| Entry Type | Assessment |
|---|---|
| Client/Group | KH |
| Entry Category | Case Study |
| Select your mentor | Steffany Moonaz |
| Intake | |
| Assessment | |
| Proposed number of sessions | 10 |
| Location of sessions | in person |
| Planned time per session | 90 |
| Presenting Problem | The client has a history of lower lumbar disk compression (bulging disk), now generally reduced flexibility, especially of the hips and knees. |
| Physical | lower back spasm and uncomfortable when standing and walking for a long period due to past injuries (bulging disk); reduced flexibility of the hips and knees. Noticed reduced range of motion of the neck and very tight inner thigh. Constitution - Pitta-Kapha |
| Client/Group goals | The client's goals are to improve flexibility overall, but especially in legs and lower back, improve muscle strength, particularly core and upper body/arms and improve muscle tone overall. |
| Energetic | Fatigue and low energy. |
| Emotional | Her overall stress level is low. However, she is frustrated with her physical body; not as limber, flexible or strong as she wants to be. |
| Spiritual orientation and needs | She is spiritual, but not religious. She studied (breathing and meditation) with a Tibet monk a long time ago. |
| Intellectual / Sense of self | Attachment to the past (wanting to be as active as when she was younger and future outcomes. She tends to push herself beyond her limitations. |
| Yoga philosophy/wisdom research reference(s) | 1. Yoga Sutra of Patanjali by Swami Satchidananda Book 2, sutra 5: Ignorance is regarding the impermanent as permanent, the impure as pure the painful as pleasant and the non-Self as the Self – The client identifies with her physical body and profession Book 2, sutra: 7: Attachment is that which follows identification with pleasurable experiences – The client attaches to her past (wanting to be strong and limber as when she was younger). From The Secret Power of Yoga- Embracing reverence and love for all (Ahimsa), we experience oneness – The difficult lesson for many of us is to learn to love and serve yourself first. The client often pushes herself beyond her limitation. Other wisdoms that can be applied here are Santosha (contentment) and Brahmacharya (the right use of energy). |
| Scientific research reference(s), why chosen, how you plan to incorporate 1-3 | 1. Yildirim P, Gultekin A. The Effect of a Stretch and Strength-Based Yoga Exercise Program on Patients with Neuropathic Pain due to Lumbar Disc Herniation. Spine (Phila Pa 1976). 2022 May 15;47(10):711-719. doi: 10.1097/BRS.0000000000004316. Epub 2022 Jan 11. PMID: 35019882. This is a single-blinded randomized, controlled trial. The study shows that yoga (12-week program, asana, breathing practice) reduces neuropathic pain as well as increases mobility, core muscle strength and flexibility after 6 months follow up in patients with lumber disk herniation. The paper also includes example poses, e.g., cat-cow, lunge, prank and tree pose. However, some of these poses will need to be adapted for my client, e.g., using a chair, for accessibility because of her limited mobility, flexibility and stamina. Contraindications include excessive flexion, extension and rotation of the lumbar spine. 2. Beazley D, Patel S, Davis B, Vinson S, Bolgla L. Trunk and hip muscle activation during yoga poses: Implications for physical therapy practice. Complement Ther Clin Pract. 2017 Nov;29:130-135. doi: 10.1016/j.ctcp.2017.09.009. Epub 2017 Sep 14. PMID: 29122250. The study used surface electromyography to quantify activation of core muscles during four yoga poses (chair, prank, upward dog and warrior 2 poses) and showed that prank activated rectus abdominis and abdominal oblique more than other poses, while Chair provided greater lumbar extension than other poses. Only healthy participants were included in the study. Upward dog is a contraindication for my client, because of her previous lower back injury. |
| Approval Notice | |
| Questions for Mentor | 1. When we practiced deep breathing, I noticed that the client did pursed-lip breathing as she was taught this way. Should I suggest that she breath in and out through her nose when we do three-part breathing? 2. The client is afraid of twisting (she injured her lower back when practiced seated twist in the past). I plan to start with supine twist and build the strength of her core and back muscles before introducing a gentle seated twist. Is this the right approach or should I just avoid seated twist entirely? 3. I found this paper that has a list of flexibility assessments. Do you think that it is a good idea to use some of them for assessment? |
| Care Plan | Outline should be a practice adapted to the needs of that client/group, including:
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:
Tools from each module should be used (not on each client – but overall) |
| Final Client/Group Report | After 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 below | Progress 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? | Do not notify Mentor (choose if you wish to continue working on this entry later) |
Admin – Practicum Workspace
