Teaching Yoga for Parkinson's Disease

As we often do with asana practice, let’s begin with the feet.

• Shoes: Typically, people enter a yoga studio and slip off their shoes. Probably without much thought, possibly while talking with another student, turning their cell phone ringers to silent, unzipping a jacket.
  
  Someone who doesn’t move with ease thinks about each step of the process to remove their footwear. A stroke survivor, for example, probably isn’t wearing slip-on shoes. And he’ll need both hands to get them off, one for steadying himself and the other to untie the laces. If only one arm is functional, he’ll need to lean against a wall, though it will still be a challenge to balance on one leg.
  
  This seemingly simple step – kicking off shoes – can cause stress to bubble up. Often, with chronic conditions, increasing stress results in increased severity of symptoms. A tremor will increase, muscle spasticity will intensify. In addition, the breath can become shallow.
  
  No yoga teacher would wish this for his or her students. Try adding benches or a few chairs (with arms) to your entryway. Wooden or metal chairs are easier to rise out of than soft, cushioned chairs. Try to keep a clear path to them and place them near the shelf or rug where shoes are stacked.
  
  A number of people wear devices in their shoes – orthotics, ankle supports, foot braces. An arthritic person with swollen feet or someone with MS may need to keep their shoes on both for the support and the proprioceptive signals they provide to the feet. Going barefoot in these cases may actually risk injury to tendons and ligaments in the feet.
  
  If you have several old mats or can collect a few from another studio, use these to make a path from the entryway to the area where class will be held. Shoes for some are yoga props that help with alignment and support just as blocks and belts do.




• Concurrent Classes: In many studios, several classes occur simultaneously. The entryway can be alive with yoga students of all levels arriving for class or just coming from one. Maneuvering through a crowd is cause for anxiety. Someone brushing by could throw off balance. Not being able to see the floor in front of them could be disorienting.
  
  Rather than scheduling classes back-to-back, try to include a five- to ten-minute window between. If that isn't possible, set up a few chairs in a corner for students to sit while the crowd clears.




• Rugs: It’s best to remove area rugs that can bunch up or slip around. A person whose balance is challenged by Parkinson’s, for example, is already on the alert for any obstacles. She might catch a toe on the edge of an unsecured carpet, stumble on a fold or wrinkle in a rug.
  
  
  

• Props: In addition to practicing near a wall, chairs (yoga chairs or folding chairs), bolsters, blocks, blankets, and straps are essential supports and props. Other useful tools are light weights (sandbags or rice-filled bags) and eye pillows. For example, light weights can help, especially during savasana, with dystonia in the legs, arms or torso. Eye pillows are useful beyond laying over the eyes. Placed in the palm, they can help ease dystonia or cramping in the hands and can calm at-rest tremors. In colder weather, place the eye pillows near a heat vent before use for a special touch.




• Mat Placement: Whenever possible, allow plenty of space between mats. Should someone take a tumble, they’re not falling on someone else, causing a domino effect. Mats placed in a circle rather than rows can help. The circular configuration can also create an inviting and inclusive sense of community, which can be uplifting to any student’s spirit.




• Music: Whether to play music and what variety of music to play are open to opinion and preferences of the teacher, yoga style, and students. When working with students with restricted mobility, however, please consider whether the music will help or hinder their practice. With a senior class, for example, there may be hearing concerns and music may be a distraction. On the other hand, studies show that following a rhythm may aid movement in a student recovering from a stroke or who has a movement disorder such as Parkinson's.2
  
  
  

Relaxation can take place on the chair. For added comfort, the student may like a second chair to put his feet on. Or, place a bolster lengthwise on the second chair and the student can lean into a modified child's pose.

For students who do recline on the mat, supports are essential to comfort. Blankets on the mat before moving into savasana adds padding. This is helpful to those with movement disorders who cannot easily adjust when uncomfortable. Bolsters under knees, legs up on the chair, or simply a folded blanket as a pillow to keep from overextending the front of the neck are all useful. A recent India study on the benefits of yoga for Parkinson’s highlighted supta boda konasana as an effective pose.3

• Additional Supports: Provide blankets. If class size allows, lay the blanket over each student after they are in repose. With certain conditions, such as MS, body temperature regulation is affected and cooling off may happen quickly or not at all. Struggling to cover up after starting to relax could cause the body to heat up again and relaxation to dissipate.
  
  It's also helpful to guide the relaxation. Verbally stepping through a body scan can provide “letting go” cues for people whose internal messages to do so are blocked, such as with dystonia or stroke.
  
  
  

Students may need a few extra minutes coming out of relaxation. Physically, they may want to use a chair to help them stand. Or, they may want to sit a few moments to allow their bodies to gear up for moving.

It may be somewhat disorienting coming out of relaxation pose. Not having back-to-back classes helps in this situation, as can that separate corner with chairs set up. This may be an ideal time to play music, whether or not it is played during class. Choose pieces with a clear, mid-tempo beat. The external rhythm can help cue motion.

By bringing our awareness to the needs of this population of students, we can create an inviting, comfortable environment that extends from the moment they enter right through to the time they step back out the door.

*Download a useful checklist to make your studio user-friendly for all abilities.

References

• National Institute of Health: National Center for Alternative and Complementary Medicine: National Health Interview Survey 2008. Updated May 6, 2010.
• Anderson, P., Music Improves Motor and Nonmotor Symptoms in Parkinson's. MedScape Today, July 2011
• Parkinson’s Disease & Movement Disorder Society. Mumbai, India.