To The Other Side of Love and Back -- By Abigail Thouin

To the Other Side of Love and Back
By Abigail Thouin
 

How can I get to the other side to help my dad transition from this life to the next? I ask myself repeatedly, as I watch this mountain of a man sit slumped over with rounded spine in a wheeled chair.  Alzheimer’s sucks.
 
I know he is stubborn, he has always been a fighter. And, now he fights for his life and against, what I perceive to be, his fear of dying and of submitting and surrendering. A tall strong handsome man, oldest son of six sons and born to his German immigrant dad, Herman.  And, his Christian Scientist mother, Peg, who was adopted later in life as both her parents died suddenly.
 
My dad’s dream was to play professional baseball.  In 1959, Jack Schomer was #55 for the Chicago Cubs and was drafted from the minors up to the major leagues that spring.  His baseball card and team roster included the likes of Ernie Banks.  Dad was a right-handed pitcher; and his career, thrown away by a simple flip of a car in Colorado during spring training.
 
The diamond of the baseball field echoes and mirrors that of the solitaire engagement diamond on my mother’s hand; marquise cut to match that of his other beloved; the baseball field.
 
Dad and Mom formed a new team.  We grew up with Louisville sluggers and leather gloves in every corner of the house.  All 5 of us kids infielders, we played t-ball but, only my three brothers went on to play at Notre Dame, Brown and Yale. It was their passion.  Baseball stitched us together as a family.  None of my brothers made it to the major leagues like dad, well at least not in baseball. 
 
Back in the 1970s through the 1980s; Dad’s baseball scout and lifelong friend, Tony Lucadello was like a third grandfather who came to visit us regularly from Toldedo, Ohio.  He was a prolific storyteller.  Tony’s enthusiasm and love of the game was contagious.  He mentored all three of my brothers and their baseball careers.   He even guided me in my competitive tennis and gymnastics with his famous:   “hey, hey, hey” mantra with advice to be ready with a stance of weight on the balls of the feet to be agile and ready for both shortstop or volley on the tennis court.  Or, Tony's legendary advice to,  “Be the ball”.
 
In the 1980s, Tony had a writer by the name of Mark Windgardner, visit our family as he was gathering tidbits for Tony’s story in a later published book, the Prophet of the Sandlots. To this day, I get the book out and read it to dad and adlib the text stating,  “Jack Schomer had three sons: Jason, John and Lincoln" and, my edits of  ‘and two beautiful daughters’,  since the author, never mentioned Dina or I.  Dad laughs every time I read it because he knows, it was all about the boys.  Or,  was it?
 
German work ethic.  Dad.  Home plate: Corporate lawyer, father of 5 and loving husband.  Now, a shell of the man he once was.  Eyes blue and twinkling but, vacant.   Boxed in by his failing body, he is slumped and rounded and benched. 
 
I bargain and I plead as his first base coach and daughter.  How his hands tremble, as he chokes up on emotion and, no longer on the bat.  His tears fly like foul balls and, when his eyes finally do open with the faintest recognition of my voice, I call that a home run. 
 
And, Mom; her endearing love keeps him companion as she lives only one floor below him at Sunrise Retirement Community.  She reads to him daily as she holds his hand.  She throws him the softballs to include: Chicken Soup for the Dog Lover’s Soul, the Lord’s Prayer and a couple of jokes in hopes that he catches and absorbs what he needs.
 
The fact that Mom is even here today is a miracle.  University of Michigan doctors wanted to let her go back in 2008 after she endured a subarachnoid hemorrhage but, dad fought hard.  He coached us all by virtue of his actions on the power of never giving up on love.  We’ll never know the how’s and why’s of her miraculous recovery but, my inner knowing suspects dad did have something to do with it.  He dug her out with a sacrificial bunt or fly at the expense of his very own well-being.  He took one for the team.
 
Over ten hard years, I saw the fear in his eyes with the thought of losing his beloved wife of over 50 years, Gail.  I saw how his fight took flight in full force against any Power that would alter the course of his expectations that they would live a long and happy life together; a ball.  Years of back and forth in rehabilitation and other serious surgeries mom endured, Dad shouldered it all: for the love of the game.   Love is a gift.  A present. 
 
Dad’s right shoulder, injured in the car accident that took his pitching arm.  It is now convex as he has shouldered much in his almost 80 years.  I don’t think it is ironic that his second son, John was in a car accident after his freshman year at Brown which burned his right arm or, that my son, John during his wrestling match his junior year of high school caused a life-threatening injury to his dislocated right clavicle which required immediate surgery.  The right side.  Where all my current injuries and ailments reside.  Right peroneal tendonitis of the right ankle, right hypermobile SI joint and right plantar fasciitis; all are mending but, slowly.
 
Right, now; this is the side where we live. Our family curse?  Maybe. I pray for daily guidance.  How can I be of service and how can I help him transition back to home plate?  

How can I get to the other side of love and back?
 
My heart waits for the perfect pitch, as my hands hold onto the batting away of my tears as I attempt to keep my aerial view.  But, Dad you have always been my home plate, a constant.  My pillar of strength. And now, I stand over you crouching, shoulders slumped and rounded spine.  It is now me who is up to bat!  Will I swing and miss?  Or, will I knock it out of the park?   Run home, Jack!  Run home, dad!
 
How do I get to the other side of love and back? The baseball field consists of 4 bases:  home, first, second and third.  The path flows only one way.    From an aerial perspective, looking down, we see a diamond, 4 sides.  From home plate, we start off running to the right to reach first base in attempt of fulfilling our dreams.   Life happens, and so we divert and turn left to second base.   If we’re lucky,  we remain and run on the left trajectory from second to third and try to remember why, as we round the corner from third base to home plate, we left home in the first place!
 
Home plate, where we all begin and where we all end.  Life is like a baseball diamond.
Counterclockwise, we start off and run to the right until all there is - is love,  left.  Home plate. 
 
Perhaps the right sided injuries are in fact the very things that put our family back on course, to round all the bases with a final grand slam?
 
A baseball diamond and bases all have 4 lines like a box.  There are rules to this world and this existence.  Life is followed by death.  The Soul, like love,  is not confined to the boxy body.  It cannot be contained.
 
How do I get to the other side of love and back?  I know it is not solely through the body.  I understand but, I don’t have to like it.  My batting average isn’t all that great with the Official Scorekeeper but, in the Spirit of the Season, the answer lies within the Christmas gift, the box underneath the tree, packaged neatly with a bow and the tag reads:
 
The present.  Love is not a box.  There are no ins and outs.  No lover. No beloved.  And, corners like bases and shoulders, carry the wear and tear of this one-way journey home.  
 
As I spill out my contents from what seems to be from the inside out; I divulge my collective bargaining with God to take me first, if it is His will, so that I may be on the other side of love to greet my Dad when the time comes.  I will make the sacrificial bunt or fly to help him round the corner to home plate. 
 

No, love is not a box.  There is no inning or outing, only loving.  Where walls and lines fade as we stand and face who and what we are:  One team, standing in the face of love when ultimately that is all we have left.  Where sacrifice like fly balls float through the air.
 
Love is not a box. Love is not a diamond.   Love is a ball.  Love is a pitch.  Love is a catch.  In order to play the bases and the game, we have to be willing to let go of the ball and trust that someone will be there ready to play, to hit it, catch it,  and throw it back.  

 
Dad, I see now with the 4 corners of my imagination, how you, through your beloved game, bow and roll inward with your convex shoulders and spine as you implode into mantra and manifestation of your dear friend and mentor's words, “Be the ball”.  You are allowing yourself to roll with it and  transform one stitch of breath at a time as your skin, like leather softens and holds your circuitious and rolling breath..."Be the ball".....
 
