Entry TypeAssessment
Client/GroupMark
Entry CategoryCase Study
Select your mentorSarala Evans
Intake
Assessment
Proposed number of sessions4
Location of sessionsClient's home
Planned time per session90
Presenting ProblemMark is a 66-year-old man, realtor, married, who has Parkinson’s disease, depression, anxiety, stress, wrist and rib injuries, and poor quality of sleep (between 2 am and 9 am), high cholesterol, pre-diabetes.
Physical

We talked about the intake and assessed his physical body with joint freeing, breathing practices, relaxation, and meditation. He is left-handed, so his symptoms (like tremors) happen on the left side of the body. He was diagnosed with carpal tunnel, and had surgery but didn’t improve his wrists. His right wrist has a lower range of motion than the left. He is part of a rock band where he plays the drums. He said generally the tremors don’t affect his music.
Although he has had the disease for 15 years, it is still in its first phase, and the doctors are amazed at that. He generally has good balance, but some stiffness.
The next day after running he feels sore, but he attributes that to getting older. He is having constipation, maybe as a side effect of the disease.
Stiffness in the right shoulder.
I noticed during cat-cow on the chair that his right shoulder blade stands out more than the left.
He felt hip pain when bringing his leg up from the floor. I advised him to bend his legs when bringing them up.
He said he feels good stretching the ankles.
At the end of the practice, he was asked to do Anjali mudra. He said it feels good in his hands, which are generally contracted, and the mudra opens them.

Client/Group goalsRelief of physical, mental, and emotional stress.
Energetic

High level of energy, rajasic.
He forces his breath when I ask him to pay attention to it.
He juggles, runs in the morning (2,5 miles), and works out.

Emotional

Moderate stress. The source of stress is the PD, age, and news. Regular anxiety every afternoon, mainly when the medicine wears off. He took 3 pills every 4 hours.
Restless sleep, about 6 hours sleep, and he feels “restless arms”, it looks like there is electricity coming down his arms, and then he can’t sleep.
He tries to have a positive attitude, but when he is down is pretty bad.
He will answer a DASS-21 scale to measure depression, anxiety, and stress.

Spiritual orientation and needs

Slightly. He wrote in the intake: “All we have in life is love and the present moment.” His spiritual practice is gratitude. He was born Jewish and follows some of his traditions but is upset with what religion has done to the world. He lived one year in Israel and when he thinks about the time he spent by the Dead Sea (which is 2000 feet below the ocean level and there is so much oxygen that you do not need to breathe too much), his breath slows down.

Intellectual / Sense of self

Intellectual stimulation: work, talking to his wife, his music.

Yoga philosophy/wisdom research reference(s)

During the assessment and relaxation, I introduced the following concept:
Our true nature is experienced in a calm mind state (citta-prasādanam). Yoga can help (Yogas Citta Vritti nirodha).
Staying in the “observer” that witnesses the body, the disease, the thoughts, and sensations, can be a way to be calmer, which will take the client to a state of breath and mind regulation.

Prana and Pranayama. Swami Nirajanananda Saraswati
The path of the Yoga Sutras. Nicolai Bachman
The Yoga Sutras of Patanjali. Swami Satchidananda
Unravel the thread. Ruben Vasquez.
Stress Management TT Manual
Raja Yoga Manual

Scientific research reference(s), why chosen, how you plan to incorporate 1-3

Medication:
About Hydroxyzine

Does hydroxyzine for anxiety work?

About THC
https://www.parkinson.org/living-with-parkinsons/treatment/medical-marijuana

About Rytary
https://www.webmd.com/drugs/2/drug-167580/rytary-oral/details

Stress Management for PD
https://www.parkinson.org/library/fact-sheets/stress

About PD
https://www.mayoclinic.org/diseases-conditions/parkinsons-disease/symptoms-causes/syc-20376055
The Effects of Yoga on Patients with Parkinson's Disease: A Meta-Analysis of Randomized Controlled Trials
https://pubmed.ncbi.nlm.nih.gov/34285724/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275425/pdf/BN2021-5582488.pdf

Effects of Mindfulness Yoga vs Stretching and Resistance Training Exercises on Anxiety and Depression for People With Parkinson Disease
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583059/

Bradykinesia
https://my.clevelandclinic.org/health/symptoms/bradykinesia

For broken/bruised ribs
https://www.webmd.com/a-to-z-guides/best-exercises-broken-ribs-recovery

Anxiety depression scale (DASS-21)
https://maic.qld.gov.au/wp-content/uploads/2016/07/DASS-21.pdf

Pain scale
https://health.mil/Reference-Center/Publications/2021/05/10/PHCoE-PCBH-Defense-and-Veterans-Pain-Rating-Scale-508

Mantra meditation for mental health:
https://www.scienced

Approval Notice
Your care plan should be approved by your mentor, with any amendments they suggested, prior to your remaining Yoga Therapy sessions.
Care PlanOutline should be a practice adapted to the needs of that client/group, including:
  • Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
  • balanced pranayama considering contraindications, meditation/centering.
  • Please include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client/group.
  • Over time, we want to see something from each branch, selected, adapted and re-framed appropriately. Tools from each module should be used (not on each client/group – but overall)
The outline should show the sequence of practices as you plan to offer them.
Your care plan proposal should be approved by the mentor before session 2 if possible, or 3 if approval is delayed by mentor.
Session
Session Instructions (Not Mentoring)Your session outline should be a practice adapted to the needs of that client, including:
  • Check in, centering, balanced hatha yoga set considering contraindications, relaxation (with imagery as appropriate),
  • Balanced pranayama considering contraindications, meditation/centering.
  • Include at least one suggestion from Karma, Bhakti, Raja, or Jnana Yoga tailored for this client.
Over time, we want to see something from each branch, selected, adapted and re-framed appropriately.
Tools from each module should be used (not on each client – but overall)
Final Client/Group ReportAfter seeing your client/group (for at least 4 sessions including interactive intake)
Please remember practicum is a learning experience. You’ll learn more from sharing what’s accurate than from what might “look good”. Things you did well, not so well, problems and questions are all valid and useful tools to teach you. We can’t serve you to become the best clinician you can be if you don’t share your challenges and mistakes. Success is anything from which you learn. You can continue to add Session entries after submitting this Final Client/Group Report.
Report briefly on each Kosha belowProgress toward wellness or worsening reported by the client/group or that you observed in the following areas
Additional Information
Personal reflection from doing client/group.
Notify Mentor?Notify Mentor of Updates/Completion