A Case Report of Therapeutic Yoga for Adrenomyeloneuropathy Charlene M
Total Page：16
File Type：pdf, Size：1020Kb
CASE STUDY Yoga as Therapy for Neurodegenerative Disorders: A Case Report of Therapeutic Yoga for Adrenomyeloneuropathy Charlene M. Muhammad, MSHM, RYT500, CNS, RD; Steffany H. Moonaz, PhD Abstract Yoga is a promising therapeutic modality for knees, and ankles; improved propulsion phase of neurodegenerative diseases. This case study presents a walking; and improvement in the patient’s ability to therapeutic yoga protocol for adrenomyeloneuropathy stand and balance without an assistive device. The effect (AMN) and its effect on a patient’s quality of life (QOL), of yoga therapy on the patient in this case study aligns agility, balance, and peripheral dexterity. A 61-y-old with current QOL improvements noted in current man diagnosed with AMN who was experiencing (1) research on yoga therapy for neurological disorders. peripheral neuropathy in his legs and feet, (2) lower- The described concepts and methods of employing back pain (LBP), and (3) osteoarthritis received 60-min therapeutic yoga provide insights for clinicians into a weekly therapeutic yoga sessions for a 10-mo period. modality that is low risk and low cost and that can Yoga therapy included hatha yoga asanas (poses) and support individuals with other neurological disorders, pranayama (breathing exercises). Hatha yoga asanas such as multiple sclerosis (MS), fibromyalgia (FM), and were aligned with 7 Berg Balance Scale (BBS) indicators diseases of the peripheral nervous system. Further study to measure improvement in balance and range of is warranted to help determine the safety and efficacy of motion. The 10-mo course of therapeutic yoga resulted yoga therapy for these conditions. in improved LBP; improved flexion of the patient’s hips, Charlene M. Muhammad, MSHM, RYT500, CNS, RD, is a arthritis (RA)—noted significant improvements in private practitioner in Columbia, Maryland. Steffany H. functional outcomes, particularly reduced pain and Moonaz, PhD, is an associate director of integrative increased agility.2 health services at Maryland University of Integrative Although current research supports yoga as one of Health in Laurel, Maryland. several complementary and alternative medicine (CAM) modalities that are indicated for neurological disorders,3 each modality is unique in its approach and potential Corresponding author: Charlene M. Muhammad, MSHM, benefits. It is outside the scope of this article to discuss all RYT500, CNS, RD CAM modalities and their effect on neurological disorders; E-mail address: [email protected] however, this case report offers a discussion about the ways that yoga can affect QOL for people living with neurodegenerative conditions. Various styles of yoga exist, some of which may not he practice of yoga as self-care for improved prove beneficial for certain medical conditions. Yoga quality of life (QOL) is gaining popularity. The practices that emphasize continuous and rigorous therapeutic use of yoga as a complementary movement (vinyasana, or “flow”), practicing in extreme Thealth modality for neurological disorders, such as heat (bikram, or “hot” yoga), or repetitious intense multiple sclerosis (MS), fibromyalgia (FM), and diseases breathing (kundalini, or “breath-of-fire” practice) may be of the peripheral nervous system is the subject of contraindicated for clients or patients with neurological multiple research studies and clinical trials.1 A meta- health challenges.4 Gentle or therapeutic yoga styles, with analysis of yoga therapy for musculoskeletal conditions— appropriate modifications individualized for a client or including FM, osteoarthritis (OA), and rheumatoid patient’s abilities, are more suited.4 Muhammad—Yoga for Adrenomyeloneuropathy Integrative Medicine • Vol. 13, No. 3 • June 2014 33 The practice of yoga therapy requires extensive training physiological and behavioral changes.9 Although the authors beyond the recommendations for training to teach general were unable to find any published reports on yoga therapy yoga classes. In 1999, the Yoga Alliance (YA), an organization and AMN, the symptoms of AMN are similar to other dedicated to yoga outreach and education in the United neurological disorders such as MS, FM, and diseases of the States, established recommended standards for yoga peripheral nervous system for which greater evidence exists teachers and yoga teacher-training programs.5 The YA for yoga’s potential therapeutic effects.1 accepts yoga teachers as registered members with a minimum of 200 teacher training hours (RYT200). Case Report Registered members may also gain an experienced teaching Zach is a 61-year-old male with AMN. Zach’s AMN status when 1000 or more teaching hours have been symptoms had been slowly progressing for 40 