I get it now.  I remember on the beach in Florida in March of 2016, when I prayed while walking the shore line for you to give me a sign.  The beach deserted.  I was looking down at my feet when what else, a baseball,  rolled inches away from my feet, I was ecstatic to look up and to see a father and son playing catch with a baseball.  It was a sign!   I am just now understanding that your message was beyond just the superficial baseball but, that your Soul is now beyond the battered body's box and,  beyond the corners of the baseball field.
 
And so I ask myself now....
 
How do I get to the other side of love and back to help you transition?  I catch you in my thoughts and write my pitch in an infinite game of baseball. You have, and continue to,  transition.  It was I that needed your coaching through  the wisdom and love of the game.

I'm not a first stringer.  But, you have always believed in me.   Together, we have made it to the majors.  Because life and love is a team sport; we roll with it.  "Be the Ball".... to the other side of love and back.
 
I love you Dad. 
 

 

On Aging by Maya Angelou

On Aging by Maya Angelou

84 year old "Moo" is a grandmother to nine active kids. She works very hard to stay active in their lives. She knows who their friends are, when they have a big test or job interview, and how to dance the night away! We all age differently. Some of us are more lucky than others. Moo is one of the lucky ones! Celebrate what you and your loved one can do, and celebrate the lovely things you remember about them.  Read more to see Maya Angelou's poem entitled On Aging. A beautiful poem about the realities of aging.

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Yoga for Brain Disorders Workshop and Class Plans

I had the privilege of assisting Dr. Nicole Absar with the Yoga for Brain Disorders Workshop held Oct 14 and 15, 2016. I helped with the yoga component, teaching yoga classes in the mornings and afternoons and helping with some poses during the workshop. I learned a tremendous amount, even though I had attended as a participant last year. There is always something new to learn. This year, I took the information I learned and created some class plans that you may be able to use for your students with mild to moderate dementia. If you find the classes helpful, please let me know how you used the classes and what worked, and what didn't work as well. Our group where I work is trying to create a resource library for yoga classes, and any input you have is helpful as we work together as a global community to create the best available to help this population. Please note the classes are the property of Integrace, but you are free to use the ideas and information in the spirit of benevolence.  Please keep in mind that this is a work in progress and your input is valued!

 

Yoga for Dementia:  A compilation of Four Class Plans for students with mild to moderate dementia for different moods

·       Feelin’ Good with Yoga (for good moods)

·       Don’t Worry, Be Happy (for sad/depressed/lethargic moods)

·       Free and Easy Yoga (for anxiety or nervous moods)

·       Re-Boot with Yoga (for anger and rage moods)

 

Class #1

Feelin’ Good with Yoga (for use when group appears to be in a good mood)

Breathwork options: cleansing breaths, belly breathing, visual alternate nostril breathing for those able

Asana options: Select poses that activate the hypothalamic-adrenal pathway (HPA axis to activate the parasympathetic nervous system) such as cat/cow, twists, heart opening and poses that enhance connections bringing balance between the cortico-limbic pathway (balancing the logical and emotional brains) such as sun salutations, warrior, mountain pose. Include poses that require cross-over and patterning/sequencing to build strength in the pre-frontal cortex (executive functioning).  Warm up with spinal flexibility poses and then move to poses that cross over the midline to enhance neuron connections between hemispheres of the brain, include heart openers to access the heart chakra (anahata) for building self-esteem, enhancing love of self and compassion for others.

Center/Theme: “ I know who I am, I am enough, I am strong”.

Cleansing breath:  Take a full breath in through the nose, exhale anything you don’t need. Breathe in feeling self-confidence, exhale anything that you just don’t need (self-doubt, negative self-talk)

Sequence: warm up

·        Seated mountain pose: 10 breaths—count them. Feel settled in! It’s time to FEEL GOOD!  Mountain pose accesses the Root chakra, Muladhara, feeling grounded and connected, a sense of belonging.  Activates Cortico-limbic pathway.   Mantra: “I am enough”

·        Neck stretches: Throat Chakra: Mantra: “I know who I am”.  Accesses sense of clarity, intuition.

·        Crescent: stretches side body for improved Cardio pulmonary function, enhanced lymphatic flow

·        Twist:  Hypothalamic-adrenal autonomic pathway: Solar Plexus: personal power, expansiveness, growth.  Mantra: “I am Strong, Stable Secure and Balanced”.

3 Poses (cross over and balance to maintain good feelings of well-being)

·        Heart opening: cat/cow activates the PNS for greater sense of well-being

·        Eagle pose: cross-over pose to enhance neuron connections on both hemispheres for balance

·        Opposite arm/leg: contralateral movement for patterning, executive function, connecting the cerebellum with the frontal lobe

Visual Alternate Nostril breathing: rather than using the fingers to plug the nostrils, the instructor walks the student through a visual tour of the inner landscape of the  body starting with finding the natural breath then exhaling out the left nostril and inviting the breath to travel all the way down the left side of the body toward the toes, then inhaling through the left foot and taking the breath back to the third eye and exhaling out the right nostril or right side of the body and so forth.

Meditation Song:  Happy  by Pharrell Williamshttps://www.youtube.com/watch?v=y6Sxv-sUYtM

 or Make Someone Happy by Jimmy Durante https://www.google.com/webhp?sourceid=chrome-instant&ion=1&espv=2&ie=UTF-8#q=make%20someone%20happy%20song

Savasana: End with Loving Kindness meditation: May you and I be happy, May you and I be at Peace, May you and I be safe, May you and I be surrounded with love.

 

Class #2

Don’t Worry, Be Happy Yoga (for use when group seems lethargic, sad or depressed)

Breathwork options: Breath of Joy:  describe as sniff, sniff, sniff and Blow out a candle to access HPA axis, breath with longer inhalation and shorter exhalation to energize the mind and body.

Pose options:  Heart openers to tap into the Heart chakra and gentle back bending  to tap into the lower back for PNS activation, sun breaths to open the chest to receive more breath, reach the arms above the heart to improve cardiovascular activity, camel pose to activate the HPA axis, polka dance to bring in energy and joy and to enhance executive function with sequence and patterning movement. Pose such as cat/cow offers a balance between heart opening and folding inward and taps into the hypothalamic-adrenal axis helping to activate the PNS to reduce depressive symptoms.

Start with dancing:  Polka: Heel toe 4x each side. Clap x8, cross over and tap shoulders x8, tap thighs x8, clap x8 then repeat until song is over.  Frankie Yankovic: Hoop Dee Doo Polka https://www.youtube.com/watch?v=YXtHyydM5Ac

Breathwork: Breath of joy

Mantra:  “I am free to be who I am”

Asana Sequence:

·        Mountain pose: Repeat mantra “I am free to be who I am”.  Questions to ponder:  What do you love about yourself, what talents do you have, what are you proud of?  Invite students to state their  name and then say I love you.

·        Cat/cow with heart opening breath (interlace fingers, place under chin, Inhale: lift elbows, Exhale, press palms out and extend elbows, round back body, chin to chest. Inahle: lift arms overhead, press out through the palms toward the ceiling, lengthen spine, Exhale: release hands and interlace behind your back, press into your sacrum, Inahle: lift your heart, Exhale: hands to your heart. Activates HPA axis, opens heart for sense of confidence, self-esteem.

·       Belt Flow: standing start with fast tapping of belly slapping with both hands quickly for up to 1 minute then move hands to back, fingers pointing down, to back of legs, inside of legs and up front of legs, do this several times bending down and back up.  Grounding and connecting, forward folding stimulates blood flow to tissues and to heart and head.

