 If you were going to tell another Veteran about yoga, what would you say? “Do it! What do you have to lose? It’s a very individual experience. Unless they try it more than once, they won’t have a clue. Cannot describe. It is very individual.” -Olaf “I would recommend it because you’re working with aspects you never worked with breath before. Movements that you don’t think will be strenuous are strenuous.” -Jim “Yes! I would recommend it for vets, anyone. Would let them know I think it helps with my perception of myself, PTSD, depression, and weight issues.” -Jo “I would recommend trying it. Gets your body loose no matter what you do.” -Rick “Yoga is for everybody. They even have people in wheel chairs practicing yoga. That was a whole new perspective for me. I used to be nervous around people in wheelchairs, now they’re my friends.” -Suzanne

42 Learning & Planning…

43 Specific Lessons Work in progress Work in progress Constant re-evaluation Constant re-evaluation Challenging our own assumptions Challenging our own assumptions Every class is different Every class is different Things change Things change Going with the flow… Going with the flow… Many ways to be challenged Many ways to be challenged Broadening criteria for success Broadening criteria for success

44 Plans for the Future Expansion Expansion Dedicated space Supplies/props Tailored classes Tailored classes Women’s clinic Spinal cord injury Measurement tools Measurement tools Biofeedback equipment Physiological measures Research Research Funding

45 Relaxation & Closing…

46 Relaxation… Guided relaxation Guided relaxation Take time to prepare for relaxation… Take time to prepare for relaxation… Types of relaxations Types of relaxations Self-Acceptance Chakra/Rainbow Healing/Golden Light Forest/Nature Starry Night

47 Adaptive Yoga Savasana

48 Bringing Practice to a Close… Checking-out Checking-out Share a word to describe your practice Share a word to describe your practice Bow & Namaste Bow & Namaste “The Teacher in me Honors the Teacher in you.”

49 Adaptive Yoga Prayer Pose

50 Adaptive Yoga Namaste

51 Namaste!

52 Adaptive Yoga Contacts Casey Linstad*, CTRS Casey.Linstad@va.gov 612-629-7618 *Veteran referrals Amy Moran, MA, RYT Amy.Moran1@va.gov 612-629-7360 Rose Collins, PhD, LP Rose.Collins@va.gov 612-467-5758

53 References (1) Bennet, S.M., Weintraub, A., & Khalsa, S.B.S. (2008). Initial evaluation of the LifeForce yoga program as a therapeutic intervention for depression. International Journal of Yoga Therapy, 18, 49-57. Bower, J.E., Woolery, A., Sternliebb, B., & Garet D. (2005). Yoga for cancer patients and survivors. Cancer Control, 12, 165-171. Carson, J.W., Carson, K.M., Jones, K.D., Bennet, R.M., Wright, C.L., & Mist, S.D. (2010). A pilot randomized controlled trial of the yoga of awareness program in the management of fibromyalgia. Pain, 151, 530-539. Descilo, T., Vedamurtachar, A., Gerbarg, P.L., Nagaraja, D., Gangadhar, B.N., Damodaran, B., Adelson, B., Braslow, L.H., Marcus, S., & Brown, R.P. (2009). Effects of a yoga breath intervention alone and in combination with an exposure therapy for post-traumatic stress disorder and depression in survivors of the 2004 south-east Asia tsunami. Acta Psychiatrica Scandinavica, 1-12. Duraiswamy, G., Thirthalli, J., Gangadhar, B.N. (2007). Yoga therapy as an add-on treatment in the management of patients with schizophrenia: A randomized controlled trial. Acta Psychiatrica Scandinavica, 116, 226-232. Gates, R. (2002). Meditations from the mat: Daily reflections on the path of yoga. New York: Random House. Greendale, G.A., McDivit, A., Carpenter, A., Seeger, L. & Huang, M. Yoga for women with hyperkyphosis: Results of a pilot study. American Journal of Public Health, 92, 1611-1614. Innes, K.E., Bourguignon, C., & Taylor, A.G. Risk indices associated with the insulin resistance syndrome, cardiovascular disease, and possible protection with yoga: A systematic review. (2005). Journal of the American Board of Family Practitioners, 18, 491-519. Iyengar, B.K.S. (1979). Light on Yoga. New York: Schocken. Jadhav, S.G. & Havalappanavar, N.B. (2009). Effect of yoga intervention on anxiety and subjective well- being. Journal of the Indian Academy of Applied Psychology, 35, 27-31. Kirkwood, G., Rampes, H., Tuffrey, V., Richardson, J., & Pilkington, K. (2005). Yoga for anxiety: A systematic review of the research evidence. British Journal of Sports Medicine, 39, 884-891.

54 References (2) Lynton, H., Kligler, B., & Shiflett, S. (2007). Yoga in stroke rehabilitation: A systematic review and results of a pilot study. Topics in Stroke Rehabilitation, 14, 1-8. Manjunath, N.K. & Telles, S. (2005). Influence of yoga and ayurveda on self-rated sleep in a geriatric population. Indian Journal of Medical Research, 121, 683-690. Michalsen, A., Grossman, P., Acil, A., Langhorst, J., Luedtke, R., Esch, T., Stefano, G.B., & Dobbs, G.J. (2005). Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Medical Science Monitor, 11, 555-561. Moadel, A.B., Shah, C., Wylie-Rosett, J., Harris, M.S., Patel, S.R., Hall, C.B., & Sparano, J.A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: Effects of quality of life. Journal of Clinical Oncology, 25, 4387-4395. Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2005). Yoga for depression: The research evidence. Journal of Affective Disorders, 89, 13-24. Pritchard, M. Ellison-Bowers, P., & Birdsall, B. Impact of Integrative Restoration (iRest) meditation on perceived stress levels in multiple sclerosis and cancer outpatients. Stress and Health, 26, 233-237. Ross, A. & Thomas, S. (2010). The health benefits of yoga and exercise: A review of comparison studies. The Journal of Alternative and Complementary Medicine, 16, 3-12. Shapiro, D., Cook, I.A., Davydov, D.M., Ottaviana, C., Leuchter, A.F., Abrams, M. (2007). Yoga as a complementary treatment of depression: Effects of traits and moods on treatment outcomes. eCAM, 4, 493-502. Sherman, K.J., Cherkin, D. C., Erro, J., Miglioretti, D.L., & Deyo, R.A. (2005). Comparing yoga, exercise, and a self-care book for chronic low back pain. Annals of Internal Medicine, 143, 849-856. Streeter, C.C., Jensen J.E., Perlmutter, R.M., Cabral, H.J., Tian, H., Terhune, D.B., Tiraulo, D.A., & Renshaw, P.F. Yoga asana sessions increase brain GABA levels: A pilot study. Journal of Alternative and Complementary Medicine, 13, 419-426. Woolery, A., Myers, H., Sternlieb, B., & Zeltzer, L. (2004). A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies, 10, 60-63. Yang, K. (2007). A review of yoga programs for four leading risk factors of chronic disease. eCAM, 4, 487-491.

55 Adaptive Yoga Questions…


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