- 78-year-old female, living in assisted-living facility
- Spinal cord injury (upper and lower) – fused C4, C5 and C6. Surgery in Sept’22.
- Broke her ankle and hit her head during Covid.
- Congenital bad valve. In Feb’22, had a heart murmur, keeled over, was resuscitated, valve replaced in Nov’22. Moved into assisted-living in Dec’22.
- Osteoporosis in her spine. Takes Folsomax for it.
- Tries to walk at least 300 steps each day. Has nerve pain which worsens when she walks too much.
- Has a reverse S-shaped Scoliosis, with a 37-degree curve in Thoracic spine. Could not sleep on her back, more comfortable on her right side.
- Had ACES, moved to USA when she was 18 yr.-old.
- Has a pet 16-year-old male cat, who she talks about a lot.
- Would like to socialize more, but not too much, because she gets tired quickly.
- Has high blood pressure, takes
- Has glaucoma, takes Timolol eye drops for it.

- Extended exhalation, barrel breath.
- Joint freeing movements, concentrating more on the lower body, to get a bigger ROM, especially her right leg.
- Using props like stress balls, rolled blankets under the knees, 1-lb ankle weight, 2 blocks.
- Guided relaxation, Yoga nidra and breath/love meditation imagery with her cat.

- Yoga for Scoliosis from the Adapted Teacher Training manual.
- Yoga for Arthritis teacher Manual.
- Fishman LM. Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis-A Nonrandomized Control Trial. Glob Adv Health Med. 2021 Feb 24;10:2164956120988259. doi: 10.1177/2164956120988259. PMID: 33717658; PMCID: PMC7917413. Isometric Yoga-Like Maneuvers Improve Adolescent Idiopathic Scoliosis—A Nonrandomized Control Trial - PMC (nih.gov)
- Ades PA, Savage PD, Brochu M, Tischler MD, Lee NM, Poehlman ET. Resistance training increases total daily energy expenditure in disabled older women with coronary heart disease. J Appl Physiol (1985). 2005 Apr;98(4):1280-5. doi: 10.1152/japplphysiol.00360.2004. PMID: 15772059. Resistance training increases total daily energy expenditure in disabled older women with coronary heart disease - PubMed (nih.gov)
- Bruce C, Achan V, Rathore S. Yoga-Based Cardiac Rehabilitation: Current Perspectives from Randomized Controlled Trials in Coronary Artery Disease. Vasc Health Risk Manag. 2021 Dec 2;17:779-789. doi: 10.2147/VHRM.S286928. PMID: 34880621; PMCID: PMC8648328. Yoga-Based Cardiac Rehabilitation: Current Perspectives from Randomized Controlled Trials in Coronary Artery Disease - PubMed (nih.gov)
- Fishman LM. Yoga and Bone Health. Orthop Nurs. 2021 May-Jun 01;40(3):169-179. doi: 10.1097/NOR.0000000000000757. PMID: 34004616. Yoga and Bone Health - PubMed (nih.gov)
- Jeng CM, Cheng TC, Kung CH, Hsu HC. Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study. Eur Spine J. 2011 Mar;20(3):408-13. doi: 10.1007/s00586-010-1547-y. Epub 2010 Aug 15. PMID: 20711844; PMCID: PMC3048237. Yoga and disc degenerative disease in cervical and lumbar spine: an MR imaging-based case control study - PubMed (nih.gov)

• Yes

Check-in. Breath awareness. Extended exhalation. Talked about making more space in the spine, imagine being pulled from the crown of your head.

Extended exhalation. Do the stretches at least twice a day, 5 repetitions.

She cut her right big toe while trimming her nail. Had a bandage and cannot put pressure on it. Had a shingles and a tetanus shot in left arm and got scratched by her cat on her right wrist. Left arm has been sore, had fever and fatigue for a few days. Had not been able to bend her right wrist, but now feels better. She said she found a friend with similar values and has been hanging out with her more.

I have a hard time re-directing people towards the practice from the talking, especially the ones living in assisted-living, since I think that they are lonely and do need that one-on-one attention. I'm working on that.

Practicing Extended exhalation on the count. Adding a few more stretches for the hands and the legs, especially the right. Lengthening of the spine.

• Yes

Check-in. Extended exhale. Strengthening exercises for her right forearm and wrist. Staff pose with feet propped on a stool. Relaxing into the stretches for 5 breaths. Bending the knee and external rotation of the hip for 5 breaths. (Modified cobbler pose). Relaxing into the stretch by placing a pillow underneath the knee and holding for 5 breaths. Guided relaxation and breath meditation, with the cat her lap.

- Extended exhale on her count. Inhale to a count of 4 and exhale to a count of 5 or 6.
- Keep doing strengthening exercises for right arm. 10 breaths for each stretch.

She participated in a Wii Bowling tournament over the weekend and her right arm was feeling sore and she had trouble lifting it up beyond her shoulder-height. Walked 750 steps the day before, so was a little sore all over. A friend passed away a day before and was feeling very emotional. She said there’s a line in the ceiling of the hallway and she imagined that her head was attached to that line while walking there, keeping her standing tall.

The person who passed away used to be a regular participant in my class at the assisted living center. We spent some time talking about him, since his passing had come as a shock. I took few cleansing breaths and kept my emotions in check to be able to work with her. I felt that her cat being present during the session helped not just her but me too. As I was leading her through relaxation, her cat came and sat in her lap. I led her through breath meditation, where I asked her to notice her cat’s breath and added a seasoning of loving kindness in it. I felt proud of myself that I was able to think on my feet and made it real for her. After the session, she said that she especially liked that part. 😊

- Will add a 1lb weight for the Right forearm and wrist stretches and continue with the rest of the practice.
- Research a little more on how I can bring her pet in her practice.

• Yes

Check-in. Hip extensions on the chair (seated sideways). Using the mirror, side bends, lengthening the sides. I propped a pillow underneath her right shoulder, which seemed to help her a lot. Retraction and protraction for the shoulder. Using the stress balls, pressing it by the foot (ball of the foot, arch and then the heel). End with breath awareness with the cat’s breath.

Keep practicing the stretches. Use 1lb wt. if comfortable. Breathing practice.

She said her pain aggravated because of the exercises that we did, because of which she had to take a week break from our sessions. The side stretch on the bed with the pillows underneath was very uncomfortable for her, so she didn’t do that. Her right wrist was still hurting because she had to clean after cat when he threw up.

In the last session, I think adding a 1lb weight to her stretches might have been ‘too much, too soon’. I let my expectations take over her practice. I suggested to her to talk to her PT about the wrist pain and also wear a wrist brace, to give her wrist time to heal. It was a little difficult to work in her apartment because of the smell that was still in the room. I asked if it’s ok to open the window. She said she had an ant infestation as well, so she’s keeping all the doors and windows closed. I should start carrying a mask with me.

It took some time for me to adjust to working with the client in her apartment. Finding suitable workspace to work with her. It helped me figure out ways to use the things that are available to her, as props. Figuring out the things that she can use on her own as well, since there is less mobility in her legs and back. Placing things by her bedside, like the stress balls, so she can use them when she can.

Working on breathing/calming practice. Talking to her PT with her permission and figuring out a way that I can supplement her PT training. Using music in the sessions.