·       Letting Go Pose--Inhale while raising arms overhead and raise up off heels, exhale with audible HA breath, drop heels and hands. Notice and feel your feet on the floor. Inhale, and move arms out to side with heels lifting, then exhale with audible HA, lower arms down and lower heels. Inhale, and raise arms shoulder height in front of body, lift heels, Exhale with audible open mouth HA and lower arms and heels. Repeat x2-3 sequences. Cleansing breaths to release carbon dioxide.

·       Infinity sign big sideways figure 8. Cross -over helps balance both sides of the brain.

·       Camel pose: hands on hips, lift heart. Return to neutral pelvis, repeat x3 activates HPA axis, stimulates activation of the PNS.

Meditation song:  Let It Go by James Bay    https://www.youtube.com/watch?v=GsPq9mzFNGY              Or Let it Be by The Beatles https://www.youtube.com/watch?v=QQ3tlLq_Z14

Savasana:  End with Jack Kornfield’s interpretation of Buddha: In the end only 3 things matter, how much you loved, how gently you lived, and how much you were able to let go of what was not meant for you.  Namaste

 

Class #3

Free and Easy Yoga (for use when group seems anxious or nervous)

Breathwork options: Lengthened exhalation such as breath to count of 4-5-8 extended exhalation to activate PNS. Inhale count of 4, hold for count of 5, exhale for count of 8 or something in this ratio

Asana options:  grounding poses to help the person get reconnected with their body, calming forward folds, sun breaths with slow exhalation, hip openers to activate the PNS, 7 shakes to shake off anxiety

Mantra:  “Letting go I can be free”

Start with dancing: Free dancing to: Don’t Worry, Be Happy by Bobby McFerrin to energize a lethargic/sad group https://www.youtube.com/watch?v=d-diB65scQU   or

Sequence

·        7-shakes: shake it off:  start bringing awarenss to the right hand, and shake it 7 times, then move to the left hand, shake 7 times, then the right foot, shake 7 times then the left foot, shake 7 times. Then do each 6 times, then 5 times, etc… until you are shaking everything just once. Then shake all over! Active pose that keeps the mind busy counting out loud and gives the body a release of anxiety, shake it all off!

·        Leg extensions with ankle circles (grounding). Go back and forth at least 3 times with each leg, sing a song or listen to quiet spa music so student can become quiet and feel grounded as this action creates a sense of calm.

·        Forward fold to activate the pre-frontal cortex of the brain. Connect movement with the breath, Inhale lift and lengthen the spine, exhale fold forward, supporting self with hands on the thighs. Repeat up to 5-6 times. Meditative movement.

·        Hip circles to loosen up the hip joint to prepare for pigeon prep pose with the block. PNS activator

·        Pigeon pose with block. Place the block on the inside edge of the right foot. Flex the left foot and invite the left knee to go out to the side as you place the pinky toe side of the left foot onto the block (supported by the right foot and leg). Keep the foot flexed to protect the knee. Inhale fully, and exhale releasing the left knee toward the earth. Then inhale, lengthen the spine, exhale, hinge forward from the hip crease keeping the spine long and the head in line with the spine. Inhale lift back up and repeat 2-3 times. Some students may be able to place the ankle on the opposite knee, but only if the spine is not compromised by rounding. Activates Hypothalamic-Adrenal pathway to invite a letting go of anger.

Meditation song: spa music with simple progressive relaxation http://chs.utep.edu/wellness/wp-content/uploads/sites/8/2015/01/Progressive_Muscle_Relaxation.pdf

Savasana: Remember how very much you are loved. (Yoga Sutra) Namaste

 

 

Class #4

Re-Boot with Yoga (for use when group seems angry and needs to re-boot)

Breathwork options: 3-5 cleansing breaths and 10 slow exhalation breaths to activate the PNS

Poses: punching, sun breaths, marching to get out energy, hip openers, chair dancing with scarves if possible

Mantra :  “I am calm”

Activate Vishudda: throat chakra: chant Sa Ta Na Ma or Do re me fa so la te do. Throat chakra governs communication, independence, fluent thought and sense of security.  Chanting OM for extended emphasis on MMMM stimulates the auricular branch of the vagus nerve for enhancing calm

Sequence:

·        Seated mountain pose: activate Muladhara to feel rooted and enhance feeling of control, survival and protection. Mantra: “I am calm”  Chant: OMMMMMM OMMMMM OMMMMMM

·        Sun breaths x10- Inhale self-control, exhale anger. Inhale Calm, exhale frustration, Inhale Calm, exhale letting go

·        Punching front, diagonal, high, low

·        Forward fold for calming: activates Pre-frontal cortex pathways

·        Twists: activate manipura: solar plexus. Key issues governed by 3rd chakra are issues of personal power, fear, anxiety, opinion. Twists activate the HPA axis.

·        Hip circles for activating the PNS

Meditation song: relaxing spa music, Cannon in D

Savasana: Namaste

The Lesson

This is what teaching yoga to those with dementia has taught me:

1. Our students are our greatest teachers.

2. There are a lot more broken shells than perfect ones and the broken shells are much more interesting.

3. Kindness in innate. People learn how to be mean.

4.  Never hold a grudge.

5. Live only in this precious moment.

6. Second and third and forth chances are all ok.

An Unexpected Sadness

I had just finished teaching a class with a group of residents with moderate to severe dementia. We had a fun and energetic class and I was feeling happy as I walked quickly down the hall toward my next yoga class. The hallway is lined with grand windows overlooking a courtyard, each window with a padded window seat; a favorite resting place for residents should they become tired. Mr. J., who suffers from severe back pain was one such resident who would find relief lying in the window well while letting the sun warm his back. On many days, I would find him resting comfortably; his wife sitting by his side rubbing his back or holding his hand. This had become a familiar sight. Typically, I would stop and say hello, and see how they were both doing, but then quickly skip off to my next class. But today, there was something about both of them that gave me pause. Looking up from watching him sleep, she said “He is sleeping so much more than he used to. I know that the end is getting closer.  I know I’m ready for his suffering to end.” We talked about how no matter how “ready” you are for the love of your life to pass, that the moment you hear it spoken out loud, there remains an element of surprise. There is an unknown component of grief that you have never experienced, and while you think you are ready, it sneaks up on you and surprises you.

She knows that there are feelings yet unexplored and that she will experience a plethora of emotions, but she said, and this time with tears in her eyes, “On the drive here today, I realized something that makes me really sad. I realized that we never got the chance to say good bye.  We knew that he was sick, and we thought we had time, but we didn’t. Two years ago were at an event and he didn’t seem right. That night he became very confused and almost combative. I had to take him to the hospital and I knew then that I had lost him. I knew that I would never get him back, and I didn’t. He went from the hospital to here. I’m very sad that we never got to say good bye.”

Her words took my breath away. I had never heard anyone say that they lost the chance to say good bye to the person they loved most in the world, when in actuality, that person was still present right next to them, breathing, eating, and walking.  That was indeed a new level of sadness I had never considered. This…..this tremendous sadness…. took me by surprise.

 

What Becomes of the Unfound? by John Tavela (who as it turns out, had early onset dementia at the time of this writing, March, 2009)

The wife of one of our residents shared this short story with me and agreed to allow me to post it in this blog so that other's may understand what it feels like to be cognizant that you are moving in the direction of irreversible dementia. This story, written entirely by John Tavela, is copied word for word. 

