Stephanie's physical activities are impacted by multiple chronic conditions, including Stiff Person Syndrome, osteoarthritis, osteoporosis, spinal and cervical stenosis, and bronchiectasis. She experiences chronic pain, disrupted sleep, waking up multiple times at night due to muscle spasms, and fatigue, leading to poor general health and inconsistent mobility. She used to practice more physically demanding yoga but now finds it challenging due to her conditions. She has difficulty balancing and avoids poses like shoulder stands and headstands due to neck and spine issues.
She could do Tree Pose but cannot stay standing with her hip externally rotated. However, she can lift her knee up in a hip flexion position
She is under pain management including Botox, heat, yoga, breathing, meditation, physical therapy, and medications. Yoga therapy can focus on pain management, and improving mobility through gentle movements to accommodate her physical limitations.

Stephanie’s energy level and quality of sleep are very low due to chronic conditions. She experiences frequent nighttime spasms and muscle cramping, leading to disrupted sleep and chronic fatigue. Although she practices yoga, mindfulness, and breathing techniques, her energy remains low, and her breathing is generally shallow. Improving her sleep quality, boosting energy levels, and promoting deeper, more effective breathing techniques are very important.

Stephanie's mental kosha is significantly affected by high stress from her chronic health conditions and her adult son's mental health challenges. She feels isolated due to poor health and struggles with a sense of purpose.
She has a history of major depressive disorder and manages stress through yoga, mindfulness, breathing techniques, and 12-step programs. Despite feeling discouraged, she maintains some resilience through spiritual practices. Reducing stress, improving emotional support, and enhancing coping mechanisms to improve her emotional well-being are important.
She was not fond of chair yoga before, but she realized that she could not do some of the poses. Now she seems to be accepting it when I suggested chair yoga. This indicates that she is capable of detaching from the past and enjoying activities within her limitations.

Stephanie is familiar with yoga from past experiences with Integral Yoga NY and retreats at Ananda Ashram.
Her spiritual practices include daily prayer, meditation, chanting and yoga practice, although physical yoga practice is limited due to her health conditions. Despite her chronic health conditions and feelings of isolation, she values healthy eating, lifestyle, and gratitude. Her spiritual practice helps her maintain resilience. She enjoys Hindu chanting and follows Krishna Das. She mentioned she practiced yoga at IYI New York.
She wants to reconnect with a community and find a sense of purpose, finding and joining a community where she can interact with others are very important for her.

Even though her physical, energetic body is heavily impacted by her health condition, she is active and engaged through reading scientific studies and learning new skills like using an Instant Pot and setting up a business. She is interested in exercises to alleviate her physical symptoms. She demonstrates resilience and a desire to stay intellectually active. Her willingness to learn how to reduce physical symptoms will help to improve her physical, mental and intellectual level.

What?
Pratyahara is translated as sense withdrawal.
Bhagavad Gita 2.58 “When one can withdraw the senses from sense objects, like a tortoise draws within, one’s wisdom is unwavering”

5.27-28 “By withdrawing attention from external things, mentally focusing back between the eyebrows and equalizing the in and out breaths, thus you control the mind, sense ad the discerning intellect.

Why?

Stephanie is experiencing physical and emotional pain due to her physical conditions and her
son’s mental conditions. Focusing inward can help shift her attention away from the physical sensations of pain. This redirection can reduce the intensity of pain perception, providing relief from her chronic conditions. Stephanie is my student in the Happy Joints (JAPA) class. She mentioned at the assessment session, JAPA is helpful because I can isolate the area and focus on a particular joint to
exercise. I believe she will be able to isolate her pain and redirect within.

How:
I will use the technique of body scan as a guided meditation practice, observing any sensations, tensions, and pain without judgment, which helps withdraw her mind from external stimuli and direct it inward. I will start with 15 15-minute body scan at the end of the session to help her to learn how to redirect her thoughts away from pain.
Also I will offer guided imagery, this mental escape practice provides her a break from pain, and promotes relaxation physically and mentally.

What?

JAPA (Joint Release) and gentle movement

https://www.mayoclinic.org/diseases-conditions/arthritis/in-depth/arthritis/art-20047971#:~:text=A%20member%20of%20your%20health,Strengthening%20exercises

Why?

Exercises for arthritis might include exercises that put joints through their full range of motion and strengthening exercises.

In a small study among elderly females, participants experienced reductions in pain interference and improvements in energy and social functioning.

https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-020-01818-y

How?
I will lead a joint movement practice (JAPA) as a warm-up before moving into gentle movements. She liked JAPA and described that it allowed her to isolate each area and focus on working on her joints. Due to her osteoporosis and cervical herniation, great attention is needed especially her neck and spinal movements.

• 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.