• 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.

1. Three-part breathing daily up to 5 minutes
2. Kirtan Kriya daily 2 to 5 minutes
3. Movement of joints and spine, downward dog and tree pose with a chair.

The client has been diagnosed with chronic inflammatory response syndrome (CIRS). She has low energy and is fear of losing cognitive function.
• Check in
• Assessment – Neuro QOL- Cognitive function and Fatigue short form
• Centering – body and breath awareness
• Movement of neck and shoulders
• Lateral bend
• Table
• Cat-cow
• Leg lift and cross over then turn the head toward the hip
• Downward dog
• Mountain
• Half sun salutation (incorporate lateral bend and chest opening)
• Chair
• Stand on one foot (assessing balance)
• Tree, holding on to a chair
• Supine, knee to chest and hamstring stretch
• Cobra
• Prone, alternate arm and leg lift
• Head to knee forward bend (Janusirsasana)
• Seated forward bend
• Seated twist
• Savasana
• Three-part breathing
• Meditation – Kirtan Kriya

Yogic wisdom: being now and accepting what is

The average score for fatigue assessment is 3.4 (5 is always fatigue). Average cognitive function score is 2.3 (1 is having difficulty/cannot do). She described her decline in cognitive function (not remembering thing) as ‘part of a video record of her activities is missing and she just has to wait for it to come back to her.’ She has difficulty or is confused about her medications. We discussed the Visual Contrast Sensitivity (VCS) test which is a non-specific test for neurological function. The test measures the ability to see at low contrast. According to the client doctor, it is a screen tool to exposure to toxic environment for individuals with CIRS. The client also mentioned that she has difficulty taking a deep breath and when she is excited (for good or bad reasons), she cannot get enough air that results in coughing.

I was planning to start with sitting on a chair, but the client would like to try sitting on the floor. Therefore, we started on the floor. The client did not have difficulty getting up and down and was able to do all, but the child pose, without any difficulty. When we attempted the child pose, she mentioned that her knees did not allow her to go into the pose. We did not have any props to place between her thigh and lower leg; so, we skipped the pose. I forgot to ask about her knee before I left, but I sent a follow up email to specifically ask whether she has had injuries or arthritis of one or both knees. I will make sure that we have sufficient props for the next class. Her balance is not solid, especially when standing on her left leg. However, she could do the tree pose with one hand holding on a chair with no problems. I did research on VCS and contrast sensitivity and found that contrast sensitivity can decline with age (doi: 10.1371/journal.pone.0261927). I will find a way to (gently) suggest to the client as it can be another explanation if she continues to fail the test (the client is in her 70s). She could not completely relax during savasana; I should check with her next time on what would make her comfortable so that she can completely relax.

Citations:
Zhuang X, Tran T, Jin D, Philip R, Wu C. Aging effects on contrast sensitivity in visual pathways: A pilot study on flicker adaptation. PLoS One. 2021 Dec 31;16(12):e0261927. doi: 10.1371/journal.pone.0261927. PMID: 34972163; PMCID: PMC8719693.

I will continue to work with her on breathing, opening the chest and balance. I will try guided imagery, e.g., being in a garden which is something that brings her joy.