     The old man walked out of his house and immediately forgot why he had gone out. He stood in his backyard and tried to remember why he had left in the first place. He was puzzled.    

He looked around, but could not for the life of him remember, had no idea of why, he was outside. he looked around to find some landmark that might give him some kind of reference but recognized nothing. He stood seeing blankness. This had happened before, but now it seemed terrifying. The yard had become a blank. It was as if he had gone blind. All around was a misty paleness. He wondered where he was.

Had he died, he wondered. How could he tell? He waved his hand in the air in hope of feeling something, anything, but there seemed to be nothing he could grasp that could give him some kind of assurance that he existed.

Finally, a calmness came over him. If he was dead, so be it. He was in no pain--he was only ephemeral. He would soon evaporate and be no more. This would simply be the end. All humans died; all living things eventually died. That would be solace he was certain. Or was it?

How could there be nothing? he felt that he was not empty--there was still himself as far as he could tell. Could he be what was left of an evaporated universe, one that might be only him? This seemed too weird to accept,--but what's the alternative he wondered.

"I am all that is left. Or there is something else? That is the only sense I can make of where I am. I feel that I exist and I am somewhere. I may be alone, but there may be others. I have no proof that there are any others. I hope there are others."

Loneliness and suffering. What if there are no others? What can I do? Can I create anything? I doubt that. Only a little while ago, I was totally lost in the fog, wasn't I? Am I not totally lost now? I have no evidence that I am here. There seems to be a fog. That is all that I know beyond that I am old, but I have no inkling how old I am. Am I anything? Is there anything? I think I am, but where am I?

Bridging the Gap

The holidays are just tough. There. I said it. As good as they are, is as tough as they are. On one hand, we get to be with people we may not spend enough time with during the year, and that can make us feel grateful and joyful. On the flip side, meeting the demands of the holidays runs us ragged as we try to keep enough food in the house, enjoy the kids who are home from school or college, or keep up with grandchildren who come to visit.  It's so wonderful, but so exhausting. I wouldn't trade a second of it. Don't get me wrong. It’s all good.

But then there are the holidays that belong to the “others". Those for whom it’s not “all good”. Those who are dealing with things outside of the norm. Especially those who have recently lost someone; that perfect someone with whom they spent every single holiday for the past 5 to 60 years. Every song on the radio, every movie ad, every decoration placed reminds us of that special someone and reverberates echoes of emptiness. This deep sadness is not solely experienced by those grieving the death of a loved one, but may be felt by families that were forced to decide that this was the year, that for whatever reason, their special someone couldn't be cared for at home anymore. This too, is a loss and enlists unbearable grief. The loss of something that was. Something so special there aren't even words to describe it.

So, the holidays are tough for everyone but we deal with the mix of emotions very differently. Our brain tells us this is so. Our cortical brain, or our "thinking brain”, tells us that the holidays are the "Most Wonderful Time of the Year", while our limbic brain, or our "emotional brain" is desperately trying to believe it. "So, if this is a wonderful time of the year, why am I so sad, or mad, or tired, or blue?" The disparity between reality and expectations disrupts our rhythm of life and makes us feel out of sync.

This syncopated rhythm may not appear just during the holidays, but during regular times of the year too. The holidays simply exacerbate the awareness of this gap between reality and expectations. This gap, or metaphorical pond, creates a space for all kinds of emotions to swim around together…..loneliness, grief, disappointment, sadness, listlessness, and yes, even happiness and joy. The thinking brain yells over to the emotional brain, “Hey you, get with the program. Life is happening over here, yet you’re splashing around in the pond. Get out and DO something!”  The emotional brain glances up and whispers, “Oh, it’s you. I don’t see you and I don’t hear you. You simply don’t exist”.

How do we create a bridge for the two sides of the brain to join together in a peaceful and meaningful way? How do we re-sync, re-boot? One way is through the practice of yoga. The word “yoga” means to yoke, or to join. Yoga can help us to take that first step toward bridging the gap in three ways. Through the breath, through meditation, and through movement.

Regulating the breath can help us to calm our nervous system and take us from a place of fight/flight to a place of rest/relax and digest. Taking a few deep breaths not only physiologically changes our nervous system, it can give us a moment of pause to stop and realign our thoughts and make room for possibility. Sometimes we just need a little space.

Meditation can help in a similar way. Learning to meditate can help us to slow down our racing heart and lower our blood pressure so first we can feel better and then consider that there might be another way. We can respond, rather than react. It can help us to walk across the bridge one step at a time, little by little until finally we can find space for accepting reality and live within that space in the present moment. Living in the here and now and accepting what is happening in the here and now helps us to worry less about the future, or perseverate less on the past.  

Movement can help us by strengthening our body so that we can take those difficult steps. It can make us stronger in body and more flexible in thought so that joining reality and intention can be done less painfully, and more peacefully.

Whether you love the holidays or dread the holidays, they present unique challenges and bring into the forefront how we deal with stress and life’s challenges. We can learn from this awareness and build on the strengths that help us to move forward, especially when we’re not certain how to even get from Point A to Point B. Yoga can help us to narrow the gap between reality and expectations. Give it a try. Walk across that bridge….one small step at a time.

Some Cry, Some Don't

A couple of weeks ago I happened to be teaching on Veterans Day. Whenever I teach senior yoga classes, I typically make a point of asking the group if there is anyone who served in the US military. Invariably, a hand raises. I do this so that I can honor them, but I also do it so that I can smile at how they remember their training, sit up tall, and open their chest a bit more. It gets me every time!  On this day, this Veteran’s Day, there was a man with moderate Alzheimer’s Disease in my class whom I shall call Lou. I asked him if he was a Vet, and he proudly shook his head yes. I bowed to him in gratitude. Immediately, tears began streaming down his face. It was unlike anything I have ever witnessed. His facial expression did not change, but those tears, the seemingly endless stream of tears. I wondered what was going through his mind. By asking him this, I wondered if he was he reliving difficult memories. I cannot begin to imagine what the men of WWII experienced. My Uncles and my father served in WWII. My Uncle Jack, whom I never met, was killed on a beach in Normandy; the others came home but never spoke about their experiences. This seems to be a common thread among many of the WWII Vets. They are the stoic, the man’s man, the salt of the earth. They never cry.

On that same Veterans Day, I had to drop off a care package for my college age daughter. The postal worker behind the counter and I began talking about Veterans Day. He told me that he served in Viet Nam and then somehow we got on the topic of his mother of 97 who recently passed away. He told me that he was very close to her but, “Incidentally”, he admitted, “I never cried at her funeral. Actually,” he confessed, “I haven’t cried in years. I can’t even remember the last time I cried.” I wondered, too, about this man, and the atrocities he witnessed in Viet Nam. And he never cried.

The two men, years apart, but tied together by the experience of war were dealing with this Veterans Day in very different ways. My yoga student with dementia was grieving with total abandon but the postal worker seemed guarded. My thoughts raced to of all of the military serving now everywhere, but especially in the Middle East; what they see, and what they do will affect them for the rest of their lives. I have three beautiful nephews at the Naval Academy and I pray for them every day that by some miracle, they will be able to avoid the horror, but in my heart, I know this isn’t possible.  I pray that if they do get deployed, that upon their safe return that they will be open to getting help that I expect they will invariably need. Mostly I pray that they will come back as the fun-loving-goofy nephews that I hugged good bye on the evening before they entered the academy. Our brave military risk their lives for us, and even when they come back, they have to live with what they saw and did. It has to be everyone’s responsibility to be there for our Vets, no matter how small  your offering, it cannot begin to out weight their offering to us. As a yoga teacher, it is validated that yoga can help Vets deal with PTSD and issues of war. Even for those with dementia, yoga can help. While it is just one tiny step, I’m grateful to be able to be a small, small part of the healing process. It makes me cry.