years, and recorded (eg, E-RYT200) and when additional teacher he was formally diagnosed with AMN at age 35. Zach had training hours have been completed (eg, RYT500).6 experienced sensory losses in his legs and feet; lower-back In 2012, the International Association of Yoga pain (LPB); OA in his hips, knees, and ankles; and Therapists (IAYT) implemented educational standards for deafness in his right ear. He had also been diagnosed with training yoga therapists.7 IAYT educational standards scoliosis and bipolar disorder. His current daily include 5 core areas of competency: (1) yoga foundations, pharmaceutical regimen included hydrocortisone and (2) biomedical and psychological foundations, (3) teaching prednisone steroids; antispasmodic baclofen, administered and therapeutic skills, (4) yoga therapy tools and their via intrathecal pump by barbotage; lovastatin for high applications, and (5) professional practice.7 Each of the cholesterol; the antidepressants bupropion and venlafaxine; competencies has additional categories of educational and over-the-counter glucosamine/chondroitin. requirements that include knowledge of human anatomy In the 10 years prior to Zach’s introduction to yoga and physiology; biomechanics and movement; therapy, additional treatment strategies had included pathophysiology; contraindications of yoga practices for (1) 2 trials of an experiential drug protocol for Lorenzo’s specific conditions and circumstances; common medical Oil, a 4:1 mix of oleic acid and erucic acid10; (2) 2 courses terminology; referencing current health care information; of physical therapy for 8 weeks; and (3) periodic and ethics in practice, as well as in-depth knowledge of the acupuncture treatment. range of yoga practices and their potential therapeutic Despite the challenges of AMN, Zach maintained an effect for common conditions.7 active lifestyle. He walked with his dogs using a sled-type IAYT defines yoga therapy as “the process of walker in which he sat as the dogs, on leashes, pulled him. empowering individuals to progress toward improved Sitting on a set of skis, Zach also participated in skiing, health and well-being through the application of the tethered to another skier who guided him down the teachings and practices of yoga.”7 The organization further slopes. He and his wife Emma enjoyed traveling around explains that “the goals of yoga therapy include eliminating, the country and the world. reducing, or managing symptoms that cause suffering; Zach and his wife Emma were first introduced to improving function; helping to prevent the occurrence or yoga by attending a local yoga class. Emma’s devotion to re-occurrence of underlying causes of illness; and moving Zach was displayed by her constant encouragement toward improved health and well-being. Yoga therapy also during the class. The instructor, one of the authors, helps clients or students change their relationship to and noted that this particular class was too challenging for identification with their conditions.”7 Zach’s ability to participate. After class, recommendations The current case report is an example of the use of were made to Zach about using a chair or other props to yoga as therapy for a rare neurological disorder, better facilitate his participation in yoga. At Emma’s adrenomyeloneuropathy (AMN). Adrenoleukodystrophy request, private yoga sessions were established for Zach. (ALD) is a genetic degenerative disease that affects the central nervous system. ALD consists of a spectrum of Initial Observations phenotypes, including AMN, which vary in the age of Zach’s private sessions began in February 2013. From clinical presentation and the severity of the disease.8 These February to December 2013, approximately 44 weeks, conditions are known as the ALD/AMN complex. This 60-minute yoga sessions occurred once weekly. As usual, hereditary disease affects both males and females.8 private yoga therapy began with a review of Zach’s medical AMN causes demyelization of nerve cells, particularly history. Health challenges and lifestyle goals were along the spinal column. A person with AMN may determined through verbal discussion with Zach and experience gradual sensory loss in his/her lower extremities, observation of his movements. As is standard practice, this causing stiffness, weakness, or paralysis in the lower limbs; information was later integrated into a working assessment and ataxia, a lack of voluntary coordination of movement of Zach’s condition, limitations, and possibilities for that affects the ability to walk. Other symptoms include improvement.7 adrenal insufficiency (Addison’s disease); visual impairment; During an initial yoga session, observation helped the mild peripheral neuropathy; difficulty speaking; and other yoga therapist gain a sense of how Zach moved and 34 Integrative