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
Casey

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

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

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

5. Amy

6. Yoga Breathing exercises Physical activity Relaxation Meditation
Amy
Ancient Mind-Body Practice
Breathing exercises
Physical activity
Relaxation
Meditation
Stress management
Philosophy
Lifestyle
Spiritual tradition

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. (
1 of 3 mind-body therapies that fall under the rubric of complementary and alternative medicine

8. Breathing exercises Physical activity Relaxation Meditation
Amy
Ancient Mind-Body Practice
Breathing exercises
Physical activity
Relaxation
Meditation
Stress management
Philosophy
Lifestyle
Spiritual tradition
Gates, 2002 8

9. Brain Injury Sequelae & Yoga Research
8 Limbs
Yoga Research
Brain Injury Sequelae
Postures/Asana
Breathing/Pranayama
Sensation/Pratyahara
Concentration/Dharana
Meditation/Dhyana
Oneness/Samadhi
Restraints/Yamas
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
Social pragmatics
Amy
Restraints/Yamas
Moderation/Brahmacarya
Observances/Niyamas
Self-Study/Svadhyaya

10. Defense Centers of Excellence
Amy
Why yoga for veterans?

11. Adaptive Yoga Program
Casey

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

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

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

15. Warm-Up
Adaptive Yoga
Casey

16. Casey
Warm-Up

17. Veteran Yogis DEMOGRAPHIC DESCRIPTION AGE RANGE 21-90 GENDER
Greater numbers men, lower numbers women, both represented
ERA
Operation 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 DIAGNOSES
Chemical Dependency
Depression
Pain (knee/joint)
Osteoarthritis
Other anxiety/mood disorders
Posttraumatic stress disorder (PTSD)
Sleep Apnea/Insomnia
CAUSES OF BRAIN INJURY
Blast
Brain tumor
Drug overdose
Fall
Motor vehicle accident (MVA)
RELIGIOUS AFFILIATION
Lutheran
Pentecostal
Roman Catholic
Protestant
Amy

18. Amy

19. Adaptive Yoga
Star Pose/
Tarasana
Amy

20. Specific Adaptations
Casey

21. Physical “Adaptations”
Breathing
Eyes
Inversions
Touching/adjustments
Modify up
Props
Visualization
Casey

22. Spinal Twist/ Ardha Matsyendrasana
Adaptive Yoga
Casey

23. Cognitive “Adaptations”
Repetition
Recreational therapy assistance
Simple demonstrations
Several models to follow
Group adjustments
Non-comparison, non-competition, non-criticism
Casey
Within class
Between classes
3 teachers + peers
Sitting in a circle
People figure out what works for them, this may require they “struggle” a little bit
Promotes independent thinking and decision-making skills

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

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
Amy & Casey

26. Awkward Pose/
Utkatasana
Adaptive Yoga
Amy

27. Eagle Pose/
Garurasana
Adaptive Yoga
Amy

28. PROGRAM EVALUATION Amy Feedback from veterans Qualitative
Informal observations
Comments/quotes
One word descriptions of practice
Quantitative
Check-in/check-out numbers
Quality of life survey
Formal interviews

29. Amy

30. Amy

31. Descriptive Words Relaxed/Relaxing Calm/Calming RELAXED or RELAXING
CALM or
CALMING
Frequency
Amy
Words used to describe practice
Overwhelmingly positive
Some neutral words
A few negative words
Top 2 Descriptors
Relaxed/Relaxing
Calm/Calming
Descriptor

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.”
Amy

33. INTERVIEWS Amy Feedback from veterans Qualitative
Informal observations
Comments/quotes
One word descriptions of practice
Quantitative
Check-in/check-out numbers
Quality of life survey
Formal 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
Amy

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
Amy

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
Amy

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
Amy

38. Adaptive Yoga Star Pose/ Tarasana Why continue to practice?
“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
Amy

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

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
Amy

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
Amy

42. Learning & Planning… Casey From a recreational therapy perspective…
From a mental health perspective…
From a yoga perspective…
From a human perspective…

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

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

45. Relaxation & Closing… Casey From a mental health perspective…
From a yoga perspective…
From a human perspective…

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

47. Adaptive Yoga
Savasana
Casey

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

49. Adaptive Yoga
Casey
Prayer Pose

50. Adaptive Yoga
Casey
Namaste

51. Namaste!
Amy

52. Adaptive Yoga Contacts
Casey Linstad*, CTRS
*Veteran referrals
Amy Moran, MA, RYT
Rose Collins, PhD, LP
Amy

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,
Bower, J.E., Woolery, A., Sternliebb, B., & Garet D. (2005). Yoga for cancer patients and survivors. Cancer Control, 12,
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,
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,
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,
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,
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,
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,
Amy

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,
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,
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,
Pilkington, K., Kirkwood, G., Rampes, H., & Richardson, J. (2005). Yoga for depression: The research evidence. Journal of Affective Disorders, 89,
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,
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,
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,
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,
Woolery, A., Myers, H., Sternlieb, B., & Zeltzer, L. (2004). A yoga intervention for young adults with elevated symptoms of depression. Alternative Therapies, 10,
Yang, K. (2007). A review of yoga programs for four leading risk factors of chronic disease. eCAM, 4,
Amy

55. Questions…
Adaptive Yoga
Casey & Amy