Love Birds

By Catherine Rees

I was sitting at home working on my computer when I heard a thump on the kitchen sliding glass door. On my way to the kitchen, I heard the distant sound of a bird chirping wildly outside my window. Just then, I realized what I was about to see. I came around the corner, looked out the sliding glass door, and there lying on the deck was my sorrow. I hoped that the impact would have killed him immediately, but his wings were still moving and I could see the rapid rise and fall of his beautiful silky chest. The movement lasted but a few moments until it finally stopped. The chirping in the distance, fell silent as well.

My reaction surprised me. I went into immediate sobbing mode. I had seen birds die before, why did this one have such an impact on me? As yoga teachers, we hear, see, and feel in our hearts beyond what is audible, visible or felt by touch. Being aware and awake to our students is both a blessing and a burden. When I saw that little bird lying there dying, I felt helpless. 

At that moment, my mind went straight to a very special student I have been working with for the past month. He came into our facility bright eyed and smiling. He was a Navy man and proud of his service. He sat up a little taller when I thanked him for his brave service, and we sang "Anchor's Away " together loud and out of tune. He was able to move his feet in his wheel chair, marching up and down, though his feet barely lifted off the floor. In his heart, he was right there, training with his troops. Man, it was beautiful to see him come to life. His wife, who also suffers from dementia lives in the same facility, but on a different floor because she is able to walk and feed herself. She comes to visit him, and when he sees her, his eyes light up, and again, he sits a little taller and he sees the bride he married 64 years ago. They smile at each other, and he reaches out for her hand. She places her very small, fragile hand in his, fitting perfectly, feeling the familiarity and the love that moves between the simple touch. She is the bird chirping wildly in the distance.

Today when I went to teach my class I saw Mr. M. sitting in his wheelchair. "Hi! Mr. M. How are you today!" I saluted him, yet he stared straight ahead, no sign of recognition, no sign of life in those big round eyes. "Mr. M! I called! I just saw your beautiful wife! She was asking about you!" Still, no response. I started singing to him and after about half way through, he joined in for a few words, and then nothing. I was losing Mr. M. He was my little bird resting on the deck, moving his wing ever so slightly, and I knew in my heart that soon the gentle rise and fall of his chest would silence as well. I'm guessing this is why seeing the bird had such an affect on me. Just as there was nothing I could do to comfort the bird in his last moments, I knew I would not be able to be there for Mr. M.  I am well aware that this is not my role, but nonetheless, it is hard watching it happen right in front of my eyes.

So why do I tell this story? I think that when you teach yoga to a residential group of seniors with moderate to severe dementia, you might, on occasion, forget that you are teaching people who are gathered together taking their final journey. Some days I enter my teaching space and the person I touched and sang with the day before, is not there the next day and I didn't get to say good bye.  This is not easy to embrace. It helps me to remind myself to stay in the moment and  maximize the time that we do spend together. And most importantly, to practice without expectations to outcomes....good or sad. Simply, to be in the moment, find joy, bring about a smile, a breath, a moment or two of peace is enough. The other reason I tell you this story is because I have the distinct privilege of witnessing love and life in it's most honest state. Being able to document these moments is an honor and I want to share them to keep their story alive.

So enjoy the birds as you see them fly overhead. You may never see that graceful flight pattern or hear the sweet song again. But because you saw it and appreciated it, that just might be enough.

Poem for the Caregiver

Alzheimer's  by Bob Hicok

Chairs move by themselves, and books.

Grandchildren visit, stand

new and nameless, their faces' puzzles

missing pieces. She's like a fish

 

in deep blue ocean, its body made of light. 

She floats through rooms, through 

my eyes, an old woman bereft

of chronicle, the parable of her life.

 

And though she's almost a child

there's still blood between us:

I passed through her to arrive.

So I protect her from knives,

 

stairs, from the street that calls

as rivers do, a summons to walk away,

to follow. And dress her,

demonstrate how buttons work,

 

when she sometimes looks up

and says my name, the sound arriving

like the trill of a bird so rare

it's rumored no longer to exist.

The Voice of the Pinwheel

I returned to work after being at the beach for a couple of weeks, which is never easy. While I was excited to see the yoga students again, I began to question the effectiveness of my efforts. All of my yoga graduate friends were working at really cool, chic yoga studios, doing all kinds of exciting asana and meditation.  I began to doubt my work; is what I'm doing useful to the community I serve. I have a couple of groups that don't seem to even know I'm there sometimes. 

Today I was with one such group. I thought it would be fun to offer pinwheels to the students so that they could tangibly explore motion and breath through movement. They could swing the pinwheels around and visibly see the effects of their effort as they watched the colors swirl. Also, they could make attempts to blow into the pinwheel, thus creating a similar effect, while getting in some deep breathing at the same time. One of the students has what some would call "chair body". Her body molds into her oversized Geri chair and she is bent with contractures. Upon any simple stimulation, her face becomes contorted, her teeth clench, and her hands curl into tight fists....seemingly in pain. Through all of this, however, her eyes remain wide open and follow me the entire time. I wondered about those big blue eyes. She doesn't speak, she doesn't seem to move voluntarily, and she doesn't seem to make any sounds whatsoever. But, those eyes. Those big, blue eyes that follow my every move. "Annie", I thought. "You see me.  I need to see you".

I was talking to the residents about the throat Chakra, about finding your voice. "Annie", I said. "I have never heard your voice, but I know you have one. Let's find a way to talk to each other." For some unknown reason, even to myself, I found a little space in the fist of her contracted hand and placed the stem of a pinwheel into that space. While the rest of us were lifting and lowering the pinwheels as we sang "God Bless America" (it was close to the 4th of July), I heard a little, subtle swishing sound to my right. To my amazement, Annie was shaking her pinwheel, albeit ever so slightly. "Annie!" I exclaimed. "I hear you!" I asked her a series of yes and no questions asking her to shake her pinwheel if she wanted to say "yes" and to leave it be if she meant 'No". "Annie", I asked her, "Are you in pain".  No response.  OK, well, let's move on.  "Annie, are you hungry".  The pinwheel began to move!  Annie had needs. Annie could communicate and had found her voice!

After that, I never doubted the value of this important work. I may go days or weeks without anything changing, but it only takes one small miracle to make it all worthwhile!

The Locked Door

 

Last week, just like the 10 weeks before, I went to practice yoga with a resident suffering from Parkinson's Disease (PD). Each week I walk through the door, it is as if nothing changed from the week before. The TV is on, his bedside table sits in front of him with his remote,a  box of Kleenex, a cup of water, and the device he uses to help him fasten his buttons. We would laugh about how that buttoning "thing" just simply did not seem to have a name. Regardless, it served a purpose.

Mr. B. was one of my first 1:1 clients, so I was a excited to do the best I could to help him. I am familiar with PD, I just needed to learn where he was along the disease trajectory. I came to learn that he was pretty far along, however, this did not stop us from setting goals for our yoga practice and enjoying each other's company. He told me that he wanted to try to sit up straighter in the chair and to be more independent with his activities of daily living, thus, the button fastening "thing".  We focused on alignment and finding space and length in his spine. He quickly grew tired, so we actually did very little yoga asana. Instead, we talked a lot about what was going on in the world, his family and how much he missed his wife. I noticed a bookshelf filled with photo albums, so we would spend the remainder of our time looking through old photos and sharing stories of his exotic travels. He was kind, and smart and he loved his pre-convalescent life. 

