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Naveen K.V Ph.D., Swami Vivekananda Yoga University Bangalore, India Derived from the Latin word "rehabilitare" meaning to make fit again. CAN THE BRAIN CHANGE ? GENETIC (Nature) EXPERIENCE (Nurture) Birth 15 months 2-3 years Nutrition Environmental stimulation Learning Social contact …… & Yoga ( which includes all the above) 1. Yogah cittavrtti nirodah Yoga is the process of gaining mastery over mental modifications Patanjali’s Yoga Sutras 1:2 2. Manah prasamanopayah yogah ityabidheeyate Yoga is the skill to calm the mind Yoga Vasista 3. Samatvam yoga uchyate Yoga is equilibrium Bhagavadgita general pain, back and neck pain, carpal tunnel syndrome, headaches, fibromyalgia, multiple sclerosis, epilepsy, muscular dysfunction, stroke, Parkinson disease, and attention deficit-hyperactivity disorder Neurology. 2008 ; 70(24): 2321-8. Yoga Therapy as an evidence based science in the management of: 1. Multiple Sclerosis 2. ALZHEIMER’S Disease 3. Epilepsy 4. Parkinson’s Disease 5. Stroke 6. Carpal Tunnel Syndrome 7. Chronic Pain An auto-immune mediated progressive demyelinating disease of the CNS The myelin sheath is destroyed and replaced by sclerotic tissue (sclerosis) CAUSE- unknown Multiple factors- viral infection, environmental factors, geographic location and genetic predisposition Common in WOMEN ages 20-40 PATHOPHYSIOLOGY Sensitized T cells will enter the brain and promote antibody production that damages the myelin sheath Plaques of sclerotic tissues appear on the demyelinated axons interrupting the neuronal transmission PATHOPHYSIOLOGY The most common areas affected are Optic nerves and chiasm Cerebrum Cerebellum Spinal cord CLINICAL MANIFESTATIONS 1. Visual problems such as diplopia, blurred vision and nystagmus 2. Motor dysfunction 3. Fatigue 4. Psychological problems like mood swings, depression 5. Spasticity DIAGNOSTIC TESTS 1. MRI- primary diagnostic study 2. CSF Immunoglobulin G Nine review articles and two original studies Six months of IyengarYoga improved the symptoms of fatigue (1) Three months of integrated yoga module reduced muscular rigidity (2) A specialized yoga module for the elderly has improved gait, balance and mobility in a geriatric population (3, 4) 1. 2. 3. 4. Neurology. 2004 Jun 8;62(11):2058-64 Proceedings of API. 1999; 29-30 Med Sci Monit. 2007 Dec;13(12):LE19-20. Arch Phys Med Rehabil. 2005 Sep;86(9):1830-7 Yoga Interventions 1. Promote physical mobility Sukshma Vyayama, Breathing exercises Asanas with support Schedule activity and rest periods Yoga Interventions 2. Prevent injuries Improve the gait and Balance Wide stance walking The Practices Baddha Konasana strech (assisted) Pavanamukthasana kriya (assisted) 3. Enhance bladder and bowel control Set a voiding schedule Adequate fluids, dietary fibers and bowel training program Yoga practices: Satvic Diet Yoga kriyas (gaining voluntary control over involuntary functions) 4. Manage speech and swallowing difficulties Speech therapy & Carefully feeding Yoga practices: Chanting (nadanusandhana) 5. Improve Sensory and Cognitive function For diplopia Offer emotional support by involving the family in the care Yoga practices Trataka Pranayama Bhakthi yoga Philosophy of yoga 6. Strengthen coping mechanism Alleviate the stress Yoga Practices: Chanting Meditation Relaxation techniques ------------------------------------------------------- A progressive neurologic disorder that affects the brain resulting in cognitive impairments CAUSES: Unknown Potential factors- Amyloid plaques in the brain, Oxidative stress, neurochemical deficiencies CLINCAL MANIFESTATIONS 1. Forgetfulness 2. Recent memory loss 3. Difficulty learning 4. Deterioration in personal hygiene 5. Inability to concentrate LATE CLINICAL MANIFESTATIONS 6. Difficulty in abstract thinking 7. Difficulty communicating 8. Severe deterioration in memory, language and motor function 9. Repetitive action- perseveration 10. Personality changes DIAGNOSTIC TEST Neurologic examination PET scan EEG, CT and MRI Other tests to rule out Vit B deficiencies and hypothyroidism Autopsy is the most definitive Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005381 Sahaja yoga improves neurocognitive functions in patients with major depression 1 Pranayama improves verbal and spatial memory scores 2 Combination of aerobic exercises and yoga improved cognitive and psychological functioning in the elderly 3 1. Psychol Rep. 1997 Oct;81(2):555-61 2. Indian J Physiol Pharmacol. 2006 Oct-Dec;50(4):375-83 3. J Gerontol. 1991 Nov;46(6):P352-61 Yoga Interventions aims at improving: 1. Physical well being 2. Cognitive functioning 3. Communication skills 1. Physical well being: improve mobility Passive sukshma vyayama Simple asanas in sitting (with props) Group practice 2. Cognitive functioning Nadanusandhana Pranayama Supported by physical activities 3. Establish an effective communication system 1. 