The client is a 69yr old male.
These are the conditions he has:
Parkinson’s disease (2012)
Deep Brain Stimulation surgery (2018)
Replace battery surgery for DBM (2021)
Broken collar bone (2021)
Osteoporosis
*Low blood pressure – BP lowers especially when he stands up from seated. He experiences dizziness.
Insomnia – He wakes 1-4x/night to use the restroom; he feels groggy when he wakes up.
He has joint pain in the hips and muscle pain in the right shin.
He can get up and down from floor.
He has the support of his wife and adult daughter.

Client Goal
The client’s main goal is to improve his balance, posture and walking.

Koshas: _x_Annamaya _x_Pranamaya _x_Manomaya __Vijñanamaya __Anandamaya

Integral Yoga: _x__Hatha __x_Raja ___Bhakti ___Karma ___Jnana ___Japa

Short Term
I would like to help him gain more mobility in his hip and strengthen his legs and fingers.

Long Term
I would like to work with him on relaxation and breathing techniques for better sleep and to reduce stress.

Stress Management TT Manual

Adaptive TT Manual

American Parkinson Disease Association Training for Fitness, Health and Wellness professionals
https://www.apdaparkinson.org/courses/pd-fitness-training/story_html5.html
(I took this training.)

Argue, J. Parkinson’s Disease and the Art of Moving. New Harbinger Publications, Inc. 2000.

Fan B, Jabeen R, Bo B, et al. What and How Can Physical Activity Prevention Function on Parkinson's Disease?. Oxid Med Cell Longev. 2020;2020:4293071. Published 2020 Feb 13. doi:10.1155/2020/4293071
https://pubmed.ncbi.nlm.nih.gov/32215173/

• Yes

Awareness Practice
Neck/shoulder warmups
Eagle (Garudasana) arm stretch
Reed – lateral stretch
Dynamic twist
Finger strengthening work and stretches with massage
Strengthening and mobility for the foot
Walk on different edges of the feet (HBED)
Balancing check – really good
Walk heel touching toe
Bridge, progressing toward 1 legged bridge on the block
Yoga nidra
Deep diaphragmatic breaths with focus on the exhale

The client practiced alternate nostril breathing.

PFS is not a chatty person. He did say he was not experiencing any pain. He mentioned that doing the alternate nostril breathing before sleep helped him fall asleep. Additionally, he said that he enjoyed the yoga nidra from last week.

He had done his workout earlier in the day, but said he still wanted to work on the physical practices I had planned for the session. The idea was to incorporate practices that were different from what his PT might focus on while allowing me to observe his physical capabilities. I had prepared some mobility and strengthening work for the muscles and joints of the hands and feet—parts of the body that usually don’t get as much attention as the bigger muscles. He especially liked the foot practices.

We also did some practices that required balance and used perhaps different muscles in his legs than most people are used to using. Since balance is one of the primary concerns in people with Parkinson’s I wanted to make sure we did some practices with balance as an emphasis.

I suspect I offered too many options in trying to anticipate his needs as a person with Parkinson’s. He was a good sport about it. Next time, we will try to do more traditional yoga asanas and just adapt everything to what he needs, since he is quite strong and mobile. At the end of the day, this session was more about exploring a little with him to see what practices might be helpful and what was not.

We will do some more mobility work on the hips as per the client’s request.

• Yes

Awareness practice
Neck warm ups
Individual shoulder rolls – helped with hand to shoulders to make movement – left shoulder is harder to move
Garudasana (eagle) arm stretch with flexion/extension
Reed (lateral stretch)
When trying to show pelvic tilt, his spine was in flexion
We paused and workshopped the isolated pelvic tilt and practiced it supine as well
Thread the needle (prompted by client)
Yoga nidra

I asked the client to bring awareness to his spine throughout the day and see if he could create a neutral spine if he noticed poor posture. He could then start work from that neutral position before doing his activities.

The client said he had no news to report. He mentioned everything was good. He was not feeling any pain and his energy was good.

This session was a balance of understanding where the client was at physically, while trusting in the knowledge I had gained to keep him safe. We did some spinal/pelvic warmups to prepare for practicing hip movements, which he had asked about in our last session. In the process, I noticed he had a hard time keeping his spine in a neutral position–with no flexion. I ended up deciding it was for the best to continue spending time isolating the pelvis so that he could feel internally what it was like to have a neutral spine with its natural curves. I suspect that having Parkinson’s was interfering with his proprioception. This made it difficult for him to have an inner sense of his body positioning and movements.