While I enjoyed our visits, as an eager yoga teacher, I didn't feel like this is what I was being paid to do. I needed to come up with another plan. AHA! Breathwork, I thought. We'll do some breathwork and meditation. The next week I came in all ready for teaching him simple 3 part breathing and guided meditation. He soon grew tired of that as well. I was at a loss. Again, we talked and looked through photo albums. He would become more talkative as animated as I waited patiently while he slowly turned page after page, marking the place we left off so we could pick up again the next week.  I felt like I was wasting his time and money, so I thought I should simply stop. What could I possibly do to help Mr. B.?

A few weeks ago I went to a workshop on Yoga and Brain Disorders--non-medicinal approaches to treatment given by Dr. Absar, who is the medical director at the facility where I work. She began to talk about treatment for PD and how important it is to focus on fine motor skills, facial exercises, and memory challenges. I thought of Mr. B. I thought about how he methodically cleared his bedside table so we could set the photo album on top of it. I thought about how hard it was for him to grasp the corner of each page as he painstakingly turned each one until finally managing the fine motor skill needed to turn one page at a time. And then I thought about how subtly his facial expressions changed while he was thinking, talking or laughing.

I suddenly realized that this entire time, we had been doing "yoga"....the exact yoga that he needed at that very moment. If someone walked in, they might not recognize it as "yoga". Yoga has many identities, the name is irrelevant. I noticed how when I first came in, he had trouble finding words, but the more we talked and reminisced about his wife and the trips they took together, how his words became more fluid and natural. Finally, I had found a way to help Mr. B.  I could tell I had helped him, because after our session, he reached for me with both of his hands, wrapped his fragile fingers around my arm and said "Thank you for being with me. It is nice to have someone to share my stories with". I felt so happy that I had not given up on our sessions because of my need to watch him sit up straighter, or breathe deeper, or do whatever it seemed a yoga teacher should be doing with someone. He showed me how to meet him exactly where he was.

Our students truly are our best teachers. The next week when I went to see Mr. B, his door was locked. I got a sick feeling in my stomach, only to be confirmed by the nurse that Mr. B. had passed away the day before. While I was sad, deep inside I was happy that Mr. B. was reunited with his beautiful bride of 54 years.

I think of Mr. B. often and how much he taught me about authentic yoga. I'm still wondering what that button "thing" is really called. But, come to think of it, it really doesn't matter. The name is irrelevant. 

"We are all so happy"

Today I arrived at my residential community feeling sad. I had just taken my daughter to the airport for an eight week European adventure and I was a little worried and a little blue. All normal reactions to missing someone you love. Regardless, I had yoga classes to teach. Upon my arrival, I found 10 students sitting in the gathering room ready for yoga. One of the residents, whom I will call Ava, loves to be outside. Since it was a beautiful day in Maryland, we decided that this was an excellent idea. With the help of the activities director, we assisted all 10 of the residents to the meditation garden that was created by a dear friend of mine. It is a beautiful space with gorgeous flowers, an infinity fountain, a Tai Chi wheel, and a big elevated sand space for dragging your fingers through while in thought. 

We found a bit of shade and began our practice. Typically we sing and laugh and do a bit of chair dancing, but today, I suppose my sullen mood kept things a bit more subdued. We began just listening to the sounds of the Earth. The song of the birds, the whistle of the breeze, the flight of planes overhead. We noticed the warm air on our skin and the feel of the sun for those outside of the shade trees. We could even hear a trickle of the fountain. Needless to say, it was peaceful, joyful, and healing.

We began to discuss gratitude and how feeling gratitude can make us feel happy rather than grumpy. When asked, residents would say they were grateful for being able to walk and talk, they felt grateful for their beating heart, and for their family and friends. One of the residents, whom I shall call Barbara, and rarely ever speaks, looked up with the most peaceful smile on her face and said, "I'm just so grateful to have all of these wonderful friends around me. We all get along so well. We are all so happy". 

I will admit that this is not a typical yoga day at our facility. Usually we have many more students with much less cognitive and motor ability and the class is focused on engaging all members of the class. Having this smaller group and allowing more time to just notice sensations, be more quite, listen to our Earth speak to us, and find space in our hearts for gratitude created an unparalleled experience.

After reciting our loving kindness meditation, I thanked the students for being my teacher and we greeted one another with a sincere Namaste.

We are all so happy. 

Kindred Souls

Let's face it, there aren't a lot of people out there teaching yoga to those suffering from dementia or Alzheimer's disease. It's difficult, and there is very little validation from your students. Practicing aparigraha is important when teaching. Doing your very best and not expecting affirmation or any particular outcome can be a challenging practice day after day.  So, when I read Clare Morris' article "How yoga can promote therapeutic relationships" published in The Journal of Dementia Care May/June 2015 Vol 23 No 3, I became very excited. Ms. Morris affirmed exactly how I have been feeling. She offers the idea of utilizing the Personal Construct Theory (PCP) created by George Kelly (1955) to give meaning to how people make sense of events around them and change. She states that "it is in the nature of people to make sense of events around us. PCP provides a very detailed and comprehension framework to describe and work with change and resistance to change"(Morris, 2015). People suffering from dementia are undergoing constant change.

Secondly, Morris discusses the concept of the client and therapist working together as "co-experimenters" as they develop a partnership in their relationship. The teacher is not expected to know everything and is allowed to make mistakes in the process of developing the relationship. She states that this freedom is "probably the most empowering thing you can do for a person with dementia, sharing their dilemma and asking them for guidance....it is respectful and effective to always ask for permission and then explain what you are doing and why....being receptive to feedback (Morris, 2015)." During her sessions, she employs Naomi Feil's Validation theory as well allowing the student to experience being their own expert in yoga, which leads clients to continue engaging. 

My favorite part of the article is her description of yoga precepts as they related to creating this unique partnership with people with dementia. She offers Jo Manuel's seven precepts for teaching yoga rooted in Buddhist teaching from (www.specialyoga.org.uk). The precepts are: humility, generosity, patience, loving kindness, empathy, gratitude and compassion. These are exactly the characteristics I would use to describe what is needed in a person teaching this population. I might add having a sense of humor to the list! Manuel suggest that "through applying these precepts comes trust, care but not fear, a soul connection, and unconditional love. In psycho-therapeutic terms, it is a therapeutic alliance" (Morris, 2015).

Throughout the rest of the article, Morris offers real life situations where yoga has made a difference in the life of someone with dementia. She describes how the brain remembers sensations and can replicate these sensations through movement using parts of the brain unaffected by the disease process. Yoga is about "noticing change in body and mind. Focusing on movement, noticing, softening, breathing, is to be mindful, to be present in the moment, and if a person with dementia can be helped to do this, the distress that arises from not knowing who is who, where they are, and what is going to happen next can be alleviated, not only in the moment but also over time"(Morris, 2015). Wow, what greater validation does one need!

Clare Morris offers workshops on Yoga for Dementia--in London. Check out her website which includes all of her publications and other valuable information. Even though we have never met, I feel like we are kindred souls! Yoga can do that, wouldn't you agree!

Source: http://www.personalconstructpsychology.co.uk/

 

 

 

"Well, that's not very life affirming!"