2. Use simple sentences, words and gestures Use of Mudras, Chanting syllables ------------------------------------------------------------------- A slowly progressing neurologic movement disorder The degenerative idiopathic form is the most common form CAUSATIVE FACTORS: unknown Potential factors: genetics, atherosclerosis, oxidative stress, viral infection, head trauma and environmental factors Pathophysiology Decreased levels of dopamine due to destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia Clinical symptoms do not appear until 60% of the neurons have disappeared CLINICAL MANIFESTATIONS 1. Tremor- resting, pill-rolling 2. Rigidity- cog-wheel, lead-pipe 3. Bradykinesia- abnormally slow movement 4. Dementia, depression, sleep disturbances and hallucinations 5. excessive sweating, paroxysmal flushing, orthostatic hypotension Forced exercise improves manual dexterity and other motor functions (1) Exercise can influence the reduced balance and leg muscle strength and freezing of gait and hence prevent falls in PD patients (2) Taichi improved balance and mobility (3) Neurorehabil Neural Repair. 2009 (ahead of print) BMC Neurol. 2009 Jan 22;9:4 Gait Posture. 2008 Oct;28(3):456-60 Yoga Intervention 1. Improve mobility 2. Improve Motor skills and enhance Self- care activities 3. Improving communication skills 4. Adopting coping strategies Yoga Intervention 1. Improve mobility Assisted balancing postures Lower limb and hip strengthening practices ▪ Uattana padasana, vakrasana (modified), lumbar stretch, cycling in supine Attention and concentration ▪ Pranayama and chanting Improve Motor skills and enhance Self- care activities Sukshma vyayama – shakthi vikasaka practices Mudras Pranayama Improving communication skills And Coping strategies Breathing and awareness Cyclic meditation (modified) Relaxation techniques --------------------------------------------------------- A group of syndromes characterized by recurring seizures CAUSES 1. idiopathic 6. brain tumors 2. Birth trauma 7. head Injury 3. perinatal infection 8. metabolic disorders 4. infectious disease 9. CVA 5. ingestion of toxins Recurring seizures may be classified as GENERALIZED or PARTIAL SEIZURES Generalized Seizures- cause a generalized electrical abnormality within the brain Partial seizures- these seizures arise from a localized part of the brain and cause specific symptoms 1. General Tonic-Clonic seizure- (Grand mal) characterized by loss of consciousness and alternating movements of the extremities 2. Absence Seizure (Petit mal)- common in children, begins with a brief change in the LOC, indicated by blinking, rolling of eyes and blank stares 3. Myoclonic seizure- characterized by brief, involuntary muscular jerks of body extremities 4. Akinetic seizure- general loss of postural tone and a temporary loss of consciousnessa drop attack 1. Simple partial seizure- typically limited to one cerebral hemisphere 2. Complex partial seizure- begins with an aura, then with impaired consciousness, with purposeless behaviors like lip-smacking, chewing movements DIAGNOSTIC TESTS 1. EEG 2. CT 3. MRI 4. LP 5. Angiography Yoga a commonly used CAM in the management of epilepsy (1) yoga meditation protocol (YMP) was useful as an adjunctive treatment in patients with drug-resistant chronic epilepsy (2) Studies on sahaja yoga and epilepsy - reduced level of stress and seizure frequency (3) 10 weeks yoga program modulated the autonomic balance and reduced seizure frequency (4) 1. Curr Neurol Neurosci Rep. 2006 Jul;6(4):347-53 2. J Altern Complement Med. 2006 May;12(4):367-71 3. Appl Psychophysiol Biofeedback. 2000 Mar;25(1):1-12 4. Epilepsy Behav. 2008 Feb;12(2):245-52 Yoga Intervention Ability to manage triggering stimuli Stress management and Coping strategies Managing a triggering stimuli Meditation and pranayam – helps de-focussing Strategies such as attend and ignore would facilitate Pratyahara the best tool in yoga Stress management and coping strategies Regular integrated yoga practice Asanas, Pranayama, Meditation, Kriyas and Relaxation techniques -------------------------------------------------------- A Rapidly developing loss of brain function(s) due to a disturbance in the blood supply to the brain. CAUSATIVE FACTORS: This can be due to ischemia (lack of blood supply) caused by thrombosis or embolism or due to a hemorrhage Modifiable risk factors Advanced age, Hypertension (high blood pressure), Previous stroke or transient ischemic attack (TIA), Diabetes, High cholesterol, Cigarette smoking and Atrial fibrillation Symptoms Early recognition: Sudden-onset of face weakness, arm drift, and abnormal speech Based on the area of the brain affected: Hemiplegia and muscle weakness of the face Numbness Reduction in sensory or vibratory sensation Trouble walking Altered movement coordination Vertigo and or disequilibrium Associated symptoms: Loss of consciousness, headache, and vomiting Pathophysiology loss of blood supply to part of the brain, initiating the ischemic cascade Infarction of the affected brain tissue Brain tissue ceases to function Diagnostic tools neurological examination, CT scans (most often without contrast enhancements) or MRI scans, Doppler ultrasound, and arteriography A slice of brain from the autopsy of a person who suffered an acute middle cerebral artery (MCA) stroke CT scan showing an intracerebral hemorrhage Kundalini yoga practice of 12 weeks showed an improvement in aphasia as well as in fine motor coordination in stroke patients (1) A Yoga-based exercise program was beneficial in people with chronic poststroke hemiparesis (2) Top Stroke Rehabil. 2007 Jul-Aug;14(4):1-8 Phys Ther. 2004 Jan;84(1):33-48 Offers variety of techniques to work at different levels viz. Physical Mental Social Emotional Spiritual Hence a comprehensive package involves the interaction between yoga therapy physician, therapist (PT), patients/clients, other health professionals, families, care givers, and communities Hence Yoga Therapy offers a Holistic Healing Experience