This was also reflected in the difficulty he had moving his shoulders during the warmups. I had noticed the tightness in his shoulder/neck area, so offered Garudasana (Eagle) arms to stretch, but it wasn’t that helpful for him, so we stopped. However, I appreciated that after we spent time on the pelvic tilt in tabletop position, the client spontaneously started to perform the Thread the Needle stretch on his own. We turned it into a full practice so he could go deeper into the stretch.

I wanted to introduce eye exercises next session as a contrast to some of our more physical practices.

• Yes

Awareness practice
Netra vyayamam
Neck warmups/shoulder rolls
Modified Garudasana (Eagle) stretch with imagery --breathe into tight muscles to stretch and soften them like taffy.
Reed stretch (lateral)
Dynamic twist
Isolated pelvic rocking/tilt
Hamstring stretch using chair for support
Warmup feet/ankles
Workshop Utkatasana (chair) pose with neutral spine
Practice Chair pose with a strap around the thighs – the client could push against the strap laterally to allow him to go deeper into the pose
Supine windshield wiper with the breath
Yoga nidra

I asked the client to practice isolating the pelvis and do a pelvic rock/tilt to find a neutral position. He performs many repetitions of weight bearing exercises in a squat position, so I would like him to really be aware of his body position before starting so that he does not reinforce poor posture.

It was interesting. The client wanted to have a conversation to hear about my understanding of Parkinsons to contrast with his personal experience of the disease. I thought this was a great idea. What’s funny is that he forgot to share his actual experience afterwards. Although he shared that he had started attending a Parkinsons Voice Project group that focused on helping clients generate more volume in speaking. He was noticeably more audible than last week. Lastly ,he asked if we could “drill down” into more depth into a practice or pose to be able to understand it very well.

Since the client asked for a more in-depth teaching of one pose it was really freeing for me as I guided him. We could talk about what parts of the body needed to be strong and what parts needed to have more movement in order to practice the pose in good form. I had wanted to use Utkatasana (chair) for today’s session, so it worked out very well. We were able to talk about stretching the hamstring, which is usually tight for people with Parkinson’s. We were able to work on ankle and foot mobility, which enhanced stability and proprioception for balance—again important for people with Parkinson’s. By holding the pose for a few breaths, we were also able to strengthen his leg and spinal extensor and stabilizer muscles.

We continued the theme of having a neutral spine by again focusing on the placement of the pelvis as the foundation for that neutral positioning of the spine. It was nice to have permission from the client to take the time to work on proper mechanics so I could make sure he could feel the position in his body. We were able to ask for the client’s wife to help him by cuing through gentle touch on the sacrum, as well as get her visual confirmation that the final pelvic and spinal posture was correct. I was grateful for her presence, as it took a few tries for him to be able to position himself correctly and determine how that felt internally. Once he found that feeling he was able to do 2 rounds of Chair, holding it for 3 breaths. Lastly, we were able to enhance the strengthening work by adding the nuance of pushing laterally against the strap to allow him to go deeper into the pose while still keeping his form.

We did 1 intake and 4 sessions.

I really enjoyed working with PFS. He didn’t have any experience with yoga before we started working together, but he approached our sessions with openness and curiosity. We were able to touch on all of the client’s initial concerns, though as we progressed, we focused on some aspects more than others per his request. During the intake he verbally mentioned that his sleep wasn’t the most restful, though it wasn’t written down as a main concern. After being introduced to alternate nostril breathing and giving it a try consistently for a week, he found that it helped him get more restful sleep. (Pranamaya, Manomaya).

He had been very active before he was diagnosed with Parkinson’s and was very diligent with exercising every day, so he was quite strong and mobile for his age and how long he had the disease. The technique that worked for us was to introduce different ways of moving that he could then incorporate on his own when he wasn’t with me. This is where we worked on some of the balance and strengthening work he had requested. In doing so, I discovered that he didn’t have a good internal sense of his pelvic position, which affected his posture. After some targeted work in that area, he started to gain more body awareness of his pelvis and spinal position. This was important knowledge to gain because he performed many repetitions during his workouts, and being able to do so with good posture would only benefit his health in the long run. After he learned how to maintain his posture, we were able to spend the last class teaching him tools to maintain his hip mobility and strength, which was one of his primary requests. (Hatha, Annamaya) Over time, he shared what it was like to live with Parkinson’s Disease. In our discussions, we talked of “intention” and “letting go” (non attachment) as important aspects of being able to live well. (Raja)

In just a short time we were able to accomplish the things that we set out to do. He was an active participant in determining how we proceeded with each session and he was very pleased to have had this experience.

He will continue to practice the pelvic tilts/rocks to keep the mobility in his lower spine as well as remind himself how to position his body to maintain a neutral spine.