Beginner's Mind: Yoga for Dementia

For almost two years, I've had the honor of working with Ron, a veteran with frontal lobe detachment and onset of dementia.  In my explorations of what this means to work with someone who exhibits keen awareness, intelligence, and ability to access breath--with diminished sensory capacity, intermittent focus, and deteriorating executive function--I've learned more than I could possibly blog here.  But I feel compelled to share some of what happens when we meet for yoga in hopes that others may try yoga with loved ones in this spectrum. 

We meet twice a week in his rec. room that's got a wall of books on fishing, fly tying, war history, some in German--many tomes belonging to Ron.  Pictures of him wading in a stream in Canada or Baxter State Park, casting lines, remind me of my own dad.  They hang beside a photo of his favorite river in Canada, which we use for drishti or gazing point while in Star Pose.  Ron and Marianne share a home of memories and the best of the best organic foods, supplements, and herbs that Marianne has been able to find.  I'm often treated to her root veggie soups and cakes or pies.  She miraculously creates meals, sensory meals--can't-pass-by-the-kitchen-without-sniffing-and-ogling meals.  Her constant care and devotion have made her an expert lay person, if you ask me.  The bar is held high for our health care system and its treatment for individuals within the dementia spectrum.  She's disappointed by what's actually offered for families like hers.  She often tells me what's happening in Germany, where she's from, and seeks ways to replicate approaches in her home.  Her German family and their doctors strongly urged her to get Ron into yoga.  --And this is how I got into their rec. room.

What I've grown to appreciate is how we always begin at the beginning.  I know this is always true on some level everywhere, but in these classes, it feels especially poignant and presses on patience, boredom, reluctance.  And yet we begin.  When he remembers or can organize himself--what his wife calls a good day--Ron gathers props, placing them exactly as the classes before:  a mat, a chair that sits half on and off the mat, two blocks for feet in front of chair, a pillow for postural support, his super tea or juice that Marianne lovingly prepares several times a day, and his Buddha box--his name for the Kleenex box, which we need before centering and breath work.

Ron has loads of wit and he loves to hear the names of the postures and references to "that spiritual stuff".  He giggles and if I'm lucky, he laughs out loud.  In that spirit, we address the serious medical "stuff" like dehydration.  We've recently named the pauses in the sequence where he takes a drink from his water bottle.  It's called slug-asana, a stopping point where he's prompted to drink and breathe three relaxing-breaths before drinking again.  He takes three "slugs" then three full breaths.  This may sound funny but it's been crucial.  Ron has forgotten many things, appearing not to care, often shrugging small tasks off, such as taking in enough fluids.   Episodes of dehydration have been sometimes frightening and in our classes, they have stopped the practice with dizzyness, fatigue, increased "zoning out" and muscle cramping.  So entered "slug-asana" into our sequences.  Three times in an hour--and the bottle is emptied.  Usually!

We sometimes have light "hippy" music (his word for my music) or big German orchestrations (distracting to me but waking to him) or silence.  Lately silence.  And I've noticed his energy flag more quickly.  Anyhow, breathwork always begins in silence and he's developed such a fidelity to one breath technique taught in trauma sensitive yoga, in which he blows air out through pursed lips, inhaling through nostrils.  One disorienting time last spring, he remembered that breath and his cell phone and his house number, reaching Marianne who found him and rescued him from dehydration and disorientation.  Truly, a victorious breath for Ron.  And that's where we begin the practice once settle in seated mountain, building on slow, smooth nostril breaths, three part breath, then layering ocean or victory breath.  We take this breath into slow head-swivel kriya, back and forth with breath, shrugs and varied sunbreaths.  Breath-focused, inhale opens arms, exhale closes arms.  Ron's developed his breath so beautifully.  Sometimes we practice breath of fire, if it seems right--sometimes in the middle of the sequence.  But the grounding, calming, focusing and balancing nature of the other breaths usually fit the bill for Ron at the start.

Through coordinating breath with the six movements of the spine,  I gauge Ron on the trajectory of mood, focus, executive function ability.  He does this in the chair, still, and I mirror him, always.  This helps him see/feel what's next, though I also give touch point cues to help him remain lifted through spine, sternum, crown.  The chair is a critical part of his yoga.  It literally grounds him, contains him.  It has armrests to anchor to for twisting.  It's a safety as he explores right and left, using the very familiar gazing points of his furniture, collections of book titles, pictures.   "Gaze at Halford on the Dry Fly!"  "Gaze at Margaree River!...Keep lifted in the gaze.."  It's all known; he almost always has a memory jog when he turns to the river picture or an interesting point about a book he's read, sometimes in German.  And where his eyes go is as important as any pose given.  The eyes are the guideposts for me as a teacher and a source of uplift and real work for Ron--from his spine up.  Gazing points, cuing to focus eyes on objects to keep attention upward and energize, are super important. 

The yoga sequencing is a combination of dogged repetition and adventure.  For example, pigeon pose arrived after a year of child pose, then half child.  We moved slowly into this pose from chair to floor, propped and unpropped.  Several months ago, we began exploring downward dog.  We're up the wall with dog, when energy and focus are there.  I've chosen those two classical postures for forward folds based on his back's flexibility or inflexibility.  We do more backbending for upward energy in our hour.  Some postures are important for people with dementia--certain others not so.  Many recommend inversions or belly down backbends like cobra.  All seem beneficial to Ron.  He enjoys legs up the chair.  And he seems to like the warriors when Marianne is practicing with us, especially.  His focus is playful when she's there and I take advantage of it, when it's right, to have them do a partner yoga pose or two.  They sit spine to spine and move in and out of wide seated forward fold and back bend, using one another's backs as props.  I almost always tear up!  They also do goddess with fierce lion's breath, tongue to chin, eyes wide, face to face.  It's really tough to be serious with this posture.  Very fun and opening.  And tension releasing!

All sequences end with quieting supported forms like twist with bolster or legs up the chair.  We end with svasana, resting pose, waking the body with contract and release from the feet up to the crown.  From a modified seated mountain (knee hug) on the floor, we bow to hands over hearts and offer a Namaste to ourselves and one another, one last slug-asana, and a fond farewell until next time. 

With love & pranic steam,

Beth

I hope you find inspiration here, as much as I'm inspired by Ron and Marianne, whom I humbly thank for allowing me to share what I do in the spirit of spreading the word of yoga and its potential for helping someone with dementia live the fullest life possible.