 

Being invited to teach in a residential community is similar in dynamics to entering a private home. You never really know what goes on behind closed doors until you walk through that door. After centering myself before entering the sacred space, I was ready with my plan, all smiles and eager to teach. That is, until I felt the palpable energy in the space and I realized that it just might be “one of those days”. People with dementia, just like anyone else, have their challenges and moods, and on certain days yoga is simply not in their plan. Within a closed space, it merely takes one resident who is agitated or anxious to effect the rest of the group. Ah, you say, what a perfect opportunity for yoga to re-arrange the negative energy and replace it with some positive spirit. Normally, after much calming, breathing, and singing, that redirection will work. But what happens when it doesn't?

I found out the answer to that question today.  Like I mentioned, I was ready. I had my “Heart Opening” class prepared (see resource section for Heart Opening class). We were going to love, love, love; that is until one of the residents who recently moved to the floor because of a fractured hip, had different plans. Very untypical of her normal behavior that I had become accustomed to on the assisted living floor, today she was hurling invectives, pounding her hands on the table, directing disparaging comments to other residents and calling people unfavorable names. As my yoga mentor once said about a difficult day that she was having, “The situation was not very life affirming”. So, no, this moment was not life affirming.

I decided that due to safety concerns (the other residents were now verbally fighting back) I needed to move her to a safe space but no one was around to help me. This sometimes happens; the yoga teacher shows up and the nursing assistants will take a much needed break to get a drink or something to eat. They work very hard and I don’t blame them for this at all. But today, I was a bit out of my comfort zone. Needing to wheel the resident out of the space, I bent over to unlock her wheel chair brake and “WHACK”, she slapped me right across the head. “ROOKIE” I said about myself under my breath. I knew better than that. I knew not to put my body within her arm’s reach. I should have used my foot to release the break. So, my first lesson to you is, DO NOT allow yourself within arm’s reach of an agitated yoga student. If you do, well, don’t become attached to the outcome!  Once I wheeled her to the nurse’s station, I went back to my group and was able to settle them down with some simple breath work and soft songs and eventually quieted everyone down. It wasn't the best day I've had as a yoga teacher, but it did help me appreciate how much yoga can help when the person you are working with is even mildly receptive. You need to know your students.

There will be days when someone, or maybe even many are not receptive and that is ok. Perhaps they never did a day of yoga in their life, so there is no trigger to help them to feel ready to open up to the opportunity. Perhaps they are in pain or in need of an adjustment with their medications. Having a urinary tract infection can cause changes in behavior as well. Getting to know your students will help you to recognize when they are not feeling like themselves, and it is best to give them space to be who they are at that moment. There are days when yoga is exactly what a person needs, but then, there are days that any additional stimulation, no matter how well intentioned, is exactly the opposite of what they need. Today was such a day. My resident needed complete quiet, to be left in peace. That is yoga too.

Be aware of physical symptoms your student may be exhibiting. Ask yourself, what could be going on with the resident that is causing resistance to a yoga practice? Could it be pain? Could it be an interaction with her medications? Could it be fatigue or depression? While we are not in the business of diagnosing, nor should we be, there are some outward physical and emotional symptoms that you can be aware of to help steer you in the right direction when you enter the sacred space for teaching. There are times for enjoying group yoga, but there are also times when your students need to sit quietly, maybe you are part of their space, maybe you are not. It is your job to figure that out.

Today, I offer you an article about how the brain with dementia responds to pain and pain medications. My student did not intend on hitting me. I entered her space uninvited and she was not in a place to receive me or yoga.

According to the article "the etiology of behavioral and psychological symptoms of dementia (BPSD) is multifactorial, and includes the neuropathological changes in the brain related to dementia, but also unmet physical and psychological needs, physical illnesses like urinary tract infections, and pain. In many cases, this results in the inappropriate treatment of behavior with antipsychotic medication. Several studies have shown that treatment of pain might indeed decrease these behavioral symptoms. It is therefore of critical importance to improve the recognition and assessment of pain to ensure that patients receive the most appropriate treatment" (Achterberg, et al., 2013)

"Common pain behaviors in cognitively impaired elderly persons according to the AGS Panel on persistent pain in older persons: facial expressions including slight frown, sad, frightened, grimacing, wrinkled forehead, closed or tightened eyes, any distorted expression, rapid blinking. Verbalizations or vocalizations include sighing, moaning, groaning, grunting, chanting, calling out, noisy breathing, asking for help, verbally abusive. Body movements that include ridged, tense body posture, guarding, fidgeting, increased pacing, rocking, restricted movement, gait or mobility changes. Changes in interpersonal behaviors, aggressive, combative, resisting care, decreased social interactions, socially inappropriate, disruptive, withdrawn. Changes in activity patterns, refusing food, appetite change, increase in rest periods, sleep, rest pattern changes, sudden cessation of common routines, increased wandering. Mental status changes, crying or tears, increased confusion, irritability or distress" (Achterberg, et al., 2013).

Pain management in patients with dementia--click on article to read entire text or google "Pain managment in patients with dementia"

Wilco P Achterberg,1 Marjoleine JC Pieper,2 Annelore H van Dalen-Kok,1 Margot WM de Waal,1 Bettina S Husebo,3Stefan Lautenbacher,4 Miriam Kunz,4 Erik JA Scherder,5 and Anne Corbett6 Clin Interv Aging. 2013; 8: 1471–1482. Published online 2013 Nov 1. doi:  

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817007/

The "Ahh Ha Moment"

Personal Experience:  An “Ahh Ha Moment”

After a long day of teaching multiple levels of classes, I was teaching my final class for the day and admittedly, I was exhausted. This last class was a group suffering from mild to moderate dementia. I was new to the process and I wasn’t sure I was doing anything right.  I was a bit frustrated. I closed my eyes, crossed my feet under my chair, and put my hands on top of my head. After taking a few quieting breaths, I opened my eyes to see all eight of my students in the exact same position that I had assumed. Amazed, and remaining perfectly quiet I extended my legs, and they did the same. I then lifted my arms overhead, coming to prayer pose, and again, they followed my exact movements. I proceeded to go through an entire series of dynamic sequential movements and they followed each perfectly. During the movement we maintained eye contact and shared smiles and what felt like very intimate/soulful interaction unlike I have ever experienced before as a yoga teacher. I knew I was on to something. I knew that some part of their brain connected deeply to the visual movement, and the lack of verbiage did not affect the accuracy of the imitation of the poses. It was then that I decided that for this level of dementia, I would implement sequential dynamic movement without words but with lovely relaxing music. I determined that I would use balancing chakras as my framework and design an adaptive yoga series around each of the seven main chakras.

Regardless of the class that I am teaching, or the class plan that I have prepared, the only thing that matters is that I enter their world, that I practice focused awareness and adapt my plan to their current status, and that I love them unconditionally. Each yoga class ends with a lovely meditation.  Typically I do the Loving Kindness Mediation, shortening it to “May I be happy, May I be at Peace, May I be Safe, and May I be surrounded by Love. Let’s greet each other by saying Namaste”. Then as when I arrived, I go to each person and say Namaste, use their name and thank them for coming to yoga class. Sometimes I will get the response “Your mamma say what?” Or ”Nah, I’m gonna stay here”, or “Yummy day”.  I throw everyone a big kiss and tell them that I will be back tomorrow, and when I return, I know that they will be meeting me for the first time…..again. 

Part III: Rules of Engagement---or some ideas that work for me!

Hopefully you've read the two previous blogs to help get you started on the right track. If you haven't read them yet, please start there. 

OK, so now you have everyone gathered into one sacred space. Sometimes this is the hardest part. You get 3 or 4 people in the room and you leave to go find more friends, and by the time you get back, 2 have already wandered off. It's best to get someone to help you gather your class if you are in a residential community. So everyone is gathered, and you have welcomed everyone using the validation theory approach. Once a climate of acceptance and welcome is established, relaxing music or familiar music is initiated and the yoga practice begins. The right kind of music is value added, the wrong music creates chaos and over stimulation and sometimes tears. Music selection is based on success or failure of particular music with the group in front of you. Some groups respond better to instrumental spa type music, while others who may not say a word throughout class, will actually sing along to familiar songs while tapping toes or clapping hands. This is a trial and error process, so best to have a variety of music in your tool box for your group. Suffice to say, that the music must be from their time period, perhaps when they were in their 20’s or 30’s.  Simple tunes and chants are equally effective at the right moment. The instructor can add yoga poses to the words and rhythm of the songs. This often time brings increased participation and enjoyment to the students. Read this article by Jill Suttie about why our brain loves music.

The instructor has a chair in front of the group, but it may go unused. The instructor may use the chair, may stand in the center of the group, may walk around from person to person, and may even sit down on the floor in front of a person who might have trouble lifting their head. Every aspect of the yoga practice is adapted to meet the specific needs of the yoga student with dementia.

Pranayama practice or breath work, is simple and audible. While normally pranayama is more or less silent, encouraging the student with dementia to inhale through the nose and exhale audibly ensures the instructor that deeper breathing is indeed being performed. Exhaling with an audible sound such as “shhhhhhhoe” is shown to be effective with moderate to severe Alzheimer’s residents (Litchke interview, 2014). The instructor can model effective breathing with the group as a whole saying “Everyone, deep breath in and blow it out with the sound SHOOOEEEE” while raising and lowering the arms in front of the chest. The physical therapists will also say, "Smell the flowers then blow out the candles". This helps with the mechanics of taking a bigger breath. My preference is to use the Hoberman’s sphere and to show them that just as the sphere enlarges, the lungs fill, and as the sphere gets smaller, the lungs exhale. In my personal experience, there is great enthusiasm for the beauty, color, and expansion of the Hoberman’s sphere (click to see photo).

 After centering and pranayama, the asana practice begins. Chair yoga poses are adapted for physical challenges and include asanas accessible to those in a wheel chair as well. No one is left out of the asana practice, no matter what their challenge. For ambulatory students, some standing poses are offered as well as adapted partner poses which are paired with a nursing assistant or family member. Partner poses can greatly add to the experience and help to satisfy the essential need for belonging and touch. Throughout the yoga class, the instructor moves dynamically around the room to each student seeking moments of engagement and following the lead of the students. If a student begins humming, it might be beneficial to engage the group in Do In yoga body tapping (click to see video) eventually coming in toward the chest and tapping the chest while creating an audible hum or ahhhh sound so that the person humming is suddenly part of the group. Moving from student to student, touching the student lightly, or holding up hands so that hands may be joined while assisting the arms to be moved in an appropriate fashion is effective, all the while seeking eye contact and a smile throughout the interaction. Looking at each person directly in the eye (from a reasonable distance and off to the side) with a warm and gentle smile often time rewards the instructor with a smile back. Touch, compassion, warmth, moving with the person, helping to move the person, inviting the leg to lift or the arms to lift by gently touching the arm or leg and gently assisting or inviting the limb to move often encourages independent movement even if just for a moment. Present moment engagement is key. Being with the person where they are at that moment is all the instructor can ask for. A small tap of a toe or a momentary gaze can mean the difference between being engaged or not. Avoiding personal attachment to outcomes is necessary to stay centered in the student’s world.

Part II: Teaching with Non-attachment--the practice of aparigraha and how it leads to present moment joy.

Teaching yoga to the student with dementia is challenging, yet rewarding. Dementia is the umbrella term used for a change in cognition leading to a disruption in daily functioning. In any yoga class, specific for dementia or generalized for seniors, you will find multiple levels of awareness and cognition. A class specific for dementia is a bit more challenging in that there are over 50 types of dementia and even students with the same diagnosis may act differently depending on the progression of their disease.   Alzheimer’s disease accounts for 60-80 percent of all dementias with vascular dementia coming in second. The participants in the classes that I teach are residents living together with moderate to severe dementia. Many of the students are non-ambulatory and some are unable to speak coherently.

The first objective for the new teacher embarking on this journey is to practice aparigraha--non-attachment to outcomes. You will soon recognize that every time you enter the sacred classroom space, you begin a brand new yoga experience for the dementia student. You cannot build on previous sessions, you start fresh and new each time. Your goals are simple and clear by meeting the student exactly where they are; “Today we are living in the present moment. My hope for you today is present moment joy!”

Our  yoga class begins with friendly and enthusiastic introductions and the residents are informed that they have the opportunity to participate in a yoga class, however, no one is forced to stay. The practice of yoga is briefly described and I utilize validation techniques with each student by shaking hands, establishing eye contact and welcoming them to the yoga class. Validation theory is described by Naomi Feil as “accepting and validating the feelings of the demented person; to acknowledge their reminiscences, losses, and the human needs that underlie their behaviors without trying to insert or force new insights. Validation techniques do not demand cognitive improvements, but rather accept their loss of social controls, cognitive thinking, sensory acuity, reflective self-awareness speech, and mobility. Validation practitioners must have empathy, be non-judgmental and be able to handle their own feelings, as well as the feelings of others. In order to validate another person, the Validation practitioner must "center", observe carefully, and then step into the personal reality of the client “(Feil, 1993).

Take your time to center yourself before class begins. As teachers, we remind our students to leave everything outside of the door. The only thing you need is a flexible plan and heart full of love and aparigraha. The challenge is to balance being prepared for your class and being willing to toss it all out the window.The keen instructor follows the cues of the student suffering from dementia remembering that present moment joy is a gift beyond measure, for both the student and for you. In my next blog, I will begin to discuss methods I have found useful when offering a yoga class for these lovely students.  Stay tuned......

Part I: You want me to audition for what?

Catherine Rees, RN, MSN, RTY200, LVCYT

Over a year ago I was selected to interview for a job teaching yoga for the dementia population at a local continuum of care facility. With great enthusiasm, I began creating my class plan. Then, I abruptly came to the realization that I had no idea what I was doing. With trepidation, I went to my audition, resulting in what I believed to be a total disaster. Throughout my class very few residents were following along.  I had to duck out of the way of residents wheeling in and out of the class space. People were sleeping, calling out, and actually singing at the top of their lungs---not the song I was singing by the way. But, much to my surprise, I was hired despite my perceived lack of success.  I actually think I may have been the only applicant! Regardless, I took the job knowing I had some work to do if I was going to be an effective yoga teacher for this beautiful group of people.

I began researching how to teach yoga for those suffering from dementia. I am a 30 year veteran nurse and I have worked with this population in clinical settings.  I have been teaching gentle yoga for seniors and have training in therapeutic yoga for seniors but despite the hours and hours of training and yoga certifications, I was still at a loss for where to begin. Throughout my research, no matter how hard I looked, I could find no specific guidelines, let alone a single class plan suggesting how to begin this journey. I reached out to any contact I could find to help me understand how to effectively tap into their world and create a meaningful class. I even traveled across the country to observe Dr. Lyn Litchke teach yoga for a similar population to see if I was on the right track.

In the past year, I have learned a great deal. I wish to share with you my research, my interviews, and mostly, my trial and errors in teaching three days per week for the past year and a half. I am hoping that this population can be better served and that more yoga instructors will consider teaching this group. It is exhausting and trying, but it nourishes the soul in unimaginable ways.

Over the course of this blog, I will attempt to share some of what I have learned, and I hope that you will share your successes and challenges as well. Together we can create the best possible yoga class for those suffering from dementia!